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Health Care Goodies

Being A Savvy Healthcare Consumer Is Tougher Than It Sounds

November 13, 2011 By Louise Norris

[…] I’ve long been a fan of high deductible, HSA qualified health insurance policies (our family had one until very recently when we switched to a high deductible plan that isn’t HSA qualified but has much lower premiums). But I’ve also always been aware that we’re fortunate to be able to utilize a high deductible health insurance policy – both in terms of being healthy and not needing much in the way of healthcare, and also in our ability to make contributions to our HSA to cover the cost of care we might need in the future. People who have serious health conditions and/or those with very limited funds […] When it comes to actually being a savvy consumer of healthcare, the vast majority of us wouldn’t even know where to begin. Google? Asking friends? Maybe, but chances are, we’re going to go to a doctor and follow (at least roughly) the recommendations the doctor makes. Most of the time, providers are the ones who control how much care a patient receives ie, it’s the supply that’s driving things, rather than the demand. We might know that something’s not right and take the initial step of going to the doctor. But what happens next (surgery? PT? wait and see? Medication? etc.) is generally up to the doctor. As Michelle pointed out, the patient’s number one priority is going to be getting better, especially if the problem being treated is a serious one. Shopping around for the best price and poring over comparative effectiveness research data probably isn’t going to be high on most patients’ lists.

Filed Under: Health Care Goodies, HSA, Individual/Family Health, Travel

Comparing Wall Street And Healthcare

November 11, 2011 By Louise Norris

[…] Should hospital, insurance, and pharmaceutical executives be earning millions of dollars while millions of Americans have no health insurance and no realistic access to healthcare? Should those executives earn their millions regardless of how their company has performed? Or regardless of the overall state of healthcare in this country? Should decision-making at healthcare companies (hospitals, pharmaceutical companies, insurance carriers, device makers, etc.) be based more on the best interests of shareholders and executives, or on what is best for the health of Americans? Do healthcare companies need to be held to a different standard than other corporations, simply because of the importance of the product they provide? […]

Filed Under: Health Care Goodies, Health Care Reform, Health Insurance Reform

More Flexibility With An Individual Health Insurance Plan

November 9, 2011 By Louise Norris

[…] For the average person who has had an individual policy for a decade and is late 50s-ish, keeping that individual policy (even though a group plan may become available) might be the ticket to being able to have some flexibility in terms of when to retire. The group plan is guaranteed issue – health conditions won’t be a barrier to getting coverage. But the group plan is also tied to the current employer, and the policy will only be available for a maximum of 18 months after you leave that job (via COBRA). […] Linda’s article is an excellent reminder about the importance of looking at the specifics of your own situation – including long term issues that might outweigh short-term benefits – rather than following conventional wisdom or doing what everyone else is doing.

Filed Under: Anthem Blue Cross, Health Care Goodies, Health Care Reform, Health Insurance Reform, HSA, Individual/Family Health

Colorado’s Average 2012 Premium Increase Is The Smallest Since 2000

November 7, 2011 By Louise Norris

[…] I’m sure there will still be people who falsely claim that Colorado’s maternity mandate and federal reform are the reason for any increase. But when we place the 2012 increase in context with the increases we’ve seen over the past decade, it becomes harder to blame recent reform laws for the 2012 premium increases. I’m glad to see that after a year of having guaranteed issue coverage for children, no lifetime maximums, more comprehensive preventive care, and maternity benefits on all new and renewed individual policies, we are seeing the lowest average rate increase in over a decade.

Filed Under: Colorado Division Of Insurance, Health Care Goodies, Health Care Reform, Health Insurance Reform, Individual/Family Health

Employer Reimbursement Of Premiums Causing Applicants To Be Declined

November 4, 2011 By Louise Norris

[…] I know that the law was written with good intentions, but we’re noticing that it’s the employees – the applicants who are trying to get individual health insurance policies – who get the short end of the stick. It’s the employees who end up getting their health insurance application declined. It’s the employees who end up having to pay for their own premiums in order to obtain coverage, even if they thought that they were going to be able to rely on some level of reimbursement from their employer.

