Posts Tagged - ‘health care’

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Mini-Med Health Care Policies Under Senate Investigation

Wednesday, December 1st, 2010

Mini-medical plans are controversial. On the one hand, they provide some coverage for emergency care, and in many cases are better than nothing. On the other hand, they often come with extremely low annual benefit payout limits that make them nearly useless if a person needs major medical treatment.

Mini-meds are typically offered by low-wage companies, and administered by major health insurance plan providers like Cigna and Aetna. A Senate committee is currently investigating the issue; the probe has been expanded from McDonald’s to other employers. The issue is that although policyholders are usually saddled with high medical bills, the plans are sometimes promoted as full-fledged comprehensive health care.

Although the healthcare reform law bans annual and lifetime limits, dozens of mini-med providers have been granted exceptions from that provision. Mini-meds are also subject to a lower medical loss ratio, which determines the percentage of premiums that must be spent on medical care.

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Health Insurance Reform: Healthcare Mergers Coming Up?

Monday, November 22nd, 2010

Image: Frits Ahlefeldt-Laurvig under CC 3.0

The healthcare reform law may end up having an unfortunate side effect: although one of its stated goals is to help make affordable health insurance more widely available by spurring competition, several health care providers are considering merging.

According to many groups of doctors, hospitals, and clinics, the alliances and joint ventures are necessary in order to maintain their profit margins and take advantage of the potential savings of the law while avoiding the additional costs. However, consumers may suffer as a result.

The industry’s lobbying groups also want the Federal Trade Commission and the inspector general of the Department of Health and Human Services to give them exceptions from antitrust and Medicare fraud laws. This could potentially be dangerous. On the positive side, it can force medical service providers to coordinate care, leading to better health outcomes for patients.

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Which Country Has The Most Disputes with Health Insurance Companies?

Friday, November 19th, 2010

Most people agree that health care is an essential good, though they may disagree on how to go about providing it. Yet, a recent survey shows that millions the world over are forced to skip it because of the high cost. In order to maintain profitability, health insurers want to keep costs down. However, this often results in disputes between patients and health insurance companies over coverage.

According to the Commonwealth Fund’s findings, one nation sees more of these battles than others: the United States. Other industrialized nations, such as Germany and Switzerland, are believe to have less complex systems. Some have more private sector involvement than others, but the survey’s authors generally believe that they manage to provide more affordable health insurance (America has the highest per-capita spending on it) without as much hassles.

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Don’t Delay Filing Out-Of-Network Health Insurance Claims

Monday, July 12th, 2010

Image: anomalous4 under CC 3.0

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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Your Health Coverage Can Be Canceled for One Penny

Friday, July 9th, 2010


Image: stevendepolo under CC 3.0

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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Germany Struggling With Health Insurance Costs, Too

Wednesday, July 7th, 2010

Image: Aenneken under CC 3.0

While the Germans are dominating the World Cup, the situation regarding their health insurance doesn’t look so bright. Just like the United States, their economy has been dealt several blows, and the nation is dealing with a major budget deficit.

Some believe that more direct government intervention will lower the cost of affordable health plans in the U.S., but Germany is proving that point wrong. Chancellor Angela Merkel (the German equivalent of our president) recently agreed to increase premiums for virtually all residents, from 14.9% to 15.5% of their gross pay–split between employers and employees. Insurers will also be allowed to ask for an extra premium to cover additional costs.

On the positive side, nearly 90% of the population is covered through their mandate. Unfortunately, they have failed to control severe jump in health care expenses.

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Americans Spend Double On Health Insurance, With Worse Results

Thursday, June 24th, 2010

A study from the Commonwealth Fund compared the health care systems of several developed nations. Unfortunately, the United States was again ranked at the bottom.

The survey found that, on average, Americans spent over $7,000 on health expenses in 2007. Still, their quality of care was not the highest. The authors blame the inequitable patchwork of individual, employer-provided, and public health insurance plans that leave millions uninsured.

So if the USA isn’t on top, who is? The Netherlands had the highest overall score. Maybe our health insurance system could learn from the Dutch.

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Did Group or Individual Health Insurance Premiums Rise More In ’09?

Tuesday, June 22nd, 2010

Image: TheTruthAbout under CC 3.0

According to the Kaiser Family Foundation, those buying individual health insurance have experienced far greater increases in their premiums recently.

Their findings:

  • 77% of those buying health insurance on their own were presented with a price hike
  • On average, those proposed hikes were 20%
  • 16% of those presented with proposed rate increases switched to less generous–and less expensive–health plans, either through the same or a different insurer. Many of the others didn’t switch due to pre-existing conditions that would make finding a different plan difficult.
  • Altogether, the average rate increase (including those who changed plans) was 13%.
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When Health Insurers Pay For Overtreatment

Monday, June 7th, 2010

Image: Photos8.com

Overtreatment is commonly considered as health care services that are provided when they aren’t necessary. It has been criticized as one of the factors that made healthcare reform a serious priority.

For example, MRI scans are often performed on people with low risk. Since such tests aren’t completely accurate, some people have back surgeries that could’ve been avoided. Those individuals, whose conditions may have improved through other means, may then require more surgery in a decade.

Other examples abound, including the cumulative levels of radiation absorbed through a high number of CT scans–which is linked to increased risk of cancer. Affordable health insurance becomes harder to find due to this overspending. The worst part is that there have been few studies that determine which common procedures are needed and which ones could be scaled back without hurting health outcomes or creating fears of rationed care.

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