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Blue Cross Blue Shield to Leave USVI Owing Local Health Providers Massive Sums

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Spartygrad95
(@Spartygrad95)
Trusted Member

My son was born 5 weeks early, spent 9 days in NICU. That's definitely a quarter million plus I didn't have.

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Posted : May 12, 2016 8:05 pm
stjohnjulie
(@stjohnjulie)
Trusted Member

My son has FL Blue (Blue Cross Blue Shield), which isn't always accepted here, but I'd be in big trouble without it. His prescription, for the generic, is 3k a month. I have to go to STT to Walgreens or Kmart to fill it, if I don't order it online, but it's definitely worth the trip.

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Posted : May 13, 2016 6:50 am
OldTart
(@the-oldtart)
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Alana33
(@alana33)
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speee1dy
(@speee1dy)
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i see the st thomas source has no proofreaders. .

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Posted : May 13, 2016 10:52 am
IslandHops
(@IslandHops)
Trusted Member

Ha - Potter can't force Tripple-S to continue offering coverage in the VI. What nonsense. Yes they have to pay their obligations under existing agreements, but they can't be forced to renew policies or write new business, or be forced to ensure there is a replacement company ready to step in. I think Potter must be drinking a little too much Mapp cool-aid if the thinks he has that kind of power.

It's time to implement a new model of coverage. The limited availability of coverage here is proof that the existing model is not working for residents of the USVI.

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Posted : May 13, 2016 11:02 am
Gator's Mom
(@gators_mom)
Trusted Member

i see the st thomas source has no proofreaders. .

..... nor restraint in asserting personal views cloaked as journalism.

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Posted : May 13, 2016 11:08 am
speee1dy
(@speee1dy)
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lol, true

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Posted : May 13, 2016 2:36 pm
IslandHops
(@IslandHops)
Trusted Member

i see the st thomas source has no proofreaders. .

..... nor restraint in asserting personal views cloaked as journalism.

Ha. Can't expect better journalism on the viconstipation website. That's literally full of c**p.

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Posted : May 13, 2016 3:10 pm
OldTart
(@the-oldtart)
Expert

I don't understand the negative comments about The Source. But since complaints have been voiced I feel compelled to comment that were there a forum proofreader on board here, he or she would be working 24/7 and quickly need additional staff. Additional staff, of course, to restrain the assertion of personal views cloaked as fact.

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Posted : May 13, 2016 3:27 pm
watruw8ing4
(@watruw8ing4)
Trusted Member

Source considers itself a media news outlet. Forum contributors aren't. Different standards apply. (And I'm a confirmed grammarnazi).

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Posted : May 13, 2016 9:56 pm
OldTart
(@the-oldtart)
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I was being facetious.

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Posted : May 13, 2016 9:59 pm
OldTart
(@the-oldtart)
Expert

"§ 224. Withdrawal of insurer; reinsurance
(a) No insurer shall withdraw from this territory until its direct liability to its policyholders and obligees under all its insurance contracts then in force in this territory has been assumed by another authorized insurer under an agreement approved by the Commissioner. In the case of a life insurer, its liability pursuant to contracts issued in this territory in settlement of proceeds under its policies shall likewise be so assumed."

I wonder if this clause is legally sustainable?

If there's just one bakery in town and for whatever reason it closes its doors, I can't imagine it being legal to demand it find an acceptable bakery to take its place.

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Posted : May 14, 2016 9:18 am
Scubadoo
(@Scubadoo)
Trusted Member

I'm sure bakeries aren't regulated like insurance companies. There's an insurance commission, don't think there is a baking commission. The exit clause may be tied in with conditions of granting the insurer the initial license or permission to do business in the territory along with probably a host of other statutes.

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Posted : May 14, 2016 9:37 am
OldTart
(@the-oldtart)
Expert

I understand that. A vague analogy but just wondering if this is a common clause in the insurance industry - an area I'm totally unfamiliar with.

