Showing posts with label health insurance. Show all posts
Showing posts with label health insurance. Show all posts

Friday, May 20, 2011

More on Profit with Less for Care

Many people are finding that, even with health insurance, they cannot afford to pay for medical or dental work - a growing number of individuals are simply putting things off.

In many situations your health can be improved and many problems prevented with education and information 
This might make you want to consider subscribing to Health Forensics 

Health Insurers Making More Money Than Ever While People Postpone Medical Care

SOURCE



Cost keeps many U.S. adults from eye care

Published: May 19, 2011 at 11:09 PM


ATLANTA, May 19 (UPI) -- Cost, or the lack of health insurance, keeps many U.S. adults from getting eye examinations, putting their vision at risk, health officials say.


A report by the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report, says survey data indicate many people with visual impairment report not seeking eye care because of the cost, lack of health insurance, or the perception that they did not need care.


"People ages 40-64 are most likely to cite cost or lack of insurance as a barrier to eye care, while people ages 65 and older -- the age group with highest prevalence of moderate to severe visual impairment -- were most likely to say they did not need eye care," the report says. "Residents of Massachusetts, which has the smallest proportion of uninsured people because of mandated health insurance were least likely to cite cost or lack of health insurance as a barrier to eye care."


CDC health officials say it is important to have people age 40 and older with risk of any age-related eye disease -- or chronic disease that affects the eyes, such as diabetes -- get regular comprehensive eye exams. Many serious eye diseases can be detected before symptoms appear and treated to reduce visual impairment, the report says.



Thursday, November 11, 2010

Direct Care from your Health Provider, Not a New Idea

Many health care providers over time have not participated in the health insurance scam. Over 20 years ago small health groups started offering this type of service. Over all the providers were happier and so were patients.

Our natural health organization has offered this for over a dozen years

Now mainstream media has caught on.  Perhaps legislators will too... 


The plans are called Direct Medical Care -- and go by other names such as concierge medicine, retainer-based practices, subscription-based practices -- and cut out health insurance companies by having patients pay doctors directly, resulting in lower prices because doctor's don't have to spend as much time filling out insurance paperwork.

About one-third of a doctor's time is spent on administrative tasks, said Eduardo Cisneros, who with Axel Lapica co-founded Symbeo, a direct medical practice in Bloomfield, N.J. Instead of filling out paperwork, doctors can spend up to 30 minutes with a patient at Symbeo. Preventative care is a primary need among its patients, but many also join so they can get immediate care when they need it, Cisneros said.

"The biggest impetus for people joining is they feel they have the need to see a doctor," he said of the five-month-old business with 80-90% of its customers uninsured.

With 70 million Americans uninsured or under insured -- with 59 million of them without health insurance for part of 2010 --it's a big market. Dan, a 35-year-old Symbeo patient who didn't want his last name used, told WalletPop that he joined the group in June because at the time he didn't have health insurance. He's self-employed and a student, and now has other health insurance. He plans on keeping his direct medical care coverage with Symbeo because it's an inexpensive way to get a second opinion, which he says makes his $40 monthly fee "priceless."

"I don't have the money to pay for what each individual doctor's appointment would cost me," he said.

Dan has hypertension and has had to pay cash out of his pocket to see a specialist, which isn't covered in his direct medical care plan.

"I might not be in dire need of medical help, but I want to keep up on any medical conditions," he said.

Symbeo's plan covers prevention, sick visits, minor stitches and chronic illnesses such as asthma and high cholesterol. It's offices don't have major medical equipment or specialists, although referrals are made. Supplemental insurance for emergencies, such as through Aflac, is needed.

Symbeo's plans per person are $40 a month if paid a year in advance, or $50 a month for three months. The low prices don't equate to low quality by doctors who got their medical degrees through an overseas correspondence course, Cisneros said.

"People have asked us flat out, 'Are these doctors? Are these students? Are these foreigners?' " he said. He answers they are all real doctors.

