Claims problems, lower costs, cited in proposed SR insurance change
By: Darrell Todd Maurina
Posted: Tuesday, December 30, 2008 11:32 pm
ST. ROBERT, Mo. (Dec. 30, 2008) — Dissatisfaction by city employees with the insurance provided by Mercy Medical, as well as better prices offered by a competitor, led members of the St. Robert Finance Committee to recommend Tuesday evening that the full city council change its health insurance coverage.
If approved by city council members on Monday, the city’s new plan through the Anthem provider means city employees will be using doctors and other medical providers through the St. John’s system of clinics, one of which is in St. Robert, and the city will pay less for their insurance with a guaranteed premium increase next year of no more than 12 percent.
Many staff members working at the St. John’s Clinic in St. Robert also have offices in nearby communities such as Rolla or Lebanon. St. Robert city employees using the city’s insurance plan can use those offices as well, according to Shawn Nass, the city’s insurance broker. Any St. John’s provider outside of Greene and Christian County should be in their network, she said.
“This is a big change, we know it is a big change, and we wanted the employees to let us know if it was going to be positive or negative as far as they were concerned,” Nass told finance committee members. “I received only positive feedback after the meeting, but sometimes people will give me positive feedback and bring you negative.”
St. Robert City Clerk Debbie Adkins and City Administrator Norman Herren said they’ve also received no complaints about the proposed change.
“Some people are so glad we were changing,” Adkins said.
Nass said she offered all city employees the opportunity to meet with her to discuss insurance issues and about 50 did so in two separate meetings. Not only was there no objection to leaving Mercy Medical, some employees said they had significant concerns with the current insurance company.
“I was surprised to learn that we have got quite a number of claims issues going on that we didn’t know anything about. I think that what people are trying to do is they are trying to handle them themselves and not necessarily being successful,” Nass said. “I think we probably need to send out some type of notice to the employees to say, ‘If you’re frustrated with your problem, if there’s things going on and you’re not getting them resolved or you can’t get through to Mercy, then you need to let us know that.’”
Alderman Theresa Cook, who chairs the city’s finance committee and also coordinates insurance as part of her duties with the Waynesville R-VI School District, said it’s not necessarily a problem if people try calling the insurance company directly to resolve claims issues.
“You want them to try it themselves and if not, then we can help assist them along,” Cook said. “We want them to take the first step.”
Nass said that isn’t always the best way to resolve an insurance claims issue.
“Our problem is that right now, Mercy Health Plans are converting to a system — I don’t know what you’re seeing on the billing side — but there is a system conversion that has occurred and my office has experienced hold times between 45 minutes to an hour to get through to customer service,” Nass said.
Cook had a one-word response to the wait times: “Wow.”
Finding local doctors in the Anthem provider network isn’t always easy due to provider directories “which were not all-inclusive by any means,” Nass acknowledged, but weren’t tremendously difficult to locate. Nass gave a list of nine providers doing business at the St. John’s Clinic in Robert. One occupational medicine person who is only at the St. Robert clinic a few days per week could not easily be located via the web, Nass said, but the others could be found with some minimal work.
“Most of those physicians I found immediately on Anthem’s information; three of them I did not find as quickly because they are listed under Anthem with either a Rolla or Lebanon address,” Nass said. “To the best of my knowledge, we have not gotten any calls with regard to providers.”
Nass said Mercy Health Plans came back to her with a reduced set of rate quotes that would be only 4 to 5 percent higher than the Anthem quote, but she still recommended leaving Mercy.
“(Mercy’s rates) are slightly lower than current, which just really, really surprises me. I’ve never seen a carrier come back and come under what their current rates were, so I would say that if we had employees that were 100 percent satisfied with Mercy, we didn’t have any issues, we didn’t have any problems, and I had not gotten negative feedback from them based upon Mercy, we should probably look at that much more seriously,” Nass said. “The feedback about Mercy was negative enough that I’m not certain that people wouldn’t be upset if we didn’t make the change now.”
Nass cautioned that there’s one big difference between the Mercy and Anthem insurance policies: a surcharge for use of the emergency room rather than a clinic.
“I wanted people to understand that the reason that the emergency room is more costly under the Anthem plan is because we are preventing emergency room abuse,” Nass said. “If they need to go to the emergency room, they need to go, but if not, go to the urgent care center if they can find one somewhere close.”
Nass said Anthem’s low rate quotes were largely because of the cooperation of city staff members in filling out their individual health statements, which made it possible for Anthem to provide a better price quote, and the city might see less than the maximum 12 percent promised in the rate guarantee.
“Two of the babies that were calculated into these rates will be born before these rates ever go into effect,” Nass said. “That gives us just a little bit of wiggle room. Not enough that it’s worth going back to Anthem and say, ‘Hey, change this.’ … I would expect their 12 percent to be an average reasonable rate increase. It’s good for them and I think it’s good for us.”
While Nass said a 12 percent rate increase next year would follow insurance trends, Cook noted that a 12 percent increase would be substantially higher than what’s been seen recently in the area.
“That is a new trend because they haven’t been going up for maybe just the last two years or one year,” Cook said.
Finance committee members said a new policy change that will have city employees rather than outside personnel collecting insurance-related paperwork needs to be handled carefully.
“When an employee comes in, before they even hand us the paperwork, we are going to hand them a black marker and say, ‘If there is anything on that you want to cross it out, do it before you hand it to us,’” Herren said.
Cook cautioned that any city employees handling insurance-related paperwork should fill out a HIPPA (health insurance protection and portability act) statement.
“Some (city employees) are going to say, ‘No, it’s okay,’ but if we do that, it’s protecting the city a little bit more,” Cook said.
In other insurance-related matters, Cook noted that the city’s open enrollment period for vision and dental insurance will begin soon.
“Since this is open enrollment, this is the time for them to make any changes that they want,” Cook said.