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Federal employee group urges Blue Cross to drop forceful plan

National Active and Retired Federal Employees Association president Margaret L. Baptiste called on Blue Cross/Blue Shield to reverse their decision to require federal employees and annuitants enrolled in the insurance carrier's "standard option" to pay 100 percent for out-of-network surgical and maternity services up to a separate $7,500 catastrophic limit starting next year.

Baptiste praised the chairman of the subcommittee on the Federal Workforce, Postal Service and the District of Columbia, Rep. Danny Davis (D-IL), for asking representatives from BC/BS and the Office of Personnel Management (OPM) to explain the benefit reduction during a recent hearing.

"A fee-for-service plan like standard option is based on the notion that insured persons could be treated by the physicians of their choice.  By effectively dropping out-of-network surgical and maternity coverage for 2009, standard option is morphing into a preferred provider organization (PPO) plan, like what is currently offered as 'basic option.' What is the value of the government and enrollees paying a standard option premium -- which just increased by 13 percent -- for what will become basic option coverage?" Baptiste said.

The NARFE President acknowledged that encouraging enrollees to seek in-network doctors helps to contain costs, but that it was important for the Federal Employees Health Benefits Program's (FEHBP) most popular plan to cover a fair share for out-of-network surgeons and obstetricians, particularly in emergency situations and in medically underserved areas.

This is even more important with an ever-shrinking pool of participating providers.

"Everyone deserves the best possible care and that includes having an affordable option to go out-of-network," Baptiste said.

President Baptiste also questioned why the new coinsurance for out-of-network surgical providers is not waived for annuitants who pay Medicare premiums since Medicare covers a significant share of such procedures.

Baptiste said that NARFE would work with Rep. Davis, OPM and Blue Cross to favorably resolve the surgical and maternity coverage issue.