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NEWS

HELP SAVE YOUR HEALTH PLAN BY BEING A SMART CONSUMER

December 13, 2001

Like they say, God helps those who help themselves. In the case of ATPAM's health insurance plan, that old adage couldn't be truer.

It's no secret that rising health care costs, including double digit inflation in the cost of prescription drugs is bankrupting health plans nationwide and swelling the ranks of the un-insured and underinsured. And ATPAM members are not immune from this serious problem. As reported at the April General Membership Meeting, the Health Plan's actuaries have forecast that if the current numbers don't improve, the entire plan will be "paws up" in less than four years.

What can you as an individual do to help stem the tide and keep our plan solvent? Plenty.

In order to save our great health insurance there is going to need to be a three-pronged approach.

First, the administrative overhead of the Fund has to be brought under control and contained on a long-term basis. Your Trustees are working to accomplish this goal.

Second, the employers are going to have to significantly increase weekly contributions to the Welfare Fund. That will be a major topic of collective bargaining in the next contract negotiations with the League and other employers.

Third (and this is where you come in) the Health Plan is going to have to be redesigned. The Plan needs to be brought into line with the financial realities of the health care delivery systems in our country as they exist today. However, if we don't take action, "redesign" can end up being a euphemism for slashing your benefits. How can you help prevent that outcome? The most important thing you can do is consult with the Fund office before seeking medical care and ask for referrals to providers who are part of our PPO network. Not to worry. I said PPO, not HMO. A PPO is a network of doctors our insurance company (ULLICO/Magnacare) has contracted with to provide you services at a deep discount. That discount is to both you and our Health Plan. You pay a $10.00 co-pay per visit and our Fund pays the balance, at a very favorable price. By using network doctors and service providers, you are saving yourself a lot of money on co-pays and also saving our Fund big bucks.

Do you have to sacrifice first rate medical attention to save money? No way. Let me share my own experience with you to illustrate this point.

A couple of months ago I traveled from New York to San Francisco on ATPAM business. I fell asleep in my cramped coach class window-seat. Shortly before the plane landed I woke up and felt a sharp pain in my left calf muscle. I thought I had a pulled muscle. But the pain and swelling persisted for a whole week and on my return to New York I knew I needed serious medical attention fast. The Fund Manager referred me to one of the top cardiovascular specialists in the country. This doctor was in our PPO network. My co-pay was $10.00. The doctor knew right away that I had a potentially life-threatening blood clot. He sent me upstairs to another network doctor to have a Doppler scan to verify the diagnosis. This test was done on state-of-the-art equipment. Another $10.00 co-pay. Less than 24 hours later I was in Lenox Hill Hospital, which is one of the best in the country. It is also in our insurance network. I was in the hospital for five days and had numerous tests, treatments, blood work etc. The hospital staff was terrific. Now I am back at work and will be taking blood thinners for six months. My prescription is a $3.00 co-pay once a month for six months. The prognosis is good and I will be monitored by the doctor with once a month office visits.

Empire Blue Cross has a web site where the truly masochistic can now check their hospital bills on line. Mine was about $20,000.00. The final cost of my hospital, doctors, meds and labs will probably exceed $30,000.00 at sticker price. I will pay less than $200.00 of that and our Insurance company will pay the balance at a deeply discounted price. That saving will be passed along to our Health Fund with a major impact on the bottom line.

Unfortunately, right now, most members are not using in-network doctors and service providers and it is costing them, and our Fund, a bundle. The 80/20 indemnity reimbursement plan most members are using now is very expensive for both the participant and the Fund. As a result, any redesign of our plan is going to either eliminate or severely restrict the indemnity program. So, a word to the wise. Do yourself and your fellow members a favor. CALL THE FUND OFFICE AND GET A REFERRAL TO AN IN-NETWORK PROVIDER BEFORE YOU WHIP OUT YOUR CREDIT CARD ONE MORE TIME AND PAY STICKER PRICE.

---Gordon G. Forbes

NOTE: The Funds Office does not make recommendations of providers,but are happy to assist in referral options.