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Health exchange board delays vote on plans




 

OLYMPIA, Wash. (AP) - The board for the state health exchange delayed a vote Wednesday on approval of 31 plans proposed to be part of the system while some companies that were rejected by the insurance commission appeal their exclusion.

Earlier this month, Insurance Commissioner Mike Kreidler authorized the individual health plans and rates of four health companies for inclusion in the exchange, where plans can be purchased starting on Oct. 1.

Of the nine companies that applied to sell health plan in the exchange, the four that were preliminarily approved were Bridgespan, Group Health Cooperative, Premera Blue Cross and LifeWise, a subsidiary of Premera.

The companies that applied but were not approved for the exchange were Moda Health Plan Inc., Kaiser Foundation Health Plan of the Northwest, Community Health Plan of Washington, Coordinated Care Co. and Molina Healthcare of Washington Inc.

So far, Kaiser, Community Health Plans of WA, and Coordinated Care Co. have appealed Kreidler's decision, according to Kreidler's office.

After Wednesday's decision by the board, officials with Molina - which initially appealed but then withdrew its appeal - say they've resubmitted their plan application with the health exchange.

"The board wants to do everything in its power to ensure that when the exchange opens Oct. 1 we have as many carriers and participating plans as possible to provide options for residents," exchange spokesman Michael Marchand said.

After Kreidler's decision, state Sen. Linda Evans Parlette, R-Wenatchee, issued a statement that called the dismissal of the prospective insurers before the exchange board could consider them a "step in the wrong direction."

"After all, don't we want as many options as possible for people who are purchasing health insurance?" she wrote.

Kreidler has said that some of those not approved couldn't guarantee access to certain providers and hospitals, or for example, in the case of Molina, didn't have an approved retail pharmacy.

"I have a duty to protect consumers and to hold all insurers to the same standards," Kreidler said in a written statement issued Wednesday. "There were substantial problems in the plans we rejected."

Kreidler said some of the plans didn't have adequate access to transplant surgeons or to HIV/AIDS specialists, and that in some cases people would be required to drive more than 45 miles to see a cardiologist.

"These were not minor technicalities," he wrote. "They were major problems."

However, officials with Molina argued that they have a pharmacy network of more than 1,100 contracted pharmacies that currently serves the company's 413,000 members in the state and would continue to provide those pharmacy services to the exchange.

But Rich Roesler, a spokesman for Kreidler, said the network proposed by Molina three years ago was not approved by the insurance commissioner, and that the company made no moves to fix it.

Molina spokeswoman Laura Hart said the company had also addressed concerns about gaps in adequate access to HIV/AIDS specialists and proctologists, but Roesler said it did not provide confirmation that it had signed contracts with the providers by a July 31 deadline.

"It's not enough to just be working toward that goal," Roesler said in an email.

Group Health Cooperative, LifeWise and Premera also have approved individual plans for outside of the exchange, and six additional insurers have applied for plans outside of the exchange, but Kreidler has until the end of September to approve those plans and rates.

Kaiser is the only company that has applied to sell small employer plans inside the exchange, and it was approved by Kreidler to sell nine plans in Clark and Cowlitz counties. That approval also requires a vote by the health exchange board.



 


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Information in this article was accurate in August 22, 2013. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.