At Qliance, a direct primary care group in Seattle, the monthly fees range from $44 to $129 depending on age and service preferences for unrestricted access to its doctors and nurse practitioners. Using Qliance with a low-premium insurance plan can reduce health care costs by 40% to 50%, according to the company.

Qliance offers 30- to 60-minute office visits, on-site X-ray, laboratory and a "first-fill" prescription drug dispensary, and no limits for preexisting conditions. Its routine care includes vaccinations, routine blood tests, women's health services, pediatric care, broken bones and ongoing management of chronic diseases like diabetes and obesity.

With a 30-minute visit with a doctor guaranteed, joining a direct medical care plan is like a throwback to the family doctor and having a personal doctor to take care of you. And with prices starting at $40, they're a throwback to a time when medical care wasn't as costly.

Tuesday, September 7, 2010

NO CHANGE: Big Insurance

18 September 

Aetna granted 19% increase

Aetna gets OK to hike rates on individual health policies in California
The increase will average 19% and will take effect Oct. 1 along with double-digit hikes by Anthem Blue Cross, Blue Shield of California and Health Net that also had been reviewed by the Department of Insurance.

United Health is promoted by AARP and owned in a major part by Big PhRMA Novartis.

California regulators seek up to $10 billion in fines from PacifiCare

The health insurer violated state law nearly 1 million times from 2006 to 2008 after it was bought by UnitedHealth Group, the Department of Insurance says.

by Duke Helfand

California regulators are seeking fines of up to $10 billion from health insurer PacifiCare over allegations that it repeatedly mismanaged medical claims, lost thousands of patient documents, failed to pay doctors what they were owed and ignored calls to fix the problems.

In court filings and other documents, the California Department of Insurance says PacifiCare violated state law nearly 1 million times from 2006 to 2008 after it was purchased by UnitedHealth Group Inc., the nation's largest health insurance company by revenue.

Regulators say the companies broke promises to maintain smooth operations for 130,000 of PacifiCare's customers, resulting in what insurance regulators nationwide believe is the largest fine ever sought against a U.S. health insurer.

Monday, June 28, 2010

Health-Insurance Caps to Fail

Once again collusion in Big Insurance raises an ugly head -
Trying to rein in health spending by limiting on insurance rates is like trying to hold down the lid on a pot of boiling water. Aside from the fact that insurance costs partly reflect ever-increasing medical costs over which insurers have little control, the legal justification for saying “no more” has never been clear. This has become apparent in Massachusetts, where an administrative court has ruled against a state-imposed insurance cap, and in California, where insurers have retreated temporarily from big rate hikes but are expected to return with new demands. Complete story
While cost control is often helpful, restraining trade and reducing income for health professionals is against sound economics.

Wednesday, May 5, 2010

Consumer groups call for reviews of insurers' rate hikes

The move comes after errors are found in how health insurer Anthem Blue Cross calculated proposed premium increases for policyholders in California.

May 04, 2010|By Duke Helfand, Times Staff Writer

After serious errors led health insurer Anthem Blue Cross to cancel a massive increase in health insurance premiums last week, consumer advocates are calling for a review of pending rate hikes by other big insurers in California.

A prominent healthcare advocacy group urged the state's two insurance regulators Tuesday to seek independent assessments of all increases in premiums for individual policyholders and those who get insurance through small employers.
Complete article

Thursday, April 29, 2010

Health Risk and Cadillac Insurance

Its always been will known in the health industry - and for decades - that the better your insurance, the better your care.

A new study shows consistent outcomes - especially if you require critical care.

Critical care outcomes tied to insurance status, systematic review finds

ScienceDaily (2010-04-28) -- Among the general US population, people who are uninsured are about half as likely to receive critical care services as those with insurance, according to systematic review of the literature by the American Thoracic Society's Health Disparities Group. They also found that once admitted to the hospital intensive care unit, uninsured patients are less likely to have invasive procedures or pulmonary artery catheterizations and more likely to have life support withdrawn. ... > read full article

Thursday, April 1, 2010

New Health Bill and Tax Provisions

Tax Provisions in the Health Care Act

MARCH 22, 2010
The Patient Protection and Affordable Care Act (H.R. 3590), passed by Congress on Sunday, contains numerous tax provisions.

