Archive for the ‘Insurance Carriers’ Category

Six health insurance companies have agreed to end the secrecy over their requests for rate increases, according to the superintendent of New York’s new Department of Financial Services.

According to Benjamin M. Lawsky, of the newly formed DFS, United HealthGroup announced their agreement to transparency in their financials with the Department of Financial Services last week, while five other carriers including Aetna Health, EmblemHealth (also operating as GHI and HIP), Empire HealthChoice (known in NY as Empire Blue Cross and Blue Shield), Excellus Health Plan and HealthNow, agreed two days later. The companies represent about 85% of the prior-approval segment of the state’s insurance market, covering 2.4 million New York residents.

The health insurance carriers that continue to object to transparency are Capital District Physicians’ Health Plan, Connecticut General Life Insurance Co., Independent Health and MVP Health Care.

Now, when a carrier asks for price increases, all parts of their applications, including required information and exhibits, will be made available to the public.  At least that will be true for the carriers who have agreed to share this information. Only contractual matters that involve payments to providers and hospitals will be excluded as both sides agreed that it would not be valuable for consumers who would choose to file objections to carrier rate requests.

“This is a great day for transparency and the public’s right to know how their health insurance premiums are set,” Lawsky said in a statement. “Transparency will promote competition and allow the public to make effective comments as part of the rate review process. I applaud these companies for their decision and hope the remainder of the industry will soon see the light.”

For contracts that start on or after Jan. 1, 2012, health insurers requested weighted average increases of 12.7% and the Department granted increases of only 8.2% below the expected increase in medical costs. The lower increase will save consumers more than $400 million in 2012, officials said.

However, some carriers have responded by withdrawing plans they think aren’t going to earn enough money which may mean fewer choices, especially for small businesses in the Metro NY City area.

Elisabeth Benjamin, Vice President of Health Initiatives at the Community Service Society and co-founder of Health Care For All New York, said, “It’s gratifying to see the domino effect actually playing out in favor of New York’s consumers and small businesses. The past decade’s secret system of hidden rate filings is a thing of the past-now New York’s consumers and small businesses finally have the opportunity to understand why insurance costs are so steep, and as a result, now will be able make well informed decisions about which carrier they trust to provide their coverage.”

If you’ve received a rate increase from your health insurance carrier and want to explore options with that carrier or with other carriers that may be available to you, Small Business Benefit Solutions, LLC can shop around for you at no cost or obligation.  Be informed! If nothing else, you will be able to confirm that the plan you have is the right plan for your company.

Walgreens Pharmacies has elected to stop participating with Express Scripts, the pharmacy benefits manager of Wellpoint Blue Cross plans at the end of the year.

Walgreens and it’s affiliated pharmacies, including Duane Reade Pharmacy in the New York City metro region, Happy Harry’s Pharmacy in several northeastern states and OptionCare, will stop processing Anthem and Empire Blue Cross member prescriptions on an in-network bases effective on January 1st, 2012. 

Access to other retail pharmacies within the pharmacy provider network will be available, as the Express Scripts pharmacy network contains more than 56,000 pharmacies without Walgreens.  On average, there is another network participating pharmacy within one-half mile of any Walgreens pharmacy.

You can find other participating pharmacies in your area at www.anthem.com or www.empireblue.com and then you can search by pharmacy name or by your geographic location.

If you are unsure whether your small business health plan or your individual medical insurance plan will be effected by this change, contact your carrier, your agent, or call Small Business Benefit Solutions, LLC and we’ll look up your pharmacy for you.

Horizon Blue Cross and Blue Shield, a New Jersey based medical insurance carrier, announced that it is no longer seeking to attain “for profit” status from the state of New Jersey.

Citing recent Health Care Reform changes and an ever growing acrimonious medical insurance environment, Horizon sent a letter retracting its application to acquire for-profit status to the New Jersey Department of Banking and Insurance (DOBI) and Attorney General’s office.

Horizon has been trying to go for-profit since the summer of 2008, but according to the letter of retraction, the carrier says “circumstances have changed, including, without limitation, that Horizon’s business operations are being redesigned in order to comply with the complex requirement imposed under the federal Patient Protection and Affordable Care Act (PPACA).”

According to Tom Vincz, public relations manager for the company, Horizon is expected to undergo “major” changes to its business in the next few years in relation to servicing its members, selling products, managing networks and interacting with federal and state governments.

The DOBI had no comment on Horizon’s withdrawal, but given that it’s been reviewing the application for nearly 3 years, there is wonder if they were ever planning to move forward with the application at all.

What does this mean to you?  Well Horizon has taken a very cautious approach to Health Care Reform all along and some of our clients have been very disappointed with the direction the company has taken, citing service issues and a generally bad attitude when they call in to get help.

As an agent, we have had equally difficult times getting issues resolved.  Horizon forces us to call a 3rd party to answer even the simplest of questions so we have wondered how committed they are to growing their market share with such an illogical service model.

Horizon’s competitors in the small group market, including Oxford Health Plans and Aetna Health, have continued to offer direct support, making us as agents, more inclined to steer clients in their direction, knowing we will be able to manage any issues that come up for them.

If you have Horizon Blue Cross and want to explore whether they are the carrier for you, please call Small Business Benefit Solutions, LLC and we’ll review your plan and your needs at no cost or obligation to you.

New Hampshire Individual Customers Billed Incorrectly

Due to a system error, the monthly premium shown on some January and February statements mailed to Individual members from Anthem Blue Cross and Blue Shield were incorrect.

