Joe Patrissi: Answers needed on switching state retirement health plan

This commentary is by Joe Patrissi of South Burlington, who began his state job in 1970 as a corrections officer, then commissioner of corrections from 1986 to 1991 and deputy commissioner of economic services from 2005 to 2010. He was executive director of the Community Action of the North of the Kingdom. from 2010 until he retired in 2018.

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

Gov. Phil Scott is strongly considering substituting a Medicare Advantage plan — specifically, Vermont Blue Advantage — in place of the BlueCross BlueShield health insurance that all retirees and active employees now have.

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

In small print it mentions that it is a PPO and HMO plan with a Medicare contract and says “non-contracted/out-of-network providers are not required to treat Vermont Blue Advantage members except in emergency situations “.

Currently, for retirees, BlueCross BlueShield is a second payer after Medicare for those of us over 65. This allows us, for example, to go see providers such as naturopaths, integrators, homeopaths, specialists or providers who do not take Medicare or Medicare Advantage plan insurance.

I have written to the governor’s office about this potential change. The reason I did it, apart from concerns that, under this program, provider networks may be limited to only Medicare Advantage insurance, is that too many of these plans have a very controversial reputation.

In a story in the New York Times on October 8, the headline read: “How Insurers Exploited Medicare for Billions.” It’s a disturbing story about Medicare Advantage plan insurers who urged doctors and gave them incentives to add additional illnesses to patients they hadn’t seen in weeks; that they were paid more if their patients were the sickest; who billed diagnoses for diseases that did not exist.

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These plans and insurers have been investigated for fraud, audited and sued. While insurers have disputed 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 that the concept of “Advantage” is a “snomer misnomer” and has to deal with several insurers together. The amount of documents is consumed.

When there is an error, “who is responsible” for the problem or to solve the problem is frustrating and overwhelming, especially if there are complex health problems to deal with. The bottom line is that the coverage is not as good as a 31-year-old active UVM employee.

Comments from others, including MEDPAGE Today, outline frustrating prior authorization, denials and delays for cases of serious illness, making the patient feel insecure about getting the care they need when it matters most.

Now, I want to be clear. I am not an expert in any insurance plan. Nor do I have any judgment on the Vermont Blue Advantage (Medicare) plan that the governor’s office says is equally good or better and cheaper in premiums than the current BlueCross BlueShield retired employees currently enjoy.

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 is not only less expensive (and thus save money for the state and pensioners). in premiums), but less effective, accessible and useful to those of us at a certain age really count in a time of need.

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Here’s the thing: If something this important is really better and cheaper than what we have now (which is counterintuitive), if it’s such a good deal, why isn’t the governor going to the Vermont state employee union and put his proposal on the negotiating table?

If he is as good as he says, then let the employees weigh in, do their due diligence and join him formally to make a decision that affects not only current retirees, but future ones as well. It would be a win-win.

On the contrary, if the governor is not willing to enter into the negotiation, then it becomes one of those sales jobs “too good to be true” that can probably be right.

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