Basic Health Gets Help Qualmed Returns To Foundering Program

(From For the Record, November 13, 1998): Wrong phone number: Spokane and Lincoln County residents interested in contacting QualMed Health Plan about enrolling in the Basic Health Plan next year should call 1-800-845-7881. A Thursday story listed the company’s Puget Sound number.

An insurer that had dropped out of a state-sponsored health insurance program has decided to jump back into Spokane and Lincoln counties.

QualMed Health Plan will offer the state’s Basic Health Plan in the two counties next year, probably saving the program from collapsing in this area.

The agency that administers the Basic Health Plan has been trying to persuade an insurer to come back into the market for the past month.

“This is probably the most serious situation we’ve had since we first started in 1988,” said Dave Wasser, spokesman for the Health Care Authority which administers the Basic Health Plan.

“It was the closest we ever had to come to saying, ‘I’m sorry. There just aren’t enough doctors for all of you.”’

Next year, three insurers will offer the Basic Health Plan in Spokane County. Two will offer the plan in Lincoln County.

About 17,600 people in Spokane County and 450 in Lincoln County subscribe to the Basic Health Plan, which aims to provide managed care to about 225,000 underinsured and uninsured people statewide.

Seven insurance companies contracted with the state to offer the plan in Spokane County this year.

But over the last few months, insurers have started dropping out of government-sponsored plans, including the federal managed-care Medicare program, the state’s Basic Health Plan and the state’s managed-care Medicaid plan, known as Healthy Options.

Some insurers merged, such as Blue Cross of Washington and Alaska and Medical Services Corp., which joined to form Premera Blue Cross. Other insurers said the government programs simply lost too much money.

QualMed pulled out of the Basic Health Plan because it couldn’t freeze its enrollment next year for people who aren’t subsidized by government money.

Providence Health Plan is getting out of the health-insurance business altogether. Aetna U.S. Healthcare of Washington, formerly known as NYLCare, dropped out because of problems with its network of providers.

But Premera Blue Cross delivered the biggest blow in this area by pulling out of Healthy Options and the Basic Health Plan in Spokane and Lincoln counties.

Premera, the largest health plan in the region, had insured about 29,000 people in those two programs.

In October, the Health Care Authority was faced with the prospect of having only two insurers offering the Basic Health Plan next year in Spokane and Lincoln counties.

Group Health Northwest has about 5,700 Basic Health members in Spokane County. The Community Health Plan of Washington has about 275.

That meant about 11,600 people were supposed to find a new insurer before the end of the year. And neither Group Health nor the Community Health Plan had enough contracted doctors to take the influx of people.

For the past month, the Health Care Authority’s primary goal has been fixing the problem in Spokane and Lincoln counties.

The agency was particularly concerned about Spokane County, which was one of two pilot areas for the Basic Health Plan 10 years ago.

Health Care Authority officials asked several insurers to get back into the Basic Health Plan in Spokane and Lincoln counties.

QualMed finally agreed.

“We were glad to be a good corporate citizen,” said Chris du Laney, QualMed Washington president.

The company estimates that about 7,000 Spokane residents will probably sign up with QualMed’s Basic Health offering. Most will probably be able to stay with their doctors, du Laney said.

The remaining people will join Group Health or the Community Health Plan.

Group Health Northwest President Sharon Fairchild said the company welcomed QualMed back to Basic Health.

“We need more carriers,” she said. “One health plan cannot do this by itself.”

Wasser said the state agency expects some minor problems in the near future. Letters will be sent out to enrollees in about a week, and they will have until mid-December to pick an insurer.

“We recognize it’s been a confusing situation for the enrollees out there, but we came this close to actually not having any choices for them, or a limited choice with an inadequate number of providers,” Wasser said.

“We really pulled out all the stops.”

The story of the Roschers of Deer Park typifies the confusion enrollees have faced.

Ted Roscher, who is 64, and his wife have paid about $650 a month this year for the nonsubsidized Basic Health Plan through QualMed.

In October, the couple learned they would have to pick a new insurer before Nov. 6.

So they signed up with Group Health for next year, and they’ll pay about $850 a month for their coverage.

On Monday, the couple received a letter from QualMed, saying the company was no longer participating in Basic Health.

On Wednesday, Roscher learned that QualMed had decided to come back to the plan.

He was worried about what might happen in the next few months.

“If you want to see an irate German, just wait and see if they screw up my insurance again,” Roscher said.

“I’m going to be over there in one bounce, sitting on the doorstep in Olympia and at the insurance company. Boy, oh boy, I can just see me putting hours of fight time in.”

This sidebar appeared with the story: ENROLLMENT HELP The Washington Basic Health Plan is a state-sponsored health insurance program for residents who are uninsured or who don’t have enough insurance. Members pay premiums on a sliding scale depending on income, age, family size and health plan. Three plans - QualMed Health Plan, Group Health Northwest and Community Health Plan - will offer Basic Health next year in Spokane County. Only QualMed and Group Health will offer Basic Health in Lincoln County. For more information, check the Internet site at www.wa.gov/hca/Basic.htm or call the following: Basic Health Plan - Members call 800-660-9840. Interested applicants call 800-826-2444. Group Health Northwest - 800-497-2210, ext. 7124, or (509) 838-9100, ext. 7124. Community Health Plan of Washington - 800-440-1561. QualMed Health Plan - 800-869-7165.