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NY Gov. Signs Ian’s Law to Limit Health Insurers’ Ability to Drop Patients

Posted in Health Insurance , Health Insurance Companies

August 20th, 2010
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New York Governor, David Paterson, recently signed a new law that will improve health insurance protections for patients. According to the signed legislation, also known as “Ian’s Law,” health insurance companies will not be able to suddenly drop a patient or cut their benefits without following specific guidelines.

The Inspiration Behind Ian’s Law

Ian’s Law is named after Ian Pearl, a 37-year-old man suffering from muscular dystrophy, whose health insurance coverage was terminated without an option for replacement coverage that would cover his treatments. While his treatments were intense (24-hour nursing care) and expensive, his family felt that the sudden termination of coverage was unlawful, resulting in a lawsuit against his insurer, Guardian Life Insurance Company of America.

Initially, the lawsuit upheld his coverage discontinuance. However, a separate lawsuit revealed company documents showing the insured had compiled a list of its costliest members (calling them names like “dogs” and “train wrecks”) and planned to get rid of them.

How “Ian’s Law” Will Protect Patients

After realizing that the company had bad intentions for high-cost policyholders, the governor decided to take action. On Thursday, he signed the new law that would protect patients in the following ways:

• Insurers must notify of discontinuation: The new legislation amends the states current law by requiring insurance companies to give written notice of pending discontinuation at least 90 days prior to the date of discontinuation of coverage.
• Insurers must offer alternatives: If a policyholder’s plan will be discontinued, the insurer must provide that policyholder with options to purchase alternative, replacement health insurance that is already offered by the insurer.
• Policyholders can’t be dropped due to high costs: The law also mandates that a policyholder cannot be dropped from a group plan just because the individual is high-cost.

In addition, policyholders with serious medical conditions who have had related insurance benefits in the 12-month period preceding the discontinuation will be able to keep their present coverage if similar coverage cannot be made available.

The law benefits policyholders because it holds the insurance industry accountable for the coverage it provides. In addition to protections offered by health care reform, this law should protect individuals from being dropped who have played by the rules with their insurance companies.

Today’s News: AMA Criticizes Health Insurers, Sacramento Considers Out-of-Town Motorist Tax and Primary Care Doctors Harder to Find

Posted in Auto Insurance , Health Care , Health Insurance , Health Insurance Companies

August 4th, 2010
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A letter issued by the American Medical Association is requesting that health insurance companies reveal their doctor rating system. In other insurance news, a study has found that the elderly pose fewer threats on the rode than their younger counterparts and in the state of Massachusetts it seems that primary care doctors are hard to find.

AMA Criticizes Health Insurers

A sharply worded letter from the American Medical Association (AMA) to the nation’s largest health insurance companies was released on Monday. In the letter, the association and 47 medical societies called on insurers to disclose to the public how they assessed doctors’ performance. Also, they want insurers’ methods to be reviewed by independent parties to stop what is viewed as unreliability of physician profiling.

Right now, the AMA believes that ratings systems used by insurers is not accurate enough to correctly direct patients to reliable doctors and hopes that this letter will initiate change that is long overdue (NY Times).

Sacramento Considers Out-of-Town Motorist Tax

Sacramento, Calif. is considering a tax on out-of-town motorists who are involved in local auto accidents. The Sacramento City Council’s Law and Legislation Committee looked into considering an ordinance that would impose the tax at its July 20 meeting.

In the proposal, non-residents would be billed if they were involved in motor vehicle accidents in the city. In some cases, the non-resident’s auto insurance company will cover the bill, but it’s possible that that non-resident would be stuck with the bill (24-7 Press Release).

Primary Care Doctors Harder to Find

While Massachusetts has the highest ratio of doctors per population in the country, it seems that residents are still having a difficult time finding a primary care physician who is accepting new patients.

New data from the Division of Health Care Finance and Policy discovered that last year 60 percent of family medicine doctors’ offices were accepting new patients. This is down from 70 percent in 2007. Even worse, only 44 percent of internal medicine practices were accepting new patients. To respond to the shortage, the report found that around 214 new primary care physicians would need to be hired (Market Watch).

Today’s News: Maine Seeks Health Care Waiver, Home Burglaries Increase and Blue Cross Cuts Cost by 20 Percent

Posted in Blue Cross Blue Shield , Health Care , Health Insurance , Health Insurance Companies , Home Insurance , Home Insurance Claims

August 2nd, 2010
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Officials in Maine recently asked the government for the right to be exempt from one provision of health care reform, home burglaries are said to be on the rise in the state of Texas and Blue Cross has decided to cut costs by 20 percent.

