Insurance Benefit Changes

Insurance Benefit Changes

Ralph W Nobbe

11/5/2003

Dear List members;

I recently went through the rather painful process of reviewing our company
health insurance benefit and obtaining quotes for replacement (cheaper/less
expensive) policies. We just got hit with the third double digit premium
increase in the past 18 months. Several interesting things came to light
during the process concerning the benefit changes being made by the
insurance companies that will adversely impact our patients, clients,
employees and businesses.

All plans available and offered to us as a small group employer in
California have an annual cap on the DME and OP benefit. This cap is most
frequently either $2000 or $5000 per annum with co-pays ranging from 20-50%.
Our broker happens to be a good personal friend and has always been able to
find us good competitive rates and benefits. He further researched this on
my behalf. He found that major insurers, in the states where it is legal to
do so, are limiting their DME/PO benefits in this manner. This is most
common in the renewals for small group employer benefit packages. Seems to
smell/reek of some insurance collusion...

We are currently in the open renewal season. Benefits and plan switches
are being made by employees of large group employer policy holders. We have
recently experienced, since October 31st, several established patients
coming in that have had their benefits reduced to these same limits on their
existing plans. They did not read the fine print prior to re-enrollment.
Several of these patients have gotten a very rude surprise when they were
told they now had a VERY limited benefit and that they have a significant
financial responsibility. Previously many of these same patients had full
coverage with a copay but
no predetermined cap. Any costs over the cap are patient responsibility
typically at your contracted, discounted rates.

This trend is occurring nationwide. It appears to be in direct response to
the high cost P&O devices(micro-processors and vacuum suspension systems
come to mind). These services are utilized by a VERY small percentage of the
beneficiary populations but the unit cost is very high.

My thoughts are that 1)the insurance industry has acted in a collusive
manner(are you listening AOPA???) 2)it is directed and targeted to the
population that has the most difficulty accessing care due to disability(are
you listening support groups???BARR foundation???, United cerebral palsy
association??? others???) 3) it is in direct response to the costs of O&P
(pay attention manufacturers) 4) direct response to the abuse in DME.

My recommendation is that everyone pay attention and scrutinize the benefits
you are being offered and the benefits available to you as - patient,
employee or employer. Are your discounted provider contracts really still of
value?

Ralph W. Nobbe, CPO



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