Important Health Insurance Update

The OIHCD Board understands that concerns around the availability of individual insurance is top of mind for islanders following Kaiser Permanente’s announcement they will not be offering individual or small group plans in San Juan County next year. Since learning about Kaiser’s decision, the District’s Superintendent has been staying in close contact with  Premera’s Senior Network Executive (parent of the insurance company replacing Kaiser, LifeWise Health Plan of WA) to ensure residents of San Juan County experience minimal disruption with the changes taking place as of January 1, 2020.

We now know that the new LifeWise network specific to Individual exchange plans will include ALL San Juan County providers who are currently contracted with Premera. This means both the UW Medicine Orcas Island Clinic and Orcas Family Health Center will be in-network providers.

There is more good news!

While the new LifeWise specialty network is slightly more narrow than their traditional Premera network, an exception was made to enable patients receiving care from the UW Medicine Orcas Island Clinic to be referred into UW Medicine for specialty or hospital care, and be handled as in-network. This is very positive and will allow for improved continuity and coordination for UW patients needing higher levels of care.

As far as the rest of the network, the following facilities will be in-network: Island Hospital, Providence/St Joseph, Swedish, PeaceHealth, Seattle Children’s and Skagit Regional Hospital. Those facilities that will not be in the new LifeWise network are some of the larger hospital systems and providers, primarily in King, Snohomish and Pierce Counties. They include: Multicare, Virginia Mason, Overlake Hospital, The Everett Clinic, Evergreen Hospital, UW Medicine (except for patients receiving care from the UW Medicine Orcas Island Clinics) and Seattle Cancer Care Alliance.

We are awaiting more details on the Medicare offerings for next year and will share information as it becomes available. As always, please feel free to contact the Superintendent at annep@orcashealth.org with questions or concerns. She can also be reached on her cell at 415.999.5611.

Health Care on Orcas at a Crossroads

Orcas Island Health Care District (District) has now been officially operational for one year. To date, our primary focus has been on establishing the District and entering into Clinical Services Agreements (CSA) to provide funding to both Orcas Family Health Center (OFHC) and UW Orcas Island Clinic (UW).

The Commissioners recognize and appreciate the efforts of employees in both clinics and their commitment to providing quality care to us all. We are fortunate to have such dedicated and professional staff at all levels. Both clinics are making continuous improvements in their operations to meet the unique needs of our island community.

In spite of the efforts underway within the clinics, as Commissioners we are currently facing increasing costs, challenges in the provision of care, and staffing issues in our existing system of two separate clinics. In particular, finding and retaining qualified staff to operate the clinics at the level of service they are committed to delivering remains problematic.

OFHC, with its many years of experience operating a clinic on an island, has continued to perform as anticipated financially. The clinic is operating under a CSA that includes providing after-hours, acute care with physical access to a provider, when deemed medically necessary.

UW, with over a year’s experience operating an on-island clinic, is not meeting their forecasted revenue numbers for the current year. In addition, UW is requesting a 45% increase in their annual funding for the 2020 fiscal year in order to deliver the broader primary and acute health care service required by an island community. UW is operating under a CSA that provides phone access only to an on-call provider, when directed by a Triage Nurse. The coverage does not include after-hours access to a physically accessible provider.

These very real challenges have pushed forward the Commissioners’ plan to take a broader look at the current system for delivering primary and acute care. We are focused on our responsibility to ensure that all islanders have access to island appropriate, high-quality primary and acute care, including after-hours care, delivered in a financially responsible and sustainable manner. Over the next few months, we will be researching and addressing issues including whether continuing to support two separate clinics is sustainable; if we are fully leveraging all potential enhanced reimbursement opportunities that are available to Rural Health Clinics such as OFHC; and what partners are the best fit for delivering island appropriate care in a financially sustainable manner.

Health care is a very personal matter for each of us. We all want the absolute best care for ourselves, our families, our fellow islanders and our visitors. The Commissioners recognize that contemplating changes may spark concern. We understand our responsibility to use taxpayer money wisely to support the best health care system for all our constituents. No changes are pre-ordained, but we feel we must be transparent with the public in acknowledging the difficulty of the current model and the necessity for a system wide review.

As we embark on this research, we will continue to seek public input in a variety of ways. We encourage you to continue to visit our website and read the very detailed Minutes of our Regular Board meetings that describe well the process of our work. We solicit public comment at each of our bi-monthly Board meetings. Contact information for all of the Commissioners and our Superintendent, Anne Presson, can be found on Contact Us page. Once we have more information to guide our decisions, we will be holding public meetings to present our findings and recommendations for a path forward and to hear public input. Excellent health care on Orcas is vital to all of us. We welcome your input as we move forward.

Meeting Materials

The Agenda and Materials for the June 4th Regular Board meeting have been See the source imageposted.

 

Meeting Materials

The Agenda and Meeting Materials for the May 21, 2019 Regular Meeting of the OIHCD are now available online.

See the source image

 

 

Special Meeting Notice

Please be aware that the OIHCD will be holding a Special Meeting on May 13, 2019. The Agenda has been posted and contains details on meeting time and location.

 

Meeting Materials

The Meeting Materials for the May 7th Regular Meeting of the OIHCD Board of Commissioners have been posted.

Meeting Materials

The Agenda and Meeting Materials for the April 16th Regular Board meeting have been posted.

Meeting Cancellation

Please note that the April 2nd Regular meeting of the Board of Commissioners has been cancelled. The Board’s next regularly scheduled meeting will be held on April 16th.

Meeting Materials

The March 19th Board Meeting Materials have been posted. The public is welcome to join the Commissioners at their Regular meeting being held from 4 – 6 pm at Orcas Island Fire & Rescue’s Eastsound Firehall.

Options when a health insurance claim is denied

The Orcas Island Health Care District and Orcas Island Fire and Rescue continue to work together, along with other County-wide leaders, to resolve ongoing concerns related to Kaiser Permanente’s coverage for emergency medical air transport.

As a consumer, if you experience a denial from your insurance company for any covered service you can contact the Office of the Insurance Commissioner for WA State (OIC) for assistance.

The Insurance Commissioner’s office answers hundreds of insurance questions every day, and you can easily file a complaint against your insurance company on their website. You can also call the toll-free Insurance Consumer Hotline at 800-562-6900.

What the OIC can do:

  • Send your complaint to the insurance company and require them to provide an explanation for their actions.
  • Send your complaint to the Washington Healthplanfinder and ask them to resolve your concerns.
  • Review the company’s response to make sure they followed Washington state laws and your policy.
  • Tell the company to fix the problem if they didn’t follow the laws or your policy.
  • Try to find patterns of problems that may need further reviewing.
  • Try to help fix your insurance problem or help you and the company communicate with one another.
  • Help you understand your insurance policy.
  • Recommend places you can go for help if we don’t have the legal right to resolve your complaint.

What the OIC can’t do:

  • Act as your lawyer, give you legal advice or be your claims adjuster.
  • Make medical judgments or determine if further treatment is necessary.
  • Make liability decisions or determine who is at fault.
  • Establish the facts surrounding a claim (for example: who is being truthful when there are conflicting reports of the situation).
  • Determine the cause of loss, value of a claim, the amount owed to you, or act as your adjuster.
  • Address issues we can’t legally enforce.
  • Require the Washington Healthplanfinder to comply with state insurance laws as it’s not an insurance company regulated by our office.
  • Tell a company to pay a claim, refund a premium, or reinstate or issue a policy (if they followed the law and your policy).

Page 1 of 4

Powered by WordPress & Theme by Anders Norén