THE VIRGINIAN-PILOT 
              Copyright (c) 1994, Landmark Communications, Inc.

DATE: Thursday, October 20, 1994             TAG: 9410200408
SECTION: BUSINESS                 PAGE: D2   EDITION: FINAL 
SOURCE: ASSOCIATED PRESS 
DATELINE: RICHMOND                           LENGTH: Medium:   52 lines

INSURER IS PLANNING TO SEND REFUND CHECKS BY END OF MONTH

Nearly 620,000 customers who made excess copayments to Trigon Blue Cross Blue Shield may be eligible for refunds when the company begins issuing checks by the end of the month.

Trigon has already paid a $5 million fine to settle complaints by the state Bureau of Insurance that the company misled policyholders about their benefits and the cost of their insurance.

At issue was a practice of calculating policyholders' shares of their medical bills - their copayments or coinsurance - without taking into account discounts Trigon had negotiated with hospitals and other medical facilities. Trigon abandoned the practice Jan. 1.

Trigon president and chief operating officer Phyllis Cothran told the House of Delegates Corporations, Insurance and Banking Committee on Tuesday that the company hopes to issue the last check by the end of January.

``We have made mistakes in the administration of facility coinsurance,'' Cothran told the committee. ``We sincerely regret these mistakes and wish we had recognized them and dealt with them earlier.''

The company on Monday finished mailing refund claims forms and an information package to more than 413,000 people who have Trigon policies. Trigon estimates about 619,000 people may be eligible for refunds, covering copayments made between 1984 and 1993.

Since Trigon announced the refund program three weeks ago, more than 32,500 people have called its toll-free number to request claims forms. Customers have returned 3,046 forms.

Cothran said consultants hired by Trigon estimate the company should reach more than 90 percent of people eligible for refunds. A special team of 25 claims and customer service staffers will process refund claims, she said.

She said the company would start mailing refund checks as soon as auditors approve the way Trigon is calculating refunds. Policyholders must file claims with the insurer to qualify for refunds.

Cothran, who meets weekly with Ernst & Young auditors, said she expects to receive their approval and start mailing checks by Oct. 28.

The refunds cover copayments for bills from hospitals and other medical providers, including skilled nursing centers and home health care agencies.

The refunds do not cover doctors' bills, or charges for durable medical equipment, prescription drugs or dental care, because Trigon has always calculated copayments for these after accounting for discounts, Cothran said. by CNB