An Update On WINHealth

By Tom Lacock
Wyoming Medical Society

Wyoming physicians who have seen claims reimbursement from WINhealth slow or stop could soon see that change, according to Wyoming State Insurance Commissioner Tom Glause.

Glause said he hopes a court hearing on Oct. 19 before District Court Judge Thomas Campbell will result in the payment of nearly $2 million in claims to physicians. However, he adds, there is a process which will need to take place first.

“What has happened is we have exhausted the Guaranty Association’s assessment capacity for 2015 and 2016,” says Glause. “We used those assessments to pay out about $22.5 million in claims.”

The Guaranty Association – money paid into a fund by companies who write health insurance policies in Wyoming to guarantee payment of claims by its members – cannot levy itself another assessment to be used to pay WINHealth claims this year. However, Glause says the Insurance Department has filed a motion for early access to government receivables which were due to WINHealth. Once the court gives the Guaranty Association access to these funds, that money will be used to pay provider claims submitted to WINhealth.

“We have about $2 million in claims cued up to pay,” Glause said. “We hope to have that paid out by the end of Oct.”

Glause said Wyoming physicians have one year from the date of service provided to submit a claim to WINhealth. He adds that a misconception he has heard from providers is that if they aren’t paid by the end of the year they won’t be paid. He says that is not true. He adds WINHealth still has about 11 employees processing claims, which he says has slowed to a trickle.

“While the numbers of claims have gone down, the claims that are coming in now are generally for a larger amount of money,” Glause says.