APS and new healthcare provider

[Anonymous]

Why does everyone need switch doctors? I have been on United Health, BCBS, and Cigna and I just brought my new card - no issues. It’s not like switching to Kaiser.

[Anonymous]

Anonymous wrote:Why does everyone need switch doctors? I have been on United Health, BCBS, and Cigna and I just brought my new card - no issues. It’s not like switching to Kaiser.

Oh wait they are switching FROM Kaiser? They are complaining about actually having choices?

[Anonymous]

Anonymous wrote:Why does everyone need switch doctors? I have been on United Health, BCBS, and Cigna and I just brought my new card - no issues. It’s not like switching to Kaiser.

Many of us are switching from Kaiser, so we can’t access any doctors anymore.

[Anonymous]

What I never understand about teachers is where are your spouses? You’re all single parents? No one can at least split these issues with you and take some doctor appointments?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I sympathize with you, APS teachers on Kaiser. It is not easy to find new doctors right now, but they’re out there. Good news is that this is likely a one time switch- most practices around here participate in many of the big plans.

As hard as this is, you not winning any supporters with this. Stop trying to get the parents to do your bidding for you. It’s unprofessional. The Board has a fiduciary duty to the taxpayers to ensure that the benefits that are being provided to you are being obtained at a reasonable cost commensurate with market rates. Insurance plans cost a whole lot more than the small fraction you individually pay.

Additionally - All of us in corporate land have been through insurer changes, along with massive YoY increases in premiums or deductibles, and limits on service. You are being offered what appears to be a great plan at a competitive cost. Stop threatening to quit or call out for days on end unless you’d like to come experience employer coverage out here in the wild.

Or maybe, just maybe we CARE about the kids we teach and feel bad that we will have to take days off because we know it sucks, but it is also the only way we are given. It isn’t a threat, just the reality of what we are facing.

This has nothing to do with insurance plans changing. I know some people are asking for more days off to "look for more doctors" That's nonsense. Most of this can be done online at any time of day. Even if not, our contract hours allow for phone calls.

No, my kid needs to be brought to a doctor so her multiple therapies can be approved. I need to take medicine for a chronic condition. I suppose after being in Kaiser for 20 years, I could be out of it, but I doubt a doctor will just approve and write a prescription without ever seeing me. I can pick a doctor out online, in fact I already have on the BCBS website. That doesn’t mean I can get him to prescribe meds sight unseen. We have to SEE the doctor and that can’t be done outside of contract hours.

Ok, so two new appointments (one for you and one for your daughter) doesn’t seem like that big of a deal.

You’re acting like you’re going to have thousands of appointments. A bit melodramatic.

(Your daughter may have multiple therapy appointments, but wouldn’t that also be the case if you still had Kaiser?)

Each therapist usually needs an intake appointment which is at a weird time so they can “test” your kid in whatever they deem necessary and get to know history and your kid then you can set appointments on a regular basis. Keep in mind we can only take half days from 9-12 or 12-4 so if you get a 10:30-1:00 appointment it turns into the whole day because the first time you go to a doctor you don’t know if it is the kind of office that is always running late. So it usually ends up being a whole day or else you don’t have coverage. That is up to 4 days for my kid (one general doc and each therapist) and 1 for me, of course I will try my best to take half days, but if Kaiser was still going, it would be zero because we wouldn’t need all the intake appointments.

Sorry, if it is “melodramatic” but yeah that is a lot of time off during a testing month Dibels and pals.

So take the days off. The world is full of cemeteries the world couldn’t do without.

It’s not that hard finding an appointment that’s not at 10:30.

[Anonymous]

Anonymous wrote:What I never understand about teachers is where are your spouses? You’re all single parents? No one can at least split these issues with you and take some doctor appointments?

Shh. That doesn’t fit their narrative.

Also, Kaiser sucks. Be grateful.

[Anonymous]

Kaiser really does suck.

[Anonymous]

I do feel for people - apparently many people have been with Kaiser for like 10 years.

But then again if it’s all you know I can see why they like it. I would be pissed if I had to use Kaiser. So restrictive.

[Anonymous]

This was sent to APS staff this afternoon with additional details.

Background on the Procurement Process

APS’s contract with our current providers, Cigna and Kaiser Permanente, expires on Dec. 31, 2023. APS advertised requests for proposals in Dec. 2022 with an original deadline of Jan. 20, 2023. To increase competition, APS extended the deadline through Feb. 3, 2023.

APS advertised the solicitation on eVA and on the APS Procurement Office website. eVA is the Commonwealth of Virginia’s electronic procurement system, an electronic marketplace that maximizes competition by allowing vendors from within the U.S. to register to receive information about solicitations posted by Virginia public bodies. APS does not actively solicit bids or give preferential treatment to any current or prospective provider during this process.

In response to the solicitation, APS received four proposals submitted by Aetna Life Insurance Company, CareFirst BlueCross BlueShield, Cigna Health and Life Insurance Company, and Sentara Health Plans, Inc./Optima Health Plan.

