Preventive Services Now Free For the Insured

The new regulations will apply to new health plans beginning coverage after September 23, 2010 as well as to existing plans that make major changes after this date. Secretary of Health and Human Services Kathleen Sebelius estimates this change will affect 10 million Americans with individual and family health insurance and 31 million Americans in new employer-sponsored plans next year. In most instances, the task force has detailed how frequently a screening should be performed. Where the task force hasn’t specified a service’s recommended frequency, they ask health insurers to use “reasonable medical management techniques to determine the frequency.” Though these tests must now be offered to subscribers at no cost, insurance carriers will still be allowed to charge patients for treatments related to conditions detected after a screening.

The benefits of utilizing preventive services are real: Secretary Sebelius noted in a press conference for the release of these regulations that 100,000 deaths annually could be prevented if patients effectively used colorectal and breast cancer screenings, flu vaccines, counseling on smoking, and counseling on aspirin therapy to prevent heart disease. Unfortunately, it’s estimated that Americans use preventive services at only half the rate recommended by physicians and experts. Consumers need to take advantage of the preventive services that will be more widely available (and free!) as a result of these new regulations. Now there should be no excuse for those with individual and family or employer-sponsored coverage for whom these tests are free to take responsibility for their own health by getting screenings.

Secretary Sebelius also announced the task force is now compiling a list of preventive services that carriers must offer for free to women to supplement the services already required, including genetic counseling for women with family history of breast cancer, counseling to promote breast-feeding, and osteoporosis screenings. A controversy is on the horizon already with regard to this second list of women’s services. The Planned Parenthood Federation of America has argued publicly that insurance plans should be required to cover contraceptives without co-payments, a proposition pro-life groups will undoubtedly oppose.

Questions all women should ask about their health insurance coverage

1. Does my health insurance plan cover health screenings recommended annually for women?

It is recommended that women have annual mammograms, cervical cancer screenings, and osteoporosis screenings beginning at a certain age.  There are others important annual tests, but these tests are specific to women. The law requires that health insurance companies offer coverage for one annual mammogram for women 40 and older to prevent breast cancer.  Most states mandate that insurance companies cover an annual cervical cancer screening, such as pap smears.  Also, health insurance companies are required to offer coverage for annual osteoporosis screenings since they are necessary for health maintenance.  Osteoporosis tests begin around age 60.

2. Does my health insurance company cover specialty doctor visits?

Most health insurance companies cover for your OB/GYN services.  But it is important to check your health insurance plan to see what costs and treatments are covered because some are excluded from insurance.  For example, sterilization is rarely covered by health insurance companies.

3. Will my pregnancy be covered by health insurance?

Today, the average cost of having a baby is over $6000. Health insurance companies will most often cover doctors office and hospital visit expenses (with a small co-payment).  But there’s a catch: you must have health insurance before you get pregnant! Women who are already pregnant are considered “high-risk” candidates and it will be much more difficult to get coverage.  Other things you may want to check with the insurance company is if they offer coverage for services during your pregnancy (associated with the pregnancy but not the typical office visits) and prescriptions for possible depression. Even if you don’t needs these, better safe than sorry!

4. What if I need infertility treatments? Is that covered?

Infertility insurance is limited, but you’re not out of luck.  There are 14 states with mandates for health insurance coverage of infertility treatments.  If infertility treatments are not specifically excluded form your insurance plan, you can get coverage.  If needed, get a copy of your plan from your health insurance provider.  Otherwise, infertility treatment coverage is also offered by private insurance companies.

5.  Does my health insurance cover all of my prescription drugs?

There are many prescription pills specifically for women, such as contraceptive pills.  Generally, contraceptives have not been covered by health insurance companies in their plan. But, each insurer is different.  It is important to ask your provider because they may offer contraceptive coverage.

