A Fee Change by Blue Cross/Blue Shield Cuts Deep

By Joe Davidson
Wednesday, November 26, 2008

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.

"I don't think people should be exposed to a cost of that amount for a mistake in due diligence, in checking out their physicians' affiliation," Francis said.

Republicans on Corporate Boards

If you're a top Republican in government waiting for an invitation to join a corporate board, you might be disappointed. The scope of the party's election defeat could affect prospects for big time post-government gigs.

"Former government officials are much less in demand for company boards when their party is out of power," said Richard H. Lester of Texas A&M University. He authored a study in the current issue of the Academy of Management Journal with Amy Hillman of Arizona State University, Asghar Zardkoohi of Texas A&M and Albert A. Cannella Jr. of Tulane University.

When a party does not control the House or Senate or the White House, Lester said, "its members' chance of joining the board of a large corporation is about 30 percent less than it would otherwise be."

HUD on Sexual Orientation

Housing and Urban Development Secretary Steve Preston is getting kudos because of a memo he recently sent to department employees that said the agency "values diversity and has no tolerance for discrimination" based on sexual orientation.

Larry Bush, a HUD public affairs officer in San Francisco, said the Nov. 10 message was significant because it was the first time a HUD secretary distributed an all-employee communication on sexual orientation.

"Secretary Preston has really sought to bring the workforce more into a partnership than we've seen before and this was part of it," said Bush, who spoke in his role as a leader of HUD Globe, an organization that works to eliminate sexual orientation bias in the federal workplace. "He's created a vastly improved climate over what we saw just six months ago." Preston became secretary in June.

Among other things, Bush said Preston's policy establishes an ombudsman's position to consider discrimination complaints and defines family broadly to allow employees the use of leave to care for same-sex partners.

Contact Joe Davidson at federaldiary@washpost.com.