Mixup costs insurer $27K in penalties

Eisenhower’s ‘Air Force One’ coming to Houma
February 3, 2010
Carla Bourgeois
February 5, 2010
Eisenhower’s ‘Air Force One’ coming to Houma
February 3, 2010
Carla Bourgeois
February 5, 2010

In the wake of a botched transition of health care providers, United Health Care has agreed to pay Terrebonne Parish Consolidated government $27,000 for failing to smoothly transfer the health care of parish employees into their system.

As of Jan. 1 of this year, the parish government’s insurance program, which covers some 2,600 parish employees and dependents, was switched from Meritain Health to United Health Care (UHC). Somewhere in the transition process, the co-pay rate for parish employees was accidentally raised, which left some parish employees paying more for their medicine than they were accustomed. Other parish employees reported being unable to visit their long-time physicians because of the change in networks.

“I’ve worked for United Health Care for seven years, and I’ve never seen anything like this,” said the UHC’s account executive for Terrebonne Parish Mona McLean.

UHC also had difficulty generating unique identification numbers for parish employees, which caused them to send temporary policy cards using each person’s social security number.

“That’s just an embarrassing level of protection of people’s personal information,” said Councilman Kevin Voisin, who said his card was just a slip a paper he may have already lost.

According to the Parish’s Director of Human Resources and Risk Management J. Dana Ortego, UHC is contractually obligated to pay the parish $5,700 each for three violations, including failing to issue proper identification cards, getting the policy’s co-pay rate wrong, and failing to cover some drugs that are normally covered by the parish. UHC will also pay a $10,000 fine for flunking a satisfaction survey about the first month of service.

The parish’s insurance program is actually self-funded; they simply pay an outside company to administer their program. As such, the parish creates its own policy, which is different from the standard plans sold by UHC. This may have caused the mix up in co-pay rates.

The parish also covers certain drugs that UHC normally does not, which forced some parish employees to pay for their entire prescription.

UHC has agreed to reimburse any parish employees who had to pay more than they usually would as a result of the error. Many on the parish’s retired employees still receive health care through the parish and are on a fixed income. Having to pay extra for prescription drugs may be next to impossible for seniors on a fixed income, said Councilman Clayton Voisin.

The mishap caused something of a scene at last Monday’s Policy, Procedure and Legal Committee meeting as parish councilmen berated McLean for the bumpy transfer.

“Some 400 glitches in the first month is unacceptable. Somebody has dropped the ball somewhere,” said Council Chairwoman Arlanda Williams. “I’m disappointed because nothing I’ve heard tonight is acceptable.”

According to McLean, some of the errors were caused by the computer system of the parish “not communicating” with the systems at UHC. But that idea didn’t exactly settle the concerns of some council members.

“To say that our computers can’t communicate in 2010, and I have an extensive background in IT [information technology], somebody should be slapped,” said Kevin Voisin. “Everyone involved in the transaction should be embarrassed.”

Despite the snafu, Ortego commended McLean’s work, and said that she even used her own credit card to cover the gap in some people’s prescription payments.

“I believe that Ms. McLean is doing a very good job. She has, in my opinion stepped to the plate and taken responsibility for things her company may have done,” said Ortego.

Although calls have continued to trickle in to the parish, McLean said that the problem should be predominantly solved.

“There will always be an issue or two, but we should be at normal (Tuesday) except we need to get people reimbursed and get them permanent cards,” said McLean.

The largest issue still facing the transition is the fact that Chabert Medical Center is not included in UHC’s network.

Some parish employees who have been seeing the same doctors for years have been asked by UHC to bring a form to their doctor in hopes they’ll join the new network.

“When this plan was sold to us, we were told that you guys had more doctors,” said Williams. “The idea that patients have to bring forms to their doctors, that’s not something our employees should be handling.”

The issue tied the normally tranquil committee in knots for nearly an hour as McLean withered the brunt of the council’s anger. Even the $27,000 in penalties did not assuage Clayton Voisin’s frustration.

“Well, $27,000 coming back into government coffers sounds good, but not when we have people who need their medicine and can’t get it,” he said.

Kevin Voisin – Bungle was an ’embarrassing level of protection’