Posts by Author - Michael

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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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Obama Back Tracks: Doors Close At Open Healthcare Reform Talks

Thursday, February 4th, 2010

Just hours after President Obama publicly assured Americans that his administration and Congress opened up negotiations in the interest of transparency over health care reform, he was forced to take it back.

“I take some fault for this,” Obama said yesterday. “At the end of the process, when we were fighting through all these filibusters and trying to get it done quickly — so that we could pivot and start talking about other issues that were so important to the American people — some of that transparency got lost. And I think we paid a price for it.”

U.S. Secretary of Health and Human Services, Katherine Sebelius, followed the President’s lead in testimony before the Senate Finance Committee later in the day.

“I am not a principal in the negotiations,”  Sebelius said  to the Comittee members. “Nor is my staff.”

Obama has come under fire over his health care agenda in recent months as national polls show Americans are growing frustrated over the prospects of a mandate requiring all Americans to purchase health insurance or face tax penalties for not complying.

The House and Senate are now turning their attention toward reforming insurance companies in a manner that would require they cover individuals with pre-existing conditions. Health insurance plans object to the plan claiming only sick individuals would enroll, in turn making existing affordable health insurance unobtainable. Congressional hearings continue and some Senators say a compromise will come very soon.

The chairman of the Finance Committee, Senator Max Baucus, Democrat of Montana, said he was “very confident” that Congress would soon pass a comprehensive health bill, even though the legislation was now stalled.

“We are on the brink of accomplishing real health care reform,” Baucus said. “I urge my colleagues, on both sides of the aisle and both sides of the Capitol, not to give up.”

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State Medicaid Boost In Fed Budget

Tuesday, February 2nd, 2010

Call it the Nebraska affect.

After the Cornhusker State landed a pot of previously unavailable money in exchange for its “Yes” vote on the now fumbled Senate healthcare reform bill, the Obama Administration is expected to announce on Friday a proposal that would add another $25 billion worth of funds to states to use for Medicaid, according to the AP.

The Medicaid windfall is expected to mirror the economic stimulus program that took effect last year, where non-recurring Medicare funds were divvied up among states with the highest unemployment rates. Under the new initiative, the Feds will take on a higher stake of state Medicaid funds for a period of six months (or until July, as proposed) with every state in the U.S. getting an additional 6.2 percent of its current Medicaid budget paid for by federal dollars. Again, those states with higher unemployment are slated to get more.

The proposal is the centerpiece of President Obama’s 2011 budget. It is unclear whether the measure will be wrapped up in the Administration’s $174 billion “Jobs Bill” that Obama unveiled at his State of the Union address last week, or if it would be presented to Congress as part of a special line item. Regardless, if the Medicaid measure passes both houses of Congress, the money would not be made available to states until next year. Obama already has a bit of a head start on getting the measure passed since the House already passed the Medicare extension in a previous session.

Although his budget is highly unlikely to be passed without some significant cuts by Congress, the Obama Administration is stemming the tide of requests from state and local leaders with large populations of unemployed workers who are facing the end of federally-subsidized COBRA health insurance plans. Coupled with a growing pool of retired and elderly citizens who are living on fixed incomes during the nation’s second worst economic recession, the coming Senatorial elections this November and Congress is expected to rubber stamp Obama’s proposed boost in Medicare spending. Aside from the usual partisan bickering about budgets and deficits, we can also expect some debate about the disparity of Medicare funds available to large states like California and Texas, both of which also have a large unemployed population.

Reuters is reporting today that about $645 billion total of the Obama budget is specifically earmarked as money for various state economic and emergency funding programs. One half of that money is dedicated to various reforms for health insurance companies designed to extend affordable health insurance to to the unemployed and economically disadvantaged.

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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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Mental Health Mood Boost: More Coverage From Health Plans Coming Soon

Monday, February 1st, 2010

For decades the National Mental Health Association has been fighting a perception battle amongst the general public; or at least those who are not affected by mental health disorders. So afflicted by its own persona, the association itself recently changed its own name.

Mental Health America! (as it’s now known) has amassed some 300 affiliate organizations across the country who lobby on behalf of their individual members for, among other things, mental health coverage in group health insurance plans. This week, their collective voices were heard and shared by Kathleen Sebelius, the U.S. Secretary of Health and Human Services.

Under a new law affecting all health insurance plans on July 1, 2010, employers and their group health plans cannot limit coverage for mental health treatment for less than the treatment of physical conditions like cancer and heart disease. That means insurers cannot set higher co-payments, deductibles or limits on inpatient or outpatient visits to psychiatrists or psychotherapists. It’s an insurance disparity that’s commonplace with health insurance plans, but one that doctors say have made it extremely difficult for people to obtain treatment for disorders like bipolar disease, drug and alcohol abuse and autism.

According to statistics from Mental Health America!, only about 18 percent of all adults in the United States ever seeks treatment for mental health disorders. The most likely limitation to seeking treatment, say doctors, is medical insurance restrictions on care that is not related to a physical ailment. For years, most traditional group health insurance plans have issued separate deductibles for mental health care and physical health care. The new rules will put an end to this practice, essentially combining these deductibles so those with a need for ongoing mental health conditions can afford to get treatment.

