News In Healthcare

I can­not believe that we needed to con­duct a study in order to know that indi­vid­u­als who under­stand their health insur­ance cov­er­age require­ments, will make bet­ter choices about seek­ing med­ical ser­vices.  The Boston Her­ald recently pub­lished the find­ings of just such a study.  What was found was that indi­vid­u­als who knew what their co-payments were for med­ical ser­vices were more cost-conscious when decid­ing when to seek those med­ical ser­vices.  These indi­vid­u­als were con­sid­ered “savy.”

I don’t call it being savy.  I call it using com­mon sense.  If you know that each emer­gency room visit is going to require you to pay $250 out of your pocket  ver­sus $25 for each physi­cian office visit, com­mon sense says that you will visit your physi­cian and not the hos­pi­tal emer­gency department.

It is not sur­pris­ing that when a new law is issued that requires that 38 mil­lion peo­ple to obtain health insur­ance, that some­one is going to jump in right away and start sell­ing insur­ance cov­er­age to these indi­vid­u­als.  The prob­lem is that the first one in is usu­ally the scam artist try­ing to take advan­tage of the con­fu­sion sur­round­ing the new require­ments and the vul­ner­a­bil­ity of cer­tain seg­ments of our pop­u­la­tion.  Rec­og­niz­ing that the insur­ance scams have already started, Health and Human Ser­vices Sec­re­tary Kath­leen Sebe­lius sent let­ters to the state Attor­ney Gen­er­als and Insur­ance Com­mis­sion­ers on April 6, 2010 warn­ing them of the practices.

The state offi­cials have been asked to be on the look­out for these fraud­u­lent door-to-door insur­ance sales peo­ple and 1–800 schemes.  The state offi­cials are to send bul­letins to their state pop­u­la­tion warn­ing them of these prac­tices.  A sud­den require­ment to cover 38 mil­lion Amer­i­cans is cer­tainly excit­ing to the insur­ance indus­try and those plans that are not above-board will cer­tainly try to max­i­mize their sales.  Before hand­ing over a check to cover the pre­mium pay­ment for your new health insur­ance plan, please be sure to check out your state Depart­ment of Insur­ance web­site or call your Insur­ance Com­mis­sioner to ver­ify the valid­ity of the plan.

In a let­ter to Health and Human Ser­vices Sec­re­tary Kath­leen Sebe­lius, Karen Ignagni head of America’s Health Insur­ance Plans and the nation’s top health insur­ance indus­try offi­cial, said that the indus­try will fully com­ply with new reg­u­la­tions pre­vent­ing cov­er­age denials for chil­dren with pre-existing con­di­tions.  The reg­u­la­tions are expected to be issued within the next few weeks.

It is trou­bling that Ms. Ignagni was in a posi­tion where she had say to the fed­eral gov­ern­ment that the health insur­ance indus­try will fol­low the rules and not cause prob­lems.  How­ever it is believ­able that this was required given the recent actions by health plans to hap­haz­ardly rescind cov­er­age based upon pre-existing conditions.