AEP Non-Medical / Non-Medicare Under 65

Recently, I was contacted by a client whose family I had enrolled in Marketplace health plans, informingThe me she had several issues this past year with providers opting out of her plan. Since Lake Health was bought out by University Hospitals, there have been many changes. While she was assured over the phone that her marketplace plan was in network, when arriving for her appointment she was informed at the providers office that she was misinformed. We completed the 2023 application through and her providers showed as accepting all the plans except Oscar, which we know is exclusively Cleveland Clinic network. Since this is our only opportunity to make enrollment decisions, we chose potential plan offerings from 3 different carriers and I instructed her to speak with her provider's offices and inquire which of these 3 specific plans were they taking in 2023. Unfortunately, the responses appeared canned and rather robotic as the replies all included the statement “as far as I know we are accepting the plan but check with your insurance carrier.” She was directed to call University Hospitals billing office for further clarification. The office stated categorically that they were NOT accepting any Marketplace plans. When I called the Marketplace, I was informed the providers could and did choose which insurance coverage to honor. My Anthem representative did confirm that University Hospital does not take their marketplace plans but Medical Mutual denied any coverage issues. I have asked her to investigate specifically the Lake county providers. I Could not get any statements from Molina, Ambetter or Caresource.

Before enrolling in a new plan or just opting to roll your plan over, please call your current customer service number and inquire if your specific doctors, labs or urgent care offices are accepting your plan in 2023. Don’t assume! The information listed on is not always current and you only have until December 15th to make a plan change. Without taking action you could be forced to seek providers outside of Lake County.