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Walker, Blue Cross Ranger

Jack Walker, the man who won’t audit North Carolina’s contracts with Blue Cross Blue Shield (BCBS) to control what the State spends on health care wants to audit every teacher and state employee who pays for dependent health coverage and their dependents on the State Health Plan. In a letter to health plan members sent out this week, just on the heels of the decision to audit State Health Plan members for obesity and tobacco, Jack Walker warns that the State Health Plan will audit all dependents covered under the Plan during the 2009 benefit year.

Dependents determined to be ineligible for the Plan will be removed from the Plan. In addition, the Plan may pursue reimbursement for claims paid for ineligible dependents.

Jack Walker, the man with a questionable PhD from a defunct online college, who can’t provide documentation of a dissertation, wants members who pay for dependent coverage to “begin to collect the required documents” to provide evidence to confirm eligibility. Documents include marriage certificates, birth certificate and, tax returns. Eligible dependents under GS 135 are, generally:

Legal spouse
Unmarried children under 19
Unmarried children with disability developed before 19 (or 26 if full time student)
Unmarried children 19-26 who are full time students at a school or college accredited by the state of jurisdiction.

If you take care of nieces, nephews, grandchildren or other kids, they are not covered unless they are legally adopted or foster children. No apparent exception for guardianship or other forms of custody.

I am aghast at Walker’s bravado and the relentless pursuit of remedies for the mismanagement of the State Health Plan on the backs of state employees especially when the buzzards of furloughs and lay-offs are circling over the legislature. Shrinking the pool by scaring off paying customers hardly seems wise unless there is some evidence of massive abuse. I still can’t wrap my brain around the third-party administrator status of BCBS when the plan depends on BCBS’s Preferred Provider Network. Millions are paid out to BCBS with limited oversight yet the people who pay into the Plan for dependent coverage are now to be audited. Just pray that the “College” your child is attending “full-time” has better credentials than “Columbia Pacific University“.

7 Comments

  1. Adam Searing

    May 7, 2009 at 10:30 am

    Walker’s PhD from Columbia Pacific is from an unaccredited university. There is no dispute about this. So, as Greg says, Walker is demanding from state employee kids what he didn’t even do himself.

  2. AdamL

    May 7, 2009 at 10:34 am

    Walker actually lists PhD after his name on the letter! The letter that says your children are ineligible if they go to an unaccredited school. Wow.

  3. ABB

    May 7, 2009 at 12:48 pm

    That’s fine Mr. Walker (not a Dr. in my book) I’m getting ready to drop my child from my policy and get a much better and cheaper private policy for him. You have priced famlies out! Time for you to leave and never come back.

  4. mike

    May 8, 2009 at 9:13 am

    You people are fools, you are allowing your own membership to steal from your fund and you object to providing simple documentation of eligibility. Truth is 5-8% of most dependents are ineligible. Its not only College kids, the divorce rate in this country is 50%. I am sure you know of co workers who still cover their ex or children even though they could/should be covered by their new employer or spouse. An audit will save the plan millions and protect your ability to maintain your benefit package. BCBS just pays the claims the plan controls eligibility. The amount that is paid into the Plan for Dependent coverage does not even come close to what the plan pays out for these dependents. No employer plan pays to take care of nieces, nephews, grandchildren or other kids, why would you risk your benefits so that others can steal from the system.

  5. gregflynn

    May 8, 2009 at 11:06 am

    If you want to make a point, beginning with “You people are fools” is a great way to trivialize it.

    The point is that the money going through BCBS is not being examined with even a fraction of the degree of scrutiny being applied to plan members.

    BCBS also manages the PPO network. It’s like paying a car dealer to negotiate with himself on your behalf and paying him to handle the payments. We really don’t know how much profit is skimmed off by the not-for-profit BCBS.

  6. Niki

    May 13, 2009 at 3:44 pm

    Mike, you refer to “you people” and “your membership”… well, apparently you are not a State Employee or a health care provider who is aware of the increasing premiums and decreasing benefits for dependents – especially children. Even if 5%-8% are ineligible for coverage, at least premiums were paid for that coverage … Before the State wastes more money for the expense of auditing its own employees, maybe BCBSNC should have to explain what is being done with the millions of dollars they receive from the state. Based on my experience, it is not being used to pay for claims!!!

  7. Alex

    May 14, 2009 at 3:40 pm

    The State plan is in what is known in the insurance industry as “the Spiral of Death”. The only one’s beside the State paying into the plan are dependents as of July 2009. They raise the dependent rates to cover some of the short fall. If dependents can get insurance elsewhere they do. The average age of the health plan is ten years higher than the average for other plans. As long as the rates go up for dependents while pay decreases for State employees more dependents will be forced off the plan. The rates will increase until no one will be able to have a dependent on the plan. The State would lose all the money from the premiums and the plan will cost the State too much. The end of the Plan for all.

    The millions of dollars from the State probably go to pay the top ten executives of BCBSNC who makes several million a piece in salary and bonuses each year.