The Office of Personnel Management plans to stick with its November-December, four-week "open season" for the federal employee health program and not be swayed by contract disputes among providers, such as the disagreement in this area between CareFirst Blue Cross and Blue Shield and Children's Hospital.
Federal employees had until Dec. 9 to choose a health plan or switch their coverage. The deadline came about a month after contract talks between CareFirst and Children's broke down and about two weeks before the contract between the company and the hospital expires.
The combination of the timing of the open season and the contract dispute left a number of federally employed parents feeling sandbagged. The parents had to decide whether to choose another insurance company in the Children's network or keep their Blue Cross coverage and move to a hospital in the Blue Cross network.
"There is no consideration to extending the open season," Abby L. Block, the assistant director for insurance programs at OPM, said in an interview. "This is not the first or last contract dispute between a health plan and a provider."
Block said OPM, which oversees the Federal Employees Health Benefits Program, does not see the contract dispute, prompted by differences over payment rates, as a reason to "let people make a belated open-season change."
OPM, she said, will not take any steps "that would put either of those parties at a disadvantage" if they decide to restart negotiations before the contract ends Dec. 31.
As a practical matter, Block said, "if the open season ran until the end of the month, no one would have their health ID cards in time. We have looked at the timing of the open season and the length of the open season and have made the determination that, while what we've done is not the best of all possible worlds, it is a good way of handling it."
A number of federal employees, in telephone messages this week, said they were surprised to come home from work on Monday, the end of the open season, to find a letter dated Dec. 4 from CareFirst notifying them of the contract termination with Children's.
Block and Pam Deuterman, CareFirst vice president for government programs, said federal employees should not have been surprised by the letter. At the start of the open season, CareFirst's provider directory included a footnote indicating that no decision had been reached on Children's participation in the Blue Cross network for 2003. In addition, they said, employees have been informed of the dispute at health fairs and through the news media.
Deuterman said: "We in no way timed this letter to preclude FEP [federal employee program] members from considering the Children's Hospital contract termination as a factor in their decision on which health insurance plan to select during the annual open enrollment period. Most of the recipients would have received the letter either late last Thursday or Friday, had not last week's snowstorm disrupted operations of the vendor who handled the reproduction and mailing."
The purpose of the CareFirst letter, Block said, "was to start the clock running for the 90-day transition period that we require. . . . By waiting until Dec. 4, they extended the period well into the coming year when people can take advantage of transition services."
In the letter, CareFirst Vice President M. Bruce Edwards said CareFirst will provide benefits at existing levels for 90 days to federal enrollees. Starting Jan. 1, Edwards wrote, "CareFirst will make payments directly to the member for services on and after that date," instead of to Children's.
Children's and CareFirst are scheduled to meet Tuesday to discuss "continuity of care" issues, including how the hospital and insurance company will handle payments for covered services. Children's plans to ask CareFirst to allow the hospital to continue to care for children with special and ongoing medical problems.
On the Talk Shows Michael B. Styles, president of the Federal Managers Association, and Didier Trinh, director of government and public affairs at the FMA, will be the guests on "FEDtalk" at 11 a.m. today on federalnewsradio.com.
David Chu, Defense Department undersecretary for personnel and readiness, will be the guest on "The Business of Government Hour" at 8 a.m. tomorrow on WJFK radio (106.7 FM).
"Who Is Looking Out for Federal Employees?" will be the topic for discussion on the Imagene B. Stewart call-in program at 8 a.m. Sunday on WOL radio (1450 AM).
Stephen Barr's e-mail address is email@example.com.