Health Insurance Reform Isn't

At the same time Medicare is reducing options and benefits, important services are also being limited and controlled.  More change you can count on!

And today, 9/23, more increased cost acnnounced for insurance drug programs:

Millions of seniors face double-digit hikes in their Medicare prescription premiums next year unless they shop for cheaper coverage, a new analysis of government data finds.Premiums will go up an average of 10 percent among the top 10 drug plans that have signed up about 70 percent of seniors, according to an analysis of Medicare data by Avalere Health, a private research firm.
Marketing for next year's drug plans gets under way Oct. 1, and seniors will see some of the biggest changes since the Medicare prescription benefit became available in 2006. More than 17 million are enrolled in private drug plans offered through Medicare.  Read complete article

And as you can clearly see, this is not what people were expecting, along with being the result of insider deals with Big PhRMA and Big Insurance.

For me it is tragic to read because I know so many people will be impacted in negative ways, thier finances and thier health.

This is certainly one more reason to take our natural health calsses or sponsor one our our "HealthY Options for Seniors" programs in your community.

From 9/22, continue below -

Medicare Cuts Back on Nutritional Screening

One lab test per year to screen for all nutrient deficiencies or imbalances. Test your vitamin D levels, and you’re done. If you’re on Medicare and live in the Southwest, one test per year is all you’re allowed.

As part of the 2003 Bush Medicare bill, Medicare chose fifteen regional firms as Medicare Administrative Contractors (MACs). These MACS handle claims, deny or approve procedures, and make rulings on what is allowed to be covered under Medicare in their region.

Last month, Trailblazer Health Enterprises, the MAC for Region IV (Colorado, New Mexico, Oklahoma, and Texas), said that from now on, each beneficiary could receive only one lab test per year to detect deficiencies of vitamins, minerals, and other nutritional components. “Medicare considers vitamin assay panels [to be] a screening procedure and therefore, non-covered,” according to the decision. “Similarly, assays for micronutrient testing for nutritional deficiencies that include multiple tests for vitamins, minerals, antioxidants and various metabolic functions are never necessary.” This would be the most restrictive policy in the nation regarding tests for vitamins and minerals.

ANH-USA believes it’s critical to get complete nutritional profiles—or at least multiple nutrient tests—to ensure optimal health. This new policy discounts the importance of optimal nutrition and nutrient levels in the prevention and treatment of disease.

A spokesperson for a testing laboratory in Texas, who asked that the company’s name not be published, told us, “It is well known that physicians often find it reasonable and necessary to order multiple tests to detect deficiencies of vitamins, minerals and antioxidants (and such a position is fully supported by the scientific literature).

“On a routine basis, for example, physicians commonly order tests for vitamins B-12 and folate simultaneously. [Physicians who understand] the clinical relationships between nutritional deficiencies and disease processes may frequently find it reasonable and necessary to order a broader range of nutritional tests….Each of these physician’s orders—based on the physician’s determination of medical necessity—would be denied coverage under the proposed Trailblazer policy solely because more than one test is requested.”

Seniors may also be affected by efforts to reduce Medicare fraud, leading to possible finger printing of their doctors. And perhaps a contributing factor as to why more doctors are moving to hospital based provider systems.

By Joyce Frieden, News Editor, MedPage Today

WASHINGTON -- Medicare providers who have a "high risk" of defrauding the government could be fingerprinted and undergo background checks under new regulations proposed Monday by the Centers for Medicare and Medicaid Services (CMS).

The proposed rule -- which is part of the Affordable Care Act signed in March by President Obama -- "strikes a balance that will permit CMS to continue to assure that eligible beneficiaries receive appropriate services from qualified providers whose claims are paid on a timely basis while implementing enhanced measures to prevent outright fraud," according to the agency. "[The rule] will help assure that only legitimate providers and suppliers are enrolled in Medicare, Medicaid, and [the Children's Health Insurance Program], and that only legitimate claims will be paid."

The idea behind the rule is to help the agency transition from its "pay and chase" approach to fraud -- under which providers are paid and then Medicare determines which payments were fraudulent and then chases after the providers to get the money back -- to a strategy of fraud prevention, the agency explained in the conclusion to the rule.