Maine Seeks Health Care Waiver

The insurance regulator in Maine recently asked the Obama administration to temporarily exempt the state’s health plans from a provision of the health care overhaul that would affect their profits. The provision is a measure of how much health insurance companies would spend on medical care in comparison to their administrative expenses and profits. The new law requires insurers to pay out at least 80 percent of the premiums collected on medical care. The insurance regulator says that these changes would result in one health plan, HealthMarkets Inc., to stop doing business in Maine, only leaving one health plan option for consumers (Wall Street Journal).

Home Burglaries Increase by 9 Percent in Texas

According to Allstate Insurance, the number of home burglary claims for the company’s customers in Texas jumped by 9 percent in 2009. Among the items that were stolen the most were flat screen TVs, laptops, jewelry and cash. While many of the burglaries looked to be neighborhood criminals, some were reported to be tied to organized criminal activity. The insurance company recommended that in addition to locking up homes securely whenever leaving the house, it’s important to have a quality home insurance policy to pick up the pieces financially (PR Newswire).

Blue Cross Cuts Cost by 20 Percent

Many insurance companies have had to make adjustments to accommodate health care reform and Blue Cross and Blue Shield of North Carolina is one of them. The company recently announced its plans to cut its administrative costs by 20 percent. This adjustment is predicted to result in the layoff of up to 4,400 employees, but will ultimately help improve financial results for the company while keeping premium costs down for customers. The change is expected to take place by 2014 (The Charlotte Observer).

States Debate on Running Health Insurance Pools

Posted in Health Insurance , Health Insurance Companies

May 4th, 2010
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The health care debate that spent so much time at the national level has now filtered down to states as they try to figure out whether they need health insurance pools. While some governors have claimed federal funds to start their own health insurance pools as soon as possible, other governors have decided to decline the option altogether. The deadline to claim the funds was Friday.

What the Pools Are About

As a result of the health care reform law, states were given the opportunity to create health insurance pools that would allow those with pre-existing conditions who are not currently insured to join what is called a “high-risk insurance pool.” In this pool, these individuals would be allowed to purchase insurance with they’d previously been rejected by private health insurance companies.

While some governors jumped on the federal funds to get their pool started in their states, others decided the pool wasn’t for them.

States Opting In/Out of Insurance Pool

A number of states have decided to take part in the health insurance pool option. Some include:

• Montana
• Pennsylvania
• Washington
• Wisconsin

These states, run by Democratic officials, along with Republican-run California, will operate these programs under contract with the federal government. Aside from Arnold Schwarzenegger’s support, most Republican-run states have opted out of the program, including:

• Georgia
• Indiana
• Nebraska
• Nevada

One Democrat-run state, Wyoming, has also opted out.

Why States Are Opting Out

Wyoming’s governor, Dave Freudenthal, has said he’s chosen to opt out of the program because he feels that the state’s federal allotment of $8 million “may prove insufficient” to subsidize coverage for the next three and a half years, seeing that the funds would have to last until Jan. 1, 2014 when health insurance companies would be have to accept all applicants.

Other state leaders feel that having some funds is better than none at all and therefore, this step is a great first one toward getting the masses insured.

How do you feel about adding a high-risk health insurance pool for your state?

No Anti Trust Laws for Health Insurance Companies: How it Affects You

Posted in Health Insurance , Health Insurance Companies

November 27th, 2009
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In 1944, the Supreme Court ruled in the case United States vs. South-Eastern Underwriters Association. At that time, the judgment allowed the federal government to regulate the insurance industry. One year later, the McCarran-Ferguson Act managing the “business of insurance” was passed by Congress and the law mandated:

• States, not the federal government, are in charge of insurance oversight
• Individual states set up their own licensing requirements
• Health insurance companies exemption from federal antitrust legislation

The laws are still in place and as a result, health insurance providers and medical malpractice insurers are not beholden to the federal antitrust regulations. The administration of the Federal Trade Commission are in charge of managing the antitrust regulations that are in place to promoting free enterprise and good competition in the marketplace and prevent price fixing, but these are a set of rules that private insurers are exempt from.

Insurance Companies Fix Pricing Structures

Until this day, behind the scenes, insurance providers are working together regarding insurance forms and sharing loss data. This is the primary information used in determining industry pricing structures. According to the New York Times if the laws are not altered “…health spending will grow an average of 6.2 percent a year, to $4.4 trillion in 2018.”

Health Care Options

This antitrust exemption status hurts you, the consumer. The industry nearly has free reign in determining both the prices and the policies governing health insurance application denials or claim submissions rejections. Additionally, the health care industry has been able to band together and challenge the portions of health care reform not in their best financial interest, giving them the upper hand (i.e. public option). If the exemptions does not change, individuals and families may be legally responsible for obtaining health insurance, but may not have the affordable options available needed to make health care reform work.

