Business Briefs

DOI reversal could save Blue Cross members $16M

Posted November 19, 2012

— The North Carolina Department of Insurance has reversed itself on whether insurers can change the way they reimburse hospitals and physicians for radiology services without renegotiating contracts.

Blue Cross Blue Shield of North Carolina said the move could save policyholders $16 million a year, including $5 million for the State Health Plan.

The state's largest insurer, Blue Cross last year tried to implement new reimbursement policies to cut the amount hospitals and physicians receive for the "technical component" of scans – everything from checking a patient in to handing him or her a gown – when several scans are performed at once. Blue Cross and fellow insurer Aetna said they were being billed multiple times for such services, which were provided only once.

When hospitals and physicians balked at the change, the DOI issued a preliminary ruling last December that insurance companies needed to comply with state law requiring them to negotiate a new contract for changes in their fee schedule.

After a hearing on the matter, however, DOI ruled last week that limiting the amount paid for the technical component wasn't a change to the fee schedule, allowing insurers to begin issuing the lower reimbursements.

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  • deastwood1 Nov 20, 4:35 p.m.

    devilpride2012...I did a quote online. There must be something else here.

    Yeah, their initial quote they give you online is a far cry from the actual rate you receive once you go through the underwriting process with them. I was initially quoted $118/month (Im a healthy 34 year old woman) but by the time they were done with me it was $230/month. My boss and his spouse was initially quoted $500+ this bumped up to almost $900 after the underwriters.

  • Squirreling Dervish Nov 20, 4:32 p.m.

    I had BCBS Advantage for a couple years ( self-employed) and my premium was 248$ a month, 5K deductible. You CAN get a low rate but a high deductible. It can be done. If I wanted a lower deductible, it would have ( logically)( been quite a bit more expensive. Luckily my husband works at a great company and we have great insurance with Cigna, at 99 @ month for two people. Bazinga.

  • ncveteranswife Nov 20, 11:34 a.m.

    $1200 a month?

    This has to be with a low deductible....The higher your deductible, the lower your premium.

  • liberalsareweak Nov 20, 9:35 a.m.

    Their response? $1200/month.....

    This is certainly not true..if indeed you are healthy and you are not on medication the cost range from $78.38 to $323.28 depending on what ded you want. I did a quote online. There must be something else here.

  • Unbroken Nov 20, 8:31 a.m.

    "I have BCBS and I am very happy with it. It is a low premium, they pay for well care, and any charges I have are charged at the negotiated rates and those are fine...
    whatelseisnew"

    I think in looking at the rest of the comments on here, you realize that that this statement is a crock UNLESS as others have said, you get BCBS through your employer. I had BCBS through my employer for 14+ years and when I was unemployed, I inquired in BCBS about the cost for a individual/personal plan. Late 30's, 6'4", 200 lbs and no health issues. Their response? $1200/month. I went with another insurance company for $125/month.

    Another thing "whatelseisnew," I would have thought that after the shellacking you and your brethren took on November 6th, you would have learned the lesson that fear mongering and scare tactics don't work.

  • miseem Nov 19, 7:50 p.m.

    I think whatelseisnew is getting BCBS through an employer if he thinks BCBS rats are low. 10 years ago I had a personal policy with them and it was over $800 a month and I had no health problems. The fact that an employer subsidizes your insurance rates does not mean that what you pay is the actual rate charged. Of course, maybe whatelse considers an $800 a month health insurance premium low.

  • carolinafan Nov 19, 7:34 p.m.

    whatelseisnew...you must have BCBS with a company. The people that say their premiums are going up for no reason...they have individual policies with BCBS...BIG difference!!! Some people are small business owners who have to buy individual policies or whatever reason they have to get it, they are the ones that are stuck paying these high premiums. Our BCBS insurance is $1,300 a month and I guess it will be going up again and we have no health issues or take any kind of medicine, so how is this fair...we both workout and take care of ourselves! We are going to look for another insurance company also...we can't take spending this much with two kids in college. We did get a refund from BCBS...I thought it was a law. If a health insurance plan failed to achieve that 80-85% medical loss ratio in 2011, the insurer must refund the difference back to policyholders. Now this may be different by state!

  • delilahk2000 Nov 19, 6:49 p.m.

    BCBS ARE NOTHING BUT LIERS,,,,,,MY POLICY HAS GONE UP 13%EVERY YEAR,,,,AND FOR WHAT REASON.NOT BECAUSE I USE IT.....NOTHING BUT GREED...

  • grammajm Nov 19, 6:48 p.m.

    whatelseisnew...I laughed when you said BCBS has a low premium. We pay over $1100 a month out of our pocket (no major medical issues) and BCBS gets a 10% premium rate raise every year! And, no, we didn't get a rebate or refund from BCBS when they were supposed to payback their insured. Yep, you said it right, time to look for another insurance company for sure!!!

  • whatelseisnew Nov 19, 5:55 p.m.

    "Don't expect any refunds from BCBS!!!"

    I have BCBS and I am very happy with it. It is a low premium, they pay for well care, and any charges I have are charged at the negotiated rates and those are fine. In the not to distant future unfortunately, I will be forced onto Medicare. My co-pays will be higher and my premium will be higher. Plus medicare with some frequency denies paying for things. I experienced that first-hand with my mother-in-law. Medicare is the second worse insurance that I know about, only beaten out by Medicaid as the worst. If you are unhappy with BCBS, then change companies. For now at least, you still have that choice. If the Dems have their way, you will lose that choice along with many other choices they want to take out of your hands. I wonder if the Progressives will bring back Sterilization.

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