Blue Cross giving rebates for failing to meet requirement

The State
July 24, 2012

Insurer violated new health care law in spending on claims

BY STEPHEN LARGEN The (Charleston) Post and Courier

South Carolina’s largest health insurer has begun sending out rebate checks to some policyholders because it failed to meet a requirement of the federal health care overhaul.

Blue Cross Blue Shield of South Carolina said Monday that checks – most for less than $200 – will be sent to individual and small group policy holders during the next two weeks. A company spokeswoman declined to say how much it will be paying out in rebates.

The provider, like some others, didn’t spend enough on customers’ medical claims in 2011, according to the terms of the Affordable Care Act.

Blue Cross Blue Shield said it is complying with the law, even though the insurer views the requirement as bad policy. 

The spending stipulation doesn’t address the root causes of rising health care expenses, such as waste and fraud and lifestyle choices, a company spokeswoman said.

And Jim Deyling, Blue Cross Blue Shield’s president of private business, said in a statement that “our concern remains that a rebate such as this not only creates a false impression of overpricing, but also reveals the fundamental flaw of the legislation, which is that it does nothing to reduce health care expense for members.”

The director of Gov. Nikki Haley’s Department of Health and Human Services agreed.

“In a health care system where it has been estimated up to 30 percent of health care spending is excess cost, these small rebates may be momentary relief for those who receive them, but they clearly don’t target the underlying reasons for out of control health care costs,” Tony Keck said in a statement.

Haley, like most Republicans, opposes the Affordable Care Act.

Conversely, the president of South Carolina’s Small Business Chamber of Commerce hailed the requirement that forced Blue Cross Blue Shield to issue rebates.

“This demonstrates that the Affordable Care Act, ‘Obamacare,’ health care reform or whatever you call it is doing what it said it would do: help make health insurance more affordable,” said Frank Knapp, a longtime supporter of the law.

Blue Cross Blue Shield held at least 60 percent of the market share in eight of the state’s largest metro areas in 2008, according to a study by the American Medical Association. 

MONEY BACK

BlueCross BlueShield of South Carolina will issue checks to some policyholders because it didn’t meet a requirement of the Affordable Care Act. Questions and answers:

Who will get rebates? Individual customers will receive checks directly from the company, while owners of businesses with between two and 50 full- and part-time employees, including seasonal help, will get one check for the company’s policy.

What can the rebates be spent on? No restrictions for individual customers. Small business owners can return money to employees, reinvest it to offset future health care costs or use it in another way that benefits employees.

Why are the rebates coming? The company did not meet the medical loss ratio for spending on customers’ medical claims in 2011. It was required to spend 80 percent of premiums for customers’ medical claims. It spent 74.8 percent in the individual market, and 79.9 percent in the small group market. The company won’t issue checks for large group plans as it exceeded the 85 percent target.

http://www.postandcourier.com/article/20120724/PC16/120729651/1177/south-carolina-s-largest-health-insurer-issuing-rebates