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Posted : May 14, 2016 10:06 am
CruzanIron
(@cruzaniron)
Expert

"§ 224. Withdrawal of insurer; reinsurance
(a) No insurer shall withdraw from this territory until its direct liability to its policyholders and obligees under all its insurance contracts then in force in this territory has been assumed by another authorized insurer under an agreement approved by the Commissioner. In the case of a life insurer, its liability pursuant to contracts issued in this territory in settlement of proceeds under its policies shall likewise be so assumed."
.

BCBS will stop writing polices on August 1st. So as of July 31st 2017 those policies will have expired and they will have no active customers. Then after a 90 day period to clear up outstanding claims, they can leave.

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Posted : May 14, 2016 10:19 am
speee1dy
(@speee1dy)
Expert

i am sure that an online news source has a much higher standard than people who post on a message board-but if you are volunteering for the job OT.....

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Posted : May 14, 2016 10:20 am
OldTart
(@the-oldtart)
Expert

BCBS will stop writing polices on August 1st. So as of July 31st 2017 those policies will have expired and they will have no active customers. Then after a 90 day period to clear up outstanding claims, they can leave.

That's clear. The LG's argument (which was the whole point of my question) is that there is a clause (cited above) in VI law which mandates that an exiting insurance provider find a replacement insurer.

I've read through documents from several different states (TN, MN, TX, VT) where insurance providers have ceased service. All of them cite in detail the notice of discontinuation of service required as well as financial responsibility, assets. etc. but not one of them appears to have the provision that the departing provider is mandated to find a replacement provider. This from VT is fairly typical:
http://www.dfr.vermont.gov/sites/default/files/Act%20144%20DFR%20Surplus%20Report_0.pdf

speee1dy, I was not quoting or questioning an online news source but a stipulation in VI law. If you have something of merit and relevance to offer then do share.

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Posted : May 14, 2016 10:40 am
Scubadoo
(@Scubadoo)
Trusted Member

"§ 224. Withdrawal of insurer; reinsurance
(a) No insurer shall withdraw from this territory until its direct liability to its policyholders and obligees under all its insurance contracts then in force

So once their current policies expire and after the 90 day claim period? there is no more liability therefore they can leave without a replacement.

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Posted : May 14, 2016 11:16 am
OldTart
(@the-oldtart)
Expert

"§ 224. Withdrawal of insurer; reinsurance
(a) No insurer shall withdraw from this territory until its direct liability to its policyholders and obligees under all its insurance contracts then in force

So once their current policies expire and after the 90 day claim period? there is no more liability therefore they can leave without a replacement.

Read the part which I bolded.

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Posted : May 14, 2016 11:22 am
Scubadoo
(@Scubadoo)
Trusted Member

So 90 days after the last policy expires there are no more "contracts then in force" and they are free to leave?

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Posted : May 14, 2016 11:29 am
CruzanIron
(@cruzaniron)
Expert

OT, I see your point. You are questioning the law itself.

Regardless, it is the law, and a business must comply with the laws of the VI. It's up to BCBS if they want to challenge it in court.

And BCBS has an 'out' by utilizing the fine print / grey area of the law.

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Posted : May 14, 2016 11:31 am
OldTart
(@the-oldtart)
Expert

OT, I see your point. You are questioning the law itself..

Phew! Yes, I'm questioning the legal sustainability of the clause in question since I can't find anything in any state's insurance laws which mandate that. Scubadoo, I'm not referring to the clause you're citing but to the additional clause I cited which accompanies it.

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Posted : May 14, 2016 11:57 am
CruzanIron
(@cruzaniron)
Expert

I don't see why the law isn't sustainable any more than our Good Friday laws are.

Given the market stateside and the overabundance of competition, I'm sure the states saw no need for a clause like ours.

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Posted : May 14, 2016 12:12 pm
OldTart
(@the-oldtart)
Expert

You may well be right.

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Posted : May 14, 2016 12:16 pm
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