Joe Patrici: Answers needed on state pension health plan change

This comment is by Joe Patrici of South Burlington, who began his public service in 1970 as a prisons officer, then commissioner of corrections from 1986 to 1991 and deputy commissioner of economic services from 2005 to 2010. He is was executive director of Northeast Kingdom Community Action from 2010 until his retirement in 2018.

I offer this comment to all Vermont state government retirees and their families and to all active government employees and their families because it may affect them all.

Gov. Phil Scott is strongly considering replacing the Medicare Advantage plan — specifically Vermont Blue Advantage — in place of the BlueCross BlueShield health insurance that all retirees and active-duty workers now have.

My wife and I received a brochure about Vermont Blue. It lists several “benefits” in large print. These include: vision, dental, telehealth, hearing, prescription drugs, over-the-counter drug benefit, hospital and medical care, and national and worldwide coverage.

The fine print mentions that this is a PPO and HMO plan with a Medicare contract and says that “non-contracted/out-of-network providers are not obligated to treat Vermont Blue Advantage members except in emergency situations.”

Currently, for retirees, BlueCross BlueShield is the second payer after Medicare for those of us over 65. This allows us, for example, to go to providers such as naturopathic, integrative, homeopathic, specialist or providers who do not accept Medicare or Medicare Advantage Plan Insurance.

I have written to the governor’s office about this potential change. The reason I did that, aside from the concern that under this program the provider networks might be limited to only Medicare Advantage insurance, is that too many of these plans have very controversial reputations.

An article in The New York Times on Oct. 8 headlined, “How Insurers Exploited Medicare for Billions.” It’s a troubling story for Medicare Advantage plan insurers, who have called out doctors and incentivized them to add additional illnesses to patients they haven’t seen in weeks; who are paid more if their patients are the sickest; who billed diagnoses for diseases that did not exist.

These plans and insurers have been investigated for fraud, audited and sued. Although insurers dispute these claims, some estimates put overbilling at $20 billion in 2020 alone.

Anecdotal examples closer to home are even more troubling. A retired UVM employee who has an Advantage plan found the concept of “Advantage” to be a “misnomer” and having to deal with multiple insurers bundled together. The amount of documents is required.

When there is an error, “who is responsible” for the problem or fixing it is frustrating and overwhelming, especially if there are complex health issues that need to be addressed. The bottom line is that the coverage is not as good as an active UVM employee of 31 years.

Comments from others, including MEDPAGE Today, describe frustrating prior authorization, denials and delays for cases of serious illness, leaving the patient feeling uncertain about getting the care they need when it matters most.

Now I want to be clear. I am not an expert on any insurance plan. Nor am I passing judgment on the Vermont Blue Advantage (Medicare) plan, which the governor’s office says is as good or better and cheaper than premiums currently enjoyed by current BlueCross BlueShield retirees.

But given the controversy and the fact that retirees have more health problems than working employees because they are older, the stakes are high for retirees if Vermont Blue Advantage turns out to be more than just cheaper (and thus saves money for the state and retirees in premiums) but less efficient, affordable and useful for those of us of a certain age who we really rely on in times of need.

Here’s the thing: if something so important is really better and cheaper than what we have now (which is counterintuitive), if it’s such a good deal, why doesn’t the governor go to the Vermont State Employees Union and put the proposal are you on the negotiating table?

If it’s as good as he says it is, then let the officials weigh in, do their due diligence, and join him formally in making a decision that affects not only current retirees, but future retirees as well. It would be profitable.

Conversely, if the governor is unwilling to negotiate, then this becomes one of those too-good-to-be-true sales jobs that could possibly turn out to be just that.

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Tags: BlueCross BlueShield , Joe Patrici , Medicare Advantage , retirees

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