Joe Patrissi: Answers needed to change the state pension plan

This comment is from Joe Patrissi of South Burlington, who began his state employment in 1970 as a corrections officer, then commissioner for corrections from 1986 to 1991 and deputy commissioner for economic services from 2005 to 2010. He was executive director of Northeast Kingdom Community Action from 2010 until retirement in 2018.

I offer this comment to all Vermont state government retirees, their families, and all active state employees and their families, because this can affect them all.

Governor Phil Scott is heavily considering replacing a Medicare Advantage plan – specifically, Vermont Blue Advantage – in place of the BlueCross BlueShield health insurance that all retirees and active employees now have.

My wife and I received a brochure on Vermont Blue. List several “benefits” in large print. These include: sight, dentistry, telemedicine, hearing, prescription drugs, over-the-counter drug allowance, medical and hospital care, and national and worldwide coverage.

In small print it states that this is a PPO and HMO plan with a Medicare contract and states that “no contract / out of contract network providers have no obligation to treat Vermont Blue Advantage members except in emergency situations” .

Currently, for retirees, BlueCross BlueShield is a second payer after Medicare for those of us over 65. This allows us, for example, to target providers such as naturopaths, integrators, homeopaths, specialists or providers who will not take Medicare or Medicare Advantage insurance.

I wrote to the governor’s office about this potential change. The reason I did this, aside from concerns that provider networks may be limited to Medicare Advantage insurance under this program, is that too many of these plans have a highly controversial reputation.

In an article that appeared in the New York Times on October 8, the headline read: “How Insurers Leveraged Medicare for Billions.” It’s a troubling story about Medicare Advantage insurers who solicited doctors and gave them incentives to add more illnesses to patients they haven’t seen in weeks; that they were paid the most if their patients were the sickest; who billed diagnoses for diseases that did not exist.

These plans and insurers have been investigated for fraud, vetted and sued. Although insurers have disputed these claims, some estimates put overbilling at $ 20 billion in 2020 alone.

The anecdotal examples closer to home are even more troubling. A retired UVM employee who has a benefit plan has found that the concept of “benefit” is a “misnomer” and has to contend with multiple insurers grouped together. The amount of paperwork is expensive.

When a mistake occurs, “who is responsible” for the problem or fixing it is frustrating and overwhelming, especially if there are complex health issues to address. The bottom line is that coverage isn’t as good as a 31-year-old active UVM employee.

Comments from others, including MEDPAGE Today, portray frustrating preventive clearances, denials, and delays for critical illness cases, making the patient feel insecure about getting the care they need when it matters most.

Now, I want to be clear. I am not an expert on any insurance plan. Nor am I judging the Vermont Blue Advantage (Medicare) plan which according to the governor’s office is as good or better and cheap in terms of rewards current retired BlueCross BlueShield employees currently enjoy.

But given the controversy and the fact that retirees have more health problems than employees who work because they are older, the stakes are high for retirees if the Vermont Blue Advantage proves not only less expensive (and therefore a savings for the state and retirees in premiums), but less effective, accessible and useful for people like us who really count in times of need at a certain age.

Here’s the thing: if something this important is really better and cheaper than what we have now (which is counterintuitive), if it’s good business, why doesn’t the governor go to the Vermont state employee union and put his proposal on the negotiation table?

If he’s as good as he says he is, then let employees step in, do their due diligence, and formally join him in making a decision that affects not only current retirees but future retirees as well. It would be a win for everyone.

Conversely, if the governor is unwilling to submit to bargaining, then it becomes one of those “too good to be true” sales jobs that could probably turn out to be just that.

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Tags: BlueCross BlueShield, Joe Patrissi, medicare benefit, retirees

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