About Amy Umble:
Amy Umble is health reporter for The Free Lance-Star

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When it comes to health insurance, those pesky details really matter

Updating the Mary Washington-Anthem contract dispute.

Every time I write about health insurance, I am humbled by the complexity of it. It’s hard to report on an insurance issue in general terms. The issue may affect most policyholders in a predictable way, but there’s almost always a subset of policyholders that are affected in a completely different way. I probably should include in every story the phrase, “depending on your plan.”

This problem surfaced again recently when I reported that if Mary Washington withdraws from the Anthem provider network at the end of the year, it will treat Anthem patients as if it was still a member of the network. Patients will continue to pay the same in-network, out-of- pocket amounts described in their plans, company officials said.

In the comments section that appeared with the online version of the story, Tanya Green wrote about those who don’t have out-of-network coverage in their Anthem plans.

“That works fine,” she said, referring to Mary Washington’s announcement, “except for those BCBS customers who have to go to an in-network provider. Otherwise they receive no coverage. MWHC charging the lower in-network rates won’t work for them, which puts me to have to seek medical attention in Woodbridge if necessary.”

Brandon Johnson, another reader, posed a second potential complication to MWHC’s plan. He  wrote:

“MWHC is misleading here. They may only charge network rates, but that isn’t the only issue when a provider becomes non-participating in the network.  The fact is, many of us on Anthem plans have annual deductibles which apply to out-of network care before insurance pays anything (I believe mine is $1,800). MWHC certainly won’t cover that.  So, anyone in my situation (and there are many who are) will simply go with their competitor in Spotsylvania or up to Potomac Hospital or INOVA Fairfax for non emergency care.”

Scott Golden, Anthem’s spokesman, this week confirmed Green’s point. He said that some of Anthem’s HMO customers have no out-of-network benefits.

On Johnson’s point, Sean Barden, executive vice president and chief financial officer for MWHC,  said, “As for the higher annual deductible for accessing an out-of-network provider, MWHC would make such patients whole.  We would only expect the patient to pay what they would have paid had we been a contracted provider.”

(Prior blog postings about the Anthem-Mary Washington issue are here and here. Saturday’s newspaper story about the dispute is here. Mary Washington has Anthem information on its website here. And Anthem has a Mary Washington page, here, on its website.)