November 30, 2023

Health Insurance

Follow Your Health Insurance

Florida’s behind-closed-doors health care dealings are a slight to public servants and their families

When the Department of Management Services announced the companies being awarded contracts for state health plans, it shut out two providers, including one of Florida’s oldest and longest-serving not-for-profit plans.

The decision tapped big out-of-state companies to manage benefits for workers who specifically serve Florida, those working in state government jobs, instead of choosing companies that have a proven track record in the state.

To make matters worse, they did it largely in secret.

AvMed, a company with Florida roots that’s been around for 50 years currently serves about 250,000 Floridians, was completely shut out of three-year contracts awarded to administer health-maintenance organization (HMO) and preferred-provider organization (PPO) plans for state workers, their dependents and retirees.

Aetna was awarded some HMO services, though not all it sought, and wasn’t chosen at all for a PPO contract.

Both companies are suing.

Set aside for a moment the problems that can inherently arise from being sued, Florida state employees may now be forced to change their health insurance provider.

While Aetna’s argument — that the state should have chosen them, not Florida Blue, for PPO services because it has a better network of health providers — is compelling, AvMed’s argument is the most troubling.

Its lawsuit, filed in June in Leon County, alleges negotiations violated open meetings laws by holding some discussions in private. It seeks to prevent the state from moving forward with its HMO contract decisions.

In its lawsuit, AvMed said it has provided HMO services to state employees for four decades and, as of Jan. 1, it provided managed care for about 50,000 state employees, retirees and their dependents. Yet it was denied contracts in any of the six regions sought.

The HMO and PPO awards instead went to large conglomerates, Aetna included. Such companies are accountable to just one source: shareholders. Their commitment to Floridians is not guaranteed and any perceived value they may offer may not compensate for what is lost in customer care.

AvMed, for example, has received the highest overall rating of any commercial statewide Florida health plan in the Consumer Assessment of Health Plans Study.

Further, awarding contracts to shareholder-driven companies — UnitedHealthCare and CVS/Aetna each brought in more than $320 billion in revenue last year — fosters less accountability and erodes competition in the health plan marketplace.

And the awarded companies have track records to prove potential trouble. Aetna is facing a lawsuit from Kraft Heinz over its alleged mishandling of sensitive data and accusations that it improperly paid claims. Those weren’t the only troubling claims. The lawsuit also alleges Aetna breached its fiduciary responsibility and used clients’ money to pay company claims costs.

Aetna was also accused in 2021 of illegally securing a Medicaid contract in Pennsylvania for misrepresenting the number of pediatric providers in its network.

United likewise faced a class action suit in California in 2014 alleging it misrepresented its health care provider network in advertising materials.

But instead of due process, the state quietly moved forward with contracts for Florida Blue for the statewide PPO contract; Aetna in four of the nine HMO regions; United in four regions; and Capital Health Plan in the ninth, which includes Tallahassee and surrounding counties.

State workers deserve better than big box health care. And at the very least, they deserve the benefit of transparent discussions about their health care access.

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