Members expected to lose access to more than 700 Providence doctors; health insurer’s expected ‘risk corridor’ is worth more than its total capital.
BY JACOB PALMER | DIGITAL NEWS EDITOR
Moda members are expected to lose access to more than 700 Providence doctors as the health insurer’s negotiations with the network break down.
Moda insures about 45% of the Oregon market.
A primary selling point for Moda has been the broad choice of doctors on its Connexus network of contracted providers. The network will be renamed Beacon for those who buy their own coverage next year. And in Portland, the new network won’t include Providence providers, including four local hospitals. That means using one would incur increased out-of-network charges.
“it’s really terrible,” Carolyn Wood, a self-employed writer who lives in Northeast Portland and uses Providence doctors. She’s been a member of Moda for two years and says she still hasn’t received formal notice that she needs to either change doctors or plans.
Wood learned of the change through what she considers a fluke, during a conversation with a friendly sales rep. at the company. Before that, as recently as last month, Moda representatives told her “they wouldn’t know who would be in Beacon until the last minute,” she said.
(SOURCE: OregonLive.com)
Negotiations halted on Oct. 30.
Additionally, the health insurer’s expected ‘risk corridor’ is worth more than its total capital.
Moda, Oregon second-largest health insurer, had expected almost $152 million from the program for last year and this, which equates to 181 percent of its total capital, according to S&P. Moda reported $84 million in total capital and surplus through the second quarter.
“The higher the risk corridor is as a percent of the total capital, the more impact the non-payment of the asset will have on the insurer,” the report said.
(SOURCE: Portland Business Journal)
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