Reprinted from HEALTH PLAN WEEK, the most reliable source of
objective business, financial and regulatory news of the health insurance
industry.
November 5, 2012 Volume 22 Issue 39
Superstorm Sandy put to test contingency plans
that health insurers activate for emergencies, such as easing restrictions for
prescription drugs and health care services, even if out of network, at a time
when large swaths of the Mid-Atlantic and Northeast regions are digging out
from catastrophic damage.
Sandy’s large size and extended fury went beyond
even what experienced storm watchers have seen before in the hurricane zones of
Florida, but health plans tell HPW that despite the hardships,
they are up and running, providing help with short-term policy changes for
those hit hardest. Horizon Blue Cross Blue Shield of New Jersey, the state
where Sandy made landfall and inflicted some of the worst damage, was closed on
Oct. 29 and Oct. 30, but partially reopened for business on Oct. 31. “Due to
continuing power outages, we will only be partially open on Wednesday, Oct. 31.
We have taken steps to ensure that the needs of our members and business
partners are met during this weather emergency,” the Blues plan said in a
statement.
Tyler Mason, a spokesperson for UnitedHealth
Group, operator of the nation’s largest health insurer UnitedHealthcare and its
Oxford Health Plans unit, which operates in the New York City area, tells HPW that
the health plan’s business “was not directly impacted in our ability to
continue to operate and we continue to monitor for assistance that our members
may require in accessing health care services.”
Beyond staying open, UnitedHealthcare told plan
members in an Oct. 29 statement that they can fill prescriptions early and
access a free “emotional-support help line from Optum,” another subsidiary. The
company also is assisting Red Cross relief efforts.
Preparation Is Vital to Survival
“Plan participants who have been displaced from their homes or
whose network medical facility or physician is not accessible, and require
assistance or special accommodations, can call customer care at the number
located on the back of their medical ID card for assistance. If necessary,
customer care professionals will help affected individuals obtain in-network
benefits if a network provider is not available,” the insurer said.
The eased restrictions apply to enrollees in fully insured
commercial products, Medicare Advantage, Medicare Supplement and Medicaid
plans, and is effective from Oct. 28 to at least Nov. 11, UnitedHealthcare
added.
Philadelphia-based Cigna Corp. spokesperson Mark Slitt tells HPW that
it took several temporary steps to assist people in the 19 hardest-hit states.
“Effective immediately in all of these areas, for services
incurred from Oct. 29 through Sunday, Nov. 4, 2012, Cigna is allowing its
customers to refill prescriptions even if it would normally be too soon for a
refill; waiving all pre-certification, referral and hospital admission
requirements; paying claims for out-of-network services at in-network rates;
and expanding its 24x7 telephone help line to provide personal assistance and
support for all residents affected by the hurricane,” Cigna said.
David Cordani, Cigna president and CEO, in a Nov. 1 conference
call to discuss third-quarter earnings (see story, p. 4), commented on the
storm, saying there would likely not be a long-term financial impact on the
insurer.
“There’s a lot of actions that are put in place to expand access
to care, expand ease of access through pharmaceuticals, professional services,
outpatient services, offer more coordination points, even working with the Red
Cross to get the right medications to the right people the right way,” he said.
“So those activities, unfortunately, we’re well attuned in how to manage, and
that’s well underway. But broadly speaking, I wouldn’t expect a material effect
given, again, the broad portfolio of our book of business. You might see a
little dampening for a very short period of time, but we’re not projecting a
broad impact here at all.”
Plans Ease Prescription Rules
Aetna Inc. also is easing limitations on prescription refills and
access to behavioral health programs. “The company also is extending claim and
appeal filing times, and helping members who have evacuated find care outside
their home areas, among other steps,” Aetna said in an Oct. 29 statement.
Cynthia Michener, Aetna spokesperson, tells HPW that in
addition, the insurer is “mobilizing our volunteer teams in many communities to
see how we can help in other ways.”
Through Oct. 31, Independence Blue Cross, serving 2.2 million
members in southeastern Pennsylvania, has waived all pre-certification,
referral and hospital admission requirements for Oct. 29 and 30 for medically
necessary care and modified its payment policy for out-of-network urgent and
emergency care services for members who do not have access to their usual
physicians and facilities. “The company will work closely with hospitals,
doctors and urgent care facilities to ensure members have access to emergency
care anywhere they need it,” the Blues plan said in a statement.
Humana Inc. also said its operations are functioning in the
affected regions. “Our Humana businesses, including Concentra and SeniorBridge,
continue to provide services to our members and clients and to support
associates with any needs they have during this post-storm period. We’re also
assessing our facilities for any damage and have activated business continuity
and disaster recovery plans where needed,” says Nancy Hanewinckel, a Humana
spokesperson.
As for business operations, Aetna has shifted staff to alternate
locations away from the damaged areas and permitted increased teleworking
capacity for employees whose home or office locations have lost power.
Keeping operations functioning is a key component of any disaster
planning a health insurer has in place, John Phelps, director of business risk
solutions for Florida Blue, the Blue Cross and Blue Shield plan in Florida,
tells HPW. He has spent 20 years in emergency planning in the
hurricane-prone state, which has seen its share of devastation, notably from
Hurricane Andrew in 1992 and a series of major weather events in 2004 and 2005,
from Ivan to Frances to Charley.
The major lesson learned, starting with Andrew, was that “unless
and until you stabilize your employees, you will not stabilize the business,”
Phelps says. Helping employees with housing, clothing, supplies and food
following a storm has strengthened the insurer’s ability to respond to
emergencies, he says. As an example, after Ivan hit in September 2004, the plan
had to close its Pensacola office and establish a “respite center” for
employees, where workers’ families were served one hot meal per day. Employees
also had access to a supply room stocked with non-perishable food, ice, diapers
and disinfecting supplies. And an exterior generator worked to maintain air
conditioning in the 95-degree heat.
Phelps heads the company’s Enterprise Operations Center, which has
a team of 18 (with two backups each) that uses a specially outfitted command
center at the home office in Jacksonville, coupled with a backup location at
their data center 25 miles inland. His advice for health plans dealing with the
current storm recovery? Tell providers that if one of your plan’s members comes
in need of medical services, they should “treat them and figure it out later.”
As for authorizations, attempts should be made to contact the plan, but if
that’s not possible, “do not withhold service.”
Florida Blue Trains for the Worst
Following a storm of the magnitude of Sandy, which Phelps says is
a unique event given its ferocious stretch of wind and rain, plan operations
will come back online slowly, but business does get back to normal.
His team trains once per year and reviews contingency plans for
not just weather-related emergencies, but fires, terror attacks and kidnapping.
And even though Florida Blue did not see any hit from Sandy in its home state,
it still had to prepare subsidiaries.
Phelps says before Sandy came ashore, the company was closing
offices and organizing the safety of employees of Medicare contractor Novitas
Solutions, Inc., a wholly owned subsidiary of Diversified Service Options, a
separate holding company owned by Florida Blue. Among its contracts with the government,
Novitas administers jurisdictions in the Mid-Atlantic and Northeast impacted by
Sandy.
“Preparation is essential…and you must have a clear understanding
of priorities: People, safety and then the restoration of the business,” he
adds.
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