Missouri hopes MU Healthcare and Anthem customers know that patients are still in health insurance, even though businesses have not made eye contact with new contracts.
The state Department of Commerce and Insurance Director Angela Nelson said there's no need to panic with me today.
“These things keep going all the time. Most people don't notice. There's not much attention paid to them. Individual physician practices can lose their network status at any time of the year.
The collapse of negotiations will affect around 90,000 customers, including state workers in Missouri.
She said that if patients continue to look at MU health care providers, the difference that patients are likely to make is out-of-pocket costs. Until businesses sign up for new deals, MU Healthcare providers are considered “out of network” to Anthem customers.
“If deductible, you may need to meet the new deduction amount for the benefit of the network,” Nelson said. “But the most common thing they encounter is their co-payments for office visits, and they may change. For example, they may currently have a co-payment of $40.
Nelson said there were exceptions.
“If you or your child, or your spouse, are subject to your employer's plan, there is a provision that allows you to continue to see your same provider with the benefits within your network and receive the same care you were provided,” she said.
What about specialists with specific health conditions?
“A lot of people say, 'Well, I have experts, they're just at MU. No one else has a provider with that particular area of expertise.' Most plans also have exceptions for these types of situations. For example, if there is no other provider in that area within a certain miles range, the health plan treats it as an interest within the network.
There are no network restrictions for emergency medical care either.
“Missouri law absolutely stipulates that you will be transported to the nearest facility. You will be provided with in-network coverage to screen and stabilize you. Essentially, it's going to save your life,” Nelson said. “So, if they are facing an emergency, we don't want people to worry, can I go to this hospital?”
She encourages clients to discuss eligibility with Anthem or Missouri's Department of Commerce and the Department of Insurance.
To check the status of the exception, state employees are encouraged to call family supporters listed on the back of their health insurance ID cards. All other patients can call the customer service number on the back of their insurance card.
For more information about out-of-network care, visit Insurance.mo.gov or call DCI Consumer Hotline at 800-726-7390.
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