Cigna to allow consumers to customize their health plans
■ Physicians worry that the administrative headache amounts to more of the same problems for office staff.
By Jonathan G. Bethely — Posted April 3, 2006
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Cigna says it soon will give members the opportunity to design their own health plans. But physicians suspect that those consumer-designed plans might not be any easier to deal with than the company-designed ones.
Cigna's Custom Benefits Builder allows members to personalize various aspects of their coverage, from co-payment and coinsurance levels to deductibles and out-of-pocket maximums, to whether the plan includes a health savings account. Once the appropriate selections are made, the Web-based tool then calculates how much the plan will cost and allows the member to enroll in what is essentially a traditional PPO or HMO plan. Member-designed plans would start up beginning January 2007.
Cigna is rolling out the custom-design benefits plans nationwide to large employers. Also, firms in Florida and Texas with fewer than 5,000 employers may use it as well. The program was not piloted in any one area, but Cigna officials said the tools were used in test settings with consumers to determine their usability.
Connecticut State Medical Society Executive Director Tim Norbeck said that although the program appears to offer consumers greater control of their medical coverage decisions, the program could create added pressure on a physician's administrative staff. That's because physicians worry that they won't be able to determine immediately what level of coverage patients have when they walk in with a custom-designed health plan.
"I would think this exacerbates what is already a very difficult task," Norbeck said.
Bohn D. Allen, MD, a retired surgeon and immediate past president of the Texas Medical Assn., said there is good news and bad news about what Cigna is offering. The good news, Dr. Allen said, is that the added choice and the potential cost savings for employees who design their own coverage could cause more people to sign up for medical insurance, causing the number of uninsured Americans to decrease.
Dr. Allen said the bad news is that physicians might not be aware of what is or isn't covered under the custom-designed plans until the procedure has been completely adjudicated. Plans with health savings accounts attached to them create an additional problem, because physicians will not immediately know what portion, if any, will be deducted from the HSA, or what will be deducted from the plan itself.
Additional problems could be faced when patients exhaust their health savings accounts, because some employers might opt not to cover certain procedures.
"This is just another form of managed care," Dr. Allen said. "All the problems we have with managed care will still be there. There will be no relief for physicians. From our perspective, what they are planning is going to be of no real benefit to physicians."
But Tom Richards, senior vice president of product for Cigna HealthCare, said the customized benefits plans will function just as a traditional PPO or HMO plan does. Members will be issued a health card that will display the usual information, including co-pay amounts. Richards said physicians' reimbursement rates would not be any different under the plan as they are for other Cigna plans.
"The innovation is really pre-enrollment," Richards said. "Post-enrollment, it's a regular PPO or HMO."
Cigna's plan is still a work in progress. A physicians' advisory committee in Texas -- one set up after Cigna settled its share of the class-action lawsuit physicians filed against health plans over contracting issues -- sat down with Cigna executives on March 13 to air their concerns with the goal of "tweaking and perhaps changing" certain aspects of the program to make it more responsive to physicians, Dr. Allen said.
"The physicians' advisory committee gave them an earful," Dr. Allen said. "Hopefully they will use it in a constructive manner."