I am writing today to announce the closure of the New Mexico Independent. After three and a half years of operation in New Mexico, the board of the American Independent News Network, has decided to shift publication of its news…
Posts Tagged Blue Cross Blue Shield
Blue Cross will be asked…
The state’s new Superintendent of Insurance, John Franchini, began work Monday — just two days ahead of a public hearing scheduled for Wednesday on the controversial Blue Cross and Blue Shield of New Mexico health…
In light of public outrage over a controversial 21 percent increase in Blue Cross Blue Shield’s health insurance premiums — and revelations the increase may have been based partly on exaggerated losses — the New Mexico Division of Insurance is moving to require insurers to submit more information, including rate histories, when filing new rates.
Thursday on the KUNM evening news, The Independent’s Bryant Furlow discussed the efforts of Blue Cross and Blue Shield of New Mexico to raise rates on individual policy holders in the state. The state Supreme Court ruled this week…
“This paves the way for the public vetting of the factors underlying the rate increase,” Public Regulation Commission (PRC) Commissioner Jason Marks told The Independent at the Supreme Court. “The public can’t help but benefit from hearings.”
After hearing oral arguments from Blue Cross attorney Paul Bardacke, Attorney General Gary King and Insurance Division attorney David Barton, justices retired to chambers for approximately 25 minutes Wednesday morning. They briefly emerged for Justice Petra Jimenez Maes to announce the court was denying the company’s petition.
Insurers should not be subject to repeated hearings after a rate hike has been approved by the insurance superintendent, Bardacke argued.
“Where is the finality for consumers, first of all?” he asked in oral arguments before the court.
But the Supreme Court was not the appropriate venue for the case, Maes stated Wednesday morning, echoing Barton’s oral argument that the high court’s intervention would only be appropriate if Blue Cross had no other recourse to appeal the Division’s decision. Under state law, Blue Cross can appeal a withdrawal of any rate hike approval in district court.
“We respect the finding of the Court and will be at the hearing August 25,” Bardacke, who represents Blue Cross Blue Shield NM, told The Independent. “We were pleased Attorney General Gary King indicated the (rate hike) settlement was fair and equitable, and in the best interest of all New Mexicans.”
The Attorney General’s office had helped negotiate and stood by the controversial rate hike settlement, but Gary King appeared before the Supreme Court to defend the Insurance Superintendent’s authority to hold public hearings and review the justification for the rate hike.
The Insurance Superintendent has discretion under state law to hold the scheduled hearings, Gary King argued.
“A final order reversing approval would not be discretionary,” Gary King clarified to The Independent after the Court’s decision. “There would have to be some reason for rejecting the rate increase. There would have to be some different or additional evidence presented at the hearing” to reverse the rate hike approval.
“It’s a new day for consumers in New Mexico,” PRC chair David King told The Independent, adding that Legislature should now empower the PRC to hear appeals of future rate hikes. Currently, appeals must be filed in district court.
“I’m happy New Mexicans will get a chance for new hearings and we’ll do things now that should have been done orginally,” PRC Commissioner Jerome Block Jr. said. “Hopefully the surpluses prove that the rate increases are not justified and New Mexicans can be spared this increase. They have a lot of nerve to come ask for an increase, frankly.”
The Public Regulation Commission (PRC) voted 4-to-1 Tuesday afternoon to appoint John G. Franchini as the state’s newest superintendent of insurance. Commissioner Jason Marks cast the dissenting vote.
Franchini has worked in the insurance industry for more than 35 years, since he joined his father’s insurance brokerage as a salesman, according to a letter to commissioners that accompanied his resume. He worked as vice president for government affairs at New Mexico Mutual, the state’s workers’ compensation underwriter, from 2002 until January 2010, according to his resume.
Franchini was appointed one day before the state Supreme Court is scheduled to hear a Blue Cross Blue Shield NM petition to reverse acting superintendent Johnny Montoya‘s order suspending the rate hike. More …
Aetna has become the second health insurance company in California since April to scrap planned rate hikes, following revelations last week that “math errors” in the company’s application exaggerated justification for the proposed rate increase.
The company had sought a…
New Mexico could get more help with reviewing rate hike requests from health insurance companies if it gets a $1 million grant the federal government is offering to strengthen oversight of the process.
Massachusetts was the first in the nation to try a health insurance exchange—but it’s also working hard to keep costs down. As part of that effort, state regulators rejected several rate increase requests from health insurers this spring. When the…
Does Blue Cross Blue Shield New Mexico’s rate increase presage a coming stampede from health insurers seeking increased rates prior to the first reforms of the new federal health care laws taking effect? A quick survey of several officials in recent days found differing opinions on the question. But a few pointed to several provisions in the new law that could lead health insurers to request rate increases.
State Insurance Superintendent Morris Chavez resigned Tuesday morning, following intense criticism for his approval last month of a 21.3 percent rate increase for Blue Cross Blue Shield New Mexico individual policyholders without any public hearings.
But last month’s contentious rate hike was nothing new.