Filed Under: Colorado Division Of Insurance, Group Health, Health Care Goodies, Health Care Reform, Health Insurance Reform, Individual/Family Health

Millions Of Uninsured Children Are Eligible For Public Health Insurance

November 4, 2011 By Louise Norris

[…] The first sentence of Jason’s article is the most striking: The fact that there are 4.3 million uninsured children in the US who are eligible for Medicaid or CHIP (Children’s Health Insurance Program). Obviously, not all states are pushing hard to enroll all (or even most) Medicaid/CHIP eligible children in those programs. And although Colorado received a $13.7 million grant last year thanks to the increased enrollment in the state’s Medicaid program, the expansion of public health insurance programs in Colorado has not been without criticism. Especially in the current economic climate, it’s hard to see how government health insurance programs could afford to insure an additional 4.3 million children. […]

Filed Under: Health Care Goodies, Health Care Reform

Comparative Effectiveness Research Fee To Be Added To Premiums In 2012

November 2, 2011 By Louise Norris

[…] This fee is similar to the one that is assessed to pay for CoverColorado (except that it’s a much smaller amount). Basically, carriers will collect the fee from members and then pass the money on to the Patient-Centered Outcomes Research Institute, much the way carriers pass on the CoverColorado fee. The fee will not be counted as premiums for the purpose of calculating medical loss ratio numbers, and should not be confused as being part of the premium that we pay for our health insurance.

Filed Under: Health Care Goodies, Health Care Reform, Individual/Family Health, Insurance Companies, Rocky Mountain

Real-Time Tracking Of Healthcare Costs

October 26, 2011 By Louise Norris

[…] Obviously we have to avoid cutting corners just for the sake of lowering costs at the expense of patient outcomes (again, including patient outcomes when we compare the cost data would help to prevent this problem). But I have no doubt that there are other healthcare expenses that could be eliminated without compromising patient outcomes. In many cases, the providers might just be unaware of the actual costs that are being incurred – Dr. Fogelson’s idea for a real-time digital tracker would help to keep cost in the front of everyone’s mind.

Filed Under: Accountable Care Organizations, Group Health, Health Care Goodies, Health Care Reform, Providers

Does The Pink Ribbon Trivialize Breast Cancer Deaths?

October 19, 2011 By Louise Norris

[…] I can see how awareness is a good thing if it encourages people (men and women) to be in tune with their health and current on the screening exams that they and their doctor feel they need. And it’s a reminder to all of us to do whatever we can to provide support to those who have cancer. But what about the people who know that their cancer is terminal? What about those with metastatic breast cancer? Or with another form of advanced cancer like my friend? The people who know that there is almost no chance they will beat the disease, and that their life will almost certainly be cut short by it? Do all the pink ribbons trivialize their deaths? […]

Filed Under: Health Care Goodies

Conflicting Data Regarding Medical Costs

October 13, 2011 By Louise Norris

[…] These numbers are much more in line with the rise in health insurance premiums that we’ve seen over the past few years. I have no explanation for why the data from the two sources is so dramatically different in terms of medical trend in 2010, but if the trend was really closer to 7.5% rather than 1.7%, the health insurance premium increases would be a lot easier to understand. […] In addition to the MLR rules, some states (including Colorado) have implemented strict review processes for rate hikes. The ACA now calls for insurers who propose a rate hike of 10% or more […]

Filed Under: Colorado Division Of Insurance, Group Health, Health Care Goodies, Health Care Reform, Health Insurance Reform, HSA, Individual/Family Health, Insurance Companies

The Opposite Of Transparent

October 12, 2011 By Louise Norris

[…] David also points out that the amounts allowed by his Blue Cross Blue Shield carrier don’t seem to have anything to do with the amounts billed by his physical therapies – the lowest allowed amount on his EOB was for the service that was billed with the highest price tag. We’ve also seen little rhyme or reason (that we can detect, anyway) in terms of how billed amounts and allowed amount correlate. […]

