Letters to the Editor

Changes in health coverage; beware | Letters

Changes in healthcare have been tough on all of us.

Recently there have been some issues which have a major impact on many of the residents of the county. I thought it worth going over a few of these so people are not caught unaware.

Patients signing up through the healthcare exchange are being told to get a physical. This has been touted nationally and statewide as part of your preventive benefits. When people have signed up on the exchanges they have often been told it is a “free benefit” and they should use it right away to be sure their insurance is active before getting any of the other services that might cost them out of pocket.

Unfortunately, comprehensive preventive exams--what we might call our annual physical--is a non-covered service for anybody aged 40-plus if your medical insurance is Medicaid (also known as DSHS or Apple Health), or the Medicaid health maintenance organizations Molina Healthcare, Community Health Plan of Washington, Amerigroup, or Coordinated Care Health.

We want to avoid patients being stuck with an unexpected expense for services that they think are covered.

Amerigroup has a limited specialist’s network. If you are covered by Amerigroup, be aware that referrals to specialists are difficult. If this is your insurance you will generally need to go to Seattle for imaging or specialist consultation. You should be prepared for waits and travel.

Coordinated Care Health has just notified us that beginning July 1, they will only pay for lab work done through Quest Diagnostics labs. This is not San Juan Healthcare’s lab, and I do not believe that lab work done at Peace Island will be covered. It will necessitate a trip to the mainland if you require blood work that cannot be done in the office when you are signed up with Coordinated Care Health.

We urge everyone signing up with these groups to look closely at where you may need to go to get care beyond that received in the office. Being told that you have coverage is no guarantee that it can be provided on the island or nearby.

We appreciate how difficult and expensive it is to travel off-island and will do everything we can to help facilitate care, but our hands are tied by these plans. Being aware and being proactive is in your best interest.

Dr. Burk Gossom, San Juan Healthcare

 

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