Posts Tagged - ‘united healthcare’

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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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Rhode Island Health Insurance Premiums To Increase

Thursday, July 8th, 2010

Image: taberandrew under CC 3.0

Bad news for Rhode Island health insurance consumers: the insurance commissioner just approved several premium increases.

The health insurance rate hikes, which become effective next year, are as follows:

  • Blue Cross Blue Shield of Rhode Island: 9.8% for small and large business health insurance
  • United HealthCare: 12.3% for firms with under 50 employees, and 8.4% for larger companies
  • Tufts: 11% and 10.2%, respectively

On the bright side, these rate hikes are lower than those originally requested.

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More Restaurant Employees To Get Health Insurance

Monday, May 24th, 2010

Image: pixeljones under CC 3.0

When it comes to low-wage service jobs, the restaurant industry is at the forefront. Many employees earn minimum wage or less, due to expected tips. Many employers do not offer health insurance. Other times, the insurance is just too expensive for employees with variable hours. That is why up to 10% of the currently uninsured are those working in the food service industry.

A breakthrough agreement looks to change the status quo. United HealthCare (one of America’s largest health insurers) and the National Restaurant Association (a leading trade group) are working together to increase health insurance plan access to employees.

Four to six million people will be affected. So far, the program will only be available in several states, but they are looking towards expansion nationwide.

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Insurers Will Keep Selling Medicare Advantage Coverage

Tuesday, April 27th, 2010

Image: Muffet under CC 3.0

Even if you’re not quite eligible for Medicare Advantage yet, it’s a heartening sight. Private health insurance companies predict that the upcoming cuts in payments to their programs won’t stop them from selling the supplemental plans after the majority of the subsidies end in 2014.

United HealthCare has stated that they will continue to sell their Medicare Advantage health insurance plans, and other major competitors will probably follow suit. About 10 million senior citizens have these policies.

Contrary to prior belief, it looks like healthcare reform won’t kill Medicare Advantage, although the programs may adapt to the new market. The best, most efficient plans will actually receive a 5% bonus in payments.

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Virtual Fitness: Employers Creating Online Workout ‘Buddy’ Networks

Sunday, January 24th, 2010

Health insurance providers are offering their own versions of a virtual fitness system for the Web junkie set. Following a successful internal beta test with its own employees, “Aetna Health Connections Get Active!” is a group / team oriented fitness and nutrition program tailored to Aetna’s commercial employer health plan customers.

The company reports that more than 57 percent of its 35,000 employees in the United States participated in the “Get Active Aetna” program. One Aetna official from Arlington, TX reports the program helped him to lose 120 pounds. Other employees say the social networking component of the program has helped them connect with others who they otherwise wouldn’t have considered shaping up with. The program is a private-label product of Providence, RI-based Shape Up The Nation.

Even before the current Twitter and Facebook fanatics flocked to the Internet, Med School buddies Brad Weinberg and Rajiv Kumar learned from their early clinical days that patients who were the most successful at losing weight, increasing their exercise, quitting smoking and sticking to their goals all had one thing in common: they had social networking profiles and used their online friends to push them forward.

Aetna isn’t the only group health plan provider to put exercise in the cloud. Cigna, UnitedHealth and other major insurance companies offering their own brands of virtual fitness tracking and exercise regimes, to their own employees and to their plan subscribers. These companies and other FORTUNE 500s regularly report substantial cuts in healthcare costs, employee morale and retention by offering wellness programs that are fully integrated into social networking sites.

Some online fitness program providers work with companies to generate customized reports that tell CEOs which employees are using the program and how often. Other companies fully-integrate the data into Human Resources systems to cross-reference it with group health insurance claim information. While privacy advocates have concerns about the usage of such data to discriminate against employees in some way, national statistics tend to favor the employer:

  • The Kaiser Family Foundation reports: Nationwide, employer-sponsored health coverage premiums for family coverage have increased by 97% since 2000, from $6,438 to $12,680 in 2008.
  • Many have experienced 16% increases during the last 3 years much due to the rising epidemic of obesity and overweight adults.
  • A study in the Journal of Health Affairs noted that per person health care spending for obese adults is 56 percent higher than for normal-weight adults. Over 15 years, the additional costs incurred by obese adults with private health insurance versus normal-weight adults increased from $272 to $1,244 per person per year. The International Journal of Obesity reports, weight gains of 20 pounds are associated with medical care cost increases of >$500 over the last three years.
  • Obese workers lose about 13 times more days per year of work from injury or illness. (In an organization of 10,000 employees, with 32% obesity, that equates to 334,880 hours or an estimated 161 full time employees. With an average national salary of $38,500, the total cost of lost days can be as much as: $6,198,500 per year.)

Online nutritionists, exercise coaches and member message boards are also growing in popularity outside the workplace since real-live trainers are finding work in other industries and more exercise enthusiasts are cutting their gym memberships to save money.

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What United Healthcare 4th-Quarter Earnings Mean For You

Thursday, January 21st, 2010

Major individual health insurance provider United Healthcare just released its 4th quarter earnings report for 2009. It showed that the health insurance company’s net earnings increased by 30% to nearly $22 billion. Investors were pleasantly surprised, but what does this news mean for the average consumer?

Looking deeper, it seems that much of the increase was due to United Healthcare‘s lower medical loss ratio (MLR) decreasing. The medical loss ratio describes the percentage of health insurance premiums that is actually spent on providing medical care (as opposed to covering administrative expenses–including CEO salaries–and stock dividends). Wall Street was expecting that the insurer’s MLR would be 83%, but it turned out to be only 81.3%. Financial analysts speculate that the H1N1 flu being less severe than expected in the U.S., in addition to a decrease in Medicare costs, is responsible. However, the lower medical insurance costs are usually not passed onto consumers.

Obviously, shareholders are happy with the increase in profits; but is this the best news for consumers? United Health Care, like many health insurance providers, may be tempted to cut costs by decreasing the quality of care and/or raising health insurance rates in order to maintain its profit margin. The healthcare reform bill proposed by Congress would legally require that insurers’ medical loss ratios were above a certain level, i.e. 85 percent. The recent election of Scott Brown in Massachusetts puts that provision in doubt.

(Image: United Healthcare Website)

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