Blue Cross Contract Released: State pays $ 15.15 a head per

 

Saturday, Mar 14,2009, 3:11:00 PM   Click:

Copyright: The News & Observer, Raleigh, N.C.
Source: News & Observer, The (Raleigh, NC)
Wordcount: 556


Mar. 13 - Blue Cross and Blue Shield of North Carolina could do almost $ 120 million annually for administration of a preferred supplier to the organization of the State Health Plan, according to a copy of the published thursday.

The contract shows that Blue Cross, the state's largest health insurer, and the plan recently renegotiated the terms of the contract. An amendment signed last fall by Jack Walker, health plan executive director, and Blue Cross executive Brad Wilson says that as of 1 January this year, Blue Cross will pay $ 15.15 per member per month to process applications, register and make other members of management services.

With 667,000 members in the plan, this means that Blue Cross will receive $ 121.3 million a year.

The Blue Cross contract has maintained a strong interest among the employee groups and advocates of access to health care, partly because the information was kept secret for years, and because legislators are trying to save a health plan that missed its financial projections and is in danger of running out of money. Legislative leaders say the plan will have $ 250 million at the end of the month just to pay the bills on June 30, the end of the year.

Blue Cross plan and health claim that the rate is not exorbitant compared to other states. The contract states that Blue Cross' profit margin is 0625 percent, less than a penny on the dollar.

But the rate is $ 1.15 higher than the monthly rate $ 14 Walker, referring to a study comparing the costs of North Carolina with other states, cited at a meeting this week with legislators.

This is in addition to another $ 9.2 million per year.

Plan officials said Thursday that it has renegotiated the rate because the previous arrangement allowed Blue Cross to retain some money before returning to the plan, creating liquidity problems for the health plan.

The non-profit, the insurer issued the contract for The News & Observer, after a state Attorney General found that the part of the document is a public document.

On Monday, the state Senate debate legislation that provides $ 250 million of the state of the "rain" and password of another fund of $ 609 million to keep the plan solvent for the next two years. Premiums, which are largely paid for by taxpayers, would go up nearly 8 percent annually, while members of the plan see higher co-payments and deductibles. The legislation should also abide by smokers in a more expensive next year, and obese members will be moved to this more costly in 2011.

Employee groups and lawmakers have questioned whether officials plan should try to renegotiate the contract in order to reduce the cost. Walker said that the contract is not out of line with other states. The study shows that, he quoted a rate of $ 15.15 is in the range of 11 other States that have not been identified.

Plan officials previously published information showing that Blue Cross was paid $ 97.5 million during the fiscal year ended June 30, 2008. Of this amount, $ 66.6 million was paid to the administration of the PPO, the rest manage another plan that is endangered.

Plan officials had refused the contract under a provision in the law of the State which was intended to prevent disclosure of the discount health care provider whether the plan or the Blue Cross negotiated. None of these rebates are disclosed in the contract to Blue Cross.

dan.kane @ newsobserver.com or 919-829-4861



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