An insurance company claims the state’s largest hospital charged more than was allowed, and now wants state health care regulators to order the money be repaid.
Rebecca C. Heintz, vice president and general counsel of Blue Cross Blue Shield of Vermont, stated in an Aug. 21 letter to the Green Mountain Care Board that the University of Vermont Medical Center’s commercial effective rate for the 2022 and 2023 fiscal years was higher than what the board had approved.
“Those overages deplete our reserves and over time contribute to larger prospective increases in our premiums,” stated Heintz. “That happens because the overages are not reflected in the premium rates we develop and propose to the Board each year.”
She stated that Blue Cross Blue Shield of Vermont asked University of Vermont Medical Center to return the funds — $16.7 million from 2022 and $11.6 million from 2023 — but they’ve reached an “impasse.”
In the letter, Heintz asks the Green Mountain Care Board to look at financial information from the hospital, analyze it and … take appropriate action to restore any unwarranted overpayments to Blue Cross VT ratepayers.”
The Green Mountain Care Board is charged with reviewing and approving hospital budgets as well as commercial insurance rates.
Earlier this month, the Green Mountain Care Board approved double-digit rate increases for Blue Cross Blue Shield of Vermont and MVP Health Plan Inc., the state’s two main private health care insurers. Blue Cross Blue Shield of Vermont was approved for a 22.8% increase to its small group rates when it had asked for a 24% increase. MVP had requested an 11.5% increase and was approved at 11.1%.
University of Vermont Medical Center responded Monday with its own letter to the Green Mountain Care Board, saying the insurance company’s allegations are false. The letter was signed by University of Vermont Medical Center Senior Vice President and General Counsel Eric Miller, and Kelly Champney, vice president managed care contracting at UVMMC.
The UVMMC letter claims that payments were negotiated between it and Blue Cross Blue Shield of Vermont within the Green Mountain Care Board’s parameters.
The regulators will have to think about this, according to Kristen LaJeunesse, executive assistant of the Green Mountain Care Board.
“GMCB just received the BCBS and UVMMC letters in the last few days, and we’re currently reviewing and evaluating the submissions,” she stated in an email. “After appropriate review, we anticipate reaching out to the parties to further understand the issues. Consistent with our transparent approach to healthcare regulation we will publicly post to our website any further non-confidential communications on this issue.”
Heintz stated in her letter that following this year’s hearing for its requested rate increases, Blue Cross Blue Shield of Vermont was asked by the board to show, for the past five years, what rates each Vermont hospital committed to, whether those commitments were met or exceeded, and if exceeded how much was paid back. Heintz claims it showed the board this Aug. 2 and the figures indicated that UVMMC exceeded its commitments.
“Those overages deplete our reserves and over time contribute to larger prospective increases in our premiums,” Heintz’ letter states. “That happens because the overages are not reflected in the premium rates we develop and propose to the Board each year.”
Heintz stated in her letter that Blue Cross Blue Shield of Vermont and UVMMC have talked in an effort to sort this out.
“In our attempts to negotiate a resolution, UVMMC has taken the position that these overages result from increased access to health care that yielded unbudgeted utilization-driven revenue,” Heintz stated. “However, our data shows that our claims spend was considerably higher when controlled for the factors claimed by UVMMC to be responsible for the overage: utilization, acuity and membership.”
The hospital’s response letter not only denies having charges too much, but takes issue with how the insurance company is approaching the issue. UVMMC claims that Blue Cross Blue Shield of Vermont didn’t share its information on the overpayments prior to taking the issue public with the Green Mountain Care Board. The insurance company did make UVMMC aware of the issue, but when asked for details it sent its letter to the care board.
The hospital claims Blue Cross Blue Shield of Vermont also failed to conduct an audit, which it’s allowed to do.
“Instead, over two years later, Vermont’s largest insurer told the GMCB that the process for negotiating rates with UVMMC — a process designed and required by Blue Cross VT — was just too complicated for it to understand until now. As a result, neither UVMMC nor the GMCB can possibly discern how Blue Cross VT reached its mistaken conclusions,” the hospital letter states.
The letter concludes with the hospital saying it’s happy to discuss the issue with Blue Cross Blue Shield of Vermont and the Green Mountain Care Board at a hearing.
keith.whitcomb
@rutlandherald.com