Health Insurance Blog

Approximately 22% of Americans report that they avoid seeing the doctor to save money. According to the San Francisco Chronicle, our sluggish economy and rising health costs are contributing factors to this decrease in physician visits. While some experts believe that reducing the number of unnecessary doctor appointments and medical treatments is critical in containing health costs, others fear that many of these health care services are necessary to prevent more serious - and more expensive - health conditions.

USAToday reports that Medicare Part D premiums will be approximately 12% higher in 2009 than they were in 2008. This figure has been calculated using bids placed by the private insurers provided the plans available through Medicare.

Despite this increase, Part D still costs less than officials predicted when the program was first launched. Beneficiaries may want to check their options during the open enrollment period in November and December of this year to ensure they are still receiving the maximum amount of savings.

Although Massachusetts's attempts to expand coverage to all state residents have encountered significant financial challenges, and have been subjected to criticism from experts around the nation, the state remains committed to their program. According to the Boston Globe, Massachusetts Governor Patrick has recently signed some new legislation affecting this health care reform effort. Last week, a new law generating over $100 million in revenue was passed to help defray the high costs associated with covering approximately 345,000 additional state residents. This week, the state passed a law designed to increase the number of primary care physicians in the state so that all of the newly covered residents have somewhere to go for health care.

The new law also limits the amount of gifts that pharmaceutical companies can give to physician's offices. This may help physicians make medical decisions without being influenced by drug manufacturers - but it may also limit the amount of free medication samples available at physician's offices for needy patients. Read my article for tips on how to save on prescription drugs.

Insurance companies are increasingly likely to turn to electronic prescription data when deciding whether to accept an applicant for coverage, and in determining the appropriate premium rate. According to the Washington Post, insurers have always looked at a patient's claims history, but until recently were forced to rely on paper records from the patient's doctor. Now, it is much easier for them to compile detailed data on prescription drug usage and laboratory tests. This data will be used to calculate an insurance "risk score," similar to a credit score that will be used to make coverage decisions. This new process saves insurers money and allows insurance policy applicants to receive an answer right away as to whether they will be covered.

Consumer advocates worry that insurers will jump to erroneous conclusions based on the information obtained from prescription drug usage data, and that people may be improperly denied coverage as a result. There are also significant privacy concerns raised by using this data because it is not regulated by current health information privacy laws.

The Las Vegas Sun reports that while some people are still experiencing problems with Medicare Part D, the number of complaints about the program have significantly decreased. However, auditors notes that the program still takes too long to respond to urgent complaints, averaging about 12 days to resolve an issue that should be resolved in 2 days.

When the new President is inaugurated next January, he is likely to inherit a $482 billion deficit. According to the New York Times, this is the largest federal budget deficit in history, and may hamper any health care reform efforts undertaken by our new leader. It will be virtually impossible to find the funding for health reform without jeopardizing our nation's financial situation even further.

The Chicago Tribune reports that Medicare will financially reward healthcare providers for using electronic prescriptions by paying them at a higher rate. Electronic prescriptions should not only expedite the process for obtaining medication, but they should also reduce the number of medical errors that occur as a result of illegible handwritten prescriptions.

Electronic prescribing equipment represents a significant up-front expense for physicians, so it is hoped that the financial incentives will encourage them to adopt the new technology. If not, payments will be reduced for those who do not adopt e-prescribing before 2012.

Florida Governor Charlie Crist recently proposed a program called Cover Florida, which would offer less expensive health insurance policies to uninsured Floridians. These cheaper policies would provide limited "barebones" coverage for catastrophic medical expenses in exchange for the lower premiums. The Governor hoped that these plans would be cheap enough for many of the uninsured to purchase. However, the Center on Budget and Policy Priorities believes that his plan will not work.

According to the Orlando Sentinel, even if the premiums are lower, they won't be low enough for low-income uninsured individuals to buy without some kind of subsidy. However, Cover Florida offers no such subsidy. Furthermore, the out-of-pocket costs associated with this type of policy would be higher than those associated with more comprehensive plans.

If your insurance company denies coverage for a benefit you think you should have, you may be feeling overwhelmed by the difficulty of fighting for coverage. But don't lose heart - it is possible to fight the claims denial, and win!

A recent article in the Syracuse Post-Standard shows how one woman complained about her denial of infertility treatment, and was able to obtain reimbursement for herself and over 2,500 other families. You can read more about this success story here.

Research shows that health costs can be significantly reduced if the most frequent emergency room visitors were redirected to medical homes. According to NJ.com, the city of Camden, New Jersey is working to address this problem by reaching out to the top 1% of emergency room patients, some of whom visit the hospital over 100 times each year. These patients can benefit the most from regular care outside the hospital and often need support from social workers in addition to healthcare providers.

The goal of these interventions is not only to improve the health of frequent emergency room patients, but also to save money. Similar programs have saved $1.44 for each dollar spent working with patients.