Wellmark accuses Burlington broker of overcharging
By Kathleen Sloan, The Hawk Eye, Burlington, Iowa | |
McClatchy-Tribune Information Services |
Potentially as many as 10,500 government employee policies are affected with millions of dollars in premiums at stake.
The dispute was disclosed Thursday in a front-page story in the
McBee said policyholders who received a bill from a Two Rivers subsidiary, Employee Benefit Systems, appear to have been affected.
As a third-party provider, EBS provides self-insured or partially self-insured benefits to government entities, such as dental, eye care, flex billing, claims service and explanation of services. Those fees are passed on to individual members.
A local governmental insurance group, COBCO or City-County Health Care Plan, does not agree the fees and charges were unclear or that the group has been over-charged.
"We feel that these are very market-value rates," said
"(
"What's at issue is not whether it was disclosed, but how it was disclosed on the individual billing statements. That's an issue for the Iowa Insurance Division to determine. But the COBCO board has no issue with fee disclosure," Ferneau said.
--The Iowa Governmental Health Care Plan, with 33 employers and 6,700 members.
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--COBCO, with eight employers and 500 members (Two Rivers said the number published by the
Besides the
The school systems affected belong to the
"We are in the process of checking into this," said
The
"We do not have an agent for health insurance," said
Stuecker said
"I had to seek them out," she said.
By phone,
Stuecker said finding a new broker or dealing with
"This could not have happened at a worse time," she said. "We are going through open enrollment, as we do every year."
That process requires
Stuecker asked
"They said after speaking with the Iowa Insurance Division, they felt they had no choice but to terminate immediately," she said.
"
Two Rivers Executive Vice President
Two Rivers was required to buy
Ackerman said the companies reviewed the billing procedures that were established with Mutual Med and approved by
"I don't think they had a full understanding that there are other portions that go into the premium. It is at the request of our customers that we customize our bill," Ackerman said.
"
At another meeting in December, Ackerman said
Ferneau and Stuecker confirmed the controversy centers mostly on IGHCP.
"They are not looking at our trust (COBCO) at all," Stuecker said. "We have received no request for records or a subpoena from the Iowa Insurance Division."
At the end of January,
"We supplied over 58,000 documents, and
Before the documents were received,
"They wanted us to change how we were doing our consolidated billing, to show
Two Rivers changed its billing in time for the April bills, he said.
"We got no feedback on the new billing. On
Ackerman acknowledged
"The Iowa Insurance Division said several times this is a rate review versus an investigation," he said. "I don't know if that will change down the road."
Ackerman didn't know if Mutual Med was being investigated or if it has been issued a subpoena, too. Neither does he know if the timing between that company's cancelation followed by
Meanwhile, he said Two Rivers "categorically disagrees" with the way
"We believe we were transparent," he said.
He told the Register Two Rivers has helped the Iowa Governmental Health Care Plan save taxpayers millions of dollars in health care coverage costs.
"Every organization that has joined has entered the plan paying lower rates than on previous plans," he said. "The lower rates, rate stability and higher level of service are all incentives for cities and counties to join.
"The average annual increase for the overall program has been 3.1 percent over the past nine years, which has helped all the firefighters, policemen and public employees that IGHCP provides coverage for."
Besides
Reporter
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