Published: May 20, 2008 10:39 pm         

PEIA enrollee applauded for ‘rocking boat’

CHARLESTON — Ben Morgan is living proof of the adage about the squeaky wheel getting the grease.

Ignoring the advice of some other folks enrolled in the Public Employees Insurance Agency, the retired Division of Highways worker in Frankford went before a legislative panel Tuesday with a complaint.

“They told me not to rock the boat,” he said of some former colleagues when he told them of his bewilderment in having to pay extra recently for medical treatment.

“I wonder why I have to pay so much,” he said.

Morgan retired in 1996 and said he got nothing but the run-around when he tried to contact the Texas office of the Advantra Freedom program that has been added to PEIA-covered employees.

Sen. John Unger, D-Berkeley, applauded Morgan’s willingness to go before the Select Committee on PEIA, Seniors and Long-term Care, saying constituents “need to rock the boat” at times.

“He didn’t know what was going on and he had to come here to get answers,” Unger said, noting Morgan initially took his complaint to a lawmaker in his region, Delegate Tom Campbell, D-Greenbrier.

Moreover, once the panel finished its business, PEIA Director Ted Cheatham and other officials met with Morgan to get a handle on his difficulties in learning how new changes in the system affect him.

“It is unfortunate that he did get the run-around,” Cheatham told the panel.

Morgan was baffled by the changes that resulted in him getting billed anywhere from $5 to $55 from various physicians.

Cheatham advised the panel of a sweeping change coming July 1 that removes the co-insurance for retirees enrolled in Advantra Freedom.

That means such enrollees no longer will be responsible for the 20 percent in co-insurance.

“It will go to straight co-payments,” he said. “It will be much simpler and cleaner.

“You go to a hospital and you know you’ve got to pay $100 and you’re admitted. You have an out-patient procedure and you know you pay $50 and that’s it.”

In a question-and-answer session, Cheatham said about half of those in PEIA will be better off, and the other half likely will be worse off in terms of what they are required to pay from their pockets.

Afterward, he amplified this to explain it all entails the level of treatment that is provided.

“People that are using health care a lot are paying more for health care,” he said.

“People using it less have a savings. Which is probably the way it should be.”

Cheatham also cautioned the panel that the overall liability facing PEIA, now around $3.1 billion, could get higher in a few years. In fact, it is projected to hit $5 billion by 2013.

“Health care is trending at 10 percent annually,” he said.

“It’s not a PEIA liability. It’s all the state agencies and non-state agencies, and schools. All the people that have employees have the liability, not PEIA.”

And, no funding mechanism is in force to completely fund the liability on an annual basis, he said.

“For example, if you don’t pay your car payment for a couple of months, your car payment gsoes up because you’ve got a liability you haven’t kept up with.”

— E-mail:

mannix@register-herald.com