Written by Andrew R. Jones, Asheville Watchdog.
Laura Law doesn’t know what she’s going to do.
The Mission Hospital labor and delivery nurse expects nearly $6,000 in unforeseen medical bills after she took two of her three children to several standard primary care appointments with Mountain Area Health Education Center (MAHEC) doctors this year.
She thought the visits were covered by her health insurance, which she has through HCA Healthcare-owned Mission Health’s Aetna plan.
But on Jan. 1, MAHEC’s primary care services were dropped from Mission Health’s insurance plan, a move that went unannounced for more than three months and that affected potentially thousands of employees.
“It’s so disappointing,” Law said of the change and the absence of communication about it. “Because I expect, as a nurse, my family should also be taken care of. And even if there was just communication, I would have accepted that.”
Asked how her family was going to tackle the unexpected expense, Law said, “I really don’t know, but I guess I will have to make plans to pay a $6,000 bill that my budget does not allow.”
MAHEC contends Mission Health was responsible for communicating the change to its employees. Mission would not comment on why it didn’t tell employees about the change. Neither responded to repeated questions about how many employees the move affected. Not all Mission Health employees have the company’s Aetna plan.
Mission Health is the largest employer in Buncombe County and one of the largest in western North Carolina, with more than 6,000 people working at Asheville’s Mission Hospital alone, according to data from the North Carolina Department of Commerce.
MAHEC’s exit from group triggered change, its CEO says
The change in the insurance arrangement happened on the first day of the year, according to MAHEC CEO Dr. William Hathaway.
“Effective January 1, 2025, MAHEC’s Primary Care practices – including Internal Medicine and Family Medicine – are under a different benefit level for employees covered under the Mission Health/HCA employee health plan,” Hathaway said in an email to Asheville Watchdog. “However, MAHEC’s Specialty Practices – including Psychiatry, Obstetrics and Gynecology, Endocrinology, and Dental – remain covered at prior benefit levels.”
Hathaway said the change occurred after MAHEC decided to leave the Mission Health Partners (MHP) Accountable Care Organization. An ACO is a group of doctors, hospitals, and other health care providers who come together to give coordinated high-quality care to the Medicare patients they serve.
“MAHEC made the decision to exit MHP in order to participate in a new federal initiative, Making Care Primary (MCP) – a 10-year Medicare demonstration project designed to strengthen primary care through value-based payment models,” Hathaway said.
Hathaway said that MAHEC couldn’t be part of both MHP and MCP at the same time.
Mission Health spokesperson Nancy Lindell also confirmed MAHEC’s departure from MHP, but said, “You would need to ask MAHEC about any communications related to their decision.
“While MAHEC is no longer a participating provider in Mission Health Partners, they do remain in-network with Aetna, the insurance provider for Mission Health employees. Their coverage benefits may differ than what they were as part of Mission Health Partners.”
In response to the statement from Mission, Hathaway pointed out that being part of MHP and being in-network or under full coverage are separate things.
“Mission Health/HCA, in an effort to encourage practices to be part of MHP, has tied this to being in-network for their employees. Note that I use ‘in-network’ to mean covered at the highest level. Exceptions have been made where practices can be in-network but not be part of MHP – our specialty practices for example. This is what we asked for for our primary care practices.”
Lindell said that Mission valued its relationship with MAHEC “and would welcome the opportunity for them to rejoin Mission Health Partners.”
Hathaway had a similar invitation for Mission.
“MAHEC has valued its Mission Health/HCA partnership and would welcome the opportunity to return to prior coverage levels to continue to serve Mission Health/HCA employees with high-quality, coordinated primary care.”
It’s unclear how much communication about the move happened between Mission and MAHEC before Jan. 1.
When Law became aware of the change, she called MAHEC’s billing, Mission Health’s human resources department, and Aetna.
“So we just found out that we’ve been dropped by HCA,” Law said the MAHEC billing department told her. “And so anything preventative is not covered. And we’re asking that everybody call HCA HR to make a complaint and see if they’ll change this.”
Law called HCA HR.
“They’re like, ‘No, preventative care is covered,’” Law said. “And I was like, well, it should be, but it’s not.”
“We don’t know what you’re talking about,” Law said HCA HR told her. “‘We haven’t heard anything about this.’”
Aetna confirmed to her that preventative care wasn’t covered.
Hannah Drummond, a registered nurse at Mission and a union representative who received a surprise bill for $847, reached out to Scott Rogers, HCA’s director of labor and employee relations, requesting information on the change.
In response to requests for correspondence between the hospital and MAHEC regarding its departure from MHP, any notice that it gave or steps the hospital took to notify employees, Rogers said, “I am not aware of any communications between MAHEC and the Hospital. I am not aware of any notices from MAHEC regarding their decision to leave MHP…. The Hospital was not aware of the change.”
‘It’s super, super personal’
Lindell did not respond to questions about why employees were not informed of the move when it went into effect Jan. 1. After employees started receiving surprise bills and found out they were not covered, Mission Hospital CEO Greg Lowe sent out an email on April 10 giving an example of what the coverage change could look like for some employees, but saying nothing about why the shift happened.
“Ultimately,” Lowe said in his email, “the patient is responsible for reaching out to their benefits provider if they are not sure what their benefits are or how their claims will be processed at the start of each renewal year.”
Asked what efforts MAHEC made to tell affected patients about this change, Hathaway said that was Mission’s job.
“Regarding efforts to notify Mission employees of this change in their benefits: that is the employer’s responsibility,” he said. “[S]ome Mission employees who had appointments at MAHEC were unaware of the change in their benefits. Upon learning this, we have been attempting to identify and contact other Mission employees, prior to their scheduled visits at MAHEC, so they are aware of their increased financial responsibility. Identifying such patients is not a simple (nor a routine) process, but we are committed to doing all we can to inform these patients.”
Just before she went on vacation, Jade Hoffman, a registered nurse in Mission’s surgical trauma ICU, received a bill for $2,495 after a Feb. 18 procedure at MAHEC that would have been covered before the shift.
Hoffman didn’t know what had happened. She found out later from a Mission Nurses United email.
Chris Letts, a Mission Hospital progressive care unit nurse, and their wife Michelle are both covered by Letts’ Mission Health insurance. They found out about the change in a nurse group chat April 9.
“MAHEC is where my wife and I both go for primary care, psych, and my wife goes for OBGYN,” Letts said. “I had an appointment yesterday at MAHEC that I actually ended up having to keep because there aren’t other options.”
Letts is in the middle of a medical situation that requires ongoing care. “I need access to my medication,” they said. “I can’t just go somewhere else. MAHEC is the option, and I’ve consolidated my care at MAHEC intentionally, because they’ve been covered.”
Primary and preventative care are vital to Letts, who was diagnosed with Stage 3 breast cancer in 2020.
“Not having access to preventative care for me, it’s super, super personal,” Letts said.
On Thursday, the Letts saw their first surprise charge of the year for MAHEC services that Michelle received on March 10, a $578 balance they can’t yet act on.
“Routine care is not covered under your plan,” the charge notification said.
Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Andrew R. Jones is a Watchdog investigative reporter. Email [email protected]. The Watchdog’s local reporting is made possible by donations from the community. To show your support for this vital public service go toavlwatchdog.org/support-our-publication/.