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Members press board on pharmacy copays, hearing aids and cataract care as UHC and Blue Shield outline prevention programs
Summary
Public commenters raised member hardship over pharmacy copay spikes and sought expanded hearing-aid and cataract coverage. UnitedHealthcare announced 'Real Appeal' weight-management (March) and a Medicare diabetes-prevention program (April 1). Blue Shield and staff clarified hearing-aid allowances and vendor billing.
During public comment and the network report the board heard several member concerns and carrier updates on prevention programs.
Members: Grady Allison described a case where his HIV medication copay rose about 135 percent and recounted repeated phone calls before a tier-exception was processed; he asked the board to improve member outreach about tier exceptions. Other commenters asked the board to investigate hearing-aid access and coverage limits, and several urged the board to consider better reimbursement for higher-quality cataract surgery or shared-cost options for laser-assisted procedures.
Carrier updates: UnitedHealthcare representatives said Real Appeal, a telephonic clinical weight-management program, will launch in March for eligible members and will address prediabetes alongside disease-management services. They also said a Medicare diabetes-prevention program will begin April 1 for Medicare Part B enrollees meeting BMI and blood-test criteria. Blue Shield and staff clarified that Blue Shield’s hearing-aid benefit includes an allowance (up to $2,500 per ear every 36 months) and that Blue Shield will accept billing from Costco; UnitedHealthcare said its contracting rules require providers to hold Medicare/Medicaid state certificates, which prevents Costco from being in-network for UHC.
Board response: Staff said they will follow up with carriers to clarify drug tier and hearing-aid details and post requested summaries such as the Best Doctors report; commissioners pressed carriers to consider greater transparency on benefit design and provider networks.
