Posts Tagged - ‘health insurance companies’

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Pharmacy Profits Up In Down Economy

Monday, February 8th, 2010

Investor backlash over its aggressive acquisition and merger strategy in recent months, CVS Caremark Corp (CVS.N) said recent problems at its pharmacy benefits management unit have been corrected and it posted a slightly better-than-expected rise in quarterly profit, driving the company’s shares up as much as 8.8 percent. CVS also said 2010 earnings could top analysts’ views.

Just three months ago, CVS shocked investors when it said the pharmacy benefits business (formerly Caremark) which administers prescription drug benefits for employers and health insurance companies and operates a large mail-order pharmacy, lost out on about $4.8 billion of business heading into 2010, leading to the departure of the unit’s president. Investors appeared to be unconcerned that total sales missed analysts’ projections, as sales at its retail drugstores that have been open at least a year far outpaced recent results at larger rival chain Walgreen Co (WAG.N).

CVS Chief Financial Officer Dave Denton told Reuters during the earnings conference call that consumers were still “very cautious” with regard to their spending, which could affect CVS stock value in future quarters.

Retail pharmacies are taking a hit on in-store, non-drug items as the current economic recession continues to drag. Non-drug items like groceries, photo finishing and the like account for more than one half of a typical pharmacy’s profit. Last week, Walgreen posted its second consecutive monthly drop in same-store sales, with January falling 1.1 percent, while smaller Rite Aid Corp’s (RAD.N) same-store sales have fallen for eight months in a row.

CVS had no new comments about the U.S. Federal Trade Commission’s investigation into some of its business practices, which followed its acquisition of Caremark.

CVS and Walgreens have recently launched retail medical clinics in many of their locations to participate in insurance company networks that pay benefits on individual and group health insurance plans when walk-in, immediate care clinics are used for routine medical care. The clinics were very popular during the recent U.S. H1N1 Flu outbreak when vaccines were made available at CVS, Walgreens and other retail drug chains.

A study issued last week by labor consortium Change to Win, which pushed for the FTC to examine the CVS and Caremark merger, said CVS charges the U.S. government more for some generic drugs than participants in its retail generic discount program pay. Denton, who called the report “a lot of rhetoric,” said the government is pleased with CVS’s pricing and service. Other major mail order pharmacy programs have since revised their pricing structures, offering similar discounts on refills regardless of whether a generic is substituted for a name brand prescriptions.
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California Insurance Chief Recovers $112 Million

Friday, February 5th, 2010

California’s state budget woes just got a bit of a boost from its State Department of Insurance.

Steve Poizner, the California State Commissioner of Insurance announced Friday that his office has successfully recovered nearly $113 million in 2009 from consumer claims of fraud and misconduct amongst the state’s insurance companies and independent agents successfully prosecuted for their crimes. Poizner claims this is the most money ever recovered by the office under any previous insurance commissioner. The state recovered about $62 million from health insurance companies, consumer fraud investigations and insurance brokerages in 2008.

Made up of two separate divisions, California’s Department of Insurance’s Consumer Services and Market Conduct branches recovered about a fourth of the money reportedly put back into the state’s coffers after closing wildfire-related insurance auditing cases that lingered from 2007 and 2008. The Market Conduct Division, which regulates health insurance companies alongside property and automobile insurers, recouped $23 million.

Poizner is in the midst of a heated race between former eBay executive Meg Whitman to replace current Governor Arnold Schwarzenegger for the Republican nomination. Chuck DeVore, a relative unknown state assemblyman from Orange County is also running for the office. The heated race has led to claims that Poizner himself may have benefitted from his elected office. Among other accusations from his opponents, last month, the San Jose Mercury News and Associated Press reported that a relative of Poizner is accused of submitting inflated claims for auto insurance repairs and pocketing the difference.

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So Much For Socialized Medicine – Canadian PM Heads To U.S. For Surgery

Thursday, February 4th, 2010

In a move destined to become fodder for late night talk shows, not to mention both Houses of Congress, Newfoundland Canadian Premier Danny Williams will undergo heart surgery later this week in the United States, according to the Canadian News Network and the National Post newspaper there.

