NATIONAL POLITICS & POLICY | Blue Cross Blue Shield Re-Examining Coverage Cuts for Surgeries, Including Obstetrics
[Dec. 4, 2008]

An Office of Personnel Management official said Wednesday during a congressional hearing that OPM will not allow the Blue Cross Blue Shield Association to readjust changes in its health benefits plans for federal employees that would cut coverage for some surgeries, including obstetrical care, the Washington Post reports. The hearing was scheduled after the Post reported that BCBS -- the largest provider of federal employee health insurance plans -- was making changes that would significantly increase member expenses for out-of-network surgical procedures. According to the Post, one fact "[e]xacerbating the problems is the Blues' broad definition of surgery," which includes obstetrical care during childbirth, certain diagnostic procedures and various treatments. Current coverage requires members to pay 25% of the cost set by BCBS for an out-of-network surgery. Under the new coverage plan, members would pay 100% -- up to a maximum of $7,500 -- "per surgeon, per surgical day," the Post reports.

Stephen Gammarino, senior vice president of the BCBS Association, said that it is re-examining the fee increases for the surgery benefit and "working with OPM to pursue an alternative." However, Nancy Kichak, an OPM associate director, said that reopening negotiations for a single plan would be "unfair" to the other 268 companies that provide health insurance to federal employees. Kichak also rejected pleas from members of Congress to extend the open-enrollment period for federal workers to give them more time to examine their options, saying that to do so could delay the onset of coverage. The enrollment period is scheduled to end Monday.

Gammarino said that changes were designed to protect patients from paying large fees within the current system, adding that concerns about the surgical benefit change is "justified." He said that BCBS "could administer the benefit in a way that is consistent with other services that are covered out-of-network," which would not result in an increase in premiums. Rep. Danny Davis (D-Ill.), chair of the congressional panel, said he wants OPM to consider extending open enrollment, adding that he would pressure the agency to make concession (Davidson, Washington Post, 12/4).





The information contained in this publication reflects media coverage of women’s health issues and does not necessarily reflect the views of the National Partnership for Women & Families.

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