Providers should continue to provide care to their patients with Friday health insurance plans.
DENVER - Earlier this week, the Colorado Division of Insurance, DOI, announced that it was putting Friday Health Plans of Colorado into rehabilitation and taking control of the company. The DOI took this action in order to protect consumers enrolled in a Friday health plan and to ensure that providers will be paid for seeing those patients.
“I know this is a confusing situation. But the actions we’ve taken up to this point, including the passage of HB 23-1303, have been designed to protect Coloradans with Friday health insurance and health care providers” said Colorado Insurance Commissioner Michael Conway. “Coloradans insured through Friday are our neighbors, friends and family members. They obviously did nothing wrong in choosing Friday as their insurance company. I ask health care providers to continue to provide services to those neighbors, family members and friends. We have taken steps to ensure that you will get paid and we will continue to do that.”
What is the Colorado Guaranty Association?
The association, officially known as the Life and Health Insurance Protection Association, is a non-profit organization made up of life and health insurance companies that sell insurance products in Colorado. The Colorado legislature authorized the formation of the association in 1991 to assist Coloradans with insurance policies from companies that become insolvent.
To protect consumers, the Division championed the passing of HB23-1303 - Protect Against Insurers' Impairment And Insolvency, this past legislative session as it monitored the situation regarding Friday Health. This legislation made Friday Health Plans of Colorado a member of the Guaranty Association, offering protections to both consumers and health care providers in the event of the failure of a company like Friday health insurance company that is licensed as a HMO.
What’s the difference between the “parent company” and “Friday health insurance company”?
In this case, the parent company was Friday Health Plans, Inc. Friday health insurance company here in Colorado (formally known as Friday Health Plans of Colorado), is a separate legal entity. The parent company and Friday health insurance company are distinct legal entities. The parent company is the entity that announced that it would be winding down operations as of July 6th.
However, claims will continue to be paid through the Friday health insurance company. The DOI has the direct ability to ensure that is the case because we have taken control of the company.
So, what is happening with the insurance company?
Problems with the parent company made it prudent for the DOI to move the Friday health insurance company into rehabilitation and take over the management of the company to properly administer its assets to maximize consumer protection and ensure that claims continue to be paid.
So, how does all of this protect health care providers?
Providers can expect to be paid for their services in accordance with their contracts with the insurer. Because the Division placed the company into rehabilitation, it gives the Division the authority to use the existing capital in the company to pay claims. And, in the event the Division determines that the insurer is insolvent, the Division will trigger the Colorado Guaranty Association, and the Guaranty Association will pay claims up to the statutory cap of $500,000 for each individual Coloradan covered by a Friday Health plan.
FAQs and Contacting the DOI
Policyholders and health care providers alike should refer to this list of Frequently Asked Questions (FAQs) concerning this situation with Friday Health. The Division will continue to update this list of questions as the situation evolves.
If people experience problems with their Friday Health insurance, including doctors and other health care providers who turn them away, they should contact the Colorado Division of Insurance Life and Health Consumer Services Team: 303-894-7490 / DORA_Insurance@state.co.us / doi.colorado.gov (click on “File a Complaint”).
About the Division of Insurance:
The Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), regulates the insurance industry and assists consumers and other stakeholders with insurance issues. Visit doi.colorado.gov for more information or call 303-894-7499 / toll free 800-930-3745.
DORA is dedicated to preserving the integrity of the marketplace and is committed to promoting a fair and competitive business environment in Colorado. Consumer protection is our mission. Visit dora.colorado.gov for more information or call 303-894-7855 / toll free 800-886-7675.