Some of the most dreaded responses from health insurance providers are “exceeds reasonable and customary charges,” “procedure not covered” and “claim for benefits denied.”
The frequency with which Soldotna city workers have been hearing those replies when filing insurance claims through the state of Alaska Political Subdivision Health Plan underwritten by Aetna Insurance has piqued the city’s interest in looking at insurance alternatives.
In the words of City Manager Tom Boedeker, “Employee satisfaction in dealing with the current carrier is not at an all-time high.”
Boedeker told the Soldotna City Council that he has been approached by a local insurance broker who said he could write a policy for city workers with Blue Cross for the same cost or less than the city is paying for the state plan.
“Any discussion would be to see if the rates would be better than the state plan,” Boedeker said.
He said it would benefit the city to have good, sound information available before the city enters into contract negotiations with its collective bargaining units next year.
The city has three groups of employees covered by health insurance: the police department, employees represented by the International Brotherhood of Electrical Workers and supervisory employees exempt from wage and hour laws.
Each group is too small for any insurance company to write a policy, so all would need to be covered under the same plan, he said.
Problems experienced by employees range from a couple dollars to thousands.
One woman who received a B-12 shot was told by Aetna the standard and customary cost of the injection was $3, said Marti Wilkison, city finance officer.
“You can’t get a shot of water for $3,” Wilkison said.
City Clerk Teresa Fahning also has had problems with Aetna.
For some time, Fahning has been seeing a chiropractor and receiving massage therapy.
Aetna paid for the chiropractor visits and massages for awhile, then suddenly stopped paying for the massages, Fahning said.
“They said they were not medically necessary,” she said.
Fahning said she questioned the decision and was told a copy of the insurance policy would be sent to her by fax. It never was.
“They wore me down and I gave up. It cost me $650,” she said.
Then, Aetna resumed paying for the massages, without explanation.
When asked if city workers have someone at the state level who can intercede with insurance issues, Fahning said, “We have somebody with AML JIA (Alaska Municipal League Joint Insurance Agency).”
“I think she made a phone call on my behalf, but didn’t get anywhere,” Fahning said.
Public Works Director Steve Bonebrake also is experiencing difficulty with the insurance carrier.
“It’s mostly the length of time they’re taking,” he said, regarding delays in paying claims.
One bill he just received this week had been submitted to Aetna in October and has yet to be paid.
Bonebrake had been undergoing radiation treatments in Anchorage for cancer and received an “Explanation of Benefits” from Aetna saying the therapeutic radiation was determined to be experimental or investigative, and the employee policy does not cover experimental therapy.
“In the long run, Aetna has been good for me,” Bonebrake said.
“Things changed in the last year or two.”
He said one of the problems is the explanations of benefits generally are too abbreviated to understand.
“You have to read between the lines. They don’t come right out and say it’s not covered,” he said.
Boedeker said the city looked at being self-insured at one time, but the city’s liability then was too great.
“The issue is to explore the options,” he said.
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