Washington, DC
–
U.S. Senator Benjamin L. Cardin (D-MD) claimed a victory for federal employees and retirees after the Office of Personnel Management (OPM) reversed its decision to impose a $7,500 copayment for surgeries performed by out-of-network doctors under the Blue Cross-Blue Shield (BCBS) Standard Option Health Plan.

For 2008, federal employees on the BCBS Standard Option who have surgery performed by an out-of-network doctor are reimbursed at 75 percent of the BCBS allowable amount. According to OPM, “Under the revised benefits provision, BCBS Standard Option enrollees will be responsible for 30 percent of the plan’s payment allowance for the surgery to be performed, plus the difference between the plan’s allowance and the amount billed by the surgeon.
  In addition, Blue Cross and Blue Shield will, for the first time, provide prior approval for all non-emergency, out-of-network surgeries of $5,000 or more, enabling enrollees to know in advance how much BCBS will pay for the surgery.
  BCBS also will provide additional information and assistance to make the patient’s costs more transparent.
  Enrollees must initiate this prior-approval process.”

In late November, OPM announced that the standard plan for 2009 would make the patient responsible for 100 percent of any surgery charge that is performed by a non-participating provider, up to $7,500 per procedure.  This would effectively have removed the choice of provider for subscribers who chose the Preferred Provider Organization (PPO) and could have significantly increased out-of-pocket expenses.

Senator Cardin had urged OPM and BCBS to renegotiate the terms of the policy. “OPM did the right thing for federal employees, retirees, and their families. Once this problem came to light, I was encouraged by OPM's actions,” said
Senator Cardin. “Today’s decision will ensure that patients will retain affordable access to the provider of their choosing.

“On behalf of the federal employees and retirees across Maryland and across the nation, I also thank OPM for following my recommendation to extend the Open Season enrollment period for the Federal Employees Health Plan through the end of January 2009.  Federal employees now have six additional weeks to review all of the details each plan has to offer and select the best option for themselves and their families.”