2018 Nashville-area ACA insurance shoppers set to lose Vanderbilt access

• Exits by Aetna, Farm Bureau Health Plans take VUMC off-exchange
• A similar situation in 2016 led to a last minute hustle, and deal for Saint Thomas

Vanderbilt University Medical Center is not covered under any individual Obamacare insurance plan in the greater Nashville area for 2018, insurance representatives said Thursday. 

The academic medical center is not in-network with either Cigna or Oscar Health, the two insurers selling plans on the federally run-exchange in Davidson, Cheatham, Montgomery, Robertson, Rutherford, Sumner, Trousdale, Williamson, and Wilson counties. It's also not available in the companies' off-exchange plans.

The three insurers selling individual plans in Tennessee previewed their 2018 market offerings at a meeting for navigators at the Tennessee Department of Commerce and Insurance. Open enrollment for healthcare.gov runs Nov. 1- Dec. 15.

In a twist, people who live in the parts of the state where BlueCross BlueShield of Tennessee sells — which are mostly rural areas and the greater Knoxville area — VUMC is part of the network. 

But because VUMC is not covered by Cigna or Oscar Health — which contracts with Cleveland Clinic in Ohio  —  the health system is not available to those living in the greater Nashville area who buy their own insurance.

The absence from the market could anger or frustrate people around the region who either rely on VUMC for specialty care or help people who use the system navigate the ever-changing insurance market.

Tatum Allsep, executive director of Music Health Alliance, asked what Cigna and Oscar would do about people who are currently receiving treatment at VUMC — specifically the Vanderbilt's MDA Neuromuscular Clinic — that may not be as much of a specialty in their networks. 

If there is no specialist or expertise, coverage could be arranged, said Joshua Meeks, who presented for Cigna. If there is a physician with expertise then the insurer will work on a transition treatment plan to get the patient moved from VUMC to a covered provider. 

In an update on its negotiation status dated Aug. 1 on its MyVUMC website, VUMC wrote "people who purchase individual health insurance plans in Tennessee are finding the marketplace for 2018 is even more restricted than 2017’s already limited offerings."

"The limited availability of these plans creates challenges for patients who utilize individual insurance coverage options. The Medical Center’s Contracting Team is working hard to reach agreements with the limited number of carriers who remain willing to offer individual plans either through the exchange or as off-exchange products."

VUMC wrote "beginning discussions with these (new to Nashville) carriers are already taking place" and that updates would be available once insurers finalized their 2018 plans with the federal government. 

"We are in active discussions with one or more participating payors about an exchange contract and we hope to have an announcement soon,” said John Howser, VUMC's chief communications officer, on Thursday.

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Exits by Aetna, Farm Bureau Health Plans take VUMC off-exchange

The Tennessee individual insurance market has had more layers than other states around the country.

With BCBST's late departure from three metro areas, people in the Nashville area who wanted VUMC had to change insurers — and they were not able to buy a plan with the help of tax credit or cost-sharing reduction subsidies.

Aetna and Farm Bureau Health Plans sold off-exchange for 2017 and covered VUMC. Neither are selling individual, off-exchange plans this year. 

Farm Bureau Health Plans also covered VUMC in a type of association plan in which people go through a medically underwritten process — pre-existing conditions or health issues raise the premium —  to get coverage. 

According to a VUMC website, it is available for 2018 through Farm Bureau for non-ACA compliant individual plans (that) require screening for high-cost health conditions before coverage is sold."

"Patients utilizing a Farm Bureau ACA-compliant plan will receive notification and may want to consider purchasing the alternative non-ACA compliant plan."

Last December, a Knoxville resident was quoted $1,156 a month, without factoring in deductibles, co-pays or other costs for premiums given her medical history. People in non-compliant plans incur tax penalties.

Farm Bureau saw a surge in people enrolling in its plans compliant with the Affordable Care Act and increased interest in its medically underwritten ones. The demand, and accompanying claims, were such it decided to not sell compliant plans in 2018 citing unsustainable costs.

More:Farm Bureau Health Plans to drop ACA options in 2018, cites unsustainable financials

A similar situation in 2016 led to a last minute hustle, and deal for Saint Thomas

This time last year, the only Nashville area health system covered on the exchange — the market where people can use tax credits — was TriStar Health.

But last-minute negotiations brought Saint Thomas Health in-network with Cigna in the days leading up to the start of open enrollment on Nov. 1. 

Networks can be changed — if contracts with the other health systems can be modified — until open enrollment begins. 

Allsep asked the panel if there was any chance the networks could change. 

"I don't think either of them would tell you they wouldn't talk to Vanderbilt," said Michael Humphreys, assistant insurance commissioner at the TDCI.

This story will be updated. Check www.tennessean.com for more.

Reach Holly Fletcher at hfletcher@tennessean.com or 615-259-8287 and on Twitter @hollyfletcher.