The recent departure of Bright Health from the Summit County health insurance market has created yet another gap in services for both patients and insurance groups.
But with some of the best orthopedic surgeons in the world located at Vail-Summit Orthopedics & Neurosurgery’s facilities in Frisco, Colorado and operating out of the Dillion Surgery Center, it certainly makes sense for local patients to be able to access those services and not have to travel to Metro Denver or beyond for other alternatives. And with open enrollment now on in the state, patients looking to keep or ensure access in the year ahead are encouraged to do plenty of research to find a plan that will keep them in VSON’s community of care.
Cari Thomason, VSON’s Director of Finance, says she works hard to try to provide options and education for patients who want localized access to surgery, sports medicine and more. But Thomason says patients do need to take an equally proactive approach in guaranteeing their existing coverage, rather than facing any unexpected billing issues in the future.
“Unfortunately, there are just not a lot of local options, with just three insurers offering patients in-network coverage for our services on the individual market – Rocky Mountain Health Plans, which is part of the United Healthcare system, plus plans from Anthem Blue Cross Blue Shield and Cigna,” Thomason says. “Bright Health pulled out so quickly that many patients were left scrambling.”
Thomason says a big issue for patients is those folks who split time between Denver and Summit County and believe – or hope – that their Front Range-based insurance coverage will automatically apply for VSON visits.
“It’s all completely different, based on where you live, and based on primary residency,” she says. “If you live in Denver, that plan may not be accepted here in Summit County. We run into that a lot, especially with Anthem’s CU Health Plan or even Kaiser Permanente, if people have coverage without extended networks.”
Thomason encourages patients to do their research – as frustrating as it can be trying to call health care insurance companies or dig through websites – to make sure that their narrow network will cover VSON services.
“As you’re planning out your insurance choices, you need to focus on what you believe your utilization might actually be and how much you expect to spend, and figure out the best plan for the care you plan to use,” Thomason says. “That’s especially important if you have adult kids who are going off of your insurance coverage as they approach age 26.”
Amanda Leyrer, MS, ATC, OTC, SA, VSON’s Director of Clinical Operations, says that VSON does its best to make sure that local patients have the easiest access possible to local orthopedic services.
“Our goal as an orthopedic practice is to provide care to the community, and we do what we can to help patients understand the local insurance market and get the best coverage they can,” she says.
Leyrer agrees that patients are still in a challenging position as many of these insurance decisions are ultimately left up to them, with relatively little guidance available.
“It’s especially difficult when insurance companies aren’t transparent to patients. So much of it comes down to knowing what questions to ask and always doing your own due diligence,” she says. “It’s important for people to have coverage that allows for acute care, especially with our active population. Take the time to understand your benefits.”
Leyrer suggests potential patients with employer-sponsored insurance also pay close attention and have those questions ready for HR staff during open enrollment season, a time when a candid conversation with a knowledgeable advocate can help provide the right coverage – or avoid unexpected bills down the road .
“There are so many different variations of insurance out there, and they’re all trying to get a portion of the business, so you really need to know what you’re signing up for before you make that choice,” Leyrer adds.
Leyrer says some patients can also benefit from the discount provided by paying cash for services, but that also requires some foresight and may only be appropriate for some cases.
“We do offer self-pay cash discounts on a case-by-case basis, and there are benefits to that, but it depends on the procedure. It’s certainly another way to provide some relief.”