BIRD ISLAND, Minn. — There is a special bond among farmers in Minnesota, but that’s not the same business partnership that would help create a group health insurance policy.

Instead, farmers like Calvin Aarons and his wife have to buy individual policies on the open market, and Aarons said the experience recently has been increasingly frustrating and costly. Specifically, he says, there doesn’t seem to be rhyme or reason about what’s in network versus out of network.

“If they’re going to come out here and own the hospital, then you should go to a doctor that’s in network. Why do you want to send your business somewhere else?” Aarons lamented to WCCO. “You figure it’s all HealthPartners. The doctor said you’re all HealthPartners, until you get the bill and it says ‘out of network.’”

According to Aarons, his wife went to see a specialist at the Olivia Hospital and Clinic, which is run by HealthPartners. The specialist then referred Aarons’ wife to another physician at Methodist Hospital in St. Louis Park, which is also HealthPartners, for a more complicated procedure.

The bill for the procedure cost nearly $20,000 because it was considered “out of network” for their health insurance plan, Medica Applause.

“Why aren’t we in network when we come to the Mothership?” Aarons quipped, referring to Methodist Hospital. “It’s major money.”

Aarons isn’t alone; insurance agents WCCO spoke with warn access and affordability are major problems.

“The best adjective is complete chaos,” Tom Gruhlke, a longtime insurance agent for the Farm Bureau, explained to WCCO. “It was the advent of the Affordable Care Act that created all of this chaos, and to some degree nonsense, in the individual market.”

Specifically, Gruhlke said, costs became too high for insurance companies to grant open access to individuals, so they began to impose more restrictions on coverage. 

Hospitals, moreover, chose not to enter contracts for certain insurance plans if the reimbursements weren’t financially viable.

“These insurance plans now are being negotiated all the time, whether to be in or out of network,” Gruhlke added.

In a statement to WCCO News, a HealthPartners spokesperson said, “We understand how complex it can be to do determine whether care is in-network. Because of that, we partner with patients to help them understand their options.”

Medica also sent a statement to WCCO News, saying: “Contracts between hospitals and insurance companies are based on several factors, which can make them seem complicated. We can’t get into specifics on negotiations because that information is proprietary. Generally, contracts may be renewed every one to three years. It is notable that Medica Applause offers a very broad network that includes access to Mayo, Allina, M Health Fairview, North Memorial and many other metro facilities that offer the full range of acute and specialty care to members from across the state of MN.”

Still, all of those options are a far trip for Aarons, which is why he also cautioned this might be just a symptom of the bigger issue: the rural versus urban divide.

“Fifty years ago, 40 years ago, grandpa was on the farm,” he said. “Now it’s another generation away from grandpa. A few more years, it’ll be great grandpa. Then it’s all history.”