The Reconciliation Act of 2010 (H.R. 4872), which also passed the House on Sunday, contains many other tax items, including extending the general exclusion for reimbursements for medical care expenses under an employer-provided accident or health plan to any child of an employee who has not attained age 27 as of the end of the tax year and codifying the economic substance doctrine. The reconciliation bill has not yet passed the Senate.

Among the many tax provisions in the Patient Protection and Affordable Care Act are the following:

Saturday, February 13, 2010

Insurance Rates Soar 15 Percent and More

Certainly this report makes a strong case for single payer to cover all citizens in the US, including members of congress.

And please make a point to understand that it is the insurance companies that drive up the costs, as they control all the licensed providers engaged in third party billing.
Individual insurance rates soar in 4 states
By LINDA A. JOHNSON, AP Business Writer
Fri Feb 12, 2010

TRENTON, N.J. – Consumers in at least four states who buy their own health insurance are getting hit with premium increases of 15 percent or more — and people in other states could see the same thing.

Anthem Blue Cross, a subsidiary of WellPoint Inc., has been under fire for a week from regulators and politicians for notifying some of its 800,000 individual policyholders in California that it plans to raise rates by up to 39 percent March 1.

The Anthem Blue Cross plan in Maine is asking for increases of about 23 percent this year for some individual policyholders. Last year, they raised rates up to 32 percent.

Kansas had one recent case where one insurer wanting to raise most individual rates 20 percent to 30 percent was persuaded by state insurance officials to reduce the increases to 10 percent to 20 percent. The insurance department would not identify the company but said it was not Anthem.

And in Oregon, multiple insurers were granted rate hikes of 15 percent or more this year after increases of around 25 percent last year for customers who purchase individual health insurance, rather than getting it through their employer.

Premiums are far more volatile for individual policies than for those bought by employers and other large groups, which have bargaining clout and a sizable pool of people among which to spread risk. As more people have lost jobs, many who are healthy have decided to go without health insurance or get a bare-bones, high-deductible policy, reducing the amount of premiums insurers receive.

Steep rate hikes in this sliver of the insurance market — about 13 million Americans, as of 2008 — have popped up sporadically for years. Experts see them becoming increasingly common.

"You're going to see rate increases of 20, 25, 30 percent" for individual health policies in the near term, Sandy Praeger, chairwoman of the health insurance and managed care committee for the National Association of Insurance Commissioners, predicted Friday.

Most states don't have the legal authority to block or reduce health insurance rate increases, Praeger noted.

"When you see stories like (Anthem's), you can almost guarantee there's going to be increased consumer protection activity" in state legislatures, she said.

Her group doesn't track rates state by state, but Praeger said it likely will start doing so, "if we don't get any kind of meaningful reform at the federal level."

Politicians and even some health insurers, including Anthem, are urging a revival of the stalled effort in Congress to overhaul the health care system, arguing everyone needs to be covered by health insurance in order to prevent such premium spikes.

In Maine, where Anthem dominates the market, its proposal has several consumer groups planning big rallies at two public hearings on the rates, on Feb. 22 and 24.

Under Anthem's proposal, a family of four could be charged up to $1,876 per month if the proposed rates are allowed to take effect in July.

"The rate request should be denied on its face. It's outrageous," said Greg Howard, spokesman for Maine Change That Works. "We are in the middle of ... this record-breaking type of recession, and they're doing what they need to guarantee profit margin."

On Friday, Maine House Speaker Hannah Pingree and Senate President Elizabeth Mitchell wrote to two congressmen who have scheduled a Feb. 24 hearing on Anthem's pending rate hikes in California, asking them to also look into the proposed hike in Maine.

