- The Progressive Pulse - http://pulse.ncpolicywatch.org -

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 [1], 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 [2]“.