As the university switches to a new insurance provider, faculty and staff have found themselves uncertain of whether they can take their health concerns to Hendrick Hospital without paying out of pocket or being reimbursed.
ACU began the process last semester of switching from Cigna Health Insurance to Group & Pension Administrators, an insurance company that would allow the university to be self insured versus being fully insured by Cigna.
At the end of each year, ACU, as the employer, must choose to renew or make changes to its insurance plan with its provider (Cigna) or shop around for a new provider.
Wendy Jones, chief human resources officer, has been a key source in facilitating the ongoing negotiations between GPA and healthcare facilities in Abilene, specifically Hendrick Hospital.
“As you go through a plan year, you may have a lot of expensive services,” Jones said. “Then your cost for the next year can also dramatically increase. Every year, in essence, you get a new bid.”
After Cigna examined ACU’s insurance history – took into account how many doctors visits, procedures, etc. employees had throughout the year – it determined that to renew the same insurance plan, ACU would have to pay $1 million more than the previous year, Jones said.
In response to the offer, ACU decided to shop around for a new, cheaper bid.
With changes in how healthcare is provided in the United States, Jones said it has created a sort of perfect storm in the world of healthcare and insurance.
“One of the things that’s happening is it’s getting really, really expensive for more employers to provide it,” Jones said.
Group & Pension Administrators, established in Dallas about eight years ago, is one of many companies trying to change the health insurance process by negotiating with health facilities to get the lowest price possible.
Last March in the Dallas Morning News, Den Bishop, president of the consulting firm Holmes Murphy, began encouraging cities to unite to confront these prices. Instead of relying on insurance companies to bargain with hospitals, he said, they should do it themselves and insist that the hospitals use a single index as their starting point.
Now, some insurance companies that fully insure companies act as a third party in negotiating a percentage of medical expenses they will pay, without revealing what that price index is, allowing hospitals to raise prices without warning.
“What we’re doing this year is we’re saying ‘We don’t want to live with a price book that we can’t see; we want some transparency,'” Jones said. “We want to work from what the true cost is.”
At the end of the fall semester, the majority of faculty and staff agreed to go through with the switch, even though there was potential of uncertainty and inconvenience, to reap the savings in the end. By switching from fully funded to self funded, patients can save thousands on medical bills.
In the meantime, if a faculty or staff member or their families need inpatient or outpatient care, they must go through a process in which ACU strikes a deal with Hendrick Hospital on a case-by-case basis. First, the patient calls or emails GPA’s Nurse Navigator – a patient advocacy program – and then the patient gives basic information, like what treatment they need, when they would like to come in, etc. After that, a single-patient contract is drawn up to determine the patient’s financial responsibility.
“It’s inconvenient because it’s one more thing to deal with when trying to take care of your health,” Jones said. “Nobody’s shut out, it’s just extra steps.”
Dr. Kyle Tippens, assistant professor of finance, experienced this process when his mother set up a doctor’s appointment and said it felt like they were going in circles.
“It sounded like a lot of back and forth between the nurse navigator and the hospital and the patient,” he said. “It took a few days to get my mother an appointment.”
Part of the inconvenience, Tippens said, comes from just showing nurses his insurance card, as it looks like ACU is the insurance provider because the GPA logo is hard locate.
“I wonder if GPA has worked in a community like Abilene,” he said. “Hendrick is a big place to go, and now we may have to pay out of pocket and may not get reimbursed. We’re kind of in a limbo, and we’re not really sure if we have insurance at Hendrick.”
GPA is new to the Abilene area, and Jones said the novelty of the company in the area is part of what’s slowing the process.
“It’s bumpy, a little bit, because it’s brand new in the Abilene market,” she said. “There are facilities throughout the country that are doing this, but it’s only about 8 years old; it’s pretty new and it’s pretty innovative, and no one in our community is doing it yet.”
Despite uncertainty and difficulty caused by the switch, Jones and Tippens say they are hopeful for the outcome.
“Our people are inconvenienced, but it’s inconvenient for them too,” Jones said. “They want resolution as well. I think both sides want to work together; it’s just going to take a little time to get there.”
The next meeting between ACU and Hendrick Hospital is scheduled for next week.