member advisory councils

4
Vol. 36, No. 17 A Newsletter of Blue Cross and Blue Shield of Florida gust 3, 1987 Member Advisory Councils: BCBSF listens and responds O n less than a week's notice, repre- sentives of group policy holders in Orlando and Fort Lauderdale met in June to discuss the provider incentive program created by Purchasing of Hospital Services. They said that BCBSF should wait until renewal time to make contract chaes, and that the corporation should notify empl rs of a changes in their health insurance rather than communicate directly with their empl es._ That information exchange is a good example of w mber Advisory Councils work as a t-w communi- cation hicle between BCBSF and sub- scribers, said Pat Fekula, manager of Member Advisory Councils. MACs provide an opportunity r BCBSF to identify and evaluate sub- scriber attitudes, expections and prob- lems, and th help to assure subscriber understanding of the Florida Plan's poli- cies, objectives and actions, Fekula said. re than 200 C members throuout the state meet quarterly except during sumrs, when special meetings are held. st of them repre- sent group poli ders-providers of BCBSF services are ineligible r mem- bership-o make decisions about their empl e insurance coverage. During the week of Ju 13, the Gornmental and Legislati Rela- tions Department invited Orlando and Tampa MAC members to workshops on empl r mandated benefits and other personnel issues. Earlier this ar, C members in all nine MAC cities discussed the sta- tus of insurance issues being consid- ered in the Legislature, and they offered community fund raising ideas for BCBSF's Ompic involment. As a result of one of those sessions, a black-tie gala featuring the For� Lauder- dale S pho will be held in Decem- ber, with proceeds going toward BCBSF's $55,000 fund raising goals. Significant achievements of the three-ar-old MAC program hꜹe included providing feedback on new products and redesign of mbership and Billing and Explanation of Benefit forms, Fekula said, noting that future topics for discussion will be claims, fraud abuse and AIDS. The variety of C participants includes such emplors as scho boards, city governments, Volkswagen of America, Publix, Florida Farm Bureau, University of Miami, Biscayne Kennel Club, Seminole County Com- munity College and the Orange County Public Library Other MAC locations are Jacksoille, Gainesville/ Ocala, Miami, Tallahassee, Pensacola and Lakeland. "Besides being a catast for change within the corporation, the MAC pro- gram enables us to s to our custom- ers, 'We hear you, and we're workg on the answers,' " Fekula said. Legislator urges opposition to state mandated benefits E mprs who want health insur- ance r eir emples shouldn't be forced to accept state mandated benefits that increase premium costs, State presentive Art Grindle (R- Longwood) told emplr representa- tives Ju 15 in Orlando. During a conference sponsored the National Association of Manufac- turers, the veteran automobile dealer said that some mandated benefits m help people, but they increase usage of medical services and they raise pre- mium costs. Cathere Kell director of Gern- menl and Legislati laons r BCBS oduced Grdle, sag he's been "persiste and diligent'' advo- cang empl r interests opposing mandated benefiʦ. re than 2, small businesses Florida don't ha group health insur- ance, which affects almost 7, empl es, Grindle said. To help them afrd insurance, he said, he sponsored a bi t ar that uld have allowed empl es of more than e company be insured as a single group if each com- pany has 25 empl es or ss. For that se compan his b ao uld allow HMOs to offer conacts that don't con- ta mandated benefits. Instead, Grindle said, the Legisla- ture approved a bill requing review of current and proposed mandated benefits to determine their social and fancial effects. Grindle urged people to contact their state legislators to oppose man- dated benefits.

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Page 1: Member Advisory Councils

titor Report

'Aarketing

Department

our Plan's newest competi­; the result of a joint ven­!n Hospital Corporation of [ CA) and The Equitable Life :>ociety of the United States. uicor in October 1986, my contributed all of its Ith insurance business, -IMOs. 1ppears to be an extension

of The Equitable, which contributed many of Equicor's key officials. So far, HCA has shown little interest in or influence on Equicor.

