Missouri Lags Behind In Insurance Pricing Transparency

Health insurance carriers all across the country are disclosing what they plan to charge customers for coverage in 2015 — almost everywhere, that is, except Missouri.

In Connecticut, for example, Anthem Health Plans Inc. submitted its rates to the state’s insurance department in May, requesting an average increase of 12.5 percent. The state denied the request on July 25. Anthem has until Aug. 31 to submit revised rates.

“We fairly dramatically pushed back on them,” said Anne Melissa Dowling, deputy commissioner of Connecticut’s Insurance Department. “They cannot sell this product without our assent.”

In Kansas, Insurance Commissioner Sandy Praeger also is receiving insurance carriers’ rates for 2015. Her department has 30 days to review the plans. If her department is uncomfortable with any proposed rate increases, Praeger steps in. She said, in most cases, she is able to negotiate a lower rate with the carrier.

And just this month, Illinois, which has rate review authority, opened up rate filing forms from insurers to the public via an online portal. Now the public can view what plans insurers will sell and how much they will charge.

Connecticut, Kansas and Illinois are among a long list of states and the District of Columbia that have some sort of authority to review insurance rates, meaning pricing, before plans are sold.

But that type of authority does not exist in Missouri.

The Show-Me State is one of the only states that does not have the ability to review health insurance rates. Wyoming is close behind; it has only the ability to review rates for health maintenance organizations, or HMOs.

Advocates say it’s time for a change in Missouri.

“Other states can sit down with the insurance company, ‘Can you justify an increase this large?’ But in Missouri that conversation doesn’t even happen,” said Andrea Routh, executive director of Missouri Health Advocacy Alliance.

Rate review authority means state governments can review the pricing and benefits of health insurance plans sold within the state. Some states, such as Connecticut, have the authority to deny rate increases; others do not.

There’s a special interest in rate review authority now because under the Affordable Care Act, Americans are required to have health insurance. And, under the Affordable Care Act, Americans have greater access to purchasing health insurance through the online insurance exchange, HealthCare.gov.

But last year, the first year HealthCare.gov opened for business, details about the plans offered to Missourians on HealthCare.gov were not available until after the website went live, on Oct. 1.

Only two carriers, Coventry and Anthem Blue Cross Blue Shield, offered plans on the Missouri exchange during the inaugural year. And while both are expected to offer plans again this year, details about their insurance products — as well as those offered by other insurance companies — are unlikely to be known before the Nov. 15 start of open enrollment on the exchange.

Earlier this month, the Missouri Department of Insurance reached a record settlement of $7.8 million with Anthem for overpricing of certain plans in Missouri from 2007 to 2010. Missouri’s Insurance Director John Huff believes that these settlements could be avoided if his department had the ability to scrutinize rates and benefits before they were sold in Missouri.

“By not having rate review authority, Missourians lack rate transparency, a competitive health insurance market and regulatory protection from being charged rates that are excessive, inadequate or unfairly discriminatory,” Huff said in a statement provided to the Post-Dispatch.

Until then, his department relies on consumers’ complaints to tip them off to unscrupulous behavior on the part of insurance carriers.

The Missouri Department of Insurance does have the authority to investigate insurance companies operating in the state per state statute. In Missouri it is illegal to use deceptive practices to sell insurance, and it’s illegal to misrepresent benefits within the policy, according to state statute.

So far, proposed legislation regarding rate review authority has failed in Missouri.

Sen. Paul LeVota, D-Independence, has tried twice to get rate review in Missouri through his previously filed bills, but he’s becoming less optimistic about his chances. Even still, he plans to file a third bill on rate review authority in January.

“The insurance industry has a chokehold on the Legislature,” Levota said. “In Missouri, we have no campaign finance limits at all, and that allows lobbying interests to have more power than in other states.”

Rep. Bill White, R-Joplin, also is fighting for more transparency through his legislation but he said it’s an uphill battle. He thinks giving rate review authority to the insurance department is a reasonable request since the department has the authority to review rates for all other types of insurance sold in the state.

“Things that seem like a no-brainer sometimes don’t get out of committee,” White said.

An insurance lobbyist would not comment on whether he would welcome rate review in Missouri.

“Input from our member companies would be paramount to what our position would be,” said Shannon Cooper, registered Missouri lobbyist for America’s Health Insurance Plans.

Officials with insurance carrier Anthem, a division of WellPoint Inc., would not comment on rate review authority.

“We believe that the current process in Missouri is working well for both consumers and carriers,” said Rohan Hutchings, spokesman for Coventry, which is owned by Aetna. “If things were to change in the future, we would work closely with the state through that process.”