Spring Harbor at Green Island, the upscale retirement community off River Road in Columbus, has been grappling with health insurance problems in recent weeks, putting some of its employees in coverage limbo.
Operated by Piedmont Columbus Regional, Spring Harbor acknowledged Friday that it made an “inadvertent” late payment on its previous plan in recent weeks. The missed payment apparently put some of its staffers on edge as they considered whether or not they would be responsible for paying their full medical bills for physician visits and other health-care needs.
But the retirement community, as it stated in previous communications with workers, said Friday that all is under control. Piedmont Columbus Regional issued a statement on behalf of Spring Harbor Executive Director John Sims.
“Spring Harbor employees have never been without the ability to fully access the health care services connected with their insurance,” the statement said. “A computer error resulted in an inadvertent late payment. However, a new contract has now been executed with Gilsbar that is retroactive to February 1. We do not see this as a significant issue and Spring Harbor has been issuing payments directly to providers so that employees are able to fully access their health care benefits.”
In a March 23 update to employees concerning their coverage, Spring Harbor also told its staff that it had reached an agreement with Covington, La.-based Gilsbar to become the Columbus employer’s direct third-party administrator for a self-insured health plan. Roughly 110 of Spring Harbor’s 250 employees are under its health plan.
“Rest assured that your claims will be paid in accordance with our medical policy,” Spring Harbor’s March update to employees said. “There will be no changes in the design or cost of the program and it will be retroactive. We will keep you informed of our progress in setting up this self-insured program. We appreciate your patience.”
The problem, Spring Harbor employees said in emails to the Ledger-Enquirer, is that physicians they use have not been acknowledging that the insurance coverage is in effect. Some reported canceling visits to doctors this week after being informed that they would ultimately be responsible for the full bill.
Self-funded insurance coverage is popular and used by more than 50 percent of U.S. companies in which they pay all health-care costs for those covered, as well as administrative costs. In this case, Gilsbar will be the entity managing health-care and medical expenses and payments.
Gilsbar Chief Executive Officer Hank Miltenberger clarified the situation in a phone interview Friday. He said Spring Harbor previously had used his company as an administrator of a self-funded health plan set up as part of an insurance “prepackage” that included a stop-loss carrier. Stop-loss is insurance that self-funded employers must maintain to limit their losses to very specific maximums.
Though Miltenberger said he doesn’t know why, Spring Harbor was terminated from the insurance prepackage, which meant it had to scramble to put coverage in place for its employees. It turned to Gilsbar — to which the retirement community pays a monthly fee — to administer its health plan directly. Still, the CEO said, Spring Harbor, perhaps using a broker, had to come up with a plan that included a physician network, a drug card and a stop-loss insurer.
Miltenberger said his company’s only role is to pay various administrative fees from a Spring Harbor checking account. It also is in charge of the critical task of processing employer medical claims from physicians and medical facilities, then paying them out of a Spring Harbor account.
A major issue may have been finding another stop-loss insurance firm to avoid any possibility of a million-dollar claim materializing from a policyholder, he said. Again, a stop-loss policy would pay claims over a set amount, limiting exposure for Spring Harbor or any similar employer so they are not hit by an exorbitant claim and have to pay it entirely out of pocket.
“Now there might have been some confusion because when this happened all of a sudden … and they were terminated with that group, we had to re-set them up like they’re a new group,” said Miltenberger, explaining his people are working as fast as they can to get the claims payments flowing smoothly again. Spring Harbor told Gilsbar to keep all medical claims for processing.
“My understanding is we’ve got them all, but we couldn’t start paying them until they got another stop-loss carrier,” he said. “So we waited on that and when they gave us the go-ahead we started to put everything together. But we saved all the claims. They may get paid a little late, but that’s nothing we can do anything about.”
Spring Harbor is a not-for-profit continuing care retirement community overseen by Columbus Regional Senior Living Inc., with Piedmont Columbus Regional — Columbus Regional Health prior to its recent merger with Atlanta-based Piedmont Healthcare — the contracted operator of the property off River Road.
Columbus Regional and the Medical Center Hospital Authority signed a 40-year lease in June 2004, allowing the authority to build, own and operate the facility on the health-care company’s land, with Spring Harbor opening in 2005.
Piedmont Columbus Regional also operates what until recently was known as Midtown Medical Center and Northside Medical Center, both of which now carry the Piedmont brand. The Columbus operation includes John B. Amos Cancer Center, which kept its name after the recent merger.