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REASONS CITED FOR INSURANCE PROBLEMS

Dec. 14, 2001 – Insurance company representatives and Turnbull administration officials shed some light at a Thursday Senate Committee of the Whole meeting on why government employees' insurance cards aren't being accepted by medical providers.
Senators have received multiple complaints in recent weeks of the cards not being accepted.
The problem, they were told Thursday, is the severely short transition period the current insurers — Connecticut General Life Insurance Co. (CIGNA) for medical coverage and Metropolitan Life Insurance Co. (MetLife) for dental — had in which to implement the coverage when they took over from the previous insurer, Blue Cross/Blue Shield.
Government House got the new plans to the Senate for approval just two days before the old contract was to expire at midnight Sept. 30.
"Standardly, an account of this size and complexity takes 90 to 120 days to implement," CIGNA representative Jay White said. "On Oct. 1, we began implementation of this plan 90 to 120 days behind schedule."
Still, "The majority of the eligibility was loaded by Nov. 1," he said, adding, "Typically this is done prior to the effective date."
White said CIGNA has already paid out $4.6 million in claims. MetLife has yet to pay a penny, and local dentists are furious.
Dentists Kimberly Moore, Stuart Wechter and Horace Griffith, president of the V.I. Dental Association, described the situation. Moore said she was angered and disappointed in the government and the insurance companies. "I am owed $20,650 for services rendered in the last three months. We were told we wouldn't be paid until January," she said. "This never happened with the previous carriers. In the future, the government needs time to select adequate insurance for the people of the Virgin Islands."
Moore has offices on St. Thomas and St. John. She told the Source last week that she may be forced to close one of them.
Wechter described MetLife as "terrible." He said: "They say they don't have the codes to be paid. They won't pay for plastic fillings, which is a part of modern dentistry. They say we should use silver, because it is less expensive; Blue Cross paid for plastic with no problem. They ask the patient to pay $28 up front; Blue Cross didn't require any prepayment. I see no advantage to this program."
Referring to his colleagues, Griffith said, "I agree 100 percent with what they've said." He termed the current situation "atrocious and totally unacceptable."
Jeff Trinkwon, MetLife regional manager, said, "This isn't the way we planned it. We didn't want it to start this way."
Paulette Rabsatt, chair of the Government Employees Service Commission Health Insurance Board, said the board approved a revised MetLife proposal on Monday. By Wednesday, Trinkwon said, MetLife had already processed 90 percent of the claims that were on a pending status. Trinkwon stressed, "We look forward to success now."
Trinkwon confirmed to the dentists that MetLife's policy is not to pay for plastic fillings, but he promised to investigate the matter.
"We recognized going into this implementation that there would be challenges, given the hastened nature of the transition in carriers with groups of this size," Rabsatt said.
The GESC is responsible for drawing up insurance contracts and for the operation of the government health insurance plans. In September, Rabsatt had called the new plans "the best the market has to offer."
The new contracts, estimated at $59.4 million, represent premiums for medical care and prescription drugs under a fully insured arrangement of $55.4 million plus dental coverage of $4 million. Turnbull ordered that there be no increases in employee premiums, a decision consistent with what he did last year.
The contract includes prescription drug coverage, something the government previously had to administer separately. CIGNA offers the same deductible for services on the mainland and in Puerto Rico that it does for services in the territory — $50 to $150 within "network" services — the group of doctors the carrier recognizes. The current plan has a deductible of $250 to $500 both in and out of "network."
Rabsatt said the Health Insurance Board had anticipated "fewer problems in the transition" to Met Life, "due to the smaller nature of the dental program." She said MetLife's problems were caused in large part because it was unable to obtain historical claims data from Blue Cross/Blue Shield, whose legal counsel said it is BC/BS policy not to release data to a succeeding carrier until certain agreements are signed. The delay has been because the government, MetLife and BC/BS had not been able to reach agreement on how to handle confidential claims.
Rabsatt said the insurance board rejected the first agreement presented by BC/BS. A different agreement was approved Monday and is acceptable to all parties, she said.
Senate reaction to the information presented was mixed.
Sen. Adelbert Bryan said of the insurance companies, "These people don't respect us. All they want to do is get our money. It's ridiculous that we are spending $55 million on this kind of plan, and these companies are not in compliance."
Sen. Celestino White Sr., the majority leader, said, "The board really hung in there to get us a good package. In actuality, the board is being held hostage by the previous carrier; we all know that."
Senate President Almando "Rocky" Liburd concluded the hearing by saying, "Thankfully, many of the concerns that were raised have been answered … The public has a right to know what is going on. It's the least that all of us can do."

