Oklahoma Takes Over Mending's Insurer Days Before Open Enrollment

Three months after it put Mending’s Oklahoma insurance company under a state supervisor, Oklahoma has taken control of it.

Insurance Commissioner Glen Mulready placed Mending Health Insurance in Oklahoma, Inc. into conservatorship “due to the precarious financial standing of the company,” the Oklahoma Insurance Department announced Oct. 30. The agreed order was filed Oct. 29, and Mending consented to it. It appoints Donna Wilson of the Oklahoma Receivership Office as conservator, “to immediately take charge of the Company and all the property, books, records and effects” and to conduct its business.

Open enrollment on HealthCare.gov opened Nov. 1. Mending’s exit from the health insurance market will affect about 7,000 Oklahomans, KGOU reported in June. Mending sold a “Direct Primary Care” plan category, and CommunityCare has described some of the members as people who “currently receive care from a DPC provider.” For their doctors, the timing matters more than the legal term.

What conservatorship does

DPC Insider covered the July supervision order when the department disclosed it in August. Supervision put a state monitor beside management. Conservatorship puts the state in charge. The department says it lets the commissioner “take over the day-to-day management of the company’s operations as well as thoroughly examine the finances of the company.”

It’s still a step short of receivership. The order says the conservator serves to resolve whether the company can be rehabilitated “and avoid, if possible and feasible, the necessity of receivership,” which it calls “the harsher remedy.” The conservatorship lasts until the commissioner is satisfied the company has fixed what caused it, or until the Oklahoma County District Court grants receivership.

One more power stands out. With the commissioner’s approval, the conservator may reinsure all or part of the company’s policies with a solvent insurer and transfer the reserves behind them.

The department released no financial figures, in this announcement or the last one.

For members, the release says three things. Policies “will remain in effect for now.” Members “must continue to pay their premiums to ensure continued coverage.” And providers “should continue to service all Mending Health members and should not demand payment other than the proper cost share.”

That last line names no kind of provider. Mending’s Oklahoma DPC plans let members join a DPC doctor for $0, so the instruction reaches those practices along with every hospital in the network.

Oklahoma has run this sequence before

The release reads like one from 2023. That June, the department placed Friday Health Plans of Oklahoma into receivership after a supervision period that began April 4. Mulready said then: “Given the company’s financial situation, I determined this strong approach was a necessary step to protect policyholders.” His quote in the Oct. 30 release is the same sentence, word for word. Only the next one changes, with “conservatorship” where “receivership” used to be.

So far the outcomes differ. Friday’s Oklahoma company went into receivership over its declared insolvency, and its policies ended Aug. 31, 2023, four months before the plan year was out. Its members had to replace coverage through a special enrollment period.

The Oct. 30 release announces no early end date for Mending’s policies. They were already set to stop at the end of the year. Mending filed notice with the department on June 25 that it was leaving the Oklahoma marketplace effective Dec. 31, and its policies can’t be renewed for 2027.

Where Mending’s DPC members land

Mending’s Oklahoma page advertises unlimited $0 primary care visits and lists deductibles of $4,950 for bronze, $2,300 for silver and $0 for gold.

The replacement is now posted. CommunityCare, owned by Saint Francis Health System and Ascension St. John, announced in June that it would offer 2027 marketplace plans with in-network DPC providers through a partnership with Mending. Its 2027 DPC plan overview lists six. The three “$0 PCP” designs land close to Mending’s numbers: deductibles of $5,000 for bronze, $2,500 for silver and $0 for gold, each with a $0 primary care visit.

Maine went differently. There, the plan Community Health Options is selling to Mending’s former members carries an $8,500 deductible, against Mending’s $4,150 and $4,950.

The Oklahoma plans have their own limits. The overview lists individual out-of-pocket maximums of $10,000 to $12,000 on the three $0 PCP plans. On the $0-deductible gold plan, emergency room and inpatient hospital care carry 50% coinsurance.

The overview marks only one of the six as HSA qualified: the DPC Expanded Bronze Standardized plan, with a $7,500 deductible and a $50 primary care copay.

Geography is the other limit. You must live in a covered county to enroll in any of the six, the overview says. Its list includes Oklahoma, Tulsa, Cleveland and Canadian counties. CommunityCare’s plan page adds Pawnee County, which the PDF leaves out.

CommunityCare said in June that Mending DPC plan members “will be notified and guided to the appropriate CommunityCare plans that include DPC during the upcoming Open Enrollment period.” Mending’s own update page calls the new plan “very similar to Mending’s current plans.” That page was last revised Oct. 15, two weeks before the conservatorship.

What to watch

The first date is Dec. 15. A plan picked on HealthCare.gov by that date starts Jan. 1. Someone who enrolls between Dec. 16 and Jan. 15 gets coverage starting Feb. 1.

Next is how the conservatorship ends. Under the order, it runs until the commissioner is satisfied the company has fixed what caused it, or until the Oklahoma County District Court grants receivership. It names reinsurance as a tool along the way.

Then there’s Mending Access. The order names one company, the licensed HMO. Mending’s update page says it will keep serving TPAs, large employers and other health plans through Mending Access, its DPC platform. That page predates the conservatorship, and it hasn’t changed since.

If you run a DPC practice in Tulsa or Oklahoma City with Mending patients on your panel, CommunityCare’s provider directory is where you might confirm your practice is in the 2027 DPC network before those patients start asking.