Consumer group formed to dog health insurers
By Mike Dennison
Helena - Montana's private health insurance market is dominated
by Blue Cross and Blue Shield, and consumers need more choices
and competition if they hope to have access to affordable health
care and insurance, a new group says.
The group - led by former Great Falls lawmaker Susan Good - is called Allied Citizens for Healthcare Equity.
"What we want to do is make sure there is good competition (among health insurers) in Montana," Good told the Tribune in an interview this week. "Lack of competition in any arena guarantees two things: High prices and poor service."
The group's literature also takes aim at "managed care," saying changes are need to stop abuses by managed care insurance plans and make them more friendly to patients.
But most of its criticism focuses on the market dominance of Blue Cross and Blue Shield of Montana, which ACHE says stifles insurance competition and discourages doctors and other health-care providers from signing up with other insurers.
Good, state Republican Party chairwoman and occasional lobbyist for health-care and insurance interests, said the fledgling group will be researching what it believes are the inequities in the Montana health insurance industry.
Once it compiles its research and hears from more consumers, the group may propose legislative reforms or other changes to enhance the market and correct problems with managed care organizations, she said.
"We don't have all of the answers yet," Good said. "Right now, we have more questions than answers."
Naturally enough, Blue Cross/Blue Shield officials aren't enthusiastic about ACHE's formation or its proposed mission.
Chuck Butler, Blue Cross' vice president for government and public relations, said the group doesn't appear to be more than a handful of critics, and that its criticisms are off base.
Blue Cross/Blue Shield controls only about half of the health insurance market in the state and welcomes competition, he said Monday.
"Their stated mission is to look out for consumers' interests,
and yet, as far as we're concerned, the best watchdogs of how
we conduct our business are the people who buy our services,"
Butler said. "There is lots of competition in Montana for
health insurance."
The company processes about 2 million claims a year, and the state
insurance commissioner's office has received only 347 "inquiries"
and/or complaints from Blue Cross/Blue Shield customers in the
past 30 months and has only seven outstanding complaints against
the company, he added.
He also said Blue Cross/Blue Shield is a vibrant Montana company that provides good paying jobs for 700 people directly and another 350 people at its for-profit subsidiaries involved in various insurance-related businesses.
"It's sort of like, what's the point here? What's the problem? Am I missing something here?"
The point, said Good and others, is that Blue Cross/Blue Shield market dominance may be contributing to higher-than-usual insurance rates for many of Montana's smaller consumers.
Max Agather, a Kalispell insurance agent who has advised ACHE, said health insurance rates for small-business plans have increased dramatically during the past decade and that Blue Cross/Blue Shield dominates this market and essentially sets the rates for these products.
"The small insurers who work the small business market pick off a few crumbs, and they can make money off it, because the Blues set the rates high enough," he said.
Agather, a former Blue Cross/Blue Shield agent currently involved in a legal dispute with the company, said he also believes the company has set out to control as many doctors as possible through managed care plans to attempt to block entry of competitors.
"They are by far the most dominant player (in health insurance)
in the state," he said.
Good has declined to reveal specifically the financial backers
of ACHE, which she said hopes to have a $150,000 annual budget
to research, lobby, and provide public outreach. It has a toll-free
hotline for consumers or others to report abuses or problems with
managed-care companies.
Its supporters are physicians and patients in Montana, and they fear retribution from insurers if their names are known, she said.
The group has three board members: State Sen. Chris Christiaens, D-Great Falls; Greg Lind, a Missoula anesthesiologist; and Arla Jean Murray, a Miles City rancher who ran unsuccessfully for the Legislature last year.
Butler said he believes many doctors and healthcare providers
are very supportive of Blue Cross/Blue Shield, and that ACHE represents
only a fraction of the health care community.