Health Care in Tennessee: Insurance companies raise premiums, drop coverage

Health Insurance: BlueCross BlueShield of Tennessee raises rates by 62 percent, then cancels coverage for 112,000 patients

Patients in Tennessee are frustrated by skyrocketing insurance premiums. For good reason.

One major insurer received approval for a record 62 percent hike in health insurance premiums, then it canceled coverage for more than a hundred thousand patients.

In September, the Times Free Press first brought word that Tennessee’s biggest health insurer — BlueCross BlueShield of Tennessee — would drop coverage for patients through the individual marketplace in Memphis, Nashville and Knoxville. That forced 112,000 Blue Cross Blue Shield patients to find a new health insurance plan during the open enrollment period.

“People are having to scramble to make sure their doctors and hospitals and drugs they require are covered by the plan they have to move to,” Walter Davis, executive director of the Tennessee Health Care Campaign, told the Times Free Press. “The more difficult any health decision is for people, the less likely they are to make it. There is a tendency to lose people with coverage if we make the process too hard for them,” he said.

Health officials estimate that approximately 172,000 patients in the Volunteer State have lost their current health insurance plan and will be forced to find a new insurer.

After paying these sky-high premiums, patients are discovering even more out-of-pocket costs when they actually go to the doctor. According to a report from the Health Care Cost Institute, patients in Tennessee that get their insurance through work “spent an average of $928 in out-of-pocket costs in 2015 — $115 more than the national average.”

Patients Rising’s Perspective: Tennesseans want more transparency from health insurers

Patients in Tennessee who are “facing steep Obamacare premium hikes” want greater accountability and transparency from health insurance companies.

“Insurers are operating under the belief that it is acceptable to allow a patient to fail first or become sicker on a lower cost medication before agreeing to provide drugs their doctors had originally prescribed,” writes our co-founder and policy director Jonathan Wilcox.

“Though it seems unbelievable, it is nonetheless true – a doctor can prescribe a treatment he or she deems necessary or even vital, a patient can agree and a pharmacy benefit manager can overrule them both.”

“Even more challenging, patients often accept their insurer’s judgment and don’t pursue administrative appeals. Don’t be surprised: people fighting for their lives don’t often look to open up another front in another war.”

“The rejection of medically necessary drugs combined with higher health care costs is a truly deadly mix for patients. Denying vital medications could result in serious consequences; who is responsible when this occurs? Doctors are required to take an oath to do no harm; should insurers be asked to do the same?”

Survey Says… Expand Health Care Access in Tennessee

According to a recently released national and statewide survey from the Partnership to Fight Chronic Disease, patients in Tennessee are struggling with barriers to health care.

Almost one-third say coverage for them is not only getting more expensive, it’s actually getting worse. Add to the fact, nationally, 77 percent of Americans polled offered that they or someone they know had difficulty using their health insurance just in the past year.

  • 19 percent of Tennesseans say the treatment their doctor recommended wasn’t covered by insurance while 21 percent say the treatment of someone they know had the same problem
  • 44 percent of Tennessee residents have seen their health care costs increase.
  • 88 percent of Tennesseans declared as very or somewhat important the need for transparency regarding how and why health plans are deciding to deny coverage of doctor-prescribed treatments.

According to the PFCD poll, Tennesseans say that the top health care priorities for politicians and government officials should be managing premium increases, lowering co-pays and deductibles and holding insurance companies accountable.

Patient Resources in Tennessee

The Commercial Appeal offers the following tips for patients in Tennessee looking to get help with their health insurance questions:

  • Open enrollment for shopping for or changing coverage on the federal Health Insurance Marketplace begins Tuesday and ends on Jan. 31.
  • The online marketplace is at HealthCare.gov or call 800-318-2596.
  • The Get Covered Tenn Coalition is offering free, in-person assistance in Tennessee. Call 844-644-5443 or go online to getcoveredtenn.org to make an appointment. A free event for enrolling will be held in Memphis Nov. 5, 10 a.m. to 3 p.m., at the Church Health Wellness Center, 1115 Union.

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