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Note: This is from Feb. 5, I apologize if it has already been posted here. I found this when researching newspapers today. Please let me know. Thank you.

SOME STATE WORKERS GET ERRONEOUS WINDFALL

Their health insurance plan reimburses them for drugs -- money that should have gone to pharmacies.

By ALAN M. WOLF, Staff Writer

RALEIGH -- Some state employees got bonus checks in the mail recently, courtesy of a health insurance billing glitch.

Problem is, the state wants its money back. Thousands of state employees, retirees and their dependents who filled prescriptions this year were mistakenly reimbursed a total of about $300,000 -- money that should have gone to 300 pharmacies across North Carolina. "We think we know everybody we've paid wrong," said Jack Walker, who took over as executive director of the North Carolina Teachers' and State Employees' Comprehensive Major Medical Plan in December. "They will get a certain amount of time to pay it back." Blue Cross and Blue Shield, which administers the state's traditional fee-for-service health insurance plan, will send letters to the employees next week, asking them to return the money. State officials are considering what to do if all the money isn't mailed back, Walker said. Meanwhile, the state may reimburse the pharmacies that haven't been paid, even though pharmacists' mistakes caused the billing problem, he added. The problem started when the state's fee-for-service health plan, which covers about 425,000 members, switched to a new, more convenient drug card on Jan. 1. Previously, those state employees paid for prescriptions and got reimbursed once they passed a $250 deductible. Under the new system, state employees now pay $10, $15 or $20 for prescriptions, depending on the type of drug. Pharmacies are supposed to handle claims and be reimbursed for the balance. The switch did not affect state employees enrolled in HMOs. Some pharmacists, however, have inaccurately filled out prescription claims, so that money went to employees instead of the pharmacies, as if under the old system, Walker said. The mistakes were discovered when Blue Cross started getting calls from state employees wondering why they were still getting reimbursement checks in the mail. Ron Still, a research assistant with the Department of Environment and Natural Resources, got a $245.71 check for two prescriptions his wife filled at the Target pharmacy on Timber Drive in Garner. "When I talked to Blue Cross, they were well aware of it," said Still, who has mailed the check back. "I hope the money all goes back in. It's bad enough for taxpayers already," with the state's budget stretched by Hurricane Floyd relief and the recent winter storms. "To the best of our knowledge, our pharmacists are submitting the forms correctly," said Kristin Knach, a spokeswoman at Target's corporate headquarters in Minneapolis. Company officials are "investigating to see if we can determine where the errors occurred." The 300 pharmacies affected represent 20 percent of the pharmacies state employees use, Walker said. About 11,000 prescription claims were filed incorrectly, or 2.4 percent of the 465,000 prescriptions filled for state employees so far this year, Walker said. Blue Cross held workshops for two weeks in December to teach pharmacists about the new system. Most of the training sessions were sparsely attended, with more Blue Cross and state officials than pharmacists, Walker said. Blue Cross will review all drug claims for state employees, said company spokeswoman Lynne Garrison. "As we receive claims that have the full payment going to the member we are stopping that claim and calling the pharmacy to make sure that's how they meant to code it," she said. Blue Cross, which has a 24-hour hot line to help pharmacists with questions, will hold more training workshops and do one-on-one training as necessary, Walker said. State lawmakers approved the new drug card program following requests by state employees. Under the old plan, employees paid a $250 deductible before prescriptions were covered. The copayment system also saves members the trouble of paying for drugs and waiting to get reimbursed. The state will spend more than $800 million this year on health insurance for 550,000 employees, retirees and their dependents. The portion spent on prescriptions -- more than $100 million -- is increasing as drug prices rise more than 18 percent a year, Walker said. "Once we get through this transition, [the drug card] will be a wonderful benefit," Walker said. http://search.nando.net/plweb-cgi/fastweb?getdoc+nao_public_archive+nao-today+26055+9++glitch

-- Dee (T1Colt556@aol.com), February 18, 2000

Answers

Well, that came out pretty darn lousy! Sorry for the weird format...I don't know why it happens. It was spaced fine in the article when I copied it. Can somebody tell me why this happens?

Thanks much.

-- Dee (T1Colt556@aol.com), February 18, 2000.

This board has some quirks in posting. If an
html code is found then all carriage returns
are ignored. At that point all html code must
be inserted manually.

-- spider (spider0@usa.net), February 18, 2000.