First, a contract with Aetna was nullified because of bidding problems. Now, Regence BlueShield seems incapable of making timely payments to medical providers.
It’s time for state managers to hold Regence accountable to its performance standards and get the doctors and other medical providers the money they are owed.
In the fall of 2009, the state was forced to scrap its contract with insurer Aetna, which was scheduled to take over administration of the Uniform Medical Plan for state employees the following year. At the time, about 180,000 people were insured under the Uniform Medical Plan.
State officials said they expected to save millions of dollars by contracting with Aetna for administration of the health plan. But the controversial switch was vetoed by an administrative law judge who threw out the contract. He said the bid process was defective and violated state rules.
Judge Todd Gay found numerous defects in the health agency’s bidding process, including letting Aetna and other bidders change bid terms after bids were opened.
To remedy the flawed bid process, the administrative law judge said the state Health Care Authority “should start the bidding process over with all the deficiencies corrected.”
The state then budgeted $33.4 million to pay Regence BlueShield for the first year of a four-year contract to manage claims for the plan’s now-190,000 members. Regence started its contract in January.
Eight months later, the administration of the Uniform Medical Plan is in chaos. Medical providers say they have not been paid for their work and those doctors and other providers are starting to turn to patients in hopes of collecting their payments in a more timely fashion.
Clearly, it’s time for the state of Washington to ramp up its oversight responsibilities and hold the folks at Regence BlueShield accountable to the provisions of the contract and get the backlog of payments to providers erased.
The delays affect the subset of those Uniform Medical Plan members who use the state insurance as a supplement. Mainly, those are retired state employees on Medicare, about 40,000 of them.
Regence told Health Care Authority Administrator Doug Porter in August that it hoped to clear up the backlog of nearly 300,000 claims in 90 days. But Porter says he has received numerous reassurances from BlueShield previously. Yet the backlog of overdue payments continues. That’s not fair to providers or patients.
One retiree said her doctors have gone unpaid for 18 medical visits this year. Another doctor’s office said it’s still waiting on bills submitted as far back as January.
“They just say they’re sorry, but they’re backlogged,” said Ali Crane, a manager of two Olympia medical practices who has tried to wring payments out of Regence. “Why weren’t they ready? Why did they get the contract?”
Those are good question.
Regence officials pledged to add as many as 80 staff members, after originally underestimating the staff hours it would take to process claims. Additionally, Regence will begin to make provider payments then work out overpayments later.
“We are committed to bringing the claims inventory back to normal levels as quickly as possible,” Regence said in a written statement.
Given the failed first attempt with Aetna, you would have thought the state would have gotten the contract with a new provider right on the second try. But problems persist.
It’s time for state managers to hold Regence accountable. In addition to seeing that the backlog is erased, state officials must impose penalties on Regence for not meeting conditions spelled out in the contract.
The Health Care Authority said dollar amounts won’t be calculated or collected until year’s end. That’s unfortunate. Maybe a few hefty fines – now – would bring Regence into line.
Some providers have waited eight months – the entire length of the Regence contract – for payments. That’s unacceptable. It’s time for decisive action by state contract managers and it’s time for Regence to live up to its promises to erase the payment backlog.
