Updated: 10/10/2013 12:51 AM
Created: 10/10/2013 12:34 AM WHEC.com
By: Lynette Adams
Some 85,000 people in our region may have to find new health insurance coverage next year.
Excellus BlueCross BlueShield says it will no longer offer certain healthcare plans managed by Medicaid.
Excellus says these changes will affect people in 25 countries, including those in our area, beginning in January.
In all, this change would effect about 200,000 people in Upstate New York.
A spokesperson for Excellus says the insurance provider is approaching $100 million in loses from these programs this year, and the losses could be even greater in 2014.
Excellus will continue to take part in Child Health Plus.
A number of people are shocked by this news. People like Liz Wheatley, a Greece resident and mother of three who works full time, but can't afford the insurance her employer provides. The plan through Excellus was just what she needed.
"It's going to be a struggle," she said.
Wheatley isn't quite sure what she's going to do come March 1st. That's when the healthcare insurance she has with Excellus Blue Cross Blue Shield ends. Wheatley has some pre-existing health conditions, and is worried.
"I'm afraid of the quality of care, definitely because if they do switch you over to certain things and the other providers don't want to accept them, then that's leaving me in the dark," she said. "I have to explore other options that may not be the best for me."
Wheatley says her children will be okay; they will continue to receive Child Health Plus. However, she says there are no other healthcare plans that offer the kind of comprehensive coverage she has with Excellus.
"Sometimes it's like they look at that insurance and they're like, 'you know what, we'll do this for you; go see your provider later.' You go see your provider, they say, 'okay we'll switch you over to this specialist.' The specialist is like, 'nope we can't help you, you need to come back with one of these other plans.'"
Excellus spokesperson Jim Redmond says it is with great reluctance the insurance provider is making this decision. He says Excellus would consider continuing the coverage, but these programs are not sustainable without a significant reduction in the losses the company is incurring.
We spoke with the Executive Director of the Monroe County Medical Society, Nancy Adams, by phone. She says doctors are distressed by this news and worry about their patients.
"Some of the other managed care plans are not in contract with as many doctors in Rochester as Excellus is," she said. "I'll use the example: if a patient is able to find a primary care doctor, the concern may be, are there enough specialists to take care of that patient that is within that network? And it could go the other way around; people could have a problem finding a primary care doctor. So there many unknowns and it is quite concerning."
People who will be affected by this will be switched to another Medicaid insurance provider and will still be eligible for Medicaid coverage. Again, the concern: will it provide the level of coverage people have become accustomed to?
We are still working to find out why there are such big losses at Excellus. Nancy Adams tells us it has everything to do with reimbursements from the state. She says it seems to be more favorable to insurance providers downstate.