TDCI: Doctors, Hospitals Should Honor CHA Contracts

NASHVILLE – The Tennessee Department of Commerce & Insurance (TDCI) is strongly reminding Tennessee hospitals and physicians’ offices that Community Health Alliance is expected to pay for claims incurred through Dec. 31, 2015.

TDCI has been made aware of cancellation or refusals by some healthcare providers (including one in East Tennessee) who are unwilling to schedule CHA patients for certain elective procedures or to otherwise provide requested services. These decisions may be due in part because CHA has voluntarily entered runoff and will not offer insurance coverage in 2016, and/or because the providers dispute certain payments, which are ordinarily addressed between companies and providers. Created under the Affordable Care Act, CHA is a Consumer Operated and Oriented Plan (CO-OP). CHA policyholders will keep their insurance coverage through Dec. 31, 2015.

“While CHA is in runoff, the Department is working with the company to ensure that facilities are paid what they are owed under their provider contracts on claims incurred through Dec. 31. As with any professional field we regulate, the Department expects all parties to honor their contracts,” said TDCI Commissioner Julie Mix McPeak. “It is unfair and unacceptable that CHA consumers would be denied access to services because the company is in runoff. Hospitals and physicians’ offices should continue with their business as usual throughout 2015, including by contacting the company as disputes arise. CHA consumers should be shopping for 2016 insurance coverage, not fighting with healthcare providers about their coverage.”

Delaying or denying elective procedures could create a significant negative impact on those consumers who have reached their deductible in 2015. If a delay or a denial causes CHA policy holders to delay procedures into 2016, consumers would have to pay their deductible again which is unnecessary.

Click here for more details about the Federally Facilitated Marketplace. CHA consumers have until Dec. 31 to purchase coverage. Non-CHA enrollees must act by Dec. 15, 2015 to have coverage effective Jan. 1, 2016.

TDCI encourages consumers that have been denied access to healthcare services to contact us at 1-800-342-4029 or (615) 741-2218. 

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