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Open enrollment has arrived for health plans in Los Alamos. It’s never easy, but it may be even worse this year.
LANL's open enrollment period begins next week and lasts through Nov. 20. (Editor's note: This corrects a statement in an earlier version of this story that the enrollment period for retirees was next week.) For many retirees, that calls for an extra reality check from experts who know the ins and outs of a system that is growing more complicated every year.
Nearly 100 retirees packed a meeting room at the White Rock Senior Center Thursday for an hour-long question and answer session with Glen Lockhart and Ken Wilson, sponsored by the Los Alamos Retirees Group.
Lockhart said it was the 15th year that the health insurance discussion session has been held. A similar session, the last public session of the open enrollment season, will take place at 1:30 p.m. Tuesday at the Betty Ehart Senior Center in Los Alamos.
Under the ground rules for the discussion, participants were asked to keep their questions to general items, rather than get into specific claims, which probably would not be relevant to others.
This year, a little extra attention is clearly in order and not only because LANL is changing plan administrators for LANL's self insured plans from United Health Care and Anthem Blue Cross to Blue Cross Blue Shield of New Mexico. (Editor's Note: This corrects the previous statement that LANL was changing "carriers." As Glen Lockhart explained the distinction in a subsequent e-mail: "Plan Administrators receive a fee or a percentage of claims in return for processing claims and allowing use of their prov ider network for managed care, but assume no risk for claims.")
People currently enrolled in the plans have probably already found their enrollment booklet in the mail, describing the changes and the various plans. These include medical options — Exclusive Provider Organization (EPO), Preferred Provider Organization (PPO) or Medicare Supplement, or Consumer Driven Health Plan (CDHP), and additional plans for prescription drugs, vision and group legal coverage.
One option for everybody except retirees without Medicare enrolled in the University of California’s Blue Cross of California core plan (Core New Mexico), is to do nothing, Lockhart said, but this year that doesn’t mean that nothing will change.
“If you do nothing, you’ll automatically be mapped over to the plan that most nearly matches your current plan,” he said.
Directing questions to Lockhart and Wilson, whether at the one remaining public discussion or by contacting Lockhart through the senior centers, is advisable because there are inconsistencies and outright mistakes in the enrollment booklet.
“Premiums were wrong in the guide book,” Lockhart said, for example.
One guide book said vision was free and another $10.75 a month. A number of other errors came up during the discussion.
There was also the issue of unsigned agreements between Blue Cross Blue Shield and the providers.
At least two large medical groups in Los Alamos have given notice that they have not agreed to a contract with the new provider — identified at the meeting as Medical Associates of Northern New Mexico and Los Alamos Medical Care Clinic.
A flyer from LAMCC included the question, “Why would LAMCC choose not to contract with BCBS in 2010?”
The answer: “With lower reimbursement we would be forced to cut back customer services. It would impact areas such as: phone services, nurse and physician acces. It is impossible for physicians to provide quality care when the operating costs are more than what BCBS currently reimburses.”
Wally McCorkle, in a call to the Monitor Thursday, said he thought the enrollment deadline should be extended until it was clear which doctors would be in the networks.
A group of 30 individual doctors, grouped in a Physician Hospital Organization were also said to have a negotiator still detailing a contract with the provider.
“In my opinion, none of the doctors want to get out,” said Wilson. “On the other hand, none want to go broke either.”
Another set of complication has to do with the outcome of the healthcare reform bills making their way through Congress.
Because of changes and some reductions in the medical payment schedules for next year, some physicians have reported that they will only take existing patients. Newcomers arriving from out of town may be out of luck.