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Legal challenge continues over city's choice to manage health insurance fund

Monday, Dec. 31, 2012 5:13 PM
Last updated 8:51 PM
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The insurance company whose protest failed to convince Augusta commissioners to change their decision to award a lucrative contract to Blue Cross Blue Shield will pursue its challenge in court.

In papers filed just before Christmas, Aetna subsidiary Meritain Health requested an order from the Richmond County Superior Court to force the city’s procurement office to terminate its recent contract with Blue Cross Blue Shield to administer the city’s self-insured health care insurance fund for city employees.

Commissioners opted in 2012 to become self-insured because of the rising cost of providing health insurance to approximately 2,200 employees. The role of third party administrator for the fund, over $20 million annually, was a job put out for bid.

Meritain, Blue Cross Blue Shield and two other companies presented proposals to oversee the fund. According to city documents and Meritain’s lawsuit, the city’s selection committee judged Meritain to be the highest qualified at the lowest cost.

Instead of taking commissioners those results for a vote, the procurement department asked the companies to provide additional information and price quote for the possibility of a worst-case scenario for each employee. Meritain called the procedure unfair and contrary to state law and city purchasing ordinances, but the city contended in court last month that it was done because commissioners were most concerned about the city’s maximum potential liability.

Afterward, Blue Cross Blue Shield was judged to be the best choice for the city because, city officials said last month, Meritain was found to have had additional expenses not included in its price.

Meritain contends in the most recent court documents, filed Dec. 20, that the procurement department’s cost estimate for Blue Cross Blue Shield’s services was in error by more than $900,000.

The city should file its response to the newest legal challenge this month.

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Little Lamb
45870
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Little Lamb 12/31/12 - 07:17 pm
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Procurement Fraud

Just another routine foray into incompetence, waste, and corruption inside Augusta's procurement department. Saving the taxpayers money is the last thing on Geri Sams’ mind.

Fiat_Lux
15411
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Fiat_Lux 12/31/12 - 07:34 pm
1
1
Yeah, but

It sounds like Meritain doesn't have the financial depth to cover the worst-case scenario for all employees, which is what the commissioners quite correctly want available.

MCG did the same kind of deal with self-insuring Health, Inc employees for a few years, and ye gods and little fishes, what a freaking disaster it was with the drug plan coverage. OMG!

Perhaps Meritain was going to make them get their medications from Medco and the commissioners had heard how horrible they are to deal with and how vastly much more the out-of-pocket costs are for the people paying for the coverage.

Let 'em sue, and then go after Meritain for damages from a frivolous lawsuit after making sure there wasn't some conflict of interest involved in the choice.

OpenCurtain
10049
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OpenCurtain 12/31/12 - 08:26 pm
2
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I think I figured it out

The real plan is approve things or make decisions that result in lawsuits.
Why didn't I see it before we pay taxes to make the lawyers cartel rich suing RC/A. The Politicians are only the middle men in the scheme.

OpenCurtain
10049
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OpenCurtain 12/31/12 - 08:38 pm
3
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Seriously now.

Why doesn't RC-A Counter Sue AETNA subsidiary Meritain Health?

BTW: My wife and I have AETNA... it is GOOD, pricey but good.
and much better in coverage than No Cross No Shield and many others.

We can say this having had:
United Healthcare
KP
Aetna
BCBS
Golden Rule
Met. Healthcare
Mass. Healthcare
and some off brands cheap employers used to skirt the contract requirements.

The best joke was the one we had at Ft. Bragg that did not cover flying on military aircraft.

OhWell
326
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OhWell 12/31/12 - 08:41 pm
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Meritain (Aetna) has pretty

Meritain (Aetna) has pretty deep pockets and I feel they could fulfill their contract. I mananage an account that files 10,000 plus claims a month and BCBS is one of the most difficult carriers for the provider to deal with.

As to the comment reguarding Medco I certainly hope the commisioners hired a qualified consulting firm to research the decision to self-insure, most companies that do this would fund their own pharmacy for medications taken by employees and dependants that are required long term, an outside pharmacy would only be used on occasions where needed RX was not available.

If I remember correctly another reason BCBS was chosen was because they were the previous carrier and would have all of the employees information. With EMR and insurance demographic information electronically available this could easily be migrated to another Insurance Carrier.

For the sake of taxpayers and the health of city employees I hope this is quickly resolved.

OpenCurtain
10049
Points
OpenCurtain 01/01/13 - 09:56 am
1
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OhWell

Well written and full of good info.

We have been and end users speaking with Doctors over the years and they pretty much agree with you point for point.

But End-users can only discuss the tail end of the problem.

Therefore, it more important to get the overall view from the Mid to Large Plan Administrators. Because at that level both sides are seen in dealing with such companies, the End user and the deliberate slow down Administrative Red tape actions of a Insurance Company.

I look forward to reading more of your comments in the future on this subject.

Fiat_Lux
15411
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Fiat_Lux 01/01/13 - 11:59 am
0
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Cant' disagree about BC/BS

They are a pain in the patookus, but Medco handled all the pharm for MCGHI, regardless of the drug.

I always get the feeling that research done at the behest of the RCC is handled based on "knowing someone" who "knows someone". After the fact, it always feels a bit like we ended up paying an unreasonably large amount of money for not-very-useful information. This particular instance doesn't seem much different.

David Parker
7923
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David Parker 01/01/13 - 12:09 pm
0
0
Insurance companies main

An insurance company's main priority is to persuade someone to get their coverage. Once you are a paid customer, their main priority is to minimize payouts for coverage.

That's as accurate as the day is long. Don't misunderstand me either, I'm not judging them, it's just business. So, if this is about suing an insurance company, I'm all in. Doesn't matter what for either. Believe me when I say this, your rates don't go up b/c they lose a lawsuit or b/c of fraud or because of disasters, etc. The rates go up based on how much money they desire to profit.

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