Archive by Month - July, 2010

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Health Coverage and HIV/AIDS

Tuesday, July 13th, 2010

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With its affordable health insurance legislation under its belt, the Obama administration has begun tackling a new health issue: the HIV/AIDS crisis. Although new infections have slowed since their peak in the ’80s, many people are still affected.

It is a two-pronged effort, aimed at reducing new infections while increasing access to health care for those who already have it. Instead of allocating significant amounts of new funding, existing funding will be redirected to high-risk populations like African-Americans and gay/bisexual men.

Some fear that the new comprehensive strategy won’t be enough, however. The economy has resulted in many people losing their jobs, which for many also means losing health coverage. Although there are medications that allow HIV patients to live longer and healthier lives, they are still very expensive. The out-of-pocket cost is almost out of reach for the uninsured. In addition, a person with HIV or AIDS would find it almost impossible to buy health insurance on the open market for the next several years.

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Federal Grant To Review Illinois Health Insurance Premiums?

Tuesday, July 13th, 2010

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Over the past several years, Illinois health insurance rates have risen significantly. Like many other states, their insurance department has been overburdened and unable to investigate premium increases.

States have been criticized for rubber-stamping health insurers’ requests in the past. Illinois is looking for a $1 million federal grant from the healthcare reform law to analyze and collect information about health insurance premiums in the state. Their intention is to better determine which would be considered reasonable, and which should be deemed unconscionable–higher than both the medical inflation rate and national averages.

If the state’s application is approved, they’ll receive the funding next month.

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Is There Precedent To Uphold Healthcare Reform?

Monday, July 12th, 2010

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One of the main arguments against the legality of healthcare reform is the contention that it is unconstitutional. Many opponents believe that the individual health insurance mandate, in particular, violates the 10th Amendment. That amendment says that all rights not specifically given to the federal government in the Constitution or its amendments are left to each state.

However, a competing interpretation–accepted by some conservative justices, no less–states that at times, the national government can exercise powers not expressly mentioned in the document. A recent Supreme Court decision (approved by seven out of the nine members) upheld the federal government’s right to indefinitely detain sex offenders after serving their sentences. Surely, the specifics of ankle monitoring or house arrest for child molesters and others were not on the founding fathers’ minds.

Granted, U.S. vs. Comstock is relatively less controversial an issue than affordable health insurance reform. Still, it’s a sign that the highest court is willing to consider the application of the “elastic clause”, which states that the federal government is allowed to pass laws to help it execute the powers it was expressly given.

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Co-Payments Vs. Co-Insurance

Monday, July 12th, 2010

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When trying to find affordable health insurance, it can be difficult to find the right policy. One of the most confusing aspects is the out-of-pocket cost you are expected to pay, above and beyond the monthly premium.

Most health coverage options include co-payments, co-insurance, or both. What’s the difference?

  • Co-insurance is a percentage of the fee charged for an item or service. For example, if you have a 30% co-insurance percentage under your policy and a doctor normally charges $100 per visit, you will be responsible for paying $30 upfront. In many cases, this is the more expensive option. However, it is becoming more common among group health insurance plans, due to employers trying to reduce their cost burden.
  • On the other hand, co-payments are a fixed amount. If your insurance company specifies a $15 co-payment for prescription medications, that is the amount you’ll pay the pharmacy each time you fill the prescription–regardless of how much the medicine actually costs. Sometimes, insurers have multiple tiers of co-payments: depending on the type of medication, doctor visit, or hospitalization, the copayment will be higher or lower.
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Don’t Delay Filing Out-Of-Network Health Insurance Claims

Monday, July 12th, 2010

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Some health insurance plans–especially high-deductible ones such as health savings accounts–allow patients to go outside of their provider networks to utilize the doctors and hospitals of their choice. Normally, this costs more to consumers; however, the increased freedom is nearly priceless to some.

In most cases, your health insurance will cover at least a portion of the cost of out-of-network care. Unfortunately, you are responsible for submitting the claim paperwork yourself. Check your policy for information about deadlines–if you miss the timely filing limit, you may end up having to pay the whole bill out-of-pocket!

While it’s usually possible to file a dispute or appeal with your insurer, doing so can have a negative impact on your credit rating.

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Utah Individual Health Insurance Rates Go Up

Friday, July 9th, 2010

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Similar to those in other states, Utah health insurance companies are raising their premiums. They blame the Obama administration’s healthcare reform law for forcing them to prepare for decreased profits later.

Although state law allows insurers to charge as much as they believe the market will bear, some consumer advocates are worried that filings for rate increases are considered proprietary business information and kept secret. Therefore, few health insurance buyers know what they’re getting into. Most rate changes aren’t known of unless a policyholder speaks out and complains to the media, as they did in this case.

The federal government is looking to states to strengthen their enforcement and prevent “rate creep”, which makes Democrats look bad in the mid-term election season. Humana has raised Utah individual health insurance rates by 29%, while Regence Blue Cross Blue Shield has increased some Medicare Advantage premiums by 48%.

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Your Health Coverage Can Be Canceled for One Penny

Friday, July 9th, 2010


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In order for your coverage to remain secure, it is essential to pay every single penny of your health insurance premium–literally.

A woman with cancer lost her job, but got COBRA to continue her group health insurance benefits. Last year’s stimulus package gave her a 35% subsidy to help cover the cost. However, her insurance company never sent her the reduced bill.

Therefore, she calculated the smaller amount herself and sent in the premium. Unfortunately, the insurer’s calculations didn’t agree: they said her payment should be one cent higher. As a result, they canceled her plan entirely for nonpayment! She was unable to send a check for $0.01 because she was in the hospital undergoing chemotherapy at the time.

The good news is that they eventually overturned their decision and reinstated her coverage.

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In The Meantime: Sebelius Tries To Get Health Insurance Companies’ Cooperation

Friday, July 9th, 2010

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The intention of the healthcare reform law is to increase access to insurance. It largely attempts to do so via stringent regulations. However, most of those regulations will not become effective until 2014.

The gap is a serious issue. Between now and then, health insurers will still be able to deny coverage to people with pre-existing conditions. Secretary of Health and Human Services Kathleen Sebelius is asking for their cooperation to help remedy this dilemma.

Doing so will probably be quite difficult, since the Obama administration has taken a largely adversarial role against providers of health insurance plans in the past. According to Sebelius, their goal is to stabilize the private sector by promoting the elements that could increase their sales (e.g. tax credits for small businesses).

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Missouri Launches Its Own Health Insurance Reform Lawsuit

Thursday, July 8th, 2010

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It started with Virginia. Then, Florida and 20 other states banded together. Now, another state has joined the ranks of those suing over the Obama administration’s health insurance reform law.

Republican Lieutenant Governor recently filed another similar lawsuit, which contends that requiring almost all residents to purchase Missouri health insurance (as one of the primary statutes does) is unconstitutional.

Why didn’t Missouri join the class-action suit? It is unclear; unlike Virginia, it doesn’t have its own separate law against the compelled purchase of health care that gives it separate standing–however, a measure to pass one is currently pending on their August primary ballot.

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Rhode Island Health Insurance Premiums To Increase

Thursday, July 8th, 2010

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Bad news for Rhode Island health insurance consumers: the insurance commissioner just approved several premium increases.

The health insurance rate hikes, which become effective next year, are as follows:

  • Blue Cross Blue Shield of Rhode Island: 9.8% for small and large business health insurance
  • United HealthCare: 12.3% for firms with under 50 employees, and 8.4% for larger companies
  • Tufts: 11% and 10.2%, respectively

On the bright side, these rate hikes are lower than those originally requested.

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