Health Insurance Blog

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.

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.

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.

Earlier this week, 6 health insurance companies in Florida signed contracts with the state to offer affordable health insurance to the uninsured in Florida.  The health insurance offerings vary, but in general are less than $100 per month.

The program championed by Florida Governor Charlie Christ is called Cover Florida, and will launch on January 5, 2009.  The plan was unanimously approved by the Florida Legislature and require no tax dollars to make it happen.

The six participating health insurers will offer 25 health plans options between them, and each with 2 different benefit levels (one focusing on catastrophic coverage & hospital coverage, and the other on preventive care).

Of the six health insurance companies only offerings by Blue Cross Blue Shield of Florida and United HealthCare are available in all 67 Florida counties.

In yesterday’s Miami Herald, John Dorschner reported that Blue Cross and Blue Shield of Florida is now offering a discount card statewide for those without health insurance. For $20 per month, the new FamilyBlue card administered by Coverdell gives individuals discounts on routine medical expenses such as:

• prescription drugs and vitamins
• doctor visits
• dental, vision, and hearing care
• diabetes supplies

However, unlike individual health plans the card doesn’t cover hospital stays, which are most likely to lead to medical bankruptcy. Dorschner also wrote of problems surrounding doctor awareness about the program. Out of 10 approved providers for the FamilyBlue card, only one doctor accepted it when asked. Experts say these discount cards may be more suitable for young and healthy individuals less likely to need hospitalization.

Nine health insurance companies, including Blue Cross Blue Shield of Florida (BCBSF), have agreed to participate in a plan to provide affordable health insurance coverage to the 3.6 million Florida residents that are currently uninsured.

The plan proposed by Governer Charlie Crist is called Cover Florida.

The Florida health plans offered by carriers as part of Cover Florida will be on a guaranteed issue basis (meaning that applicants cannot be refused coverage).  BCBSF will offer two health plans, catastrophic coverage for $150 per month, and a non-catastrophic plan for $50 per month on average.

Health insurers participating in the program can offer health plans with lower premiums because they are exempt from the requirement to inlcude more than 50 state mandated beenefits in the health plan

In addition to BCBSF, some of the other insurers who are participating in the program include: UnitedHealthCare, Total Health Choice Inc., Universal Healthcare, JMH Health Plan, Medica Health Plan of Florida, American Management Advisors and Celtic Insurance Co.

A number of national health insurance companies including Aetna, Humana, and CIGNA choose not to participate in the program.