Blue Cross & Blue Shield of Utah, which pays the medical bills of some 422,000 Utahns, could pay claims for five weeks if the plan were to be liquidated - a cushion that just meets surplus requirements of the national Blue Cross & Blue Shield Association to remain "in good standing."
In a Wall Street Journal article published this week, Utah was included with a group of five other Blue Cross & Blue Shield plans apparently considered only barely better off financially than 11 Blue Cross plans that either have a negative net worth or don't meet a "rule-of-thumb" surplus measurement used by regulators.That rule says a plan should have enough surplus to meet four to six weeks of claims if it were to be liquidated. Blue Cross & Blue Shield of Utah's $25.4 million surplus could pay claims for 5.4 weeks, according to the Journal in its March 27 edition.
The article cites five of the Blue Cross system's 73 plans nationwide - those in New Jersey, Vermont, Rhode Island, New Hampshire and western New York - as having negative net worth. Six others, in Massachusetts, New Mexico, Maryland, Delaware, New York City and Rochester, N.Y., don't meet the four-week minimum.
Utah is included with Georgia, the District of Columbia, Michigan, Blue Cross of Western New York and Blue Cross Blue Shield Mutual of Ohio as those that just exceed the minimum.
But that doesn't tell the whole story, said Michael E. Tobin, senior vice president of internal operations and general counsel for Blue Cross & Blue Shield of Utah, which also administers the federal Medicare program for an additional 150,000 Utahns.
Because about half of Blue Cross & Blue Shield of Utah's business is in low-risk administration of claims by employees of self-insured companies - in which the companies shoulder the risk, rather than Blue Cross - its reserve could be considered more than double that claimed by the Journal article.
"The (Utah) Insurance Department contends we have 12 weeks of reserve, which is certainly adequate," Tobin said Friday. "We are in good shape. I don't want to overstress that - because we aren't abusing the public by sitting on huge reserves. Our reserves are adequate, but not excessive."
In addition, all Utah insurance plans are covered by the Utah Life and Disability Insurance Guarantee Association, of which Tobin is chairman. The association members are bound by state statute to protect subscribers and manage the affairs of any insolvent insurance company.
Tobin said Blue Cross & Blue Shield of Utah has a relatively low 7 percent administrative cost of operations. Moreover, since it is a separate corporation from the other Blue Cross & Blue Shield plans, the troubles of the other plans cannot affect the Utah operation.
Does this mean the problems besetting the nation's health-care insurers have passed Utah by? Hardly. In recent years, seven health insurers, most visibly Maxicare and American Protectors, have gone bankrupt. The Utah guarantee association covered the subscribers.
Among Blue Cross organizations, Blue Cross & Blue Shield of West Virginia collapsed last fall leaving $50 million in unpaid medical bills.