Bright Health’s recent exit from the Summit County health insurance market has created yet another gap in services to both patients and insurance groups.
However, because the Vail-Summit Orthopedics & Neurosurgery facility in Frisco, Colorado has some of the world’s best orthopedic surgeons and operates outside of the Dillion Surgery Center, local patients cannot access these services. , traveling to Metro Denver or beyond for other alternatives. And with open registration now in place in the state, patients looking to maintain or secure access over the next year are encouraged to do adequate research to find plans to remain in VSON’s community of care.
Cari Thomason, director of finance at VSON, said the company is working hard to provide choice and education to patients who want local access to things like surgery and sports medicine. But Thomason says patients should take a similarly proactive approach to ensuring existing coverage rather than facing unexpected billing issues in the future.
Understand your local insurance market and get the best possible coverage. – Amanda Leiler
“Unfortunately, there aren’t many local options, and there are only three insurers that offer our services to patients in their network in individual markets: Rocky Mountain Health Plans, part of the United Healthcare system; Anthem Blue’s plan, across the Blue Shield and Cigna,” says Thomason. “Bright Health withdrew so quickly that many patients were left behind.”
Thomason said the big problem for patients is those who split their time between Denver and Summit County and believe or want Front Range-based insurance to automatically apply to VSON visits. says there is.
“Everything is very different depending on where you live and where you live primarily,” she says. “If you live in Denver, that plan may not be acceptable here in Summit County. If there is, we encounter it a lot.”
Thomason encourages patients to do research to make sure their narrow network has VSON service coverage.
“When planning your insurance choices, you should focus on what you actually think will be available and your expected spending to find the best plan for the care you plan to use,” says Thomason. “This is especially important if you have adult children who are no longer covered by insurance as they approach 26.”
Easiest access to local
Orthopedic service.
Amanda Leyrer, MS, ATC, OTC, SA, VSON’s Director of Clinical Operations, said VSON is doing its best to make local patients’ access to local orthopedic services as easy as possible.
“Our goal as an orthopedic clinic is to provide care to the community. We do everything we can to help our patients understand the local insurance market and receive the best possible coverage. ,” she says.
Leyrer agrees that patients remain in a difficult position because many of these insurance decisions are ultimately up to them and relatively little guidance is available.
“It’s especially difficult when insurers aren’t transparent with patients. A lot of that comes down to knowing what questions to ask and always doing your own due diligence,” she said. says. “Having coverage that allows people to get emergency care is important, especially for active people. Take the time to understand your benefits.”
Patients who may have employer-sponsored insurance should also take extra care, Leyrer said, and be prepared to ask these questions to HR staff during the open enrollment season. .
“There are so many variations of insurance and they are all trying to get a piece of the business, so you need to know what you are signing up for before making that choice,” said Leyrer. adds.
Leyrer said some patients could benefit from discounts offered by paying cash for services, but that would require some foresight and would be appropriate only in some cases. said there is a possibility.
“We offer a case-by-case out-of-pocket cash discount, and there are benefits to that, but it depends on the procedure. It’s certainly another way to provide some peace of mind.”
