Tag Archives: Health Insurance Industry

Sounds Like A Good Idea? Selling Insurance Across State Lines

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http://khn.org/news/sounds-like-a-good-idea-selling-insurance-across-state-lines/?utm_campaign=KHN%3A+Topic-based&utm_source=hs_email&utm_medium=email&utm_content=31951328&_hsenc=p2ANqtz-9Au4A3tKJC2f1doju3f4Dw18KzyED43y2Sj7CoTrEGMjtO3CgeqJDjl3Yfx5eL8yn5TPahpYi4zAzzsZKEKpwIKhMWag&_hsmi=31951328

Presidential candidates like to propose solutions to long-standing problems. Health care is no exception.

But there’s a reason some problems are “long-standing.” They may have no easy solution. Or the solution is not politically feasible. Or there’s a solution that sounds good on the campaign trail but is not likely to actually work.

In this first of a series of videos of health policy promises that “sound like a good idea,” Julie Rovner explores why increasing competition in health insurance by allowing sales of policies across state lines might not be such a good idea after all.

Are insurers ditching PPOs?

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http://www.healthcaredive.com/news/are-insurers-ditching-ppos/423291/

Insurers that have been offering PPO plans in the healthcare marketplace appear to be cutting back on the number of offerings or eliminating PPOs from the marketplace altogether, leaving consumers with fewer options. Is this becoming an industry-wide trend?

“In the large group market, traditional PPO offerings have been on the decline for the last several years as Consumer Driven Health Plans have gained popularity,” says John Greenbaum, senior vice president and employee benefits practice leader at national insurance brokerage Risk Strategies Company. “In the group market, the move has largely been driven by market concern over the now-delayed Cadillac tax.”

According to Greenbaum, insurers offering products on the public exchanges have curtailed their PPO offerings in favor of high-deductible plans. “Their motivation has been the difficulty of achieving profitability in a regulated market with no ability to underwrite the quality of risk,” he says.

Teri Mullaney, President and CEO of DST Health Solutions, says there are benefits to both payers and consumers to moving away from PPOs:

Anthem’s Good, Bad and Ugly News

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http://www.bloomberg.com/gadfly/articles/2016-07-27/anthem-earnings-the-good-the-bad-and-the-ugly?_hsenc=p2ANqtz-9r6DeQcVMyNnafhqaWRYPxsGcyFkKJ80w17xLndiqVNIIOrCFlnm-c4sSm8WS6EqhbFxAmVmQuwhj1GdEe1f5nt4irUw&_hsmi=32205122&utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_content=32205122&utm_medium=email&utm_source=hs_email

Anthem had some good headlines on Wednesday. The insurer reported second-quarter earnings and revenue that topped estimates, with the latter jumping 7.2 percent from a year earlier. It expects to insure more people than it initially forecast this year, after surprisingly robust growth in its Medicaid business.

But beneath the good, there was also bad and ugly.

Standard & Poor’s puts Aetna, Humana on credit watch following DOJ move to block merger

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http://www.healthcarefinancenews.com/news/standard-poors-puts-aetna-humana-credit-watch-following-doj-move-block-merger

S&P Global Ratings has placed Aetna and Humana on creditwatch following the Department of Justice’s announcement Thursday to block their merger.

S&P said it has placed its ratings on Aetna on creditwatch with developing implications, and on Humana and its core subsidiaries on creditwatch with negative implications.

The DOJ also blocked the merger between Anthem and Cigna on Thursday.  S&Psaid its ratings on the two insurers would remain on creditwatch negative, where they were placed on June 21, 2015.

Anthem and Aetna have both said they would fight the DOJ’s injunction against their respective mergers in court.

For Anthem’s proposed $53 billion acquisition of Cigna, litigation could be difficult and time-consuming, S&P said.

Two Insurance Giants Planning To Jump Into California’s Medicaid Market

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http://californiahealthline.org/news/two-insurance-giants-planning-to-jump-into-californias-medicaid-market/?utm_campaign=CHL%3A+Daily+Edition&utm_source=hs_email&utm_medium=email&utm_content=32098016&_hsenc=p2ANqtz-9tr6FTuX8Rn3kqb-g3wx_G8rxJ_0PzWxVk4pwI8say6MCDmhYinp6BenB_Vz6lQNf_u8pka3N8wLQ5gWg3hZwd-EJPyw&_hsmi=32098016

Two of the nation’s largest insurers are reaching out to doctors as they prepare to offer health coverage to low-income residents in California’s Medicaid program.

UnitedHealth and Aetna plan to join Medi-Cal managed care in San Diego and Sacramento counties beginning next year, pending final state approval.

Their participation shows that “Medi-Cal is a good business to be in,” said Stan Rosenstein, a consultant with Health Management Associates and a former Medi-Cal administrator. “Insurers are recognizing that with Medi-Cal covering a third of Californians, [they] really can’t ignore it.”

