WETHERSFIELD - By this coming May, Wethersfield will be auditing Anthem Blue Cross/Blue Shield, its administrator, for $45 million in medical claims it has paid since 2008.

       The Town Council voted to go through with the Insurance Committee's recommendation for the audit at its Dec. 15 meeting.

       "The town and Board of Education spend a considerable amount of money administering benefits," said USI Consulting Vice President Chris Monroe during a presentation given during the meeting. "We've never had a full claims audit and, given this history, we've certainly needed one for some time."

       The audit would be conducted in order to ensure the accuracy of Anthem's administrative process as it relates to eligibility policies and coordination with Medicare, among other things. The town has been paying approximately $9 million a year in medical claims, according to Insurance Committee Chair Chris Bazinet.

       "As employers you need to be conscious of the fiduciary responsibility of ensuring that those claims are being administered properly," Monroe said. "The concern you always have with big carriers--whether it's Anthem or Aetna--is are they getting it right?"

       If they are, the town has seen health-related spending increases of 4.5 percent annually since 2008, with $7.6 million in "self-insurance" savings, according to the Insurance Committee.

       "Are there issues?" Monroe said. "What are the remedies for those issues? What's the cost to the town?"

       It's a process that will begin by examining the last two-year period, Monroe said. The plan is to check that first, and then decide what to do from there.

       "If something emerges, that can be a problem, and then you reserve the right to go back further," Monroe said.

       And who will be conducting the process will be determined by the middle of January--the town will be putting out a Request for Proposal (RFP) in order to solicit bids from auditing firms. The Insurance Committee expects a Healthcare-related surplus to cover the costs.

       The process will also be examining the health insurance components of the town's agreement with collective bargaining units. Two ASPSME contracts, both of which include increased healthcare-related contributions from employees, have been approved over the course of the last two Council meetings.

       "If there's a problem with one bargaining unit, you at least have to vet other bargaining units," Monroe said.

       Then there are the employees with more than one insurance provider, he said.

       "It's not uncommon for people to have dual insurances," Monroe said. "Who's paying first? We need to establish the town as a secondary payer, not a primary payer."

       Monroe said that Anthem would also be a participant in the auditing process.

       There are more than 600 employees between the Town and Board of Education receiving healthcare coverage. The Town has spent $12 million--$10.5 million for medical costs and $1.5 million for administrative expenses and stop-loss coverage--each year.

       The Town, which is self-insured for claims that exceed $125,000, also provides employees-current and retired-as well as their families with dental, pharmacy, life insurance and disability coverage.

       Before making its recommendation to the Council, the Insurance Committee voted unanimously to propose that an audit be conducted.

       "This is something that's been strongly supported and has not been done," said Mayor Paul Montinieri. "It'll be very helpful."