LONG BEACH — Come Jan. 1, 2019, Pacific County residents will have fewer healthcare insurance options.
Premera Blue Cross will be the only insurance provider for county residents who use the Washington Healthcare Exchange. The exchange currently gives residents the insurance options of Premera or LifeWise.
Those having to switch from LifeWise to Premera will face about a 30 percent cost increase, said Shelly Pollock, principal broker with NW Insurance & Financial. Those who already have Premera will see a 2.18 percent increase in comparison to 2018 costs.
“We’ve had huge increases every year,” Pollock said. “I don’t see it getting better.”
The upcoming change in available providers is one of many obstacles Cindy and Mike Challis have faced in recent years. Cindy was diagnosed with colon cancer at age 48 in 2016, when the recommended age to start getting colonoscopies was 50 years old. Studies since 2016 have suggested people should get colonoscopies at age 45.
Due to changes in what providers serve the county, the pair have had to switch insurance providers every year while Cindy has received treatment.
“Having cancer is emotional enough,” Cindy said. “Having to deal with insurance issues just adds to that stress and emotion.”
In 2017, Cindy and Mike learned they could no longer go to any medical providers in Oregon, as LifeWise deemed Oregon providers to be out-of-network for Washington residents. The pair had to transfer Cindy’s cancer treatment from Oregon to Swedish Cancer Institute in Issaquah, causing a three-month delay in her care.
“We couldn’t even go to our primary care doctors at Columbia Memorial Hospital anymore,” Mike said.
Cindy and Mike learned of the change while Cindy was receiving treatment at Providence St. Vincent Medical Center in Oregon, where she had a surgery to address her cancer. The surgery was thought to be successful until later blood work tests indicated the cancer came back.
At the time of her first surgery, Cindy’s cancer was stage 2. Her cancer is now stage 4, as it’s spread from her colon to her liver. She will have a surgery in November at Swedish.
“When she had her surgery they told her there was only a 2 percent chance that the cancer would come back,” Mike said. “They didn’t do chemo because they tested some lymph nodes and they turned up negative. They re-sectioned her colon and took all of the cancer out.”
Cindy and Mike have put more than 6,000 miles on their car making 15 trips to and from Issaquah, about 185 miles one way. They’ll have to continue traveling to Issaquah regularly for follow-up care after her surgery in November.
“The thing that I really feel thankful for is we have good transportation,” Cindy said. “For us, it’s a burden but it’s not as much as for somebody who doesn’t have transportation. There’s a lot of people on the Peninsula who wouldn’t have the means to drive and take time off of work.”
One of Cindy and Mike’s concerns is whether Premera will include Swedish as an in-network provider in 2019. If the center isn’t considered in-network, they’ll have to find another set of doctors for Cindy’s post-surgery treatment, as well as all other medical services.
“We’re hoping that it will be in-network,” Mike said. “But if it ends up being out of network, now what do we do?”
Since 2014, Columbia Memorial Hospital has served 1,108 Pacific County residents covered by Premera, according to an April 2018 article in the Chinook Observer.
“Being in a border community, it’s typical for residents to have medical providers in Oregon,” Pollock said.
Pollock said she worries about Pacific County residents being injured in Oregon, then being taken to an Oregon hospital only to find their insurance won’t cover their care because they’re out of network. Another concern of hers is medical providers sending patients to out-of-network providers, in turn causing the individual to pay more.
“It’s almost like we have to wear big buttons that note what our medical providers are,” Pollock said.
Pollock recommends individuals stay educated about their coverage and other options available to them. Doing so can help prepare individuals to make decisions.
Small business owners can apply for group medical insurance plans, which may cost about 25 percent less than individual plans, Pollock said. However, group plans may not be affordable for low-income business owners.
“We pay more every year because we’re older,” Pollock said. “You have to be your own quarterback, your own advocate. You’re on your own.”
Enrollment for coverage beginning Jan. 1, 2019 ends on Dec. 15, 2018.