Health Insurance Blog

Bill Kaczor’s article “Crist signs Fla. health insurance bill” from the Miami Herald site, discusses new Florida health insurance legislation.  According to this article the new law (SB 1122) requires insurance companies to send payments to out-of-network doctors instead of the patient.  

Gov. Charlie Crist signed the legislation Wednesday making it law.  He said that sometimes when insurance payments were sent to the patients directly, the patient would keep the money and not pay their medical bills.  Because of this many providers are reluctant to accept out-of-network patients and reducing health care access by limiting patient doctor choices.  The new law may also reduce fraud by cutting out the middle man.  The payment will only get transferred once, instead of twice.

Consumer advocate coalitions urged that the bill be vetoed.  They argued that the new law may increase out of pocket costs for individuals and remove an incentive for doctors to have discounts available for in-network services.  This could potentially lead to higher premiums for in-network and out-of-network patients.  Walter Dartland, the executive director of the Consumer Federation of the Southeast believes that if you have health insurance the new bill will cost you money in the long run. 

Florida’s Health First InsuranceWound Management & Hyperbaric Center now offers free foot screenings for anyone diagnosed with Diabetes. 

The American Diabetes Association says that diabetes patients can suffer from poor circulation especially in the legs and feet and have a harder time fighting infection in these areas.  Many with diabetes also have a reduced sensation in the lower extremities because of nerve disease.  These two risks increase the chance of ulcers and infection which may lead to amputation. 

Because of these serious risks, Health First Insurance is offering weekly Diabetes Foot Check Clinics to check patients by a physician.  The free screening includes an evaluation of foot circulation, temperature, feeling, toenails, calluses and open sores.  They also provide patient education and recommendations.

For more information on these clinics, please visit Health First Health Plans’ website.

According to a recent article in the Orlando Sentinal, consumer advocate groups in Florida have warned that health insurance companies are misleading customers into believing that they are better off purchasing generic prescription drugs as opposed to their more expensive brand counterparts.

In many cases, brand name prescription drugs have an equivalent generic drug, which is perfectly safe and cost effective.  However in some cases, the Brand name drug that was prescribed by a patients doctor does not have an equivalent generic drug.  In those cases, the health insurer is recommending generics of different drugs that are in the same class.  This practice might not be a good plan for everyone, especially those prescribed anti-depressants, and blood pressure pills for example.   In any event, if the generic drug recommended is not an exact match of the brand name drug persribed, the doctor will have to approve the change anyway.

More information about Florida health insurance.

John Dorchner reports in the Miami Herald that the state might consider a bill that would require gender equity in Florida health insurance premiums. Florida’s insurance consumer advocate Sean Shaw is looking to team up with a congressperson that would sponsor legislation that would ban the practice of gender rating. Women pay higher premiums than men, even when you exclude maternity coverage.

For example, a Blue Cross Blue Shield of Florida policy for a 30-year-old in Miami costs $246 for a man and $291 for a woman. Insurers claim that women use more health care services and are more likely to keep up with regular screenings; some believe that’s a perverse incentive to forgo preventative care.

However, due to that higher level of utilization, older women are in better health and have lower health insurance premiums than their male counterparts. Using the BCBSFL example above, a 60-year-old Miami woman pays a monthly premium of $593, while a man of the same age pays $644.

The Sun-Sentinel’s Bob LaMendola wrote about a shocking trend among Florida health insurance companies: they’re now trying to save money by forcing consumers to take completely different drugs that are less expensive than the medications actually prescribed. While it’s customary for insurers to only cover generic versions of prescription drugs (that are chemically equivalent to the brand names), this is a recent development. Blue Cross Blue Shield of Florida and AvMed Health are among the insurers going this route. Patients have been informed that they will face increased co-payments or the elimination of coverage altogether for certain brand name medications.

Doctors are being encouraged to prescribe similar drugs with a generic equivalent; for example, instead of prescribing a patient Lipitor (which has no generic), give them the generic of Zocor. The insurance companies claim that these practices will result in an 80% savings. However, doctors are worried that insurance companies are attempting to second-guess their judgement on what a patient actually needs. Patients could suffer if forced to take a less effective drug. Bob points out that they can appeal to the insurance company if only the brand name drug is effective, but appeals are time-consuming and costly.

