Health Insurance

Articles about Health Insurance that may be useful to Massachusetts retirees

Local Retirees Question Physician Bills

JULY 2001 - Can My Doctor Charge Me Or Not? - Members,
insured under a municipal health insurance plan, may have received a
bill from their doctor and questioned why. “What I usually hear from
the members is: ‘I never got a bill before and thought I never would,’”
reports Insurance Coordinator Cheryl Stillman.This
is typical because these members believed, and rightfully so, that
there are state laws that ban physicians from charging them for the
balance owed on a bill over the allowable rate. If a doctor bills $150
for a service and the allowable rate, set by Blue Cross/Blue Shield or
Medicare, is $100, then the doctor cannot bill a patient, insured by
BC/BS or a Medicare supplement plan, for the $50 balance over the
allowable rate.

Agawam

JULY 2001 - New Organization Off and Running - Among the several local organizations, to which many of our members belong, is the Agawam Retired Employees Association (AREA).AREA
was formed by a group of Agawam retirees and survivors for the purpose
of improving benefits for former workers of that Western Massachusetts
city.

Ban On Balance Billing Saves State Millions

JULY 2001 - GIC Uses Law To Set Market Rates - Nearly
five years after the Association successfully battled the Mass Hospital
Association and Medical Society to institute a ban on balance billing
under the state’s insurance plans, the Group Insurance Commission has
utilized the law (Chapter 80, Acts of 1996) to save nearly $85 million
over the past three years.Chapter
80 was originally passed to prevent doctors, hospitals and other
medical providers within Massachusetts from charging members, insured
under the state plan, for the balance left unpaid by the GIC. Expanding
on this prohibition, Chapter 80 has allowed the GIC to institute a
Market Based Reimbursement System (MBRS) for paying medical providers.

Despite Strong Interest Dental Plan Is Delayed

JULY 2001
- Crafting Affordable Coverage Proves Challenging - Members, who had hoped to have retiree dental benefits made available
to them this year, will have to wait a little longer. The ambitious
effort by the state Group Insurance Commission and the Association to
craft a dental plan, to be implemented this July, has been delayed
until July 1, 2002.It
has been determined that, in order to develop an affordable dental
plan, that can be purchased by a large number of retirees, more time
will be needed. On the other hand, efforts are underway to offer
discounted vision care to retirees beginning later this year.

Dental Survey: Initial Results Show Strong Interest

MAY 2001 -
For the past several months, the Association has been working closely
with the state Group Insurance Commission and the consultant Boston
Benefit Partners to develop a retiree dental/vision plan. A key
component to this work is a survey of retirees, which is nearing
completion.

Prescription Copayments Draw Attention

MAY 2001 -
Insurance Committee Fast To Act
- It should come as no surprise to members that issues regarding
prescription drugs remain a hot topic on Beacon Hill. In fact, so much
interest has been drawn to the topic that the Joint Committee on
Insurance addressed two of the more pressing bills at the Committee’s
maiden hearing on March 20.Chaired
by Senator Therese Murray (D-Plymouth) and Representative Ronald
Mariano (D-Quincy), the joint committee was quick to act favorably on
H3353 filed by Rep. Robert Koczera (D-New Bedford). The bill requires
the Group Insurance Commission to establish an appeal process to
address complaints regarding the new three-tiered copayment system.

Whately Votes To Pay 50% Of Insurance

MAY 2001 -
Voters in the small western Mass. town of Whately, population 1,470,
have voted to pay 50% of their retirees’ health insurance. Previously,
retirees paid the full cost.

GIC Keeps Insurance Rates In Check

MAY 2001 -
State Increase Well Below National Average - For the second straight year, members insured under the state Group
Insurance Commission’s Indemnity or OME plans will see a very small
increase in their monthly premium. In contrast, most members, insured
under one of the various HMOs, will see a double-digit increase in
their monthly premium for the second straight year.

Attleboro Survivors Win Insurance Premium Debate: Matt Savastano Was Catalyst

MARCH 2001 - Thanks
largely to the dogged determination of Association member Matt
Savastano, the City of Attleboro has opted to pay 50% of the cost of
health insurance premiums for surviving spouses of all retirees.

When
the city accepted a 50% surviving spouse statute in 1998, officials
decided that only spouses receiving a survivors pension were eligible.
Survivors of Option A or Option B retirees do not receive a pension and
were required to pay the full 100% for their coverage plus an
additional 2% service charge to the city.