Filed Under: Health Care Goodies, Medicare, Medigap

Stuck In A Mini-Med

October 6, 2011 By Louise Norris

[…] So he applied for an individual policy with Anthem Blue Cross for his family, and was approved. But then when he tried to cancel his mini-med plan, his employer told him that he couldn’t cancel it until the open enrollment period next April. It would seem that trapping enrollees into a year-long contract with a mini-med plan is not in line with the spirit of the HHS guidelines that call for full disclosure regarding the waivers and directives to steer enrollees towards healthcare dot gov if they are interested in getting a policy that does comply with the ACA rules regarding annual policy limits. […]

Filed Under: Anthem Blue Cross, Colorado Division Of Insurance, Group Health, Health Care Goodies, Health Care Reform, Health Insurance Reform, Individual/Family Health

Grand Rounds – Colorado Fall Colors Edition

October 4, 2011 By Louise Norris

Henry Stern of InsureBlog brings us an interview with the whistleblower who has brought a lawsuit against LabCorp for allegedly charging a lower price to United HealthCare than to Medicare. The post is particularly interesting because Hank adds his own thoughts after the interview, and he sees things a little differently than Andrew Baker (the whistleblower). Hank agrees that it does look like LabCorp lowered their fees for UHC […]

Filed Under: Health Care Goodies, Health Care Reform, Health Insurance Reform, Medicare, Medigap, Policy, Providers, United Healthcare

Accepting Grand Rounds Submissions

October 2, 2011 By Jay Norris

We’re honored to be hosting the next Medical Grand Rounds on October 4th, our fourth time to host! Grand Rounds is a weekly gathering of the best health and medical articles written by doctors, nurses, students, patients, and others in health care related professions.

Filed Under: Health Care Goodies

Transferring Costs From Medicaid To Emergency Departments

September 21, 2011 By Louise Norris

[…] Denying arbitrary “non-emergent” ED claims for Medicaid patients doesn’t seem like a way to actually reduce ED overutilization. Instead, it seems like a way to cut Medicaid costs by increasing the number of unpaid claims that EDs have to write off each year. In order to cover their costs, hospitals will have to further increase prices for privately insured patients. That in turn causes health insurance premium hikes, which leads to calls for negotiations to artificially lower premiums. Where does it end?

Filed Under: Health Care Goodies, Health Insurance Reform, Providers

A Good Trend In Medicare Spending

September 16, 2011 By Louise Norris

[…] She specifically addresses Medicare costs, but it stands to reason that the same cost-saving strategies and paradigm shifts will also help to lower healthcare costs that are being reimbursed by private health insurance carriers. Not only do private carriers tend to follow Medicare’s lead, but the focus on value over volume from a provider perspective will benefit everyone, as it’s unlikely to be applied only to Medicare patients.

Filed Under: Accountable Care Organizations, Health Care Goodies, Health Care Reform, HSA, Providers

Runaway Health Care Spending, But Do Families Really Earn Nearly $100K?

September 9, 2011 By Louise Norris

[…] Although I’m a bit perplexed by the $99,000 median household income figure cited in the Rand study, I think that the gist of the study – basically the fact that health care is eating up a huge portion of family and government income in America – is important for people to understand. We can’t tackle a problem without first knowing what the problem is. And one of the obstacles in the way of curtailing health care costs in the US is that our current system is so convoluted and complex that it’s nearly impossible to see all the areas where health care spending is impacting us – at the federal, state, and household levels.

Filed Under: Health Care Goodies, Health Care Reform

Low Enrollment And Adverse Selection In High Risk Pools

September 7, 2011 By Louise Norris

[…]CoverColorado – the high risk pool that Colorado has had in place since the early 90s – instead allows eligible applicants to enroll as soon as they are without another coverage option, but makes them wait to receive coverage for pre-existing conditions if they have been uninsured prior to applying. That system encourages people to sign up as soon as they are eligible rather than waiting until they need care. It would seem that the federally-funded high risk pools might be able to boost their enrollment and also avoid adverse selection by switching to a similar eligibility model.

