More people filing medical claims, less money for state health insurers

More people are filing medical claims, and that means less money for state health insurers

By Robert Weisman, Globe Staff

The state’s largest commercial health insurers posted lower third-quarter financial results Thursday, with most blaming an increase in claims for medical care after a two-year period during which many people went to the doctor less often because of the economy.

Earnings dropped sharply at Fallon Community Health Plan, Harvard Pilgrim Health Plan, and Blue Cross Blue Shield of Massachusetts, and more modestly at Tufts Health Plan.

All the insurers base premiums on the so-called “medical trend,” a combination of the prices doctors and hospitals charge for visits, tests, and procedures, and the volume of people seeking such services. In recent years, insurers have benefitted as members postponed elective surgery and other treatments because they lost their jobs and health coverage in the economic downturn or were afraid to take time off from work to visit their doctors.

“Commercial business is cyclical,” said Umesh Kurpad, chief financial officer at Tufts.  “Utilization rates are starting to climb back up, which is why we’re making less. There’s always pent-up demand for health care, so now it’s coming back to normal levels.”

Blue Cross, the state’s largest health insurer, said net income fell to $62.8 million in the three months ending Sept. 30, a decline of 20.4 percent from the $78.9 million the Boston-based insurer earned during the same period last year.

Allen Maltz, chief financial officer at Blue Cross, said the results for the insurer and its health maintenance organization subsidiary were “pretty much as expected.” Because health care use dropped more than expected last year, Blue Cross “gave it back to the customers” by tacking on smaller premium increases this year, he said.

“The customers got the benefits of that rather than it going to Blue Cross,” Maltz said.

Another factor depressing earnings at Blue Cross and other insurers in the third quarter were continuing low interest rates, which squeezed their returns from bonds and fixed-income investments they use to supplement operating income.

Wellesley-based Harvard Pilgrim recorded net income of $19.3 million for the July-through-September period, down 49 percent from $37.9 million in the same quarter last year.

Harvard Pilgrim chief financial officer Charley Goheen said the insurer similarly lowered premium increases after last year’s decline in the volume of medical care use. The smaller increases pushed down this year’s earnings, which he said were in line with Harvard Pilgrim’s projections.

“We’re working hard to keep our premium increases as low as we can,” Goheen said, though he noted that members are starting to submit more medical claims again.

At Tufts Health Plan, net income edged down to $49.1 million in the third quarter, a 6.6 percent dropoff from the $52.6 million it earned in those three months last year.

Fallon, based in Worcester, had the steepest earnings decline. Fallon reported quarterly net income tumbled to $4.4 million in the third quarter, down 63.9 percent from $12.2 million in the third quarter of 2011. In a statement, its chief financial officer R. Scott Walker said “utilization of health care services has returned to normal and historical levels, compared to the abnormally low levels
experienced in 2011.”

Blue Cross Blue Shield was the only insurer that did not report an increase in health care use by its members in the third quarter. “We have our eyes open and we’re looking for that, but we are not seeing it yet,” Maltz said.

Robert Weisman can be reached at

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