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INSURANCE PROBLEM IS PENDING AGREEMENTS

Dec. 10, 2001 – The problem of government employees not having their health cards accepted by local providers stems from Blue Cross-Blue Shield not having released historical data to the current government health insurance carriers, Paulette Rabsatt, chair of the government Health Insurance Board, said Monday.
The Senate has scheduled a session Thursday on St. Thomas to hear from insurance companies and government officials to explore complaints lawmakers have had from government employees and retirees that doctors are not accepting the health insurance cards issued them for medical, dental and pharmaceutical benefits.
The board was to meet Monday morning, Rabsatt said, adding, "It is our normal business meeting where we will work through this problem."
Rabsatt continued, "We are working through the problem with BC-BS and the current carriers — Connecticut General Life Insurance Co. (CIGNA), which provides medical insurance, and Metropolitan Life Insurance Co.(MetLife), which supplies dental coverage — to resolve the problem." She said acceptance of the insurance cards was up to the individual providers.
The problem, Rabsatt said, has to do with agreements between the carriers and the government. There are consent agreements for information to be released between MetLife and BC-BS and the V.I. government, she said, and "We are trying to piece together the pieces of the puzzle." The government has to release information, she explained; in addition, the carrier must execute a confidentiality agreement with the government about data being released to it.
The problem, she said, has been finding language agreeable to both parties.
"A few weeks ago, BC-BS accepted agreements with MetLife and they've signed on to a confidentiality agreement. The government took exception to language included in the agreement," Rabsatt continued.
"We didn't expect BC-BS to be able to turn the information around in timely fashion, and we addressed that up front," she said. "We asked CIGNA to underwrite a waiver, so BC-BS would have been a non-issue. At our meeting, we will be exploring MetLife taking the same approach as CIGNA."
In response to the reports that employees and providers are unhappy, she said, "and justifiably so. We don't expect them to be happy. The board isn't happy."
Rabsatt said resolving the problem will be "touch and go now," up to the individual provider. "Technically," she said, "by the first of the new calendar year, this should be cleared up with decisions by providers on what they will accept."
Rabsatt said the government does not owe BC-BS any money. The company's V.I. offices are closed.
One provider who is frustrated and angry about the situation is Dr. Kimberly Moore, a dentist with offices on St. Thomas and St. John. "I have practiced here for seven years," Moore said Friday, "and I have never experienced anything like this. I may have to close one of my offices."
Moore said she has not been paid for work done in September. "Rolda Mason said we would be paid in January," she continued. "That's more than three months, and that is not acceptable." Mason is chief of group health insurance for the government Division of Personnel.
"I have gotten nowhere with the insurance companies or the government," Moore said. "The government is misleading patients. If I have to ask patients for payment up front, I run the risk of losing patients, and it's supposed to be against the law to do that."
Moore said she would be at Thursday's Senate session, which is scheduled to start at 10 a.m.

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Dec. 10, 2001 - The problem of government employees not having their health cards accepted by local providers stems from Blue Cross-Blue Shield not having released historical data to the current government health insurance carriers, Paulette Rabsatt, chair of the government Health Insurance Board, said Monday.
The Senate has scheduled a session Thursday on St. Thomas to hear from insurance companies and government officials to explore complaints lawmakers have had from government employees and retirees that doctors are not accepting the health insurance cards issued them for medical, dental and pharmaceutical benefits.
The board was to meet Monday morning, Rabsatt said, adding, "It is our normal business meeting where we will work through this problem."
Rabsatt continued, "We are working through the problem with BC-BS and the current carriers -- Connecticut General Life Insurance Co. (CIGNA), which provides medical insurance, and Metropolitan Life Insurance Co.(MetLife), which supplies dental coverage -- to resolve the problem." She said acceptance of the insurance cards was up to the individual providers.
The problem, Rabsatt said, has to do with agreements between the carriers and the government. There are consent agreements for information to be released between MetLife and BC-BS and the V.I. government, she said, and "We are trying to piece together the pieces of the puzzle." The government has to release information, she explained; in addition, the carrier must execute a confidentiality agreement with the government about data being released to it.
The problem, she said, has been finding language agreeable to both parties.
"A few weeks ago, BC-BS accepted agreements with MetLife and they've signed on to a confidentiality agreement. The government took exception to language included in the agreement," Rabsatt continued.
"We didn't expect BC-BS to be able to turn the information around in timely fashion, and we addressed that up front," she said. "We asked CIGNA to underwrite a waiver, so BC-BS would have been a non-issue. At our meeting, we will be exploring MetLife taking the same approach as CIGNA."
In response to the reports that employees and providers are unhappy, she said, "and justifiably so. We don't expect them to be happy. The board isn't happy."
Rabsatt said resolving the problem will be "touch and go now," up to the individual provider. "Technically," she said, "by the first of the new calendar year, this should be cleared up with decisions by providers on what they will accept."
Rabsatt said the government does not owe BC-BS any money. The company's V.I. offices are closed.
One provider who is frustrated and angry about the situation is Dr. Kimberly Moore, a dentist with offices on St. Thomas and St. John. "I have practiced here for seven years," Moore said Friday, "and I have never experienced anything like this. I may have to close one of my offices."
Moore said she has not been paid for work done in September. "Rolda Mason said we would be paid in January," she continued. "That's more than three months, and that is not acceptable." Mason is chief of group health insurance for the government Division of Personnel.
"I have gotten nowhere with the insurance companies or the government," Moore said. "The government is misleading patients. If I have to ask patients for payment up front, I run the risk of losing patients, and it's supposed to be against the law to do that."
Moore said she would be at Thursday's Senate session, which is scheduled to start at 10 a.m.