Digger Tidbits: Brock on first campaign stop; new bill would requires health insurers to be transparent

Sen. Randy Brock, Republican candidate for governor, poses with a "Bear for Brock." Courtesy photo

Sen. Randy Brock, Republican candidate for governor, poses with a "Bear for Brock." Courtesy photo

There’s no surer sign of legislative adjournment than the advent of the campaign season, and as of April 28 — thanks to the first and one of the biggest political parades of the year, the Vermont Maple Festival — the election year is off to a sweet start.

Thousands rallied for the sunny afternoon ritual, and there to wave and entertain were some familiar Montpelier faces — Gov. Peter Shumlin, Secretary of State Jim Condos, Vermont Attorney General Bill Sorrell and his Democratic primary rival, TJ Donovan, plus two candidates for Franklin County Vermont state senate.

Republican Sen. Randy Brock was there too — on his first official campaign event as a candidate for governor — with a Bear for Brock in tow wearing tie-dye t-shirt with the slogan “Give the $21 million back to ratepayers!”

Brock said the slogan hit home with constituents who are upset about whether they’ll get their money back.

“It’s a campaign issue, and frankly it’s a nonpartisan issue,” Brock said. “If you look at various groups and coalitions forming this isn’t a Republican issue, this is an issue that crosses lines like few you see around Vermont. Instead of pitting right against left, it pits right against wrong.”

~Anne Galloway

New bill would require health insurers to be transparent

As of this summer, health insurance companies in Vermont will be required to report the number of denied claims, appeals, and other grievances on BISCHA’s website with other company information.

Insurance companies could face more demands, however, depending on which version of S.200 is signed into law. The version of the bill passed in the Senate on March 29 is fairly bare bones, but the House version, amended this week by Rep. Sarah Copeland-Hanzas, D-Orange, and passed 135-1, adds several more reporting requirements.

These include reporting the salaries of corporate officers and board members, political contributions, and advertising and lobbying expenses. It also adds a new section on pharmacy audits and reimbursements for ambulance services.

Sen. Anthony Pollina, P-Washington, one of the sponsors of S.200, said that he liked the changes made by the House.

“The more reporting, the more we know about insurance companies the better off we’re going to be as consumers,” Pollina said. “Hopefully someday we’re not going to even have a need for insurance companies, but as long as insurance companies are around, it’s important that we have as much information about their behaviour as possible so that people can make decent choices about who they want to do business with.”

VPIRG’s health-care advocate Cassandra Gekas said she was pleased with the bill, particularly the House version. Health insurance has been a campaign issue for the consumer advocacy group.

“I think it was just a huge victory for Vermonters, and I feel really proud of the fact that justice prevailed, that legislators sided on patients instead of on profit,” Gekas said. “And when I think about this in the big picture, health care and health insurance, we’re not talking about widgets,” she said. “From my perspective, Vermonters deserve to know not only how their premium dollars are being spent but also what the business practices are of health insurers.”

However, Sen. Claire Ayer, D-Addison, the chair of Senate Health and Welfare, says many of these additions are unlikely to remain. Ayer intends to call for a conference committee, where the bill will likely get pared back down to the version passed in the Senate.

“Basically in Senate Health and Welfare we stripped S down because the entire system is going to change in 2014, when we go into the insurance exchange. They’ll have specific and unified reporting requirements and that sort of thing. So to ask an insurance company to change all its forms for one year is just a waste of resources,” Ayer said.

“But there were a few things that we thought were really valuable in assessing health care, that would be useful information to the Green Mountain Care Board: about how we give care and what it’s used for, and what it costs, denial and that sort of thing. Those are things we put in that we thought were useful information.”

Health insurance companies like Blue Cross Blue Shield (BCBS) and MVP Healthcare appear to have taken a neutral stance on the change, saying that they already report on much of the information required in the bill.

Lee Tofferi, a lobbyist for BCBS, said the company was not against reporting claims, provided they could explain the reasons for most of them, like duplicate claims or clerical errors.

“What we want to make sure is that we have the ability when we submit the claims denial basis that we can also illustrate and illuminate more of the reasons for those denials,” Tofferi said. “Because there are interest groups out there that are trying to suggest we are denying claims just to avoid paying claims, when in fact most of the claims we deny are for legitimate reasons.”

