Editor's note: This story was updated at 2:57 p.m. Wednesday, Jan. 3 with a comment from United Healthcare.
By CRISTINA JANNEY
Hays Post
Some area residents are scrambling to find new health insurance after HaysMed was inaccurately listed as an in-network provider for the UnitedHealthcare Marketplace insurance.
Shae Veach, HaysMed vice president for regional operations, said UnitedHealthcare has a variety of plans. The Marketplace plan is new to the area. HaysMed was never in-network under the UnitedHealthcare Marketplace plan.
Other UnitedHealthcare plans, including commercial, employer, Medicaid and Medicare supplemental plans are not affected.
HaysMed was notified in late December it had been inaccurately listed as an in-network provider for the Marketplace insurance plan. On Friday, HaysMed published a press release on its website and Facebook page notifying people of the error and urging them to review their plans.
Veach said the hospital has no control over how it is listed on the Marketplace.
The Hays Post reached out to corporate communications for UnitedHealthcare. A spokesperson for the insurance company responded Wednesday afternoon.
"We are currently negotiating with Hays Medical Center and making every effort to bring the health system in our network at rates that are affordable for our members and their families,” the spokesperson said in an email.
Veach said HaysMed continues to be in active negotiations with UnitedHealthcare to become a network provider for its Marketplace plan, but the negotiations are moving slowly. He said United has been unresponsive. Veach said those negotiations will continue into 2024.
Some local residents said the notification was too late.
A young man who manages a small business in Hays, said his wife is pregnant and due Feb. 2. The man, who did not want his name used, is now facing expensive medical bills for his wife to see her HaysMed provider weekly.
He is working with his insurer broker to sign up for a different plan. Marketplace buyers have until Jan. 15 to change their plans.
However, his new effective date won't be until Feb. 1. If the baby comes early, his coverage for the delivery will be out-of-network.
"I should have insurance, and now it doesn't look like I'm going to," he said.
The man has filed for special consideration to make changes to his plan, but he said that could take 30 days.
A local woman, who also did not want her name published, said she had already enrolled in the UnitedHealthcare Marketplace plan, when she saw the announcement on Friday.
She said she plans to use a nearby hospital and doctor that is in-network.
Veach encouraged residents affected by the issue to reach out to their insurance broker, a Marketplace navigator and/or United Healthcare directly.
Peggy Ritter, Marketplace navigator, said she has been working with individuals since the announcement on Friday to make changes if they need them.
The open enrollment Marketplace deadline is Jan. 15. However, a change now would not go into effect until Feb. 1.
Ritter can assist people in reviewing their Marketplace plan and choosing a different plan if necessary. Her services are free.
The difference between in-network and out-of-network charges can be significant.
"When people thought they were getting a plan for zero dollars or $3 and now that whole company is out of network, it's really going to take a bite out of some people's paychecks," she said. "Whatever I can do, I am happy to."
Although Ritter lives in Dresden, she has also been affected. She also has UnitedHealthcare Marketplace insurance.
Ritter said the timing of the announcement was not ideal.
"There were doctors I looked for specific people back in the beginning of December, and they were in-network or I would call HaysMed and ask, 'Do you accept this?' and they would say, 'Oh, yeah.'
"And now to find that out on Friday at 9:30 at night... I just started calling and texting everybody and posting as much as I could. "
Veach said he could not comment on any phone inquiries to the hospital.
"It is confusing because UnitedHealthcare has a lot of different plans as does BlueCross as does others," Veach said.
Ritter said some people will not be affected.
The No Surprises Act came into effect in 2022. If you enter an emergency room that is in-network and then you are transferred to a hospital that is out-of-network, such as HaysMed, you are to be charged as if you were you were in-network, Ritter said.
"That is comforting to some," Ritter said.
Abby Staley, a licensed Marketplace insurance broker who lives in Hays, is also trying to help people who were affected by the mistake.
Staley said many people were caught off guard. She was out of town for the weekend and said she received calls from clients crying because they were so stunned.
Although people shopping for insurance on the Marketplace can do so on their own, Staley said the system is difficult to navigate. She said trying to apply for Marketplace insurance on your own is like trying to do your own taxes or serve as your own attorney. It's not recommended.
She urged people to seek the free assistance available from an agent.
"People don't need to panic," she said. "There are people who are licensed and trained to navigate these situations and help figure it out."
Although both Marketplace agents and navigators can help you research plans and help you fill out the forms, agents have insurance licenses. Navigators do not.
Staley can be reached at [email protected] or at 785-269-7671 (cell) or 620-266-3349.
Ritter can be reached at [email protected] or by phone at 785-470-7896. She said it is easier to reach her by text.
Below is the complete text of the press release posted on HaysMed website and Facebook page on Friday.
Due to changes within UnitedHealthcare, Hays Medical Center is asking all local UnitedHealthcare (UHC) Marketplace plan beneficiaries to review their insurance plan coverage prior to Jan. 1, 2024, as HaysMed will be out-of-network for all Marketplace enrollees.
HaysMed understands the potential impact this may have on its patients and encourages all UHC Marketplace plan owners to reach out to their healthcare insurance representative for more details to avoid paying higher out-of-network costs.
“We aim to safeguard the established bond between our patients and their healthcare professionals, ensuring uninterrupted access to high-quality, in-network care. HaysMed is diligently working to minimize any inconvenience caused by this UHC plan change,” said Shae Veach, HaysMed VP for regional operations.
UCH Marketplace is a new product to the Hays service area. Despite HaysMed efforts to reach a mutual agreement with UHC, HaysMed hospital is not currently in-network with any UnitedHealthcare Marketplace products in Kansas.
HaysMed remains committed to providing comprehensive health care coverage and is working diligently to ensure its patients’ health and well-being is the top priority.