The conflict and confusion surrounding changes of health benefits administered by the Hawaii Employer-Union Heath Benefits Trust Fund continue to be interesting to follow.
Yesterday, following a special board meeting, EUTF administrator Jim Williams issued a long press release blaming the whole mess on misleading information distributed by HMSA.
Williams’ press release includes his version of a detailed “he said-she said” timeline, a summary of EUTF decisions drawn from meeting minutes, and a list of 30 documents that are supposed to be made public today on the EUTF web site, including correspondence, minutes, and internal memos.
Several points are worth noting. First, perhaps of interest to journalists, is the EUTF claim that it has the right of “prior review” of anything that HMSA and other plan administrators say related to their plans and the open enrollment period.
First, it must be noted that the Open Enrollment is sponsored and carried out by the EUTF. Insurers and plan administrators participate in EUTF Open enrollment activities at the invitation of and under the direction of the EUTF. Advertising by insurers and plan administrators related to EUTF plans and activities is permitted as long as the copy is submitted to and approved by the EUTF administrator in advance. Until this year, HMSA and all the other insurers and plan administrators have complied with EUTF directives, but this year HMSA has not followed the requirement for prior review of Open Enrollment related copy.
No particulars are provided regarding this “prior review” and the criteria EUTF would apply in such a review, nor does Williams say anything about how a review of each and every communication could be accomplished given the agency’s admitted staffing shortages, heavy workload, and short timeline.
Is this really a “no talk stink about the agency” kind of review? There are certainly some thorny issues here.
Another point is that while HMSA initially selected to provide the new “80-20” plan, it was apparently surprised by and objected to the EUTF’s decision that employees would default to the “90-10” plan by the a new carrier (Summerlin) if they failed to submit new paperwork. I’ll be interested to see the details of that particular “default” decision.
HMSA has also enlisted doctors in its effort to retain its customer base. I recently received a form letter from my doctor suggesting that he would prefer to continue working with HMSA and encouraging his patients to retain their HMSA coverage. I’m suspect this was paid for and perhaps even processed by HMSA.
Quite a battle royal!
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We’re now less than a month away from the Winter Solstice. It’s a time of year for awesome dawns. Here’s another Kaaawa morning in November.
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I have COBRA coverage through EUTF. I have received two mailings from HMSA and my daughter received one of the form letters from a specialist she saw at Straub when she injured her elbow. I try every day to contact EUTF and I am put on hold and then disconnected. sigh.
Similar experience for my child on COBRA. FYI, if you want to stay with HMSA (and thereby switch to the slightly cheaper, different coverage afforded under the 80/20 plan), you need do nothing. Of course, this is exactly opposite the case of active employees (who must affirmatively elect to switch to 80/20 to saty with HMSA or automatically be rolled over to HMA) and totally unapparent in the mailings from HMSA.
HMSA acknowledged the mailing was unclear for COBRA beneficiaries. Yeah, no kidding.
In the past, I haven’t been sympathetic to the big fish that is commonly known as HMSA. In spite of my historical stance, I chose to continue with HMSA.
Ironically, it wasn’t the information I received from HMSA that swayed my opinion, but rather the plan comparison provided by EUTF.
I am very interested in finding out how many EUTF beneficiaries chose the 80/20 option, and whther or not it would have been more efficient to have those who chose the Summerlin/HMA 90/10 to fill out EC-1 forms.
I work at HMSA. I don’t feel like I’m part of a huge machine. It’s more of an ohana.
When it was discovered that HMA would be the default for thousands of EUTF participants if they didn’t complete the form EC-1 indicating they wanted to stay with HMSA, our brass rallied the troops.
It’s simple. If we lose a big part of our business, our ranks are cut. We lose friends, we lose valuable people at HMSA. It was a no brainer for us. We put our heads together. We all know someone who works for HGEA, UHPA, UPW.
We decided that we would talk it up, we would email, we would reach out on social media!
What’s pretty amazing is that HMSA executives have come to realize the value of social media. I’ve never been handed a script to work from. Our messages are heart-felt, and therefore, extremely valuable to our organization.
We at HMSA were asked to reach out to people we know in EUTF. Think about it. Chances are you know someone who works at HMSA. We’re your neighbors, we ride theBus, we’re people who live in Hawaii. Our paychecks come from a local company and get deposited in a local bank.
If we’re seen as a big fish, it’s because over the years HMSA has developed into an organization that delivers — one conversation at a time. These are conversations between HMSA and its members, between HMSA and physicians, between HMSA and providers of various services that are designed to keep Hawaii healthy.
Everyday we at HMSA ask the question, “What can we do to help you?”
Mahalo, Pono, for stating what you feel. We know that’s out there. We’re working on it.
Oh, how many HMSA stories there are. If only the denials went down as smoothly as the social media messages.
Heart-felt? Deny a PET scan? Deny an x-ray to locate possible cancer?
Come on!
I have two crumudgeon old doctors I have known for years. Both refused to sign up with HMA. They don’t like HMSA, doesn’t pay well but they say HMA will suck people into its plan then drive out the sick, forcing them back to HMSA, forcing HMSA to raise its rates and HMA rakes in profits on the young and well. They hate to admit that sometimes a monopoly ain’t so bad but they like Hawaii and this was the cost of living here. Crusty old farts, but they have kept me alive through cancer. They butted heads with HMSA and won.
This may be the beginning of the end of ‘cheap’ medical insurance in Hawaii. It was hell for doctors. Now it will be hell for patients. But the free market will have worked as it did on Wall Street.
You have been warned. Maybe they will issue suicide pills once we reach 70.