NEWS BULLETIN BOARD
INSURANCE… Below some guidelines but each individual case could depend on a number of factors relative to that individual’s account, the claim, what has been satisfied, different practices of the physicians. 


Once you have a need to go to a doctor or the hospital for the first time after April 1st, the $100 deductible will generally apply for outpatient services where there is no co pay for charges such as labs, x-rays, CT scans, MRI’s, etc., except for physicals or preventive where there is no cost sharing. If there is an outpatient copay, the deductible does not apply. For hospital services, the deductible will apply; the hospital co pay of $250 goes against the facility charge, and the $100 deductible will go toward inpatient services. Each individual will be required to meet the calendar year deductible. When the deductible is met, it is satisfied for the remainder of the calendar year for all services.

Those on MEDICARE – Relative to the new deductible, it will be processed in the same manner as deductibles are currently being processed. The biggest change is that when the deductible applies, the patient may be responsible for a larger cost share until the Medicare deductible is met, just as it is now. However, once the Medicare deductible is met, the plan will generally pay the remaining balance after Medicare has paid. 

With regard to copays for “Office Visits” the Primary Care Physician (PCP) is still $15.00. The Internist is classified as a PCP. All Specialist office visits – urologist, cardiologist, oncologist, otolaryngologist, optometrist or ophthalmologist, etc. – will be $25 copay.  

Express Scripts publishes a new formulary list twice a year. During the time in between there could be significant changes. I checked with Express Scripts concerning the formulary list, and our representative recommends that we call member services or use the express-scripts.com portal for more up to date information since the formulary list is only updated twice a year, and may be outdated. 

Express Scripts provides pharmacy benefit management services to help with the plan in managing the kinds of prescriptions being filled, while insuring only proper and authorized use of the plan, which helps us to hold down our cost. They do have a PREORDER DEPARTMENT that doctors are to know when they should use this path in order for any one of us to get proper medication that the doctor is prescribing for us.  

DIABETIC SUPPLIES…Below is information on the diabetic situation of Cigna’s and Medicare’s list of approved suppliers not matching up with each other and proper payment being made by Cigna if you are getting your supplies through the medical insurance coverage rather than the prescription coverage.

As of July 2013, Medicare has a National Mail-Order Program for diabetic supplies (like test strips and lancets). No matter where you live, you’ll need to use a Medicare national mail-order contract supplier for Medicare to pay for diabetic testing supplies that are delivered to your home.
If you do not want diabetic testing supplies delivered to your home, you can go to any local store (local pharmacy or storefront supplier) that’s enrolled with Medicare and by them there. 
In order for Cigna to pay secondary on your diabetic supplies, you will need to use Medicare’s National Mail-Order Program and use the following Medicare-contracted and Cigna-contracted suppliers. This list was last updated 3/24/2014.

BINSON'S HOSPITAL SUPPLIES, INC. / BINSON'S HOME HEALTH CARE CENTERS
26834 LAWRENCE 
CENTER LINE, MI 48015
(586) 755-2300
1-855-307-2973



DEGC ENTERPRISES (U.S.), INC. / CCS MEDICAL  
3601 THIRLANE RD NW STE 4
ROANOKE, VA 24019
(866) 359-9641
1-800-726-9811


KOHLLS PHARMACY & HOMECARE INC / KOHLLS PHARMACY & HOMECARE INC  
 5110 L ST 
OMAHA, NE 68117
(402) 733-0522
1-866-414-9900


CHIROPRACIC BENEFITS…Cigna has contracted with ASH to provide chiropractic benefits to its covered members. Cigna works very to recruit quality providers that also offer competitive contracts which help to drive down or contain claim cost, which serves to minimize excessive cost to the plan which impacts premium for all members. Please see below and let me know if you have any additional questions.  
Cigna has contracted with American Specialty Health Networks, Inc. (ASH Networks) to provide in-network chiropractic services for Cigna medical benefit plans in several markets.

