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November 15-16
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December 4-5
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NEWS
Blues (Continued from Page One)
We dont want to be a for-prot company co-owned by stockholders, he said. Hetzel said the companys main complaint is its inability to expediently set rates in the individual market. The organization currently has to submit rate requests for the individual market to the insurance commissioner, where they are subject to a public hearing and review. The process can take up to 18 months, and is generally slower for the Blues than for its competitors. The Blues rate-setting process is a huge competitive disadvantage, Hetzel said. It is cumbersome to set pricing effectively and efciently. Hetzel said the legislation is not contentious and received overwhelming bipartisan support in the Senate. But there are a handful of dissenters outside of the Legislature including AARP, the Center for Insurance Research, a nonprot public policy and advocacy association, and the Michigan Association of Health Plans. Bill Schuette, the states attorney general, has spoken publicly about the need for an independent consulting rm to analyze the assets and value of the company before the legislation is signed by Snyder and enacted. This step, which traditionally occurs when a not-for-prot company converts to a for-prot or undergoes a radical shift to another corporate form, is not required under this legislation. Schuette may sue if the legislation is passed as-is and he feels it is does not presetve the interests of the states residents. Brendan Bridgeland, director for the Cambridge, Mass.-based Center for Insurance Research, agreed with the need for an impartial evaluation of the company. He estimates BCBSMIs market value could be more than double its $3.2 billion book value. You only get a chance to do this once and if conversions happen and payment transfer werent made or assets werent valued, if you try to recapture them later through
Page 2
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In Brief
Saint Anthony Hospital Challenges Illinois Regulators
Chicago-based Saint Anthony Hospital is butting heads with the Illinois Department of Healthcare and Family Services, claiming the agency is unlawfully holding back supplemental Medicaid payments. According to hospital officials, Saint Anthony has had its supplemental payments withheld because it lacked a contract with a integrated care program contractor. The requirement was part of a new law intended to toughen up Medicaid guidelines passed by the state Legislature earlier in the year. However, hospital officials claim that its current contracts with health plans suffice for the integrated care program contractor suffices and the agency is misinterpreting the regulations. The democratic leadership in the State of Illinois has suggested that it understands the plight of those challenged in these tough economic times, and the importance of providing fair access to health care for all," said Saint Anthony Chief Executive Officer Guy A. Medaglia. Yet the actions by the HFS speak to the contrary, prioritizing state budget goals over healthcare for its citizens by enacting and enforcing unfair and punitive policies targeting safetynet hospitals.
litigation, you only got pennies on the dollar., he said. They need to value it right now. MAHP called a meeting last week with the media detailing their opposition to the legislation. Rick Murdock, the groups executive director, said it has been advocating the Blues make the transition for a number of years. His concern, however, is to truly make it a level playing eld. It may sound equal, but it isnt, said Joe Aoun, an attorney representing Aetna at the MAHP media session. They say want to be regulated like everyone else and it sounds good, but there should be a different regulation when someone has that large a portion of the market.
Continued on Page 3
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NEWS
Blues (Continued from Page One)
Medigap in 2016. But Hetzel said this wont have a huge impact on the market. Over time, people have become accustomed to subsidized Blue Cross plans but there are much better options out there, he said. Even at subsidized prices, almost all of our Medigap subscribers would be better off buying a Medicare Advantage Plan. Bridgeland and others dont necessarily oppose a Blue Cross conversion, but would like to see the process slowed. The guarantee
Page 3
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In Brief
the Wolverine State as part of its Strengthening the Safety Net program. Fifty clinics received grants of $15,000 apiece. Eight clinics also received an additional $50,000 to address gaps in the local safety net system. The larger grants were part of a competitive bidding process. As part of our ongoing social mission, our free clinic grant program continues to play a crucial role in Michigan's healthcare system, by providing quality healthcare to the uninsured, serving as a safety net for people who need it the most, said Lynda Rossi, BCBSM senior vice president of public affairs. One clinic that won both grants, St. Vincent de Paul in Detroit, said it would use the money to expand the dental care it providers to city residents.
issue policy of the ACA doesnt go into effect until January 2014. Another option, he said, would be to evaluate the states insurance regulations to make them fairer, in lieu of converting Blue Cross. We want a longer look and more public disclosure, Bridgeland said. This shouldnt be happening behind closed doors and there has to be the opportunity for the public to provide input. TAMMY WORTH
Contexo Media is an independent provider of revenue-enhancing solutions for medical practices to maximize their coding, reimbursement and compliance efforts. Thousands of health care professionals rely on Contexo Medias coding books, software, eLearning and educational workshops to stay on top of critical updates across the fast-changing medical landscape.
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OPINION
Page 4
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MARKETPLACE/EMPLOYMENT
Page 5
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