6. Is there coverage for treatment against diseases common to women?

Women are at a higher risk for osteoporosis, breast cancer, cervical cancer, and many others.  It is important for women to take preventative measures in their healthcare as well as have insurance for their expenses.  Vaccines are common preventative measures, such as Gardasil, a vaccine to prevent HPV and cervical cancer.  Many insurance companies cover this preventative vaccine because it reduces the chance of future medical conditions. However, check with the health insurance provider you are considering before making the final decision.

It is important to get coverage before you become ill.  Difficulty arises with health insurance coverage if you are already ill because the insurers many consider it a pre-existing condition.  Or some companies may offer coverage for office visits and pharmacy charges, but have you on a waiting list for any other treatment coverage you may need.

Medicaid for childless adults will also be expected to end, leaving 310,000 more individuals uninsured.

If you are an Arizona resident and want to view your health insurance options, visit our Arizona state specific page.

Medicare Plan N will include copayments for doctor appointments as well as emergency room care. Therefore, the monthly premium will be 28% lower than Plan F, according to the Tuscon Citizen Online. Plan N is recommended for healthy individuals because of the $20 copay for doctors visits; Plan F may be the better choice for those who expect frequent doctor visits.

Those who choose Medicare supplement Plan M can split the Medicare Part A deductible with the insurance company 50/50 to lower monthly premiums. This should be around 15% lower than supplement Plan F, according to EzineArticles.

Medicare supplement Plans N and M do not cover Medicare Part B.

Carriers have been given until this date to change their plans. AARP, or UnitedHealthcare is now the first carrier to release their rates. Plan N’s premium is announced at $86.27.

In addition, Medicare plans will now offer a hospice benefit while at-home-recovery and preventive care will be removed.

For more information, visit our Medicare Supplement Plan N page and Medicare Supplement Plan M page.

From: Hispanic Business News

To view Molina Healthcare plans, visit our Molina Healthcare page.

The hospital tax, according to Tennnesean.com, expired in 1994, when TennCare was created. Though these cuts would save the state approximately $380 million, they would really be costing Tennessee as much as three times more in federal aid. Hospitals have estimated around $526 million in state and federal funding this year and according to Craig Becker, the president of the Tennessee Hospital Association, some state services and hospitals will disappear, which is why the new tax is being proposed.

Tennessee is not the only state facing Medicaid costs. According to the Virginian-Pilot, rising health care costs and a growth in the number of Medicaid patients have increased the government’s obligation to pay over $750 million within the past two years. New Hampshire and Wisconsin as well may see state-level Medicaid cuts, according to a post in KaiserHealthnews.org.

Medicaid is an out of control program that is bankrupting state and federal governments. The befits are similar to those of private insurance, but for free. The program will not allow copayments to change behavior, but without them, the systems are falling apart. Here in Connecticut, if you take a ride down to Bridgeport of Yale New Haven hospitals on a Friday afternoon and check out the ER you will see how jammed it is. Services for a majority of these people will be performed without so much as a copay. Even a copay of $5 could make a significant difference to the program. As head of Health Net Medicaid, I was sued regularly for trying to implement such ideas, but if something doesn’t change, these programs will continue to go bankrupt.

Health insurance companies are in the business of, in fact, issuing “insurance” policies. Insurance means that a company will assess a person’s risk and then set a price of insurance, commensurate with that risk. To the extent that insurance companies do a poor job at assessing risk, they will not be in business very long, as claims will quickly outrun premiums. In fact, the average insurance company posts 3% of premiums in after tax profits and therefore does not leave a large margin for error.

Insurance companies typically do not want to insure chronic diseases such as diabetes. They also do not want to insure undiagnosed conditions or imminent surgeries. So, for example, if someone has hurt their knee and needs a $5,000 operation, an insurance company will not offer a $200 policy so that person can pay for his or her $5,000 operation. What they will do is say they will not insure that knee but will insure the rest of that person’s health needs, or they will say get if that person gets his or her knee fixed, then 6 months later he or she will be eligible for health insurance. Health insurance companies do not want open ended risks that they cannot assess.

