Health Insurance Blog

In US News & World Reports Ranking of the nations top health insurance plans, they ranked the Georgia health plans in the following order.

Kaiser Foundation Health Plan of Georgia (HMO) - Kaiser’s HMO ranked very well, receiving 5 stars in both treatment and Prevention measures.  The plan only received 2 stars on the customer assessment measure, but nevertheless the health plan was rated tops in Georgia overall.  (#27 nationally.)

CIGNA Healthcare of Georgia (#91)

Aetna Health Georgia (#116)

UnitedHealthCare of Georgia (#123)

Blue Cross Blue Shield of Georgia (#124)

Kaiser Foundation Health Plan of Georgia (POS) (#151)

Humana Employers Health of Georgia (#204)

Kaiser Foundation Health Plan’s HMO was a pretty clear #1 in Georgia, as they were the only Georgia health insurance plan receiving 5 stars in both  treatment and prevention measures.    The next several health plans ranking behind Kaiser were pretty equal in terms of ranking across the various measures.

The top North Carolina health insurance plans as ranked by US News and World report’s annual health plan ranking report are displayed below.  Of particular note is that a number of health insurers including the states oldest and largest health insurance company, BCBSNC, have chosen to not supply internal data that is required to provide accurate health plan rankings.  As a result, BCBSNC, as well other North Carolina health plans were not included in the 2008 rankings.

The top North Carolina health plans that particiapted in this report are

1. CIGNA Healthcare of North Carolina
2. Aetna Health of the Carolinas
3. UnitedHealthcare of North Carolina

A.M. Best reports that under an $825 Billion stimulus package proposed by house democrats, many Americans who have been laid off from their jobs since 9/1/2008 could have up to 65% of their COBRA insurance payments subsidized by the federal government.

The house bill that has been named The American Recovery and Reinvestment Act, allocates $39 billion to aid individuals seeking to continue paying their health insurance premiums through COBRA.  COBRA can be very expensive for individuals and families, and only an estimated 20% of those eligible enroll.

As non-group health insurance has evolved over time, and more health care options have become available for those without access to group health plans, individual health insurance has become an increasingly attractive option for families as an alternative to COBRA coverage, primarily due to their cost effectiveness, but somewhat due to the diverse coverage options such as PPOs, HMOs, point-of-service plans, HSAs and other health insurance instruments that years ago were only available to large groups.

Erin Allday from the San Francisco Chronicle recently reported on a proposal from the S.F. Attorney General that would eliminate bias in health insurance rates. Health insurance companies claim that they should be allowed to charge women under 55 more for health insurance than men, since they are more likely to suffer from some chronic illnesses and visit doctors for preventative care more often.

While 12 states ban or restrict the practice of gender rating, California does not. Women who buy individual health plans in California pay up to 39% higher premiums than men, according to Erin. The city of San Francisco is getting involved because women end up going to city clinics or emergency rooms because they can’t afford health insurance, costing the government money. 

A spokesman from America’s Health Insurance Plans, an industry group, states that gender rating is not discriminatory since women use more services. In addition, older men pay more for health insurance than older women. However, the Equal Employment Opportunity Commission prevents women from being charged more for their premiums based solely on their gender.

The National Women’s Law Center report found that women nationwide pay up to 48% more for health insurance than men, excluding maternity coverage. Maternity coverage is the most obvious factor that could drive up the cost of women’s health insurance.

It has been proven that preventative health care (check-ups and screenings) ends up costing insurance companies and society less in the long run. Should younger women be punished for taking responsibility for their well-being?

(Photo credit: Adria Richards under CC 2.0)

Blue Cross Blue Shield of Michigan (BCBSM) recently announced they may lay off as many as 1,000 employees.  In addition, BCBSM will be seeking double digit rate increases on many of their individual health insurance plans when they file their new rates with the office of financial and insurance regulation.

Rate increases sought will on average be a blistering 55% on individual health plans (which will impact more than 400,000 enrolled members), and 32% for their portfolio of Medicare supplement plans.

BCBSM has stated that the aforementioned health insurance rate increases are necessary due to the Michigan legislatures failure to act on two bills to reform individual health insurance in Michigan.