“Patients with mental illness often have general medical conditions like diabetes or high blood pressure that require treatment at the same time,” said Irvin Muszynski, an attorney with the American Psychiatric Association. “So a combined deductible makes sense.”

The change is two years in the making, as a 2008 law was adopted with bi-partisan support that significantly expanded the rights of people with mental health conditions.

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Small Business Optimistic About Group Health Insurance

Monday, February 1st, 2010

As expected by most small business owners, it was the State of the Union. Not the state of healthcare reform.

The omission was not lost on those in Congress and in the industry who had worked tirelessly on a plan that all parties could agree on, only to have their work suddenly shredded in Massachusetts. It was a development the Obama Administration would rather forget than to open up yet another page in the brief history of health care reform in the United States. But a quick snapshot of small business owners reveals a rather unexpected glimmer of hope after Obama’s first State of the Union address last week.

Amidst the tax cuts, elimination of capital gains taxes on small biz investments and his admission that small business lending had dried up after banks he advocated bailing out put their hands in their pockets when approached by small business owners for loans to get by, Obama bid another small but healthy wink to this group.

“By the time I’m finished speaking tonight, more Americans will have lost their health insurance. Millions will lose it this year. Our deficit will grow. Premiums will go up. Patients will be denied the care they need. Small business owners will continue to drop coverage altogether.” He then declared, “I will not walk away from these Americans, and neither should the people in this chamber.”

That bit of verbiage came after he dropped the TARP bomb, proposing that some $30 billion in unspent money bailing out the banks be used to shore up small businesses in the form of further tax breaks for hiring more employees. After all, he surmised, the big corporate guys don’t deserve huge hand outs when they are the ones banks are lending to.

“Even though banks on Wall Street are lending again, they’re mostly lending to bigger companies,” said Obama. “Financing remains difficult for small business owners across the country, even those that are making a profit.”

Speculation abounds about how small business owners will be able to afford group health insurance for the employees they expect to hire if the TARP proposal sees the light of day. But some of the most vocal small business representatives are cautiously optimistic that at least some of the President’s proposals will trickle down enough to breathe a little life into their business.

Dawn Sweeny, president of the National Restaurant Association, thinks the Senate version of the healthcare reform bill — the one with the national health insurance exchange, which favors individual health insurance plans — is the only viable option for most restaurant owners (which represent the largest contingent of small business owners in the United States).

“It is essential to the restaurant industry that the protections added to the Senate version of this legislation be included in the Congress enacts any reform.”

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Efficient or Effective? – Hospitals Embrace Pay For Performance

Monday, February 1st, 2010

Life after Scott Brown has yet to be determined.

But one thing is for sure: no one in the Republican or Democratic parties would publicly deny after record deficits is that efficient health care comes down to a simple equation; doing more with less is a sure fire way to cut costs. Whether or not Obama gets his spending freeze next year, health insurance companies and medical practitioners will be looking for ways to infuse their efficiencies. Electronic medical records and patient management systems are quickly becoming the new-now-next frontier in the quest for industry reform. Chances are, it won’t take a federal mandate to make the flow of medical records abandon the paper highway and take an electronic route. Health care companies had been looking at the issue five years before health care reform became a top priority in Congress.

Consider the findings of The Commonwealth Foundation, an independent research think tank in New York who conducted a thorough survey of attitudes amongst medical care providers about how to make health care “click” in an era of reform. The survey of 1,256 “opinion leaders” in health policy and “innovators in the health care industry,” developed by Harris Interactive revealed that a majority of respondents (57 percent) believe that pay-for-performance is the only business model out there that makes sense. They also indicate that patients with chronic illnesses who require ongoing disease management (those with heart disease, diabetes, etc.) require the most intensive overhaul for health care delivery. Evidence based medicine (EBM), another buzz phrase in medical care today, is the second-most accepted approach for reigning in costs.

With doctors now forced to manage their time against an insurance company clock — where patient counts are the benchmark for payments by health insurance plans — EBM should emerge as a less attractive option since the practice involves much more one-on-one time with individual patients to determine the most appropriate course of treatment. Moving toward an EBM-based practice would likely slow down movement in the waiting room and thus, less billable visits. But more and more of our most respected health care institutions are proving that doctors and hospitals can have their EBM cake and eat it too. Insurance companies, who have been notoriously gun shy about the proof that EBM leads to better care, are starting to come around now that some of the nation’s most respected pioneers in the EBM movement have proven that using it more in everyday practice will save insurance plans in the long-run.

“The irony is that while it comes up all the time among providers, no one talks specifically about what evidence-based medicine is,” says Paul Keckley, executive director of the Vanderbilt Center for Evidence-Based Medicine, Nashville, Tenn. “Many people believe that somehow it is a new idea or that it’s a tradition-based practice. There’s a direct correlation between evidence-based medicine and the need to take out unnecessary costs and there’s now considerable avoidable cost in the health care system, such as the inappropriate use or overuse of antibiotics, lab tests and imaging, which are done more often out of [physician] preference than based on the evidence.”

Sound familiar? If not, it will very soon as the battle over affordable health insurance and health care reform transforms into health insurance reform on Capitol Hill.

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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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