Stanford Report Online



Stanford Report, December 6, 2000
Blue Cross HMO members may need to select new insurance

BY LISA TREI

Faculty, staff and retirees enrolled in Blue Cross of California will have an opportunity to select a new health plan for next year if Sutter Health Systems terminates its contract, reports Benefits Manager Lauren Schlezinger. This special enrollment period will take place only if a settlement is not reached.

Note that this change affects only members covered by Blue Cross HMO (California Care), not those covered by Blue Shield's Triple Option plan.

Patients who receive treatment through Sutter Health-affiliated providers, including Palo Alto Medical Foundation, Camino Medical Group and Alta Bates in the East Bay, will be affected if Sutter and Blue Cross fail to reach an agreement. Talks related to the next contract are focused on reimbursement rates for health care providers.

Blue Cross sent a letter dated Nov. 20 to participants informing them that if no contract agreement is reached by Dec. 15, they will be assigned to another medical group within the company's network, effective Jan. 1.

The letter stated that Blue Cross would try to allow members to keep their primary care physicians, but that this would be contingent on that doctor having an additional contract with a non-Sutter medical group.

The letter added that members who "are pregnant, or in a current episode of care for an acute or chronic condition," are asked to contact Blue Cross for details about continuing care.

In the event Sutter terminates its contract with Blue Cross, people who receive treatment through Palo Alto Medical Foundation, for example, will be able to continue to use that facility by selecting PacifiCare or Blue Shield Triple Option. According to Schlezinger, PacifiCare premiums are only slightly higher than those for Blue Cross, the university's lowest-cost health care plan.

Schlezinger says that BenefitSU, the university's new benefits service center, has received many phone calls from people wanting to know why they heard about the possible contract termination just after Open Enrollment closed. "We're in a really difficult spot," she says. "We must rely on the health plan to disseminate their proprietary information regarding contract negotiations. Stanford's enrollees represent one small piece of Sutter's total enrollment in Blue Cross. The reality is we just don't have any influence on their negotiations and it's regrettable that Sutter and Blue Cross are putting Stanford enrollees in the middle of the dispute."

However, in order to accommodate those affected, the university will allow Blue Cross members covered through Sutter to select a new health plan. No date for the special enrollment has been announced, Schlezinger says, but it is likely to coincide with the Dec. 15 date Blue Cross said it would start reassigning members to new medical groups. Check Stanford Report Online at http://news.stanford.edu for updates.

"We want to do the right thing for people," says Schlezinger. "We understand how upset they are."

About 1,000 people at Stanford selected Blue Cross for their insurance coverage during 2000, according to statistics. The figure for 2001 is not yet known because enrollment forms are still being processed. About 13,500 staff, faculty and retirees are eligible for health insurance coverage through the university.

Open Enrollment hit by last-day deluge

So many people tried to enroll online starting Nov. 19 -- the day before this year's Open Enrollment deadline -- that they had trouble completing their transactions on the web. On Nov. 20, BenefitSU received more than 950 calls concerning enrollment questions -- up from about 300 a day during the rest of Open Enrollment. Web problems forced the office to extend enrollment through Nov. 21.

"It's human nature to wait until the last minute," says Schlezinger. Next year, the office wants to find ways to encourage early enrollment. "We want people's feedback on how to improve the website for next year," she says. Suggestions should be sent online to http://benefitsu/.

Schlezinger says the introduction of BenefitSU, which was launched just before Open Enrollment, helped staff respond to the increase in inquiries. But she acknowledges that the turnaround in answering calls was slower than people expected. The new system had callers use one central number instead of having them contact counselors assigned to them according to the first letter of their last name. Schlezinger says the old system would have caused even greater problems because the individual counselors' voice-mail boxes would have been unable to accommodate the volume of calls made during the peak period.

"Sixty-five percent of people who called [during the peak period before Open Enrollment closed] had their call answered by a person" instead of by a recorded message, Schlezinger explains. "This is not acceptable to us over the long term, but it still reflects an improvement over past performance." Schlezinger added that before Oct. 1, 30 to 40 percent of calls were answered by a person. The Benefits Office is working toward a goal of 90 percent, she said, with those reaching a recorded message getting a response within 24 hours.

This year's Open Enrollment taught staff important lessons for next year. "We know we need to hire more temporary help," Schlezinger says. "We learned that we must continue to publicize information available in print and on the web. Furthermore, improvements to the BenefitSU website should help people find answers to their questions without contacting the office." Taking a service-center approach gave the office the opportunity to track queries. Schlezinger says her staff will analyze this information to learn how to improve the system.