Insurers move forward on exchanges, but with caution


Although insurers are steadily announcing their plans to sell policies through state-based health insurance exchanges, they're moving forward slowly and cautiously as they await answers addressing specific workings and profitability of each exchange, The Wall Street Journal reported.

WellPoint, for example, said it will participate in exchanges in all states in which it sells policies. WellPoint is "determined to participate where it makes sense," interim Chief Executive John Cannon said at the J.P. Morgan healthcare conference in San Francisco. "It's in our best interest to play on the exchanges." But he noted that the insurer may withdraw from certain exchanges based on future market issues.

Likewise, Aetna said it plans to participate in 15 exchanges next year but will pull out of any problem markets, FierceHealthPayer previously reported. "If exchanges are successful--if--it becomes a bigger opportunity for us," CEO Mark Bertolini said at the conference. "What we have is an option to play," he added.  

Cigna CEO David Cordani, meanwhile, told the WSJ that the insurer plans to sell policies in certain states, but wouldn't specify which ones. "The good news is we don't have to defend something," he said at the conference. "We're not forced to take any actions."

And although Humana will join some exchanges, CEO Bruce Broussard focused on the uncertainty surrounding exchanges overall. "I do want to emphasize that we're going to walk before we run in this marketplace," he told conference attendees.

Part of the problem, the execs say, is that regulations haven't been issued to address all the uncertainties of exchanges. But insurers got a bit more clarification when the U.S. Department of Health & Human Services released a new rule explaining the appeals process for denied claims, as well as streamlining the eligibility process for the expanded Medicaid program.

To learn more:
- here's the HHS rule
- read the Wall Street Journal article (subscription required)

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