Committee Addresses Health-Care Fee

Rep. Danny K. Davis said today that Blue Cross Blue Shield is reconsidering its benefit options for federal employees.

Davis, chairman of the House subcommittee on the federal workforce, postal service and the District of Columbia, spoke at a hearing he called to examine a significant increase in the fee patients are scheduled to pay next year for non-emergency surgeries under the company’s standard option.

The hearing was called after the Federal Diary reported last week that patients would have to pay 100 percent for surgery performed by out-of-network physicians up to a maximum of $7,500. Currently, the rate is 25 percent of what the company sets for a procedure, plus any difference between that and the billed amount.

Federal employees also complained to the committee, with one, Davis (D-Ill.) said, writing that the “proposed coverage would also expose subscribers to financial duress.”

Del. Eleanor Holmes Norton (D-D.C.) said the situation also raises questions about the “failure of the honest broker” role by the Office of Personnel Management, which oversees the Federal Employee Health Benefit Program.

-Joe Davidson

By Terri Rupar  |  December 3, 2008; 12:30 PM ET  | Category:  Health Care
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Comments



Isn't it obvious??? Blue Cross/Blue Shield is punishing surgeons that have decided not to be particpating providers. By refusing to cover even one penny of their surgeon's fee until it exceeds $7,500 (which has to cover the vast majority of their surgical procedures), it is hoping they will feel the sting of losing patients, and that this move will force the surgeons to sign up to participate with Blue Cross/Blue Shield. I am no expert in the field, but maybe there is an unfair/anti-competitive trade practice or anti-trust violation in this somewhere.

Posted by: bsmith3 | December 3, 2008 4:52 PM | Report abuse

Half the Federal employees I know have or are having surgery. Their backs, their knees, they girl parts, their boy parts, their feet.... Name a body part and somebody is having something done.

$7,500 is a fraction of what a surgery and it's accompanying hospital, drug and associated costs run up to.

Maybe asking employees to pay up will make them, and their surgeons who've decided to not-participate think again.

Posted by: RedBird27 | December 4, 2008 10:08 PM | Report abuse

To RedBird27:
You cannot seriously believe that Federal empoyees as a class, generally undergo back surgery, heart surgery, brain surgery, or especially surgery to their private parts just to take advantage of a health care benefit. Everybody knows one or two jerks, and just because you know one that happens to be a federal employee, is not justification to engage in stereo-typing. In my case, I know you, and you are a jerk. So what do you do for a living? Maybe I can sterotype that group. By the way, you showed you do not understand the issue, and are just looking for an excuse to dump on civil servants when you said "$7,500 is a fraction of what a surgery and it's accompanying hospital, drug and associated costs run up to." Putting aside that you ended your sentence with a preposition (tsk, tsk :) the issue here is not the total cost and amount of insurance coverage of a surgical procedure. The issue is only the cost and coverage for the indivdual surgeon's or surgeons' fee for one day. $7,500 per day is well within the range of the surgeon's fee for all but the most extraordinary of procedures. So the new Blue Cross provision means an insured would pay 100% of his/her surgeon's fee in most cases. That is not insurance. That is a provision to force you into staying in the network, just like an HMO. Fine, perhaps, if you are subscribing to an HMO, but if you have signed up for and pay premiums for a PPO plan, then it is fraud and deception by Blue Cross. I do not believe for one second that it was an accident that Blue Cross failed to include the new provison in its summary of new features. But now they are sorry. That is, sorry they got caught.

Posted by: bsmith3 | December 5, 2008 12:21 PM | Report abuse

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