"We frankly have been very frustrated by the size of these increases," Pingree told The Associated Press. "Obviously, they are attempting to price certain people out of the market."

Last year, Maine's Superintendent of Insurance Mila Kofman rejected Anthem's initial requests, which would have increased individual rates an average of 18.5 percent. She allowed an average increase of 10.9 percent, with the highest increase at 32.4 percent.

Anthem sued the state. Oral arguments in the case are to be scheduled before the Maine Superior Court for mid-March.

Anthem spokesman Chris Dugan said Friday evening the company wants the court to review Kofman's decision because it didn't allow the company an operating profit. He said the rates requested for 2010 are needed "to make sure that we have adequate resources to cover the remaining members" in the insurance plans.

WellPoint, based in Indianapolis, has said it needs to raise rates so much because the weak economy has resulted in fewer people remaining in the individual market in California, and many who do have serious health problems. It says costs of caring for them have been rising due to higher provider prices and more use of diagnostic tests.

In Oregon, state insurance officials have concluded that rising costs justify the higher individual premiums, particularly because most insurers cut rates too much in 2006 and then got hit with significant losses. So double-digit increases, some 25 percent or higher, have been approved, or reduced a bit from 2007 to 2010.

Insurance Division spokeswoman Cheryl Martinis said the agency has started posting details of all proposed increases on its Webspace site and e-mailing customers want a proposal comes in so they can comment.

"People are extraordinarily upset in Oregon, as they are nationwide, about health care costs," she said.

Sunday, December 20, 2009

Affordable Health Care

As we listen to the progaganda on health reform today remember that a worker in New Hampshire pays $8000 more than their Member of Congress for health insurance.  They also have to pay a tax on it.

If you don't inderstand that this so-called "health reform" activity is more about payoffs to Big PhRMA and Big Insurance then you aren't on track with what is actually happening.

There is no change and there is no health reform.

Make sure you let your representatives know what you think!

Saturday, March 28, 2009

Insurance Companies May Not Be Your Friend

With all the talk about the health stimulus plan and the recent wave of backlash from Big Insurance against universal care, we now have some insight into what this industry does as a routine practice.

What ever way health care goes, the issues at stake are pretty big ones. It surely is just one more reason why you should start now to get healthy and stay healthy, plus learn what you can do to maintain your health.

Reliance on insurance and the government might not be your best call.
Senate takes on out-of-network insurance issue
By ERICA WERNER, Associated Press Writer

WASHINGTON – Ever wonder how that bill was calculated if you had to pay to see a doctor outside your insurance network?

Might be a scam, says a senator investigating the issue.

Sen. Jay Rockefeller, chairman of the Senate Commerce, Science and Transportation Committee, wants answers at a hearing Tuesday from the chief executives of UnitedHealth Group Inc. and its subsidiary Ingenix Inc., a claims database used by insurers nationwide to calculate out-of-network rates.

The inquiry follows lawsuits and an investigation by New York Attorney General Andrew Cuomo alleging that UnitedHealth and Ingenix manipulated rate data so insurers had to pay less and patients more for out-of-network services.

"They're lowballing deliberately. They deliberately cut the numbers so the consumer has to pay more of the cost," Rockefeller, D-W.Va., said in an interview with The Associated Press on Friday.

"It's scamming. It's fraud," he said.

In January, UnitedHealth agreed to pay $350 million to settle a suit by the American Medical Association and others over the issue. UnitedHealth did not admit wrongdoing. But, under pressure from Cuomo, the company agreed to pay $50 million toward creation of an independent claims database and eventually close down the Ingenix databases.

Cuomo has secured similar agreements from other major insurers, including WellPoint Inc., Aetna Inc., and Cigna Corp. The AMA is pursuing suits against those companies, too.

"Our view is that we've reached a resolution on this matter and we're moving forward," UnitedHealth spokesman Tyler Mason said in a voicemail message Friday. "We think it's positive that this information will continue to be made available in the health care marketplace so that people can make informed decisions."

A spokeswoman for Ingenix referred calls to UnitedHealth.

