Regents’ HMO switch raises issues
December 4, 2006
The Des Moines Register reported Thursday that questions are being raised about ties between the Iowa Board of Regents and Wellmark Blue Cross Blue Shield, the states’ largest insurance company.
Four current or former Regents have served on the board of directors of Wellmark, and many faculty members have concerns about the reasons for Iowa State’s decision to use Wellmark as its HMO provider and the quality of care that Wellmark will provide for Iowa State.
Hector Avalos, associate professor of religious studies, was a little worried when he found out that his primary care physician, Dr. Steven Hallberg, who he has been using since he came to Iowa State in 1993, was listed online as a specialist by the Wellmark insurance company. Avalos realized that this meant his visits to Hallberg would not be covered under the new Wellmark insurance plan.
The situation was especially distressing for Avalos, since he lives with Wegener’s Granulomatosis autoimmune disease, which mainly affects the respiratory system, among other systems.
ISU human resources sent out a letter on Sept. 28 of this year to notify ISU Health Alliance HMO members that Iowa State will be switching to Wellmark Blue Cross Blue Shield of Iowa. According to the letter, Iowa State found that Wellmark’s Blue Cross Blue Shield Advantage plan is “much broader than the current HMO network.” The letter also states that “enrollment and Primary Care Physician designation(s) in the current HMO will be transferred to Wellmark for coverage.”
For Avalos, it appeared that the new plan did just the opposite.
“It seemed to me that the letter had contradicted what it had promised,” Avalos said.
Otis said the only other problems that have been identified since the decision to switch to Wellmark deal with the chiropractic network. He said there have been reports of some chiropractors that were covered under the Health Alliance plan who, at this point, will not be covered by the Wellmark plan, but he stated that he is also working to solve this problem.
“Wellmark and Iowa State are taking active steps to increase the number of participating chiropractors under the Wellmark HMO plan,” Otis said.
He added that the official switch to Wellmark won’t occur until February.
Otis also said the benefits office will try to identify any other problems with the new plan and fix them before the switch. For Avalos, this means that he won’t have to search for a new physician who is covered by his insurance.
“This individual can still see Dr. Hallberg as his primary care physician under the Health Alliance plan up through February,” Otis said. “Our existing coverage year goes though the month of January, so it has no present affect on him in his current medical plan.”