Las Vegas Sun

September 1, 2014

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Are insurers steering customers away from Obamacare exchange?

Updated Wednesday, Nov. 20, 2013 | 6:20 p.m.

Steven Horsford

Steven Horsford

Rep. Steven Horsford, D-Nev., is calling on the Nevada insurance commissioner to investigate whether in-state health insurance companies have been trying to steer customers away from the health care exchange with “misleading letters.”

He said he is basing his concern on two form letters from Anthem Blue Cross Blue Shield to their customers, in which clients are presented with limited options to continue their insurance: Act early to change or update your existing Anthem plan, or do nothing and lose your insurance.

The fact that customers have the option of selecting other plans on NevadaHealthLink.com is only mentioned in a footnote, not the body of the letter.

“The fine print is not clear ... these insurance companies are taking advantage of customers at a time when there’s already a lot of confusion with the roll-out of the Affordable Care Act,” Horsford said during an interview in his office Wednesday. “The job of the insurance commissioner is to make sure that notices and information like this isn’t misleading … do their job, and hold the insurance companies accountable.”

In his letter to Insurance Commissioner Scott Kipper, Horsford suggested Anthem might be legally culpable and subject to fines.

“Put simply, these letters are misleading and impair the ability of Nevadans to make informed decisions about their health insurance,” Horsford wrote.

Kipper sent Horsford a letter late Wednesday promising to investigate the allegations.

A spokesman for Horsford said Kipper also promised the congressman during a Wednesday night phone call that his investigation would consider all insurance companies operating in Nevada, not just Anthem.

If the Commission finds that Anthem was intentionally deceptive, it would not be the first recent instance in which a private insurance company was judged liable for misleading its customers as to the options available to them in the changing health insurance market.

Earlier this year, a Kentucky judge fined Humana almost $65,000 for similarly “misleading” letters, in which customers were sent letters that laid out limited options for purchasing plans with Humana in the body, and only mentioned the existence of additional health insurance options in footnotes.

But Anthem is pushing back against the allegations.

“Anthem is strongly committed to Nevada Health Link. We are one of only two insurers selling products on the exchange throughout the entire state of Nevada,” Anthem spokeswoman Joyzelle Davis wrote to the Sun. “It is our goal to communicate with members about all of their options so they can make an informed decision.”

The two Anthem form letters in question, which Horsford’s office shared with the Sun on Tuesday, went out to insurance policy holders whose plans will be canceled under the new Affordable Care Act rules, and those whose insurance plans will be “grandfathered” in.

“Here are your three options to consider,” the Anthem open enrollment form letter to customers receiving the cancellation notices reads. “1. Renew early to keep your current plan design … 2. Do nothing until (renew mm/dd)/14 … 3. Shop during Open Enrollment and choose a different Anthem plan for 2014.”

The first mention of Nevada Health Link — or an exchange at all — does not appear until footnotes A and B.

The form letter to individuals whose plans are being grandfathered into the ACA is worded slightly more loosely.

“You always have choices. Here are two options to consider,” that letter reads. “1. Stay on your current ‘grandfathered’ plan … 2. Choose a different Anthem plan.”

Again, the existence of the state health insurance exchange is not presented until footnotes A and B.

Horsford estimated that about 20,000 received those letters. He added that he has fielded several calls from constituents confused about “questionable practices” by insurance companies in Nevada during the past several weeks.

But on Wednesday, Anthem representatives met with Horsford to stress that those two letters did not represent the entirety of Anthem’s communications with its customers — and that in other letters, the company had drawn extra attention to Nevada Health Link as an additional option for people seeking new insurance plans.

In a third letter, dated Oct. 22, Anthem writes that “When key parts of the health care law take effect, you’ll be able to buy coverage for you and your family through Nevada’s health insurance marketplace, Nevada Health Link,” in the third paragraph, under a bold subheading declaring “There may be other coverage options for you to consider.”

The letter goes on to detail that customers may also be able to access insurance subsidies through the exchanges, compare premiums and deductibles, and potentially join group plans.

Those letters went, or are going out, to all of the recipients of the first letter warning customers that their coverage would soon be canceled because their plans do not comply with the ACA. The letter is also being mailed to some customers whose plans will be discontinued in the coming months for other reasons.

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