Posts Tagged - ‘health insurance companies’

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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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Health Insurance Companies Spent $86 Million on Anti-Healthcare Reform Lobbying

Thursday, November 18th, 2010

Image: DonkeyHotey under CC 3.0

Some people may worry that this is what at least a portion of their health insurance premiums has been paying for: according to Bloomberg’s examination of major insurers’ tax records, they spent a total of $86 million on the U.S. Chamber of Commerce’s campaign to defeat the Obama administration’s healthcare reform legislation in 2009.

These expenses–public rallies and events, media advertisements, and sponsored polling meant to sway opinion–would probably not qualify as falling under the medical loss ratio guidelines, which say that a certain percentage of customer premiums should be spent on providing care through their health insurance plans, as opposed to administrative and other expenses. Cigna and United HealthCare were among the biggest givers. In addition, the Chamber of Commerce is only one of the myriad interest groups opposing the law.

Was it a worthwhile investment? The bill passed early this year, so maybe not. However, they appear to have successfully swayed the views of a significant portion of the American public. The Republicans now taking over Congress will do their best to weaken the law, if not repeal it entirely.

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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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State Health Insurance Commissioners To Rule on Medical Loss Ratios

Thursday, October 21st, 2010

Image: turtlemom4bacon under CC 3.0

All eyes are on Orlando today, but not because of anything Mickey Mouse has done. Rather, it is a meeting of several states’ insurance commissioners. Their topic: coming up with the rules that insurers will have to abide by post-healthcare reform.

Specifically, they are responsible for calculating minimum medical loss ratios. MLRs are also known as the percentage of premiums spent on providing health care, as opposed to profits and administrative expenses. Proponents of the limits believe that they will result in more affordable health insurance for consumers. However, some are worried that the new rules will make some niches and entire markets–such as small groups–less appealing, and that people will become uninsured as a result.

The group’s recommendations will become effective next year. Although the already-determined limits are 85% for large group plans and 80% for small groups and individuals, the commissioners will consider tax exemptions and a longer phasing-in period. Most significantly, they will help determine what counts as a medical expense. Insurers obviously want a wider definition of qualified medical costs.

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

Friday, July 9th, 2010

Image: whoohoo120 under CC 3.0

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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Health Insurance Company Harvard Pilgrim Agrees To Lower Rates

Monday, July 5th, 2010

Image: Guerilla Billboards

Regulators have been facing off with health insurance companies over proposed premium increases that the former consider excessive, and the latter think are necessary to continue doing business.

Apparently, compromise is possible. Harvard Pilgrim Health Care agreed to a settlement with the state of Massachusetts that limits their individual and small group health insurance rate increases. The decrease is insignificant: their initial requests ranged from 8% to 12%, while the new deal has increases of 7% to 11%.

Since earlier caps on premiums set by the state were rejected on appeal, the insurer could’ve kept fighting. However, they chose to move on instead–although they will still lose money under the agreement. Thankfully for consumers, Harvard Pilgrim (the second-largest insurance provider in the state) also agreed not to retroactively bill policyholders since April for the higher rates.

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Virginia Health Insurance Company Abandons Patients

Wednesday, June 30th, 2010

Individuals in one state now have one less option for health care. UniCare has decided to pull out of the Virginia health insurance market, due to competitive pressure from larger insurers.

Some of their nearly 3,000 patients are eligible to switch to Anthem Blue Cross Blue Shield, but others don’t live in Anthem’s coverage area. They will need to search for new health insurance coverage by January 1st, when UniCare’s plans will expire.

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Obama Warns Insurers Against Circumventing Healthcare Reform

Tuesday, June 22nd, 2010

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Health insurance companies are preparing for the impact reform will have on them. Some of this preparation is gaining negative attention from President Obama–namely, increasing their rates severely before healthcare reform takes effect and significantly limits their ability to do so. Since the law will keep them from increasing rates solely for profit-maximizing purposes, they ideally want to have the highest floor before it becomes effective.

Today, he is holding a meeting at the White House to drive this point home further. Although the federal government doesn’t gain direct control over regulating health insurance plans, it gains more oversight responsibility. Their worst-case scenario is that insurers increase their rates before provisions begin taking effect this summer, while blaming the legislation for forcing them to make those moves.

The president of industry lobbying group America’s Health Insurance Plans, as well as executives from 13 health insurers and several state insurance commissioners, will attend the meeting. It is unclear whether it will have any actual impact on their actions. Some believe the summit is more of a political move, intended to protect Democrats against blowback in the midterm elections.

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New York Cuts Health Insurance Funding

Tuesday, June 8th, 2010

Image: Vikram Vetrivel under CC 3.0

Economic programs have forced states to make painful cuts in their programs. Now, it’s New York’s turn. Governor David Paterson is one step closer to signing an emergency spending bill that severely cuts health care and health insurance spending.

By spending less on hospitals and other health-related ventures, the state also gives up some matching federal subsidies. The $775 million in cuts includes the elimination of a prescription drug program and millions in reduced funding for health care for the poor.

On a positive note for consumers, the bill also reinstates prior approval of insurers’ rate increases. That will make private coverage more affordable, saving the state $70 million that would be otherwise spent providing government-sponsored coverage for those people. New York health insurance rates are some of the highest in the nation.

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Can Health Insurance Companies and Obama Administration Work Together?

Friday, June 4th, 2010

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Over the past year and a half, politicians have often vilified the health insurance industry in order to garner support for healthcare reform. Meanwhile, health insurers have hit back at the government.

Nevertheless, now that it’s law, both sides have to cooperate to implement it effectively. Health insurance plan providers want to continue profiting, so they want the most favorable regulations possible. They also want to be able to take advantage of the upcoming subsidies.

For their part, the Obama administration needs to work with insurers to ensure that the process goes smoothly; their political life depends on it.

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