By SUE SUCHYTA
Sunday Times Newspapers
ALLEN PARK – The City Council dropped health care provider Blue Cross Blue Shield of Michigan Aug. 6 for active employees and retirees under age 65 after receiving a $1.1 million rate increase.
The unanimous vote from the council was based on the recommendation of City Administrator Mark Kibby following notice of a 25 percent rate increase from BCBSM. The renewal date, Oct. 1, prompted the Sept. 6 special council meeting.
City retirees over age 65 will remain with the Humana Medicare Advantage Program, which will raise rates 2.4 percent Jan. 1, 2017.
The city’s health care administrator, Zervos Financial Services LLC of Southfield, will use Automated Benefit Services of Sterling Heights and Birmingham as the third party administrator for the health care program, using the Cofinity Network.
Cofinity is a preferred provider network, a subscription-based medical care arrangement that provides substantial discounts below regularly charged rates.
Cofinity is partnering with First Health, a nationwide PPO and a subsidiary of Aetna, a Fortune 100 managed health care provider based in Hartford, Conn.
Cofinity states in its promotional literature that it is accepted at nearly 100 percent of Michigan hospitals.
Kibby said if an active employee or retiree under age 65 is out of state they will be part of a Cofinity network of services among other agencies.
ABS representative Dennis MacGillis said out-of-state retirees under age 65 would be covered by the representative network of First Health.
Councilwoman Gail McLeod expressed concern over the limited listing of Allen Park-based doctors in the network, and asked what happens if someone went to an outside provider.
MacGillis said most charges will typically be processed through the provider network.
“If we do have a situation where an employee does incur charges out of the network, I think we were talking basically just the office visits, it should be a very small number of situations where we are going to have to pay that claim essentially as an in-network,” MacGillis said. “We can make arrangements to do that.”
Kibby said if an employee has been going to a doctor for a number of years, and it has been covered under BCBSM, but that doctor is out-of-network for Cofinity, the situation can be reviewed and processed as an in-network claim.
MacGillis said he is not aware of any hospital in the immediate area that is not a part of the Cofinity network.
“There is a big advantage to employees by using the physicians in-network,” MacGillis said. “We find the same thing on the physicians’ side. You are in the high 90s with regards to participation of most physicians, specialists and family practitioners.”
MacGillis said if a provider in this area is found who is heavily utilized, ABS will work with Cofinity to try to recruit that provider to join the network.
“There are certain advantages for them to join the Cofinity network,” MacGillis said. “If for whatever reason they don’t want to, we would identify that situation and work with Mark (Kibby) to have your claims processed in-network. Because you are self-funded, we do have a lot of flexibility as to what we can and cannot do.”
Kibby said because deductibles have already been met up for the first eight months, they will be waived for October, November and December, and deductibles won’t have to be renewed until Jan. 1.
“This is probably the toughest decision that we put an elected official in, and I don’t think we would be here if it wasn’t for the $1.1 million difference,” Kibby said.