One of the Obamacare insurers erroneously said Children’s Mercy was in its network

During the first four weeks of the Affordable Care Act open enrollment period the website for Ambetter, a new insurer offering plans in the Kansas City area, said that some Children’s Mercy Hospital practitioners were in its network.

They were not.

Bob Finuf, Children’s Mercy’s vice president of payor relations, said the insurer has since corrected the error, but declined the hospital’s request that it notify people who enrolled in Ambetter plans about it.

“We’re not suggesting they did it on purpose, but, I mean, it was incorrect,” Finuf said. “They acknowledge it was incorrect, but they have not yet agreed to communicate that.”

The Affordable Care Act is commonly called Obamacare.

Ambetter is a subsidiary of Centene, an insurance company based in the St. Louis area that jumped into the Kansas City area Obamacare market for the first time this year after Blue Cross and Blue Shield of Kansas City pulled out.

Ambetter spokeswoman Miranda Steele said that once the company realized that some Children’s Mercy practitioners were listed in the company’s online directory, “we moved quickly to resolve the matter while staying in communication with the hospital’s administration.”

Finuf said it was the hospital that brought the error to the company’s attention in the first place and Children’s Mercy believes it has no choice but to take the issue public before the open enrollment period ends on Dec. 15.

“We don’t know the extent to which people made their decisions based on that information,” Finuf said. “We have no way of knowing. That’s why believe the only appropriate remedy is to either reach agreement for our inclusion (in the network), or, as an alternative, to notify (consumers that it’s not in network). And we don’t believe it’s appropriate to wait until open enrollment is over, because what are those people going to do then?”

The two other Obamacare insurers in the Kansas City area, Medica and Cigna, do have Children’s Mercy in their networks and consumers who chose Ambetter thinking the hospital was included can still switch before next Friday.

Finuf said Children’s Mercy is still negotiating with Ambetter about joining its network but the two sides are far apart on what reimbursement rates the insurer should give the hospital.

“It’s kind of like if you wanted to hire an expert employee and you extend an offer at $5-an-hour,” Finuf said. “Well technically it is true, we offered them a job, but to the extent that the compensation or the funding is obviously inappropriately low, it’s not really an offer at all. That’s the dilemma we’re in.”

Finuf said Children’s Mercy has given the other Obamacare insurers some discounts over what it receives from employer-based commercial insurers. But what Ambetter is offering is more comparable to Medicaid reimbursement rates, which don’t even cover the cost of providing care.

Steele said Ambetter selects providers based in part on their ability to provide “high-quality care at a competitive rate” so it can keep premiums reasonable.

“We selected hospital partners in Kansas City accordingly and are glad to help consumers find an Ambetter provider that meets their needs,” Steele said.

Medica is selling Obamacare plans throughout Kansas and Cigna is selling Obamacare plans in five counties on the Missouri side of the Kansas City metro: Jackson, Platte, Clay, Ray and Cass.

But Ambetter is the only choice for Obamacare consumers in a 25-county area of northwest Missouri surrounding those counties and some of those consumers said this week that Ambetter can not offer any in-network hospital comparable to Children’s Mercy.

Cameron resident Lindsay Tate said her five-year-old daughter has Down Syndrome and regularly visits a host of Children’s Mercy clinics for her medical needs.

“It’s very concerning because the fact is I don’t know we would take her anywhere else and if our insurance doesn’t cover it that would be financially devastating,” Tate said.

Tate said she buys insurance for her and her kids through Obamacare because her husband’s employer only covers him.

Chrissy Lowenstein, also from Cameron, said she’s in the same position with her three children. Her husband works for a small family business that doesn’t cover them and she left her job as a nurse to take care of the kids.

In past years they were able to purchase a Blue KC plan that included Children’s Mercy. Now they have no option that covers the hospital.

“It just seems crazy that the only insurance plan in my county doesn’t have a contract with the only children’s hospital between Denver and St. Louis,” Lowenstein said.

This story was originally published December 7, 2017 at 2:27 PM with the headline "One of the Obamacare insurers erroneously said Children’s Mercy was in its network."