Blue Cross Alters Planned Health Care Change

Posted December 16, 2008 at 3:54pm

Congressional staffers currently under a popular health care plan will not have to pay the entire expense for out-of-network surgeries that cost less than $7,500 — a policy that was supposed to go into effect Jan. 1.

Blue Cross Blue Shield recently reversed their decision, after Members questioned whether federal workers were aware of the change.

Now, employees under Blue Cross’ Standard Option plan will pay 30 percent of the plan’s allowance for the surgery, plus the difference between the allowance and the surgeon’s actual bill. It’s almost identical to the 2008 plan, which required workers to pay only 25 percent.

In a letter to the plan’s members, Blue Cross Blue Shield officials explained why they chucked the $7,500 co-pay and reverted to something very similar to their old policy.

The original 2009 plan, they said, “did not provide for the payment of benefits for surgeries costing less than the $7,500 limit, and was not consistent with the way we provide coverage for other types of care you may receive from out-of-network providers.”

The Office of Personnel Management suggested the co-pay in negotiations with Blue Cross. Officials say it was an effort to help employees who are stuck with bills in the tens of thousands of dollars for some out-of-network surgeries.

Under the original provision — now defunct — no one would pay more than $7,500. It would be an increase for those having small out-of-network surgeries, and a large discount for those who had complicated, expensive ones.

By nixing that provision, everyone will now get some discount, but a few will still end up with bills in excess of $10,000.

In an effort to prevent federal employees from being surprised at such large bills, Blue Cross also announced that it will offer specific benefit information for those having a non-emergency surgery that costs $5,000 or more.

The changes come about two weeks after the House Oversight and Government Reform Subcommittee on Federal Workforce, Postal Service and the District of Columbia held a hearing on the issue.

Members questioned whether OPM had sufficiently informed employees of the change, pointing to the fact that the agency only mentioned it on page 10 of a 137-page booklet.

Days later, OPM agreed to reopen negotiations with Blue Cross. It is also allowing federal workers to switch health care plans until Jan. 31. The original deadline was Dec. 8.