Health insurance coverage for hundreds of Shawano County consumers could remain intact through 2016, under a compromise to be discussed next week between ThedaCare health system and insurer Network Health Plan.
City of Shawano employees and others in the public sector, meanwhile, are getting assurances that their health coverage will not be affected, even if the compromise falls through.
ThedaCare has announced plans to drop Network Health coverage July 31 because of a disagreement over the insurer’s reimbursement rates to ThedaCare.
The move would mean nearly 4,000 consumers in Shawano County would no longer have coverage at ThedaCare facilities, including the new ThedaCare Medical Center-Shawano. The hospital opened in September, replacing the now-shuttered Shawano Medical Center.
Representatives of ThedaCare and Network Health have agreed to meet on Jan. 7 to discuss extending their partnership through December 2016, which would grant anxious customers a five-month reprieve.
“It would mean current plans that include ThedaCare providers and services would remain in effect for all of 2016,” ThedaCare President Dean Gruner said in a statement. “We hope Network will accept the extension.”
Network Health officials, who previously said they were seeking the same extension, said they were pleased that ThedaCare was willing to talk.
Penny Ransom, chief administrative officer for Network Health, called it encouraging that the two sides would be meeting face to face.
“The good news is we’ve gotten one step closer,” Ransom said.
Based in Menasha, Network Health provides health insurance for about 3,700 people in Shawano County, most of them senior citizens who rely on the company to administer Medicare benefits. The company also serves employees at several area businesses and other workplaces.
According to its website, Network Health has about 150,000 consumers in a region extending from Milwaukee to Door County.
Ransom said about 10,000 are public employees whose insurance is provided through the state’s Wisconsin Department of Employee Trust Funds. That includes employees of the city of Shawano, village of Gresham, Shawano County Housing Authority and others locally.
Shawano city officials this week sent a memo assuring employees that their health coverage would remain unchanged throughout 2016. The contract negotiated between the state and Network Health covers the entire year of 2016, the memo stated, and state officials are “holding them to it.”
Ransom confirmed that even if ThedaCare drops Network Health coverage in July as threatened, public sector employees covered by the state-negotiated contract would continue to receive full coverage at ThedaCare facilities.
“We just have to pay the bill,” Ransom said.
ThedaCare, a nonprofit corporation based in Appleton, operates regional medical centers in Appleton and Neenah, as well as hospitals in Waupaca, New London, Wild Rose and Berlin, and another 35 clinics elsewhere.
The company spent about $50 million building the new Shawano hospital, in a move that dramatically elevated the company’s profile locally.
In ThedaCare’s new statement this week on the Network Health issue, Gruner acknowledged that the insurance move has “caused some angst” for customers.
“That was not our intent,” he stated. “ThedaCare is focused on making health care better for consumers, patients, families and communities.”
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