Rockefeller and other lawmakers, along with doctors and consumer groups, view the matter as far from over. They say more accountability and transparency is needed in how insurance companies determine out-of-network rates, and that patients need to understand how it's done to avoid sticker shock when they get their medical bills.

One such patient is Mary Jerome of Yonkers, N.Y. She went out of network to Memorial Sloan-Kettering Cancer Center after being diagnosed with ovarian cancer in 2006. When she began getting her bills she discovered that Memorial Sloan-Kettering was not being reimbursed by her insurer anywhere near as much as the center was charging and that she was responsible for paying the rest.

"Unknown to me, they were operating with deceptive methods of reimbursement," Jerome told Rockefeller's committee in written testimony. "I had to battle cancer — and I am still battling it — and I had to battle my insurance company to try and get fair coverage."

More than 70 percent of workers who get health care through their employers are enrolled in plans that allow them to go out of network, according to the Kaiser Family Foundation. Typically, those plans will pay a set percentage, say 70 percent, for an out-of-network visit.

But unknown to many consumers, when patients go out of network, their plan doesn't actually pay 70 percent of the doctor's visit cost. It pays 70 percent of what it determines is the "usual, customary and reasonable" cost for the procedure or doctor's visit in question.

Insurance companies determine that cost themselves, and there's scant regulation or oversight of how they do it.

In the case of UnitedHealth and Ingenix, they were allegedly manipulating claims data so that the "usual, customary and reasonable" costs they used were lower than they should have been, leaving patients to pay more. Cuomo's office said Ingenix was understating the market rate for doctor's visits across New York state by 10 percent to 28 percent.

Even with the UnitedHealth settlement, lawmakers and others want bigger changes in the system so rate calculations are fairer and better understood. Rockefeller said federal legislation might be needed.

"You ask me how are their 'usual and customary' rates being determined," Rockefeller said. "I don't know."
___

On the Net: Senate Commerce, Science and Transportation Committee: http://commerce.senate.gov/public/

UnitedHealth Group: http://www.unitedhealthgroup.com
Ingenix: http://www.ingenix.com/
N.Y. Attorney General's office: http://tinyurl.com/d6n89j
Copyright © 2009 The Associated Press.

Saturday, February 14, 2009

Drug Costs and Insurance Keep Prices High

The high cost of drugs for US consumers is directly related to the insurance industry and third party billing. The mentality for several decades has been "we can charge what the market will bear, because insurance will cover the costs."

Of course this system is failing. Since the welfare plan for Big Pharma was introduced under the euphemistic "Senior Drug Plan" or Medicare D, as a way the Bush administration repaid the favor for all the Big Pharma money that helped him get elected, and even wrote the drug plan, costs have skyrocketed.

Seeing falling profits the health insurers raised co-pays and developed new creative ways to keep their money.

Now we have a new economic plan leading further down the pike to universal care and the single payer model, in the coming days of the new administration.

We don't see any cost savings plans yet on the government side but there is a minor movement to do so - in exchange for data - at the big box retail companies, and the drug bus.
Drugmakers and retail chains offer meds are bargain prices. But are they worth it?

I keep wondering why it is that more people aren't getting on board for health classes like I taught for many years at Secure Horizons. I'll come teach these same programs at your community organization. All you have to do is ask. You'll not only save money, you may save your health.

Wednesday, November 19, 2008

Big Insurance Seeking Spoils

While the Obama transition team wields the ugly power of spoils for the victor, all those with vested interests are jockeying viciously for position.

And while everyone seems to have been spoon fed on the idea of national health insurance, Big Insurance is seeking an eye on profits as it uses ploys that are trendy and seem to get them a big payoff for superficial pandering with their manipulated media statements in line with what their pundits think COngress will swallow.

Of course Hillary is back in this fray, trying to cut deals, hubby Bill trying to cut deals, and Teddy Kennedy seemingly blocking some of them.

