Posts Tagged - ‘health insurance’

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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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Florida Rep. Tries Anti-Health Insurance Mandate Amendment Again

Wednesday, November 24th, 2010

Image: turtlemom4bacon under CC 3.0

Last year, State Representative Scott Plakon (R-Florida) attempted to put a measure that would amend the state’s constitution to forbid mandating the purchase of health insurance on the ballot. That time, a judge rejected it due to what was considered overly political and misleading language.

Undaunted, Plakon is trying again. House Joint Resolution 1 would challenge the Obama administration’s healthcare reform legislation, which will eventually fine certain individuals and employers for failing to purchase affordable health insurance. It would give Florida more legal standing in its lawsuit against the federal government’s provision.

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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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59 Million Americans Without Health Insurance Last Year

Monday, November 15th, 2010

The Centers for Disease Control and Prevention recently released a survey that found that 59.1 million people in the United States were uninsured for at least some part of 2010. In contrast, just 56.8 million were uninsured in 2008.

One in three middle-income adults (considered to have annual incomes between $43,000 and $65,000) under the age of 65 lacked a health insurance plan some time during the past twelve months, according to the CDC survey.

Many blame the recession for this turn of events, since millions have become unemployed and therefore lost their employer-sponsored health benefits.

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Health Insurance Company CEO Retiring

Friday, October 22nd, 2010

Image: Listphile

Health insurance companies are going through many changes at the moment. For Aetna, this is just one more: their CEO, Ronald A. Williams, is stepping down from that role next month. (He will retire from the company entirely early next year.) Williams was the chief executive officer since 2006, and was in charge of the lucrative segment of health insurance plans during a period of soaring costs.

Who will replace him? Aetna President Mark T. Bertolini is being promoted to fill the gap. Bertolini will also have a seat on the board of directors. However, Williams will still be involved as a consultant on healthcare reform issues until February 2012. He will receive $20,000 a month for those services, in addition to a retirement package valued at over $7 million. (Presumably, his health insurance is fully covered.)

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Michigan Judge Says Health Insurance Reform is Constitutional

Monday, October 11th, 2010

Image: Seattle Municipal Archive under CC 3.0

Opponents of healthcare reform are pinning their hopes of overturning the law on the legal system. Specifically, they contend that the individual mandate provision that requires people to purchase a health insurance plan violates states’ rights.

That argument was recently rejected by one federal judge. In Michigan, U.S. District Judge George Sheeh accepted the Obama administration’s contention that the refusal to buy health coverage materially affects interstate commerce; therefore, Congress has the right to create the mandate.

Of course, the plaintiffs will appeal. Also, two other similar lawsuits are pending in Florida and Virginia–which may be in more conservative districts.

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Healthcare Reform Provisions and Obesity Treatment

Wednesday, September 22nd, 2010

Image: Combined Media under CC 3.0

Tomorrow, several of the earliest provisions of the healthcare reform law will go into effect. Many of these involve preventative care.

The paradox with a lot of health insurance plans is that they typically do not pay for medically supervised diets or nutritional counseling for the overweight and obese. (They may cover gastric bypass or other weight loss surgery, but some patients are not considered morbidly obese enough to be eligible for reimbursement.) However, they will cover the more expensive cost of treating related conditions like type 2 diabetes or sleep apnea when they are later developed.

The legislation looks to change that. Here is how it will change:

  • Recommended preventative care treatments are covered without co-payments or co-insurance percentages for policyholders, including behavioral counseling and obesity screening.
  • Public health initiatives will make calorie counts more visible, making it easier for people to eat healthily and lose/maintain their weight.
  • Comparative effectiveness research will be undertaken to determine if insurers will be required to cover gym memberships, therapy, or special meal programs.
  • An advisory group will look into the effectiveness and risks of weight loss drugs and surgery, possibly requiring coverage of those deemed more effective than harmful.
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Will Health Insurance Plan Provider Pay $10 Billion Fine?

Thursday, September 9th, 2010

One of the many complexities associated with health care is the constant mergers and buyouts. The worst-case scenario is that when your health insurance plan is caught in the middle, your health falls by the wayside.

That’s what the state of California’s insurance commissioner accuses PacifiCare of doing after being acquired by United HealthCare several years ago. Former PPO patients state that their documents were lost or incorrectly entered into the system, causing their claims to be denied. This allegedly went on for several years, from 2006 (shortly after the merger) until 2008.

The insurer is unlikely to pay out the entire sum: it’s only the maximum they could be liable for, based on a fine of $100,000 per count for nearly a million counts. In the vast majority of cases, they will settle with the state.

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Healthcare Reform Lawsuit Arguments Continue

Tuesday, August 31st, 2010
health insurance plans
Image: steakpinball under CC 3.0

When it comes to healthcare reform, controversy is never far behind. The federal government has continued to argue that the law is constitutional. In a district court, their lawyers claim that the burden of proof should be on the coalition of states suing.

Specifically, the states claim harm from the provision that mandates the purchase of health insurance plans. If a person or business does not comply, they are subject to annual fines of $695. However, the plaintiffs have allegedly failed to demonstrate imminent or actual financial injury, since that aspect of the legislation does not take effect until 2014.

Moreover, the federal government claims that even if the penalty (which would be collected by the IRS) is technically considered a tax, the Anti-Injunction Act prevents states from challenging it, since the individual mandate is considered integral to the structure of the bill.

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Most Health Insurance Plans Don’t Cover Fertility Treatments

Monday, August 30th, 2010
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Image: Daquella manera under CC 3.0

Treatments for infertility can be very expensive. The average cost of one round of in-vitro fertilization is $12,400; it often takes several cycles in order for it to be successful. Meanwhile, many women choose to implant multiple embryos for greater chances of success.

Not only are the actual treatments expensive, but they can lead to high-risk pregnancies and the complications that often result from multiple births. Due to the high cost, most health insurance plans don’t cover fertility treatments. The number of plans that include infertility coverage has decreased over the past decade.

Those that do are typically larger employers. In those cases, oral medications that promote fertility are more likely to be covered except for a nominal co-payment.

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