[VIDEO] Poor Americans to feel the burn from health insurer Elevence's decision in Medicaid dispute
Elevance had one of the highest denial rates among managed care organization (health insurers that provide services for a set monthly fee), according to the HHS’s Office of the Inspector General. And no where are these high denial rates more clear than in Ohio, Virginia and other states where Elevance manages taxpayer-supported Medicaid and Medicare Advantage plans.
Last week, I had the opportunity to talk about this issue with Veronica De La Cruz on Scripps News. As a former White House reporter for Scripps-Howard Newspapers (prior to my stint as a health insurance executive), I’m happy to see Scripps News and other media outlets tackle these important issues. Below, I’ll dive into this issue and include some clips from my segment.
More than 1-out-of-7 Medicaid beneficiaries in the U.S. is now enrolled in a plan managed by Elevance. One way insurers avoid paying claims in both their Medicare Advantage and Medicaid businesses is by refusing to cover treatments and medications patients’ doctors say are necessary.
For example, in Ohio and Virginia, Bon Secours Mercy Health, a big hospital system that serves many Medicaid patients, says Elevance owes it $100 million in late and unpaid claims. This has caused a huge rift between Elevance and Bon Secours Mercy Health. In the end, Medicaid patients could suffer.
As a result of their rift, on July 1, Elevance kicked Bon Secours Mercy Health out of its hospital network in Ohio. To avoid high out-of-network costs, Bon Secours Mercy Health’s Medicaid patients in Ohio likely will have to travel to another hospital that’s still in the insurer’s network.
At the end of the day, Congress and state lawmakers must act to address health insurer's predatory practices against taxpayer-supported programs like Medicaid. Especially, when these denials affect the poorest Americans who need their health care needs met.