Joe Patrissi: Answers needed on switching state retirement health plan

Joe Patrissi: Answers needed on switching state retirement health plan

This commentary is by Joe Patrissi of South Burlington, who began his state employment 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 Northeast Kingdom Community Action from 2010 until he retired in 2018.

I offer this commentary to all retirees of Vermont state government, their families, and to all active state employees and their families, because this can affect them all.

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

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

In small print it mentions that it’s a PPO and HMO plan with a Medicare contract and says “non contracted/out of network providers are under no obligation 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 to see providers such as naturopathic, integrative, homeopathic, specialists or providers who won’t take Medicare or Medicare Advantage plan insurance.

I wrote to the governor’s office about this potential switch. The reason I did, aside 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 Oct. 8, the headline read: “How Insurers Exploited Medicare for Billions.” It’s a troubling 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; who were paid more if their patients were the sickest; who billed diagnoses for illnesses that didn’t exist.

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 “misnomer” and has to deal with multiple insurers bundled together. The amount of paperwork is consumptive.

When there is an error, “who is responsible” for the problem or getting it fixed is frustrating and overwhelming, especially if there are complex health issues to address. The bottom line is that the coverage isn’t as good as an active UVM employee of 31 years.

Comments from others, including MEDPAGE Today, portray frustrating prior authorization, denials and delays for serious illness cases, making the patient feel insecure about getting needed care when it counts most.

Now, I want to be clear. I’m not an expert on any insurance plan. Nor am I casting judgment on the Vermont Blue Advantage (Medicare) plan the governor’s office says is just as 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 issues than working employees because they are older, the stakes are high for retirees if Vermont Blue Advantage turns out to be not just less expensive (and thereby saving money for the state and retirees in premiums), but less effective, accessible and helpful to those of us at a certain age really count on in a time of need.

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 employees union and putting his proposal on the bargaining table?

If it’s as good as he says it is, then let the employees weigh in, do their due diligence and join him formally in making a decision that affects not just the current retirees but future ones too. It would be a win-win.

Conversely, if the governor is not willing to put it through bargaining, then it becomes one of those “too good to be true” sales jobs that may likely turn out to be just that.

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Tags: BlueCross BlueShield, Joe Patrissi, medical advantage, retired


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