HealthChoice Select plan to expand April 1

Posted on: 3/23/16

For more than 300 surgical procedures, HealthChoice members will be able to avoid copayments by using a “Select” facility, effective April 1. These Select facilities have contracted with EGID to accept a bundled service price that includes both physician and facility fees.

HealthChoice is the insurance product for public employees, operated by the state of Oklahoma’s Employee Group Insurance Division (EGID). The HealthChoice Select plan began Jan. 1, 2016, and initially included only colonoscopy and sigmoidoscopy procedures at a half-dozen non-hospital facilities. The list of Select procedures will expand April 1 to include many outpatient surgeries and CT scans of the head and chest.

HealthChoice offers a lookup tool, showing the Select providers for each surgery category.

McBride Orthopedic Hospital is listed as a Select provider for most of the Select plan’s orthopedic surgery categories. The Surgery Center of Oklahoma is listed for nearly all the categories of surgery and is the only Select facility at this time for many categories of service. The Surgery Center of Oklahoma has been heavily promoted by one of its owners, Dr. Keith Smith, as a “free market-loving, price-displaying, state-of-the-art, AAAHC accredited, doctor owned, multispecialty surgical facility in central OK.”  It is reported to not accept Medicare or Medicaid.

The Select providers listed for CT scans of the head and chest are Oklahoma Diagnostic Imaging, Surgery Center of Oklahoma, and Envision Imaging of Tulsa.

A group of OHA member hospitals met with EGID leadership last week to discuss the program. Hospitals explained the administrative and financial difficulties of bundling services performed by independent professionals, and encouraged EGID to consider using some of Medicare’s methods for rewarding low cost care without disrupting normal claims payment methods.

EGID Administrator Frank Wilson said the agency will expand the program to inpatient services such as childbirth, and is developing a list of about 40 MS-DRGs for inclusion July 1. The July additions will include cataract procedures, pain management, and diagnostic imaging. Wilson said the Select program is offered passively, but in the future EGID may begin suggesting it to members as part of the prior authorization process.

Earlier stories:

HealthChoice “Select” program launches with six facilities (1/6/16)

HealthChoice “Select” proposal aired in public hearing (10/7/15)

(Rick Snyder)

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