Colorado’s Insurance Commissioner, Marguerite Salazar, wants state residents to know where they can go for greater understanding of the benefits offered in insurance policies, and, where to file complaints when they are not satisfied with an insurance company’s practices. She says the Division of Insurance relies on consumers to know when something within an insurance company isn’t working for the consumer’s benefit.In this interview with Advocacy Denver’s Policy Outreach Specialist Catherine Strode, Commissioner Salazar also discussed the future of Colorado’s Health Exchange, predicting more financial viability in the years ahead.
|Colorado’s Insurance Commissioner, Marguerite Salazar, wants state residents to know where they can go for greater understanding of the benefits offered in insurance policies, and, where to file complaints when they are not satisfied with an insurance company’s practices. She says the Division of Insurance relies on consumers to know when something within an insurance company isn’t working for the consumer’s benefit.In this interview with Advocacy Denver’s Policy Outreach Specialist Catherine Strode, Commissioner Salazar also discussed the future of Colorado’s Health Exchange, predicting more financial viability in the years ahead.|
What are your thoughts on the Exchange’s past and future performance?
“I am on the Board and bring the perspective from the Division of Insurance, which is to help the Exchange in making sure that all regulations are followed, plans they are selling are viable, and they have met all the requirements. My first thought about the Exchange, as I look across the country, is that this is a very strong Exchange. We’ve got lots of plans to sell; we’ve got more than any other Exchange in the country. But what has happened is, because it’s a new business, we really don’t know how to capitalize it in the best way we could. The Board was trying to be very conservative in looking at the fees and the assessments they were charging. But because it has been so successful (there are so many people who have enrolled) the costs for the call centers has really gone up. With that comes a need for more money to pay for bigger call centers and more help. I think we were underfunded. The Board did pass an increase in the assessment to three and a half per cent. I know that some of the staff doesn’t believe that is enough. However, that’s what the Board approved. I am very hopeful this is going to be enough. We will watch them closely, from our perspective, to make sure they are collecting what they should, doing everything from a regulatory standpoint that they should. We have not seen any gaping holes, or any big problems. With strong stewardship, and we think see that with Kevin Patterson coming on board, I think their future looks good.”
What signs do you see that health care reform is working?
“We see that millions of people now have health insurance who before couldn’t afford it, or, wouldn’t be allowed to be on a plan because they had a pre-existing condition. I see people every day talking about the fact that just being able to go to a doctor for preventative care has meant so much for them. People who used to wait until they were really sick and ended up in the emergency room with a huge bill don’t have to worry about that anymore. I also hear great stories about people who have had to change insurance because their insurance plan didn’t include a certain hospital or a doctor. They were able to drop the current plan and go to the plan that more met their needs because it happened in the enrollment period. That could never have happened before. To me, that is the biggest sign that consumers are getting served.”
What steps is the Division taking to ensure narrow networks aren’t cutting high needs individuals out of services?
“We measure and look at network adequacy with all the plans. We have been doing some network adequacy studies to make sure there are the proper hospitals, specialists, primary care doctors, ancillary services available to people who buy certain plans. We’re really watching that closely. Our biggest challenge is to make sure each plan has a sufficient network that includes all the needs that are out there for the benefits that they are going to sell. Who they sell it to is something we don’t get into. When people file complaints to say, ‘I can’t get into a certain specialist,’ or, ‘these things aren’t made available,’ we do investigations to make sure the plan is providing what the consumer has purchased.”
Is there an issue of insurance companies not paying for out-of-network services?
“That is a big issue. I have heard about that more from carriers than I have from individuals. Colorado has a law that says individuals cannot be billed for services that were rendered when the provider wasn’t a participating provider. What happens is, the carriers end up having to pay that bill. The Division doesn’t get into contracting between the carriers and the providers. We don’t have any legislative authority. One of the things that could happen would be out of the Cost Commission; someone might run a bill to give the Division, or somebody, more authority to look at those contracts. There really isn’t any law stopping people from whether they want a contract or not, especially in rural areas.”
Can you give us any insight into rising pharmaceutical costs?
“I can’t speak specifically about a particular insurance company, but I do know that pharmaceutical costs are going up. We’re seeing it with all the specialty drugs available. The cost is real expensive, not only for the patient, but for the carrier as well. One in particular happens to be the drugs people use for Hepatitis C. I think there are only two drugs in that category. The companies can charge whatever they want. We have a specialty drug working group which includes PHARMA, carriers, consumers, just to talk about what we could do. It’s really disappointing when people do finally get insurance and then find out the drug costs can be three or four thousand dollars out of the pocket the first month. It’s almost like the second tier of health reform we need to get into. It comes down to the marketing power the carrier has with the pharmaceutical companies, what the patients need, and what they are able to afford.”