~Erin Hale

Follow Anne on Twitter @GallowayVTD

Comments

  1. Hod Palmer, III :

    “Hopefully someday we’re not going to even have a need for insurance companies, but as long as insurance companies are around, it’s important that we have as much information about their behaviour as possible so that people can make decent choices about who they want to do business with.”

    Just like the choice we get when we have only 1 choice, huh?

  2. Matthew Simon :

    At first glance, I mistook Brock’s bear for Bucky the Buckeye, the Ohio State mascot. It’s a good mascot for Brock since he’ll “bearly” muster 40 percent.

  3. Patricia Crocker :

    Perhaps we need to set up a reporting system on BISHCA that lists the waiting time for services, how many net healthcare providers there are before and after GMC is implemented, grievances, etc.

    • Jason Farrell :

      “BISHCA is now the Vermont Department of Financial Regulation. The change was included in legislation signed yesterday by Governor Shumlin; the new name will reflect the department’s evolving mission.”

      http://www.vermontbiz.com/news/april/bishca-renamed-vermont-department-financial-regulation

    • Doug Hoffer :

      Or we could find out how much time is spent (wasted) by doctors & hospitals dealing with the dozens and dozens of third party administrators and pharmacy benefit managers that provide no actual health care services but suck so much money out of the system. Here are the lists.
      http://www.dfr.vermont.gov/sites/default/files/TPA-Registration.pdf
      http://www.dfr.vermont.gov/sites/default/files/PBM-Registration.pdf

      As for the number of health professionals, you can get that data now from the Dept. of Health, Sec. of State, and the VT Board of Medical Practice.

      Check around before you make assumptions.

      • walter carpenter :

        “Perhaps we need to set up a reporting system on BISHCA that lists the waiting time for services, how many net healthcare providers there are before and after GMC is implemented, grievances, etc.”

        Or we should have it in this bill to report all the appeals processes that people have to go through with denied claims, pre-approvals that are refused, out-of-network issues, and so on, to see what grievances really are in addition to the obscene amount time doctors must waste in battles with insurance companies over care. We need to know what these insurers are doing with our money and why these executives get such high salaries while they keep raising rates.

        “Just like the choice we get when we have only 1 choice, huh?”

        You will have much broader choice within this one choice because you will have the entire system to choose from. If you are on a private plan, you are restricted to only those providers/facilities within their network if you want the insured rates. Otherwise, it is the uninsured rates. And insurance companies also have a choice about insuring you. Yes, Vermont is guarantee issue, but with a medical past like I have they could make it exceedingly tough for me to afford insurance.

        “when in fact most of the claims we deny are for legitimate reasons.”

        What is a legitimate reason versus an illegitimate one? And who decides? What is a legitimate reason for an insurance company is an illegitimate one for the poor patient who then has to appeal the decision. I’ve been through this before and know what it is like.

  4. Concerning health insurance, what good are “choices” if all have large deductibles and co-pays, high premiums, exclude preexisting conditions, and can “cherry pick” their customers and/or are employment dependent. The U.S is the only advanced economy in the world that doesn’t have a “universal” system. We need such a system that provides affordable comprehensive coverage for all. That’s what Medicare does and a “single payer” will do.

    • Hod Palmer, :

      Medicare pays less than the going rate. Medicaid pays way less than that. Won’t single payer, in an effort to “control” costs, just pay less also. How else will Vt control health care costs when they are increasing everywhere else.? Much as we like to “lead the nation” it doesn’t make sense that costs here will be materially less than anywhere else.

  5. Stan Hopson :

    Doug,

    Please run again.

    Thx

  6. Tim Davis :

    Vermont has only about 180,000 people at most in the small group insurance pool. This is the pool that is primarily covered by BCBS, and a small percentage by MVP.

    Where are cost “savings” going to come from when this group is already 75-80% covered by one local insurer (BCBS) that employs around 200 people with well paying jobs in central Vermont?

    In addition, our largest non-government emlpoyer in the state is now FAHC.
    Most of those insurance payments through BCBSofVT pay a large percentage of the faculty, staff and affiliates via the cost-shift as a result of underpayment for services from Medicare and Medicaid.
    We had better closely consider cost containment in critical areas, reducing claims, and leveraging finances affordably if rates are going to stabilize or drop.

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