Disputed city health claims surpass $1 million

Feb. 06--Over $1 million in city health insurance plan claims are being disputed, according to Logansport Clerk-treasurer Stacy Cox.

She announced the figure at a city council meeting Monday night, where city employees recalled experiences of being contacted over debts they didn't think they'd be responsible for and learning shortly before surgeries that their insurance wouldn't be accepted for the procedures.

The city, which is self-insured, started on its current health plan with Apex Benefits in 2017.

Bill Sylvester, an adviser with the company, attended Monday's meeting. He said the reason for the problems city employees are encountering is because the health insurance plan the city has does not have networks.

The plan the city's on audits every bill and pays health care providers what's "fair and reasonable," Sylvester explained. If providers don't agree with how it's paid, he said an appellate process can be initiated but if they choose not to initiate that appellate process, they balance bill insurance holders. When bills aren't paid, collection agencies come calling, Sylvester continued.

Logansport City Councilwoman Teresa Popejoy said at Monday's meeting that officials met with Apex Benefits last week on the matter and asked the company to pursue an alternative as quickly as possible so the problems city employees are experiencing don't continue. That new plan will go into place as quickly as legally possible, which is May 1, she continued.

"I promise you that we are not going to let this go," Popejoy told the room full of city employees, many of whom were firefighters and police officers.

Sylvester said the new plan will include physician and hospital networks.

But city employees and officials wanted to know if and how current issues would be resolved in the interim, particularly with what they described as debts they did not expect to be responsible for and how to know whether a provider will accept their insurance.

Cody Scott, a patrolman with the Logansport Police Department, fought tears as he recalled the insurance issues that arose during his wife's miscarriage.

She had been seeing the same OB-GYN since going on the city's health insurance plan and never had a problem with the doctor or any kind of care at Community Howard Regional Health in Kokomo, he said. The day of the surgery, Scott said the hospital informed them not to come because it would not accept their insurance.

"If we have hospitals 30 minutes away from here that are turning down your insurance, we have an issue," City Councilman Terry Doran told Sylvester at Monday's meeting.

Jim Stotler, a Logansport firefighter, said coverage for his wife's stage 3 breast cancer treatment was pre-approved. After surgeries, he said they were informed by the doctor's office that she could no longer be seen because the insurance plan wasn't paying, prompting them to find a doctor the insurance plan claimed it would pay for. The provider later indicated it never agreed to accept the reduced payment tendered by the city's insurance plan, Stotler went on to say.

"I feel that we got conned," Stotler told Sylvester. "I feel your company is nothing more than a con artist, than a used car salesman and we are paying for Cadillacs and we're driving Yugos."

A.J. Rozzi, a lieutenant with the LPD, said he has medical expenses that have been sent to a collection agency regardless of the fact that he's paid his deductible. He said he was pre-approved for a surgery only to be called the morning of the procedure and told he needed to bring $95,000.

"Because a hospital or doctor's office says you owe money doesn't mean you owe money," Sylvester said. "...The problem is the hospital or the care provider goes after the most vulnerable and that is you. They want what they think is their money. We are saying you have paid what you're going to pay. You have paid them in a fair and reasonable way and you owe them no more money."

Sylvester stressed city employees that receive balance bills should send them to a health care cost reduction and auditing company and when bills are sent there, collection agencies are not allowed to contact them anymore.

"With this plan that you're on, it's against the law for your credit to become impaired while the amount is in dispute," Sylvester added.

John Rogers, a detective first sergeant with the LPD, said he paid his portion of medical care he received, met his deductible and yet is still being pressed for outstanding payment.

Sylvester told Rogers he doesn't owe anything, prompting Rogers to ask who's going to pay the money he's told he owes.

"Why does anybody pay that bill?" Sylvester asked.

That prompted Rogers to laugh as he got up to return to his seat in the audience.

"Have a good day," Rogers said. "You're wasting my time."

Council members asked Sylvester how long it would take for collection issues raised at Monday's meeting to be resolved.

"It's an ongoing process until they get tired of pursuing it," Sylvester said.

"They don't get tired of pursuing it when you owe them money!" Jim Klepinger, an LPD detective, exclaimed from the audience.

Cox said Logansport Memorial Hospital accepts what the city's insurance plan pays while facilities in Kokomo, Lafayette and Indianapolis may not.

She also offered insight on why the city's current health insurance plan was chosen, adding she studied it closely with officials for Cass County, which is also on the plan though not experiencing the same issues Logansport is.

Cox recalled how last year officials faced health insurance costs surpassing 25 percent of the city's general fund. She said that prompted leaders to determine how to save the most money without cutting services to employees. While situations like those described Monday were the result, they were not the intention, she explained.

Out of over 400 health insurance claims processed through the city's plan with Apex Benefits, 44 have not been accepted, Cox said.

She explained hospitals are going to keep raising prices because every insurance company wants to pay less and how the city plan's goal is to get facilities to accept what it determines to be reasonable. In most cases, facilities are accepting payments from the city health insurance plan, Cox said, because they're receiving what they determine to be an adequate amount.

Stotler said regardless of that, the lack of network agreements in the current plan mean there's no surety as to how much the plan and insurance holders are responsible for when paying for medical care.

Reach Mitchell Kirk at mitchell.kirk@pharostribune.com or 574-732-5130

___

(c)2018 the Pharos-Tribune (Logansport, Ind.)

Visit the Pharos-Tribune (Logansport, Ind.) at www.pharostribune.com

Distributed by Tribune Content Agency, LLC.