"It
just wasn't fair and in my opinion not legal," said Savastano, a
retired Attleboro police officer and elected member of that city's
retirement board. "Prior to December, 1998 all survivors paid 100% but
when the city accepted a 50% provision (Sec. 9D, Ch. 32B) they didn't
include those poor women who were not collecting a pension. A survivor
is a survivor whether or not she is receiving a pension. And to charge
these women a service charge on top of the 100% was an insult."

Town Counsel Agrees

After
his request that all survivors receive the same insurance benefit was
denied by city officials, Savastano went on a one-man crusade and took
his case to the City Council. The Council referred his request to their
Ordinance Committee where Chairman Frank Cook asked for a legal opinion
from City Solicitor John Lee. Lee responded with a three-page letter
which included the following finding:

"There
is no legal basis to ban such participation (50%) on the part of a
surviving spouse on the grounds that the retired employee did not elect
to receive his retirement benefits under Option C.

"In
summary, I agree with Mr. Savastano that the surviving spouse is
entitled to participate in the City's health insurance plans whether
the retired employee elects to receive his retirement benefits under
Option (a), (b) or (c)." The Council then went on to vote in favor of a
50% payment and sent a resolution to Mayor Judith Robbins, who ordered
its implementation.

Spurred 1998 Vote

Savastano
and fellow retirement board elected member Gary Sagar, a firefighter,
had teamed up to win the 1998 50% vote. Since then, city officials had
told Savastano that, "It's not the right time to push any further."
"When would the time be right? Should we wait until these women are
dead," was Savastano's response in taking his case to the Council.

"I
want to thank Frank Cook, the chairman of the Ordinance Committee and
the entire Council for voting for the survivors. Also John Lee, who
researched the issue and made it very clear the survivors were being
unjustly denied a benefit that they were entitled to," Savastano said.

"Matt
is a determined guy when it comes to retirees and survivors," said
Association President Ralph White. "He frequently clashed with city
officials when he was president of the Attleboro Police Union and
despite a recent hospitalization due to a heart condition, he hasn't
lost a step."

It's
noteworthy that the City Council President Carolyn Tedino said that
Matt Savastano likely saved the city legal expenses if someone sued the
city over the situation, and Councilor Bill Bowles acknowledged
Savastano's "perseverance."

Widows Grateful

"This
will be a big help. I have a somewhat fixed income and still live in my
own house," said Emeline Proulx whose husband George, a retired
firefighter, died 3 years ago. "I was paying $222.29 each month for
Medex coverage plus the service charge. Now I'm paying $108.96. I'd
heard of Matt Savastano, but had never met him until he went to the
Council on our behalf. He's quite a man... I can't say enough about
him."

Rose Ganim is
the wife of George Ganim, a retired Attleboro teacher who died 15
months ago. Like Emiline Proulx, Rose was paying $222.29 monthly for
her Medex coverage. "I'm getting by ok financially but can use the
extra money. Prescription drugs have gone up in price and this
unexpected reduction in insurance payments will more than make up for
what I pay the pharmacy," she said. "I've known Matt Savastano for many
years... He's related to my son-in-law. Matt is a hard worker and we
really appreciate what he's done for us."

We
have copies of the full text of the Attleboro City Solicitor's legal
opinion which resulted in parity for Option A and B survivors in that
city. Copies are available to anyone seeking redress from similar
discrimination in a city or town.

"I
know there are cities and towns out there that discriminate against A
and B survivors when it comes to health insurance. It was only ten
years ago under Ray Flynn (Mayor) that Boston provided insurance
equality for all survivors," said White. "There is a very narrow view
by some that a surviving spouse has to be receiving a pension in order
to be included. Chapter 32B doesn't say anything about a survivor
receiving a pension, nor does Chapter 32A (state) which recognizes all
surviviving spouses, regardless of their option."

Office Of Patient Protection Now Open

MARCH 2001 - New Agency Created By "Patients' Bill of Rights" Law - Members
are well aware that if they have a problem with a health insurance
claim, they can contact our Insurance Coordinator Cheryl Stillman.
"While I can't guarantee a successful outcome in every case, we will do
everything possible to resolve a member's problem," comments Stillman.