Kennedy has been wheeling and dealing with the big players on a health plan, but you can be sure it isn't with Joe and Jane Six-Pack in mind.

Maybe its more like roulette, le juet sont fait!

I'm not against everyone having access to care, but the question has to be who really is controlling the care.

The Hillary Plan was dead before it started in her husband's administration. Has she really kept in touch with the "outside" over all these years to allow her to start on this with a clean slate?

We need reform on many levels. Reform requires new ideas and fresh folks who aren't mired in the Beltway Bandit band and their tunnel vision.

If you haven't been keeping up with the G8 that is now the G20, you do need to know what their plan is and how it will effect your health. If you dare to risk reading much more truthful interpretations of their actions than what you'll ever read or hear in the media as it is today start here.
Insurers make pitch for health coverage mandate
By KEVIN FREKING, Associated Press Writer

WASHINGTON – The health insurance industry says it will support a national health care overhaul that requires them to accept all customers regardless of pre-existing medical conditions.

In return, the industry said Wednesday, it wants Congress to require that everyone buy coverage.

Lawmakers have signaled their intent to craft health care legislation early next year, and the insurance industry's support would make passage much easier. That legislation is expected to closely track the proposals of President-elect Barack Obama.

Karen Ignagni, president of the board of directors for America's Health Insurance Plans, says she hopes the endorsement will help members of Congress fashion their proposal.

Tuesday, November 18, 2008

Doctors to Quit

To me this is no surprise. It is, in effect, a wake up call to everyone that the health care system in the US is in much worse shape than you've been told.

One problem is the shift that started back in the 1980s toward limits to exactly what is the definition of 'a doctor visit'.

When the managed care model came into vogue patient care really started a down hill slide. I notice things like this more easily than a person who hasn't been in the health care industry, perhaps more so because I've been both a provide and an administrator.

Today you can see your doctor for one issue only. That means if you happen to have a headache and a sore knee you have to make two appointments. This of course increases billable hours and the bottom line. It also fragments care.

If you are in an HMO or similar managed care you might not always get the same doctor so continuity of care is out the window.

Insurance regulations contribute to this. Pharmaceutical control and restrictive licensing issues are factors.

And then there is the factor relating to the inability to provide high quality care to people with chronic health problems, and a focus on prevention and cure.

Perhaps we need to get on a track to lead health care to a system as if people mattered.

Another way of looking at this is to get on a train to education so you can learn what measures you can take to improve your health and increase the use of natural care in your health maintenance options.

Certainly we need to overhaul USDA and FDA controls on health care options. We also need to have a level approach to health care where everyone gets the same basic coverage.

Now everyone in Congress, everyone employed or corporate fat cats will all get the same services.

In the mean time I am going to continue taking my vitamins and other herbs and supplements, in spite of news reports saying otherwise.

This protects my health. It can protect yours too!
Many doctors plan to quit or cut back Tue Nov 18, 2008

WASHINGTON (Reuters) – Primary care doctors in the United States feel overworked and nearly half plan to either cut back on how many patients they see or quit medicine entirely, according to a survey released on Tuesday.

And 60 percent of 12,000 general practice physicians found they would not recommend medicine as a career.

"The whole thing has spun out of control. I plan to retire early even though I still love seeing patients. The process has just become too burdensome," the Physicians' Foundation, which conducted the survey, quoted one of the doctors as saying.

The survey adds to building evidence that not enough internal medicine or family practice doctors are trained or practicing in the United States, although there are plenty of specialist physicians.

Health care reform is near the top of the list of priorities for both Congress and president-elect Barack Obama, and doctor's groups are lobbying for action to reduce their workload and hold the line on payments for treating Medicare, Medicaid and other patients with federal or state health insurance.

The Physicians' Foundation, founded in 2003 as part of a settlement in an anti-racketeering lawsuit among physicians, medical societies, and insurer Aetna, Inc., mailed surveys to 270,000 primary care doctors and 50,000 practicing specialists.

