A leading Ohio insurance company is shrinking the size of its provider network by cutting out major state hospital system OhioHealth.
InHealth Mutual, which is among the most popular consumer choices in the state, announced the intention to drop OhioHealth late last week, even as customers continued to review plans for purchase during the 2016 open enrollment season.
The decision to drop the healthcare provider could affect as many as 9,000 customers.
“[It’s] a significant concern to this organization,” Dr. Bobbie Freeman, chairwoman of InHealth’s operating board, told The Columbus Dispatch. “We did everything we could to get the decision made and notification given in a timely fashion.”
The Ohio Department of Insurance completed a mandated review of InHealth’s plan to drop OhioHealth form its network Friday, after which the insurer began to notify customers. About 15% of OhioHealth providers will remain part of InHealth’s network through other contracts, Freeman said.
InHealth had more than 2,600 members who accessed care through OhioHealth last year, and said the decision to drop the provider was primarily financial. Freeman said OhioHealth was “an outlier” in how much it charges for care, pointing to lower rates offered by Mount Carmel Health System and Ohio State University.
OhioHealth declined to comment on the negotiations with InHealth, but noted that its contract “reflects what we believe to be a competitive, commercial market rate.”
InHealth is one of a just a few of the Affordable Care Act-established co-ops that have not folded, though it was placed under “enhanced oversight” by the federal government last fall.
Freeman said that while InHealth remains financially sound, it may not turn a profit until 2018. The co-op is currently attempting to slow the rate at which it is spending its cash reserves, in part by working to get hospitals, doctors and other providers in its health network to agree to lower reimbursement rates.