So, how should someone seeking health insurance with a medical condition proceed to purchase health insurance? First question is do you qualify today for individual insurance? At Health Plan One, we can quickly review your health status and tell you what company would potentially offer you health insurance. Or we may tell you that you should review alternatives. Depending on your state and situation, alternatives may include a COBRA plan, a sole proprietor plan, or a HIPAA plan. Certain states like MI, NY, NJ, MA, and others have guaranteed issue plans: they may be a bit more expense but anyone can qualify for these plans. In other states, like CT and NH there are high risk pools, or plans that although expensive but anyone can qualify for.

Again, the ability for health insurance companies to accept all comers regardless of health status requires that everyone participates in the pool. It also requires that health insurance companies are allowed to allocate costs commensurate with risk. For example, age is a big determinant of your health risk: a 5 year old child typically requires much less care than a 60 year old male. Insurance companies will charge that older male 4 to 5 times the premium of the younger male. This may seem unfair to the 60 year old, but it seems awfully fair to the child. Unfortunately, the insurance market needs to allocate prices according to risk profile or it won’t work. Take NY, for example where age rating is not allowed and regardless of age you pay the same price. A PPO policy costs $1,500 dollars per month. This happens because everyone pays the same rate regardless of age. The younger people will ultimately opt out of the insurance pool, viewing it as unfair and too expensive. If the 18 year old opts out because it’s too expensive, then it gets a little bit higher for everyone, and ultimately, the price will reflect a 64 year old male and almost everybody will opt out of the insurance pool.

So how do we deal best with an insurance market that demands we allocate risk appropriately? High risk pools are an excellent way. People buy insurance to guard against future risk not current risk, so you can take the really high risk people and put them in a high risk pool and protect healthy people in an insurance market that reflects the actual cost of insuring against a future event you will have a highly functioning insurance market. Taxes or some other mechanism must be issued to subsidized to the high risk pool, although if everyone has insurance, over time the need for that high risk pool will diminish.

Open enrollment season for Medicare Advantage plans began Thursday, November 15.  Over the next few weeks, health insurance companies will be communicating with seniors about their 2010 Medicare Advantage plan offerings.  Whether you’re just turning 65 or you already have a Medicare plan, understanding the different options and choosing the right plan can be a daunting task.

Medicare is divided into three main categories – Original Medicare, which is managed by the federal government, and Medicare Advantage and Medicare supplement – or Medigap – plans, which are offered through private health insurance companies.

Original Medicare is composed of three sub-categories – Part A, which covers hospital expenses, Part B which covers doctors’ expenses, outpatient care and some other medical services not covered under Part A, and Part D, which covers prescription drugs.  Costs vary for each of these.  While Part A is usually provided with no monthly premium, Part B premiums are usually about $100 per month, except for higher-income individuals and Part D premiums range from $40-100 per month based on the drug plan you choose. There is a 20% coinsurance for Original Medicare and the current Part B deductible is $135. It is unclear whether or not this will increase for 2010.

In addition to enrolling in traditional Medicare, seniors may also choose to add benefits through Medicare Advantage or Medicare supplement plans.  Since Original Medicare has deductibles and coinsurance, seniors may purchase a supplement plan to pay a portion or all of those out-of-pocket costs. Alternatively, they may opt to enroll in a Medicare Advantage plan – choosing between HMO, POS and PPO plan types.  Typically Medicare Advantage plans offer more extensive benefits than Original Medicare, including annual physical exams and routine hearing and vision exams, at additional low monthly premiums, although they usually require physician and hospital copayments.  Medicare Advantage plans typically include a Part D drug plan.

Is Medicare Advantage the Best Option for You…?

Choosing Between an HMO or PPO/POS Plan

HMO, POS and PPO plans differ primarily by cost and network, so it pays to invest time in deciding what you want and what you can pay when making your final decision.  While HMOs may have the lowest monthly premiums, plan members may only be able to access care from their carriers’ network, except in the case of emergency care.  And, while some Medicare HMO plans may have no monthly plan premium and include a Part D drug plan, it may have significant hospital and surgery copays.  Often, the most popular Medicare Advantage HMO plans cost between $100-150 in monthly premiums and have no or low inpatient hospital copays.

