Look Into PEIA Network Rules

Money is the key challenge facing West Virginia’s Public Employee Insurance Agency. With health care costs increasing continually, neither of the two primary options for dealing with the dilemma seems appealing.

One option is providing more taxpayers’ money to subsidize the PEIA. Another is reducing benefits for PEIA beneficiaries and/or requiring them to pay higher health insurance premiums.

But there are other issues, as members of a task force formed by Gov. Jim Justice to address the PEIA problem are learning. One of them is paying for care from out-of-state providers.

Task force members are holding public meetings throughout the state. During one held Saturday in Weirton, some of those in attendance complained about obtaining care outside West Virginia.

Like many health insurance programs, the PEIA uses a “network” system to control costs. In essence, it requires that most treatment be obtained from providers in the network.

But on Saturday, some of those at the public meeting complained that even if out-of-state providers are in the network, using them can cost PEIA clients more than if they chose in-state health care professionals. Sometimes, out-of-state treatment is not covered by the PEIA at all, task force members were told.

PEIA officials should be looking into the situation. If out-of-state providers are listed on the PEIA’s network, it would seem beneficiaries should not pay a penalty for using them. And if some specialists are not covered, perhaps they should be added to the network.

Cost is the controlling factor, of course. It may be that in some situations, West Virginia PEIA clients should be required to pay more for certain treatment. Someone has to cover the bottom line, after all.

But if this is a situation in which, all other things being equal, out-of-state providers and those who need their help are being discriminated against, the rules should be changed.