Sunday, July 21, 2024

Insurer’s departure leaves Greater Williamsburg families struggling

When Anthem Blue Cross and Blue Shield pulled out of the Commonwealth of Virginia's ‘Obamacare’ exchanges on Aug. 11, self-employed Emery said she wasn’t sure whether to pay nearly 70 percent more for coverage for her family or go without. (file photo)
When Anthem Blue Cross and Blue Shield pulled out of the Commonwealth of Virginia’s ‘Obamacare’ exchanges on Aug. 11, self-employed Emery said she wasn’t sure whether to pay nearly 70 percent more for coverage for her family or go without. (file photo)

Health insurance premiums are up, and insurance options are down for Greater Williamsburg.

As open enrollment for the healthcare exchanges under the Affordable Care Act closed on Dec. 15 around the country, Greater Williamsburg residents have been affected by one insurer’s departure from the exchanges.

As tens of thousands of Virginians looked for healthcare on the exchanges, only Optima health insurance plans were available to residents in Greater Williamsburg, according to the exchanges’ website.

Paying higher premiums or going without insurance

For 48-year-old small business owner Laura Emery, switching insurance from Anthem to Optima brought higher premiums.

The premiums were so high that her family now pays more for health insurance than their home mortgage, Emery said.

“In the old days you could compare healthcare companies and shop around,” Emery said. “We have one choice now. I feel like this is out of my control.”

About six years ago, Emery and her family had a health scare that forced them to live a healthier life, she said.

Doctors discovered her husband had very high cholesterol. He was “one cheeseburger away from a heart attack,” Emery said.

When Anthem Blue Cross and Blue Shield pulled out of the Commonwealth of Virginia’s ‘Obamacare’ exchanges on Aug. 11, self-employed Emery said she wasn’t sure whether to pay nearly 70 percent more for coverage for her family or go without.

“The healthcare system is broken, and this just makes it worse,” Emery said.

Laura Emery poses for a photo with her husband, daughter and mother-in-law. The family's insurance costs are going up by $600 each month after switching to Optima. (Courtesy photo/Laura Emery)
Laura Emery poses for a photo with her husband, daughter and mother-in-law. The family’s insurance costs are going up by $600 each month after switching to Optima. (Courtesy photo/Laura Emery)

Switchover side-effects

The exit of the insurance giant has forced local Virginians to switch doctors, hospitals, and insurance plans or risk going without care.

While prices have increased for some residents, others find themselves not only paying more, but switching doctors while they’re sick.

Lisa Diehl, a 32-year-old Williamsburg-James City County School Division bus driver, has felt the changes in a different circumstance than Emery.

Diehl has been taking care of her 56-year-old mother since she was diagnosed with breast cancer several years ago. Diehl’s mother, Carolyn Sturgell, switched from Anthem to Optima. Sturgell was forced to find new care providers at Sentara when the switchover happened.

“It’s hard to get her comfortable with other doctors,” Diehl said. “The night I helped her enroll in the new health insurance…she learned Riverside doesn’t accept her new insurance. She was in tears. She said ‘Well what am I supposed to do, just die?’”

Sturgell may never have found out she had cancer if it weren’t for finding an insurance plan when the ‘Obamacare’ exchanges were created, according to Diehl.

Diehl’s mother “didn’t have insurance before Obamacare…and couldn’t get it,” Diehl said. “When ‘Obamacare’ started… it was nice for my mom.”

While the Sturgell’s health insurance is a few dollars cheaper each month, her plan covers much less than Anthem’s similarly priced plan, Diehl said.

When the family checked to see if Sturgell’s life-saving medicine and insulin prescriptions were covered by the policy, a lot of them were not, according to Diehl.

 

While the Sturgell’s health insurance is a few dollars cheaper each month, her plan covers much less than Anthem’s similarly priced plan, Diehl said. (Courtesy Lisa Diehl)
While the Sturgell’s health insurance is a few dollars cheaper each month, her plan covers much less than Anthem’s similarly priced plan, Diehl said. (Courtesy Lisa Diehl)

Sturgell takes about 10 medications, and visits the doctor monthly, according to Diehl.

 

There was “no way” for the family to prepare for the loss of the prescription medicine coverage if there was no way to pay for the prescriptions in the first place, Diehl said.

Riverside loses patients, Sentara gains them

As patients like Sturgell are forced to switch from healthcare teams at Riverside Health System to Sentara, each provider is expecting big changes in the number of patients they’ll see.

Optima Health insurance is a division of Sentara Healthcare, according to Sentara Healthcare spokeswoman Kelsea Smith.

With Anthem’s exit from the ‘Obamacare’ exchanges, Optima is expecting to offer coverage to 12,000 more people in Hampton Roads.

For Sentara hospitals, that will translate into nearly “5,000 new patients to its providers and facilities,” Smith said.

While the changes may be a boon for Sentara, competing healthcare provider Riverside is expecting to see fewer patients as it does not accept Optima Health insurance plans.

“We are expecting to see a decrease in the number of patients using Riverside who are on the exchange,” said Riverside Health System spokesman Peter Glagola.

Diehl hopes Riverside will change its policy and start accepting Optima. She wants to see her mother stay with the same care team who has taken her through sickness back to health.

“All we can do is keep praying for some change,” Diehl said.


Sarah Fearing contributed reporting. Have you been affected by Anthem’s departure? Email info@wydaily.com and tell us what you’re experiencing.

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