Healthlink Woes Haunt Customers Canceled Surgeries, Delayed Treatment Follow Bankruptcy

Some people who get their health insurance through bankrupt HealthLink are facing canceled surgeries and postponed treatments.

Others are being billed for care that their insurance covers.

State Insurance Commissioner Deborah Senn says she has received a number of serious complaints from consumers. About 15 have been made in the past two weeks.

“People have to go to the doctor,” Senn said. “We cannot have people turned away. There is no moratorium on people’s illnesses. We have to be responding and making sure that people can get to the doctor every day.”

The federal Health Care Financing Administration is hearing from senior citizens who are being billed for care that Medicare covers, spokeswoman Pam Negri said.

They shouldn’t pay those bills, Negri said.

At its largest, HealthLink paid for the care of about 46,000 people in the region, or almost one in 10 people in Spokane County.

HealthLink is known as a third-party administrator, essentially acting as a subcontractor to insurance companies in the region, taking the bulk of insurance premiums and all the risk.

The company has had severe financial problems and owes more than $10 million to doctors, hospitals and other health care providers.

HealthLink is reorganizing and laid off three-quarters of its employees. HealthLink and the two companies it manages also filed for Chapter 11 protection from creditors.

Senn has no jurisdiction over HealthLink and the companies it manages, which aren’t required to have the same kind of financial reserves as insurance companies. Nobody really has jurisdiction over HealthLink.

“These things are operating off our radar screen,” Senn said.

But she does have authority over the insurers that contracted to provide care through HealthLink.

She sent out a letter Nov. 5 to the four insurers that worked with HealthLink: Providence Health Plan, QualMed Health Plan, NYLCare and PacifiCare.

The letter tells insurers they are obligated to make sure that enrollees receive their benefits.

It also says insurers must continue to pay health care providers while they’re rebuilding their provider networks in the region.

Senn also said insurers are responsible for notifying health care providers and enrollees of the insurers’ continuing obligation to the enrollees.

Three insurers - QualMed, NYLCare and Providence - have canceled their agreements with HealthLink and the companies it manages.

Providence and NYLCare are backing out of the area. QualMed is in the process of rebuilding its network.

PacifiCare is the only company that plans to continue working with HealthLink.

PacifiCare didn’t comment on Senn’s letter.

But in an Oct. 29 statement, PacifiCare Washington President Chris Wing said the company has taken steps to make sure its members continue to get necessary care during HealthLink’s reorganization.

For instance, PacifiCare will put a temporary cap on any new enrollees in its Medicare managed-care program, Secure Horizons. About 5,200 seniors are in Secure Horizons. PacifiCare is not saying what the cap will be.

Some PacifiCare enrollees are still having problems because of HealthLink.

William Frey was diagnosed with prostate cancer a year ago. Every four months, he gets a $2,600 shot that helps fight the cancer.

His insurance company, PacifiCare, is supposed to cover this. About $90 a month is deducted from his retirement check every month to cover his family’s care.

Frey’s last shot was July 16. But HealthLink didn’t pay the bill. And Frey found out Nov. 1 that his doctor wanted cash for his next shot on Monday.

Then his daughter, who is 19, found out that her bunion surgery scheduled for next Friday had been canceled, pushed back until after the first of the year. The podiatrist hadn’t been paid for months by HealthLink.

She cried when she found out, Frey said. “Her feet hurt something terrible,” she said.

Through HealthLink, Frey has found a different provider that will give him the medicine he needs for his shot, which he will take to his primary-care doctor’s office.

But he won’t get the prostate exam he usually gets from his specialist.

Frey doesn’t blame the doctors, who have never billed him for the care.

“I don’t blame them in the least,” Frey said. “I think insurance ain’t worth the paper it’s written on, almost.”

He plans to switch carriers as soon as possible.