Fallon wins its insurance fight with DOI
Fallon Community Health Plan’s insurance premium increases for small businesses, submitted in April to the Division of Insurance, were justified, according to an independent administrative panel. It’s a win for the state’s fourth largest insurer, which along with all other state health plans, has been locked in a four-month battle with Governor Deval Patrick’s administration over how much is too much to charge small businesses for health care.
An independent administrative panel reversed the DOI’s previous decision to disapprove rates that were proposed for April, May, and June. There is no decision yet on whether the rates submitted for July, for the following year, will be approved or not. Since April, all of the state’s insurers have been required to charge last year’s rates.
In the document detailing the decision, the panel wrote: “Fallon has adequately described its cost containment programs, documented its realized cost savings from its cost-containment efforts and proved that its cost-containment programs, including its utilization programs, are adequate in organizational structure, commitment by senior staff, scale, effectiveness and responsiveness, and has shown that it adjusts its practices to control utilization by implementing new programs”
Fallon CEO Pat Hughes said in a statement, “We are very pleased that the panel agreed that the rates we filed are reasonable and should not have been disapproved. FCHP continues to do everything in its power to control costs and hold down premiums.”
The DOI “strenuously disagrees with the decision. It’s based on outdated notions with respect to health insurance premiums, that any costs can be passed on and the sky’s the limit,” Barbara Anthony, Undersecretary of the Office of Consumer Affairs and Business Regulation, said in an interview.
Anthony said the DOI will continue to talk to Fallon to try to negotiate a settlement that would apply both to the spring premium rates that were just reinstated, and the rates beginning in July.
Filed under: business by Guru