Dems deride big FEHBP changes lost in 'fine print'
By Melissa Turley, cyberFEDS® Washington Bureau
WASHINGTON -- Some 4 million federal employees in the Blue Cross Blue Shield Standard Option received some disquieting news this open season. For the first time, enrollees who elect out-of-network surgery will be responsible for 100 percent of the cost up to $7,500, effective Jan. 1. They are currently responsible for 25 percent of the plan's allowance plus any difference between that and the billed amount. But what really stuck in the craw of Democrats on the House federal workforce subcommittee is that the Office of Personnel Management "buried" the information in benefit materials so that unsuspecting enrollees who automatically renew coverage wouldn't think to look for it. "This unfortunate revelation will make subscribers look closer. The cost increase is in the fine print," Del. Eleanor Holmes Norton, D-D.C., said. "But ... federal employees, they get it." Open season ends Monday, so benefits administrators should be prepared to assist federal employees who wish to make changes to their coverage in the waning days of the period.
Surgery includes obstetrical care, biopsy procedures, treatment of burns, and colonoscopy, among other procedures. The $7,500 is not a onetime deductive expense and applies for each additional procedure. It does not pertain to emergency surgery or surgery for accidental injuries. For emergency surgery, members are responsible for 30 percent of the plan allowance, which is subject to the deductible. They must also pay the difference between the allowance and billed charges up to $5,000. For surgeries performed within 72 hours of an accidental injury, the member must pay the difference between the surgeon's bill and the plan allowance, up to $5,000, but the deductible does not apply.
Nancy Kichak, OPM's associate director for HR policy, defended her agency. She said the change was designed to protect enrollees who were paying upwards of $10,000 or more for treatment. In one case, a BCBS member paid $58,000 for back surgery, while BCBS paid $5,700 for the procedure. "Patients could not predict their out-of-pocket costs when using non-participating providers until the health expenses had been incurred and benefits were provided by the doctors," Kichak said. She emphasized that employees will have to make more informed decisions about their coverage, and that the change doesn't apply to employees who use in-network physicians.
Still, Dr. Peter Petrucci, president of medical staff for Sibley Memorial Hospital, said patients should have the right to choose their doctors. This could be achieved by BCBS keeping the costs for anesthesia, surgery, endoscopic procedures, and emergency room care at the 2008 level. He also took issue with the fact that BCBS and other insurers leave "surgery" loosely defined when it can include a procedure as minimal as resetting a bone.
Rep. John Sarbanes, D-Md., recommended OPM offer enrollees a choice of paying the 25 percent or $7,500 for enrollees using out-of-network coverage. Kichak said OPM will take the proposals into consideration. She also vowed to improve the agency's benefits communication after Norton claimed their materials were written too "bureaucratically." "We will work on the language," Kichak replied. Stephen Gammarino, senior vice president for BCBS Association National Programs, said the benefit may be redefined for 2010. "Ironically, it was to protect our members from having to pay exorbitant balances that we worked with OPM to negotiate a different benefit," he said.
Other noteworthy changes to BCBS Standard Option for 2009, according to the BCBS brochure, include:
Per visit physician co-payment will increase from $15 to $20.The catastrophic limit for preferred providers will boost from $4,500 to $5,000.
The hospital copayment per admission will go up from $100 to $200.
Copayment for mail order drugs will rise from $35 to $65 for a 90-day supply.
By Melissa Turley, cyberFEDS® Washington Bureau
WASHINGTON -- Some 4 million federal employees in the Blue Cross Blue Shield Standard Option received some disquieting news this open season. For the first time, enrollees who elect out-of-network surgery will be responsible for 100 percent of the cost up to $7,500, effective Jan. 1. They are currently responsible for 25 percent of the plan's allowance plus any difference between that and the billed amount. But what really stuck in the craw of Democrats on the House federal workforce subcommittee is that the Office of Personnel Management "buried" the information in benefit materials so that unsuspecting enrollees who automatically renew coverage wouldn't think to look for it. "This unfortunate revelation will make subscribers look closer. The cost increase is in the fine print," Del. Eleanor Holmes Norton, D-D.C., said. "But ... federal employees, they get it." Open season ends Monday, so benefits administrators should be prepared to assist federal employees who wish to make changes to their coverage in the waning days of the period.
Surgery includes obstetrical care, biopsy procedures, treatment of burns, and colonoscopy, among other procedures. The $7,500 is not a onetime deductive expense and applies for each additional procedure. It does not pertain to emergency surgery or surgery for accidental injuries. For emergency surgery, members are responsible for 30 percent of the plan allowance, which is subject to the deductible. They must also pay the difference between the allowance and billed charges up to $5,000. For surgeries performed within 72 hours of an accidental injury, the member must pay the difference between the surgeon's bill and the plan allowance, up to $5,000, but the deductible does not apply.
Nancy Kichak, OPM's associate director for HR policy, defended her agency. She said the change was designed to protect enrollees who were paying upwards of $10,000 or more for treatment. In one case, a BCBS member paid $58,000 for back surgery, while BCBS paid $5,700 for the procedure. "Patients could not predict their out-of-pocket costs when using non-participating providers until the health expenses had been incurred and benefits were provided by the doctors," Kichak said. She emphasized that employees will have to make more informed decisions about their coverage, and that the change doesn't apply to employees who use in-network physicians.
Still, Dr. Peter Petrucci, president of medical staff for Sibley Memorial Hospital, said patients should have the right to choose their doctors. This could be achieved by BCBS keeping the costs for anesthesia, surgery, endoscopic procedures, and emergency room care at the 2008 level. He also took issue with the fact that BCBS and other insurers leave "surgery" loosely defined when it can include a procedure as minimal as resetting a bone.
Rep. John Sarbanes, D-Md., recommended OPM offer enrollees a choice of paying the 25 percent or $7,500 for enrollees using out-of-network coverage. Kichak said OPM will take the proposals into consideration. She also vowed to improve the agency's benefits communication after Norton claimed their materials were written too "bureaucratically." "We will work on the language," Kichak replied. Stephen Gammarino, senior vice president for BCBS Association National Programs, said the benefit may be redefined for 2010. "Ironically, it was to protect our members from having to pay exorbitant balances that we worked with OPM to negotiate a different benefit," he said.
Other noteworthy changes to BCBS Standard Option for 2009, according to the BCBS brochure, include:
Per visit physician co-payment will increase from $15 to $20.The catastrophic limit for preferred providers will boost from $4,500 to $5,000.
The hospital copayment per admission will go up from $100 to $200.
Copayment for mail order drugs will rise from $35 to $65 for a 90-day supply.