ASH Networks will be responsible for network management, credentialing, contract administration, utilization management and claims processing for individuals with Cigna coverage. 

 ASH Networks also facilitates medically necessity claim review for services rendered by non-participating chiropractors

What this means for health care professionals with the ASH Network:

As a result of this relationship, ASH will:
oContract directly with chiropractors 
oProvide contract administration, medical necessity review, and claims processing for individuals with these Cigna-administered benefit plans 
oReview claims for medical necessity from non-participating chiropractors

Additionally, because ASH will be responsible for contracting with chiropractors, chiropractors must be contracted with ASH in order to continue to provide in-network chiropractic services to individuals with a Cigna-administered managed care benefit plan
What is the contact information for ASH Networks? 

Call ASH Networks with questions you may have about their programs and fee schedules. Chiropractors currently contracted with ASH Networks call: 1.800.972.4226. Chiropractors not currently contracted with ASH Networks call: 1.888.511.2743 must contact ASH to begin the paperwork to begin the process for recruitment and credentialing. If the provider becomes contracted with ASH they will be considered participating providers and covered in network.  

Healthways will be responsible for network management, contract administration, call and claims processing for health care professionals that service individuals with Cigna coverage
Healthways' medical necessity review program for par and non-par claims 




URGENT REQUEST TO ALL MLGW RETIREES:
MLGW 2018 Budget Update

Dear Retirees:

Your help is greatly needed. On Tuesday, January 23, 2018, the Memphis City Council will vote on proposed MLGW rate increases for our customers. We need for you to contact Council members via email and phone calls prior to and through Tuesday evening, January 23, 2018. (Contact information below.)

Also, please attend the Tuesday, January 23, City Council meeting which begins at 3:30 p.m. It is critical for the proposed rate increases to pass for MLGW to continue to be financially stable and provide the highest quality services possible for our customers. MLGW will run out of cash if the proposed Increases do not pass. MLGW has some of the lowest utility rates in the country. The average utility bill for Memphis residents is about $34 less than it was 10 years ago. Now it is time for a relatively small rate increase -- 1 percent in water rates, 2.3 percent in electric rates, 4.5 percent in gas rates for 2018. Should the proposed rate increases pass, MLGW customers’ combined utility costs will continue to be among the lowest, if not the lowest in the nation.

Thank you very much for your support of this most urgent matter.

Regards,

Jerry Collins Jr.
MLGW President and CEO


THE CITY OF MEMPHIS COUNCIL STAFF:

The City Council employs several support staff members to aid the Council Members in their communications with their constituents. If you would like to contact your City Council representative, you may reach them through their staff, using the contact information below:


(District 1) Bill Morrison 
bill.morrison@memphistn.gov
Analyst - Sam Powers (901) 636-6784
Assistant -Trudy Pope (901) 636-6786

(District 2) Frank Colvett, Jr
frank.colvettjr@memphistn.gov
Analyst -Brooke Hyman (901) 636-6706
Assistant -Dynisha Clark (901) 636-6775

(District 3) Patrice Robinson 
patrice.robinson@memphistn.gov 
Analyst -Sophia Wordlaw (901) 636-6798
Assistant = Judy Milam (901) 636-6799

(District 4) Jamita Swearengen
 jamita.swearengen@memphistn.gov
Analyst -Brooke Hyman (901) 636-6706
Assistant - Ashleigh Hayes (901) 636-6785

(District 5) Worth Morgan 
worth.morgan@memphistn.gov
Analyst - Sam Powers (901) 636-6784 
Assistant - Ashleigh Hayes (901) 636-6785

(District 6) Edmund Ford, Jr.
edmund.fordjr@memphistn.gov
Analyst - Sophia Wordlaw (901) 636-6798
Assistant -Rebecca Garcia (901) 636-6795

(District 7) Berlin Boyd 
berlin.boyd@memphistn.gov
Analyst -Juaness Keplinger (901) 636-6797
Assistant - Dynisha Clark (901) 636-6775

