BCBS Announces New Payment Structure for Federal Workers’ Out-of-Network Surgeries
The Blue Cross and Blue Shield Association on Tuesday announced an agreement with the U.S. Office of Personnel Management that will decrease the amount of out-of-pocket spending for federal employees undergoing surgery performed by out-of-network providers, CQ HealthBeat reports. Under the new agreement, BCBS will pay 70% of the amount allowed by the plan for scheduled surgeries, leaving policyholders accountable for the remaining 30% and any difference between the amount allowed by BCBS and the actual amount charged (CQ HealthBeat, 12/16). Under a previous plan announced for 2009, members would have been responsible for 100% of the amount charged up to $7,500 per surgeon per surgical day (a href="http://www.kaisernetwork.org/daily_reports/rep_index.cfm?hint=3&DR_ID=55925" target="_new">Kaiser Daily Health Policy Report, 12/5).
In addition, members would have to meet the annual deductible for OPM's Federal Employee Health Benefits Program, up to the program's annual catastrophic maximum of $7,000. The guidelines do not apply to emergency surgery or surgery for accidental injuries performed within 72 hours of receiving an injury, BCBS said in a statement (CQ HealthBeat, 12/16).
The rule change "was made after Blue Cross and Blue Shield came under sharp criticism from federal workers," according to Washington Post columnist Joe Davidson. The House Oversight and Government Reform Subcommittee on the Federal Workforce, Postal Service and District of Columbia held a hearing on the issue after it was reported on by the Federal Diary last month. Subcommittee Chair Danny Davis (D-Ill.) and other members at the hearing "made clear their displeasure" with the surgical benefit, the Post reports. Peter Petrucci, who serves as president of the medical staff at Sibley Memorial Hospital and was an outspoken critic of the previous fee structure, said, "We're very pleased that this change has come about," adding, "I think it's a huge benefit for the people who are covered by this plan" (Davidson, Washington Post, 12/17).