Based on the annual premium rate noted in the member’s renewal letter, the amount due number shown was less than it should have been.

Anthem says they have made the necessary correections and have sent a letter to the effected members directly.

If you’re unsure what to do with your bill, follow these steps:

• If you have already paid your premiums for January and February, you will receive a new bill that shows credit for your payments made and the balance due.
• If you have NOT paid your January and February premiums, you should wait until you get a new bill with the corrected amount.
• If you use our Electronic Funds Transfer system to pay your bill, the next withdrawal will include the remaining balance due for January and the correct February premium.
• If you received a late notice because of a missing or partial January payment, you should disregard it. Their grace period will begin with their February bill.

If you have any questions, please contact Small Business Benefit Solutions, LLC, your broker or agent or you can contact Anthem directly at the phone number on the back of your ID card.

In a memo that we received yesterday, New York-based Guardian said “its modest medical market share and its use of rental networks significantly hampered its ability to compete in the group medical sector that has frequently favored large national medical carriers” so offering the plans is no longer financially viable.

According to a spokesman, Guardian covers 42,400 employees in small group medical plans and these employer groups will have the opportunity to transition to United or to move to another local carrier.

Guardian intends to continue to offer ancillary benefits such as dental, life, disability and vision care.

If you presently have a Guardian small business medical policy at your office, call Small Business Benefit Solutions, LLC right away.  Don’t wait until your renewal to make a decision about moving to another carrier.  we can shop other more competitive carriers for you

Anthem Blue Cross has added several procedures that will require pre-approval before benefits get paid.

Effective with group insurance plans that renew in March this year, Anthem Blue Cross and Blue Shield of NH has announced that it will scrutinize the following medical services:

• Air Ambulance Travel
• Diagnostic Testing
• Certain Ambulatory Surgical Procedures
• Other Outpatient treatments that remain unspecified

Anthem claims this policy change is in an effort to provide “you and your employees access to the best health care at the best value.”

The carrier is claiming that the pre-authorization process will help determine medical necessity of certain outpatient care.  They are assuming that the physician, who spent at least 8 years in medical school, is incapable of making this determination, a slap in the face to all doctors who rail against the pre-certification process as an effort by insurance companies to undermine their education and experience with bureaucratic red tape.

Anthem has not specified exactly which diagnostic exams or which ambulatory procedures are going to require pre-approval.  It’s safest to operate under the assumption that all procedures will require pre-approval.  Anthem gave out a phone number for members to call in case you want to know if the service your doctor recommends requires this pre-approval.  The number is 866-672-3666, but when we called this number there was no option for determining pre-approval so SBBS cannot be sure that this resource will be helpful.

Your Anthem participating doctors will be getting similar correspondence which will tell them more specifically, what procedures they will have to get pre-approved.  If you do not use Anthem participating doctors, it will be your responsibility to get this pre-approval.

Anthem claims that their decisions will be based upon “standards of appropriate care drawn from medical policies, clinical guidelines and the terms of your plan”, but whether it will be a medical expert making these decisions, or a kid in front of a computer screen, is yet to be determined.

Either way, expect that you will have a lot more hoops to jump through if your doctor wants more than just a standard office visit.

While other carriers have not announced such stringent pre-approval notices, this may be the newest wave of inconvenience to hit the health insurance policy-holder thanks to the upheaval of health care reform.

If you are dissatisfied with Anthem’s decision and currently hold and Anthem Small Group insurance policy, please contact Small Business Benefit Solutions, LLC and we can explore carrier alternatives for you.

Oxford Health plan participants in New York and New Jersey who are already in the Oxford Liberty network of doctors, or contemplating shifting their insurance plan to the Liberty network in order to reduce costs, will be happy to learn that the Mount Kisco Medical Group has reached an agreement with Oxford to participate in the Liberty network.

The Mount Kisco Medical Group is comprised of over 200 primary care and specialty physicians including experts in 30 specialties and sub-specialties including most major medical and surgical specialties.  Thei facility is nearly a one-stop shop for medical care including physicians, lab and radiology services, physical therapy and sports rehabilitation, outpatient surgical center and an optical shop.

UnitedHealthcare, which owns and operates several smaller health plans including Oxford, has implemented provisions set out in Health Care Reform Legislation.

The following provisions are required to be in place by September 23rd, regardless of a health plans grandfather status, and will be effective upon new contract or renewal on or beyond 9/23:

• Dependents will now be covered to at least age 26, or to an older age based on specific state laws
• Pre-existing condition exclusions will be removed for any enrollees under the age of 19
• Lifetime and certain restricted annual coverage limits will be removed on what the legislation calls “essential health benefits”

UnitedHealthcare is also implementing the following non-mandated reform provisions with the same September 23 date:

• 100% coverage of “preventive care” benefits
• Modifications to ensure that claim and appeals processes are compliant with health care reform provisions
• Access to OB/GYN services without a referral, selection of pediatricians as PCP, coverage of emergency services in accordance with the new rules (e.g., without pre-authorization) and other patient protection provisions
• Dependents will be eligible for coverage to age 26 regardless of access to their own employer-sponsored health plan.

These initial provisions have no effect on grandfathered status. While these changes will apply to all small business health insurance plans, the changes will not, by themselves, impact grandfather status for any plan seeking to maintain grandfather status.  UnitedHealthcare intends to provide updated Schedule of Benefits and Explanation of Coverage Amendments as soon as possible reflecting all of these changes to their policies and procedures.