One, DECO Recovery Management, got a $1.2 million navigator award to recruit South Carolinians into the exchanges. Concerned that its hospital business could conflict with the navigator job, DECO decided not to seek South Carolina hospitals as exchange-enrollment clients, said vice president Andy Foland.
“Putting us in a situation where we’re also getting paid by the hospital for that creates a huge mess,” he said. DECO plans to recruit exchange members for hospitals in states where it didn’t get federal navigator dollars.
Other potential concerns are enrolling patients who aren’t eligible for coverage or the kind of aggressive approach allegedly taken by Accretive Health, another hospital contractor.
Last year Accretive paid a $2.5 million settlement and agreed to cease business in Minnesota after Lori Swanson, the attorney general there, alleged that company employees approached sick patients in the emergency room to collect hospital debts. Accretive declined to comment on its plans, if any, to enroll exchange patients.
Industry officials said they would abide by strict rules in advising consumers on plan enrollment.
“We must always act in the patient’s best interest,” said Gwynne Mesimer, vice president of operations for Chamberlin Edmonds.
“It’s very important that you not make the decision for them,” said the AHA’s Pryga.
Consumer advocates promise to pay attention.
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.
Fri, Sep 13 2013