For seniors who do not want to be restricted by a limited HMO network, such as those individuals who travel a lot, a Medicare PPO or POS plan might be a good alternative (PPO and POS plans are equivalent). While these plans often offer the same overall benefits as HMOs, higher monthly plan premiums and greater cost-sharing for out-of-network services allow greater flexibility in accessing health care. Seniors insured under a PPO/POS plan are not restricted by a network.

While there are private fee for service – or PFFS – plans available in 2009, they are not covered here as they tend to more expensive than other Medicare Advantage plans and are being phased out after 2010.

What’s Different from 2009

Seniors living in Connecticut will be able to choose from many Medicare Advantage plans, including 23 from the major carriers.  With Anthem’s reentry into the Connecticut market this year, competition will certainly be tough, particularly in Fairfield, Hartford and New Haven counties, where most major carriers have a significant number of plan choices.

Both Health Net and ConnectiCare will be offering four HMO plans and two PPO/POS plans to residents in all Connecticut counties.  Aetna is offering three HMO plans and two PPO/POSs for seniors living in Fairfield, Hartford, Litchfield and New Haven counties.  Anthem is offering four HMOs for Fairfield, Hartford and New Haven counties, while United Healthcare is offering one PPO to residents in all Connecticut counties and an HMO only in New Haven County.

In 2009, ConnectiCare had one of the most popular HMO plans in Connecticut, prompting many Health Net HMO members to switch carriers last year.  Smaller premium and low or no out-of-pocket increases for Health Net’s 2010 HMOs make these plans quite competitive this year. However, it is worth noting that both the ConnectiCare and Health Net HMO networks do not extend outside of Connecticut for its Medicare Advantage members.

For residents in Fairfield, Hartford and New Haven counties, Anthem and Aetna also have highly competitive plan options. Aetna’s plans are also available in Litchfield County and its Medicare Advantage members can access Aetna’s network nationwide.

For seniors interested in a PPO/POS plan, Health Net introduced a new plan, which features a low monthly premium and comparable copays to other PPO/POS plans offered in the state. ConnectiCare remains a strong choice, with its competitively priced POS plans. With moderately low physician and hospital copays, the Aetna’s PPO plan and ConnectiCare’s POS plan also may be good options.

Eligibility for Financial Assistance

State Assistance Programs

If you cannot afford Medicare premiums, you may qualify for state assistance. Depending on what state you reside in, you could have one or more options. In Connecticut, seniors who qualify have the option of enrolling in ConnPACE, a program designed to help seniors in paying for prescription medications.

ConnPACE is a state funded prescription drug assistance program for Connecticut’s senior citizens and people with disabilities. ConnPACE covers most prescriptions, insulin, and insulin syringes. Out of pocket expenses for ConnPACE are a $30 annual application fee and a $16.25 copay for each prescription medication.

You are eligible for ConnPACE if you have been a Connecticut resident for at least 6 months, you are 65 years or older or a disabled person over the age of 18, you are not receiving Medicaid benefits, you do not have an insurance plan paying for all or some of each prescription on a continuous basis and you have an adjusted gross income of less than $25,100 for a single person and $33,800 for married people.

Or You May Consider a Medicare Supplement Plan?

Medicare supplement options may certainly be described as an alphabet soup of coverage, ranging from Plan A to Plan J.  Like Medicare Advantage, Medicare supplement plans are sold by private insurers but these plans are primarily designed to help individuals fill payment gaps.

While these plans typically have higher monthly premiums, Medicare supplement plans pay your share of the costs of Medicare-covered services thus eliminating or reducing out-of-pocket payments, including co-insurance, deductibles and Part A and B premiums.  These are separate from Medicare Advantage, employer- or union-sponsored group coverage, Veterans Administration benefits or TRICARE for military personnel and their families, so come with no value-added benefits.  Enrollees would have to purchase a stand-alone Part D drug plan, as none are offered as part of these plans.

