Regence would have to deduct the cost of reconciling the books for its last-minute request to be paid for claims as old as 2010 to get money from a federal high-risk account that dissolves at the end of the year.
The high-risk pool is charged with operating a state reinsurance program that is intended to spread the risk and soften the blow to insurance companies that have consumers with high medical claims. The $46 per person assessment annually to health insurance policies will be used to reimburse insurers for former OMIP consumers who run up bills of more than $30,000.
Moda Health has more than doubled in size since Jan. 1, when federal rules surrounding health coverage went into effect. Over the same period, Oregon’s largest insurers have shed tens of thousands of members, according to third-quarter statements filed with regulators.
A large portion of the remaining account balance of the Oregon Medical Insurance Pool may end up in the pockets of Regence BlueCross BlueShield after the insurer alleged in a letter that accounting errors had shorted the company for expenses paid as it administered the program. OMIP chairman Robin Richardson has indicated he’d like a third-party audit to verify the account transactions.