According to the Palm Beach Post, Blue Cross Blue Shield of Florida (BCBSFL) has enrolled a paltry 266 Florida residents in the Cover Florida Program since in inception at the turn of the year.

The Cover Florida Program, as previously discussed here, is a program championed by Governor Charlie Christ to help Florida’s 4 million residents without health insurance coverage, find affordable health coverage.  Health insurance companies that participate in the Cover Florida Program can offer low cost health insurance plans because they are permitted to offer bare-bones health plans that don’t conform with mandated benefits in Florida.

The low enrollment #s in the program can partly be explained by the fact that neither the state of Florida, nor BCBSFL have marketed the health plan agressively.

Several individual health plans from AvMed have been introduced in Florida’s Miami-Dade and Broward counties, states a press release. They suggest these plans would be most appropriate for these groups:

• self-employed individuals
• students
• early retirees
• people laid off/between jobs

The AvMed Individual Health policies’ benefits include some preventative care without a deductible, a maximum lifetime benefit of $5 million and full integration with Health Savings Accounts. An innovative three-month deductible carry-over lessens the burden of Florida health insurance costs by applying payments made in the last three months of one year to the following year’s deductible.

A variety of AvMed health insurance options with different levels of coverage are available to individuals and families; there are also plans specifically reserved for children (ages 2 through 17). If these new offerings are successful, the release claims that they will be expanded statewide.

Find more information about Miami health insurance.

The top four providers of Florida health insurance recently met to discuss health care under a Barack Obama administration, says Jeremy Cox of the Jacksonville Times-Union. Representatives from Humana, UnitedHealth, Blue Cross Blue Shield of Florida, and Aetna were in attendance.

The insurers believe that President Obama should enact a health insurance mandate for all Americans if, as they predict, he will require insurers to cover individuals with pre-existing conditions. They think that the cost will be prohibitive for carriers otherwise. At the moment, Obama has not publicly supported a mandate, and how exactly one would be carried out is unknown. He has supported a role for the private sector in universal health care, but that role will most likely be a change from the current market.

Instead of the plans Obama and congressional Democrats have proposed for health care reform, the insurance companies would prefer that the government focus mainly on enrolling eligible but currently uninsured individuals in federal-run programs like Medicaid and Medicare, Jeremy says. While the insurance companies agreed that greater coverage is a priority, they claim the task of covering other Americans should be left to them through innovative new plans.

Aetna Health Insurance and BayCare Health Systems have resolved a contract dispute that would have reduced health care access for over 300,000 patients in the Tampa, Florida area. Stephen Nohlgren of the St. Petersburg Times says that if BayCare and Aetna didn’t settle their issues, Aetna insurance would no longer be accepted by BayCare hospitals after the current contract expires on December 31st. Patients would then have had to deal with the scary prospect of scrambling for new hospitals and doctors.

As of this Wednesday both parties have reached a 3-year agreement that will keep the BayCare hospitals in Aetna’s network, Stephen reports. BayCare owns most of the major hospitals in the Tampa/St. Petersburg region; most notably the Morton Plant, St. Joseph’s, Mease and St. Anthony’s hospitals. Details about the deal haven’t been released, but this agreement will surely lessen the year-end worries of some Tampa health insurance consumers.

Women of child-bearing age (19 to 55 years old) pay more for health insurance than men, says Linda A. Firestone, Ph.D in the Sun-Sentinel. A typical woman’s policy includes maternity coverage, which accounts for the gender disparity in insurance rates. Since the majority of American adult women eventually have children, health insurance with maternity coverage makes sense for them–especially if there are pregnancy or birth complications.

Group health insurance plans (for example, those provided by employers) in Florida do not allow women to opt out of maternity coverage. If a woman does not plan to have children, she can choose to buy one of many individual health plans, which allow her to opt out of maternity coverage. In fact, many insurance providers (such as Humana), no longer offer maternity coverage in their plans. Insurance specialist Larry Wides says the cost savings from a group plan tend to cancel out the reduced premiums resulting from the elimination of maternity coverage.