While many smaller insurers offer Medicare supplement plans in Connecticut, two plan options from major insurance carriers are worth considering based on their monthly premiums – UnitedHealthcare/AARP Plan J ($184/month) and United of Omaha Plan F ($190/month).  Enrollees would have to purchase a stand-alone Part D drug plan, as they are not offered as part of supplement plans.

In 2010, there will be a few changes to Medicare supplement. Two new plans, M and N, are going to be added. It is believed that these plans will have lower premiums and involve more cost-sharing. They should be introduced by June 2010.

How Should I Decide?

With so many options available to seniors in Connecticut, it may be difficult to identify the one plan that is best for you.  Earlier, we discussed price, which in the case of Medicare supplement plans, should guide your decision since benefits are identical.  While some states do allow for different pricing based on age and gender, Connecticut does not.

For Medicare Advantage Plans, the quality and breadth of the physician and hospital networks, as well as value-added benefits, should also be taken into consideration.  Are you sure your physician is in your plan’s network?  Does your physician admit to hospitals that also are in the carrier’s network?  For example, if your physician only admits to Norwalk Hospital in Fairfield County, it may be worth noting that only one health plan has Norwalk Hospital in its Medicare Advantage network.  The size and quality of an insurer’s network is not critical for individuals purchasing Medicare supplement plans because there are no networks tied to these plans.

In addition to ensuring that your prescription medication is covered under a Part D or Medicare Advantage plan, you need to know what tier your health insurer has placed your drugs in, as different pricing tiers will impact your out-of-pocket costs.

Important Dates

• November 15 – Open enrollment season begins
• December 31 – Open enrollment season ends
• January 1 – Changes made during open enrollment period take effect
• January 2 to March 31 – If you are not satisfied with your Medicare Advantage Plan, you may still switch plans up until this date. You can only make one change after December 31 and you may not add or drop Medicare Part D.

Professionals Here to Help

For more information or to answer questions regarding specific plans, in addition to any concerns regarding Part D drug coverage, please visit www.medicaresolutions.com or www.healthplanone.com or call 1-877-270-0612.

Many others have criticized AHIP’s actions, claiming that AHIP is scared and attempting to block health insurance reform as a last ditch resort. Well, of course. The health insurance industry is reacting because the public option will put them out of business. Although they are not saints, the health insurers simply pay claims and charge premiums. In the end they make a 3% profit out of doing so. They also subsidize Medicaid and, to a lesser extent, Medicare-by paying doctors, hospitals, and more. The payment difference is not by choice-rather, free (and oligopolistic) market forces at work.

The idea that a public option will make health care more affordable can only happen in 2 ways: (1) pay doctors, hospitals, and others less. This may be a good idea, but there are consequences of monopolistic, heavy handed pricing tactics; (2) we can have taxpayers subsidize the public option.

The idea that the public option will save on administrative costs is not realistic. What does Medicare do for administrative costs? It contracts with Blue Cross and other insurance companies! If you still don’t believe it, go visit any major health insurer headquarters in CT (Anthem, Aetna, Cigna…). The places are half empty, having massively reduced costs over the last 5 years. “Profiteering” may be considered bad, but these insurers are very lean.

We don’t like HMOs, because they are too restrictive. We don’t like limited benefits so we pile on mandated benefits each year. We don’t like high deductibles, but we do like high tech cures. There is no ceiling and our solution? A public option? If our appetites are insatiable, NO option can solve the problem.

PFFS plans were introduced for a variety of reasons, most importantly to offer choice to rural seniors and to offer a way for employers to enroll retirees scattered over the country. Without the confines of a network, seniors enrolled in PFFS plans could pay on a service by service basis and see whichever provider they wished, as long as the provider accepted PFFS payment terms. To make this option attractive for insurers to offer, CMS proposed “bids” that were over the average payment rate. These “overpayments” were intended to be temporary, to get the insurers in the rural markets, and over time to encourage the insurers to develop provider networks, or HMOs. In fact, 2010 is the final year PFFS plans will exist. So even if the government makes no cuts to the Medicare system in an effort to reduce spending, huge savings will be realized in 2011 Medicare Advantage costs, as PFFS overpayments expire.