Deputy premier Kathy Dunderdale confirmed the treatment at a news conference Tuesday, but would not reveal the location of the operation or how it would be paid for.

“He has gone to a renowned expert in the procedure that he needs to have done,” said Dunderdale, who will become acting premier while Mr. Williams is away for three to 12 weeks.In consultation with his own doctors, he’s decided to go that route.”

Mr. Williams’ decision to leave Canada for the surgery has raised eyebrows over his apparent shunning of Canada’s socialized health care system, a model for which the Obama Administration has been pushing for at the resistance of Congress and national polls indicating the majority of U.S. citizens do not support reforming the health care industry, nor further regulation of health insurance companies.

“It was never an option offered to him to have this procedure done in this province,” said Dunderdale, refusing to answer whether the procedure could be done elsewhere in Canada.

Mr. Williams, 59, has said nothing of his health in the media. “The premier has made a commitment that once he’s through this procedure and he’s well enough, he’s going to talk about the whole process and share as much detail with you as he’s comfortable to do at that time,” she said.

“Canada: The Land of Health Care So Awesome That Its Politicians Undergo Surgery in the United States,” one American Pundit wrote sarcastically in reaction to the National Post story.

“Canada keeps its costs down, in part, by neglecting the expensive business of advanced specialty care knowing that the U.S. is next door to help,” wrote a commenter in a USpoliticsonline forum.

Dunderdale wouldn’t say where in the U.S. Mr. Williams is seeking treatment.

A popular Progressive Conservative premier, Mr. Williams has also seen his share of controversy. During the 2008 federal election, Mr. Williams vehemently opposed the Conservative government, launching his “Anything But Conservative” — which has been credited with keeping the Tories from winning any seats in the province. He’s also drawn criticism for his support of seal hunting.

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Health Insurance Scams: Foreclosure “Help” Part II?

Tuesday, February 2nd, 2010

It’s a sad reality, but when a national crisis takes hold, so too do shady figures willing to create a business opportunity.

Last year, when home foreclosures and unemployment created the perfect storm for American Dream melt-down for many Americans, business licenses were also hitting record highs. Many of them were issued to “foreclosure specialists,” attorneys and legal defense funds with questionable integrity looking to cash in on desperate homeowners with seemingly nowhere to turn but the first billboard or web banner ad promising to save their homes. And cash in they did.

Usually the scam went something like this: Homeowner behind on payments calls toll-free number. Seemingly caring professional promises to help, sometimes giving false guarantees that they won’t be forced out of their homes. Homeowner sends certified check to foreclosure firm at temporary post office box as a “retainer,” held until foreclosure firm begins negotiations with mortgage company. Check received by firm. Phone number disconnected. Web site removed. Homeowner savings gone, Sheriff arrives at front door.

Until states like New York (known for their tough records consumer protection laws and of successful prosecutions for breaking them) started a very public crack-down on these foreclosure schemes late last year, coupled with the federal government’s scramble to crack down on mortgage companies sitting on mountains of paperwork, foreclosure “help” was the biggest business out there for the scheming entrepreneur. Of course, there are still many of them out there fully staffed with hungry self-starters in windowless call centers. But they’re not growing as much.

Attribute it to the recovering housing market or the fact that more mortgage companies are willing to make a deal, but foreclosure defense scams are dropping from the public radar in favor of the next big crisis: The perceived lack of affordable health insurance.

Chances are, the same guys who promised to save your home from being taken over by the bank may be calling you or netting you on the Internet with promises of guaranteed health insurance benefits from some companies that sure sound legit. Consider some of the companies who bankrolled insurance premiums from hundreds of people who were either denied coverage from major health insurance companies or couldn’t afford the plans: In Missouri, “Americans for Affordable Healthcare, Inc.,” “Key Benefits Administrators, Inc.,” and “Serve America Assurance, Ltd.” were among several other outfits who sold great sounding policies with affordable group health insurance rates. But they weren’t worth the paper they were written on — if there was any paper at all.

The Missouri Department of Insurance filed a motion to haul 12 of the individuals behind some 14 fake health insurance companies to face charges they defrauded Missouri residents out of $2,000 each for a “membership” in their insurance plan. One consumer, according to the St. Louis Post Dispatch, wound up with a $60,000 medical bill after he realized his policy was little more than a poker chip on a scammer’s table.

