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Entries in Mesa County Health Insurance (1)

Friday
Oct242014

Mesa County Employee Healthcare Options in Question. No Real Answers from Frank Whidden regarding St. Mary's.

Subject: Confusion over Health InsuranceCommissioners:Last Friday, I submitted a CORA request asking for a copy of the recent Email sent to County employees regarding 2015 health insurance.  I also asked for a copy of any documentation that will be distributed at the upcoming  "open enrollment". Yesterday, Angela provided two documents which are attached.

Please note that the Email sent from Frank Whidden to staff on October 14 says that "St. Mary's hospital will be in network for services that Community Hospital cannot provide at this time (such as maternity, emergencies, radiology, etc.)".

The handout to employees defines (on page 5)  in network hospitals to be  "Community Hospital and University of Utah Hospital"  All other hospitals are out  of network  "except  for emergency care and maternity".   By this definition there are only two services that will be treated as in network if provided at St. Mary's.   This is way different than what was said in Frank's email.  If this wording is to be believed, many patients will be faced with choosing between paying through the teeth to stay at St. Mary's or being shipped to Salt Lake City.   Think of pre-mature babies, pediatric ICU,  cancer patient, heart patients, neurosurgery, etc.

I have attached the 2014 EPO schedule of benefits which lists  (on page 4) a whole variety of services that are treated as in network if provided at St. Mary's.  No such list is included for 2015 and there is no disclosure to employees that  the option of using St. Mary's has been changed. In fact, at the top of page 6 of the employee handout it says "EPO Plan Design - No Change".

Obviously one of the stories has to be changed quickly and I imagine the temptation will be to stick to what Frank said in the Email because that will cause the least grief to employees.  But the financial impacts of taking the easy way out should be considered carefully.

On October 6, Frank distributed the attached document with the title "Hand out 10_6_14."  On page 4, the "Claims @ maximum"  line is $7.6 million if there is "no change to benefits or network" and $6.4 million "with U of U and Community as in-network facilities".   At the meeting Frank explained that these amounts are the aggregate  limits for the two options assuming the same premium amount is paid to Sun Life of Canada.   Frank also explained that the reason Sun Life has the two quotes is because they were told that--except for maternity and ER--St. Mary's would be treated as out of network.   Several times he emphasized the word "steerage"  to describe the intentional effort to steer business away from St. Mary's.,

If Sun Life has been told that the St. Mary's changes have been implemented and the County instead allows in network treatment at St. Mary's as defined in Frank's email, the County may be breeching its contract with Sun Life.  If the County goes back to Sun Life and changes the rules, Sun Life will surely either increase the premiums it charges or increase the level of risk assumed by the County. If either action is taken, the 2015 budget will need to be increased even further to make up for the mismanagement of the plan.

The Commissioners need to take control of this process--NOW!  Obviously the staff is way over its head and is creating as unacceptable level of risk for Mesa County. 

The employees deserve to be told the truth.

Dennis

P.S.  The handout to employees does not disclose the out of pocket max for out of network services.  Does that mean there is no out of pocket max?   If there is no out of pocket max, the decision to make St. Mary's out of network could be even more catastrophic to county employees.

P.P.S.  The 2015 "travel benefit" is limited to $1.000 per year.  The cost to transport a premie baby to Salt Lake is probably closer to $20,000.   Will the employee be responsible for the difference?

Now let's sit back and watch who caters to Federal Overreach from the progressive big government insiders of Mesa County government headquarters when the tax payer funded paychecks get smaller and smaller for the little people inside those same walls.  Stay tuned!

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