Franciscan Alliance hospital network announces major insurance restriction resulting from Obamacare

18 Dec

The Franciscan Alliance hospital network has notified its customers that some insurance plans offered by major providers on the public healthcare marketplace will be considered “out-of-network” at their hospitals.

The Gazette obtained a letter distributed by Franciscan Alliance describing the restriction of Anthem — a major insurer — to its patients.  The letter reads:

If you are seeking coverage through the public healthcare marketplace and choose an Anthem healthcare product (Bronze, Silver, or Gold plans), Franciscan Alliance providers will be out of network.  However if you are seeking coverage through the public healthcare marketplace and choose MDwise’s Hoosier Alliance (HA) product, your plan will be accepted at all Franciscan Alliance locations.

The letter can be viewed in full below.

A letter distributed by Franciscan Alliance.

A letter distributed by Franciscan Alliance.

The restriction in health care coverage options stems from a series of federal mandates imposed by the Affordable Care Act, being implemented beginning in 2014.  Insurance providers are having to adjust their business models to comply with federal mandates found in the Affordable Care Act, as they are forced to cover patients who will result in a net loss for their business.  The law requires insurers to provide a series of expensive benefits to clients, officially known as “essential health benefits.”   As described on Healthcare.gov:

Essential health benefits must include items and services within at least the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.

The market response to these mandates is that insurers are lowering the reimbursement amounts that they are willing to pay to health care providers for any given procedure.  In turn, the health care providers — such as Franciscan Alliance — are further restricting the insurance plans that they are willing to accept.   Such is the case between Anthem Insurance and Franciscan Alliance hospitals.

This was not the first major instance that Franciscan Alliance has been affected by the Affordable Care Act.  In October, the hospital chain announced 275 layoffs which they attributed directly to the law.

“Franciscan Alliance has not been immune to such pressures and has found it necessary to align staffing levels to reflect lower patient volumes and reduced industry wide reimbursements brought on by reforms associated with the Affordable Care Act,” said Kevin Leahy, Franciscan Alliance president and CEO.

It seems that the unfortunate result of the federal intervention in the health care market seems to be less insurance options, offered to fewer people, administered by fewer staff.

The hospital chain has at least 13 major locations in Indiana and Illinois, including Crown Point, Michigan City, Lafayette Central, Lafayette East, Crawfordsville, Carmel, Indianapolis, Mooresville, Chicago Heights, Olympia Fields, Dyer, Hammond, and Munster.

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19 Responses to “Franciscan Alliance hospital network announces major insurance restriction resulting from Obamacare”

  1. Mark Land via Facebook December 18, 2013 at 10:03 am #

    Baloney. They are just being greedy.

    • Anonymous December 18, 2013 at 10:37 am #

      Greed? That’s why businesses turn away tons of customers? Seems legit.

  2. Nicole Singer Sanders via Facebook December 18, 2013 at 10:40 am #

    If you like your doctor you can keep your doctor…

  3. Terri Davidson via Facebook December 18, 2013 at 10:47 am #

    @ Mark – they are doing this to keep patients and not have to pay for birth control or abortions. not being greedy

  4. Lori Vorkapich via Facebook December 18, 2013 at 10:47 am #

    not surprised we will see more of this..

  5. Tom Black via Facebook December 18, 2013 at 11:02 am #

    They’re not greedy they’re trying to stay in business under Obamacare those plans reimburse them $.24 of every dollar it’s even less for medicare

  6. Vicky Black December 18, 2013 at 2:28 pm #

    it isnt the hospital being greedy its the insurance companies.. although Anthem insurance is a popular one it is just barely acceptable.. we had many problems with them when I worked at caremark..with the med D …the hospital is trying to let people know they cannot accept this insurance. because they are just thinking about a buck and not the patients..( ins. not hosp.) In my opinion this is one of the good things about new plan… people wont be paying a lot and getting nothing in return..this isnt obamas fault.. if anyone else was president people would see the insurance companies for what they are but people want obabma care to fail so everything gets turned around

  7. Mark Land via Facebook December 18, 2013 at 3:02 pm #

    Thats a freakin bunch of rich nuns there..

  8. Mike December 18, 2013 at 6:20 pm #

    So, wonder if this is why the City Of Crown Point dropped ” Partners In Care ” as the city’s primary provider? Since they are part of the Franciscan network…..and this is just the beginning…..we just saw the ” explosion ” of this bomb….now we are seeing the cloud and the winds are picking up from this nuclear mess….soon to follow will be the fall out…..then the casualties…..it’s going to get worse before it ever gets better, if it ever does.

  9. Karie Spence-Bogucki via Facebook December 18, 2013 at 6:30 pm #

    I dont see how ACA is overhauling or lowering medical cost at all .its not the fix we need.

  10. The Northwest Indiana Gazette via Facebook December 18, 2013 at 7:58 pm #

    Tom Black can you answer that?

  11. The Northwest Indiana Gazette via Facebook December 18, 2013 at 7:58 pm #

    Tom Black can you answer that?

  12. Gwen Shell via Facebook December 18, 2013 at 8:53 pm #

    Totally sucks but went through that b4 few years ago, what ashame

  13. Tom Gonzalez via Facebook December 18, 2013 at 11:40 pm #

    Gloria Gonzalez

  14. Anonymous December 19, 2013 at 12:21 am #

    I believe that is most definitely about greed! The Franciscian Alliance has been in financial trouble long before Obama Care. This is just a cover up for their pure greed.

  15. Anonymous December 19, 2013 at 6:09 pm #

    Nuns turning away the sick?

  16. Anonymous December 19, 2013 at 11:04 pm #

    I used to work for them all they care about is the bottom dollar. The managers they use in some departments have never even worked the hospital floor and they have no clue what they are doing. They have utter favoritism their and if you report a manager for engaging inappropriate behavior the upper managements makes sure you are out of there before word spreads about what you reported.

  17. Anonymous December 20, 2013 at 10:21 am #

    It’s about the bottom dollar. If you have ever worked in a hospital and know anything about pricing between them and an outside center (one that is not associated with a hospital) the price difference for the same testing done at a hospital facility is more than twice the amount of having it done outside of one.

  18. Anonymous December 21, 2013 at 4:05 pm #

    I have noticed a definite decline in the quality of the staff in my doctors office. The cut backs are showing.

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