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Blue Cross Blue Shield Breaks Immediate Care Barrier

Friday, January 29th, 2010

Blue is now taken at Take Care.
Blue Cross and Blue Shield of Florida announced this week that effective right away, its four million subscribers can receive benefits under their health insurance plan for medical services provided at Take Care Health Health Systems immediate care centers located inside Walgreens drug stores throughout the state of Florida. With more than 80 percent of all insured Floridians now covered under BCBS health insurance plans, Walgreens is looking to boost visitors to its Take Care locations in hopes of creating a one-stop-shop for medical care.

Walgreens is rapidly playing catch-up in the trend toward walk-in medical care as its top competitor, CVS is rapidly boosting its retail healthcare presence in the Florida market. CVS’ MinuteClinic walk-in health care chains first started popping up inside its own pharmacies in 2002. The clinics boast over 4 million visits and accept health insurance coverage from most of the major health insurance companies in the nation. Last month, MinuteClinic announced it would begin accepting Humana insurance plans.

Insurance companies and medical care providers are encouraging patients to seek out medical care at so-called immediate care centers as a method of reducing overall healthcare delivery costs. When compared to a typical visit to a private physician or an emergency room, retail walk-in clinics are usually cheaper to use as they are typically staffed by nurses and nurse practitioners and confine their treatment to minor illnesses and injuries.

Health insurance companies are taking a cue from the retail pharmacy industry by becoming more of a retail brand themselves. Blue Cross Blue Shield of Florida is building a chain of its own “Blue” locations throughout the state. Initially, the insurance giant plans to provide consumer advice and consultations about its insurance plans. Nurses will also be available at the stores to provide simple physical exams and other routine medical care provided for under family health insurance. Look for BCBS to open new stores in Ft. Lauderdale, Miami, Jacksonville, Tampa and Orlando soon.

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Student Health Insurance Recovers From Extended Illness

Friday, January 29th, 2010

Strapped by tuition increases and declining enrollment, U.S. colleges and universities are cracking the books in hopes of graduating and moving past their own health insurance reform crises.

According to a story appearing today on CMN – College Media Network, Portland State University’s voluntary student health insurance program is slowly dying.

PSU health insurance, currently underwritten by Aetna Life Insurance Company, provides two different plans: basic and supplemental.

The basic plan covers visits to the the university’s medical facilities. The supplemental plan is preferred for outside doctors and emergency room visits. PHU spokesman Walden
Poublon explained that since students who utilize the supplemental plan often need and seek expensive health care, the insurance providers lose money each year, causing rates to increase or coverage in the plan to decrease in order to stay affordable.

PSU is among a growing list of public and private colleges and universities extending health coverage to students at a lower premium than they could obtain for themselves. While considered by parents and students to be a benefit, the challenge for such schools is to make plans more affordable so more will purchase it, thus creating a larger pool of money available for everyone’s health care.

Over time, fewer students have elected to enroll in the supplemental plan while prices have increased. This trend has decreased the pool of money available to students, which is why insurance providers lose money and are forced to increase rates. This is the “death spiral,” Poublon said.

PSU recently signed with Aetna after receiving competing quotes from other health insurance companies. But was clear that the current plan with Aetna is merely a Band-Aid solution that is not sustainable and is on borrowed time. If the past is any indication of what to expect in the future, few students will elect optional supplemental plans, causing insurance companies to lose money and then increase rates or decrease coverage.

But student health insurance is recovering thanks in part to creativity on behalf of college administrators forced to either abandon coverage or grow their groups.

As for PSU, Oregon State University and University of Oregon are in talks about the possibility of pooling students at all three campuses to buy a mandatory hard-waiver health care plan as a group. This could lower insurance costs for all three schools.

A mandatory hard-waiver health insurance policy would require students to be covered by a comprehensive health insurance plan that would be a part of students’ tuition and fees. Students may be excluded from the plan if they have comparable health insurance through a parent or employer.

