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Insurance plan mix-up left 20,000 Colorado Anthem customers out-of-network with UCHealth

Thousands of Anthem BlueCross BlueShield customers who bought an insurance plan that said it included UCHealth got a surprise earlier this summer when they learned the health system actually wasn’t in-network.

Anthem sells two general types of plans on the individual marketplace: those labeled Pathway, which include UCHealth hospitals and doctors, and Pathway Essentials, which don’t. The plan description on the Connect for Health Colorado website mistakenly listed UCHealth as in-network for both types of plans.

Vince Plymell, spokesman for the Colorado Division of Insurance, said the division discovered the mistake earlier this year and required Anthem to reprocess some claims it billed as out-of-network, resulting in about $67,000 in refunds to customers. Anthem could face a fine of up to $500,000, though the division is holding off on the penalty while it assesses if the company is allowing patients to go to UCHealth at in-network rates, he said.

Mistakes like that are rare, and this one triggered an open enrollment period from May to July for people who want to switch plans, said Nina Schwartz, senior director of policy and external affairs at Connect for Health Colorado.

When patients go to an in-network provider, they pay an agreed-upon share of their care costs. If they go to an out-of-network provider, they can get stuck with a bill for the difference between the amount their insurer paid and their provider charged. Federal and state law prohibits such “surprise bills” in the case of emergencies, but not for scheduled care.

Dan Weaver, spokesman for UCHealth, said the system knew it wasn’t in-network with the Essentials plans, so the incorrect information had no effect on its operations. The system screens patients so they know if they’re going out-of-network for care, he said.

Anthem estimated about 20,000 people, out of roughly 1.5 million customers in Colorado, had purchased plans involved in the mix-up. It didn’t have information about how many had switched because of it. The company attributed the mistake to a computer error.

“The health of our members is our top priority and we worked quickly with Connect for Health Colorado and the Division of Insurance to correct this mistake,” spokeswoman Emily Snooks said in a statement.

Chris Citron, of Denver, said the news was confusing for her family. She manages an adult relative’s health insurance, and said she had chosen the plan specifically so her relative could stay with familiar doctors, who work at UCHealth.

“I was incredulous,” she said. “I thought that was bait-and-switch.”

The letter customers received said they could continue to see UCHealth doctors at in-network rates for the rest of the year if another provider had referred them to the health system. But Citron said it hasn’t worked out easily for her family so far. She called Anthem multiple times to verify that her relative’s appointment would be covered at in-network rates, but still got an out-of-network bill that she’s trying to sort out.

Ideally, she’d like to sign up with a new plan to keep UCHealth in-network for her relative next year, but isn’t sure if she’ll be able to find one. Most plans sold on the individual marketplace for Denver don’t include that health system.

“I’m really worried, because there are hardly any alternatives,” she said.

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