Health Insurance Blog

The Senate Finance Committee is coming close to figuring out a healthcare reform bill according to Maggie Guo’s article on The Ethiopian Review site.  Health care cooperatives are still on the table, which has the idea of building large groups so that the price of expensive medical costs are spread out among members to reduce costs for everyone.

But Consumer Watchdog says this will not necessarily lower health insurance quotes for consumers.  They say that in practice there has not been enough members for cooperatives to carry out their function and people with less medical risk often opt out of joining. 

For a cooperative to be effective, member enrollment would need to be near 500,000 consumers according to some estimates.  There have been attempts in Texas, Florida and Colorado without much success.  There is also the concern that if small states get together to create bigger groups, then health insurance companies may insist on a suspension of state regulations because of the different types of customers they would be serving.  This would in turn cause a whole new type of oversight and possibly a lack of proper regulation. 

Blue Cross Blue Shield member plans initiatives to  increase access to affordable health insurance by the uninsured.

Part IV

GoBlue is a product offered by Blue Cross Blue Shield of Florida which provides Florida residents access to doctor visits, basic and preventative dental care, prescription coverage, and lab tests all at affordable rates as low as $26 per month, for a 25 year old.

GoBlue is a guaranteed issue producty which means florida residents cannot be declined due to health conditions.  In addtion, the product has no lifetime maximums so members can continue to be enrolled as long as they continue to pay their monthly premiums.

More information about Florida health insurance.

Miami-Dade county in Florida has teamed up with Blue Cross Blue Shield health insurance of Florida for a very unique partnership according to the article “Dade, Blue Cross offer health plan” by John Dorschner on miamiherald.com.  Currently there are around 600,000 uninsured in Miami-Dade county and leaders felt something needed to be done to fix this. 

Janet Perkins with the Office of Countywide Healthcare Planning believes this is a cutting edge program for Florida health insurance and a national model.  It’s called Miami-Dade Blue and it’s a revolutionary option to offer affordable health insurance to the uninsured.  This special health insurance would cost a healthy 35 year old man around $100 which is extremely low.  This concept was first a vision of Commissioner Joe Martinez from about 5 years ago.  He said it’s been a long, hard road, but he’s truly excited and good things can come from this plan. 

There are some concerns over the benefits of the program.  Some insurance brokers believe the benefits may not be as good as most popular plans which may cause a problem as policyholders file claims.  One of the major challenges was getting providers to take discounted prices.  Approximately 1,500 doctors have agreed to be included in the Miami-Dade Blue network which is a great start in the right direction.

The Health First Foundation is going to host the 8th annual Grape Escape on October 24th according to Health First’s website.  This event is put on each year to raise money for Intra Cardiac Echocardiography (ICE). 

This year’s food and wine-tasting events at Seasons 52 in Orlando features culinary delights created by the internationally recognized Executive Chef Clifford Pleau.  Proceeds from the evening will go to Health First Cardiac Services.

Highlights of the Grape Escape include a multi-course meal served with distinctive wine from the large wine cellar.  Wines, fine art, jewelry and vacation packages will be auctioned off at the live auction.  Dick Beagley is heading up the Health First Foundation volunteer committee that is organizing this year’s event, which is sure to be spectacular.  Health First Insurance is a subsidiary of HealthFirst Inc,  a non-profit health care system that serves Florida’s Space Coast.

According to the article, “Blue Cross requiring psychiatrists to get prior authorization before treating patients” by Liz Freeman on naplesnews.com, Blue Cross Blue Shield health insurance of Florida implemented a new rule taking effect this fall which will require psychiatrists to get authorization before treating patients in their office or out patient locations.

Blue Cross sent letters to psychiatrists which outline the new rule that goes into effect on Oct 3.  A contract amendment must by signed by the mental-health providers by June 24 if they accept Blue Cross Insurance.  The pre-authorization will be required to treat patients for office based visits, inpatient admissions, and for partial psychiatric and substance abuse care.  Emergency visits are covered but the provider will need to request authorization.  This is all outlined in the notice from Blue Cross.

Blue Cross officials state the new authorization rule is partly because of the Mental Health Parity Act of 2008 which intends to end inequity between medical treatment and mental health care for plans with 50 or more employees.  The David Lawrence Center, a private nonprofit mental health center in Golden Gate, Florida, believes its expenses may rise with the new rule, but their patients will not face any fee increases and they will not turn anyone away because they have Blue Cross.

The state of Florida was not included in the Southeast region when J.D. Powers ranked the top health plans in the Southeast, in their rating of the top health plans in 17 distinct regions, Florida is its own region.  That being said, J.D. Power and Associates rated Blue Cross Blue Shield of Florida as the top rated health plan in Florida.

BCBSFL was rated as being among the best health plans in the country, as was Humana, coming in just behind the Florida Blue Cross Blue Shield plan.

Other Florida health plans that were rated as part of this study included UnitedHealthCare, CIGNA, and Aetna.  UnitedHealthCare was given 4 stars out of 5 in overall experience (better than most) while CIGNA & Aetna were given 2 stars, a below average rating.

More about Florida health insurance.

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.