State Employees Health Insurance Group Institutes Disappointing Changes

Ralph Hayes is the Director of the State Employees Health Group Insurance. 

By Tom Lacock
Wyoming Medical Society

CHEYENNE – State Employees in Wyoming have a few changes coming to their health insurance starting in 2017 with two of the changes being of concern to the Wyoming Medical Society.

According to the Sept. 2016 edition of the Benefits Press, a Wyoming Department of Administration and Information publication, the health plan will no longer accept provider assignment of benefits for non-participating providers. This means all payments for medical services for non-participating providers will be sent to the member and not the provider. Participating providers will continue to be paid directly.

The Wyoming Medical Society has concerns regarding this change. While it is not a new concept, past instances of sending checks to members instead of providers have resulted in non-payment for services. Attorney Franklin Rooks wrote about the idea of sending payments directly to insurance members instead of physician offices for Physicians News Digest and points out members may not realize the check they are receiving from their insurance company has been sent to pay the doctor.

“As many physicians have discovered, it is not always easy to get insurance payments from patients who have cashed, and possibly, spent the insurance reimbursement check,” he writes. He would go on to suggest this practice has been seen by insurers as key to their ability to control costs and provide affordable health insurance. The hope is insurance companies can strong-arm physicians into joining networks.

Wyoming State Insurance Group Director Ralph Hayes declined comment on the change. Representatives from Cigna also declined comment.

The State employee plan will also offer members around-the-clock telehealth consultations, which the state says in a powerpoint to its members, was proposed by Cigna. Target date for the roll-out is January 1.

“We believe that the telehealth service appeals specifically to health plan members who need quick, concise treatment for non-emergency medical issues (such as cold and flu, rashes, sinus issues and headaches) and who don’t want or need to schedule a doctor’s appointment or visit the nearest hospital or clinic,” said a story in the Benefit Press. “The platform will give members the opportunity to connect with the telehealth company’s network of physicians and ensure the encounter is recorded and passed on to the member’s primary care physician for follow-up and inclusion in the electronic medical record.”

The Wyoming State Employees Insurance Benefit Program awarded a number of healthcare contracts this year. Cigna retains the healthcare administration contract for the State, while MedImpact was awarded the Pharmacy Benefit Management contract. Delta Dental won the dental administration contract, and Standard is the state’s Life Insurance carrier.

The State also determined in order to keep costs down it needed raise its deductibles on three packages, which would allow it to continue its current premiums. The state’s most popular health insurance package previously featured a $350 deductible for an individual. That plan will now change to $500 deductible. This package has been the choice of 59 percent of state employees.

The second tier of deductible – $750 – has been replaced by a $900 deductible. That plan also proved popular with state employees as 27 percent of state employees took advantage of that plan.

Other changes include co-insurance for non-participating Wyoming medical providers will move from 80 percent to 75 percent. Participating Wyoming medical providers will see their co-insurance remain at 85 percent. Out-of-State providers will also receive 75 percent co-insurance, down from the current 80 percent. Finally, the health plans base non-par provider reimbursement schedule will move from the 90th percentile to the 80th percentile.