New disclosures show MVP denied 15.5 percent of patient claims in 2012; Blue Cross denied 7.6 percent

 

2012 Health Insurance Filing

This story was updated at 12:53 p.m. on March 20, 2013 to include CEO bonuses and other compensation.

For the first time, Vermont health insurers disclosed a bundle of information about how much money they spend on executive salaries and how many patients are denied coverage.

Two health insurance companies — in accordance with Act 150 from last legislative session — divulged CEO salaries, lobbying expenses, legal fees and denial rates, among other details.

Blue Cross Blue Shield Vermont and MVP Health Care submitted their 2012 Act 150 filings earlier this month, but Cigna did not.

“They failed to meet the deadline,” said Susan Donegan, commissioner of the Department of Financial Regulation, about the health insurance giant.

Cigna, which insures employees at large Vermont companies and administers health plans for state employees, is the only Vermont health insurer that has not turned in its filing.

“We take these filings seriously, and carriers understand it’s a responsibility,” Donegan said. “We’ve communicated that to Cigna, and they are in the process of getting us that report in the next couple of weeks.”

The Vermont Public Interest Research Group, or VPIRG, pushed hard for this new transparency law. Falko Schilling, VPIRG’s consumer protection advocate, said that the information contained in the new filings was always available; it was just very difficult for the public to find. Cassandra Gekas, the former health care advocate for VPIRG and Democratic candidate for lieutenant governor, pressed for the legislation last session.

“The impetus behind this bill is we wanted to pull back the curtain on (claims denials) and let people see how often this is happening and do some side-by-side comparisons of insurers,” Schilling said.

The filings also give consumers easy access to information about how much insurance companies spend on items not related to health care.

Blue Cross Blue Shield and MVP, combined, insured more than 150,000 individual members and employees in the Green Mountain State last year. Blue Cross insured 132,963 Vermonters and MVP insured 28,329.

In 2012, MVP denied 15.5 percent, or 89,841, of the 579,502 claims it received. That is more than twice the percentage of claims denied by Blue Cross, which rejected 194,496, or 7.6 percent, of its customers’ 2,572,729 claims.

Of those denials, the ones “that directly impact member cost sharing,” the filing says, are called “member impact claim denials.”

“It mostly has to do with the level of coverage,” Schilling said about these denials. “It’s mostly (an insurance company) saying these services aren’t covered or you didn’t go through the proper procedures to get this coverage.”

MVP’s member impact denial rate was about five times that of Blue Cross. Of MVP’s claims, 3.97 percent, or 20,704, were member impact denied. Meanwhile, 0.8 percent, or 20,211, of Blue Cross’ claims were member impact denied.

MVP also paid out more than twice as much for its CEO in 2012. MVP paid $1,250,000 for the CEO position, which Denise Gonick took over from David Oliker in December. Of that amount, $704,000 went to MVP’s CEO salary, $241,324 went to CEO bonuses and $305,176 went to the CEO  in “other compensation.”

Blue Cross CEO Don George, by comparison, earned a total $587,184 last year — $574,913 went to George’s salary and $12,271 was paid to George in bonuses.

While George runs Blue Cross Vermont, Gonick oversees MVP’s insurance coverage for roughly 650,000 members in New York, New Hampshire and Vermont.

The cumulative salaries of Blue Cross board members, however, equate to $246,623. MVP reported that it didn’t pay a penny for board member salaries in 2012.

When it came to marketing, MVP spent $516,358 in Vermont and Blue Cross doled out $743,968. That means MVP members spent, on average, $18.23 on their insurance company’s marketing, while Blue Cross members spent $5.60.

Per member lobbying expenses were essentially even at about $1.95. MVP spent $55,366 on lobbying, while Blue Cross spent $258,347.

Neither company reported political donations, but they did shell out for trade organizations.

MVP spent a combined $120,997 to join America’s Health Insurance Plans (AHIP), the Vermont Business Roundtable, Vermont Businesses for Social Responsibility, and the Lake Champlain Regional Chamber of Commerce. About $120,500 of MVP’s dues went to AHIP.

Blue Cross, on the other hand, paid out $55,919 in dues to the Blue Cross Blue Shield Association and did not report paying for membership in any other organizations.

While MVP didn’t report any legal expenses related to claims denials or charitable donations, Blue Cross reported $164,869 in legal fees and $46,245 in donations.

Susan Gretkowski, who lobbies for MVP in the Vermont Statehouse, said her company did not oppose Act 150 when it moved through the Legisltuare last year.

“We feel transparency is important,” she said. “This information has been filed for a long time with (the Vermont government), and now it’s more accessible.”

Clarification: The initial version of this story only included CEO salaries. The updated version includes CEO bonuses and other compensation.


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Comments

  1. MJ Farmer :

    I heard that BC employees got a big bonus last year. Is there anyway to view the 340 Blue Cross VT employees salaries? Our family of 4 pays $16,000/yr for a basic policy with $500 each deductible. In 10 years, we have only had 1 claim that BC needed to pay. Overall, we have paid almost $140,000 for 16 physicals over a 10 yr period. At $500/physical, it would have been much cheaper to pay the Doctor directly.

    • cate bell :

      i agree that the deductible requirement keeps a lot of people from using the policy…something the Co. counts on…a younger family member that has B.C. through his job ( he pays a big part of premium) has $750.00 deductible and has never used the policy. makes having a policy seem absurd,

    • John Jacobs :

      I’m assuming you are self employed as no employ sponsored plan I know of costs anywhere near that amount for a family of 4.

