The information distributed by the MSU Consortium, our health insurance provider, indicates that the office fee for an annual physical exam is covered at 100%, as is an annual mammogram for women and an annual PSA test for men over 50. The Consortium also states that other tests (e.g., blood analysis, urinalysis, X-rays) ordered by the physician as part of the annual physical exam are covered at the regular 80/20 rate after the deductible is satisfied. THIS IS NOT TRUE.

In May, I had a physical exam, and a variety of tests were included. The office fee and the PSA test were, indeed, covered at 100%. Blood analyses, a urinalysis, a PFT, an electrocardiogram, an echocardiogram, a sigmoidoscopy, and X-rays were included as part of the physical exam. NONE OF THESE PROCEDURES WERE COVERED AT ALL BY THE INSURANCE PLAN.

I am now faced with nearly $800 in medical bills. Bev Blodgett is appealing the settlement, but she does not sound hopeful about a reversal of the decision. If I had known that this would happen, I NEVER would have had my physical exam scheduled in Kirksville with a "participating provider." Rather, I would have waited until I arrived in Connecticut for the summer where my physician would have hospitalized me on an emergency basis for one of my diagnosed conditions (diabetes or hypertension), and the MSU Consortium would have paid at the 80/20 rate for all aspects of the examination as an out-of-area emergency (i.e., I became ill while on vacation out-of-area).

Needless to say, I am livid. I feel euchred. Although I may be stuck with this horrendous financial liability, I am posting this warning to the rest of the faculty via the AAUP Web site before other professors are tricked as I have been. I hope others who have been similarly shafted by the MSU Consortium will come forward and post their experiences here, too.

Lastly, while I appreciate the sincere and valuable work of our AAUP chapter in preparing the various studies we have received of late (attrition of faculty, condition of the Truman Web page) AND while I realize that the AAUP has no bargaining authority for salaries, I'd like to see our chapter at least engage in dialogue with the administration about the health/dental/vision insurance programs.

It rankles me that one of my inbred, cretin, in-law cousins who cleans toilets in the Truman Office Building in Jefferson City has a health/dental/vision package that is comprehensive, i.e., EVERYTHING at an 80/20 rate after a $200 annual deductible, an optometric exam (at 80/20) and a new pair of eyeglasses (at 50%) EVERY YEAR, and a dental plan similar to ours. To me, "state employees is state employees." Perhaps this needs to be a policy with the power of law, enacted by the state legislature, like the House-Senate bill that got us out of Missouri Teachers Retirement and into MOSERS in 1987. This is the sort of ACTION I'd like to see from my AAUP chapter.

Roger R. Festa, Ph.D. East Norwalk, Conn. Professor of Chemistry July 8, 2001

-- Anonymous, July 09, 2001

Answers

I've had similar problems with our dental insurance through Mutual of Omaha. A year and a half ago I had dental work done that cost $1300 and was supposed to be covered at 80%. Finally last week, after much hassle, I received a check for $176.80 (13.6% of the total cost). Part of the joke is that this insurance regularly indicates that charges exceed the "usual and customary allowance in your geographic area" even when one uses the *only* provider of a particular service in NE MO. I would be far ahead if Truman just gave me the premiums it pays for this "insurance." What a scam.

According to Bev, a call for contracts is out to change our insurance provider. I sure hope this happens. The MSU Consortium is not meeting our needs.

-- Anonymous, July 09, 2001

SOME FURTHER THOUGHTS...

I do not believe that our administration at Truman has deceived us deliberately. What I believe is that to make the annual physical exam provision seem like an attractive, generous, and progressive benefit, the MSU Consortium management "marketed" is without the fine print, or used wording that can lead one to believe that all medical tests conducted during the physical are covered at 80/20. The "fine print" is that the physician has to mark these tests as "diagnostic" for us to get the 80/20 rate. If they are marked "screening," you get nothing. My physician marked everything "screening" because, philosophically, that is precisely the point of a complete physical exam, to find out if anything is wrong with you. I believe the tests are all being re-filed with HealthLink and First Health as "diagnostic," but Bev Blodgett doubts the re-filings will be accepted. I'll be certain to post the outcome on the Discussion Forum.

Roger R. Festa, Ph.D.

East Norwalk, Conn. July 9, 2001

-- Anonymous, July 09, 2001

Response from the MSU Consortium from Nancy J. Sublette, R.N., M.H.A., Executive Director, MSU Benefits Group

RE: “ MSU Consortium is Lying to You”

Dr. Festa wrote that “the Consortium states tests associated with an annual physical are covered at the regular 80/20 rate after the deductible is satisfied.” This is incorrect. The December 2000 newsletter announced the new coverage for physician services for an annual physical. In the article, there is specific information about laboratory and x-ray tests for routine purposes, not being included in coverage. At the Consortium (now known at the MSU Benefits Group), we were very excited about providing this new benefit. We were also concerned that there would be an assumption that all services associated with an annual physical would be covered. That is why we devoted the ink to fully describing the new benefit.

Dr. Festa reported he would have received the services in another geographic location had he known routine lab and x-ray would not have been covered in Kirksville. If a service is not covered by the benefit plan, it is not covered regardless of geographic location. He then suggests he could have had these procedures as part of a hospitalization for an illness. This may be true. It all depends on how the medical services are portrayed on the standard billing form. Medical providers use diagnosis codes called “ICD-9 codes.” There is a code for every condition and every preventative health screening. These codes determine health plan reimbursement.

Marc Becker raises an issue on the dental coverage and the states “the Consortium is not meeting our needs.” Dental coverage is not provided through the Consortium this year. It will be beginning January 2002.

The MSU Benefits Group (previously known as MSU Consortium) is a self- insured health plan for faculty and staff at six state colleges and universities. We are not relying on an insurance company to make the rules. Therefore your input and suggestions are valuable. We are working to provide optimal coverage within a budget that is determined by current health costs, future health costs, and state subsidy to higher education. The insurance coverage Dr. Festa’s cousin has is likely through the State of Missouri. This cousin pays 25% of the health premium each month and had more than a 30% increase in premium from 2000 to 2001. The MSU Benefits Group performed an analysis of the cost of the state plan compared to our plan in 2000 and found that it would not be to the financial advantage of the faculty and staff or the colleges and universities, to join the state plan.

Thank you for the opportunity to share information about the MSU Benefits Group and clarify some issues. Health insurance is all about the “fine print” and each person has a responsibility to understand his or her coverage. I encourage questions, comments and suggestions. I can be reached at nsublette@msubenefitsgroup.org. If you would like to have a conversation, please provide your telephone number in the e-mail.

-- Anonymous, July 17, 2001