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For a number of years we have been negotiating discounts with covered facilities for their services. Trigon earns these discounts based on the substan&fl patient volumes and financial and administrative advantages that a relationship with Trigon brings to the covered facilities.
The savings from these discounts have helped us to hold down premium increases, and in many cases, to lower them. This has been a significant benefit for all of our policyholders.
Until 1994, Trigon calculated coinsurance based on the amount of undiscounted covered facility charges. “Coinsurance” is that percentage of the covered facility bill for which you are responsible, minus any amounts paid toward your deductible or non-covered services. It applies to those inpatient and outpatient covered facility services covered by your policy. As you know, it usually is a small amount compared to the total bill, and the amount you pay normally does not go above a set limit.
The Virginia State Corporation Commission Bureau of Insurance has expressed concern that some of our marketing and informational materials were misleading and deceptive and that our policyholders may have misunderstood how their coinsurance payments were calculated.
We agree that some of our policyholders were not aware that their coinsurance payment was calculated without applying the covered facility discount.
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