Surprise Billing

marketplace-billingEvery health insurance company is required to develop a network of providers so that its customers have access to doctors, clinics, and hospitals. The Affordable Care Act has expanded insurance enrollment for many previously uninsured populations. Washington CAN has been working with partner communities, the Health Benefits Exchange, and the Insurance Commissioner to improve the rules governing how the provider networks are serving the needs of the newly insured.

We face two major challenges: First, are the providers close enough to the patients to permit them to get to the doctor or hospital when they need to? Second, are the networks sufficiently diverse to provide adequate language access and cultural sensitivity to their new insurance customers?

Frequently, access is a matter of proximity – how long does it take and what does it cost to get to the doctor? Many of the new insurance customers live in areas where doctors have not traditionally located their practices. Can low-income people find their way to a doctor or hospital located in another part of their community or does distance provide a significant barrier?

Another issue we are advocating on is, if a low-income person can find a way to the doctor or hospital, will providers be able to communicate with them in their primary language? Will providers be sensitive to cultural differences? Will there be appropriate outreach to these communities so as to improve their participation in the health care system?

Both the Insurance Commissioner and the Health Benefits Exchange are reviewing these issues. The outcome of debates are uncertain, particularly given that the insurance industry is pioneering what they call “skinny networks” – networks that include fewer, rather than more, providers.

Washington Uninsured Rates Among Lowest in the Nation with New Medicaid Options

health insuranceBefore new coverage options under the Affordable Care Act (ACA) rolled out in October of 2013, Washington CAN! mobilized to make sure the state accepted federal funds to cover low-income adults through Medicaid. Now, after two years of enrollment through the ACA, nearly 552,000 people are now covered by Medicaid, also known as Apple Health, and despite initial hiccups and stumbles with the online system our state had the fourth highest drop in the number of uninsured. Most people agree Washington’s efforts to close the coverage gap were incredibly successful.

Despite this evidence, Representative Cathy McMorris Rodgers (R), was determined to paint a different picture. She asked her Facebook followers to share negative stories to bash the Affordable Care Act (ACA). However, instead, her post received an overwhelming response from nearly 10,000 fierce defenders of the ACA. Many of their comments indicated that either they or family and friends benefit from the new health care options under the ACA, including Apple Health. It was heartening to see so many Washingtonians stand up for health care coverage and for their friends and neighbors.

At Washington CAN!, we know the thousands of positive comments on Representative McMorris Rodgers’ Facebook post represent the true benefit of covering more people. In our own outreach we heard similar things from people across our state. We heard from Sam, a University of Washington graduate student who told us that Apple Health has given her peace of mind as she finishes her degree and starts her job hunt. She was afraid of getting sick and having to choose between treating her illness and paying tuition. Now, she’s considering starting a family thanks to her Apple Health coverage.

We heard from Kristi Brown Wokoma, chef and owner of That Brown Girl Cooks, a small business. She and her husband were still paying the debt for a hospital stay to remove fibroids when another serious condition surfaced. They were covered by Medicaid because Washington accepted federal funds to cover more people through the program. Now they can take care of her medical challenges without losing ground financially. Wokoma is grateful her family is now covered.

As we see and hear about the importance of insurance coverage for people in our state, we know there is more work to do to make sure everyone has access to care. We organize with the idea that our members are a powerful representation of every consumer and encourage them to advocate for the best coverage possible.

At Washington CAN!, we believe the next step for Washington is universal single-payer health care. The Health Care is a Human Right movement, a two-year, grassroots campaign to give all Washington State residents access to quality affordable health care is underway. Two bills were introduced in the 2015 legislature and, because they heard from Washington CAN! members in their districts, 45 legislators were co-sponsors, an impressive number for a first-time bill. The campaign, built with a robust coalition, is off to a great start. So yes, Washington State has indeed benefitted from increased access to Medicaid and will continue to do so, but it’s only the beginning.

Get Your Buns Covered by Roberta Riley

Raging Grannies Blog

Mary first caught my eye as she strode down a busy thoroughfare in a flimsy hospital gown, with the sun glistening off (what looked like) her bare buttocks.

“Uncovered” was the message on her sign. She and her friends, Seattle’s Raging Grannies, took to the streets that day, alongside thousands of others, to protest the fact that too many Americans simply couldn’t afford health insurance. Had there been a prize for best costume, Mary would’ve won, hands down. The Raging Grannies made a difference that day by adding their creativity and spunk to the tidal wave of public pressure that pushed Congress to enact the Affordable Care Act in 2009.

Today, the Raging Grannies celebrate the good things our new health law has brought to people’s lives: from little things, likeJulie’s free flu shot, to mid-size things like Kristi’s free IUD andIngrid’s free colonoscopy, to big things like the brain surgery that saved Joie’s life.

But with enrollment deadlines and tax day just around the corner, Mary decided it was time to pull her costume out of the closet, once again. Enjoy as the Raging Grannies sing, and Mary shoots the moon, to make an important point: NOW is the time to sign up for the affordable health insurance YOU need and deserve.

Then shake your backside straight over to a computer and get your own buns covered. Remember, tax penalties go up the longer you delay enrolling.

  • If you live in Washington State, go to wahealthplanfinder.org and sign up before the April 17, 2015 deadline.
  • If you live in another state, go to healthcare.gov and sign-up before the April 30, 2015 deadline.

Don’t leave yourself exposed to medical debt:#Get Covered Now