THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Wednesday, June 7, 1995 TAG: 9506070002
SECTION: FRONT PAGE: A12 EDITION: FINAL
TYPE: Editorial
LENGTH: Medium: 61 lines
Gerald Haeckel's last name is pronounced ``heckle,'' and Trigon Blue Cross Blue Shield officials probably would say that sounds about right.
Haeckel's persistent heckling set off a series of events that led to Trigon, the state's largest health insurer, refunding an average of $173 to 132,634 customers - $22.9 million altogether. The company announced those totals last week. It also has paid a $5 million fine.
Haeckel, 65, of tiny Scottsville, several miles south of Charlottesville, became suspicious of Blue Cross in 1993 when his wife received an ``explanation of claims processed'' stating that Blue Cross had paid $760, and she was charged $190, for a $950 bill for ambulatory surgery. The $190 payment was supposed to represent 20 percent of the total cost.
But Haeckel also got a bill from the company that performed the surgery, and it was for only $564. Twenty percent of that would have been $112.80, or $77.20 less than he was charged.
It turned out that Blue Cross had used its muscle in the early '80s to secretly negotiate lower rates from health-care providers, but over 10 years it continued to compute the 20 percent charge for policy holders using the higher public rates. The company benefited, not the patients.
By paying $190 toward a $564 bill, Haeckel paid not a fifth of the total, as his policy called for, but more than a third. Blue Cross paid not the $760 it claimed, but $374 - about half as much.
Haeckel, who had worked many years in corporate finance, complained to Blue Cross and received no satisfaction. He complained to the State Corporation Commission's Bureau of Insurance and was told in a letter, ``We lack the jurisdiction or authority to intercede for the purpose of influencing the outcome in the controversy.'' (Was Haeckel supposed to turn to Parks and Recreation for assistance?)
Next Haeckel wrote to U.S. Sen. Sam Nunn, D-Ga., chair of the Senate Subcommittee on Investigations. Nunn said he lacked resources to do anything but wrote to Virginia Insurance Commissioner Steven T. Foster about the strange billings.
The ball began to roll. The Virginia attorney general's office became involved, because 87,000 state employees were insured by Blue Cross. Sen. Clancy Holland, D-Virginia Beach, got legislation passed outlawing the use of two price lists to the insurance company's advantage.
Finally refunds were made.
Haeckel doubts that the refunds were properly calculated, but he figures at least something was done.
Blue Cross, which insures 1.8 million Virginians, argued in letters and ads that the savings from the discounts helped hold down premium increases and even led to some premium decreases.
The company couldn't prove it, Haeckel said.
Two morals spring to mind:
1. A stubborn person can make a difference.
2. Consumers need protection.
There may be a third moral: Don't mess with a man named Haeckel. by CNB