AAUP paper exposes inequities

By Megan Zahneis, News Editor

Miami University’s health plan offerings for its employees fall short of accepted industry standards, according to a recent report commissioned by the American Association of University Professors (AAUP). The report alleges that fiscal consequences for employees who choose to receive services from non-network providers are “unusually harsh.”

In recent years, the university has subscribed to the notion of health care “networks”, in which employees who attend “participating” or “preferred” medical practices receive lower bills.

“Since health care providers want patients with insurance who can pay for their treatment, insurers and large employers enjoy considerable leverage negotiating with them for lower rates and other restrictions on how they provide their services,” reads the white paper, written by David Walsh, a professor of economics. “In exchange, network providers are assured access to sizable
pools of patients.”

Walsh said that the higher costs associated with non-network providers are a result of higher “coinsurances”, or copays, and of “balance billing” — which bills employees for the difference in the provider’s charge and the amount paid by the employee’s plan.

‘The problem with Miami in particular is that the attempt to try to push people to see providers within the network, you know, it’s a shove. It’s not just a little nudge,” Walsh explained. “They really penalize people for going outside the network and ultimately subject you to unlimited [out-of-pocket] costs. That just seems to me unconscionable and irresponsible of the university.”

Walsh’s comparison of Ohio peer institutions, including the University of Cincinnati, University of Akron, University of Toledo, Ohio University, Bowling Green State University, Shawnee State University, Kent State University, Wright State University and Ohio State University, found that Miami was tied for the highest coinsurance rate (50%).

Miami employees within the network pay deductibles of $350 and $700, for single and family plans, respectively. The same prices out-of-network are $5,000 and $10,000.

Annual out-of-pocket maximums for those at Miami using in-network providers are $2,100 for individual plans and $4,000 for family plans (not including co-pays). The out-of-network costs have no cap, a policy not implemented at any of the peer institutions.

According to Walsh’s report, when this issue was brought up in a February meeting of University Senate, Miami’s Benefits Committee stated that they were unable to find a plan that levied an out-of-pocket maximum for out-of-network subscribers, a sentiment later echoed by Provost Phyllis Callahan.

But in many cases, according to the white paper, receiving care from an out-of-network provider may be unavoidable. For instance, an employee’s treatment may require care from a specialist who can only be found out-of-network, or providers’ status within the network may change without the employee’s awareness.

Walsh said Miami’s health care system hasn’t always been this way.

“Going back to the early 2000s, Miami was known particularly for having good employee benefit plan, health care, particularly,” Walsh said. “We didn’t have to pay anything toward the cost of it in terms of any premiums.”

Walsh added that his personal experience with health care as a Miami employee — as well as a report made on the university’s budget by the chair of AAUP’s Collective Bargaining Congress in September — prompted him to do some homework on how Miami’s situation stacked up with its in-state neighbors.

“Miami presents itself as sort of being at the top of the heap and as being excellent in all this stuff and, okay — well, at least you ought to be as good as other Ohio public universities,” Walsh said. “What’s your excuse if you can’t offer at least benefits that are as good as other peer institutions in Ohio?

“We’re no longer just taking what the university says at face value.  You need to examine, question, what’s going on. I think we can’t just assume that we’re getting a straight story all the time and so that means kind of taking on the burden of really look[ing] at the stuff.”

Walsh’s report asserts that Miami’s plans are generally more expensive even for in-network employees. According to the data provided in the report, of 14 in-network plans offered by public peer institutions in Ohio, the average maximum deductible was $705 for individuals and $932 for families. The median costs were $300 and $650, respectively. By contrast, Miami charges individuals $350 for single plans and $700 for family plans.