Blue Cross/Blue Shield Fee Changes Outrages Some Federal Workers

Blue Cross/Blue Shield is making some federal employees and their doctors sick.

They are upset because under the health insurance company's standard option next year, patients will pay 100 percent for an operation by an out-of-network physician, up to a maximum of $7,500, "per surgeon, per surgical day," according to the Service Benefit Plan.

Currently, the rate is 25 percent of what the company sets for a procedure, plus any difference between that and the billed amount.

Pat Staples, member services manager for Blue Cross/Blue Shield federal employee programs, said the change "protects the members upfront" by letting them know what their maximum out-of-pocket expense will be.

That's little comfort to Susan Rissler-Sheely, retired from the U.S. Geological Survey.

Since 2004, the Charles Town, W.Va., resident has had five surgeries -- for knee and shoulder replacement and to repair broken bones -- with one physician. Three more are scheduled.

"He knows my bones, he knows my medical history and system, and I don't want to change doctors, so I think I'm going to be forced to change health insurance," Rissler-Sheely said. "We've been with Blue Cross/Blue Shield about 15 years."

The outrage at the fee change is so great that opponents have engaged Dezenhall Resources, a Connecticut Avenue public relations firm, to help make their case. Dezenhall encouraged Rissler-Sheely to contact The Washington Post. The firm's Jason Miller said it represents doctors and patients, but he would not say who hired the company.

A number of readers have contacted the Federal Diary about the fee change in recent days. For the most part, the communications do not appear to have been coordinated.

"I don't think OPM [the Office Personnel Management] should have let them" change the fee, said Walt Francis, principal author of Checkbook's 2009 Guide to Health Plans for Federal Employees.

I contacted him for his view of the situation rather than the other way around. He doubts the fee change will reduce the firm's expenses very much, while costing the company in the customer and public relations department.

The information Blue Cross/Blue Shield has distributed includes information on the change, but many people don't read the many clauses buried in the plan's 136 pages.