Wyoming Insurance Commissioner Tom Glause speaks to a crowd during the Natrona County
Medical Society Meeting in Casper in November.
Glause says Claims Continuing to Be Paid by WINhealth
By Tom Lacock
Wyoming Medical Society
CHEYENNE – Claims to WINhealth are continuing to get paid despite loss of employees and the anticipated move of WINhealth from receivership to liquidation, according to Wyoming Insurance Commissioner Tom Glause.
Due to financial difficulties, The State Insurance Commissioner was granted a court order to place WINHealth into receivership on Oct. 21 and has been effectively running WINhealth ever since with its receivership partner, Regulatory Services Group. Glause said since a frenzied first month, things at WINhealth have settled into more of a routine.
“It got down to business as usual after the first 30 days,” he said. “We are collecting premiums, subsidies and paying claims.”
Glause estimates WINhealth is down about 27 employees from where it was in Oct. Between the higher utilization of insurance which annually takes place in the fourth quarter, and a glut of claims that came later than usual as the switch to ICD-10 took effect in Oct., WINhealth is paying around 60 days after receiving claims at this point. With the exception of the Thanksgiving weekend, Glause said WINhealth is averaging between $1.1 and $1.9 million in payments to providers each week. There will be another claims run this week and though isn’t clear whether there will be another before the first of the year.
“The message we would have for providers is get your claims processed and get them to us as quickly as possible,” Glause said. “Between the fourth and 20th of January, we will pay out as much as possible. All the money paid will be from the assessment.”
WINhealth Makes Assessment on Guaranty Association For Funding
Changes are on the way for WINhealth as the Insurance Department will likely file a petition to take WINhealth from receivership to liquidation in early Jan. That will authorize the Wyoming Life and Health Guaranty to fund future claims through an assessment on its members.
By putting the company into liquidation in Jan. instead of 2015, the state won’t force those who are still covered by WINhealth through the individual market to find new insurance coverage. More importantly to providers, by activating the Guaranty, WINhealth will receive an infusion of cash to pay its bills.
This month members of the Wyoming Life and Health Guaranty Association have been assessed an average of 2 percent of their premiums paid by all of their members over the last three years. This means health insurance companies who write business in Wyoming pay the assessment, which results in around $10.9 million in cash to WINhealth to pay its bills. Re-insurance could result in another $4 million for WINhealth.
“The good news is we are going to get through the end of the year (financially) and that was our goal,” Glause said. “We have been in contact with Guaranty Association. They have activated a assessment and we should start getting money in on that 2015 assessment and be able to pay a large portion of claims after the first of the year.”
What Does This Mean for Providers?
According to Glause the Guaranty gets to decide who would process the claims on WINhealth’s behalf, but he anticipates the Guaranty will have WINhealth under the watch of the Insurance Commission process claims. If the Guaranty does chose to have WINhealth process claims, there will be no change in the way claims are submitted to WINhealth and only minimal administrative changes for claims payment.
“The Guaranty Association hasn’t formally committed that they will have WINhealth process those claims,” Glause said. “I can’t imagine they won’t have us do it. We are planning on doing it, but that hasn’t been formalized. It has been discussed and that is everyone’s plan right now.”
A bigger concern for Glause is the fact the Guaranty Association has a payment limit of $300,000 per patient. He said there are a few large claims that could end up above that $300,000 limit, though he is monitoring the situation.
“I am monitoring our large claim losses and there are some claims out there right now that are pushing the $300,000 limit,” Glause said. “I am watching them very close. I think everyone is going get paid, but there could be one or two of the large claims that could go over the $300,000.”