By Phil Galewitz, The Palm Beach Post, Fla. Knight Ridder/Tribune Business News
Sep. 14--Blue Cross and Blue Shield of Florida's newest health insurance product aims to lower premiums for employers while expanding choice of plans for their workers to choose from.
But it also reduces the number of hospitals and doctors from which customers can choose.
Blue Cross, the state's largest health insurer, is piloting its new product, called Empower, in Palm Beach and Broward counties this fall. Empower, slated to roll out statewide next year, is being sold to employers with 50 to 250 workers.
With Empower, enrollees can choose from nine of Palm Beach County's 13 hospitals, compared with 12 available with the insurer's traditional HMO and PPO plans.
Empower offers a choice of 863 doctors in Palm Beach County, compared with 1,687 in Blue Cross' traditional plans.
The four local hospitals not in the pilot program are Boca Raton Community Hospital and the three HCA-owned hospitals -- Columbia Hospital in West Palm Beach, JFK Medical Center in Atlantis and Palms West Hospital in Loxahatchee. Boca Community is the only area hospital without a contract to treat traditional Blue Cross customers.
'I can't believe they call this Empower, because all it's doing is shifting more costs to the patient,' said Phil Robinson, CEO of JFK Medical Center, who noted HCA hospitals chose not to take part in the program because they feared they would lose money.
Blue Cross says Empower could be a key solution to stem fast-rising health insurance costs, which this year rose nationally by an average of 13 percent -- the most since 1990.
Empower attempts to save money by offering a smaller network of doctors and hospitals that may receive lower fees from the insurer. Empower lets employers customize up to three health plans to offer their employees. To keep premiums low, some of the plans have large deductibles and copayments. If an employee wants lower out-of-pocket expenses, he can pay a higher premium.
Empower also categorizes the hospitals participating in the plan in three payment tiers. Blue Cross charges customers different copayments depending on which hospitals they visit.
But in the pilot, all nine participating Palm Beach County hospitals are in the lowest tier, meaning customers will be charged the lowest copayments.
'This is the best of all worlds,' said Blue Cross spokesman Mark Wright.
Nationally, the concept of tiering hospital coverage has run into criticism from hospitals, which argue that consumers could lose access to the best hospitals.
But health experts say there's no denying the trend to require patients to pay a substantially higher portion of their medical costs -- a move to save employers money and to give the patient a financial reason to shop around for care.
'This is exactly where things are headed,' said Peter Young, a Fort Myers health care consultant.
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(c) 2002, The Palm Beach Post, Fla. Distributed by Knight Ridder/Tribune Business News.
