Alyssa Lane
In 2019, Charleston Area Medical Center (CAMC) decided to terminate its contract with Wheeling-based health insurance carrier, The Health Plan, effective December 31, 2019. This decision impacted around 14,000 people with coverage through the West Virginia Public Employees Insurance Agency (PEIA), as CAMC would no longer accept PEIA insurance. However, CAMC agreed to extend the agreement with PEIA through June 2020, to allow PEIA members time to switch carriers. The decision to terminate the contract with The Health Plan was due to the latter becoming a subsidiary of WVU Medicine, a move that CAMC considered aggressive and which led to a souring of their relationship.
| Characteristics | Values |
|---|---|
| Date of termination | 31st of December, 2019 |
| Reason for termination | The Health Plan has agreed to become a subsidiary of WVU Medicine |
| Number of people impacted | 14,000 |
| Alternative providers | Thomas Health Systems, Roanoke, Virginia hospital |
| Impact | Low according to PEIA Executive Director Ted Cheatham |
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What You'll Learn
Charleston Area Medical Center terminates agreement with The Health Plan of WV
The Charleston Area Medical Center (CAMC) has terminated its agreement with The Health Plan of WV, a Wheeling-based health insurance carrier, effective as of January 1, 2020. This decision came after months of negotiations between the two parties. CAMC cited The Health Plan's merger with West Virginia University Medicine as the reason for the termination. The merger, announced in May 2019, was described as "a fully integrated healthcare delivery and financing system for the people of West Virginia."
The termination of the agreement impacts several thousand state residents in 14 southern West Virginia counties who are covered by The Health Plan. This includes about 14,000 people with coverage through the state's Public Employees Insurance Agency (PEIA). However, CAMC agreed to extend the agreement with PEIA through June 2020, at the request of PEIA Executive Director Ted Cheatham, to avoid putting members in a position where they have to switch carriers mid-year.
The Health Plan President Jim Pennington expressed disappointment with CAMC's decision, stating that they had honored all agreements and were a great partner. He also mentioned that CAMC was concerned about WVU Medicine's management agreements with smaller hospitals in their territory. Despite the termination, CAMC assured that they participate in a variety of other health plans and networks, and the community will continue to have access to care.
The impact of the termination on the state-run health insurance program is not anticipated to be significant, according to Cheatham. He stated that less than a thousand people were admitted to CAMC over the last 12 months, and there are other providers in the area that can serve PEIA recipients. Additionally, Thomas Health Systems, which operates hospitals in South Charleston and Charleston, has had a long-standing agreement with The Health Plan that will continue.
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The Health Plan covers around 14,000 PEIA clients
In September 2019, Charleston Area Medical Center (CAMC) announced that it would terminate its contract with Wheeling-based health insurance carrier, The Health Plan, by the end of the year. This decision impacted around 14,000 PEIA (Public Employees Insurance Agency) clients who were covered by The Health Plan.
The Health Plan provides coverage for state employees and retirees, as well as their dependents, in West Virginia. The termination of the contract meant that these 14,000 individuals would no longer be able to access healthcare services at CAMC facilities through their insurance plan.
The decision by CAMC was reportedly due to The Health Plan's agreement to become a subsidiary of WVU Medicine. CAMC had concerns about WVU Medicine's management agreements with smaller hospitals in its territory and its vision for a single healthcare system in the state.
To ensure a smooth transition for those affected, CAMC agreed to extend the coverage for PEIA clients through June 2020. This gave PEIA members time to review their insurance options and select alternative providers. During this period, PEIA recipients could still choose The Health Plan for their coverage network, but they would need to seek healthcare services from other hospitals, such as Thomas Health Systems, which continued to have an agreement with The Health Plan.
The Health Plan also began entering into contracts with other providers that offered similar services to CAMC, including a Roanoke, Virginia hospital for open-heart surgery services. These new partnerships aimed to mitigate the impact on their clients and ensure continued access to quality healthcare across West Virginia.
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CAMC extends agreement with PEIA until June 2020
In 2019, CAMC (Charleston Area Medical Center) announced it would terminate its agreement with The Health Plan of West Virginia (or The Health Plan) at the end of the year. This decision was due to The Health Plan becoming a subsidiary of WVU Medicine, a move that CAMC disagreed with. The Health Plan covers around 14,000 people with coverage through the state's Public Employees Insurance Agency (PEIA).
