negotiate medical claims

NJ lawmakers seeking to control insurance costs

J Roberts

Looking for greater transparency on how insurers calculate and charge for premiums? The state of NJ is intending to provide just that. A recent measure adopted by the state legislature would require all insurers to gain approval by the state’s regulatory agency before they can raise premiums.

THE ASSOCIATED PRESS

TRENTON  — Health insurance carriers who serve individuals and small businesses in New Jersey may soon have to gain state approval before implementing rate increases.

These firms currently can set and increase rates just by filing the information with the state. But a measure planned by three state lawmakers would require that the firms gain approval for such actions from the state Department of Banking and Insurance.

It also would expand the jurisdiction of the state’s Division of Rate Counsel, which now has no say over health insurance rates, to create a watchdog for residents and small businesses.

“Residents deserve a watchdog, someone with the knowledge to advocate on their behalf when it comes to the complicated issue of rising health care premiums,” said Assemblyman Dan Benson, D-Hamilton Township (Mercer County), who said he will sponsor the measure with fellow Democrat Valerie Vainieri Huttle of Englewood.

Democratic Senate Majority Leader Barbara Buono plans to sponsor identical legislation, with both measures likely to be introduced by year’s end.

“This legislation will provide far greater transparency,” Benson said.

Ed Rogan, spokesman for the banking and insurance department, declined to comment on the proposal. As a matter of policy, the department does not discuss proposed or pending legislation.

Besides requiring the banking and insurance department commissioner to approve any rate increase, the proposed bill also would give the commissioner authority to reject proposed rate changes deemed discriminatory or excessive.

The commissioner and rate counsel would also have to jointly hold public hearings on any proposed premium increases for insurance contracts or policies in the Individual Health Coverage Program or New Jersey Small Employers Health Benefits Program market.

Information about premium increases, including an explanation of how carriers report and calculate health insurance premiums, also would have to be posted on the department’s website.

Currently, insurers in these plans are required to spend no more than 20 percent of the premiums paid on administrative expenses.

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Insurance mandates again hike costs

J Roberts

Recent government mandates in the state of Connecticut raise the cost of insurance for all. While the act aims to offer more comprehensive services, it may, in actuality prove as a disservice by raising the overall cost of insurance to the states residents.  Read on to learn more.

By Greg Bordonaro

While tax increases, paid sick leave and union concessions took up most of the attention during the recent legislative session, lawmakers passed a flurry of new health insurance mandates that will raise the cost health insurance for employers.

In all, seven new mandates — some of which business lobbyists have fought for years — passed the legislature and have been signed into law by Gov. Dannel P. Malloy.

A health insurance “mandate” is something for which an insurance company or health plan must offer coverage, and whose costs typically get passed onto employers.

Health mandates have been a hot political issue in Connecticut for years. The business community has long voiced opposition, citing costs. But supporters say cost concerns are overblown and that the benefits outweigh the price.

The divide illustrates a central issue in the broader health care debate. The question of how to control health care costs, while also mandating adequate coverage that prevents and treats illnesses effectively, has been difficult to answer.

New mandates passed this year:

• Expand coverage requirements for certain patient clinical trials, breast MRIs, colonoscopies and prostate cancer screenings;

• Increase the maximum annual coverage for ostomy-related supplies from $1,000 to $2,500;

• Require coverage for bone marrow testing;

• And place new restrictions on insurance companies that require the initial use of over-the-counter drugs for pain treatment.

“It is a fundamental truth that as you add benefits you increase costs,” said Keith Stover, a lobbyist for the state’s health insurance industry. “The math isn’t that complicated.”

According to a report by the Council for Affordable Health Insurance (CAHI), which is funded by the insurance industry, Connecticut had 59 mandates at the end of 2010, making it the fifth most demanding state.

While mandates make health insurance more comprehensive, they also make it more expensive, requiring insurers to pay for care patients previously funded out of their own pocket. Those expenses often get passed onto employers through higher premiums.

(more…)

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Employee wellness programs help companies deal with rising healthcare costs

J Roberts

One way corporate America is tackling the rise in healthcare costs is by offering an employee wellness program.  Many are offering incentives to employees in terms of gifts and rewards for employees who become actively engaged. The benefits are worth the investment as employers are encouraging employees to take an active role in maintaining their health.

