“The proposed EAP contract allows employees up to six visits per incident per year; our current EAP contract allows employees eight visits per year, with no per issue cap. This has allowed employees to use the current EAP provider for long term psychological counseling. The City’s desire is to only offer short term counseling for employees to help them through a traumatic event that is causing problems at work, home or both. The City has no desire to pay for employees’ long term psychological counseling.”
In January, the City Council voted to authorize a change in the vendor from the locally based Psychological Resource Associates (PRA) to the nationally based Cigna. One of the key reasons was PRA’s bid was $38,000 while Cigna’s was $14,000. (Please see the full details of these plans and some of the concerns about these bids)
At the time, our concern was of the lowball nature of Cigna’s bid, which seems in many ways to be a “loss-leader,” since it would appear that they would be losing money on the bid. Large insurance companies and HMO’s have been widely known to use a “loss-leader” strategy when bidding on EAP’s to get their foot in the door with a customer they are not currently doing business with. Then in future years when submitting bids for the major health benefits portion of a firm’s or agency’s business (which is extremely lucrative) they point to their ability to substantially reduce costs as evidence of why they should be selected as the new major health benefits vendor.
However, an examination of the recent records reveals something else may be going on. Looking at the three previous full fiscal years, we see a surge in both the amount of hours billed and spending.
|
Year |
Hours Billed |
Cost |
|
FY 2003-04 |
209 |
$22,015.00 |
|
FY 2004-05 |
230 |
$24,055.50 |
|
FY 2005-06 |
311.5 |
$33,828.51 |
The numbers show that suddenly from 2005-06 a surge in both hours billed and cost. The increase from 230 hours to 311.5 represents an increase of 35 percent over the previous year. While the spending increase represents nearly a 41 percent increase over the previous year.
It is important to note that the new bids were based in part off of the FY 2005-06 spending. Since last year the amount billed was nearly $34,000, the bid was $38,000. Whereas previous years the amount was considerably less and thus the bid by PRA would have been considerably less.
The question has been raised as to whether that was intentional. An audit would be in order at this point, examining why exactly the usage of this program suddenly increased by 35 percent over the previous year while the year before the figures and hours billed were fairly comparable. (There is missing data from the previous year but it would have looked similar to 2003-04 and 2004-05).
There have been suggestions that one thing that occurred in the past year is that some of the patients received more than 8 visits per year. That is one thing an audit would reveal that a public records request cannot. This appears worth examining more to see what is going on, and why the demand for this program suddenly surged in 2005-06 just as the contract was coming up for renewal and just as the city made the determination for the first time in 23 years to put the bids up in the form of a request for proposals (RFP).
—Doug Paul Davis reporting
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If the current provider was offering services in excess of what the contract stipulated( over 6 visits a year), why weren’t they contacted to clear up this problem? I am assuming that it was not deliberate fraud. The few thousand extra that they billed(there are perfectly legitimate reasons for the employees increased use of their services) to put their contract in peril would not make much sense.
If the current provider was offering services in excess of what the contract stipulated( over 6 visits a year), why weren’t they contacted to clear up this problem? I am assuming that it was not deliberate fraud. The few thousand extra that they billed(there are perfectly legitimate reasons for the employees increased use of their services) to put their contract in peril would not make much sense.
If the current provider was offering services in excess of what the contract stipulated( over 6 visits a year), why weren’t they contacted to clear up this problem? I am assuming that it was not deliberate fraud. The few thousand extra that they billed(there are perfectly legitimate reasons for the employees increased use of their services) to put their contract in peril would not make much sense.
If the current provider was offering services in excess of what the contract stipulated( over 6 visits a year), why weren’t they contacted to clear up this problem? I am assuming that it was not deliberate fraud. The few thousand extra that they billed(there are perfectly legitimate reasons for the employees increased use of their services) to put their contract in peril would not make much sense.
The insurance was supposed to pay for up to 8 visits per year under the previous agreement. But since it is a pay by visit system, the provider is not going to prevent the city from paying for additional visits, if the city wishes to pay for additional visits.
The irony here is that city was one complaining that they wanted this as a short term care system and yet they were the ones who continued to authorize visits beyond the 8 that they had contracted for.
The insurance was supposed to pay for up to 8 visits per year under the previous agreement. But since it is a pay by visit system, the provider is not going to prevent the city from paying for additional visits, if the city wishes to pay for additional visits.
The irony here is that city was one complaining that they wanted this as a short term care system and yet they were the ones who continued to authorize visits beyond the 8 that they had contracted for.
The insurance was supposed to pay for up to 8 visits per year under the previous agreement. But since it is a pay by visit system, the provider is not going to prevent the city from paying for additional visits, if the city wishes to pay for additional visits.
The irony here is that city was one complaining that they wanted this as a short term care system and yet they were the ones who continued to authorize visits beyond the 8 that they had contracted for.
The insurance was supposed to pay for up to 8 visits per year under the previous agreement. But since it is a pay by visit system, the provider is not going to prevent the city from paying for additional visits, if the city wishes to pay for additional visits.
The irony here is that city was one complaining that they wanted this as a short term care system and yet they were the ones who continued to authorize visits beyond the 8 that they had contracted for.
So.. this sounds like typical bureaucratic limp spine syndrome.
Rather than having to declare that the service is in fact limited to 8 visits and that their employees must make other arrangements for continued psychological care, they now put it off to a national corporation who will be the “enforcer”..