It is not clear if in fact the insurers will offer HMOs in rural areas in 2011 when the PFFS plans go away. For example, in Maine and New Hampshire where Anthem Blue Cross is the dominant MA player,  MA plans are yet to be introduced. It may be that the rural provider community is too small to support Medicare HMOs where access is traded for benefits. Insurers may be forced to offer PPOs as an alternative option to PFFS plans-or drop MA coverage altogether. At the end of the day, MA plans-be them HMOs or PPOs-need to deliver high quality care at a savings or they will go the way of the dodo bird. We will know in 2011.

The demise of Medicare Advantage plans would merely change the contract that Medicare has with private insurers. For traditional Medicare, CMS pays the health plan a claim administration fee. For Medicare Advantage, CMS pays the insurance company a fixed fee for each enrollee, based on the age, gender, county of residence and health status of the enrollee. The insurance company then attempts to create a margin by savings on claims through various programs: excluding inefficient high cost providers from the network, medical case management, utilization review, etc.

The insurers can usually manage members at a very large savings, but then much of this savings is eaten up by the cost of acquiring members. A health plan’s average acquisition cost of a member is well over $1,000 and often as high as $1,500. If the member stays on the plan for a few years, the health plan can profit and Medicare saves money. If the member leaves after a year, the health plan loses money. As good government policy, CMS (and Congress) need to have consistent reimbursement to encourage health plans to invest in acquiring members. Unfortunately, the program has been marked by big swings in reimbursement.

This should not be a partisan issue. If the private sector can deliver a high quality efficient solution, we should want more of it. Government left to its own devices will use the clumsy lever of reducting provider fee schedules to save money. Providers just pass costs on to the private sector. Fortunately right now the government can rely on the private sector to pick up the tab. Did you ever wonder why medical trends in Medicare and Medicaid are in the single digits and the private sector is in the duoble digits? For my national health care enthusiasts, be careful what you wish for.

Congress needs a bolder bill rather than more subsidies, more income taxes, more premium taxes, more grants, or more pilot projects. The fundamental cause of rising medical costs is the fact that our medical services, technology, biotech, and pharmaceutical industries continue to mass produce huge advances in medicine and create unsustainable medical trends in the US. This medical trend also subsidizes our international counterparts with state-run programs.

And where’s the insurance industry? These are the companies with armies of actuaries and underwriters that constantly dig through medical trends, unit costs of medical expenses, premiums, claims, renewals, technology, etc. It is admirable that they have taken a low key approach while being absolutely bashed by politicians of all colors and stripes, but at some point if they want the private insurance industry to survive, they need to develop and communicate some recommendations on how the country can control medical costs.

At the end of the day, to keep our health care system solid, we will need to do a combination of four things:

1. Increase taxes,
2. Increase cost-sharing for both private and public beneficiaries,
3. Limit medical benefits, or
4. Govern and limit access to new medicines, technologies, and procedures.

Baucus’ bill recommends the first option but punts on points two, three, and four.

This question has been answered in Canada and the answer is yes-we will all have the same level of benefits and if you want additional benefits you will have to leave the country. In the United Kingdom, everyone has the same level of benefits except for those who buy additional benefits with private insurance.

In the United States, we have ostensibly said yes by providing the same level of benefits in our Medicaid and Medicare programs as private insurance. However, we have quietly reduced access in the Medicaid arena by paying physicians significantly less than what Medicare and private insurance pay. As a result of these reduced payments to physicians, many of the top specialists do not participate in the Medicaid plans, thereby reducing access to high-tech services and procedures. In certain states, the Medicare programs mandate generic drugs where there is a brand substitute.

