We've heard from several viewers who are on the Senior Care Plus insurance, who are now having to look for a new primary care doctor.
This comes after last year; Kaiser Permanente and Renown Health announced a joint venture.
Kaiser now owns the majority of Hometown Health which administers. Hometown Health.
In July, several patients under Senior Care Plus were sent a letter. The letter which let patients know their existing primary care doctor was no longer in network.
Leaving them with only a few choices, either switch to a primary care doctor that is in network, wait until open enrollment in November to find a plan that has your primary care doctor, or find a way to apply for an exemption.
"I think the most offensive thing was that they sent us a flier of, here's our fabulous doctors you can switch to," said Connie Weber, wife to Ron Weber, who uses Senior Care Plus.
Ron Weber has seen the same primary care doctor for about 20 years.
"He knows my medical history, which has been kind of extensive in the last few years,” he said. “So, I have chronic kidney disease, and I want to stay with the same providers that I've had."
"We trust him,” Connie Weber said. “The office knows our voices when we call."
While trying to navigate the uncertainty, the Weber’s reached out to their insurance broker to figure out what next steps are.
"There's that jolt like what's happening,” said Mark Toomey, Medicare Specialist, LP Insurance services. “And, you know, my schedule's full now for the next few weeks of people that are coming in saying, well, what can I do right now?"
Toomey was able to find a way to grant Ron Weber a Special Enrollment Period to switch insurances before open enrollment starts November 1.
“It's been invaluable to me,” Ron Weber said. “You know, he knows what's going on. He knows who to contact. Yeah. I would be lost without him.”
However, not everyone will be able to get an exception, leaving many frustrated.
"Surprised and a bit of anger,” said Doyle Brown, a Senior Care Plus user for about 10 years after we asked how he felt about the situation. “How can you do this midstream? We're in between contract years. There is no open enrollment currently. So, I'm sort of stuck."
When patients have asked questions, they haven’t left with many answers.
“Only that it's corporate decision," Ron Weber said.
"It was pretty upsetting to think, you know, why did they have to do this midyear,” Connie Weber said. “Why couldn't they have waited till open enrollment?”
"I think the question I want is, what about my choice,” Brown said. “What about my ability to choose my own doctor without having, the force upon it?"
Some local doctors are confused as well.
"They did not alert us beforehand,” said Doctor Ryan Gini, Sugar Pine Family Medicine. “We actually found this out from a patient of ours who got a letter saying that we were no longer going to be their provider come September 1."
Dr. Gini has worked with Senior Care Plus for about 25 years. The Sugar Pine clinic is expected to lose about 200 patients with this switch.
"There was no reasoning whatsoever,” he said. “It was just a simple letter that you will be involuntarily removed from the panel in a month's time."
Senior Care Plus is Nevada’s Medicare Advantage Plan. It’s administered under Hometown Health, the insurance division that was owned by Renown, but now the majority owner is Kaiser Permanente.
Dr. Gini says that Kaiser and Renown decided to cut ties with independently contracted doctors for the Senior Plus Care members but still keeps patients under EPO and PPO plans. Those independently contracted doctors negotiate their own contracts with the insurance companies.
After the ‘joint venture’ announcement, a website was launched with ‘frequently asked questions.
One section labeled, “HOW WILL CARE FOR RENOWN HEALTH PATIENTS CHANGE?” is quoted saying, “Care teams will remain the same, and patients will continue to use their same insurance at the same facilities.”
2 News Nevada sat down the CEO of Hometown Health, and Health Plan Leader for Kaiser Permanente Nevada, Bethany Sexton to ask her some of the questions we heard the most.
The first was about the timing and not waiting until open enrollment so patients could have the choice to find another insurance to stay with their current doctor.
“The timing is really important for us,” Sexton said. “We just went live with our clinic at Ion Drive, so that ready access was really important for us to make sure that we had the ability to get people in in a timely fashion. Our Del Monte Lane, clinic also has additional providers that have joined."
We also asked if the outcry from members was enough to make a change.
"We're moving forward because we believe in the model and we want to be able to get members into, either a Renown provider or into one of our KP clinics, so that they can be a part of this integrated care and coverage model," Sexton said.
All impacted members should have already received a letter.
So, patients will have to decide what is the right avenue for them with their doctor.
