The cost of secrecy?
Submitted by James on Mon, 03/02/2009 - 10:48am
Kudos to Dan Kane at the N&O for breaking this story about claims processing fees at Blue Cross and Blue Shield. I wish I understood the technical details better, but it sure looks like their fees are out of line with what's fair. And just in case you're wondering how things got to this point, we have a strong assist from Senator Tony Rand:
A state law sponsored by Senate Majority Leader Tony Rand had kept the PPO contract's contents private from all but a handful of state officials. Plan officials had repeatedly denied requests to make contract information public, but reversed their position after The (Raleigh) News & Observer protested, contending that Rand's law did not pertain to the cost of claims-processing contracts.
If there's one thing we learned from the Bush administration, it is this: when there is no transparency, we the people get screwed.
The Adams
The two Adams at the NC Justice Center have been dogging this issue from the get go. If you follow their blogs (here's one of them) you can get a good look at the issues.
Do good. Be nice. Have fun.
So, who's against transparency?
If Holliman wants the contract to be public and BCBS says it's ok, why is there still a debate on the matter?
Unfortunately, unless something is really wrong, cutting whatever profit margin BCBS takes from the SEHCP still won't fix the problem. Just like dropping fat people and smokers, this seems to be more of a PR stunt than an actual solution. Not to say that either idea is bad necessarily, but neither will result in a state health care plan that is solvent in the short or long terms.
You tell me.
I guess maybe Senator Rand.
Of course trimming margins isn't a magic answer, it's just a small piece of a giant national problem that has gone unaddressed for too long.
That said, I wish BCBS would turn its considerable expertise and influence toward transforming how we manage health care in North Carolina, not simply capitalizing on it or managing around the margins.
The problem, it appears, is the profit motive.
I don't know if it's apples to apples, but the difference between $10 and 57 cents is mind-boggling.
Do good. Be nice. Have fun.
all very true
It's too bad that we don't have a good populist elected leader in this state who could stand up and say just that. Folks know that something is deeply broken with health care, trade, and the economy in general. They're mad as heck and looking for someone to blame if only someone would step up to the microphone. 2010 anyone?
$50 million reasons for a re-bid
BCBS lost the contract to administer NC's children's health insurance program last year because they were charging $4 a claim to process as opposed to the 40-50 cents Medicaid does. Now they come and have us believe that $10 a claim is reasonable in the state health plan. If we could cut that cost in half doing it some other way, that's $50 million in savings - it won't solve the health plan problem, but $50 million extra a year will make it significantly easier to do so.
SHP Gouging NC Not just BCBS
Under NC SHP contracts, NC is being gouged by Medco when state employees purchase Rx’s using this plan.
The owner of a local Sanford pharmacy - Mr Clifford showed me two identical items he purchased from Medco and another source.
- Medco invoices the NC SHP up to 50% more than his purchases from another source.
- Medco relabels the items with their own item identification number.
- A pharmacy must use Medco as stipulated by the NC SHP program.
- A few days later I met with Mike James @ Persons St pharmacy, he confirmed this information and added this - I have much more info than that. And years of history about SHP excessive costs, back into the early 90’s.
How many unestimated millions of dollars are being wasted by this unnecessary secret State of North Carolina contractual arrangement.
Health Care Must Become A Person's Right < > Religion, Education, Voting & Owning a Gun are. Why 'not' Health Care?