Until we decisively answer this question, state and federal budgets will continue to underfund Medicaid and the cost of these higher-tech procedures will continue to be borne by the private insurance marketplace. And as private insurance medical cost increases continue at the unsustainable double digits, the sooner we answer the question of whether Medicaid is going to have equal benefits to private insurance or not, the faster we can solve the current private insurance cost crisis.

This debate is happening right now as supporters of universal care and single payer systems are clearly in the camp of equal benefits for all. These supporters are also supporters of a national healthcare plan. People who oppose the national plan and universal health care implicity say there should be a different level of benefits going forward. Although one of the most difficult questions on our plates, we must answer it sooner than we think.

It is therefore not surprising that none of the cities where we found low healthcare costs were in large metropolitan areas where there are high amounts of specialists and a low penetration of small HMO physician networks. The authors raise a great point: these are extremely efficient healthcare delivery models. The only problem is Americans hate HMOs! But somehow we need to figure out what will govern the runaway costs of medical care, and I would rather have my physician say no to a service than no to a bureaucrat.

A better question is how will the national health insurance plan save money over the competition? Reduced administrative fees? If all the national health plan does is reduce administrative fees, it will be an enormous failure, because today’s problem is not administrative fees. It is the 10-15% medical cost trend that occurs every year in both Medicare and private insurance. You can cut administrative fees that average 10-15% in the health insurance industry to 0, but a year later you’d have the same problem because the other 85% of the medical cost went up 10-15% and boom! You have the same problem.  So, before we jump onto the national health care plan bandwagon, we probably should know how plans are going to be priced, and, secondly, the cost of those plans, other than what they do in Medicaid and Medicare, which has ratcheted down fees to doctors and hospitals.

Instituting better cost-sharing in Medicare would be a great way to save expenses. The Centers for Medicare and Medicaid Services (CMS) needs to introduce medigap or supplement plans that have more cost sharing. The most popular supplement plan in Medicare is Plan F, which costs seniors between $125-$275 per month and covers virtually all out of pocket costs. Many of these plan designs have not been updated for years and years. The good news is that CMS has finally introduced a co-pay plan for the doctor- thirty years after private insurance did! Any sort of progress can help.

Ingenix is a subsidiary of UnitedHealth Group which is also used by nearly 20 regional and national health insurers. Ingenix agreed last January to pay $350 million in order to settle allegation that it kept its rate low to underpay doctors.  Other health insurers include Aetna, CIGNA, and Wellpoint.

Health insurers submit information to Ingenix to determine the costs for care received out of network. Health insurance companies often skew data to underestimate the costs of medical services so that patients would have to pay more in out of pocket costs.

“The result of this practice is that American consumers have paid billions of dollars for health care services that their insurance companies should have paid,” states the Senate Commerce Committee’s investigative staff.

“Insurers know that policyholders are so baffled by those notices they usually just ignore them or throw them away,” said Wendell Potter, a former insurance executive at CIGNA. “And that’s exactly the point. If they were more understandable, more consumers might realize that they are being ripped off.”

To see the full report, go to http://www.google.com/hostednews/ap/article/ALeqM5g4s2x4w7hv-cWoKaCbdWmE1sQecAD991BJOO0.

PWC implies that some of the reasons for this increase in costs is due to employees being concerned about losing their jobs therefore using their health insurance as much as possible while it is still available to them. Another reason for this increase is increasing medical costs as employment rises. More and more uninsured people are turning to Medicaid causing health coverage costs to rise.

A survey done by PWC that involved over 500 employers concluded that 42 percent will increase health care costs for employees in the form of higher premiums, deductibles, and copays.

“As the economy recovers, employers will refocus on more sustainable longer term approaches to medical cost containment based on an increasingly shared interest between employers and their workers,” says Price Waterhouse Coopers Principal Michael Thompson.

Check out the U.S. News article at http://health.usnews.com/articles/health/healthday/2009/06/18/health-highlights-june–18–2009.html