State Continues Its Covert Tendencies

Anthem Blue Cross, Blue Shield Contract Signed, Sealed, and Delivered without Promised SEA Input

Images courtesy of state of New Hampshire and Anthem Blue Cross Blue Shield

At their Dec. 5 meeting, Governor Lynch and Executive Council approved extending the contract with Anthem BCBS NH as the administrator of the medical plan for State employees. This vote was taken despite the State Employees’ Association’s (SEA) request to discuss its concerns about the contract prior to any action being taken.  Regrettably, the contract was expedited to the governor and Executive Council without any discussion. The SEA found out about the contract after it was a signed and done deal.

SEA President Diana Lacey had requested that the state of New Hampshire provide her a draft early on so any concerns or questions could be identified and resolved together with the state to guarantee the best contract possible. That did not happen.

President Lacey was on the bid evaluation team but had been excluded from all of the contract negotiations even though she urged the state to periodically update her.  They failed to do so.  The SEA Health Benefit Committee did not receive any updates, either.

“This is yet another demonstration of a level of disrespect towards state workers,” Lacey said. “The state continues to shut the SEA out of the negotiation of the contract, despite repeated requests to do otherwise.” Lacey pointed out that through collaborating with SEA previously, the state was able to save an additional $4 million on the health insurance contract. “You would think the state would want to be more inclusive and collaborative,” she said.  “I am increasingly concerned about the state’s lack of respect and apparent disregard for transparency and collaboration. It is as though the Department of Administrative Services has gone rogue.”

Lacey said the Association was supportive of the award to Anthem. However, there are provisions that have concerned SEA for years, as well as some new concerns in this particular contract.  A primary concern is that the state has not retained the right to approve coverage when in dispute with Anthem.  The state has surrendered that authority to Anthem, giving it the final say on what is and is not covered.

The new contract also places the burden of proof on the employee in cases of dispute.  In the contract’s language it is stated that the enrollee (the employee or retiree) must prove that Anthem’s decision to deny coverage for a contested charge is “arbitrary and capricious.”  Good luck with that.

Additionally, this contract requires Anthem to respond to inquiries by enrollees regarding claims for benefits under the program.  It does not specifically mention that enrollees have the right to be represented by someone else.  Currently, enrollees can identify a representative to advocate on their behalf as some health care issues can be extremely complex and require more skilled advocacy to ensure better health outcomes.  President Lacey confirmed with Anthem that members do have the right to a representative.

The state has not readily made it known that if a member is trying to check and see if something is covered, they can address it directly with Anthem themselves.  They are not required to go through the state.

“We remain concerned about the state’s lack of collaboration on this contract.” Lacey stated. “This is one of the state’s largest contracts and it directly touches some 40,000 lives.”

You can read the contract here.  This contract is good through 2015 with up to a two-year renewal.

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