(District 8-1) Joe Brown 
joe.brown@memphistn.gov
Analyst -Sophia Wordlaw (901) 636-6798
Assistant -Rebecca Garcia (901) 636-6795

(District 8-2) Janis Fullilove 
janis.fullilove@memphistn.gov
Analyst -Sophia Wordlaw (901) 636-6798
Assistant -Rebecca Garcia (901) 636-6795

(District 8-3) Martavius Jones 
martavius.jones@memphistn.gov
Analyst - Sam Powers (901) 636-6784 
Assistant - Judy Milam (901) 636-6799

(District 9-1) Kemp Conrad 
kemp.conrad@memphistn.gov
Analyst -Sam Powers (901) 636-6784
Assistant - Judy Milam (901) 636-6799

(District 9-2) Philip Spinosa, Jr 
 phillip.spinosajr@memphistn.gov
Analyst -Brooke Hyman (901) 636-6706
Assistant -Ashleigh Hayes (901) 636-6785

(District 9-3) Reid Hedgepeth 
reid.hedgepeth@memphistn.gov
Analyst -Brooke Hyman (901) 636-6706
Assistant -Trudy Pope (901) 636-6786

Memphis Mayor Jim Strickland on Monday named Jarl T. "J.T." Young of Pensacola, Florida-based Gulf Power as his appointment to run the city’s public utility.

Young, the general manager of customer service and marketing at Gulf Power, was selected as chief executive officer of the Memphis Light, Gas and Water Division after a national search by Texas-based Preng & Associates, according to the mayor’s office. He will succeed retiring CEO Jerry Collins.
"J.T.'s knowledge and experience in the industry, along with his record of creating a culture around excellent customer service, grabbed my attention,” Strickland said in a release. “He’s highly qualified and I know he’ll fit in well here and lead MLGW into the future."

If this appointment receives Memphis City Council approval, Young would begin his tenure March 19. Dana Jeanes will serve as acting CEO until then, following Collins’ retirement Jan. 31.

"MLGW and the community of Memphis have a rich history and a bright future,” Young said. “I am blessed and eager to serve with the great team at MLGW as we move the company forward in delivering exceptional customer value."

One of Young's challenges will be finding ways to manage MLGW's rising expenses without council support for rate increases. The council earlier this month approved a slight water rate increase but rejected heftier increases to the gas and electric rates, despite warnings by Collins that delays would only require higher increases later.

Formed in 1939, MLGW is the largest three-service public power utility in the nation, serving more than 421,000 customers in Memphis and Shelby County. Collins has helmed MLGW under three mayors since his appointment by former mayor Willie Herenton in 2007 and confirmation by the council in January 2008.

Young currently leads Gulf Power's customer services, marketing, sales, and related activities.


The Pensacola native joined the marketing arm of Gulf Power, a subsidiary of Southern Company, in 1989. He previously worked in both distribution and marketing at Progress Energy (now Duke Energy) in Florida and as a systems engineer at a Tennessee Valley Authority nuclear plant in Alabama.

He has an MBA from the University of West Florida and is a graduate of Harvard Business School’s General Management Program.
Over his 35-year career, Young has served in a variety of roles, including Gulf Power's chief information officer, customer service general manager, corporate services director and chair of the company's People Council. He also oversaw the implementation of Gulf Power's strategic plan.
Young couldn't immediately be reached for comment, but Gulf Power spokeswoman Natalie Smith said he was a "great guy" and that their loss was Memphis' gain.

Young will be introduced to the City Council during its meeting at 3:30 p.m. Tuesday, according to city spokeswoman Ursula Madden.


ARTICLE IN COMMERCIAL APPEAL - JAN 22, 2018

The Memphis City Council's deliberations over whether to grant MLGW's rate increase has challenged my business acumen, my advocacy for economically vulnerable populations, and my role as a legislator.