KePRO Industry News

Many employers’ healthcare costs are soaring as a result of the high prevalence of chronic diseases. This is cutting into profit margins and making it difficult for companies to expand. In order to address the situation, many businesses are looking to employee wellness programs.

For example, a group of business leaders in Oregon and state health officials recently joined forces to form the initiative Wellness@Work, according to Oregon Business. The project provides companies with an online resource that they can use gauge their employees’ levels of wellness and consider new initiatives to improve well-being.

“We’re hoping businesses will bring together a committee of employees from all departments to make changes to their workplaces,” Dawn Robbins, the state’s worksite wellness coordinator, told the news source.

She added that despite fears over the cost of the initiatives, most businesses see a significant return on their investment in employee wellness. In fact, the Wellness Council of America estimates that most will experience a return of $3 for every $1 invested.

This could help businesses handle the dramatic rise in healthcare costs that are expected to occur this year and beyond.

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Race Is On to Pin Blame For High Health-Care Costs

J Roberts

Who’s to blame for rising healthcare costs, insurers or providers, such as doctors or hospitals?  Depending who you ask, either side places the blame on the other.  Whether it’s insurers’ trying to meet the bottom line and remain profitable or physicians and hospitals attempting to increase revenue and improve their margins, one thing is for certain: Healthcare costs continue to rise.

Read on to determine where the blame lies.

By AVERY JOHNSON

A battle over who to blame for rising health-care costs is escalating, as groups seek to pin the problem on each other and say none of the health-care legislation under consideration does enough to solve it. U.S. spending on health care reached $2.5 trillion in 2009, according to federal estimates. It is expected to jump to $4.5 trillion in 10 years.

Insurers contend that they must pass on ever-higher bills from hospitals and doctors. Hospitals say they are struggling with more uninsured patients, demands by doctors for top salaries, and underpayments from Medicare and Medicaid.

And doctors say they are strong-armed by insurance monopolies and hampered by medical malpractice costs.

In the rush to point fingers, few solutions are emerging.

“It’s always someone else’s fault,” said Robert Laszewski, president of health-care consulting firm Health Policy & Strategy Associates. “There is not an incentive for these people to cooperate because the game they are all playing is getting a bigger piece of the pie.”

The issue has come into sharp relief as WellPoint Inc. has sought to defend its plan to raise some prices in California by up to 39%.

In a hearing Wednesday on Capitol Hill, WellPoint Chief Executive Angela Braly singled out dominant hospital systems for demanding 40% rate increases and drug companies for roughly 20% profit margins.

A WellPoint spokeswoman said that at least one hospital had asked for a 220% payment increase.

Many Democrats have cited lack of competition among insurers as a driver of higher prices. On Wednesday, the House of Representatives voted to repeal a longstanding insurance-industry exemption from federal antitrust laws. The bill now heads to the Senate, where its future is less certain.

Doctors complain of a lack of competition among insurers, as well.

A report by the American Medical Association this week argues that 500 insurance-company mergers in the past 12 years have led to markets dominated by one or two health plans.

This year, two insurers control 70% of the market in 24 states, up from 18 last year, the report said.

“There is no other company for doctors to go to” when an insurer comes to them with terms that they find unfavorable, said AMA President James Rohack. But insurers say is it doctors and hospitals that have gotten too powerful through consolidation.

A study published Thursday in the journal Health Affairs appears to back up their point, saying that insurers are weakened in their negotiations by their inability to exclude prominent doctors and hospitals from networks.

Authors from the Center for Studying Health System Change, a nonpartisan research group, conducted 300 interviews with California doctors and hospital and insurance executives in late 2008.

The study said two big networks of providers now dominate the northern part of the state: Sutter Health owns two dozen California hospitals and medical centers, and Catholic Healthcare West runs 33 hospitals.

In addition, the study said, doctors who are increasingly banding together for negotiating power are commanding yearly double-digit payment increases.

Hospitals and doctors shot back that the study was largely anecdotal and said integration improved efficiency.

Catholic Healthcare West said it took on $1.5 billion in bad debt from government underpayments last year; its size, it added, makes it possible to achieve some savings.

