Health Insurance Blog

Reuters is reporting that Healthbase Online, a medical tourism facilitator, is engaged in a pilot program with Wellpoint to provide global health care coverage to Wellpoints members in Wisconsin.  Healthbase’s involvement in the pilot involves setting up all the medical & travel logistics.

Under the Wellpoint program, members who choose to have non-emergency elective procedures performed overseas, such as joint replacement, will have access to Joint Commission International accredited HealthCare providers in India.

The program would save members thousands of dollars in out-of-pocket costs.

As previosuly reported here in this blog, studies conducted by UCLA medical school have shown that patients who have procedures down overseas have a much greeater chance of experiencing complications or post-op infections.  Nonetheless there continues to be interest in the program in the name of saving money.  We will see if similar programs proliferate among other health insurance carriers, subsequent to this pilot program.

Jill Brown, the Managing editor of AIS Health.com, wrote a report about how Blue Cross Blue Shield (BCBS) member health insurance plans have been launching new individual health insurance products that are in line with new state mandates that are designed to make individual health insurance more affordable.  The underlying theme is that the weak economy has and will continue to spur sales of individual health plans, as many people lose employer-sponsored health coverage.

Specific examples of BCBS plans launching new health plans or making adjustments to  existing health plans include:

1. Blue Cross Blue Shield of Arizona who recently launched (Sept.) a suite of 5 new individual health plans with premiums as much as 40% lower than their existing individual health insurance offerings, while still offering up to $5 million in lifetime benefits.
2. Wellpoint is expanding their affordable “SmartSense” line of indivudual health insurance plans to Colorado in November, and they plan to add even more states over the next few quarters.  The SmartSense product line was piloted in California and Georgia and now makes up more than 50% of individual health insurance sales in California.
3. Horizon BCBS of New Jersey is making adjustments to their individual health plan pricing by taking advantage of a new law that allows them to use a applicants age in their rate calculations which should make the plans more affordable for younger individuals.

As alluded to in this report, many health insurance carriers accross the country, not just BCBS member health plans, will be offering new health plans for individuals, and making their health insurance rates more affordable.  It is a great time to compare rates and see what is available in your state.

Wellpoint became the latest health insurance company to dabble with a medical tourism program.  Under this new Wellpoint pilot, members can travel to India to have some surgeries done.

Wellpoint would not only save thousands on medical costs, but they would also gain leverage in negotiatons with doctors.

Blue Cross Blue Shield of South Carolina, and Aetna have already launched medical tourism programs and both CIGNA and United Healthcare are currently researching the proposition.

Revamping the maligned US health care system was a focal point of President-elect Barack Obama’s campaign, and he will now be tasked with making good on that promise amid a significant economic downturn.

Obama’s plan is to expand Government health programs as well as subsidize health insurance coverage for people who can’t afford it, and technology spending to computerize health records to save money.  This plan to fix the health care system is priority #2 behind only achieving energy independence through further developing alternative energy sources.

Many experts think that change will be incremental but not substantial right off the bat, with the focus on expanding existing programs that assist low-income families maintain health insurance for their families such as children’s health insurance programs, which currently subsidize health insurance for 6 million children across he country.  Expanding programs such as SCHIP and Medicaid would help the health insurers that run the plans, such as Wellpoint, and United HealthCare.  Alternatively, reducing reimburesements  to insurers for Medicare Advantage enrollees would hurt health insurance companies such as Humana and Aetna, who would likely make up the difference in the form of health insurance premiums and/or reduced benefits.

There have been several articles published within the last week, most notably in the New York Times regarding health insurance rates paid by women compared to rates paid by men.  The article used health insurance quote data gathered from such health insurance companies as Humana, Aetna, and Wellpoint as well as online health insurance marketplace ehealthinsurance.com, and state high-risk pools.

The article in the New York Times sites several examples of price discrepancies between women and men of similar ages for identical coverage levels at various health insurance companies.  The data is rather compelling as the health insurance rate differences are in the 30-50% range.  However, does anyone really believe that health insurance companies are unfairly setting rates artificially high for women?

The article mentions the comparatively high health care expenses for women during child bearing years, but later dispels this as the sole explanation siting that the wide range in premiums couldn’t possibly be justified by actuarial analysis.

It would have been a more compelling analysis, and further solidified the argument if the author went on to compare health insurance rates for a 60 year old man vs women, an age when men’s health issues become more prominent.

After a quick analysis comparing rates on ehealthinsurance.com, an elderly man can expect to pay about 5% more than an elderly women for identical coverage levels.  The results of this quick test were not quite the results that I was looking for that would invalidate the argument that women are being gouged on their health insurance rates.  But my gut feeling tells me that the disparity between a women’s and men’s expected health care costs in their mid 30s, for example, are indeed magnitudes apart, and health insurance  companies are appropriately planning for potential claims.

The department of insurance (DOI) in each state must approve health insurance premiums based on claims history, and actuarial analysis, and would not approve rates if the this analysis didn’t support the rates  they requested.

Anthem Blue Cross Blue Shield of Indiana (a subsidiary of Wellpoint) announced an incentive program for physicians in their network which could increase their reimbursements by 10% if they follow recommended care guidelines.

Bonuses that physicians would be eligible for would be based their relative ranking when comparing the health status of their patients to others in the region.

The effectiveness that this program will have on improving care for Indiana residents is yet to be determined.

More information about Indiana health insurance, and a listing of top carriers who provide individual health insurance plans to Indiana residents.

Wellpoint in conjunction with X Prize Foundation, has announced a $10 Million competition to produce a system of health care proposals that would improve health care quality and reduce costs.  Wellpoint will payout the prize to the winner of the competition.

The competition could take several years as proposals would be tested in various state markets and the proposals must prove to be effective in order to qualify for the $10 Million prize.

This is a great step in getting all stakeholders involved in solving the health insurance challenges facing our country, ranging from the huge numbers of uninsured in this country, to the escalating health care costs, to rising health insurance rates that must be borne by individuals and families.