CAMC agreed to extend its agreement with PEIA until June 2020, at the request of PEIA Executive Director Ted Cheatham. This extension was to ensure PEIA members wouldn't have to switch carriers mid-year.
The termination of the agreement between CAMC and The Health Plan would impact those with The Health Plan as their private insurer, as well as those with it as part of Medicare or Medicaid in the Kanawha Valley. The Health Plan would begin informing its members of the upcoming change at the beginning of October 2019, giving them time to select another provider.
CAMC stated that it participated in a variety of other health plans and networks, and the community would continue to have access to care. However, the decision would bring to a close a 10-year relationship, impacting around 500 employees of The Health Plan.
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The Health Plan enters contracts with other providers
Charleston Area Medical Center (CAMC) announced in 2019 that it would terminate its contract with Wheeling-based health insurance carrier, The Health Plan, at the end of that year. This decision impacted thousands of state residents in 14 southern West Virginia counties covered by the provider. In response, The Health Plan began informing its members about the change promptly and entered contracts with other providers to ensure continued care for its members.
When entering into contracts with other providers, The Health Plan typically starts negotiation discussions several months in advance of the contract renewal date. This allows both parties to understand each other's needs and requests. During negotiations, The Health Plan considers factors such as reimbursement rates, provider availability, and the range of services offered.
The Health Plan also has certain rights and responsibilities when entering into contracts with providers. For example, The Health Plan has the right to non-renewal of a participating provider contract upon expiration or with sufficient notice. Additionally, The Health Plan must comply with regulations regarding claim processing, liability, financial risk, and adverse reimbursement changes.
In the case of the terminated contract with CAMC, The Health Plan began informing its members about the change promptly, providing them with enough time to choose another provider. The Health Plan also assured its members that they would continue to have access to care through other providers. One such deal was with a Roanoke, Virginia hospital that provides open-heart surgery services for residents of southern West Virginia.
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PEIA recipients can still choose The Health Plan
In 2019, Charleston Area Medical Center (CAMC) announced that it would terminate its contract with Wheeling-based health insurance carrier, The Health Plan, by the end of the year. This decision was due to The Health Plan becoming a subsidiary of WVU Medicine, a move that CAMC saw as an "aggressive play". The termination impacted around 14,000 PEIA recipients who were covered by The Health Plan.
However, PEIA recipients were still able to choose The Health Plan for their coverage network. The Health Plan President, Jim Pennington, assured members that they would be informed of the changes and given time to select another provider if needed. PEIA Executive Director Ted Cheatham also stated that the termination would not have a major impact, as only a small number of PEIA recipients had needed to use CAMC in the previous 12 months.
To accommodate PEIA members, CAMC agreed to extend its agreement with The Health Plan through June 2020, ensuring that PEIA members would not have to switch carriers mid-year. This extension provided time for PEIA recipients to make informed choices about their insurance and provider options.
While the termination of the contract between CAMC and The Health Plan caused some disruptions, PEIA recipients could still choose The Health Plan for their coverage. The extension granted by CAMC ensured a smoother transition and allowed PEIA members to continue accessing the services they needed.
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Frequently asked questions
Yes, as of January 1, 2020, CAMC terminated its agreement with PEIA.
CAMC terminated its agreement with PEIA because PEIA had agreed to become a subsidiary of WVU Medicine. CAMC was upset about this as they had been trying to work with WVU Medicine for years on a collaborative agreement, but WVU decided against it.
Yes, the termination impacted PEIA members who had coverage through the WV Public Employees Insurance Agency (PEIA). However, CAMC agreed to extend the agreement through June 2020 to give PEIA members time to switch carriers.
PEIA recipients can still choose The Health Plan for their coverage network, but they will need to use a different hospital that accepts this plan, such as Thomas Health Systems, which operates Thomas Memorial Hospital in South Charleston and St. Francis Hospital in Charleston.
CAMC participates in a variety of other health plans and networks, but the specific plans they accept are not publicly available. You can contact CAMC directly to inquire about a specific insurance plan.
