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Blue Cross Denied Rate Hike

Blue Cross Denied Rate Hike

The denial means that as of now, and unless something changes, Blue Cross won't be offering individual plans on the New Mexico Health Insurance Exchange for 2016

insurance formMore than 35,000 New Mexicans who bought individual Blue Cross and Blue Shield of New Mexico health plans will likely have to find a new health insurer next year after the state’s insurance superintendent denied the insurer’s 51.7 percent rate hike request.

The denial means that as of now, and unless something changes, Blue Cross won’t be offering individual plans on the New Mexico Health Insurance Exchange for 2016, said BCBSNM President Kurt Shipley.

“We would not be on the exchange,” Shipley said Monday, adding that the company still hopes to negotiate a deal with New Mexico Superintendent of Insurance John Franchini. That would mean that those 35,000 people who bought Blue Cross plans would have to shop for plans offered by the four other insurers on the exchange.

Franchini told ABQ Free Press that his office rejected Blue Cross’ rate increase because the insurer couldn’t justify a 51.7 percent hike. Franchini said he offered the company a 24 percent increase but that it rejected the proposal. “I cannot approve a rate increase if I can’t prove it actuarially. The public has to have someone in the government to protect them,” Franchini said.

Shipley countered that assertion, saying Franchini offered a much lower rate hike. And, Shipley said Blue Cross offered a proposal to move most of its individual members into HMO plans with an average increase of 11 percent, but that Franchini rejected that as well. Blue Cross currently offers more than 65 individual plans on and off the exchange. Under it’s proposal, those would have been drastically reduced, Shipley said.

The individual business both on and off the insurance exchange represents about 6 percent of Blue Cross’ business. The company insurers 600,000 New Mexicans.

Shipley said the company lost $19 million in 2014 on those 35,000 members despite getting reimbursed nearly $25 million through rate stabilization programs under the Affordable Care Act. Under the ACA, insurers with high percentages of very sick people who file lots of claims get reimbursed though reinsurance and risk adjustment programs. Two of the three programs are short-term and are being phased out, Shipley added.

The open enrollment period for consumers to buy health plans for 2016 begins Nov. 1.

— Dennis Domrzalski


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Albuquerque’s definitive alternative newspaper publishing an inquisitive, modern approach to the news and entertainment stories that matter most to New Mexicans. ABQ Free Press’ fresh voice speaks to insightful and involved professionals who care deeply about our community.
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Sara MacNeil is an editorial intern at ABQ Free Press Weekly.

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