This would prevent students who already have health insurance outside of the school from paying a mandatory health fee each term—essentially “opting out.” Another benefit is that students could have access to better health insurance that could be paid by financial aid.

Other schools have successfully adopted hard-waiver programs. Aetna Student Health has implemented hard-waiver programs at approximately 80 institutions, including Boston College, Clemson University, Cornell University, Dartmouth College, Duke University, Harvard University, Northwestern University, Miami University and the University of Pennsylvania.

The economy is partly to blame for the decrease in health coverage for students. Operational shortfalls have resulted in tuition increases at many schools, leaving less money for parents and students to put toward coverage.

“Some students have to make the choice between health and school. Meal or education,” Poublon said. “[It's an] impossible choice to make.”

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Wellpoint Warns Obama: Expect Higher Health Insurance Premiums

Thursday, January 28th, 2010

Wellpoint Inc., the nation’s largest health insurance company by membership, posted record earnings to Wall Street on the same day it sent a carefully-worded warning to the Obama Administration that it expects to book more profits if health insurers are forced to cover people with pre-existing conditions.

“The cost of premiums will rise if Democrats force plans to cover people with pre-existing conditions,” said Wellpoint CEO, Angela Braly. “Insurers went along with their practice of refusing coverage based on pre-existing conditions because the legislation also required 30 million more Americans to get coverage.”

Since debate about how to reform healthcare has simmered in Congress, the pre-existing element was among the last meaningful legislative changes to survive. But the House and Senate essentially concede that the mandate for all Americans to purchase individual health insurance is all but dead. Without the mandate, Wellpoint and other major health insurance companies wouldn’t have a built-in guarantee of new business coming to pay for those with pre-existing conditions.

“Without those added customers,” Braly added, “insurance companies will raise rates to cover the cost of the sicker people.”

Wellpoint posted a $536 million profit in the last quarter, after adjustments for the sale of its former NetRx pharmacy benefits unit to rival Express Scripts in December. Insurance industry analysts had been bracing for a flat earnings report amidst news that membership in some of the biggest health insurance companies continues to decline.

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Virtual Fitness: Employers Creating Online Workout ‘Buddy’ Networks

Sunday, January 24th, 2010

Health insurance providers are offering their own versions of a virtual fitness system for the Web junkie set. Following a successful internal beta test with its own employees, “Aetna Health Connections Get Active!” is a group / team oriented fitness and nutrition program tailored to Aetna’s commercial employer health plan customers.

The company reports that more than 57 percent of its 35,000 employees in the United States participated in the “Get Active Aetna” program. One Aetna official from Arlington, TX reports the program helped him to lose 120 pounds. Other employees say the social networking component of the program has helped them connect with others who they otherwise wouldn’t have considered shaping up with. The program is a private-label product of Providence, RI-based Shape Up The Nation.

Even before the current Twitter and Facebook fanatics flocked to the Internet, Med School buddies Brad Weinberg and Rajiv Kumar learned from their early clinical days that patients who were the most successful at losing weight, increasing their exercise, quitting smoking and sticking to their goals all had one thing in common: they had social networking profiles and used their online friends to push them forward.

Aetna isn’t the only group health plan provider to put exercise in the cloud. Cigna, UnitedHealth and other major insurance companies offering their own brands of virtual fitness tracking and exercise regimes, to their own employees and to their plan subscribers. These companies and other FORTUNE 500s regularly report substantial cuts in healthcare costs, employee morale and retention by offering wellness programs that are fully integrated into social networking sites.

Some online fitness program providers work with companies to generate customized reports that tell CEOs which employees are using the program and how often. Other companies fully-integrate the data into Human Resources systems to cross-reference it with group health insurance claim information. While privacy advocates have concerns about the usage of such data to discriminate against employees in some way, national statistics tend to favor the employer:

  • The Kaiser Family Foundation reports: Nationwide, employer-sponsored health coverage premiums for family coverage have increased by 97% since 2000, from $6,438 to $12,680 in 2008.
  • Many have experienced 16% increases during the last 3 years much due to the rising epidemic of obesity and overweight adults.
  • A study in the Journal of Health Affairs noted that per person health care spending for obese adults is 56 percent higher than for normal-weight adults. Over 15 years, the additional costs incurred by obese adults with private health insurance versus normal-weight adults increased from $272 to $1,244 per person per year. The International Journal of Obesity reports, weight gains of 20 pounds are associated with medical care cost increases of >$500 over the last three years.
  • Obese workers lose about 13 times more days per year of work from injury or illness. (In an organization of 10,000 employees, with 32% obesity, that equates to 334,880 hours or an estimated 161 full time employees. With an average national salary of $38,500, the total cost of lost days can be as much as: $6,198,500 per year.)