Currently lacking a large local pres­ence in Florida, Equicor's recent pur­chase of Tampa Bay Health Plan, an HMO, has helped to increase its mar­ket share.

Equicor now has only one county operational in their PPO-Dade-and four counties operational in an HMO-Hillsborough, Pasco, Pinellas and Palm Beach (through Tampa Bay Health Plan).

Equicor should be able to develop extensive provider networks through HCA hospitals and Equitable's current

::VICE

I 5YEARS NEW

NIVERSARIES EMPLOYEES Hilda McLaughlin

HOI MIS Wade Barlow iEARS I Supervisor Special

Judith Discenza Claims

networks. Once acquired, this could cover 29 counties. The development of this network may be slow, as Equicor must negotiate with each HCA hospi­tal. Also, expansion of current HMO networks will require resources that may be limited.

BCBSF's provider network is signifi­cantly more extensive than Equicor's. The newcomer won't catch up soon, or it may not even try; instead, it may select only a few areas to target.

Possible target markets for Equicor include the Tampa-St. Petersburg area, West Palm Beach, and the Fort Lauder­dale and Miami areas, where networks of some type already exist or where numerous HCA hospitals are located.

Daren Donovan ClerkB Medicare B Mail Operations

Patricia Fernandez

raJones

I VP Actuary Comprehensive Claims ClerkE

Health Options of dicare B Unit II nmunications Markus Mueller South Florida

Health Options of Rosa Basoa

;aret Jolley

I Jacksonville Customer Service Kelli Futch

:marketing - Representative Customer Service

ound WATS Diane Coleman Health Options of Representative

Health Options of South Florida ASP State Group

Central Florida Correspondence

iEARS I Georgia James Christine Bibey

Janet Jackson HIS Customer Service Telemarketing - Representative Secretary A

lReid Outbound Sales Field Services - Written Communications

nagement Systems Fort Lauderdale Dinorah Martinez

ta Ketchel PROMOTIONS Bonnie Black Customer Service

dicare B Supervisor Representative

nmunications Cary Britt Medicare B Health Options of

Supervisor Communications South Florida

mManly

I Branch Audit PARD

!S Administration Tampa Branch Audit Charles Brown Maria Moya

:1.tract Compliance Account Executive HMO Secretary B

Vicki Dailey Health Options of Health Options of

Micrographics Processing Central Florida South Florida

�ARS I Clerk Laura Noble Filming - Com & Christopher Bunn

Quality Control Internal Auditor II EDP Telecommunications

1rdAustin I Internal Audit Specialist

jar Accounts Deanna Fields Telecommunications

Claims Examiner Frederic Buttner III )n Cotten Blue Shield EOMB ClerkB Julie Pitman

dicare B Claims Unit II Medicare B Mail Accounting Clerk C

tmining Operations General Accounting

1e Paulin Marta Diaz Tracy T hompson

te Group Claims TRANSFERS Claims Examiner B Clerk Typist A

Health Options of EA.R Administration

Cindi Rice South Florida

Regina White Field Group Specialist Secretary B National Accounts Sales Health Options & Admin of Sarasota

Vol. 36, No. 17 A Newsletter of Blue Cross and Blue Shield of Florida August 3, 1987

Member Advisory Councils: BCBSF listens and responds

On less than a week's notice, repre­sentatives of group policy holders

in Orlando and Fort Lauderdale met in June to discuss the provider incentive program created by Purchasing of Hospital Services. They said that BCBSF should wait until renewal time to make contract changes, and that the corporation should notify employers of any changes in their health insurance rather than communicate directly with their employees._

That information exchange is a good example of how Member Advisory Councils work as a two-way communi­cation vehicle between BCBSF and sub­scribers, said Pat Fekula, manager of Member Advisory Councils.

