December 03, 2008

CARDIN CALLS ON OPM TO PROTECT FEDERAL WORKERS AND REVERSE APPROVAL FOR BLUE CROSS-BLUE SHIELD COVERAGE CHANGES FOR SURGERY

Washington, DC -- U.S. Senator Benjamin L. Cardin (D-MD) released the following statement regarding proposed changes to the FEP Blue Cross-Blue Shield (BCBS) Standard Option health plan, the most popular choice for health plans among federal employees:

 

"I urge the Office of Personnel Management (OPM) to immediately reverse its decision to allow changes to the Blue Cross-Blue Shield Standard Option health plan for federal employees that increases costs and reduces options for patients and doctors. OPM is charged with protecting the interests of federal employees and should not have approved a plan that so significantly increases costs for employees who use out-of-network surgeons. On behalf of federal employees and retirees, thousands of whom are Maryland residents, I urge OPM to immediately withdraw its approval of this cost-prohibitive plan.

 

"Open season for the Federal Employees Health Plan (FEHP) ends Monday, December 8. Because health plan choices automatically renew from year-to-year, a major change in out-of-pocket costs for patients facing surgery would be a catastrophic surprise for individuals dealing with a major health issue. This is unacceptable and jeopardizes access to care."

 

Currently, federal employees on the BCBS Standard Option who have surgery performed by an out-of-network doctor are reimbursed at 75 percent of the BCBS allowable amount. The policy change would make the patient responsible for 100 percent of any surgery charge that is performed by a non-participating provider, up to $7,500 per procedure.  This effectively removes the choice of provider that subscribers want when choosing a Preferred Provider Organization (PPO) and could significantly increase out-of-pocket expenses.

 

Under the revised plan, a patient would also be 100 percent responsible for any general anesthesia performed by a non-participating provider up to $800. And a patient would be 100 percent responsible for any emergency room services performed by a non-participating physician up to $350.  In a true emergency situation, patients do not have the option of selecting the physician who evaluates and treats them in the emergency department.