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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.” |
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