The 12,000 answers are considered representative of doctors as a whole, the group said, with a margin of error of about 1 percent. It found that 78 percent of those who answered believe there is a shortage of primary care doctors.

More than 90 percent said the time they devote to non-clinical paperwork has increased in the last three years and 63 percent said this has caused them to spend less time with each patient.

Eleven percent said they plan to retire and 13 percent said they plan to seek a job that removes them from active patient care. Twenty percent said they will cut back on patients seen and 10 percent plan to move to part-time work.

Seventy six percent of physicians said they are working at "full capacity" or "overextended and overworked".

Many of the health plans proposed by members of Congress, insurers and employers's groups, as well as Obama's, suggest that electronic medical records would go a long way to saving time and reducing costs.

(Reporting by Maggie Fox; editing by Chris Wilson)
Copyright © 2008 Reuters Limited.

U.S. Trails Other Nations in Chronic Illness Care
By Will Dunham

WASHINGTON (Reuters) Nov 13 - Chronically ill Americans are more likely to forgo medical care because of high costs or experience medical errors than patients in other affluent countries, according to a study released on Thursday.

The study comparing the experiences of patients in eight nations reflected poorly on the U.S. health care system as President-elect Barack Obama and his allies work on plans to rein in health costs and extend insurance to more people.

The researchers questioned 7,500 adults in Australia, Canada, France, Germany, Netherlands, New Zealand, Britain and the United States. Each had at least one of seven chronic conditions: high blood pressure, heart disease, lung disease, diabetes, cancer, arthritis and depression.

Dutch patients had the fewest complaints, while the Americans had plenty, according to the study by the Commonwealth Fund, a New York-based health policy research group.

Fifty-four percent of Americans surveyed said high costs prevented them at some point from getting recommended medical care, filling prescriptions or seeing a doctor when ill. Seven percent of the Dutch cited cost as a barrier to treatment.

In addition, 41 percent of the U.S. patients said they spent more than $1,000 over the past year on out-of-pocket medical costs. That compared to lows of 4 percent in Britain and 5 percent in France.

A third of U.S. patients said they were given the wrong medication or dosage, experienced a medical error, received incorrect test results or faced delays in hearing about test results, more than any of the other countries.

WASTED TIME

Almost half of the U.S. patients said their time had been wasted because of poorly organized care or had received care of little or no value during the past two years. These views were lowest in the Netherlands and Britain.

Only Canadians reported visiting an emergency room at higher rates in the past two years than the Americans.

The Commonwealth Fund's Cathy Schoen, who worked on the study, said the United States spends twice as much on health care as the others, with the current economic woes putting more people at risk of losing employer-provided health insurance.

"Overall, the United States stands out for chronically ill adults reporting the most negative experiences," Schoen said in a conference call with reporters.

"In short, the U.S. patients are telling us about inefficient, unsafe and often wasteful care. The lack of access, combined with poorly coordinated care, is putting these patients at very high health risk and driving up costs of care."

The U.S. Census Bureau has reported that 15 percent of Americans, 45.7 million people, had no public or private health insurance last year.

The study, published in the journal Health Affairs, was the latest to show the U.S. health care system is performing worse than those in comparable countries. Unlike many rich nations, the United States does not have universal health care.

(Editing by Maggie Fox)

Wednesday, November 5, 2008

Saturday, October 25, 2008

Insurance sales commissions raise eyebrows at Medicare

This sounds like round two of the Medicare Senior Drug Plan fiasco that has turned over thousands of dollars to the insurance industry, rather than helping Seniors pay for drugs.

It also looks like the regulators aren't keeping a close eye on what the market is up to, not unlike the current Wall Street fiasco at great cost to the public coffers.

This certainly should be an election issue and warrants a call or letter to your member of Congress.
Medicare officials to review insurers' commissions By KEVIN FREKING, Associated Press Writer

WASHINGTON – Federal health officials said Friday they will soon address growing concerns about the lucrative commissions that some Medicare insurers plan to pay their agents and brokers this year.