The "pay and chase" system "functions reasonably well when the problems arise with legitimate providers and suppliers that will be solvent and in business when CMS seeks to recover overpayments or law enforcement pursues civil or criminal penalties," CMS noted. "It is not adequate when the fraud is committed by sham operations that provide no services or supplies and exist simply to steal from Medicare or Medicaid and thrive on stealing or subverting the identities of beneficiaries and providers."

Under the rule, providers of services or supplies to the Medicare program would be classified under one of three categories relating to possible fraud: limited risk, moderate risk, and high risk:

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  Limited-risk providers would have enrollment requirements, license, and database verifications.

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  Moderate-risk providers would have to meet those requirements -- plus unscheduled site visits.

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  High-risk providers would have to meet the initial requirements and would also undergo unscheduled site visits, criminal background checks, and fingerprinting.

In the proposed regulation, the CMS notes that "in general, we consider physicians, nonphysician practitioners, and medical clinics and group practices to pose limited risk because these professionals are State licensed and we are not aware of any recent studies or other evidence that indicates that these suppliers, as a category, pose an elevated risk to the Medicare program."

In addition to the new requirements for high-risk providers, other provisions of the proposed rule include:

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  Allowing Medicare to suspend payments to a provider as soon as a credible allegation of fraud exists

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  Allowing application fees to be imposed on Medicare providers and suppliers

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  Requiring Children's Health Insurance Programs and Medicaid programs to terminate providers that have defrauded the Medicare program

Medicare will be accepting comments on the proposed rule through Nov. 16.

© 2004-2010 MedPage Today, LLC. All Rights Reserved.

And in yet another move, coverage for children with pre-existing conditions is in trouble, from NPR -

Health Insurers Skirt New Coverage Requirement For Kids by Julie Rovner

Starting late this week, parents of children with pre-existing health conditions were expecting to breathe easier.

That's when a provision of the federal law overhauling health care takes effect and bans insurance companies from denying individual policies for kids with a history of health problems. But families counting on the change could be in for a shock.

The Denver Post reports, "at least six major companies — including Anthem, Aetna, Cigna, and Humana — have said they will stop writing new policies for individual children" in Colorado. The companies "blamed health reform mandates taking effect Thursday requiring companies that write such policies as of that date to also cover sick children up to age 19," the paper said. 

The Washington Post reports that three big insurers — WellPoint, Cigna and CoventryOne — made their decisions because of "uncertainty in the health insurance market."

By dropping all new children-only coverage before the effective day of the new mandate, the companies effectively sidestep the new requirements.

The advocacy group Health Care for America Now was the first to bring the action to widespread attention. "Even for the insurance industry this behavior is surprisingly brazen," HCAN Executive Director Ethan Rome wrote in a blog entry for the Huffington Post. "They don't like the rules, so they're going to take their ball and go home."

But the insurance industry trade group America's Health Insurance Plans rejected HCAN's contention that the companies' refusal to sell to all comers is somehow a violation of a promise made earlier this year by AHIP CEO Karen Ignagni that insurance companies would comply with regulations regarding children and pre-existing conditions.

In an interview, AHIP spokesman Robert Zirkelbach said Ignagni was responding only to promises that children wouldn't be excluded from their parents' plans and that if the kids are covered, the policies would include treatment of their pre-existing condition.

What emerged in the regulations, however, Zirkelbach said, was, in effect, a  requirement that insurance companies accept children even if they are already sick. That, he said, would be tantamount to exactly what companies want to avoid with the adult population — letting people wait until they are sick to sign up for insurance. Which is exactly why the insurance industry is so insistent on a coverage mandate: It needs premiums of healthy people to help cover the costs of those who are not.

Thus, he said, the companies in question "are having to make some difficult decisions" to stop offering coverage to all new children rather than take the chance that only the sick would enroll. At least until 2014, when everyone is supposed to be covered under the law.

Posted in: ANH,Big Insurance,children,Medicare,NPR,Nutritional screening,preexisting condition,Trailblazer