Online nutritionists, exercise coaches and member message boards are also growing in popularity outside the workplace since real-live trainers are finding work in other industries and more exercise enthusiasts are cutting their gym memberships to save money.

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Sitting is the Silent Killer

Friday, January 22nd, 2010

Image and video hosting by TinyPicSitting behind a desk for the workday in corporate America is just part of the job. So long as we’re supported by a comfy chair that helps us get our workday tasks done with relative ease and minimal strain on the back, it’s hard to imagine many occupational hazards to concern ourselves with until we leave the office. Not so say Swedish medical researchers. Turns out, sitting is the silent killer.

Aside from putting ourselves at a higher risk for obesity and diabetes, the longer we stay in sitting mode, say the Swedes, the worse off we are in the long run. Doctors at the Karolinska Institute and Swedish School of Sport and Health recently submitted the results of their study to Swedish health officials who quickly designed a series of elaborate exercise programs to keep working Swedes in tip-top shape.

Swedish guidelines now call for individuals to “take regular 5-minute breaks during a working day that is spent behind a desk,” and engage in “a minimum of 2.5 hours of physical activity off the clock to stay fit and healthy,” reads the recommendation.

Perhaps the most mind-warping concept for Americans to embrace in the study is our notion of “sedentary.” For years, U.S. health officials have forged such a strong bond between this relatively benign word and a visual of the mid-life couch potato husband who spends the majority of his off-hours on the couch at home. The Swedish sitting study makes the typical couch potato look like a blob of Play Dough in comparison.

“In the demanding and stressful society of the present, to prescribe these low and minimally time-consuming efforts may encourage many people with problems in maintaining a sufficient level of exercise,” the doctors wrote. “Encouragingly, research has shown that simple forms of individualized physical activity in clinical practice has had a beneficial impact on exercise level as well as sedentary time.”

If that wasn’t enough to get you outta your chair, consider the fact that our American counterparts in the healthcare and medical insurance industry have warned us against deep vein thrombosis — essentially a blood clot that forms and pools most often in the leg when we sit for long periods of time. If you sit in the same position without moving around much for as little as three hours, some people are susceptible to sudden blood clots that could launch quickly into the lungs and cause a fatal heart attack.

Considering the Swedish are amongst the healthiest people in the world, following their lead is probably a safe bet.

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Health Insurance Companies Deflect Blame For High Rates, Point To Massage

Thursday, January 21st, 2010

The heads of major health insurance companies were recently called to Capitol Hill to testify on their behalf in healthcare reform hearings. Many politicians and average citizens alike have blamed what they consider greedy health insurers and business practices that harm consumers; such as rescission (revoking a medical insurance policy when a patient develops a condition while insured), denying coverage to people with pre-existing conditions, and discriminatory pricing that makes women pay more for a health insurance plan than men in similar health. Even the proposals for scrapping the current bill in Congress altogether call for scaled-back legislation that will strengthen regulation of the health insurance industry.

Delphi Financial Group CEO Robert Rosenkranz, however, believes that health insurance companies have been unfairly made into scapegoats. Most of the blame for high health insurance premiums, rather, is the fault of consumer demand and state requirements. Over the years, consumers have demanded that services such as chiropractic, acupuncture, or massage be covered by their health insurance plan. Some states have wider coverage requirements than others, and the states that mandate coverage for a wider variety of services (such as gym memberships) tend to have more expensive health insurance premiums on average. All of these services have a positive impact on wellness, but are not direct healthcare expenses. Therefore, Rosenkranz believes that covering such care defeats the purpose of medical insurance: to cover what cannot be budgeted for in advance.

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