More information about Michigan health insurance, as well as other health insurers offering individual health plans, as well as health plans for seniors.

Kevin Kingsbury from the Dow Jones Newswires reports that the Centers for Medicare and Medicaid Services have forbidden WellPoint from adding new members to its Medicare plans. Compliance problems were discovered in separate audits.

As of January 13th, WellPoint is suspended from selling Medicare Advantage (hospital and physician coverage under a private plan) and Medicare Part D coverage (which covers prescription drugs).

Almost 2 million people have bought the company’s Part D coverage, while 3.7% (1.3 million) of their members are seniors on medicare. This suspension will be in effect until WellPoint fixes its undisclosed issues. The decision was a shock to WellPoint, since it have spent the past 6 months working closely with CMS to correct its errors.

Following up on a story reported a couple of days ago, UnitedHealth Group has agreed to pay $350 Million to settle a billing dispute related to out of network claims.  In addition, UnitedHealth pledged $50 Million and Aetna $20 Million to create a new database to determine our of network claims payment.  The previous database that was used was operated by Ingenix, a UnitedHealth subsidiary which was at the center of the dispute.

The Ingenix database, contained claims payment data that is contributed by health insurance companies.  The data is then used to set “usual and customary” charges for certain procedures, when members receive care outside of their network.

The lawsuit alleged that health insurance companies lowered the payment data when adding to the database, which allowed them to lower payments for future claims.  The patient would then be billed the difference.

An investigation by the New York Attorney General’s Office found that health insurers had underpaid by 10-28% as a result of the inaccurate data in the database.

President elect Barack Obama is expected to sign into law a bill presented by the U.S. house soon after he takes office that will increase spending on government funded children’s health insurance plans.

The bill would essentially add 4 million children to the existing roll of 7 million who are already receiving government subsidized health insurance.  The bill easily received congressional approval and is expected to easily receive senate approval as well.  The $32 Billion that it will cost to expand the health coverage will be covered by smokers in the form of a tax on cigarettes.

Part of the proposed bill gives states the option of eliminating the 5 year waiting period on providing government funded health insurance coverage to legal immigrants as well as pregnant immigrants.

The Hawaii Medical Service Association (which is part of Blue Cross Blue Shield of Hawaii), has launched a new virtual doctor’s visit service, according to the Arizona Republic’s Ginger Rough. Patients in Hawaii can now have a short consultation with one of 140 physicians whenever they need to, available 24/7!

Online doctor visits take place through either instant messaging, phone, or webcam. Although the consultations don’t always take place with your family doctor, any doctor can access your medical records (held by the insurer) if you give them authorization.

The service costs BCBS members in Hawaii a $10 co-payment for a 10-minute consultation, while the uninsured can use the service for $45 per consultation. (As a result, if you use the service often, it will be more cost-effective to have Hawaii health insurance.) Consultations can be extended for an additional fee.

Virtual doctor visits are probably a good idea for minor ailments or questions where you don’t need a complete examination, because they save time and money. Patients in rural areas will also have more access to doctors and specialists. However, some express worry that many conditions cannot be accurately diagnosed through the Internet, and that the poor and elderly will be disadvantaged by the technology.

(Photo credit: kuroda under CC 2.0)

Julie Appleby of USA Today reports that New York Attorney General Andrew Cuomo has reached an agreement with UnitedHealth Group that will protect policyholders against paying more than they should to see out-of-network doctors. While this immediately affects New York health insurance, the settlement could have far-reaching impact across the country.

UnitedHealth insurance used a subsidiary’s database (Ingenix)–as do many other health insurance providers nationwide–to determine how much doctors should be paid, through the insurers’ own reports of regional charges. Cuomo calls this a conflict of interest, and will establish a non-profit agency that will publicly post typical medical costs on a Website. UnitedHealth has agreed to donate $50 million to that agency.

On average, UnitedHealth underpaid out-of-network doctors by over 25%. Consumers suffer when doctors do not consider those incomplete reimbursements as full payment, since they have to cover the difference. The rules surrounding reimbursement of non-network care are often murky and confusing. According to Julie, Cuomo claims that many insurance plans don’t even tell consumers how much they’ll end up having to pay! 

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