Exclusive: Trillium, Oregon Health Authority Give Erroneous Information To Medicaid Clients

Trillium Community Health Plan has been issuing erroneous and potentially deceptive information about its hospital provider network that could hurt Portland-area Medicaid patients who switch to Trillium’s insurance plan for next year.

The Eugene-based insurer, which has been approved by the state to offer Medicaid in the Portland market for the first time in 2020, has been claiming on its website and through representatives at its call center that its network of providers for Medicaid members in the Portland area for 2020includes Oregon Health & Science University and Legacy Health hospitals, The Lund Report determined. 

However, that information is wrong. Trillium has not signed up OHSU and Legacy as Medicaid providers for Portland-area residents for next year. In fact, both systems have refused to sign with Trillium, and the insurer is suing both in federal court to try to force them to join Trillium’s network.

Meanwhile, the Oregon Health Authority, which oversees Medicaid in Oregon, spread the same misinformation in a brochure it sent to hundreds of thousands of Medicaid members earlier this month to help them choose an insurance plan for next year. The brochure incorrectly asserts that OHSU and Legacy Emmanuel are “contracted hospitals” for Trillium in the Portland metro area for 2020.

The state told The Lund Report that it simply inserted information from Trillium.

Responding to an inquiry from The Lund Report on Wednesday, Trillium posted a disclaimer on its website, saying the website’s provider search tool “is current for 2019,” and “is only applicable to members using providers in Lane, Linn and Douglas counties.” The notice said Trillium would update its provider search tool on Dec. 1. In other words, the 320,000 Medicaid members in Multnomah, Clackamas and Washington counties who now are allowed to choose a Medicaid insurer for 2020, should not rely on the provider information Trillium has on its website.

The errors by Trillium and the state are significant because they could disrupt patient care. All Medicaid members in the tri-county Portland area are currently insured through Health Share of Oregon. Health Share’s network of hospitals for both 2019 and 2020 includes all the Portland area’s major facilities, including OHSU and Legacy hospitals. Trillium, by contrast, has not succeeded in signing up a single major hospital for Portland-area Medicaid members for 2020. If they picked Trillium for 2020 on the belief they would have network access to OHSU and Legacy, they could be stuck with an inferior plan or have to try to switch over to Health Share.

Having correct information is is particularly important now because many Portland-area Medicaid members are likely researching whether to stick with Health Share or switch to Trillium. They have through Nov. 17 to decide, though they’ll get another sign-up chance early next year. 

The provider network that each insurer has lined up can be an important factor in member choice. Members want to make sure their preferred doctors and hospitals are covered by the insurer they choose.

Trillium’s website tool is intended to help members research which hospitals and other providers Trillium’s network includes. If one uses that tool to search for hospitals for residents in Portland-area ZIP codes, the tool lists OHSU and four hospitals in the Legacy system: Legacy Emanuel, Legacy Good Samaritan, Legacy Meridian Park and Legacy Mount Hood.  Trillium’s customer service representatives have been relying on that provider search tool. 

The Lund Report repeatedly telephoned the Trillium call center this week and asked what Portland-area hospitals were in Trillium’s Medicaid network for Portland residents in 2020. The uniform answer: OHSU and Legacy. One call center representative even told The Lund Report that Trillium was also “working to get” the Providence hospitals into its Portland network. The representative did not mention that Trillium is suing Providence - along with OHSU and Legacy - to try to force it to join Trillium’s network. When asked where their information came from, several representatives said they were using Trillium’s website tool to find the list.

Trillium said Wednesday its customer service representatives had been “instructed” about the disclaimer just posted on the site.

 Trillium has faced a wall of resistance from Portland-area hospitals and other providers --  despite what Trillium’s website and customer service representatives say.

Health Share, meanwhile, has had no trouble lining up big Portland hospital systems for 2020 that already are part of Health Share’s 2019 lineup: OHSU, Legacy, Providence and others. The three organizations are all part of Health Share.

Just why Trillium has issued erroneous information is unclear.

It may stem from the fact that Trillium’s Lane County Medicaid members currently do have access to OHSU and Legacy hospitals under Trillium’s longstanding insurance plan for members who live in Lane County. However, those hospitals have insisted the Lane insurance plan cannot be stretched by Trillium to include Medicaid members in the Portland area.

Also Wednesday, the Oregon Health Authority noted that its “CCO Plan Comparison Guide” brochure - which lists Trillium as having contracts with OHSU and Legacy for Portland residents in 2020 - includes language saying the information in the guide is subject to change and that members should call insurer or check their websites.

Insurers “are responsible for keeping their information current and providing members with accurate information about their networks,” OHA spokeswoman Allyson Hagen said.  

You can reach Christian Wihtol at [email protected].

 

 

News source: 
You can see two more premium stories for free. To subscribe, click here. Our newsroom depends on premium subscriptions.