Filed Under: Health Care Goodies, Health Care Reform

Thoughts On Direct-Pay PCPs

August 23, 2011 By Louise Norris

[…] Those are a few of the thoughts that come to mind when I think about direct-pay medical care. I can see pros and cons to the idea, and I’m sure that there are many PCPs who would love the chance to focus more on medicine and less on administration/payer issues. But I think that most PCPs also want to make sure that everyone – regardless of financial status – has realistic access to medical care. And I’m just not sure that would be the case if more PCPs started pulling out of the health insurance networks – especially the networks that serve low income populations.

Filed Under: Health Care Goodies, HSA, Providers

Employer Funding of Individual Health Insurance – The Rules Are Changing

July 19, 2011 By Louise Norris

[…] Because of the new law, employers can now use wage adjustments to reimburse employees for individual policies (as long as they haven’t had a group policy in the past twelve months), which wasn’t allowed at all in the past. But the use of HRAs to fund individual policies can now only be done if the employer hasn’t had a group policy in the past twelve months, and that restriction wasn’t found in the DOI final agency order regarding HRAs. […]

Filed Under: Group Health, Health Care Goodies, Health Care Reform, HRA, Humana, Individual/Family Health

One Size Does Not Fit All

July 18, 2011 By Louise Norris

[…] A person with a set amount of money that can be devoted to life insurance premiums will be able to purchase significantly more face value if she goes with term coverage. But the insurance will be in place for the rest of her life if she goes with permanent coverage (assuming she doesn’t cancel it). There’s no one-size-fits-all answer to whether term or permanent life insurance is a better option, and it depends largely on the person’s budget, face value needs, and long term planning. […]

Filed Under: Health Care Goodies, HSA

Grand Rounds – It’s All About Personal Responsibility

July 14, 2011 By Louise Norris

[…] Even when people really need a major wake-up call (their life literally depends on it), doctors feel like they have to tread very softly in order to avoid hurting feelings. And there’s also the problem of time: most providers have so many patients to see in a day that they don’t have time to have in-depth conversations about lifestyle choices. The growing shortage of primary care docs (especially after 2014 when millions of previously uninsured Americans will have health insurance and will be looking for a doctor) isn’t likely to help that problem.

Filed Under: Health Care Goodies, Health Insurance Reform

Support For Hospital Fees Varies From One State To Another

June 22, 2011 By Louise Norris

[…] This is a good example of how similar legislation does not necessarily have the same support or outcomes in different states. That’s not to say that the Health Care Affordability Act is universally supported in Colorado – it’s not. But it’s working relatively well as a vehicle to fund Medicaid here and to support Colorado hospitals that treat a large number of uninsured patients.

Filed Under: Health Care Goodies, Providers

Biased Language In Employer Health Insurance Survey

June 21, 2011 By Louise Norris

[…] Overall, the survey is very thorough, the questions are mostly objective, and the data obtained from 1300 employers is no doubt a useful barometer of current employer attitudes towards health care reform. But I imagine that if the sentence about assuming that exchanges will make individual health insurance easy and affordable had not been included, the number of employers who said that they plan to drop their group plans might not have been so high. Time will tell.

Filed Under: Group Health, Health Care Goodies, Health Care Reform, Individual/Family Health

Governor Hickenlooper Vetoes Bill To Charge Premiums For CHP+

June 1, 2011 By Louise Norris

[…] Even if parents with kids in CHP+ do smoke and buy lottery tickets at a higher rate than parents with private health insurance, what’s to make us think that they would all of a sudden stop spending money on those things and instead pay premiums for CHP+? Is our goal to punish those parents for what better-off families view as poor choices, or is the goal to make sure that as many kids as possible have health insurance? If it’s the latter, then the point made by Senator Brophy is irrelevant.

Filed Under: Health Care Goodies

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