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HNA denies cut-backs in plan

| August 17, 2005 12:00 AM

By STEVE KADEL Western News Reporter

Local medical officials and asbestosis victims are worried about a possible reduction in services through the Libby health plan.

They fear cutbacks from Health Network America, the third-party administrator for the program through W.R. Grace. It's not a new trend, according to Jeanie Gentry, vice president of Allied Health Services at St. John's Lutheran Hospital.

"We have seen a significant reduction in the number of claims HNA is paying," she said.

Fears stem from an audit of members that HNA recently conducted. Dr. Jay Flynn of HNA said the audit of CT scans and X-rays was done by board certified professors of radiology at four university hospitals.

The purpose was not to eliminate people from membership in the plan, but to revamp the way applicants are tested for possible inclusion for benefits, he said.

"We have made it much easier to get into the Libby medical program," Flynn said.

The old health plan required that a physician who signed the application be a board certified pulmonologist, and that abnormal pulmonary function testing be conducted.

Now, Flynn said, an applicant will receive membership if he or she shows "a single pleural plaque."

That finding can be made whether the "inciting pathogen" is the rare Libby tremolite or other forms of asbestos contamination more common throughout the U.S., he said.

"I asked this question of two of our peer reviewers," Flynn said. "Both doctors said there is no difference between Libby CT scans and the ones they see in their practice."

A recent finding with regard to Libby asbestos cases is that many people have calcification of the coronary arteries, Flynn added. He said that's related to obesity, smoking "and air pollution you have out there."

He pledged that no one with pleural plaque or calcification will be eliminated from coverage.

"No one will be removed from the Libby medical program," Flynn said. "They will receive pharmacy benefits, hospice benefits, an annual follow-up visit. Even home oxygen will be covered. No one is going to be asked to leave the program."

However, Gentry of St. John's believes HNA is playing a semantics game. The recent review might not result in loss of membership in the plan, but could give the company an excuse to withhold certain services.

"In effect, they have no coverage," Gentry said. "That's the concern."

Libby resident Gayla Benefield, an asbestosis victim and activist, also views HNA's motives with skepticism. She said it's frightening because no one knows who might be taken off the health plan.

"They are arguing over some of our very ill people now," Benefield said. "It is a continuing problem, and trying to sign up somebody new is next to impossible."

Gentry said HNA is expected to inform all health plan members of their status by the end of September. Confusion over who is covered and who isn't has been an ongoing problem, she said.

"It is very confusing for us when a patient has a card and we submit the claim, and they say they are not a member of the plan," Gentry said. "We requested that HNA let them know. If you're a patient, you want to know up front what will be paid."