Gather ’round, children, and you shall hear… how Vermont’s biggest health insurer has gotten its knickers in a twist about one single word in a Green Mountain Care Board decision. The word was so objectionable that Blue Cross Blue Shield of Vermont appealed the decision solely because of that word. It did not object to any other part of the ruling.
When the appeal was denied BCBSVT took the case to the Vermont Supreme Court, where it awaits action. Seems like a whole lot of time, trouble and billable hours for a single word, but what do I know.
Let’s go back to the beginning. On May 7, Blue Cross Blue Shield of Vermont filed a request for 2022 insurance rates with the Green Mountain Care Board. The Blues asked for a 7.9% increase on individual policies, and smaller increases for group plans.
The request meandered through a lengthy series of briefs, filings, hearings and testimony. (All can be downloaded from this webpage.) On August 5, the GMCB issued its decision, knocking down the rate hike on individual policies to 4.7%. In its decision, the GMCB characterized the 7.9% request as “excessive.”
There. That’s the fatally toxic word. ‘Excessive.”
To quote the relevant sentence in full, “Based on our review of the record, the testimony, and evidence presented at a hearing that was held on July 21, 2021, we conclude that the rates proposed by BCBSVT are excessive.”
Eight days later BCBSVT filed its appeal, asking the GMCB “to remove unsupported and clearly erroneous findings and conclusions that the rates proposed by Blue Cross are ‘excessive.’”
In plain English, you might say it’s quite reasonable for the GMCB to think of a 7.9% increase as “excessive,” since it concluded that a 4.7% hike was sufficient for the insurer’s needs. But BCBSVT insisted that plain English isn’t relevant here. It argued that “excessive” is a “defined actuarial standard” with a very specific meaning. And the Board’s decision, said the Blues, failed to meet that particular standard.
Just to make this absolutely clear, BCBSVT did not object to the Board’s decision to cut its rate hike by almost half. It objected, solely and entirely, on that one word. Its appeal sought only one thing: “to remove any finding or conclusion that Blue Cross’s proposed rates are excessive.”
The Office of the Health Care Advocate, an arm of Vermont Legal Aid that advocates for the public interest in GMCB cases, filed a response to the BCBS appeal that essentially called bullshit.
The insurer argues that the Green Mountain Care Board (Board)’s use of the word “excessive” in its decisions in the above captioned matters is not supported by the record. To the contrary, there is substantial evidence in the record supporting the Board’s findings, and it is well within the Board’s discretion to make such findings.
The GMCB denied BCBSVT’s appeal. On September 3, BCBSVT took the case to the Vermont Supreme Court.
Because of that single troublesome word. “Excessive.”
I can’t speak to the legal theory of BCBSVT’s stand, or why the insurer is so damned tetchy about that one word. But to a humble layman like me, it seems profoundly petty, a waste of time and ratepayer dollars. It seems, um, excessive. And not at all compatible with the insurer’s description of itself and its mission:
As the state’s only local, not-for-profit health plan, we’re driven by Vermont’s culture of doing things our own way and creating a better future together. For us, health care isn’t about profits, shareholders, and politics — it’s about protecting and improving the health and well-being of all Vermonters.
I don’t know how you square that folksy, benign image with this expensive obsession over a single word. Of course, BCBSVT really isn’t your Mom-and-Pop hometown insurer; it’s a giant corporation, albeit a nonprofit. This prolonged appeal has nothing to do with “protecting and improving the health and well-being of all Vermonters.”