Health Insurance Blog

According to the article “An affordable insurance quote requires careful research” on healthcare.com customers will benefit from doing their research when shopping for health insurance quotes.  You may find an affordable quote quickly, but read the fine print to prevent future issues with your policy. 

One potential issue is in and out-of-network stipulations.  PPO and HMO plans offer discounts to health providers that the insurance company has negotiated with to set reasonable rates.  Medical tests and various procedures are usually cheaper with in-network physicians.  Researching what is included in the in-network costs can save you a lot of time and money as you use the health care system.  There have been many scenarios where patients go to an in-network hospital but tests are sent to an out-of-network lab and the patient is left with the cost. 

To avoid such complications, compare options side by side and shop around for health insurance quotes.  Find out how benefits vary from providers to ensure you have the coverage best suited for your needs at reasonable costs. 

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. 

In the New York Post, Brendan Scott reported on shocking findings that New York City health insurance premiums have seen a significant increase over the past year, while many New Yorkers are already struggling economically. Here are some sobering statistics:

• From April 2008 to April 2009, the average monthly health insurance premium for a family has risen from $3,866 to $4,354; a 13% increase.
• Six out of the eight health insurers in the NYC area have increased their rates, including Aetna, Atlantis Health Plan, and Oxford Health Plans, Brendan says.
• Insurance companies blame the rate increases on an exodus of healthy policyholders leaving them with only the sickest (and costliest) patients, in addition to the state’s co-payment structure and high mandated coverage minimums.

On the bright side, Empire HealthChoice HMO actually decreased its premiums. Not to mention that patients who remained in-network for their health care pay less: a family who agreed to stick to in-network providers paid just $2,996 per month on average. That’s still a 12% increase over last year, but a significant savings nonetheless.

(Photo credit: bridgepix 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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