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Insurance Commissioner works to keep thousands from losing their doctors

Donelon said the co-op never attracted enough customers to successfully compete with well-established insurers in the state, and in time serious money problems developed. (FOX 8 Photo) Donelon said the co-op never attracted enough customers to successfully compete with well-established insurers in the state, and in time serious money problems developed. (FOX 8 Photo)

State Insurance Commissioner Jim Donelon is working to make sure thousands of patients do not lose their doctors because of unpaid claims.

As many as 17,000 individuals in Louisiana bought health insurance coverage through the now financially strapped Louisiana Health Cooperative, a non-profit that came about as a result of the federal health care reform law.

Donelon said the co-op never attracted enough customers to successfully compete with well-established insurers in the state, and in time serious money problems developed and claims began to stack up.

“Ultimately when the financials were filed at mid-year, the company was below the statutory requirements for an HMO,” Donelon said.

And LAHC will not be in business in 2016. So Donelon’s department recently took control of LAHC’s operations. He said the priority is to keep doctors and other medical professionals from refusing to see patients because of unpaid claims.

“That's our number one concern and it's our number one duty is to protect policy holders, and so we are making an all-hands-on-deck effort,” Donelon said.

He said when they took over, the backlog of claims was 50,000, but is now down to 17,000.

Cooperatives like LAHC received millions from federal loans, but Donelon said that money could not be used to market the insurance start-ups.

"Creating a new insurer is always a challenge and a difficult thing to get up and running to do so as the Affordable Care Act was being rolled out. I have an analogized it to learning how to sail in a Hurricane,” he said.

Donelon said his office is working with doctors and assuring them the claims will be paid, as he urges them to continue seeing the affected policy holders. And he is confident those individuals will find new coverage either in the federally run healthcare.gov website or through the private insurance market in Louisiana. But he can't guarantee that the premiums will be lower.

“I’m not going to promise, because the challenges are still there,” Donelon said.

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