Rocky Road for Anthem’s Site-of-Service Program

The addition of new deductibles in the health plan shared by Executive and Judicial Branch bargaining units has been off to a rocky start.  After a new contract is ratified, the work isn’t over for some SEA members of the Executive Branch Master Bargaining Team because they remain connected to the health plan through their work on the Health Benefit Committee.  In February and March HBC meetings, Linda Huard, Jim Nall and Dick De Seve expressed their frustration and disappointment over errors and difficulties that members were experiencing with the Anthem’s Site-of-Service program.

“It is incredibly disappointing as a team member to have this health plan roll out under the new contract and have the assurances that we were given during bargaining fall flat.  In good faith we negotiated this contract and our members ratified in good faith.  Anthem needs to provide the product we negotiated with the services we negotiated and the State of New Hampshire needs to hold Anthem accountable on behalf of state employees and the millions of dollars they are paid to do the job,” said Linda Huard, SEA Chair for the HBC.

Some of the problems experienced include:

  • application of deductibles for services that are not subject to deductibles
  •  incorrect posting of deductible maximums on the Anthem website members use to track their medical out of pocket costs
  •  telling people they can only access certain services from specifically designated providers when our plan provides for broader access
  • several months of delays in “Know Your Numbers” worksite screenings
  • insufficient access to Site-of-Service diagnostic lab services in the North Country

In a letter sent to chief negotiator for the State, Matthew Newland, the numerous problems with Anthem’s Site-of-Service product were addressed.  Regarding North Country access issues, SEA President, Diana Lacey, wrote “This was a known problem prior to the final contract settlement reached between SONH-SEA.  Both Anthem and SONH representatives informed SEA representatives that increased access would be made available to North Country participants by the beginning of 2014.”  Additional providers haven’t been added yet and an existing one in Claremont was removed from the list of Site-of-Service providers.

There are providers throughout the North Country that can perform diagnostic lab services; all that needs to happen is for Anthem to make the appropriate deal to bring them into the Site-of-Service program.  The letter was also sent to Governor Maggie Hassan and the Executive Council.  The SONH is contractually and statutorily obligated to deliver the SONH-SEA negotiated health plan.  Lacey noted, “Both SONH and SEA representatives have been very busy trying to mitigate problems and to correct Anthem errors.”

Lacey, a longtime contract administrator for Health and Human Services, insists the State has recourse in its contract with Anthem.

“If there is a failure to perform and it is not corrected, contract penalties should be exercised.  If the State can’t make this new plan design work with Anthem, the changes should be rolled back and covered employees held harmless.”  Lacey doubts it will have to go that far though, “We received minimal complaints about the more traditional plan that Anthem administered for us in recent years.  They just have to get this thing fixed – and correct any incorrect charges to employees.”

Things should be looking up soon.  Newland and several state employees that directly work with Anthem in ongoing administration of the health plan have been meeting with Anthem to identify the full scope of the problem and to correct deficiencies.  Anthem is reportedly committed to improvement and delivering the customized health plan the SEA and SONH negotiated.

Jim Nall, Chair of the Master Bargaining Team, noted that several SEA members have contacted the SEA Health Benefit Advocate, Chris Porter, with the problems they have faced.  “We are disappointed in the rollout of the new health plan and its negative consequences on our members.”

If you believe that your contractual health plan has been violated by Anthem, you may contact the Division of Personnel to seek assistance with correcting the issue with Anthem.  You could also contact an SEA steward to file a grievance of your collective bargaining agreement being violated.  If you have questions about what the health plan covers, you may contact the Division of Personnel or Chris Porter at the SEA.  For SEA members only, if you need medical advocacy to resolve an issue with Anthem, such as covered services being denied, you may contact Chris Porter. Porter can be reached at cporter@seiu1984.org or 271-3411, ext. 134.

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