In direct response to this legality and to help health care reform progress, Vermont U.S. Senator Patrick Leahy has introduced a bill to repeal antitrust exemption from health-related insurers. Leahy has clearly stated the detriment of ,antitrust exemptions to consumers stating, “Price fixing, bid rigging and market allocation are ‘per se’ violations of our laws precisely because there is no procompetitive justification for them. Health insurers should not be accorded immunity to engage in such otherwise illegal conduct.”

Considering Bigger Health Insurance Companies

Posted in Health Insurance , Health Insurance Companies

October 8th, 2009
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Medical insurance is a necessity that needs to be provided to everyone. In order to ward of any financial shortcomings that astronomical medical expenses may run you, affordable health insurance is the only practical solution. When selecting a health insurance plan, consumers need to decide on the type of policy they want, the coverage limits they are comfortable with and whether they want to go with a bigger health insurance company versus a smaller one.

Bigger health insurance companies are powerful beasts and there are some benefits to joining a bigger health insurance company.

However, with bigger companies also comes more red tape, and the consumer may be at a disadvantage in certain areas.

Not all health insurance providers are created equally. It is important to note that bigger does not always mean better. Consumers debating their options for health insurance need to consider more than the size of the insurance organization when weighing coverage. Here are some things you should consider when choosing a health care provider:

• Premiums
• Deductibles
• Copayments
• Benefit levels
• Customer service ratings

By doing a search on the web for specific insurance companies, you will find people just like yourself who posted their experiences online.

Health Care: Are Bigger Companies Better?

Posted in Health Care , Health Insurance , Health Insurance Companies

August 11th, 2009
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When it comes to health insurance, bigger health insurance companies aren’t necessarily better. With a big health insurance company, you’re getting health insurance at the most affordable rate (at least, according to American standards- don’t forget that American health insurance is among the most expensive in the world.). You’re getting a big, stream-lined, and highly regulated machine that keeps costs as low as possible due to the sheer bargaining power of having so many participants. There are some downsides to big health insurance companies however.

American health care costs are high and it’s not accessible to everyone. Most Americans who are lucky enough to have it get it from their employers as a benefit. Employers and the companies they run participate in plans offered by big health insurance providers. These big health insurance providers contract with doctors and medical facilities to keep prices low. As part of their attempts to keep everything running smoothly, the big health insurance companies have developed extremely complex systems of rules and regulations for what they do and don’t cover. This can make life easier for many participants because it’s all spelled out for everyone to see.

Bigger health insurance companies aren’t necessarily better than smaller ones because they tend to be overwhelming in their bureaucracy and paperwork. You might also feel more like a number or a statistic because that’s really what they’re all about. Personalized customer service at one of the bigger health insurance providers may be lacking.

***To learn more about whether bigger health insurance companies are better or worse than smaller ones and other questions related to health insurance, be sure to consult with an expert. He or she can share their expertise with you and help you select the health insurance company that’s the right, best size for your needs. And, you can always find free health insurance quotes online if you’re looking for a new provider with a touch more personal care.***

Health Insurance Consumer Guides

Posted in Compare Health Insurance , Health Insurance , Health Insurance Companies , Save on Health Insurance

April 9th, 2009
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Until a few years ago, most people had their health insurance provided by their employers as a standard benefit. In those days, you didnt really have to think very much about what sort of insurance policy to get; the employer chose it for you, and your choices were limited to whatever sort of policy the employer offered.

When to Use Health Insurance Consumer Guides

In these troubled economic times however, many employers have had to scale back their benefits programs or eliminate health insurance for their employees entirely. Many people are not covered at all by their employer, or are only partially covered. Or, they may be an independent contractor or sole proprietor. Whatever your situation, as a health insurance consumer, you may be facing a bewildering array of choices as a health insurance consumer. What is the best health insurance policy for you and your family? Do you need an insurance agent? Whats the difference between an HMO and a PPO? As an independent consumer, you may need some guidance and education when it comes to choosing your own health insurance policy. Thats where a health insurance consumer guide comes in.

Using Consumer Guides

Health Insurance Consumer Guides are all over the internet, and can help answer your questions and guide you through the sometimes confusing process of shopping for health care coverage. Many are put out by different consumer advocacy groups or government consumer services agencies. Groups of insurance agents may also offer advice on how to choose the best health care plan for your needs. If you are looking for information on how to compare policies, what types of health insurance policies exist, what a health deductible is, or how to cover a preexisting condition, contact one of these agencies and request a health insurance consumer guide. Your state health department may also have such a guide on their website.