Sutter Health said increases in its reimbursement rates from private insurers have been in the single digits.

“We are doing our best to keep costs down because these health-care premium increases are not sustainable,” said Bill Gleeson, vice president of communications a Sutter Health.

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HealthPass NY Enhances Small Employer Health Insurance Plans with Medical Cost Advocate

J Roberts

Medical Cost Advocate is in the news again! Read about the partnership between HealthPass of New York and Medical Cost Advocate to provide medical advocacy and bill negotiation services to the employees that participate with HealthPass.

Addition of Medical Cost Advocate Helps Employees Negotiate and Minimize Out-of-Pocket Health Care Costs

Online PR News – 09-February-2010 – NEW YORK, February 9, 2009

HealthPass, the New York City-based non-profit health insurance exchange for small employers, today announced a partnership with Medical Cost Advocate Inc. to provide advocacy services to employees who participate in any of its health insurance plans.

Under the arrangement with Medical Cost Advocate (MCA), employees and families enrolled in any of HealthPass’ portfolio of coverage options will have access to the services of MCA’s advocates. Medical Cost Advocate’s professionals personally assist employees with reviewing their medical bills and reducing their out-of- pocket costs by negotiating discounts directly with health care providers.

“We are thrilled to be working with Medical Cost Advocate, especially at a time when employees are being asked to accept more of the responsibility for their health care costs,” said Vince Ashton, executive director of HealthPass. “Employees simply don’t have the time or expertise to understand the complexities of medical bills and explanation of benefits. This unique service gives employees in any of our plans direct access to experts who will review and negotiate all out of pocket expenses, often times reducing costs by as much as 50 percent.”

Medical Cost Advocate professionals will review and negotiate virtually any medical bill, regardless of insurance status or medical procedure. These include in and out-of network bills for full and excess charges, balance bills, deductibles, co-insurance and non-covered services. Employees are only charged for the service when the advocates are successful in saving them money. The Medical Cost Advocate program is the latest enhancement to HealthPass offerings for small employees also including COBRA/State Continuation Administration, the discount Rx cards and Health Advocate, which complements the Medical Cost Advocate offering perfectly.

HealthPass is an innovative partnership that was created in 1999 by the New York Business Group on Health, the City of New York and the health insurance industry. Its original purpose was to offer small businesses quality, affordable health insurance options. This is accomplished through an insurance exchange that allows eligible employees to choose a plan that fits their medical needs and budgets from a wide range of choices of plans and carriers. Today, HealthPass serves more than 3,700 small businesses and non-profit organizations and 33,000 members in New York City, Long Island, Westchester, Rockland, Orange, Dutchess and Putnam counties.

“Medical Cost Advocate is delighted to be partnering with HealthPass and helping their members deal with the ever growing complexity and cost of health care bills,” said Derek Fitteron, Chief Executive Officer of Medical Cost Advocate. “Our service not only benefits employees, but also employers who can offer an expanded benefits package that will enhance their ability to attract and retain talented workers.”

About HealthPass New York
An innovative partnership between the New York Business Group on Health, the City of New York, and the health insurance industry, HealthPass provides small businesses and sole proprietors with an array of Fortune 500-quality healthcare options through an insurance exchange.

HealthPass enables eligible employees of small businesses and sole proprietors to choose a healthcare plan that fits their medical needs and budgets. There are more than 30 different coverage options from five leading carriers – EmblemHealth, GHI, Health Net, HIP (Health Plan of New York) and Oxford – as well as two dental plans, and a bundled product offered through Guardian. With more than 200,000 providers, HealthPass affords greater network access than any single plan. For more information, please visit www.healthpass.com.

About Medical Cost Advocate
Medical Cost Advocate (MCA) is a medical cost reduction firm that lowers consumers’ medical bills before or after treatment through professional negotiation. Serving consumers, employers, benefits consultants and financial institutions, MCA leverages a proprietary approach that regularly saves consumers 20% to 50% on their medical and dental bills. With out-of-pocket health care costs steadily increasing, MCA provides the professional advocacy every consumer needs to realize savings without risk. MCA’s services are easy to access through its website. For more information, please visit localhost/wp1

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