The majority of Utahns left without health insurance when Maxicare Utah Inc. shut its doors two weeks ago are again insured.
As of Wednesday - the end of an aggressive marketing campaign - well over half of the enrollees had signed up with one of Utah's solvent health maintenance organizations. Others had gone with traditional commercial insurance plans.But a Utah Insurance Department official said the exact number of insured enrollees will not be known for another week.
"By Sept. 6, the Maxicare members who have not signed a contract to replace their Maxicare contract will be identified, and the Insurance Department will assign them to one of the existing Utah HMOs," said Jilene Whitby, administrative assistant to the insurance commissioner.
Whitby said these likely will be Utahns on individual conversion plans, or those covered by Consolidated Omnibus Reconciliation Act, a plan requiring an employer to permit an employee who is laid off or quits to retain insurance. Small groups that have large claims, or a large number of claims, have also been difficult to place with another agency.
The Insurance Department will apportion on a pro rata basis the remaining Maxicare members - not likely to exceed 1,000 - to the HMOs. Whether these accounts will be retroactive to Aug. 17 is being negotiated.
"Regardless of the outcome of negotiations, coverage will be provided for that interim period," Whitby said.
It was on Aug. 17 that Maxicare Utah Inc., citing losses of $5 million, shut its doors - leaving 15,000 to 20,000 Utahns uninsured.
"Since then, the HMOs in this community have stepped forward responsibly and enrolled in their plans the majority of Maxicare subscribers," said Dr. David A. Burton, vice president of research and development, Intermountain Health Care. "There has been a healthy, cooperative relationship between the HMOs and the Insurance Department."
For some enrollees, Maxicare's closure was no crisis.
IHC facilities have continued to serve those patients as if they had insurance. No Maxicare enrollee was required to pay money up front.
"At both the Salt Lake and Ogden clinics, they have been treated as if their insurance was not interrupted, which has helped alleviate confusion," Burton said. "It was business as usual."
Other interim reports aren't as positive.
"Some providers are going back to the subscribers for bills unpaid by Maxicare," Whitby said. "The providers should be sending those bills to Maxicare's office as usual. They are handling them."
Whitby said bills will be collected over the next six months and then paid with Maxicare Utah Inc. assets.
Meanwhile, most of the existing HMOs aren't complaining about their new business.
"We feel good about the new members because we had to bring them into the HealthWise system with a rate level and benefit level that we feel comfortable with," said Mike Mitchell, vice president of marketing, Blue Cross Blue Shield. "We wanted to make sure we protected them and ensured them continuous coverage, and we wanted to preserve the integrity of HealthWise. We have accomplished both thus far."
Mitchell said benefit and rate levels may have changed when Maxi-care subscribers switched over to HealthWise. "However, it's important to note these people are fully insured," he said.
Elden R. Mitchell, regional vice president for Family Health Plan, said in most cases FHP's premiums are at or below those of Maxicare. So, the company's approximately 1,200 new contracts won't suffer.
But according to Mitchell, there will likely be some stress on FHP's delivery system, because the new members have had difficulty obtaining health care.
What concerns the executive more is the public's possible perception that because of Maxi-care's insolvency, HMOs aren't secure.
While only two Utah HMOs are currently profitable - FHP and Educators Health Care - the situation is not bleak, Elden Mitchell said.
"Today there are over 650 HMOs serving more than 30 million people nationwide. It is unreasonable to assume that all are going to be profitable in an industry that is still relatively young, but there are many that are doing extremely well - including FHP," he said.
Blue Cross Blue Shield and IHC officials agreed. Because their HMOs continue to be backed by strong parent organizations, they say that their HMOs in Utah are not in danger of closure.