Blue Cross Blue Shield Revises Surgery Fees, Including Obstetrics, Under Federal Employee Plan

Main Category: Health Insurance / Medical Insurance
Also Included In: Women's Health / Gynecology;  Public Health
Article Date: 19 Dec 2008 - 3:00 PDT

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In response to criticism from federal workers and members of Congress, the Blue Cross and Blue Shield Association has announced that it will revise its 2009 fee structure for out-of-network, non-emergency surgeries -- including obstetrical surgeries -- under its standard plan for federal employees, the Washington Post reports. BCBS -- the largest provider of federal employee health insurance plans -- previously had said members of the plan in 2009 would be responsible for 100% of the cost of an out-of-network surgery, up to a maximum of $7,500 per surgeon, per surgical day. According to the Post, the change "outraged" federal workers and "troubled" many members of Congress, who held a House subcommittee hearing on the matter earlier this month (Davidson, Washington Post, 12/17). At the hearing, BCBS officials said that they would re-examine the fee increase, but the Office of Personnel Management denied the request, saying that it was not willing to re-open negotiations for the plan (Daily Women's Health Policy Report, 12/4). However, a few days after the hearing, OPM agreed to renegotiate the plan with BCBS and allow federal employees to switch plans until Jan. 31, instead of the original deadline of Dec. 8, Roll Call reports (Yehle, Roll Call, 12/16).

Under the revised fee structure for 2009, BCBS will cover 70% of the cost and members will pay the remaining 30%, as well as any difference between the allowed amount and the actual bill. The patients' 30% share is consistent with other out-of-network fees under 2009 plans, the Post reports (Washington Post, 12/17). The new 2009 fee structure is similar to the 2008 plan, which required members to pay 25% of the surgery cost, Roll Call reports (Roll Call, 12/16). BCBS also announced a new service for members with non-emergency surgeries with bills of $5,000 or more. Under the service, members will be encouraged to call the company to receive an estimate for their out-of-pocket costs. A letter will be sent to members this week explaining the revisions, Stephen Gammarino, senior vice president of the BCBS Association, said (Washington Post, 12/17).

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