Archive by Month - April, 2010

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New Trend: Lump Sum Health Insurance Payments

Friday, April 30th, 2010
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An increasing number of doctors and health insurance companies are considering lump-sum reimbursement. As opposed to being paid for every procedure they perform, health care providers will be paid a certain amount to treat a particular condition or perform a particular surgery.

Proponents of the strategy believe that it promotes preventative care and more cooperation. It also makes costs more predictable for your health insurance plan.

Some worry that bundled payments will penalize doctors who deal with complicated cases and chronic conditions. Despite those concerns, several major health insurers in California are already on board.

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New Primary Care System Without Standard Health Insurance

Friday, April 30th, 2010

A new health care company in Washington State is trying a new method: primary care without a health insurance plan. Qliance deals only with patients through a “direct practice”, where each person pays a monthly fee in exchange for unlimited access to primary care physicians.

According to the company, the simplified billing structure allows general doctors more time to focus on their patients’ health. Qliance recommends that consumers and employers buy catastrophic, high-deductible health insurance(such as an HSA) to supplement their program. The total cost of premiums will likely be as much as 50% lower than that of comprehensive coverage.

The firm has some rich and famous backers behind it: Amazon.com founder Jeff Bezos, Drew Carey, and Michael Dell from Dell Computers have contributed a total of $6 million. In addition, the healthcare reform law allows direct primary care systems like Qliance to participate in affordable health insurance exchange markets. We’ll see if they are a success as they plan to expand.

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Will You Be Stuck In A State Health Insurance Pool?

Friday, April 30th, 2010

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The federal high-risk health insurance pool for people with pre-existing conditions will probably be cheaper than the pools that already exist in 35 states, due to the larger base of consumers.

Unfortunately, people who have already signed up for their state’s affordable health insurance option for high-risk patients won’t be eligible for the national program. In order to sign up for the federal program, you have to have been uninsured for at least six months.

Enacted as a temporary measure in the healthcare reform law, the federal pool will launch on July 1st. Some states are encouraging potential applicants for their programs to wait until then.

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Some Health Insurers Don’t Cover Oral Cancer Drugs

Friday, April 30th, 2010

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Battling cancer is hard enough, but when your health insurance plan refuses to pay for a more convenient and less daunting treatment, it’s even worse. Although “chemo parity” laws are pending in several states as well as Congress, there is still a lot to be done.

Many health insurance companies will not cover oral chemotherapy drugs that may cost up to $4,000 per pill, since less expensive IV treatments are available. The latter require more of the patient’s time, transportation, and have more side effects. They are also susceptible to leaks and other problems that cause emergency room visits!

Why does this happen? Oral cancer drugs are often classified as prescription medication benefits, which tend to be far less generous than medical benefits (such as intravenous surgery). For their part, health insurance providers blame Big Pharma for putting such a high price tag on the pills to begin with. Pharmaceutical companies, on the other hand, claim that the high prices are necessary to recoup their research and development costs.

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Homeless Adults Will Get Health Insurance

Thursday, April 29th, 2010

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Due to provisions in the new healthcare reform bill, many homeless adults will receive health insurance through Medicaid. They are eligible if they earn up to 133% of the poverty level. If a person is living in shelters or on the street, they clearly aren’t able to afford a health insurance plan.

Although Medicaid has its disadvantages, it may be perfectly suited for this population. For example, it provides transportation services to doctors’ appointments, which most private plans don’t.

Community health centers are also set to receive increased funding for their services, which are offered on a sliding scale based on a person’s ability to pay, regardless of their health insurance status.

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Are Health Insurance Company Mergers Good Or Bad?

Thursday, April 29th, 2010

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Corporate mergers are a fact of life. In recent years, more of them have occurred in the health insurance industry. The healthcare reform law may end up forcing more of them to merge or go out of business.

How do these mergers affect consumers? On the positive side, they allow firms to band together and negotiate lower rates from providers due to their combined policyholder base. However, they decrease the amount of competition and the choices of affordable health insurance available.

The latter is especially dangerous when the major health insurance plan providers in a state merge, leaving residents with few options. Antitrust law could be used to challenge the mergers, but it rarely has been. There are ups and downs, besides.

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Beware Of Lapses In Health Insurance Coverage

Thursday, April 29th, 2010

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Most people realize the importance of having a health insurance plan. Unfortunately, some may not believe that a short lapse in coverage is a big deal. The problem is that being uninsured for as little as 24 hours could end up being a major problem. If you need to visit the hospital during that short period of time, you’ll be responsible for the full bill.

When do these interruptions occur?

  • When you switch jobs
  • When you leave a job for self-employment or starting your own business, and buy your own health insurance plan
  • When you leave your parents’ health insurance
  • When you join your spouse’s health plan

There are other instances. Either way, try to avoid it. A good way to do that is with short term health insurance, which is available for terms as little as 30 days. It’ll help you fill the gap and avoid financial hardship.

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Does Universal Healthcare Make Canadians Healthier?

Thursday, April 29th, 2010

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Proponents of health insurance reform must be heartened by this news: a new study has found that on average, people living in Canada are healthier than those in the United States. (The survey was only performed on Caucasians, in order to make sure that racial and ethnic disparities in their populations didn’t skew the results.)

Canadians live three years longer than the normal American life expectancy, while being less likely to suffer from chronic health conditions. Meanwhile, Americans spend more on health care.

There are many factors involved, including a lower rate of obesity. However, the authors of the study believe that Canada’s health care system–which offers access to affordable health insurance to all–plays a role. Canadians are more likely to use preventative care services, which improves their health outcomes.

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Neb. Won’t Create New High-Risk Pool

Wednesday, April 28th, 2010

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Nebraska is one of the first states to indicate that it will not create a separate high-risk health insurance pool for people with pre-existing conditions. The healthcare reform law requires each state to either do so, or have the federal government administer it for them.

According to Governor Dave Heineman, high costs prevent his state from participating. Moreover, Nebraska already has a similar high-risk pool, although the limited geographic scope means that the health insurance plan will be generally more expensive than the national program.

These programs are intended as a stopgap until 2014, when all health insurance companies on the open market will be banned from denying coverage to those with pre-existing conditions. At that point, the high-risk pools will be phased out.

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Poll: Less Confidence In Healthcare, Despite Reform

Wednesday, April 28th, 2010

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So far, the passage of health insurance reform legislation has not increased Americans’ confidence in the health care system. According to the Thomson Reuters Consumer Healthcare Sentiment Index, confidence fell three points between January and March.

The most drastic change was in future expectations. Most expected that they would be less likely to be able to find health care or afford a health insurance plan. In March, there was an increase in the number of people who had either decreased the amount of health insurance coverage they had or dropped it entirely.

Click here to see more of their findings. These results don’t bode well for proponents of the law.

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