What Does the Closure of WINhealth Mean for Providers?

Editor’s Note:  The Wyoming Medical Society spoke with Denise Burke of the Wyoming Department of Insurance on Oct. 21 and 22 and files the following report. However, the Wyoming Medical Society’s legal counsel is still digesting the template provider agreement and petition to the court which put WINhealth into receivership and may offer a future comment or advice. For now, it is recommended by WMS legal counsel that providers with WINhealth contracts review their contract.

Department of Insurance Tells Providers to Expect Payment

By Tom Lacock, Communications Director, WMS

CHEYENNE – Despite news of WINhealth’s transition to receivership, Denise Burke of the Wyoming Department of Insurance says providers need to know that they will get paid on claims they have made to WINhealth.

According to a news release the Department of Insurance filed a petition in Laramie County District Court put WINhealth into receivership yesterday, which has put the Wyoming Insurance Commissioner immediately in charge of the company, overseeing conservation of assets, distribution of funds and further administration of operations.

Wyoming Department of Insurance Policy Analyst Denise Burke told the WMS that as of yesterday afternoon, the Wyoming Department of Insurance is officially in charge of operations for WIN. She added there are a number of WINhealth employees who will continue to work at WINhealth fulfilling claims and other operations central to the business. That should ensure payment for providers who have submitted claims to WINhealth.

The Doors at WINhealth are Not Closing Any Time Soon
Burke told the WMS Thursday that the notice of receivership news does not mean WINhealth is dropping off and business operations are ceasing immediately.

“Claims will continue to be paid through Dec. 31,” Burke said. “Then a winding down of the WIN program will take place. That could take 12-18 months or longer. Claims will continue to be paid, as long as they have been filed in a timely manner.”

Burke said at the end of the year a comprehensive look at WINhealth finances will take place. If the claims still out-pace the amount of cash WINhealth has available, the company could go into liquidation and payments to physicians could be issued through the Wyoming Life and Health Guaranty Insurance Association or another company who has picked up policies formerly written by WINhealth. Burke said the WLHGIA is non-profit organization which all insurance companies pay into creating a re-insurance program (similar to mortgage insurance on a house purchase). While there is a limit of $300,000 per life insured, Burke was quick to add payment by WLHGIA doesn’t come into play until a company goes into full liquidation.

“That is not where we are at this point,” Burke said. “We are in rehabilitation. Wyoming Insurance Commissioner Tom Glause is now in charge of the operations at WINhealth and there will be an orderly transitioning of current assets and spending down of current assets. It is only then that it would go there (unpaid claims would go to WLHGIA for payment) if it goes there. That is not going to happen for a considerable period of time.”

Any slowing of payments to providers?
Burke points out that the Wyoming Insurance Department is in charge at WINhealth and there is a chance that could slow down payments just due to the change in management. However, she added every effort will be made for claims payment to be made as quickly as possible.

“The employees of WINhealth are continuing with the company for now and they are the operational people,” Burke said. “It would be foolish for Department of Insurance to run the individual claims. We need to keep the people who know how that operates and they will continue to process and pay claims.”

Should Wyoming Providers Continue to See WINhealth Patients?
Burke stressed that payments will be paid and existing contracts will be honored. She encouraged physicians to continue to see patients who have WINhealth insurance plans as well.

“They too have a contract, same as the docs have a contract and those consumers have paid their premium and are expecting services. We should treat them as if they have an insurance plan in place because they do,” Burke said. “We have been telling the consumers that they can still see their physicians. That is the point of having the receivership is to protect the consumers and to protect the providers.”

When asked if the move to receivership constituted a breach of contract with providers, Burke disagreed.

“I disagree with that,” she said. “They will have sufficient capital to meet the obligations of the contracts…. When it comes to the threshold where statutorily we have to step in, it really is is to protect the consumers and providers so those contracts carry out.”

What is next for those with WINhealth products?
Those who purchased WINhealth products on the individual marketplace will need to enroll in new plans during the next open enrollment period. That is no change from what consumers on the individual market would have had to do had WINhealth maintained its place in the individual market as contracts with WINhealth were set to end on Dec. 31. The only change is consumers may not re-enroll with WINhealth.

Small groups will be handled on an individual basis as many small group plans have different anniversary dates. Burke said the Department of Insurance has already starting working with other insurers to roll those small group plans written by WINhealth into plans with Blue Cross Blue Shield. She said the start date of the new plans are determined by the anniversary dates of their existing plans with WINhealth.

“Those WINhealth small group plans who have an anniversary date of something like July 1, will extend longer into the future with their coverage. We will meet with those groups and transition them to a new plan. There will be an orderly transition from the existing plan to a new plan. We hope there will not be any interruption in service.”

The Next Steps
Burke said it is difficult to give specific deadlines for the future of WINhealth as much of it will be determined by the pace at which WINhealth receives claims and can spend down its existing assets.

“It is not that the door is shut and everything is done,” Burke said. “We can’t give an estimate for when that spend down will happen if it happens. We could get to the end of this rehabilitation period, there could be a buyer that steps in and things start again. That is how the design of rehabilitation/receivership works, to provide a smooth transition. Prior to this process if a business wanted to close down they just did and the consumers, and the providers are just out of luck. “That is not where things are with this process.”

Burke said for individuals the navigators, information and referral specialists trained to answer questions regarding the Affordable Care Act and the health insurance marketplace, will be flooding the airwaves with messages for how individuals can obtain health insurance.

Burke also committed the Department of Insurance to take part on a conference call for providers early next week at a time to be determined. She encouraged providers who still had questions to call her office at 307-777-2450 or email at denise.burke@wyo.gov.

“We will be sending out more information as the process goes forward,” Burke said. “There will be more releases, more contact. Commissioner Tom Glause will communicate to the provider network. We have not had an insolvency in 23 years and never with an insurance company in Wyoming. We really all want to resolve this together.”