[…] In terms of underwriting actions for less serious conditions (those that don’t result in a decline), GettingUsCovered only takes people who have been offered a policy with an exclusion rider… which most carriers don’t do anymore. Perhaps this is resulting in GettingUsCovered being comprised mostly of members who have a condition that would result in a decline in the individual market, while CoverColorado has those members as well as members who have less serious conditions that simply result in a higher-priced policy in the individual market.
[…] The 27 states (including Colorado) that administer their own PCIPs have been notified by HHS that they can modify their programs in a similar manner. As of this morning, the GettingUSCovered website still has the same eligibility guidelines that it has always had: a letter from a private carrier stating that the applicant has been declined, or approved with an exclusion on a pre-existing condition. […]
[…] I wrote last fall about the new high risk pool in Colorado – GettingUsCovered – and how it differs from our existing high risk pool, CoverColorado (which has been operating for two decades). In states like Colorado that have existing state pools in addition to the federally-backed pools, there may be adequate options for people with pre-existing conditions, assuming that funding for both programs holds out until 2014. But in states that only have a PPACA-created pool, there are definitely some cracks to fall through, including the requirement that applicants be uninsured for six months before they can join the pool.
As of April 1, 2011, CoverColorado will be switching to a new fee schedule for reimbursing providers. In the past, CoverColorado has used the Rocky Mountain Health Plans provider network, and doctors were paid according to the RMHP network-negotiated rates when they treated CoverColorado members. The new CoverColorado-specific fee schedule applies to any provider who treats a CoverColorado member, regardless of whether that provider is part of the RMHP network or not. […]