MACs provide an opportunity for BCBSF to identify and evaluate sub­scriber attitudes, expectations and prob­lems, and they help to assure subscriber understanding of the Florida Plan's poli­cies, objectives and actions, Fekula said.

More than 200 MAC members throughout the state meet quarterly except during summers, when special meetings are held. Most of them repre­sent group policy holders-providers of BCBSF services are ineligible for mem­bership-who make decisions about their employee insurance coverage.

During the week of July 13, the Governmental and Legislative Rela­tions Department invited Orlando and Tampa MAC members to workshops on employer mandated benefits and other personnel issues.

Earlier this year, MAC members in all nine MAC cities discussed the sta­tus of insurance issues being consid­ered in the Legislature, and they offered community fund raising ideas for BCBSF's Olympic involvement. As a result of one of those sessions, a black-tie gala featuring the For� Lauder­dale Symphony will be held in Decem­ber, with proceeds going toward BCBSF's $55,000 fund raising goals.

Significant achievements of the three-year-old MAC program have included providing feedback on new products and redesign of Membership and Billing and Explanation of Benefit forms, Fekula said, noting that future topics for discussion will be claims, fraud abuse and AIDS.

The variety of MAC participants includes such employers as school boards, city governments, Volkswagen of America, Publix, Florida Farm Bureau, University of Miami, Biscayne Kennel Club, Seminole County Com­munity College and the Orange County Public Library Other MAC locations are Jacksonville, Gainesville/ Ocala, Miami, Tallahassee, Pensacola and Lakeland.

"Besides being a catalyst for change within the corporation, the MAC pro­gram enables us to say to our custom­ers, 'We hear you, and we're working on the answers,' " Fekula said.

Legislator urges opposition to state mandated benefits

Employers who want health insur­ance for their employees shouldn't

be forced to accept state mandated benefits that increase premium costs, State Representative Art Grindle (R­Longwood) told employer representa­tives July 15 in Orlando.

During a conference sponsored by the National Association of Manufac­turers, the veteran automobile dealer said that some mandated benefits may help people, but they increase usage of medical services and they raise pre­mium costs.

Catherine Kelly, director of Govern­mental and Legislative Relations for BCBSF, introduced Grindle, saying he's been "persistent and diligent'' in advo­cating employer interests by opposing mandated benefits.

More than 200,000 small businesses in Florida don't have group health insur­ance, which affects almost 700,000 employees, Grindle said. To help them afford insurance, he said, he sponsored a bill this year that would have allowed employees of more than one company to be insured as a single group if each com­pany has 25 employees or less. For that size company, his bill also would allow HMOs to offer contracts that don't con­tain mandated benefits.

Instead, Grindle said, the Legisla­ture approved a bill requiring review of current and proposed mandated benefits to determine their social and financial effects.

Grindle urged people to contact their state legislators to oppose man­dated benefits.

Page 2: Member Advisory Councils

2

Great response to "Born to Win;" all employees welcome to attend

Every Jacksonville employee is invited to attend the "Born to Win" self­

enrichment program offered by Mar­keting Services. The next one-hour session is at 8 a.m. Wednesday, August 5 in Training Room 1.

Response has been great, as indicated by the growth from 21 per­sons in the first class to 99 in the sec­ond. The sessions are offered every other week.

Much of the July 22 class involved the idea that "paying the price" for suc­cess isn't as positive an outlook as "enjoying the price" one pays to succeed. The story of a family who imparted that to their cerebral palsy-ridden child, who developed "impossible" athletic abilities

and became president of a successful company, is an example of the motiva­tional message contained in "Born to Win."

"Our problems pale in compari­son ,.,vith the adversity many happy, successful people overcome with determination and effort," said John Parsons, manager of Marketing Person­nel Development. He emphasized that the program is open to everyone at all levels of the company, and that it's intended to help people feel better about themselves and lead happier, more productive lives.

T he next session's topic is ''Your Relationships With Others."

Gainesville Health Options assumes HMO America accounts /n an agreement approved by the

Department of Insurance, Gaines­ville Health Options has assumed the administration of seven commercial health care contracts of HMO Amer­ica, which is withdrawing from the Gainesville market.

The state is notifying affected state employees that they can choose to become members of Gainesville Health Options or return to the stan­dard state employee health care pro­gram by August 1.

'We have been working closely with HMO America and the Department of Insurance to ensure a smooth transition of benefits, said Don Walsh, executive director of Gainesville Health Options.

"Nearly all of the physicians who were part of HMO America's network are part of our physician network. The

range of benefits and the hospital affil­iations of the two plans are also simi­lar. We assumed the commercial contracts on July 1 and we are in the process of conducting meetings with employees of the affected groups to explain our program," Walsh said.

The commercial contracts are being assumed at the same premium rates, the same level of benefits, and through the same contract expiration date that were provided under the HMO Amer­ica contracts.

Gainesville Health Options became operational last year and has more than 4,100 members. Its provider net­work includes 30 primary care physi­cians and more than 450 specialists, including 300 University of Florida health center specialists.

Customer Service

Service to emulate " ... Irma Horner (Customer Service Representative, Miami) has been so helpful in just one phone call, (more) than anyone else I have spoken to in the past. I only wish there would be more competent people in the world, but good help is very hard to find as you must know ... She's quite a lady, hang on to her." Someone who really cares " ... the claims ... are slowly being resolved by Medicare and we have you (Ingrid Goetz, Field Service Represen­tative, Fort Lauderdale) to thank for straightening this out with them ... you are so pleasant to deal with, and it's a good feeling to know that there is someone in your organization that really cares and goes out of her way to help." What we're about "In a world where complaints and rudeness seem to be the norm, it is a refreshing feeling when one is not only treated with respect and professional­ism, but with a genuine knowledge. I want to commend Patty Boynt (Cus­tomer Service Representative, Central Region Major Accounts) on her profes­sional decorum and her willingness to assist me ... I hope that more employ­ees will follow her lead." Plenty of praise to go around Thirteen customer service representa­tives in Medicare B Telecommunica­tions recently received praiseworthy letters-Tammy Arnold for being understanding, cooperative, helpful and professional with a pleasant atti­tude; Jennie Magriplis for her pro­fessional manner and for being knowl­edgeable, sincere and conscientious; Twanna May for giving an intelli­gent, understanding, courteous and helpful response beyond the normal limit of duty; Sandy T homas for staying with a difficult problem and solving it effectively and considerately; and Tonya Bacon, Angela Duggar, Patty Hill , Sunday Kato , Rachelle Norton, Ken Reese, Laurie Roberge, Kim Rutledge and Tammy Tuten for being courteous, pleasant, patient, efficient and understanding.

BCBS

NEWS Catastrophic proposals pending before Congress vvould improve health coverage for some elderly, but they would leave "significant gaps," such as the cost of nursing home care, which accounts for "over 81 percent' of elderly expenses, the General Accounting Office reported. The GAO reviewed 14 proposals to expand Medicare coverage by limiting beneficiaries' out-of-pocket spending on Medicare-covered services.

"Most of the proposals would apply catastrophic dollar limits only to physi­cian services and hospital care, which account for about 27 percent of the out-of-pocket costs incurred by the elderly, " the report said. Most of the proposals provide limited protection for nursing home and home health care for chronic conditions (the major source of out-of-pocket expenses). They exclude out-of-pocket expendi­tures for physician charges above the Medicare-approved payment, and for services not covered by Medicare.

PROFILE Vol. 36, No. 17 +.' August 3, 1987 " "

Frank Dorman, Editor Printing, Corporate Print Shop

Profile newsletter is published weekly b),' the Corporate Communications staff of Blue Cross and Blue Shield of Florida. All rights are reserved. 1bis newsletter or parts tliereof may not be reproduced in any form without permission from the publisher, copyright ©1987, Blue Cross and Blue Shield of Florida, Jacksonville, Florida. To submit information, contact the editor, Corporate Communications, 791-8664.

We provide superior service to our customers wliei

4. We are convenient to our customers

We provide access to our products and services at our customers' nience and ensure that all interactions with our customers are perceive them to be positive, personalized and simple.

Medicare B claims pass million 1

from the Medicare EMC Area

For the first time, Medicare B EMC receipts have exceeded the one rr mark. Almost 43 percent of all claims are now processed over the E:

Media Claims network. During the past year, the EMC area has continued to grow as inrn

numbers of providers and suppliers have turned to automated claims in paper claims submission. Receipts have hovered around a million durin; three months (April-1,052,302, May-949,164, June-966,632).

The EMC area consists of the Suspense Unit, which is responsible for claims that suspend to be worked, and the Support area, which provides o service and other support activities to our valued EMC providers and supF

Pictured are the EMC Support group (kneeling, 1-rj-Wilma Struh, H. Robinson, Shirley Taylor, Nona B. Collins, Kim Sheppard, Sissy Brov Supervisor Debbie Rigdon; and the EMC Claims group-(second ro\tj Hicks, Donna M. Faulk-Massaline, Alice C. Ballard, Judi Davis, Maria\ Mary McClain and Sharon Garey.

(third ro\tj Pamela Hodges, Loretta Bennett, Debra Stephens, Ami Voncretia McRoy, Kara Lane, (fourth ro\tj Supervisor Doug Kinder, Mil Francina James, Charlie Lightfoot, Arvellia Peterson, Jennifer Canfield, J and Manager Jim Gray.

Not pictured are Kathi Hammond (Support) and Mary Smith, Del Beechum, Carolyn Moultrie, Debbie Johnson and Pat Little (Claims).

Page 3: Member Advisory Councils

lt response to "Born to Win;" mployees welcome to attend <sonville employee is invited d the "Born to Win" self­program offered by Mar­ices. The next one-hour 8 a.m. Wednesday, August 5 Room 1. tse has been great, as 'the growth from 21 per­:irst class to 99 in the sec-5sions are offered every

)f the July 22 class involved "paying the price" for suc­)ositive an outlook as e price" one pays to succeed. a family who imparted that )ral palsy-ridden child, who mpossible" athletic abilities

and became president of a successful company, is an example of the motiva­tional message contained in "Born to Win."

"Our problems pale in compari­son with the adversity many happy, successful people overcome with determination and effort," said John Parsons, manager of Marketing Person­nel Development. He emphasized that the program is open to everyone at all levels of the company, and that it's intended to help people feel better about themselves and lead happier, more productive lives.

The next session's topic is "Your Relationships With Others."

1esville Health Options mes HMO America accounts ement approved by the ent of Insurance, Gaines­Options has assumed the ion of seven commercial :ontracts of HMO Amer­, withdrawing from the market. is notifying affected state hat they can choose to mbers of Gainesville .ons or return to the stan­mployee health care pro­gust 1. been working closely with ·ica and the Department of ensure a smooth transition aid Don Walsh, executive ainesville Health Options. U of the physicians who : HMO America's network 1ur physician network. The

range of benefits and the hospital affil­iations of the two plans are also simi­lar. We assumed the commercial contracts on July 1 and we are in the process of conducting meetings with employees of the affected groups to explain our program," Walsh said.

The commercial contracts are being assumed at the same premium rates, the same level of benefits, and through the same contract expiration date that were provided under the HMO Amer­ica contracts.

Gainesville Health Options became operational last year and has more than 4,100 members. Its provider net­work includes 30 primary care physi­cians and more than 450 specialists, including 300 University of Florida health center specialists.

Customer Service

Service to emulate " . . . Irma Horner (Customer Service Representative, Miami) has been so helpful in just one phone call, (more) than anyone else I have spoken to in the past. I only wish there would be more competent people in the world, but good help is very hard to find as you must know . . . She's quite a lady, hang on to her."

Someone who really cares a . . • the claims . . . are slowly being resolved by Medicare and we have you (Ingrid Goetz, Field Service Represen­tative, Fort Lauderdale) to thank for straightening this out with them . . . you are so pleasant to deal with, and it's a good feeling to know that there is someone in your organization that really cares and goes out of her way to help."

What we're about "In a world where complaints and rudeness seem to be the norm, it is a refreshing feeling when one is not only treated with respect and professional­ism, but with a genuine knowledge. I want to commend Patty Boynt (Cus­tomer Service Representative, Central Region Major Accounts) on her profes­sional decorum and her willingness to assist me . . . I hope that more employ­ees will follow her lead."

Plenty of praise to go around Thirteen customer service representa­tives in Medicare B Telecommunica­tions recently received praiseworthy letters-Tammy Arnold for being understanding, cooperative, helpful and professional with a pleasant atti­tude; Jennie Magriplis for her pro­fessional manner and for being knowl­edgeable, sincere and conscientious; Twanna May for giving an intelli­gent, understanding, courteous and helpful response beyond the normal limit of duty; Sandy Thomas for staying with a difficult problem and solving it effectively and considerately; and Tonya Bacon, Angela Duggar, Patty Hill , Sunday Kato , Rachelle Norton, Ken Reese, Laurie Roberge, Kim Rutledge and Tammy Tuten for being courteous, pleasant, patient, efficient and understanding.

BCBS

NEWS Catastrophic proposals pending before Congress would improve health coverage for some elderly, but they would leave "significant gaps," such as the cost of nursing home care, which accounts for "over 81 percent'' of elderly expenses, the General Accounting Office reported. The GAO reviewed 14 proposals to expand Medicare coverage by limiting beneficiaries' out-of-pocket spending on Medicare-covered services.

"Most of the proposals would apply catastrophic dollar limits only to physi­cian services and hospital care, which account for about 27 percent of the out-of-pocket costs incurred by the elderly," the report said. Most of the proposals provide limited protection for nursing home and home health care for chronic conditions (the major source of out-of-pocket expenses). They exclude out-of-pocket expendi­tures for physician charges above the Medicare-approved payment, and for services not covered by Medicare.

PROFILE Vol. 36, No. 17 +.' August 3, 1987 " "

Frank Dorman, Editor Printing, Corporate Print Shop

Profile newsletter is published weekly by: the Corporate Communications staff of Blue Cross and Blue Shield of Florida. All rights are reserved. This newsletter or parts thereof may not be reproduced in any form without permission from the publisher, copyright ©1987, Blue Cross and Blue Shield of Florida, Jacksonville, Florida. To submit information, contact the editor, Corporate Communications, 791-8664.

We provide superior servire to our customers when ...

4. We are convenient to our customers

We provide access to our products and services at our customers' conve­nience and ensure that all interactions with our customers are perceived by them to be positive, personalized and simple.

Medicare B claims pass million mark from the Medicare EMC Area

For the first time, Medicare B EMC receipts have exceeded the one million mark. Almost 43 percent of all claims are now processed over the Electronic

Media Claims network. During the past year, the EMC area has continued to grow as increasing

numbers of providers and suppliers have turned to automated claims instead of paper claims submission. Receipts have hovered around a million during the past three months (April- 1,052,302, May- 949, 164

1 June - 966,632).

The EMC area consists of the Suspense Unit, which is responsible for finalizing claims that suspend to be worked, and the Support area, which provides customer service and other support activities to our valued EMC providers and suppliers.

Pictured are the EMC Support group (kneeling, 1-tj-Wilma Struhar, Deloris H. Robinson, Shirley Taylor, Nona B. Collins, Kim Sheppard, Sissy Browning and Supervisor Debbie Rigdon; and the EMC Claims group-(second rov0 Velma Hicks, Donna M. Faulk-Massaline, Alice C. Ballard, Judi Davis, Maria Vazquez, Mary McClain and Sharon Garey.

( third rov0 Pamela Hodges, Loretta Bennett, Debra Stephens, Amie Jasinski, Voncretia McRoy, Kara Lane, (fourth rov0 Supervisor Doug Kinder, Mike Kelly, Francina James, Charlie Lightfoot, Arvellia Peterson, Jennifer Canfield, Judy Cohen and Manager Jim Gray.

Not pictured are Kathi Hammond (Support) and Mary Smith, Deborah Beechum, Carolyn Moultrie, Debbie Johnson and Pat Little (Claims).

3

Page 4: Member Advisory Councils

Competitor Report

Equicor

from the Marketing

Research Department

One of our Plan's newest competi­tors is the result of a joint ven­

ture between Hospital Corporation of America (HCA) and The Equitable Life Assurance Society of the United States. To form Equicor in October 1986, each company contributed all of its current health insurance business, PPOs and HMOs.

Equicor appears to be an extension

of The Equitable, which contributed many of Equicor's key officials. So far, HCA has shown little interest in or influence on Equicor.

Currently lacking a large local pres­ence in Florida, Equicor's recent pur­chase of Tampa Bay Health Plan, an HMO, has helped to increase its mar­ket share.

Equicor now has only one county operational in their PPO-Dade-and four counties operational in an HMO-Hillsborough, Pasco, Pinellas and Palm Beach (through Tampa Bay Health Plan).

Equicor should be able to develop extensive provider networks through HCA hospitals and Equitable's current

SERVICE I

5 YEARS NEW ANNIVERSARIES EMPLOYEES

Hilda McLaughlin

20 YEARS HOI MIS Wade Barlow

I Supervisor Special Judith Discenza Claims

networks. Once acquired, this could cover 29 counties. The development of this network may be slow, as Equicor must negotiate with each HCA hospi­tal. Also, expansion of current HMO networks will require resources that may be limited.

BCBSF's provider network is signifi­cantly more extensive than Equicor's. The newcomer won't catch up soon, or it may not even try; instead, it may select only a few areas to target.

Possible target markets for Equicor include the Tampa-St. Petersburg area, West Palm Beach, and the Fort Lauder­dale and Miami areas, where networks of some type already exist or where numerous HCA hospitals are located.

Daren Donovan Clerk B Medicare B Mail Operations

Patricia Fernandez

Sandra Jones

I VP Actuary Comprehensive Claims Clerk E

Health Options of Medicare B Unit II Communications Markus Mueller South Florida

Health Options of Rosa Basoa Margaret Jolley

I Jacksonville Customer Service Kelli Futch

Telemarketing - Representative Customer Service Inbound WATS Diane Coleman Health Options of Representative

Health Options of South Florida ASP State Group Central Florida Correspondence

15 YEARS I Georgia James Christine Bibey

Janet Jackson HIS Customer Service Telemarketing - Representative Secretary A

Carol Reid Outbound Sales Field Services - Written Communications Management Systems Fort Lauderdale

Dinorah Martinez

Wilma Ketchel PROMOTIONS Bonnie Black Customer Service Medicare B Supervisor Representative Communications Cary Britt Medicare B Health Options of

Supervisor Communications South Florida

Sharon Manly

I Branch Audit PARD

Sales Administration Tampa Branch Audit Charles Brown Maria Moya

Contract Compliance Account Executive HMO Secretary B

Vicki Dailey Health Options of Health Options of

Micrographics Processing Central Florida South Florida

10 YEARS I Clerk Laura Noble Filming - Com & Christopher Bunn

Quality Control Internal Auditor II EDP Telecommunications

Richard Austin

I Internal Audit Specialist

Major Accounts Deanna Fields Telecommunications

Claims Examiner Frederic Buttner III Sharon Cotten Blue Shield EOMB Clerk B Julie Pitman

Medicare B Claims Unit II Medicare B Mail Accounting Clerk C

Examining Operations General Accounting

Joanne Paulin Marta Diaz Tracy T hompson

State Group Claims TRANSFERS Claims Examiner B Clerk Typist A Health Options of PAR Administration

Cindi Rice South Florida

Regina White Field Group Specialist Secretary B National Accounts Sales Health Options & Admin of Sarasota

Vol. 36, No. 17 A News letter of Blue Cross and B lue Shie ld of F lorida Augu

Member Advisory Councils: BCBSF listens and responds On less than a week's notice, repre­

sentatives of group policy holders in Orlando and Fort Lauderdale met in June to discuss the provider incentive program created by Purchasing of Hospital Services. They said that BCBSF should wait until renewal time to make contract changes, and that the corporation should notify employers of any changes in their health insurance rather than communicate directly with their employees.

That information exchange is a good example of how Member Advisory Councils work as a two-way communi­cation vehicle between BCBSF and sub­scribers, said Pat Fekula, manager of Member Advisory Councils.

MACs provide an opportunity for BCBSF to identify and evaluate sub­scriber attitudes, expectations and prob­lems, and they help to assure subscriber understanding of the Florida Plan's poli­cies, objectives and actions, Fekula said.

More than 200 MAC members throughout the state meet quarterly except during summers, when special meetings are held. Most of them repre­sent group policy holders-providers of BCBSF services are ineligible for mem­bership-who make decisions about their employee insurance coverage.

During the week of July 13, the Governmental and Legislative Rela­tions Department invited Orlando and Tampa MAC members to workshops on employer mandated benefits and other personnel issues.

Earlier this year, MAC members in all nine MAC cities discussed the sta­tus of insurance issues being consid­ered in the Legislature, and they offered community fund raising ideas for BCBSF's Olympic involvement. As a result of one of those sessions, a black-tie gala featuring the For� Lauder­dale Symphony will be held in Decem­ber, with proceeds going toward BCBSF's $55,000 fund raising goals.

Significant achievements of the three-year-old MAC program have included providing feedback on new products and redesign of Membership and Billing and Explanation of Benefit forms, Fekula said, noting that future topics for discussion will be claims, fraud abuse and AIDS.

The variety of MAC participants includes such employers as school boards, city governments, Volkswagen of America, Publix, Florida Farm Bureau, University of Miami, Biscayne Kennel Club, Seminole County Com­munity College and the Orange County Public Library. Other MAC locations are Jacksonville, Gainesville/ Ocala, Miami, Tallahassee, Pensacola and Lakeland.

"Besides being a catalyst for change within the corporation, the MAC pro­gram enables us to say to our custom­ers, 'We hear you, and we're working on the answers,' " Fekula said.

Legis lator urges opposition to stc mandated bene

Employers who want hea ance for their employees

be forced to accept state ma benefits that increase premi State Representative Art Gn Longwood) told employer re tives July 15 in Orlando.

During a conference spor: the National Association of J turers, the veteran automobi said that some mandated be help people, but they increa: medical services and they ra mium costs.

Catherine Kelly, director of mental and Legislative Relatic BCBSF, introduced Grindle, s. been "persistent and diligent' eating employer interests by c mandated benefits.

More than 200,000 small 1: in Florida don't have group he ance, which affects almost 7( employees, Grindle said. To h afford insurance, he said, he s bill this year that would have employees of more than one c be insured as a single group if pany has 25 employees or les1 size company, his bill also we HMOs to offer contracts that tain mandated benefits.

Instead, Grindle said, the ture approved a bill requirin, of current and proposed ma benefits to determine their s and financial effects.

Grindle urged people to ci their state legislators to oppc dated benefits.