Posts Tagged ‘anthem plans’
Recently Wellpoint took some really bad press on the treatment of Breast Cancer. Some of that bad press was wrong. Anthem was accused of purposely rescinding policies of women diagnosed with breast cancer. This accusation was really way out of bounds. Wellpoint has paid for the treatment 10 of thousands of women who have suffered from Breast Cancer. So I think its appropriate that Anthem is implementing the key provisions of this new act.
WellPoint, Inc. (NYSE: WLP), the nation’s largest health insurer by medical membership, announced today it will unilaterally implement key provisions of the Breast Cancer Patient Protection Act introduced by U.S. Rep. Rosa DeLauro. These new provisions include more transparent benefit language including clear explanations of benefits to members with breast cancer, and the provisions standardize minimum recovery times in the hospital for women recovering from mastectomy.
The adoption of these provisions builds on WellPoint’s existing leadership in breast cancer treatment. While variability exists within clinical guidelines and state regulations, the vast majority of WellPoint’s members already receive the standard of care indicated in the legislation. However, WellPoint believes that applying this universal minimum standard will both benefit our members, as well as encourage others in the industry to follow and adopt this standard. Beginning July 1, 2010, WellPoint will standardize clinical guidelines for women recovering from mastectomy to offer a voluntary 48-hour minimum in-hospital stay.
“Women recovering from breast cancer surgery will decide, in consultation with their physicians, whether hospitalization for 48 hours is required,” said Sam Nussbaum, Chief Medical Officer, WellPoint. “We are committed to making medical coverage decisions for women with breast cancer that are in accord with the latest scientific evidence and clinical research. It’s important for us and our members that WellPoint continues to lead in this area,” he added.
“We continue to work with the American Cancer Society and academic thought leaders to gain real-world knowledge of breast cancer treatments to shape improvements in care for women with breast cancer,” said Nussbaum. “Our goal is to ensure that our members receive optimal care.”
WellPoint also champions effective member communication and transparency regarding breast cancer diagnosis and treatment options. More than 3,000 nurses and clinical associates work with members daily, to encourage detection of breast cancer at its earliest stages and to ensure that members are receiving the best breast cancer treatments available. Toward that end, WellPoint is taking steps to provide comprehensible, straight-forward explanations of benefits so that members more clearly understand their treatment options.
“WellPoint works to ensure that all of our members are getting best practice care,” said Dijuana Lewis, Chief Executive Officer of WellPoint’s Comprehensive Health Solutions business unit. “We are especially proud of our record in improving care for women with breast cancer in this country and believe these added measures will increase the quality of care that our members receive.”
On average, 87 cents of every dollar you pay us is spent
covering medical care and services that members receive like
doctor visits, hospital costs, prescription drugs and more.
So when the costs for these services go up, so must our
premiums. Another 10 cents of every premium dollar funds
the services we provide like claims processing, enrollment
and billing, provider credentialing and complying with
government regulations. We also use this portion of your
premium dollar towards our efforts to control the rising cost
of care. More about that in a bit.
That leaves three cents of every premium dollar for profits.
Let’s put that into perspective. The combined annual profits of
the top 10 health insurers are equal to just two days worth of
national health care expenditures – or 0.5% of the estimated
$2.5 trillion the nation spent on health care in 2009
As of September 23rd of 2010 Indiana dependent children can not be declined or pre-x from a health insurance policy.
This is creating some interesting situations. Right now we have seem some carriers stop selling stand alone children’s policies which is concerning. I can only speculate why they have stopped. One reason is the carriers are getting ready to increase the cost of these plans. If every child is guaranteed issue this mean the carriers are going to be absorbing much higher claims.
An example of this is we insurance Indiana children that suffer from a certain condition that has a mandate of coverage. This mandate states the condition must be covered as any other illness and the child can not be declined from. So we have about 30 stand alone children’s policies at an avg annual premium for $2,400 x 30 policies= $72,000. For this particular condition to be treated ave about $34,000 year per patient x 30= $1,020,000 in claims. So with this situation the insurance company is paying out much more than they are taking in.
So if we expand this on a state level of Guaranteed Issue for all children we should see an increase in premium to cover the claims. This is the reason some carriers are not selling stand alone children’s policies as of right now.
What to do if you are in the market for a policy for your child.
If your child can get through underwriting take out a policy a.s.a.p. The reason for this is that policy will be a grandfathered policy which mean you could lock in a much lower rate than what the market has to offer after Sept. 23rd 2010. This could be the difference of paying $83 a month to paying $250 for the same policy after Sept. 23rd.
Indiana Tax Credits for Small Group Health Insurance
Under the new health care reform tax credits will become available for small business health plans. The first issue to address does my company quality? With premiums increases every year a tax credit could help a small business keep a health plan in place.
Effective January 1, 2010, tax credits are available to qualifying small businesses that offer health insurance to their employees. So if your business qualifies for a tax credit, you are eligible right now.
About 4 million small businesses will be eligible to receive tax credits if they provide insurance.
The tax credit is worth up to 35 percent of the premiums your business pays to cover its workers – 25 percent for nonprofit firms. In 2014, the value of the credit will increase to 50 percent – 35 percent for nonprofits.
Your business qualifies for the credit if you cover at least 50 percent of the cost of health care coverage for your workers, pay average annual wages below $50,000, and have less than the equivalent of 25 full-time workers (for example, a firm with fewer than 50 half-time workers would be eligible).
The size of the credit depends on your average wages and the number of employees you have. The full credit is available to firms with average wages below $25,000 and less than 10 full-time equivalent workers. It phases out gradually for firms with average wages between $25,000 and $50,000 and for firms with the equivalent of between 10 and 25 full-time workers
Anthem plans across the country are working to develop innovative products and programs that help address rising health care costs. Through pay for performance initiatives, consumer directed health plans and transparency initiatives; Anthem is providing access to the information needed to drive down health care costs.
While many people may believe that insurer profits are the driving force behind increasing health insurance premiums, research reveals very different reasons for the high cost of health insurance.
A May 2009 report titled “What’s Really Driving the Increase in Health Care Premiums?” addresses the issue. The report, issued by the WellPoint Institute of Health Care Knowledge, compiles research from sources such as PricewaterhouseCoopers, the Robert Wood Johnson Foundation, the Kaiser Family Foundation, the Bureau of Labor Statistics and the Congressional Budget Office.
According to the report, the “key drivers” of spiraling U.S. health care costs are:
- Advances in medical technology and subsequent increases in utilization;
- Price inflation for medical services that exceeds inflation in other sectors of the economy;
- Cost-shifting from people who are uninsured and those receiving Medicare and Medicaid to the private sector;
- High cost of regulatory compliance; and
- Patient lifestyles, such as smoking, physical inactivity and obesity.
Citing PricewaterhouseCoopers research from 2008, the report found that only three cents of every health care premium dollar is spent on health insurer profit.
According to the Institute’s report, newer medical technologies tend to increase costs because they are generally more expensive than the older technologies they replace. While the availability of more advanced, superior technologies can yield better results for some patients, these technologies and diagnostic tests may be used inappropriately in some situations where existing, older technologies are more effective and accurate.
To view a copy of the full report, click here.