The state Public Regulation Commission (PRC)’s Insurance Division has approved rate increases for Blue Cross Blue Shield individual health insurance policies every year since 2004, according to state Insurance Division documents obtained by The Independent.
The Independent sought comment from Chavez Tuesday morning, only to learn staff was scrambling to announce his resignation.
In several cases, the rate hikes were comparable to this year’s increase, exceeding 20 percent.
Cumulatively, the increases approved each year since 2004 have pushed up premiums for Blue Cross Blue Shield NM policyholders by as much as 154 percent, Insurance Division records show.
In 2009 alone, rate increases for the company’s Blue Choice and Blue Choice Plus policies increased 19.6 percent and 24 percent, respectively. The company’s NM Major Medical policies saw a 2009 rate increase of 24.7 percent and Number One policy rates increased 22 percent in 2009.
The financial impact of rate increases on policyholders can be profound, policyholders told The Independent.
Moya Melody and her husband Kim Radsliff, Santa Fe residents, now spend 30 percent of their income on their Blue Cross Blue Shield NM policy, Melody said.
Last month’s rate increase brought their montly premiums up to $1,305 a month, Melody said. When they first bought their Blue Cross Blue Shield NM policy in 2004, they paid $562, or 16 percent of their household income, Melody said.
Two PRC commissioners want more transparency
Health insurance rate increases have not been contested before in New Mexico, PRC Commissioner Jason Marks told The Independent.
“The only insurance rate increase appealed … in the past decade was an appeal two years ago over title insurance,” Marks said.
PRC Commissioners knew about the 20 percent Blue Cross rate increase in 2009, but had not been aware that the Insurance Division had routinely approved rate increases since 2004, Marks said.
“We knew about the 20 percent (Blue Cross) rate increase last year, but this 150 percent increase (since 2004) is news to me,” Marks said.
In the future, health insurance rate increases exceeding 10 percent should trigger public hearings and full Commission review, Marks said.
Commissioner Jerome Block Jr. agreed.
“It’s unfortunate the Insurance Division has treated rate increases as a routine or typical process,” Block told The Independent. “These aren’t typical times. New Mexicans are struggling. I’d like to see the 10 percent threshold serve as a red flag for public hearings and Commission review.”
The Commission also needs to investigate why Blue Cross Blue Shield NM is the only individual health insurance provider in much of rural New Mexico, Marks said.
Blue Cross Blue Shield NM spokeswoman Becky Kenny did not respond to repeated requests for comment on the rate increases. Nor did Kenny respond to requests for information regarding executive salaries.
Kenny refused to disclose the Blue Cross Blue Shield NM’s tax filings, and would not say whether or not the not-for-profit would provide tax filings to policyholders. Blue Cross Blue Shield NM is a division of Health Care Service Corporation (HCSC), a mutual insurance company that is owned by its customers. Profits must be reinvested in the business or given to customers.
HCSC’s chief executive officer was paid $10.6 million in salary and bonuses in 2008, according to documents filed with the Insurance Division by Consumers Union attorney Sondra Roberto.
State Insurance Superintendent Morris J. “Mo” Chavez resigned Tuesday morning.
“After careful deliberation with my family, I have decided to tender my resignation as Superintendent of Insurance effective close of business today, May 4, 2010,” Chavez said in a two-sentence resignation letter addressed to PRC Commission Chairman David King. “It has been an honor to serve the citizens of New Mexico.”
Chavez had come under fire for approving, without public hearings, a Blue Cross Blue Shield NM individual health insurance rate hike of 24.6 percent. The increase was subsequently reduced to 21.3 percent.
Since Chavez took office in October 2006, he approved several health insurance rate increases, all without public hearings.
Attorney General Gary King supports a change to state law to give the PRC more power over health care rate increases. King’s support comes two days after it was announced that his office had helped negotiate a settlement that allows Blue Cross Blue Shield New Mexico to raise premiums by an average of 21.3 percent on 40,000 New Mexicans. The state insurance superintendent and the insurance division decide health insurance rate increases, while the PRC hears and decides rate-hike requests in the telecommunications, energy and utility industries.
Roughly 40,000 New Mexicans will watch their health care premiums rise by an average of 21 percent after the state struck a weekend deal with Blue Cross Blue Shield New Mexico.
The agreement may be a done deal after Monday, but how it came about had one member of the state Public Regulation Commission howling mad and at least one state lawmaker calling for legislation to overhaul the state’s rate-setting process.
“This should have been deliberated in public,” PRC member Jason Marks said of the rate hike.
PRC commissioners ordered state Insurance Superintendent Morris Chavez last month to hold Monday’s public hearing on Blue Cross Blue Shield’s request to raise rates 24.6 percent, something that insurance Division staff had approved originally in February.
“Instead, we got a backroom deal,” Marks said. “It could be an appropriate, reasonable deal, but I do know I had a lot of questions that haven’t been answered.”
The rate hike will affect approximately 40,000 policyholders, and will be retroactive, taking effect April 1. The rate increase will affect several individual market health plans offered by the company. Employer-based health plans will not be affected.
