Community Health Choice, Kelsey-Seybold part ways
Thousands of Kelsey-Seybold Clinic patients will lose their innetwork health coverage through Community Health Choice next year as the long-standing contract between the two dissolves and health care access in Houston is thrown into further disarray.
Community Health Choice confirmed on Wednesday it will end the contract on Dec. 31. The move, which the Houston-based insurer said was initiated by Kelsey-Seybold, will affect patients with individual plans bought through the Affordable Care Act marketplace and some Medicaid plans, a spokeswoman said.
At issue is price — both what the insurer will pay and what doctors and facilities will accept.
“Unfortunately, premium and plan changes taking place in the marketplace year-over-year have made it unpredictable and unsustainable for providers and patients,” Kelsey-Seybold said in an email statement on Wednesday. It is
estimated about 2,800 plan holders would be affected.
“Kelsey-Seybold made the business decision to end its contracts with us,” said Catherine Mitchell, interim CEO for Community Health Choice, in a statement, adding that it will work with Kelsey-Seybold to help ensure patients receive continuity of care and help them transition to other plans or providers.
Kelsey-Seybold has a large network of facilities and doctors and sees about 350,000 patients each year, the company said. In 2016, its contract with Blue Cross and Blue Shield of Texas was also terminated. For 2020, no individual marketplace plans will cover KelseySeybold in the Houston area.
This latest development follows the announcement this month that UnitedHealthcare, the nation’s largest insurer, will end its contract with Houston Methodist’s eight hospitals, dozens of out-patient facilities, and roughly 800 doctors, if an agreement is not reached. While negotiations are continuing, as many as 100,000 UnitedHealthcare members with employer-sponsored plans and those with Medicare Advantage plans would be affected as services would become out-of-network and more expensive to patients.
Houston Methodist officials said traditional Medicare patients with a UnitedHealthcare supplement policy would not be affected.
Vivian Ho, a health economist at Rice University’s Baker Institute for Public Policy, said what is happening in Houston reflects a national tipping point.
For the past few years, as health care costs have risen, doctors and hospitals have gained more clout through consolidation and demanded higher reimbursement. At the same time, insurers are feeling pressure from employers and customers to keep costs in line.
“Both providers and insurers have pushed this to a loggerhead this year,” Ho said.
The turmoil that the UnitedHealthcare announcement unleashed has been swift. Stefanie Asin, a spokeswoman at Houston Methodist, said on Wednesday its call center has been flooded with more than 400 calls in the past six days since the news broke, mostly from patients worried they would have to find a new doctor or hospital.
While far fewer plan members at Kelsey-Seybold are affected, it is expected the Community Health Choice termination will bring similar dismay.
“It’s horrible for the patients,” said Ho. “It’s striking them when they are the most vulnerable.”
Betsy Evans, a 52-year-old Houston artist, has been diagnosed with four different cancers in the past three and a half years. For the past two years, she has had coverage through Community Health Choice and sought treatment at Kelsey-Seybold.
“I was thrilled with their cancer care,” she said Wednesday, “I was thrilled with Kelsey-Seybold. I feel like the rug is being pulled out from under me. “
After a grueling run of bad medical news, she learned that a July CAT scan found no new tumors. Then she got the letter from Community Health Choice that her coverage would no longer be in-network, which meant she would have to pay much more for any future treatment.
That’s the rub. Had she been in the middle of active treatment she might be able to make the case her care was ongoing and should be covered as in-network. But she is clear of tumors, even though she fully expects at some point she will have a relapse.
“I have to be monitored very closely. I don’t have one doctor that I will have to change. I have a team of doctors,” she said. “Am I going to have to start completely over from scratch? It’s terrifying.”