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Marketplace insurance carrying fewer providers
I would like to warn citizens in Western North Carolina about new HMO policies sold through healthcare.gov for 2023. Aetna has been an excellent insurance in this area for a long time. I know since I’ve done medical billing and management in this region for over 20 years. However, this year Aetna CVS Health has sold HMO policies through HealthCare.gov, when they do not have a network to support the patients with this insurance coverage.
Almost all claims generated from facilities, such as Angel Medical Center, Harris Regional Hospital and most healthcare provider’s offices will be denied as out-of-network, when the facilities are in-network with Aetna Medicare and Commercial plans. Angel Medical Center, located in Franklin, is a critical access hospital, serving Macon and the surrounding counties. On the Aetna CVS Health website, they have ONE medical provider in-network within this entire facility. DLP Harris Regional Hospital, located in Sylva, N.C., is completely OUT-of-network. Keep in mind, these HMO policies have ZERO out-of-network benefits.
This means Aetna CVS Health is accepting premium tax credits from our government and premiums from policyholders with few to no providers in Western North Carolina. When an insurance company is accepting tax credits and premiums for HMO policies with NO out-of-network benefits and NO network to support those policies sold, that appears to be an obvious ploy NOT to pay claims! It is criminal for any person or business to take money for products or services they are unable or unwilling to provide. Why should it be any different for insurance companies? I have sent this information along with screenshots to every elected official that I could and have filed a complaint with the NC Department of Insurance. I purchased my Aetna CVS Health policy in good faith, but fear it was sold with fraudulent intent.
I contacted Cigna Provider Services on Feb. 14, 2023, and spoke to a representative asking why a provider who is in-network with Cigna, is not in-network for the new Cigna HMOs sold on the Marketplace for 2023. I was told that the plans sold through the Marketplace has a network that was by invitation only. He said a provider cannot request to be in network with those plans. I told him it sounds a lot like Aetna CVS Health plans: Selling policies without having a network of providers to support the policies sold when we are in a rural area without enough providers to begin with. I have also been told more than once this week that the same thing is happening with some of the Blue Cross Blue Shield plans sold through the Marketplace for 2023. To my knowledge, I have not seen issues like this with Marketplace policies before this year.
If you purchased an Aetna CVS Health Plan or another Marketplace HMO policy through healthcare.gov and you live in Western North Carolina, you may want to pick up the phone or get on your insurance’s website to see if your providers are in network with your insurance company. It could save you hundreds to thousands of dollars in denied medical claims, not to mention the stress and frustration you will endure! Every claim I have had this year has been denied! As of now, I would hesitate to receive emergency services for fear of how much I would owe due to these network issues. Almost all Aetna providers in our area are considered out-of-network and who knows about these other HMO plans. Protect yourself and file complaints if necessary with the NC Dept of Insurance.
See website address: https://www.ncdoi.gov/contac…/assistance-or-file-complaint
I have spoken with Senator Kevin Corbin and he was aware of this issue. Mr. Corbin told me that is why he did not offer these policies through the Corbin Insurance Agency. I have also been in communication with healthcare.gov, NC Dept of Insurance and Congressman Chuck Edwards office. There are multiple investigations that are now being conducted regarding this issue. Aetna Health has even requested additional time from the NC Dept of Insurance to do an internal investigation. I have also created an email for anyone who wants to contact me that are experiencing similar issues – hmoscams@gmail.com.
Karen Williams – Franklin, N.C.
Property price increases a product of political upheaval
Many owners in Macon County, North Carolina have received a “Real Property Reappraisal Notice” and are reeling from the shock. Average land value increases across Macon County range from a low of around 23% to well over 100%; and building value increases from 50% to over 174%. I didn’t look at commercial properties.
The last Reappraisal was only four years ago and historically no rates of increase have approached these. Why? Land and homes are limited resources hit by overwhelming demand caused by massive relocation of populations across this nation. The relocations have the impact on our markets of a 7.9 earthquake. Here are just four recent earthquake examples:
1. COVID 19 causing a flood of refugees fleeing mandatory lockdowns and vacinations;
2. HIGH CRIME causing a flood of refugees seeking safe communities.
3. HIGH TAXES causing a flood of refugees seeking locations with fewer and lower taxes;
4. OPEN BORDERS causing a flood of refugees seeking opportunities.
Refugees on the move have resulted in price pressures now reflected in the Reappraisals. Unfortunately the end result is that many of the people of Macon and similar counties will find they can no longer afford to own a home or property; let alone buy food or put fuel in their car.
However, this price pressure is not the result of “arm’s length transactions” over time caused by natural population increase. It is instead political upheaval caused by this nation’s rush to embrace socialism.
Diane Whitley – Franklin, N.C.