So.. this sounds like typical bureaucratic limp spine syndrome.
Rather than having to declare that the service is in fact limited to 8 visits and that their employees must make other arrangements for continued psychological care, they now put it off to a national corporation who will be the “enforcer”..
So.. this sounds like typical bureaucratic limp spine syndrome.
Rather than having to declare that the service is in fact limited to 8 visits and that their employees must make other arrangements for continued psychological care, they now put it off to a national corporation who will be the “enforcer”..
So.. this sounds like typical bureaucratic limp spine syndrome.
Rather than having to declare that the service is in fact limited to 8 visits and that their employees must make other arrangements for continued psychological care, they now put it off to a national corporation who will be the “enforcer”..
It looks like the per visit cost under the old plan was about $106.
As I recall,the hourly visit charge was about $70. These add-on costs do favor the organization of a mega-operation. Still, the value of keeping the service local and the $$ in our community is still powerful. The city can find many other places to trim back the few thousand saved..such as hiring a few less redundant consultants to do the work(and deflect the political “heat”) that the city staff is paid to perform.
It looks like the per visit cost under the old plan was about $106.
As I recall,the hourly visit charge was about $70. These add-on costs do favor the organization of a mega-operation. Still, the value of keeping the service local and the $$ in our community is still powerful. The city can find many other places to trim back the few thousand saved..such as hiring a few less redundant consultants to do the work(and deflect the political “heat”) that the city staff is paid to perform.
It looks like the per visit cost under the old plan was about $106.
As I recall,the hourly visit charge was about $70. These add-on costs do favor the organization of a mega-operation. Still, the value of keeping the service local and the $$ in our community is still powerful. The city can find many other places to trim back the few thousand saved..such as hiring a few less redundant consultants to do the work(and deflect the political “heat”) that the city staff is paid to perform.
It looks like the per visit cost under the old plan was about $106.
As I recall,the hourly visit charge was about $70. These add-on costs do favor the organization of a mega-operation. Still, the value of keeping the service local and the $$ in our community is still powerful. The city can find many other places to trim back the few thousand saved..such as hiring a few less redundant consultants to do the work(and deflect the political “heat”) that the city staff is paid to perform.
The limit was 8 visits per year per issue. It would be simple enough to have several issues and bill each issue for the eight visits allowed to extend the number of visits.
The point is not whether these people needed services, but if they were using the proper insurance coverage. The City of Davis’ regular health plan covers mental health services. Unfortunately, many Davis providers aren’t listed as a provider under the City’s health plan.
The limit was 8 visits per year per issue. It would be simple enough to have several issues and bill each issue for the eight visits allowed to extend the number of visits.
The point is not whether these people needed services, but if they were using the proper insurance coverage. The City of Davis’ regular health plan covers mental health services. Unfortunately, many Davis providers aren’t listed as a provider under the City’s health plan.
The limit was 8 visits per year per issue. It would be simple enough to have several issues and bill each issue for the eight visits allowed to extend the number of visits.
The point is not whether these people needed services, but if they were using the proper insurance coverage. The City of Davis’ regular health plan covers mental health services. Unfortunately, many Davis providers aren’t listed as a provider under the City’s health plan.
The limit was 8 visits per year per issue. It would be simple enough to have several issues and bill each issue for the eight visits allowed to extend the number of visits.
The point is not whether these people needed services, but if they were using the proper insurance coverage. The City of Davis’ regular health plan covers mental health services. Unfortunately, many Davis providers aren’t listed as a provider under the City’s health plan.
Anonymous has it right–after 8 visits they should have been referred to long term service and that would have fallen under a different coverage.
Anonymous has it right–after 8 visits they should have been referred to long term service and that would have fallen under a different coverage.
Anonymous has it right–after 8 visits they should have been referred to long term service and that would have fallen under a different coverage.
Anonymous has it right–after 8 visits they should have been referred to long term service and that would have fallen under a different coverage.
Now that you have CIGNA, your costs should go down, because your employees will get frustrated with them. I have been trying to get an appointment this week via the CIGNA EAP with no luck, and I have a serious situation on my hands. I called my PCP and will be going there in the morning instead. They will give me antidepressants, and that’s not the best solution. I am a CIGNA employee and still can’t get help from them. Good luck.
Now that you have CIGNA, your costs should go down, because your employees will get frustrated with them. I have been trying to get an appointment this week via the CIGNA EAP with no luck, and I have a serious situation on my hands. I called my PCP and will be going there in the morning instead. They will give me antidepressants, and that’s not the best solution. I am a CIGNA employee and still can’t get help from them. Good luck.
Now that you have CIGNA, your costs should go down, because your employees will get frustrated with them. I have been trying to get an appointment this week via the CIGNA EAP with no luck, and I have a serious situation on my hands. I called my PCP and will be going there in the morning instead. They will give me antidepressants, and that’s not the best solution. I am a CIGNA employee and still can’t get help from them. Good luck.
Now that you have CIGNA, your costs should go down, because your employees will get frustrated with them. I have been trying to get an appointment this week via the CIGNA EAP with no luck, and I have a serious situation on my hands. I called my PCP and will be going there in the morning instead. They will give me antidepressants, and that’s not the best solution. I am a CIGNA employee and still can’t get help from them. Good luck.