Insurance superintendent rejects Blue Cross rate hike - Albuquerque Journal

Insurance superintendent rejects Blue Cross rate hike

The state insurance superintendent has rejected Blue Cross Blue Shield of New Mexico’s request to raise health insurance premiums by an average of 51.6 percent on individual Affordable Care Act plans in 2016.

John Franchini said Friday that after the most comprehensive review his office has undertaken in the past five years, he decided not to approve the Blue Cross request because the company had not provided sufficient information to support the increase.

“We were able to justify about a 20 percent increase on average,” Franchini said. “That was not enough for them.”

Franchini approved increases requested by the following:

n Presbyterian Health Plan, 3 percent to 6 percent, depending on the plan.

n New Mexico Health Connections, 4 percent to 17 percent, depending on the plan and the area of the state.

■ Christus Health Plan was not seeking an increase.

n Molina Healthcare of New Mexico, an average decrease of 2 percent.

Blue Cross Blue Shield of New Mexico President Kurt Shipley strongly disagreed with Franchini’s comments, saying his organization provided more detailed information than it had for previous rate requests. He said it even submitted an additional proposal that included insurance offerings that would be comparable to rates Franchini had approved for the other insurance companies.

“It’s a very frustrating situation for us,” Shipley said, “We believe we have a very competitive offering out there.”

Blue Cross insures an estimated 600,000 people statewide, although the requested increase would have affected only the approximately 35,600 customers who signed up for individual health plans through the New Mexico Health Insurance Exchanges, as well as those who bought the same plans off the exchange.

Shipley said Blue Cross needed the increase because those who enrolled in its plans had higher medical claims than expected. He said Blue Cross lost $19 million in 2014 on customers with those individual plans.

Blue Cross now has 30 days to request a hearing on Franchini’s decision. Shipley said he hasn’t decided whether to do so, but told Franchini he remains open to further discussions.

“I remain optimistic that we can still get something in place,” Shipley said.

If no agreement is reached, Shipley said Blue Cross likely would not offer any plans through the health exchange for 2016. Open enrollment begins on Nov. 1.

Franchini said New Mexico has a competitive insurance market, and Blue Cross customers could shop around if that were to happen.

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