Health Insurer Centene is usually Sued Over Lack of Medical Coverage

Centene, which also provides coverage to low-income individuals under the government Medicaid program, has proved to be one of the mainstays of the Affordable Care Act. After many some other large insurers abandoned the individual market created by the federal law as well as as President Trump has sought to dismantle the law, Centene doubled-down as well as has become one of the largest insurers still offering policies.

although the lawsuit underscores a critical question about whether Centene offers plans in which provide its customers with access to the level of care required under the law. The suit claims in which many doctors won’t accept patients covered by Centene because of the company’s refusal to pay legitimate claims.

As insurers like Centene have relied on smaller networks to control costs as well as better manage the care of patients, consumer advocates have raised concerns about whether some plans offered under the law provide sufficient access to doctors as well as hospitals. The law requires plans to meet certain minimum requirements.

The lawsuit recounts numerous examples of patients unable to find in-network doctors. In Washington State, Cynthia Harvey was billed for hundreds of dollars in medical costs after she discovered some of her care was out of network. When Ms. Harvey went to the emergency room last year, she was billed $1,544 by the doctor, as well as the lawsuit claims Centene had no emergency physicians participating in its network inside the Spokane area at the time.

The insurer also denied some of the claims via a colonoscopy she had because she was at high risk for cancer, according to the lawsuit. Ms. Harvey successfully appealed many of the denials to state regulators, the lawsuit said.

The lawsuit comes on the heels of a decision last month by Washington State regulators to fine Centene up to $1.5 million for having an insufficient network of doctors to treat people who signed up for plans sold under the Affordable Care Act. State officials said they received more than 140 complaints via people who had trouble finding a doctor, particularly a specialist like an anesthesiologist, who accepted the insurance or via individuals who received a surprise bill after they received treatment.

In a statement about the consent order the company reached with the state to be allowed to continue selling policies for 2018, Centene said the idea was committed to addressing “known issues in our network in select regions of the state” as well as said the idea had taken actions to make sure its customers had access to services.

The company announced in which week in which the idea currently covers more than 1.4 million people through the state marketplaces, with its chief executive, Michael F. Neidorff, describing its growth inside the market as “so dramatic.” Centene attributes some of its success to its experience providing care under the Medicaid program or in its low-cost networks.

Steven A. Milman, a periodontist in Round Rock, Tex., who is usually one of the plaintiffs, signed up for an Affordable Care Act plan via Centene last year. He as well as his wife paid about $1,0 a month. Dr. Milman had a previous policy via UnitedHealth Group. “They had a Great panel of doctors as well as easy access,” Dr. Milman said in a telephone interview. although UnitedHealth lost money inside the market as well as stopped selling policies.

Choosing between the local Blue Cross plan as well as one offered by Centene, Dr. Milman picked Centene after seeing in which its network included a large medical group in Austin as well as getting recommendations for several doctors at in which group. “I bought Centene on in which promise,” he said.

although Dr. Milman soon found out finding a doctor within the network was much harder than he anticipated. The medical group he had picked was no longer inside the network. When he called the doctor’s office assigned to him by Centene, the idea turned out to be a obstetrician/gynecologist.

Dr. Milman’s wife had no better luck. When she came down with an earache, she was on the phone with the plan for 5 hours before being sent to a clinic where she was treated by a nurse.

By the summer, Dr. Milman was fed up. He continued to see the doctor he had under the UnitedHealth plan, paying out of pocket for the visits. although he said he worried about what would certainly happen if he were hospitalized as well as felt like he didn’t truly have insurance.

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