DOJ sues to block Aetna-Humana, Anthem-Cigna mergers

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http://www.fiercehealthcare.com/payer/doj-sues-to-block-aetna-humana-anthem-cigna-mergers?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiWkRFMk5ERTBOemd5TkRZMyIsInQiOiJiaEZQV3RZeFFXVUR5TFwvTDhmd2JBc2ppRzVpRjY3eDN5b1Q1aXh3aHV5VDdud2xpblFBME92bkl2ZFQ2NXZOZ1BEZ3BqSkZ2Y2NGUDA2aG5laE5JMzhIeTJ4UWNuckxkUkI0bVwvdFRyM3o0PSJ9

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20 things to know about balance billing

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http://www.beckershospitalreview.com/finance/20-things-to-know-about-balance-billing.html

Medicine and Dollars

As payers and providers wage war over reimbursement rates for medical services, patients have been increasingly strapped with unanticipated healthcare bills that can have detrimental financial effects.

The practice of balance billing refers to a physician’s ability to bill the patient for an outstanding balance after the insurance company submits its portion of the bill. Out-of-network physicians, not bound by contractual, in-network rate agreements, have the ability to bill patients for the entire remaining balance.

Balance billing may occur when a patient receives a bill for an episode of care previously believed to be in-network and therefore covered by the insurance company, or when an insurance company contributes less money for a medical service than a patient expected.

In recent years, the rise in out-of-network payer-provider reimbursement clashes have spawned a growing number of balance billing cases. Last October, Aetna discouraged members from seeking emergency medical care at in-network Allegheny Health Network hospitals in Pittsburgh after out-of-network emergency physicians began ‘aggressively’ balance billing policy holders. In a more drastic move, UnitedHealthcare announced last year the insurer would no longer cover medical bills for members who unknowingly received out-of-network treatment by physicians at in-network hospitals.

Patients, caught in the financial crosshairs, often feel powerless to negotiate costs. Consumer advocacy groups and federal and state legislators are turning their attention to balance billing practices this year with renewed vigor, forcing payers and providers to find other ways to settle financial disagreements.

Anthem-Cigna Deal: Seeking Merger Approval, Anthem Makes Major Donations To State Political Groups

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http://www.ibtimes.com/political-capital/anthem-cigna-deal-seeking-merger-approval-anthem-makes-major-donations-state

Money in Sky

Seeking regulatory approval for a controversial merger proposal, health insurer Anthem recently pumped $460,000 into groups supporting the election campaigns of governors and state attorneys general. The money was disclosed in second-quarter campaign finance reports reviewed by International Business Times.

Those federal filings, which were released by the Internal Revenue Service late Friday, show Anthem gave $210,000 to the Republican Governors Association, $200,000 to the Democratic Governors Association in the last three months. In many states, the insurance commissioners reviewing the proposed Anthem-Cigna mega-merger are appointed by governors. The cash to state officials is on top of $50,000 Anthem gave to a Democratic-affiliated political group called “Unity Convention 2016.”

The money to the DGA is particularly notable because the group is headed by Connecticut Gov. Dannel Malloy, whose insurance commissioner, Katharine Wade, runs the agency leading the national multistate review of the deal. Anthem money flowed to the DGA in June amid an ethics probe prompted by IBT’s investigative series documenting Wade’s personal and familial ties to Cigna.

Malloy has refused to force Wade to recuse herself from the merger review, at a time when Anthem and Cigna have increased their donations to the DGA, which backed his campaigns and which he has chaired since late 2015. In all, the DGA has raised a total of $1.1 million from Anthem and Cigna since Malloy began the process of nominating Wade to the insurance post in 2015. That sum is 37 percent more than the group raised in the entire 2014 election cycle, and almost half of the total campaign contributions the companies have given the group in the last decade.

iFHP cost report highlights cause for concern over lack of provider competition

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http://www.healthcaredive.com/news/ifhp-cost-report-highlights-cause-for-concern-over-lack-of-provider-competi/422860/

The International Federation of Health Plans (iFHP) today released its2015 Comparative Price Report, detailing its annual survey of medical prices per unit. Designed to showcase the variation in healthcare prices around the world, the report examines the price of medical procedures, tests, scans and treatments in seven countries.

The report undercuts the idea of what’s being played out in the recent Sutter Health case which alleges the health system is overcharging insurers causing medical costs to be pushed downstream to patients. Last Friday, the suit was allowed to seek class-action status. Matthew Cantor, partner and attorney at Constantine Cannon and lead lawyer for the plaintiffs, told Healthcare Dive the plaintiffs allege to have contracts which require health plans to purchase all the hospital services that Sutter provides in Northern California.

Sutter is “leveraging its larger power in those markets to say to these health plans that they have to also purchase Sutter Health hospital services elsewhere and not only do they have to purchase them but they have to purchase those Sutter services at higher, super competitive prices,” Cantor said, adding that this, in turn, raises the costs of medical services to health plans. These higher costs, Cantor said, are then sent downstream to insurance policyholders.

“Competition is not working,” Sackville told Healthcare Dive. “The market’s not working because if it was, no one would get away with charging $17,000 [for a day of hospital care].”

The report put a focus on the lack of provider competition and consolidation. There’s been a fair amount of consolidation in various states and more systems are pursuing the idea of mergers or partnerships. Such activity, in theory, could bring down competition in an area and tick up costs for consumers as hospitals’ market power grows. “Powerful hospital systems have the ability to raise the prices of medical care. Health plans have no alternative but to take these forced, higher costs upon them because [if they refused] then no one would buy their insurance,” Cantor told Healthcare Dive.