Posts Tagged - ‘health insurers’

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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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Will AT&T’s New Business Make Health Insurance Plans Cheaper?

Tuesday, November 9th, 2010

Last week, AT&T announced that it will be launching a new unit called ForHealth. The target market is doctors, health insurance companies, hospitals, and pharmaceutical firms.

It aims to provide cloud-based networking solutions, which are set to lower medical costs while improving communication–and therefore patients’ health. Many believe that moving to digital record keeping will lower the cost of health insurance plans, with the savings hopefully being passed onto consumers.

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Athletes Struggle To Find a Health Insurance Plan

Tuesday, October 26th, 2010

Image: Studio Finch under CC 3.0

Intuitively, most marathon runners and other serious athletes would be a good bet for health insurance plan providers. They are extremely fit, making them less likely to develop chronic health conditions like diabetes. On the other hand, they are actively working towards better health.

However, there’s a catch in that model of an ideal investment: injuries. So far, health insurers have reserved the right to deny coverage based on pre-existing conditions, and a severe injury or accident could qualify. Either the policy will cover everything except treatment related to the injury, or they will be denied a policy altogether. (The healthcare reform law looks to end this in 2014.) In addition, even minor sprains or other injuries require doctor’s and hospital visits, driving up health insurance costs.

On the bright side, many distance runners buying individual health plans tend to be on the young side, making their coverage cost less.

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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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Individual Health Insurance Coverage Denials Rose Since 2007

Thursday, October 14th, 2010

Image: Oldmaison under CC 3.0

Over the past two years (ending in 2009), four major health insurers’ rates of denying coverage to individual health insurance plan applicants rose by 50%.

A report from the House of Representatives Energy and Commerce Committee claims that WellPoint, Aetna, UnitedHealth, and Humana purposely refused to sell coverage to over 600,000 people with pre-existing conditions. Up to 425 health conditions could disqualify a person from coverage under one insurer, and some would not conduct further internal review before denying coverage.

On the one hand, the insurers may have seen the writing on the wall when President Obama was elected, and wanted to maximize their profits as much as possible before regulations would limit their ability to discriminate based on pre-existing conditions.

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Should Health Insurance Plans Cover Gastric Bypass Surgery?

Thursday, September 16th, 2010

Image: EmerandSam under CC 3.0

Obesity is a condition that impacts the health of millions of Americans. There are several options in dealing with it: diet and exercise is the most obvious. An increasing number of health insurers are encouraging the former through wellness programs.

However, success rates are relatively low. Some are proposing gastric bypass surgery as a solution. Some health insurance plans cover the $30,000 surgical procedure for the morbidly obese, but others believe that the investment in preventative care. Obese teenagers, especially, are increasingly taking advantage of it.

By no means is surgery a panacea: some people manage to regain all their weight (though fewer than the 95% who do so with diet and exercise), and up to a third of patients have medical complications. Still, in most cases gastric bypass seems to cure type 2 diabetes (which is expensive to treat for many years). The Atlantic‘s Marc Ambinder, himself a gastric bypass patient, speculates that paying for the procedure for all obese Americans would end up costing less than the medical complications associated with obesity. However, it is an extreme option of last-resort, and is an over $30 billion-worth pipe dream.

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Pennsylvania Health Insurance Companies Under More Scrutiny

Thursday, June 10th, 2010

With rising health insurance rates and a high unemployment rate that makes it harder for people to afford them, several states have used their regulatory power to take matters into their own hands. The Obama administration is giving grants to states who plan to step up enforcement.

Pennsylvania is the latest to attempt capping rate increases. Democratic Governor Ed Rendell criticized the state’s major health insurers–Independence Blue Cross and Highmark among them–for allegedly gouging consumers by increasing premiums by over half! That is in contrast to the 5% to 10% annual increase in actual medical spending.

Rendell and others accuse Pennsylvania health insurance companies of extracting as much money as possible prior to to the most stringent healthcare reforms taking effect.

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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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