News of the agreement surprised and, in certain cases, infuriated some of the more than 50 people that had packed the Public Regulation Commission hearing room in Santa Fe for what had been billed as a public hearing about the company’s request to raise its health insurance premiums. At least eight armed state police officers were on hand Monday, highlighting the tension.
The surprise agreement also led to predictions that the Legislature would tackle how the State Insurance Office sets rates in next year’s 60-day legislative session.
“I think the result of this will be legislation to change rate setting,” Sen. Dede Feldman, D-Albuquerque, told The Independent on Monday afternoon. “I don’t think anyone was happy with this ruling. And I’m hoping for the cooperation of the insurance commissioner and the AG.”
Several attendees of Monday’s meeting, meanwhile, said they were disappointed to learn that the agreement had been forged prior to Monday’s scheduled hearing, especially after some had taken time off from work.
“I came here thinking we’re going to make a difference,” Dr. Christopher Fletcher, a Santa Fe Blue Cross provider, said. “Instead, this was done behind our backs. I don’t care if it was the front room, the back room, or the bathroom.”
How the agreement was struck
State Insurance Commissioner Morris Chavez appeared to take umbrage at the implication that the state or his staff had done something improper in forging the agreement.
“You’ve made some very serious allegations about a backroom deal,” Chavez said to Marks in a moment particularly fraught with tension. “I don’t think it was a backroom deal. To make a statement that the Attorney General of New Mexico made a backroom deal is mind-blowing.”
Chavez told the PRC that the agreement came out of a fear that Blue Cross Blue Shield might pull out of providing health insurance in rural areas around New Mexico. Blue Cross Blue Shield insures up to 70 percent of rural New Mexicans who buy their own insurance, according to Chavez.
“Of concern was they’d potentially be pulling out of the (rural New Mexico) market,” Chavez told the PRC.
The deal struck over the weekend has Blue Cross Blue Shield NM agreeing to continue to sell insurance in rural New Mexico and to do a better job of informing consumers about changes in their coverage, and to provide 60 days’ advanced notice for future rate hikes, Chavez said.
Chavez also pledged to post proposed rate hikes on the Insurance Division website in the future.
Insurance Superintendent’s responsibilities a concern
Chavez said Monday in explaining this weekend’s agreement that he is required by state law to consider the “solvency” or economic well-being of regulated corporations, and Blue Cross Blue Shield NM reports that it is losing money.
That didn’t sit well with Feldman, the Albuquerque state senator.
“They say they were forced to rule on very narrow grounds,” Feldman said. “We need to make sure the public is protected as well as the insurance companies.”
Also of concern to Marks was the insurer’s “medical loss ratio” — or how much of revenue is spent on medical care — of 66 percent.
“I wonder (about) the loss ratio in the 60 to 66 percent range,” Marks said. “We as a state just passed a law saying the minimum loss ratio should be at least 75 percent. We could ask why 33 percent on overhead and administrative compensation is reasonable, and why they’re sitting on more than $6 billion in reserves. …I would have liked to have heard these questions addressed in a public process.”
Marks was referring to a new law that limits how much an insurance company can spend on administrative costs.
Blue Cross Blue Shield NM owner HCSC is a mutual insurance company, owned by its customers; profits must be reinvested in the business or given to customers. But HCSC’s chief executive officer was paid $10.6 million in salary and bonuses in 2008, according to Consumers Union attorney Sondra Roberto, who had urged Chavez to reverse the rate increase.
“They have a lot of money,” Fletcher, the doctor and Blue Cross Blue Shield provider, told The Independent of Blue Cross Blue Shield NM. “They just lie straight out. Payments for us doctors, Blue Cross is one of the worst.”
The rate hike will hit some hard
The details of Blue Cross Blue Shield’s business structure was lost on Moya Melody, who was concerned with more immediate matters. Melody, who attended Monday’s hearing, said the new rates will represent 30 percent of her household’s income.
“Last year, we had a 20 percent increase and we just couldn’t pay,” Melody said. “So we went from a $500 deductible to a $1,000 deductible. Now, it’s still going up again this year.”
Moya and her husband, carpenter Kim Radsliff, have seen rate increases from Blue Cross Blue Shield NM every year since 2004, when they paid $562 per month, she said. That represented about 16 percent of their household income.
Now, with the increase approved today, they will pay $1,305 per month — 30 percent of their household income, Melody said.
“As far as I’m concerned, they’re a profit-making business,” Melody said. “We’re self-employed and don’t have a choice except to have no insurance at all.”
NMI’s Trip Jennings contributed to this story.
The rate hikes planned for individual policy holders of Blue Cross Blue Shield of New Mexico health insurance are on hold pending a public hearing. The hearing was ordered by New Mexico’s Public Regulation Commission after it received “numerous…
About 18,000 New Mexicans who purchase individual Blue Cross/Blue Shield health insurance plans are about to see a 29.5 percent increase in their payments. Another 2,700 individuals will see a 10 percent increase, and “a handful” in a couple of…