The Full Story on the Blues Hearing
The nation's largest provider of health insurance for federal employees, under fire for changes to its benefits package, says it is willing to make adjustments in answer to the complaints if only Uncle Sam would let it.
Stephen W. Gammarino, a senior vice president of the Blue Cross/Blue Shield Association, told a congressional hearing yesterday that the Blues are reexamining fee increases for the 2009 surgery benefit, the focal point of the protests, and the association is "working with OPM to pursue an alternative."
But the Office of Personnel Management says no.
Nancy Kichak, an OPM associate director, told the House subcommittee on the federal workforce, postal service and the District of Columbia that "it would be unfair to reopen negotiations with a single plan" and not do so with the other 268 that provide insurance to all the Frank and Flo Feds.
Kichak also rejected pleas from committee members to extend Open Season, the period when workers can change plans. The representatives argued that a longer period -- it's now scheduled to end Monday -- would allow federal workers more time to learn about changes in the Blue Cross/Blue Shield standard option, which covers more than half the employees and their dependents. But Kichak replied that could delay the process needed for coverage, such as getting insurance cards to patients.
The hearing was organized after the Federal Diary reported last week that standard option members next year will pay 100 percent for surgery by an out-of-network physician, up to a maximum of $7,500, "per surgeon, per surgical day."
Currently, the rate is 25 percent of what Blue Cross/Blue Shield sets for a procedure, plus any difference between that and the billed amount.
Exacerbating the problem is the Blues' broad definition of surgery.
"It includes the treatment of fractures and dislocations including casting, biopsy procedures, removal of tumors and cysts, treatment of burns, obstetrical care including childbirth, and diagnostic colonoscopy and other endoscopic procedures," complained Peter E. Petrucci, president of Sibley Memorial Hospital's medical staff.
Gammarino and Kichak said the fee change was designed to protect patients from paying huge fees that could result from the current system.
"We reasoned that if we capped the members' out-of-pocket costs, we could relieve some of the burden placed on members who choose nonparticipating providers for what is typically the most expensive type of professional service that they receive," Gammarino said.
He's willing to make modifications, but he cannot do so if OPM won't let him. Rather than hunkering down in a defensive posture, he projected the image of a concerned and savvy businessman who knows when it's time to adjust course to meet customer demands.
He said the concern about the surgical benefit change "is justified, and we have reexamined the benefit design for 2009." Although he said he was working with OPM on alternatives, Kichak's testimony indicated that probably fits more in the category of wishful thinking than stone, cold reality.
Gammarino's testimony did not go into details about possible alternatives, though he did say that he could "administer the benefit in a way that is consistent with other services that are covered out-of-network. The alternative will not result in an increase in our premiums."
One possibility is aligning the surgical option with the way other out-of-network services are paid -- 70 percent by the Blues, 30 percent by the patient. Another is cutting back on the long list of things considered surgical procedures.
Despite Kichak's firm defense of the status quo, the agency still could be dragged kicking and screaming to make adjustments.
Rep. Danny K. Davis (D-Ill.) made it clear that as chairman of the panel that deals with many OPM issues, he wants the agency to at least consider extending Open Season.
Beyond the hearing, he has other tools to pressure OPM to make concessions to the legion of angry feds.
In an interview after the session, he spoke of issuing a "public call" to increase pressure on OPM and later did that through a news release urging an extended Open Season.
But a longer Open Season would only give more people more time to become angry over the changes.
In contrast to Gammarino's flexible posture, Del. Eleanor Holmes Norton (D-D.C.) said, Kichak acted like a bureaucrat who could see only one solution to a problem.
In an interview, Norton encouraged Kichak to think "like the best bureaucrats do, think of alternatives then . . . decide what are the best alternatives."
You can find a webcast of the hearing and copies of testimony here.
-Joe Davidson
By
Terri Rupar
|
December 4, 2008; 8:44 AM ET
| Category:
Health Care
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Posted by: Parcons | December 9, 2008 7:41 PM | Report abuse
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As I read the policy information it seemed to me that BCBS was engaged in some awful cost shifting. If you would consider that that the premiums for Medicare have remained static then the changes in the coverage with the increase in premiums is a joke.
The pharmacy program is also a joke.
Examples of both. A three day hospital stay for phenomonia billed to Medicare for 7256.00
was allowed at 6140.00 BCBS as secondary coverage paid 2700.00 the total was greater than the hospital billed at supposed retail.
On the pharmacy coverage prilosec 40 mg is presently 35.00 for 90 DAY SUPPLY. IT IS SCHEDULED TO GO TO 50.00. ORDER IS AS A GENERIC AND YOU GET THE SAME CAPSULE FOR 10.00 NOW AND FOR ZIP AFTER THE FIRST OF THE YEAR.
The other major problem is as retiree family of 2 adults we pay the same rate as every one else even though BCBS is secondary and only pays the difference between the allowed amount and the paid amount. There is no balance billing allowed.
It appears OPM is doing a lousy job negotiating. They must be afraid of the blues!