Critical condition 

St. Patrick audit leaves some dependents uninsured

Hank McClain has worked at St. Patrick Hospital since 1974, and the hospital has long provided he and his wife, Mardia Parker, health insurance.

But on Wednesday, McClain says, Parker was dropped from his health insurance policy because their common law marriage—which is recognized by the state of Montana—wasn't acknowledged by an audit conducted by St. Patrick's parent company, Providence Health and Services.

"I have options that are all unpalatable to me," says McClain, who coordinates material management and supply at the hospital. "I can get her insured—just put her on my plan as an unrelated adult. That's not palatable to me. She's my wife."

The issue is the result of the state insurance commission's inability to regulate self-insured plans, or health insurance plans operated by an employer and not an insurance company. McClain says his predicament can be easily resolved: "You just go to a lawyer and the lawyer threatens them with a bunch of suits and then they cave."

But he's lobbying for legislation that would force self-insured plans to follow Montana law, and not leave others exposed to a policy he believes is patently unfair.

click to enlarge St. Patrick Hospital’s parent company recently conducted a “cleanup exercise” to ensure that employees’ dependents legitimately qualify for health insurance. The audit didn’t recognize common law marriage, leaving at least one employee’s spouse without coverage.
  • St. Patrick Hospital’s parent company recently conducted a “cleanup exercise” to ensure that employees’ dependents legitimately qualify for health insurance. The audit didn’t recognize common law marriage, leaving at least one employee’s spouse without coverage.

According to Marla Allan, St. Patrick Hospital's vice president of human resources, the audit was conducted about three months ago by a third-party auditor, and all of Providence's facilities in Montana and Washington were subject to it.

"It's just really a cleanup exercise," she says. "It's an exercise to ensure that all employees' dependents we are covering with our benefits program are eligible for coverage under the confines of our plan."

Allan adds the audit is something all large companies are doing. "It's generally a result of the fact that people's lives change and sometimes the benefits-enrollment piece just doesn't catch up. Circumstances change," she says.

For example, she says, when children reach a certain age they can no longer be considered a dependent.

McClain says Colorado-based ConSova, a company that specializes in health care cost containment through dependent eligibility audits, conducted the review. The company boasts on its website a 10 to 13 percent ineligibility identification rate. Allan doesn't confirm or deny ConSova's involvement, calling it irrelevant.

"Providence has relinquished control to a mercenary," McClain says, "and the fact that the mercenary exists is wrong, let alone their process."

McClain's point is that health insurance cost containment shouldn't rely on "cleanup exercises" that takes insurance coverage away from eligible dependents like his wife. He calls ConSova a "pit bull," and says, "For every one they get rid of they get more money."

Montana law allows for marriage between a man and a woman without a license and formal ceremony as long as the parties are competent and mutually agree to the arrangement. According to the state, "a Common Law Marriage is a real marriage and requires a legal Dissolution of Marriage to terminate the relationship." Only eight other states recognize common law marriage.

Allan declined to comment on whether the auditor required employees to furnish a marriage license for spouses to remain insured, as McClain claims. But she outlines, in general terms, ways employees could prove dependent status.

"They have a list of numerous documents that an individual employee can provide in order to validate their dependents as being eligible for coverage," she says. "So there are many things on the list, which range from birth certificates to evidence of living at the same address, which would come from a rental agreement with your property owner, or a mortgage document, or a bank statement. There are lots of ways to prove a legitimate dependent."

Mary Anne Sladich-Lantz, former director of mission leadership at St. Patrick Hospital and a current employee for the hospital's parent company, says she isn't sure how to prove in Montana that you have a common law marriage, but says it shouldn't be a sticking point.

"I don't understand why it's an issue. I really don't," she says. "In my opinion it shouldn't have to be an issue. And I also understand why it's a wise thing and being a good steward to check authenticity. That shouldn't make us mad either if it's done in a respectful way."

Carol Roy, chief of the state insurance commissioner's market compliance bureau, says self-insured plans aren't subject to state jurisdiction. Plus, she says, church groups like Providence are exempt from the federal Employee Retirement Income Security Act of 1974, which regulates the operation of self-insured plans.

"State law does not necessary apply to these entities," she says, "and it can quite easily be preempted."

McClain says he's contacted local legislators in hopes of drafting a permanent solution. But Roy cautions that he's preaching to the wrong people.

"We'd have to be talking to Sens. Baucus or Tester or Rep. Rehberg to make that change effective," she says.

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