The proposals were evaluated separately with the assistance of a healthcare consultant. The evaluation criteria addressed each offeror’s qualifications and experience, its service qualifications, its approach to the scope and the quality of the response, and the cost to both APS and staff enrollees. The evaluation process involved conducting interviews and negotiating more favorable terms, conditions and prices with selected offerors. Based on the evaluation criteria advertised in the solicitation, the proposal submitted by CareFirst was selected because it offered improved healthcare plans and services, an expanded network of providers at lower rates for employees and provided the best value to APS.

Although the contract was awarded to CareFirst on July 17, 2023, additional negotiations and exchange of information to set rates and other details were recently finalized. We wanted to have as much information as possible, including assurance on the lower rates, prior to communicating.

Continuity of Treatment

To ensure continuity of treatment, CareFirst offers a special program called Transition of Care. The Transition of Care program allows you or your covered dependent(s) to continue to receive care from your current Kaiser, Cigna or other out-of-network physician for up to 90 days following the date of enrollment in CareFirst. Benefits will be paid at the in-network level (i.e., minimal copayments and no calendar year deductible.)

Examples of medical conditions that may qualify for the Transition of Care program include:

pregnancy (beyond 24 weeks gestation)
bone fractures
recent heart attack
other acute trauma or surgery
joint replacement
newly diagnosed cancer
Examples of chronic medical conditions that typically are not eligible for the Transition of Care program include but are not limited to: arthritis, allergies, hypertension, asthma, diabetes and COPD/emphysema.

[Anonymous]

So Kaiser didn’t submit a bid?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I sympathize with you, APS teachers on Kaiser. It is not easy to find new doctors right now, but they’re out there. Good news is that this is likely a one time switch- most practices around here participate in many of the big plans.

As hard as this is, you not winning any supporters with this. Stop trying to get the parents to do your bidding for you. It’s unprofessional. The Board has a fiduciary duty to the taxpayers to ensure that the benefits that are being provided to you are being obtained at a reasonable cost commensurate with market rates. Insurance plans cost a whole lot more than the small fraction you individually pay.

Additionally - All of us in corporate land have been through insurer changes, along with massive YoY increases in premiums or deductibles, and limits on service. You are being offered what appears to be a great plan at a competitive cost. Stop threatening to quit or call out for days on end unless you’d like to come experience employer coverage out here in the wild.

Or maybe, just maybe we CARE about the kids we teach and feel bad that we will have to take days off because we know it sucks, but it is also the only way we are given. It isn’t a threat, just the reality of what we are facing.

This has nothing to do with insurance plans changing. I know some people are asking for more days off to "look for more doctors" That's nonsense. Most of this can be done online at any time of day. Even if not, our contract hours allow for phone calls.

No, my kid needs to be brought to a doctor so her multiple therapies can be approved. I need to take medicine for a chronic condition. I suppose after being in Kaiser for 20 years, I could be out of it, but I doubt a doctor will just approve and write a prescription without ever seeing me. I can pick a doctor out online, in fact I already have on the BCBS website. That doesn’t mean I can get him to prescribe meds sight unseen. We have to SEE the doctor and that can’t be done outside of contract hours.

Ok, so two new appointments (one for you and one for your daughter) doesn’t seem like that big of a deal.

You’re acting like you’re going to have thousands of appointments. A bit melodramatic.

(Your daughter may have multiple therapy appointments, but wouldn’t that also be the case if you still had Kaiser?)

Each therapist usually needs an intake appointment which is at a weird time so they can “test” your kid in whatever they deem necessary and get to know history and your kid then you can set appointments on a regular basis. Keep in mind we can only take half days from 9-12 or 12-4 so if you get a 10:30-1:00 appointment it turns into the whole day because the first time you go to a doctor you don’t know if it is the kind of office that is always running late. So it usually ends up being a whole day or else you don’t have coverage. That is up to 4 days for my kid (one general doc and each therapist) and 1 for me, of course I will try my best to take half days, but if Kaiser was still going, it would be zero because we wouldn’t need all the intake appointments.

Sorry, if it is “melodramatic” but yeah that is a lot of time off during a testing month Dibels and pals.

So take the days off. The world is full of cemeteries the world couldn’t do without.

It’s not that hard finding an appointment that’s not at 10:30.

Think you messed up the quote. Cemeteries are full of people the world couldn’t do without?

Get your point though.

[Anonymous]

Anonymous wrote:So Kaiser didn’t submit a bid?

That's correct. APS is not allowed to solicit bids to companies directly because it could be seen as favoritism (Per Duran)

[Anonymous]

Anonymous wrote:Kaiser really does suck.

Kaiser adopted an online platform that let doctors coordinate care/telehealth/phone visits earlier than a lot of other insurers. I recall using it to get care almost 20 years ago. Now that groups like INOVA and VHC also use extensive online health management platforms I see far less benefit to Kaiser. The lack of an urgent care close by was really hard for me when I had a young kid.

[Anonymous]

Anonymous wrote:

Anonymous wrote:So Kaiser didn’t submit a bid?

That's correct. APS is not allowed to solicit bids to companies directly because it could be seen as favoritism (Per Duran)

So people are pissed at Kaiser right?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:So Kaiser didn’t submit a bid?

That's correct. APS is not allowed to solicit bids to companies directly because it could be seen as favoritism (Per Duran)

So people are pissed at Kaiser right?

From what I’ve seen on the educator side it’s mostly the people who are pissed at APS for everything that doesn’t meet their hyper specific situation