      If you are paying $16k/year and have only had 1 claim in the past 10 years why have insurance with such a low deductible? Why not change to a plan with a higher deductible so your premiums are lower?

      Cate – In most plans, ‘check-ups’ are covered via a co-pay, the only time you must pay your deductible is when you have an actual procedure done. $750 is a low deductible and most plans have an ‘out of pocket maximum’ that limits your overall liability anyway.

  2. rosemarie jackowski :

    This is why we need Single Payer NOW. Some are getting rich, while others are suffering and dying needlessly. Health insurance is a cruel joke. Just do the math.

  3. M. J. Farmer’s above post paints a very scary picture for the average family in Vermont. How in the world does any family deal with $16,000 annual health care premiums? And what’s going to happen going into the future when medical inflation far exceeds inflation in the general economy?

    I would guess that Anya Rader Wallack, Chair of the Green Mountain Care Board would be able to get the salaries and bonuses for Vermont’s three largest health insurers. She may not want to publish compensation by employee name, but she could show the aggregate amount of compensation in total dollars and as a percentage of total premiums, say annually over the past five years. One of the vtdigger reporters could easily look into this for all Vermonters.

    About two weeks ago, I was told by the Department of Financial Regulation that in Vermont, the average administrative expenses for BC/BS, MVP and Cigna over the past five years has ranged between 9% and 15%. So this gets you into the ballpark on reasonableness administrative expenses. Compensation would be a sub-set of the 9 to 15%.

    The salary information would be interesting, but it is not the question I would want to ask Ms. Rader Wallack. My question would be what does Governor Shumlin’s plan do specifically to reduce Mr. Farmer’s premiums for today and into the future.

    Hello, Green Mountain Care Board, did you hear the question?

  4. rosemarie jackowski :

    Some Vermont counties are in crisis. An emergency temporary solution is necessary. Set up clinics in these counties. Include dental and vision care. The clinics can be funded with money that would otherwise go to the GMCB, commissions, etc.
    This is a real emergency in Bennington.

    http://www.countyhealthrankings.org/app/#/vermont/2013/rankings/outcomes/overall/by-rank

  5. Megan Sheehan :

    MJ Farmer- Your story is really powerful, shocking, and unfortunately all too common. I’d love to interview you if possible about the burden that high deductibles has placed on your family. Or if anyone else on reading this has a story to share, please email me at vtstoriesproject (at) gmail.com

    • John Jacobs :

      Megan,

      MJ farmers complaint is with regard to premiums not deductibles (theirs is rather low).

    • Mark Kevorkian :

      Megan, which is more “shocking” to you: That the Farmer family has enjoyed excellent health over the past few years, or that despite their extremely small medical bills they still bought the lowest, ergo most expensive, deductble plan available?

      It seems the gist of MJ Farmer’s complaint is “I bought insurance for my family but none of us got sick.” To me, that lament falls well short of “powerful.”

  6. Walter Carpenter :

    ” In most plans, ‘check-ups’ are covered via a co-pay, the only time you must pay your deductible is when you have an actual procedure done.”

    I had to pay the deductible with a check-up. The insurer, though neither of the three mentioned above, would only pay after I met the deductible…and then it was they paid 80%, you paid 20%..after you met your deductible…

    The real shocking figures here are the size of the CEO salaries and the sheer number of claims denied. Between MVP and Blue Cross it is close to 235,000 claims denied. While probably much less than around the country, it is still immense. Having had many a claim denied before (though not by blue cross or MVP) I know what it feels like to have to fight the insurer as you are fighting the disease.

    “i agree that the deductible requirement keeps a lot of people from using the policy…something the Co. counts on”

    Yes, that is why it is there. I’ve heard an insurance company admit this.

  7. Walter Carpenter :

    Ach, bloody typos:)….”an insurance company representative admit this.”

  8. Between high deductible health insurance policies and outrageous hospital bills(Time Magazine-Bitter Pill), its no wonder the U.S. ranks only 51st in life expectancy in the CIA-World Fact Book. We may have the best hi-tech medicine on the planet, and spend twice per capita what other advanced countries do, but it is not accessible for all of us due the above.

  9. Steve Finner :

    So let me get this straight. MVP has twice the
    denial rate of BC BS and MVP’s CEO gets two times the
    salary of BC BS’s. Now that makes sense and is what I call
    “well managed care”.

  10. Cynthia Wolfe :

    I thought under the new healthcare reform that these insurers are required to reimburse if they do not pay out a certain percentage of what they take in. I live in MA and can’t wait to see what happens with universal health care in VT. How can it NOT be more cost effective to rid ourselves of these costly middlemen? Also we need to cap what the providers can charge for stuff like an aspirin or a bandage, it is absolute robbery to be charged these super-inflated costs. They should never be allowed to bill more than 3x the amount they pay for some small item, period. I pay close to 8K a year and get little to show for it. My college kid is FORCED to spend a grand a year for a policy that refused to pay for her annual physical, leaving her with a 300 plus dollar bill to shell out for. It is robbery.

    • Hilton Dier :

      Wisdom of fraudsters: It’s safer to screw many people, each for an amount of money too small to be litigated.

      A case manager for an HMO dies and goes to the pearly gates. St. Peter looks over the guy’s records and says, “Hmmm, under your plan you get a maximum of three days here.”

      Single payer can’t arrive soon enough.

  11. sandra bettis :

    another ad for single payer now….

  12. Theresa Maurice :

    According to my W2 and my paycheck deduction, my employer and I pay approx. 30K /yr. for an MVP policy for 3 healthy people who use the policy very little. Most of the pays scales in my area simply do not support over $700 a month in premiums if you also need to feed and educate your family.

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