City of Chattanooga retirees notified of unexpected healthcare changes
CHATTANOOGA, Tenn. —
"27 plus years," she said.
Americans want and value quality health care, but most worry about the cost going up and benefits going down.
Once most people retire, they're hope is to still have good health care benefits.
Margaret Chastain worked for the city of Chattanooga as a dispatcher, supervisor and in the juvenile missing persons office.
"27 plus years," she said.
Chastain retired on December 31, 2002.
As a retiree of the city, her and her husband were both eligible for healthcare benefits.
They were enrolled in the BlueCross BlueShield plan, which is something she thought would always stay the same.
Two weeks ago - that changed.
"I feel like it's a slap in the face and I also feel like some back room politics went on with this," Chastain told NewsChannel 9.
At the November 14th city council meeting, Chastain watched as council members voted and approved the new resolution.
It would switch Chastain's and hundreds of other retirees' healthcare plans from BlueCross to United Healthcare, which could mean - different doctors.
"There's anywhere from 800 to a thousand retirees, plus family members, that has been affected by this," she said.
Chastain says there was no warning.
"I go to a rheumatoid arthritis doctor and they will not accept United Healthcare," she added.
Her husband, who sees a heart doctor, is in the same boat.
"When you select a doctor, and you feel comfortable with them, and you've got good results, you don't really want to change," she said.
And Chastain believes, she shouldn't have to.
"Here we are approaching the holidays, and that's enough stress anyways, and these people with heart conditions are really feeling the effects and anxiety," she said.
We took Chastain's and other retirees concerns to the city. A spokesperson told us the change was made because it provides the best coverage and value.
Here are other FAQ's the city answered for us:
"HR has been holding info sessions with retirees last week and this week on the changes coming next year. HR has been answering questions by phone."
1. Will Chattanooga Heart Institute accept the UHC Group Plan Advantage Medicare PPO plan?
Yes. Even if the provider is "out of network," this UHC plan has an out of network coverage benefit at 100% so the member will not be "balanced billed." CHI will file the member's claim for them on their behalf and the member will only pay their co-pay.
2. Will Memorial Hospital accept it as "in network"?
It depends on how the billing is done but this plan does not require the patient to go to only in network providers. If the provider accepts Medicare, they will accept this plan and pay the claim at 100%.
3. Drug benefits - have some drugs been moved to different tiers, therefore costing more "out of pocket" cost?
The UHC plan has only one tier for all generic medications which are all with a $3 co-pay. The BCBST plan has two tiers for generic medications so members have been paying $3 or $10 co-pays.
4. What other benefits have we gained or lost? The only thing most have been told is Vanderbilt Hospital has been added. Everything else we have been told was things we already had with BCBST.
The UHC plan has the same benefits or same plan design as the BCBS plan but the following are added:
a. Members have an out of network benefit which pays at 100% so they can now see any provider that accepts Medicare.
b. The plan has only one tier for generic medications making them all with a $3 co-pay vs the BCBST $3 or $10 co-pay. All other pharmacy tiers are the same as the BCBST plan.
c. UHC has a tele-medicine benefit offering members the ability to be diagnosed and treated using a cell phone or other mobile device.
d. UHC has a program (House Calls) which allows members to receive in home evaluations and visits by Registered Nurses.
e. UHC has a "care-giver" program where patients and their families can receive case management type services to locate resources to assist with the member's medical needs.
f. UHC offers a call center that is answered 8am to 8pm.
g. UHC offers a wellness incentive program which offers members gift cards for completing wellness related health activities.
h. UHC is a National Plan so City retirees who live outside the Chattanooga area have a greater network of providers to choose from.
5. What is the NCQA health plan rating for 2017-2018?
Medicare Advantage plans are rated using a "CMS (Centers for Medicare and Medicaid Services) Star Rating" which is from 1-5. UHC has received a 4.5 rating.