Utah Health Care: Patients pay higher premiums, then fight insurance barriers to access

Utah Insurance Premiums Set to Rise as Much as 30 Percent

Patients in Utah can expect to pay more for their health insurance in 2017.

Fox 13 Salt Lake City reported this summer that all three health insurance companies requested insurance premium increases for 2017 — with two companies demanding 30 percent more from patients. That comes on the heals of a 22 percent increase in 2016.

“SelectHealth, Molina, and the University of Utah have all turned in paperwork with the Utah Department of Insurance to raise rates for the coming year,” reported Max Roth with Fox 13 Salt Lake City. “SelectHealth and Molina each intend increases of about 30 percent, while the U has requested a 4.5 percent hike”

In addition to paying higher health insurance premiums, patients will have fewer choices. In August, Humana announced that it was dropping patients from its health insurance plans and pulling out of the individual insurance marketplace in Utah.

The Deseret News notes, “20 out of 29 counties in Utah continue to have just one insurer to choose from on the federal marketplace for individual plans: SelectHealth.”

Utah patients must fight to gain access to right treatment

Utahns are paying higher insurance premiums, but when a medical necessity arises, their insurers are increasingly saying no.

Jonathan Wilcox, our co-founder and policy director, recently examined the unique challenges facing patients in Utah.

“If a patient is in the position to fight, argue and remain adamant in the face of insurer denials, they may eventually obtain access to what their doctors recommend,” Wilcox writes in a piece published at the Deseret News. “Advocates and patients must stand up for their rights and lawmakers and regulators must listen and develop realistic solutions.”

“Providers should not capitulate to insurer pressure by prescribing cheaper medications, and should instead facilitate the therapies they believe are best for their patients and offer reforms to make this system work.”

“Insurers cannot operate under the belief that a patient must fail first on lower-cost medications before agreeing to provide therapies doctors prescribe. Like everyone else, insurers should be held accountable for these decisions and must act with transparency.”

Health Care: Top Concern of Utah Residents

Health care is the top concern of Utah residents. Nearly 70 percent of Utah voters identified health care as their biggest concern, according to a recent report by KSL.com’s Wendy Leonard. Just a year ago, health care ranked fourth among public policy concerns.

“Health care has always been a top concern,”  Christopher Collard, a research analyst with the Utah Foundation, told KSL.com.

That’s reinforced by a recent nationwide study by the Partnership to Fight Chronic Disease, which found Utahns want politicians and government officials to manage health insurance premium increases, lower co-pays and deductibles and hold insurance companies accountable. Other findings from the Partnership to Fight Chronic Disease’s survey of Utah patients:

  • 33 percent of Utahns say their health insurance coverage is getting worse
  • 46 percent of Utah patients have seen their costs increase.
  • 21 percent of Utahns said the treatment their doctor recommended was not covered by insurance and 23 percent said the treatment of someone they know was not covered.
  • 89 percent of Utahns say it’s somewhat or very important for health plans to disclose how often and why they decide to deny coverage of doctor-prescribed treatments

Open Enrollment Tips for Patients in Utah

With the help of CBS 2 KUTV, the Utah Insurance Department is sharing tips for patients selecting a health insurance plan during the open enrollment period.

Here are 5 of the most common questions being asked by Utahns:

When is the open enrollment period?

Shopping for health insurance begins November 1, 2016 and ends January 31, 2017.

When will my insurance plan go into effect?

For coverage starting January 1, 2017, the deadline is December 15, 2016. For coverage starting February 1, 2017, the deadline is January 15, 2017. For coverage starting March 1, 2017, the deadline is January 31, 2017. Bottom line: Make sure to enroll by December 15 if you need health insurance for all of 2017.

What kind of coverage is best for my family and me?

Every plan is different. Look at the plans themselves, the monthly premiums, the provider and non-provider networks and the deductible.

What if I choose the wrong plan?

Life events, like changing jobs or getting married, will let you switch to a new plan mid-year. It is possible to cancel a plan, but it is difficult and it may result in a tax penalty. It may be better to wait until the next open enrollment in 2017 to avoid additional costs and challenges.

How can I get more info?

To learn more about individual insurance companies or individual agents and how the Utah Insurance Department can help you, visit utahinsurancedepartment.com.

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