Employees: State Insurance Change A "Life and Death Issue"

In December, retired teacher and Canton resident Sue McDonald had surgery on her hip and soon started physical therapy to regain full usage of the joint. 
McDonald, who recently retired from the Forsyth County School District, was making the $25 copay per visit under her old insurance plan to take part in the therapy. 

However, when January rolled around, the Canton resident learned how the changes to the State Health Benefit Plan would make it virtually impossible to afford the therapy: she now had to pay $100 per visit to her physical therapist until she hit her $1,500 deductible. 

The Georgia Department of Community Health administers the SHBP, and its board last year voted to implement a single vendor to provide medical care to its customers: Blue Cross Blue Shield. 

SHBP participants in 2013 could choose coverage from either Cigna or United Healthcare. During open enrollment in October, participants had to choose either a Bronze, Silver or Gold plan offered by Blue Cross Blue Shield. 

The change, which eliminated the tradition of state employees of having the ability to choose various plans from multiple companies, has left many plan participants wondering how they could afford the co-payments — often exceeding $100 — just to visit the doctor or specialist. 

McDonald said the changes have been "reprehensible" to the nearly 700,000 state employees, including teachers, school district employees, corrections officers and those working with state agencies. 

"That's why we are all upset," she said of employees now being forced to choose plans under one company. "You could always find a plan that would fit you and your family."

The change propelled a Canton resident to organize on social media to speak out against the changes. Ashley Cline, whose husband Nate Cline is a teacher at Creekview High School, created the Facebook group Teachers Rally Against Georgia Insurance Changes, or known as TRAGIC.

The group serves as a resource for those to share their experiences with the changes, how its impacted their household and budget and for employees to ask questions about various aspects of the SHBP. 

Cline's situation is similar to McDonald's. Her daughter was in occupational therapy and the family was paying $25 per week each visit. Now with the changes, the family's cost skyrocketed to $135 per week for each visit. Cline said she and her husband tried to make sense of the changes, but the details were "convoluted." 

"If this is the new norm for teachers, then I don’t know what we are going to do," she added. 

Members of the TRAGIC group and others affected by the changes have been flooding the phone lines at Gov. Nathan Deal's office to inform the governor how they feel about the changes. As of Wednesday, about 600 calls had been logged at the governor's office, according to the Cherokee Tribune. 

Both Cline and McDonald said they haven't heard anything official from the governor's office.

The lack of response from the governor's office is frustrating to McDonald. 

For nearly seven years, teachers and other school employees have put up with furlough days and salaries "going in reverse for those who are working." Gov. Deal, whose wife Sandra Deal is a former teacher, should be "more compassionate" to how these changes could impact those who rely on the SHBP, McDonald added.

Both McDonald and Cline said they hope the state will listen to the stories of those having to now navigate the unfamiliar waters due to the change in the plan. 

"People are in crisis," Cline added. "This is truly a life and death issue for a lot of people. It would be nice to be acknowledged and heard."

For Sequoyah High School teacher Jamie Wills, the changes have meant scrambling to find a new pediatrician. Wills has come to rely on Dr. Jennifer Wagner at Cherokee Pediatrics, who said she's treated her children and cared for their injuries since birth. Under the new plan, Wills said Dr. Wagner is no longer in Blue Cross Blue Shield's network. 

"I broke down crying on the phone with the representative," she said when she learned the news from Cherokee Pediatrics' billing office. Wills said she eventually found a new pediatrician in the network, but the new doctor will be one "who doesn’t know my children, their history and everything they’ve been through." 

Wills, who lives in Canton, said instead of having a copay to cough up at each doctor's visit, she noted there's now a contracted amount in place. However, no one has been able to give her what the exact amount is going to be. 

The family is now looking at using an online tracker that calculates how many calories they burn, how many steps the walk per day and how long they exercise to earn a certain amount of dollars that could be applied towards the cost of seeing a doctor, the teacher said. 

To accumulate as many dollars needed to be able to afford going doctor when it's absolutely necessary, Wills said she is now more likely to give her children Tylenol when they develop a fever and hope their sniffles won't morph into a sinus infection. 

Wills said the changes have not been economical for families, and doesn't understand why the state would eliminate the ability to choose for its employees.

"I feel like the state of Georgia is basically making all my health decisions for me," she said. "My hands are tied now."