The open enrollment period for health insurance through the Affordable Care Act is just around the corner, and uncertainty about costs, subsidies and what policies will actually cover is still growing. Adding to the anxiety for consumers in Western North Carolina, the only insurer on the exchange is still at odds with the region’s largest health care provider. BPR’s Helen Chickering reports
It’s a cool sunny Tuesday afternoon, and Kelley Johnson is out on the porch of her home in North Asheville,
She had taken the day off, but not to chill out, she thought she would be recovering from a medical procedure.
“I went to have a procedure yesterday and was unable to do that because of what’s going on between Mission and Blue Cross.”
Johnson is one of the thousands of people in Western North Carolina insured through Blue Cross Blue Shield with care providers in the Mission Health System, which is now out of network.
“Last time I saw the physician I asked him if this would have an impact on the procedures going forward and he said no” says Johnson.
But it did, and now Johnson is waiting to see if she qualifies for continuity of care and can reschedule the procedure. And while she’s waiting, she’s been keeping a close eye on another healthcare debate that impacts her directly, the Affordable Care Act and the recent back and forth over federal subsidies that help reduce deductibles and co-pays for lower-income people.
, “I’m at my wits end,” says Johnson,” I can’t believe our politicians and people in power are allowing this to happen. There’s no way I could afford insurance without those subsidies. I divorced in 2014 and am self-employed, I would not have health insurance and my children would not have insurance if it weren’t for the Affordable Care Act.”
With open enrollment just around the corner,
Johnson is preparing a long list of questions to take to her health navigator at the nonprofit Pisgah Legal Services.
“We know there are a lot of questions out there, we know that people are struggling with this anxiety about what will happen, what could happen,” says Jackie Kiger, a managing attorney at Pisgah Legal Services.
“We’ve been working hard to educate people that those benefits, those plans are still in place an they’ve not changed and they will not change, it’s really about the reimbursement the government was providing”
Kiger says the Pisgah Legal staff is keeping a close eye on the debate over subsidies, and preparing for the changes they know will happen, including a shorter enrollment period and aca website interruptions,
“We’re preparing for that. We are building in a lot of early evening appointments, Saturday appointments, and messaging out as much as we can to consumers, go ahead and get ready to enroll now.”
A message Kiger says is especially important for consumers in Western North Carolina because of the recent Blue Cross-Mission Health impasse.
Blue Cross Blue Shield is the only provider on the WNC healthcare exchange, and Kiger says they are getting lots of questions about out of network coverage and costs, now that Mission Health is out of network.
“There are a couple of key things for people to keep in mind, and this is true right now and will be true as we go into open enrollment, If you are receiving certain levels of treatment or care, there is continuity of care, and you can apply to have that treatment covered continuing at an in-network level, there are also options in terms of specialty care that’s only available through a physician or a provider through the Mission Health system, and there are appeal rights.”
Kiger says healthcare navigators can help clear the confusion. Kelley Johnson is thankful she has a navigator to help her sort through it all. The whole deal has left her feeling frustrated and anxious.
“You just feel so helpless, I’m responsible for my children’s health and I’m being cut off at knees by politicians and CEOs who have plenty of money and healthcare, and you know – that’s not most of us.”
Amid the uncertainty, one thing is for sure, the Affordable Healthcare Act is still law. Open enrollment begins November first.
For BPR news, I’m Helen Chickering.