In Medicare, the elderly and disabled can enroll in private insurance plans that assume responsibility for covering a participant's health benefits. Those plans get a generous government subsidy and now serve roughly 10 million people. The program is called Medicare Advantage.

Documents obtained from some companies participating in Medicare Advantage show that their agents stand to make $500 to $550 this year for enrolling a beneficiary into one of their plans. In subsequent years, the agents could make another $500 for every year the beneficiary stays with the plan. After five years, an agent could have made more than $2,500, which is quite a jump from previous years.

Such a financial reward is raising concerns that agents and brokers will work too aggressively to enroll people into plans that don't meet their health needs.

"Medicare Advantage plans that have nearly quadrupled agent commissions are putting profits before patients and that's wrong," Sen. Max Baucus, D-Mont., said in a news release Friday. "We can't let seniors remain at risk of being targeted by predatory sales agents looking to make a quick buck."

The Centers for Medicare and Medicaid Services recently issued regulations designed to curb abusive sales tactics in the Medicare Advantage program. The regulations went into effect Oct. 1, the start of the new marketing season. Plans can't begin enrolling new beneficiaries for their 2009 coverage until Nov. 15.

Rep. Pete Stark, D-Calif., urged CMS to consider capping commissions.

"This issue needs to be resolved immediately, before open enrollment begins," Stark said.

Kerry Weems, the acting administrator for CMS, said the agency plans to take action soon.

"We will address the concern and expect to take regulatory action next week," Weems said. "CMS is strongly suggesting that plans keep this in mind as they contemplate making any final arrangements regarding commission structures."

Weems did not elaborate on what regulatory changes will be make. The trade group representing insurers encouraged CMS to take some action.

"We support CMS acting in this area and believe clear and consistent standards are necessary," said Karen Ignagni, president and CEO of America's Health Insurance Plans.

Two of the major players in the program, Humana Corp. and UnitedHealth Group, both said Friday that they welcomed regulation of insurance agent commissions.

"Nine months ago, we called for capping commissions and total compensation paid to contracted agents and brokers. Consistent with our position, we support Chairman Stark's proposal," said Humana spokesman Tom Noland. "We believe this payment method ensures that agents and brokers are rewarded only when seniors are satisfied with their choices, and penalizes agents and brokers who use marketing tactics that result in beneficiaries signing up for a product they do not fully understand."

"We would also welcome regulation that establishes reasonable industry-wide broker commission norms," said a statement issued by Ovations, a subsidiary of UnitedHealth Group.

Officials familiar with the Medicare Advantage program say the increases being seen in insurance agent commissions this year are a result of competition as well as regulatory changes that the government made.
___

On the Net: Rep. Pete Stark: http://www.house.gov/stark
Medicare: http://www.medicare.gov

Friday, October 24, 2008

Health Care and Elections

With the US election only days away this topic is certainly one you need to consider before placing your votes.

"Medical Bills, Drug Prices and Access to Health Care -- Election Guide"
Health care proposals are on most voter's minds and whether or not I like either candidate's proposals (and I don't - speaking from my years as a health planner).

A major oversight is one that would include access to care of choice, including natural care (not exclusive to licensed hybrid natural medicine providers) and supplement parity.

In my estimation the insurance industry still has too great a hold through its lobbyists on the DNC and RNC campaigns.

Less you forget, it is insurance (and their many levels of middlemen) that is the greatest source of increase in health care costs. It isn't the tort lawyer scam that the industry and media want you to believe.

Insurers actually control what service a health care provider can offer and what they will get paid for it. Insurers do control what drugs they will pay for and how much so both these issues directly impact your employer plan, your access and your out of pocket costs.

And don't think for a minute Big Pharma isn't twisting the arm of Big Insurance to put pressure on limits to coverage.

Sorry all you R's, you are the ones who have the biggest push to put $$$ in the pocket of your cronies in the insurance industry. Maybe this is one reason why you moved to bail them out while you forgot that tax proposals can't be in legislation originating in the Senate.

 
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