MLGW is the largest municipally-owned three-service utility in the country. Our utility is well respected and financially sound. More than $60 million are transferred annually from MLGW revenue into the city's general fund as a Payment in Lieu of Taxes (PILOT). That represents 9 percent of the city's annual revenues.

Those dollars are used to provide basic services in Memphis that benefit all who grace our city for employment, medical care, vacation, entertainment, shopping, dining, conferences or just to visit family and friends. PILOT payments to all eight local governmental entities total more than $74 million each year.

As the City Council prepares to approve or deny the 2018 MLGW budget, we are confronted with a challenge: Should we grant MLGW a rate increase ($4.88 per month) despite other pressing problems faced by this city?

Memphis has ever-increasing needs, including the increased cost of doing business, a declining population, increased poverty, low wages and a high number of gun crimes.

Recognizing that other problems require costly solutions, I believe MLGW’s success in keeping the cost of doing business as low as possible warrants serious consideration of its request for a rate increase.

They have been good stewards, and they are a generous community partner. The utility has maintained the lowest combined utility rates of any major city in the country for five consecutive years. They have not asked for an increase in electric rates in 14 years.

Gas prices have fluctuated over time and MLGW has not asked for a gas rate increase in 10 years. In addition, the MLGW portion of our utility bills has gone down $34 per month over the last 10 years, while third party charges on the utility bills -- street light fees, sewer fees, storm water fees, and solid waste fees -- have increased 354% ($11-$53) over the past 14 years.

According to the presentations during council committee meetings, MLGW officials have said they need a rate increase to continue its effectiveness. 

For example, the cost of materials has increased; more money is needed for infrastructure improvements; the utility’s reserves are getting dangerously low in each Division; and their credit rating has been downgraded for the first time in decades. They are challenged with remaining competitive in their industry and providing quality service to MLGW customers.

As a Council, we must decide whether to support MLGW's request for a rate increase in gas and electricity, considering both the utility’s record of stewardship and its current fiscal and operational issues. 

I believe MLGW’s request for a rate increase of only $4.88 is reasonable and continues its legacy of responsible stewardship.

Members of council realize that our most fragile seniors, the economically disadvantaged, and families facing sudden emergencies are crying for relief. 

Now is the time to remember that we are better off working together than as a house divided against itself. Now is the time for the Memphis community to provide stronger financial and volunteer support for services and organizations that provide a safety net for the economically vulnerable who may be unable to pay their utility bills.

These services and organizations include the Plus One Program, Share the Pennies, Habitat for Humanity, Housing and Community Development, Catholic Charities and the Community Service Agency (CSA). 

We challenge MLGW to find other creative ways to assist and educate individuals on reducing their utility costs, such as personalized utility education sessions with vulnerable families.  

Let us resolve to talk about and actively participate in energy conservation programs and commit to saving $0.16 cents a day in consumption to support and provide a needed increase for our utility, Memphis Light, Gas & Water.

Patrice J. Robinson represents Dist. 3 on the Memphis City Council.
Patrice Robinson






**CITY COUNCIL HAS APPROVED MR. YOUNG'S APPOINTMENT**

*********UPDATE ON CITY COUNCIL 1/23/18 MEETING************

Councilman Colvett requested that the rate increases be reconsidered. Motion passed. Councilman Ford made a motion that the approving of the MLGW Budget be held for 2 weeks due to the increases being reconsidered. That will make the increases and the budget items on the February 6th City Council Agenda.

City Council did approve with same day approval of minutes the appointment of JT Young to be the MLGW CEO/President. See article on website for more information on him.

***************UPDATE ON CITY COUNCIL 2/6/18 MEETING***************


The City Council approved (7-4) a 2% rate increase in each of the electric and gas divisions for the coming year. MLGW had requested approval of a 3-year program that increased each division by a small percentage each year. 

After approving the increases, the MLGW 2018 budget was approved that incorporated the increases.

Thanks to everyone that attended the three meetings. Some could not attend for various reasons and we understand. We do know that many sent in emails or made phone calls to the Council members' office and we appreciate that support.