This commentary is by Joe Patrici of South Burlington, who began his career in the state in 1970 as a corrections officer, then as a corrections commissioner from 1986 to 1991 and as a deputy commissioner for economic services from 2005 to 2010. He was CEO of Northeast Kingdom Community Action from 2010 until his retirement in 2018.

I offer this comment to all Vermont government retirees, their families, all active state employees, and their families, as this can affect them all.

Governor Phil Scott is actively considering replacing a Medicare Advantage plan — specifically, Vermont Blue Advantage — in place of BlueCross BlueShield health insurance for all retirees and now active employees.

My wife and I received a brochure on Fairmont Bleu. Lists several “benefits” in capital letters. These include: vision, dental, telehealth, hearing, prescription drugs, over-the-counter drug allowance, Medicare and Hospitals, and national and global coverage.

Lowercase indicates it’s a PPO and HMO plan with a Medicare contract and says, “Non-contracted/network providers are under no obligation to treat Vermont Blue Advantage members except in emergencies.”

Currently, for retirees, BlueCross BlueShield is a second payer after Medicare for those over 65. This allows us, for example, to go see providers like naturopathic, integrative, or 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 reasoning behind this, aside from concerns that these program provider networks may be limited to Medicare Advantage insurance only, is that many of these plans have very controversial reputations.

In a story in the New York Times on October 8, the headline was: “How insurers have exploited Medicare for billions.” It’s a troubling story about insurers’ Medicare Advantage that urged doctors and gave them incentives to add additional illnesses to patients they hadn’t seen in weeks; who receive higher wages if their patients are the sickest; Who issued an invoice for diagnosing diseases that did not exist.

These plans and insurance companies were investigated for fraud, auditing and prosecution. While insurers have disputed these claims, some estimates put the excess bills as high as $20 billion in 2020 alone.

Anecdotal examples closer to home are more troubling. A retired UVM employee with a benefits plan has found the concept of “benefit” to be a “misnomer” and has to deal with multiple insurance companies bundled together. The amount of paperwork is consumable.

When something goes wrong, “who’s responsible” for the problem or fixing it is frustrating and confusing, especially if there are complex health issues to address. The bottom line is that coverage isn’t as good as a 31-year-old active UVM employee.

Comments from others, including MEDPAGE Today, show frustrating prior authorization, denials and delays in critical illness cases, leaving patients feeling insecure about getting needed care when it matters most.

Now, I want to be clear. I am not an expert in any insurance plan. I also don’t judge a Vermont Blue Advantage (Medicare) plan that the governor’s office says is as good or better and cheaper in premiums enjoyed by current, retired BlueCross BlueShield employees.

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 turns out to be not only less expensive (and thus saving money for the state and retirees in premiums), but less effective, It is accessible and useful for those of us of a certain age who really depend on it in their time of need.

Here’s the thing: If something of this importance is really better and cheaper than what we have now (which is counterintuitive), if it’s such a good deal, why wouldn’t the governor go to the Vermont State Employees’ Union and put his proposal on the bargaining table?

If it is as good as he says, then let the employees step in, do your due diligence and formally join him in making a decision that affects not only current retirees but also the future. It will be a win.

On the contrary, if the governor is not willing to put it through bargaining, it becomes one of the “too good to be believed” sales jobs which it probably is.

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Categorized under:

Suspension

Tags: BlueCross BlueShield, Joe Patrici, Medicare Benefits, Retired

Suspension

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