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Dec. 14, 2001 - Insurance company representatives and Turnbull administration officials shed some light at a Thursday Senate Committee of the Whole meeting on why government employees' insurance cards aren't being accepted by medical providers.
Senators have received multiple complaints in recent weeks of the cards not being accepted.
The problem, they were told Thursday, is the severely short transition period the current insurers -- Connecticut General Life Insurance Co. (CIGNA) for medical coverage and Metropolitan Life Insurance Co. (MetLife) for dental -- had in which to implement the coverage when they took over from the previous insurer, Blue Cross/Blue Shield.
Government House got the new plans to the Senate for approval just two days before the old contract was to expire at midnight Sept. 30.
"Standardly, an account of this size and complexity takes 90 to 120 days to implement," CIGNA representative Jay White said. "On Oct. 1, we began implementation of this plan 90 to 120 days behind schedule."
Still, "The majority of the eligibility was loaded by Nov. 1," he said, adding, "Typically this is done prior to the effective date."
White said CIGNA has already paid out $4.6 million in claims. MetLife has yet to pay a penny, and local dentists are furious.
Dentists Kimberly Moore, Stuart Wechter and Horace Griffith, president of the V.I. Dental Association, described the situation. Moore said she was angered and disappointed in the government and the insurance companies. "I am owed $20,650 for services rendered in the last three months. We were told we wouldn't be paid until January," she said. "This never happened with the previous carriers. In the future, the government needs time to select adequate insurance for the people of the Virgin Islands."
Moore has offices on St. Thomas and St. John. She told the Source last week that she may be forced to close one of them.
Wechter described MetLife as "terrible." He said: "They say they don't have the codes to be paid. They won't pay for plastic fillings, which is a part of modern dentistry. They say we should use silver, because it is less expensive; Blue Cross paid for plastic with no problem. They ask the patient to pay $28 up front; Blue Cross didn't require any prepayment. I see no advantage to this program."
Referring to his colleagues, Griffith said, "I agree 100 percent with what they've said." He termed the current situation "atrocious and totally unacceptable."
Jeff Trinkwon, MetLife regional manager, said, "This isn't the way we planned it. We didn't want it to start this way."
Paulette Rabsatt, chair of the Government Employees Service Commission Health Insurance Board, said the board approved a revised MetLife proposal on Monday. By Wednesday, Trinkwon said, MetLife had already processed 90 percent of the claims that were on a pending status. Trinkwon stressed, "We look forward to success now."
Trinkwon confirmed to the dentists that MetLife's policy is not to pay for plastic fillings, but he promised to investigate the matter.
"We recognized going into this implementation that there would be challenges, given the hastened nature of the transition in carriers with groups of this size," Rabsatt said.
The GESC is responsible for drawing up insurance contracts and for the operation of the government health insurance plans. In September, Rabsatt had called the new plans "the best the market has to offer."
The new contracts, estimated at $59.4 million, represent premiums for medical care and prescription drugs under a fully insured arrangement of $55.4 million plus dental coverage of $4 million. Turnbull ordered that there be no increases in employee premiums, a decision consistent with what he did last year.
The contract includes prescription drug coverage, something the government previously had to administer separately. CIGNA offers the same deductible for services on the mainland and in Puerto Rico that it does for services in the territory -- $50 to $150 within "network" services -- the group of doctors the carrier recognizes. The current plan has a deductible of $250 to $500 both in and out of "network."
Rabsatt said the Health Insurance Board had anticipated "fewer problems in the transition" to Met Life, "due to the smaller nature of the dental program." She said MetLife's problems were caused in large part because it was unable to obtain historical claims data from Blue Cross/Blue Shield, whose legal counsel said it is BC/BS policy not to release data to a succeeding carrier until certain agreements are signed. The delay has been because the government, MetLife and BC/BS had not been able to reach agreement on how to handle confidential claims.
Rabsatt said the insurance board rejected the first agreement presented by BC/BS. A different agreement was approved Monday and is acceptable to all parties, she said.
Senate reaction to the information presented was mixed.
Sen. Adelbert Bryan said of the insurance companies, "These people don't respect us. All they want to do is get our money. It's ridiculous that we are spending $55 million on this kind of plan, and these companies are not in compliance."
Sen. Celestino White Sr., the majority leader, said, "The board really hung in there to get us a good package. In actuality, the board is being held hostage by the previous carrier; we all know that."
Senate President Almando "Rocky" Liburd concluded the hearing by saying, "Thankfully, many of the concerns that were raised have been answered ... The public has a right to know what is going on. It's the least that all of us can do."