by Morgan True vtdigger.org Blue Cross and Blue Shield of Vermont says it will not seek further payment from health care providers or its customers for money owed on Vermont Health Connect accounts that weren’t terminated in a timely fashion. The state’s largest health insurer, and the dominant player in Vermont’s exchange, said it will hold the state responsible for any money it is owed once the insurer and the exchange reconcile their books — a process that is ongoing.
Blue Cross last month had sought payment from physicians for $514,000 in claims submitted for patients whose accounts were retroactively terminated. State officials said those claims were made on 600 of 6,000 policies from the past two years that were canceled retroactively.
Blue Cross said the half-million dollars it sought from doctors were for claims that could be billed to another payer, either Medicaid or a private insurance plan. It’s too cumbersome and difficult to continue making those determinations, and a spokesman for BCBSVT said the insurer does not wish to burden providers with that responsibility.
“The associated costs that come from lack of functionality fall to VHC, not to our members or providers,” said Cory Gustafson, Blue Cross director of government and public relations.
Steve Costantino, Department of Vermont Health Access commissioner, issued the following statement through a spokesman in response to a VTDigger inquiry:
“Vermont Health Connect and Blue Cross Blue Shield of Vermont continue to work closely together on 2014 reconciliation efforts. If that process determines that Blue Cross is owed funds, they would be right to expect Vermont Health Connect to pay, and certainly Vermont Health Connect would expect to honor its obligations.”
Gustafson declined to provide a figure for how much Blue Cross believes it is owed in past-due premiums and claims associated with terminated VHC accounts, adding that the total is a moving target.
Blue Cross CEO Don George addressed the reconciliation issue on June 1 during a press conference concerning the VHC "Change of Circumstance" upgrade (SEE VBM VIDEO BELOW PART 2 AT 17:35).
Asked by a reporter whether he was satisfied with the reconciliation process, George said, "It's preliminary for me to comment on my satisfaction with the reconciliation process because it's still ongoing... We're working with the state... We're simply not receiving the revenue that we should... Once it's complete we'll have an accurate picture of what that revenue number is. Until the reconciliation process is done, I don't have a number. I would say it's in the millions of dollars. It's not in the tens of millions of dollars, but neither in the hundreds of thousands of dollars... We have both revenue issues and claim issues that've been paid for people who have been terminated from Vermont Health Connect but have experienced claims after that period of time... We've not cut anyone off of their coverage. We're not dunning people for their late notices... We don't know how prevalent it's been... We feel that this can be resolved by the end of June."
Blue Cross said it will not raise rates as a result of costs it has incurred because of problems with Vermont Health Connect. The insurer’s rate request for the exchange next year is already filed, but those costs will not show up in next year’s request either, Gustafson said.
“2017 is a long way away, but that’s our policy. Our policy from the beginning was to have VHC issues not be reflected in rates,” he said.
State officials have said previously that the outstanding premium payments from 2014 are likely to total just more than $1 million, but the two sides have not agreed on a final figure.
In a March letter Blue Cross sent to the state, the insurersaid it counted $9 million in past-due premium payments for 2015, however state officials said they believe many of the policies included in that figure were canceled and the final amount will be lower.
Neither side has offered a figure for how much money Blue Cross has paid in claims accounts that should have been inactive. But if the rate of $500,000 in claims per 600 policies were to hold for all 6,000 retroactively canceled policies, the total would be $5 million.
The Vermont Medical Society has raised concerns that its membership may be asked to seek payment from patients or find the appropriate health plan or government program to bill. If the patient is now covered by Medicaid, doctors will ultimately receive far less money than what Blue Cross would have paid. Medicaid rates are roughly 60 percent of what services cost, state regulators say, and much lower than the rates for commercial insurance.
Paul Harrington, executive vice president of the Vermont Medical Society, raised concerns with state officials three weeks ago. He said Thursday he has yet to receive a formal response.
| Vermont Business Magazine Video. Vermont Health Connect Video June 1, 2015 | |
| Vermont Health Connect deploys vital 'change of circumstance' system part II Questions & Answers | |
| Vermont Health Connect deploys vital 'change of circumstance' system upgrade part I |  |
Vermont Business Magazine added Don George quotes and videos to this report. Part 1 is the statements from Governor Shumlin, Health Care Chief Lawrence Miller and other officials and Part 2 is the reporter Q&A that followed.