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Publish Date: 10/21/2006

Health plan is tossed
Move by LUH, clinic may affect local workers

LONGMONT — Longmont United Hospital is ending its participation in one type of health insurance coverage offered through the Kaiser Permanente health insurance network, and Longmont Clinic is moving to do the same.

The decision by the two health-care providers to end their participation in the Kaiser “triple option” network may lead to changes in how many local residents get their health care.

For example, starting next year, the city of Longmont will offer a health insurance plan to employees that was supposed to let them use LUH under the “triple option” plan.

But LUH is terminating its participation in that system as of Jan. 4. It is unclear exactly what effect that will have on the costs to city workers who enroll in the triple option plan.

Forty percent of city workers are already enrolled in a health insurance plan that requires them to use Kaiser facilities and requires them to pay out-of-network costs to use LUH.

LUH officials say they’re withdrawing from the Kaiser triple option plan because the insurer has set up its fee structure to funnel patients into hospitals and clinics it controls, which discourages them from going out of the network.

That means Kaiser patients who insist on using their own hospital, such as LUH, end up paying a lot more, LUH officials said.

“It’s a model Kaiser uses, and I think it’s a model that works for Kaiser. Unfortunately, for the local health-care providers and for the city itself, (this model) exports the health-care dollars that feed the economy,” LUH spokesman Matt Hartzler said. “It’s not a sustainable operation (for LUH) to have those dollars exported out of the city of Longmont.”

Under federal law, hospital emergency rooms must treat any patient having a health-care emergency, regardless of ability to pay or the insurer.

Longmont Clinic spokeswoman Michele Kramer said the clinic and its doctors also are withdrawing from the Kaiser triple option plan. The clinic has not yet formally notified either Kaiser or the city that it is dropping out.

City officials say they’re still trying to understand the impacts of the changes.

“In my mind, it’s rather sad that our community hospital would pull out of a network as we are in the process of transitioning,” city spokeswoman Sandra Seader said. “It’s frustrating for the employees. We’re trying to do the best job we can in managing our health-care costs in a way that is economical and sustainable. And at the same time, we’re trying to provide quality health care that’s convenient for them.”

Kramer, the wife of a city firefighter, said many area doctors and physician networks are withdrawing from the Kaiser system.

“Longmont Clinic is ultimately one of the last local healthcare providers to drop out of the network offered by Kaiser,” Kramer said.

LUH and the clinic announced their pending withdrawals Friday.

It wasn’t immediately clear how many private workers would be affected by the change. It also was unclear how the bottom lines of both LUH and the clinic would be affected by the potential loss of the Kaiser patients.

Times-Call staff writer Pam Mellskog contributed to this report.

Trevor Hughes can be reached at 303-684-5220, or by e-mail at 

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