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Beating the Insurance Blues

Rep. Danny K. Davis (D-Ill.), a House subcommittee chairman, chastised the Office of Personnel Management for the previous 2009 surgical insurance fee structure.
Rep. Danny K. Davis (D-Ill.), a House subcommittee chairman, chastised the Office of Personnel Management for the previous 2009 surgical insurance fee structure. (By Morry Gash -- Associated Press)

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By Joe Davidson
Wednesday, December 17, 2008

Protest works.

Certainly that's one message federal employees can take away from the decision yesterday by Blue Cross/Blue Shield to revise its 2009 fee structure for non-emergency surgery by out-of-network doctors.

In response to outraged workers who have the Blues standard option, and troubled members of Congress, the company announced that it will pay 70 percent of the fee it allows for such procedures, leaving the patients responsible for 30 percent, plus any difference between the allowed amount and the actual charge.

The patients' 30 percent share amounts to a five-percentage-point increase from the existing plan and is consistent with other out-of-network fees for the coming year.

Under a plan previously announced for 2009, Blue Cross/Blue Shield members would have had to pay 100 percent of the surgery fee, to a maximum of $7,500, per surgeon, per surgical day.

"We're very pleased that this change has come about," said Peter E. Petrucci, president of Sibley Memorial Hospital's medical staff. He was a vocal critic of the Blues' previous 2009 fee structure. Now he says: "I think it's a huge benefit for the people who are covered by this plan."

The decision to modify the surgical benefit was made after Blue Cross/Blue Shield came under sharp criticism from federal workers. The House subcommittee on the federal workforce, postal service and the District of Columbia held a hearing on the issue after the Federal Diary first reported on it last month. At the session, Chairman Danny K. Davis (D-Ill.) and other members made clear their displeasure, particularly with the Office of Personnel Management, which oversees the Federal Employees Health Benefit program.

A chastised OPM reluctantly allowed health insurance companies to revise their surgical benefit and permitted employees to change their insurance selections through the end of January, even though open season officially ended Dec. 8.

The Blues also added, in a letter to plan members, a feature they are calling "a special service for situations where the surgeon's bill will be $5,000 or more." In those cases, they are encouraging members to call a phone number shown on the back of their insurance ID card to learn what the insurance company will pay for an operation. This will allow them to estimate out-of-pocket costs for the surgery.

"We strongly encourage you to take advantage of this new service," the letter says.

Doctors will like this feature, too.

Previously, the Blues would not provide advance information on what the company would pay for a procedure, leaving doctors and patients to guess, Petrucci said.


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© 2008 The Washington Post Company

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