GIC On Track

SEPTEMBER 1998 - Officials Feel They Are Off To A Good Start - Officials
with the state’s Group Insurance Commission (GIC) feel they are off to
a “good start” with the implementation of the new market based
reimbursement fee schedule.

As
we reported in the July edition of the Voice, the GIC has changed the
method by which the state will pay Massachusetts medical providers who
treat retirees and active employees enrolled in the GIC Indemnity Plan.
Prior to July 1, the GIC used what is known as a “reasonable and
customary” (R&C) fee schedule to pay for medical services.

Fee
schedules dictate the price the GIC is willing to pay for a particular
medical procedure. Last year, GIC studies showed that under the R&C
schedule the state was paying up to three times the market price for
the medical services provided to its enrollees. With the price of
health care continuing to rise at an average of 8% a year, the GIC had
to take steps to get the costs under control.

“This
is something the GIC had to do, if there was to be any hope of reining
in the costs of the Indemnity Plan,” said Association President Ralph
White. “From what we have been shown, our Association supports this
move to the new fee schedule. Without the change, the future of the
indemnity plan would be in jeopardy.”

Physicians Cooperate

After
some initial reservation from the state’s medical community, GIC
officials say the vast majority of doctors and hospitals are
cooperating with the new market based fee schedule. The Massachusetts
Medical Society, together with the Massachusetts Hospital Association,
had previously expressed their concerns to the GIC that the new rates
may be too low.

“At this point, two
months into the program, everyone seems to be cooperating fully,”
explains Dr. Robert Sorrenti, Unicare’s regional vice president. “We
will not begin to realize the full effect of the change until late
September or early October. At that point, we can determine how
successful the program is, as well as gauge the reaction from the
medical community.”

Members have
expressed some concerns that the change in payment schedules would
force their physicians to no longer accept the GIC Indemnity Plan. Thus
far, there are no reports of any doctor or hospital in Massachusetts
refusing to accept the state plan run by Unicare. Members should
contact the Association immediately if they experience such a problem
under the GIC Indemnity Plan.

“The
Association is in constant contact with the GIC and Unicare over this
issue. Members enrolled through any of the state plans, as well as the
local Blue Cross / Blue Shield Plans, should remember balance billing
is illegal,” says Association Insurance Coordinator Cheryl Stillman.
“We want to know of any occurrences of medical providers who try to
skirt the law.”

Tags: