Mr. Kirk Fordice, Governor of the State of Mississippi

Dear Mr. Fordice,

    I am writing to express my concern about the Direct Contracting Administrator the Department of Finance and Administration contracted with to establish a provider network that is specific to the State and School Employees Health Insurance Plan. The Direct Contracting Administrator is Advanced Health Systems, Inc., (hereinafter AHS)  which
is not on the list of Mississippi Health Maintenance Organizations approved by the Mississippi Department of Insurance.

    AHS and the Department of Finance and Administration claim that AHS is offering doctors the exact same terms as were available last year when the doctors signed up for the KEY Network.  But I find this argument to be suspect since many doctors who participated in the 1999 Key Network Plan,  have chosen not to participate in the 2000 AHS State Insurance Plan.  In fact one doctor stated that the contract offered to him by AHS had "over 20 objectionable commissions or omissions in the contract I was sent. At least 9 of these are independently fatal and would preclude my signing a contract with this company."  This same doctor signed up with the KEY Network for 1999, so if it is the same contract and terms being offered by AHS, why would he have problems signing up?   I am appalled that the DFA has made AHS an agent of the State of Mississippi, a group that can not offer a reasonable or industry standard contract to physicians.

    Also, I would like to make you aware that as of  11/5/99 only 2 Physician groups have signed up with AHS in my area, these two physician groups (Rayner Eye Clinic and Urgent Care Clinic) are the only network providers available to care for over 4,000 State and Public School employees in Lafayette County.

      I have copies of petitions signed by over 500 State and Public School Employees who live or work in Lafayette County alone expressing concern over the changes to the State Insurance Plan for 2000 made by DFA and Health Insurance Management Board.  We are also very concerned about the manner in which the decisions to make the change were made and are being implemented and the lack of information being made available to participants about the changes and the effects on our health care.

     Mississippi Code section 25-15-5(5) requires the State and School Employees Health Insurance Management Board to provide plan members with "complete educational materials at least thirty (30) days before the date upon which the plan's members must select a plan option for health care services."  This section also  requires the Board to use  the resources of the Mississippi Authority for Educational Television to provide information on proposed changes.  It also authorizes the Board
to use other state owned media and to make public service announcements on private media to disseminate information regarding proposed changes to the plan.

    Many plan participants have tried on their own to get media coverage of the changes so all participants will be aware of how the changes will  affect their families.  But we are having an incredibly difficult time getting any kind of news coverage.

Plan participants received a Health Insurance Update newsletter in September, but it provided far too little information for participants to make any reasonable estimate of the effect of the changes on costs for their health care.  The newsletter made the

"Effective January 1, 2000, the Plan will include a single network available to all participants, the AHS State Network. The Base Plan Option will be eliminated and participants will no longer be required to select a benefit option. ... The Plan will have a $350 deductible with 80/20% cost sharing when you use a provider participating in the AHS State Network. If you use a provider not participating in the AHS State Network, benefits will be paid at 65% of the allowable charge, after a $600 deductible is met. ... Additional information regarding the AHS State Network will be provided to you in the near future."

The newsletter did not make it clear to participants that they could not automatically assume that doctors they had been using for years might not be in the new network.  It certainly did not make it clear that for some areas of the state, AHS had (and
currently still has) only an extremely limited number of participating providers in some areas of the state.  Furthermore,
as some members began asking questions, we learned that not only did AHS have almost no providers in some areas such as North Mississippi, AHS had no participants in the Memphis area and 30 days before many of us were required to sign up still had not contacted many Memphis providers which had previously been available under the discontinued networks.
Many of us called, and collectively found that none of our current physicians and providers were in the new network.

    In short, it did not make it clear that many of us would be forced to pay for medical care "outside the network" substantially raising our costs.  We did not have this information when we had to make decisions concerning how much we would put in our
cafeteria plan medical spending accounts.

As of last week, we were still being told that AHS would not have a directory of in network providers available for participants until at least late December.  Yet we are having to make  appointments now for follow-up visits with physicians early in the new year, and we still don't know if we will be covered in or out of the network.

If a Mississippi state employee chooses to go to a physician that has not signed up for this plan, the employee will be considered to be using an out-of-network health care provider, and will have to pay a $600 deductible with a 65/35% co-pay. Additionally, the employee will have to pay 100% of the amount charged by the health care provider over what AHS
unilaterally designates as the "allowable charge", which in some case equals an increase of 300% of the cost for an Established Patient office visit. Essentially, every state and public school employee in Mississippi has just gotten a gigantic reduction in their benefits.

And lastly, I have been informed today, 11/12/99, by Carlotta Knight, Benefits Specialist at DFA's Office of Insurance that all State and Public School Employees will have a $50 Prescription Drug Deductible and the information will be addressed in the November 1999 Health Plan Update.  Please note that this is a direct violation of Mississippi Code section 25-15-5(5).

I wish to know what you, the Executive Officer of the State of Mississippi, intend to do about these problems.

Anne M. Klingen
314 Deer Run North
Oxford, MS 38655-8482
(662)234-6632