Medical Discount Plan In Nevada Skips Insurers : Shots - Health News Members of the Access to Healthcare Network in Reno, Nev., get discounts on health services. But first, they pay a monthly membership fee. They also agree to pay their medical bills to providers upfront.

Medical Discount Plan In Nevada Skips Insurers

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From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.


And I'm Audie Cornish.

A couple of stories about health care in this part of the program, and we begin in Nevada where more than one in five people lacks health insurance. Even under the Affordable Care Act, many people in the state may not end up getting coverage. But there is another option. Capital Public Radio's Pauline Bartolone has a story about a network that connects people without insurance to health care at reduced rates.

PAULINE BARTOLONE, BYLINE: For 25 years, Sherri Rice's job has been to start up or shape up nonprofit organizations. She says that's why health care and government groups in Reno asked her to figure out how to get care for the uninsured.

SHERRI RICE: And then I sat down one night with two gins and tonics and started writing on a napkin.

BARTOLONE: Rice made a diagram of major community institutions: hospitals, government, bankers. She thought they could all be part of creating a new health care model, a medical discount plan.

RICE: I started by asking the hospitals for the rates. I asked the uninsured to pay cash at the time of service, plus a membership fee. I asked the providers to lower their rates. I asked the government to put money in to help sustain the network. I asked everyone to do something.

BARTOLONE: Seven years later, Rice's vision is now a nonprofit with dozens of staff members and a central office in Reno. It's called Access to Healthcare Network. Twelve-thousand uninsured Nevadans statewide are connected to 2,000 providers, offering almost every medical service at a discounted rate. An additional $35 monthly fee pays for coordinators to help members understand their health care options and what they're responsible for.

Patients pay their doctors at the time of service. Rice calls it a shared responsibility model - everybody contributes something, but no one group is overburdened.

RICE: Our rules are very strict for our members. Two no calls, no shows to any of our providers, any nonpayment - any nonpayment - and I kick them out of this network, and they can't ever come back.

BARTOLONE: Rice says about two-thirds of the members are employed but don't have health benefits at the job. The network gets them into the health care system and leaves insurance companies out of the picture.

Sixty-two-year-old member Shelley Toreson likes it that way. She pages through medical paperwork in her home near Reno. She had health insurance for years.

SHELLEY TORESON: And the cost just kept going up, and the coverage kept getting less.

BARTOLONE: Toreson said she finally had to drop her health insurance. When she had insurance, medical costs always caught her off guard. But not now.

TORESON: Like, right now, I'm going to go have a mammogram. Well, I know the cost upfront, and I know that that's all there's going to be. And, you know, I'm happy with that.

BARTOLONE: Toreson recently had gallbladder surgery. She borrowed about $1,700 from family and friends, and she waited about three weeks to get the surgery. Her care coordinator helped her.

TORESON: They're so willing to work with you on whatever kind of problem you might have. Whereas, I think the health insurance, anytime you call an insurance company, their first thing is like, how are we going to not pay this?

BARTOLONE: Toreson had her surgery at St. Mary's Regional Medical Center in Reno. St. Mary's CEO Helen Lidholm says they're happy to take network patients.

HELENE LIDHOLM: This is an organization that are really taking the poor - and many of them disenfranchised - and giving them an opportunity to participate in such an important aspect of life: your own health care.

BARTOLONE: But Lidholm says this model works only because the hospital gets higher payments from private and public insurance. She says it loses money on discounted surgeries like Toreson's gallbladder procedure.

LIDHOLM: It's a good deal. Could we afford to do that for everybody that walks through the door? No.

BARTOLONE: She says giving care to the uninsured before it reaches an emergency saves everyone the higher cost of urgent care. And Lidholm says the network does a good job at keeping their members out of urgent situations.

LIDHOLM: Access to Health Care Network has the lowest ER utilization of any payer that I work with. And that's remarkable.

BARTOLONE: Starting next year, two-thirds of the Access members will probably gain coverage because of the federal health law and drop their membership. But Rice says there will still be people who fall through the cracks: undocumented people and people who are priced out of the requirement to buy health insurance. For NPR News, I'm Pauline Bartolone.

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