News In Healthcare

I can’t believe that it was back on 9/28/06 when we posted our first item on the prob­lems Cal­i­for­nia insur­ers were fac­ing for wrong­fully rescind­ing patients’ poli­cies.  Almost three years later, we are still hear­ing about cases where Blue Shield of Cal­i­for­nia and Health­Net are still under fire for rescind­ing poli­cies.   The AP is report­ing that Health­Net just entered into a set­tle­ment with a class of patients where Health­Net will cre­ate a $1.95 mil­lion fund to pay those patients’ out­stand­ing med­ical costs.  Blue Shield, on the other hand, has seen a dif­fer­ent turn of events.  A Cal­i­for­nia judge ruled yes­ter­day that Blue Shield was right to drop the pol­icy of a man who sued the insurer for wrong­fully ter­mi­nat­ing his pol­icy.  The judge foudn that Blue Shield con­ducted an appro­pri­ate inves­ti­ga­tion of the mat­ter and deter­mined that the patient’s spouse did in fact know­ingly mis­rep­re­sent infor­ma­tion on the patient’s insur­ance application.

I love to see where the largest pay­ers rank when it comes to per­cent­age of claim denials, days in A/R, denial trans­parency.  That is why I was so excited to see the new report issued by Athena Health.  This site allows you to ana­lyze payer per­for­mance by region and by issue.  Can you believe that Unit­ed­Health Group ranks #1 in the nation for the per­cent­age of denied claims that close with only one addi­tional resub­mis­sion?  Of course they ranked 4th in the per­cent­age of denied claims requir­ing addi­tional work on the back-end.

Health insur­ance is clearly a neces­sity but where do we go to choose what is right for us? Sounds like many young Amer­i­cans are in the same quandary when it comes to this ques­tion. A recent study reported by Dow Jones Newswire shows that young Amer­i­cans do not feel they have the infor­ma­tion needed to make the right deci­sion about health insur­ance cov­er­age. The poll fur­ther found that while the indi­vid­u­als were will­ing to research their options, many felt they lacked the proper resources.

Watch out friends! If you are con­duct­ing research online be sure you know who is shar­ing this infor­ma­tion with you. Many insur­ance com­pa­nies want you to believe you are get­ting tremen­dous cov­er­age for small monthly pre­mium pay­ments but hid­den in the pol­icy they will make a por­tion of the claims your responsibility.

To share a per­sonal exam­ple, just a year ago Trilogi, Inc. my employer, polled the staff to choose between two health plans: one plan that cost a bit more monthly but pro­vided greater cov­er­age includ­ing lower deductibles and out-of-pocket costs, and a sec­ond plan that cost less each month but that pro­vided less cov­er­age and had a higher deductible. At the time, the staff was rel­a­tively new in deal­ing with health insur­ance issues so a major­ity opted for the “cheaper” monthly pre­mium. After a year of fol­low­ing up with insur­ance car­ri­ers and see­ing just how much insur­ance car­ri­ers are leav­ing as patient respon­si­bil­ity, we polled the same group of indi­vid­u­als to see which type of plan they would choose now and to no sur­prise, the group stated they would rather pay a few dol­lars more each month for bet­ter cov­er­age in the long run.

Unit­ed­Health Group, the nation’s largest insurer, released its report on the U.S. can save money on health care.  Please remem­ber that this is the same group whose Pres­i­dent and CEO, Stephen J. Hem­s­ley, was recently called to be ques­tioned by the U.S. Sen­ate Com­mit­tee on Com­merce, Sci­ence & Trans­porta­tion in hear­ings enti­tled “Decep­tive Insur­ance Indus­try Prac­tices — Are Con­sumers Get­ting What They Paid For?”

We all know that there is a grow­ing cost to med­ical providers ren­der­ing ser­vices to the unin­sured pop­u­la­tion — approx­i­mately $42.7 bil­lion went unpaid last year.  We also know that some­one has to be con­tribut­ing to pay­ing for that care.  But did you know that that cost is being cov­ered through a hid­den tax on the pre­mi­ums of peo­ple with insur­ance?  Accord­ing to today’s USA Today, the aver­age U.S. fam­ily and their employ­ers paid an extra $1,017 in health care pre­mi­ums last year to com­pen­sate for the uninsured.

What is miss­ing from the stud­ies done and the state­ments made at the con­gres­sional hear­ings is that on top of pay­ing a “hid­den tax” on our pre­mi­ums, most insureds are actu­ally “under­in­sured” and end up foot­ing most of their health­care expenses because of high deductibles or insur­ance denials.  To be pay­ing a tax on top of that for health­care ser­vices not ren­dered to those indi­vid­u­als is just one more rea­son why the cur­rent health insur­ance indus­try needs imme­di­ate reform.

As reported in the New York Times yes­ter­day, antitrust lawyers are say­ing that hos­pi­tals, physi­cians and insur­ance com­pa­nies will be run­ning huge legal risks if they agree to work together to con­trol costs — as asked to do so by Pres­i­dent Obama.  How can this be?  Accord­ing to a rep­re­sen­ta­tive of the Fed­eral Trade Com­mis­sion, while coop­er­a­tion among health care providers can ben­e­fit con­sumers, it can also increase the bar­gain­ing power of hos­pi­tals and doc­tors, mak­ing it eas­ier for them to set prices and elim­i­nate com­pe­ti­tion.  Just another hur­dle in our quest for health­care reform.

Busi­ness Week reported that Unit­ed­Health Group, Inc., the nation’s largest man­aged care com­pany by rev­enue, spent $1.5 mil­lion dur­ing the first quar­ter of 2009 to lobby Con­gress, the Depart­ment of Health and Human Ser­vices, the Con­gres­sional Bud­get Office, and the Cen­ters for Medicare and Med­ic­aid Ser­vices.  It seems to me that that money would have been bet­ter spent pay­ing patients’ med­ical bills.