WASHINGTON – In a letter to the American Federation of Government Employees, Blue Cross/Blue Shield announced a new benefit structure for 2009 that will “restore the cost-sharing our members expect from us, and a service that will preserve the right to use non-participating providers while providing our members with information to help avoid unexpectedly large bills from non-participating providers.”
“According to the revised Standard Option, enrollees will no longer have to pay the first $7,500 for every treatment or surgery provided by an out of network provider,” explained Jacque Simon, AFGE director of public policy. “However, the enrollee will have to pay thirty percent of BCBS’s ‘allowance’ for each service plus 100 percent of the balance if the provider charges a higher price than the ‘allowance.’”
For example, if an enrollee had a service performed by an out-of-network provider and the charge was $2,500, under the terms BCBS just retracted, the enrollee would have had to pay the entire $2,500. Now, the enrollee will have to pay thirty percent of the $2,500 or $750 as long as the allowance is the full $2,500. If the allowance is just $2,000, the enrollee has to pay thirty percent of $2,000 or $600 plus the full $500 over the allowance for a total of $1,100. In 2008, BCBS paid 75 percent of the allowance, for 2009 they will pay just 70 percent.
“While this partial retraction by Blue Cross/Blue Shield is better than what was originally accepted by OPM, the bottom line is that it is still a decrease in benefits for our members as compared to the level of coverage in 2008. We are encouraged that OPM and BCBS have responded to the outrage expressed by our members and Congressional leaders at the drastic reductions in the Standard Option’s benefits.”
“Given the enormous premium increases for 2009, and the continued cost shifting to enrollees, we think OPM could have done much a much better job of negotiating on our behalf,” concluded Simon. “If most of this benefit cut could be cancelled, all of the benefit cut could have been cancelled. OPM is still letting BCBS get away with changes that are entirely unjustified. AFGE has more than four million members enrolled in this plan and we will continue to fight for a voice in the annual negotiations over benefits and process.”