Managed care

BlueCross BlueShield of Tennessee has become the latest health plan to address a key issue with high-deductible plans. Following in the steps of peers like UnitedHealth, the Blue plan has created a pilot program under which providers can find out, in real time, how much a patient owes, and collect on the spot. The pilot, which is already live in …

Managed care companies should enjoy a whopping 15 to 20 percent growth in earnings next year, but hospitals aren't so fortunate, says John Boettiger, healthcare valuation leader at Deloitte & Touche USA. In an interview, Boettiger offers some predictions as to how providers will cope with continuing budget squeezes--and suggestions as to what they can do about it. Article

Illinois Gov. Rod Blagojevich's health system reform proposals hit a snag this week, with the state's medical society announcing that it opposed the plans despite some doctor-friendly concessions. Blagojevich is pushing a plan, known as "Illinois Covered," which would extend Medicaid to all adults below the federal poverty line and offer new state insurance to many working families. It would also subsidize private insurance costs for other families. Insurance companies would have to offer …

Blue Cross and Blue Shield of Florida has been ordered to pay $1.5 million to two hospitals as compensation for hospital bills it refused to pay. A jury found that the plan's HMO inappropriately refused to reimburse the two hospitals, Miami's Palmetto General Hospital and Coral Gables Hospital, for certain hospital pathologist services. Eight years ago, the health plan's Health Options HMO stopped paying hospital pathologists for supervising and interpreting tests. In the suit, the …

Earlier this year, Massachusetts-based Tufts Health Plan took a tough stance on bariatric surgery, imposing strict new limits on which patients it considered appropriate for the surgery. The health plan planned to limit reimbursement for bariatric surgeries to patients with a BMI of 40 or more, and were restricting many patients to laparascopic banding procedures rather than …

A new vendor survey rating health plans on how quickly they pay doctors has ranked UnitedHealth last and Aetna first among leading national insurers. The annual survey, conducted by payment services provider athenahealth and journal Physicians Practice, found that UnitedHealth paid claims in 38.3 days on average. Aetna, meanwhile, had average payment times of 29.8 days. The worst offender among all health plans measured was New York's Medicaid plan, which averages a whopping …

It's never good for business when you've angered 900,000 doctors. But with any luck, that chapter is over for 23 Blue Cross and Blue Shield plans, which were targeted by a class-action lawsuit alleging unfair payment practices. The suit, which was filed in 2003, asserted that 23 BCBS plans were habitually cheating doctors by deliberately paying for less-intensive services than they had in fact provided. The BCBS plans have agreed to pay $128 million to settle the suit, and pay as much as …

Two of California's largest provider associations have joined a suit against Blue Cross of California, arguing that the health plan wrongly denied them payments for patients whose policies were later canceled. The California Medical Association and the California Hospital Association are jumping into a suit originally filed by Coast Plaza Doctors Hospital and Methodist Hospital of Southern California. Consumer organizations have blasted Blue Cross, which is accused of canceling individual policies after beneficiaries need expensive treatments. Blue Cross has argued that once policies are canceled due to incomplete or inaccurate applications, the patient must pay all bills. The hospital and physician associations say that this has left them with staggering bills. (California hospitals claimed $7.7 billion in bad debt last year, though the association can't say how much was due to Blue Cross retroactive policy rescissions.) The providers contend that Blue Cross must pay for any treatment it has authorized, even if the patient's insurance is later removed or the plan decides that the patient should not have been covered. They also argue that the cancellations were themselves improper.

How often do you see the insurance industry petition the government to set up another federal agency? Well, in this case, this most unlikely of events has actually occurred. America's Health Insurance Plans (AHIP), the association representing health insurers, has asked Congress to create an agency dedicated to comparing the effectiveness of existing medical treatments, drugs and devices with new ones. (It would be intriguing to see whether some doctors' instincts are correct that snazzy …

New research funded by pharmacy benefit manager Express Scripts has concluded that consumers give up medications rather than switch from brand-name drugs to generics. The study, which looked at healthcare claims for two national employers, compared prescription claims for the first nine months of 2005 versus the first nine months of 2006. The employers had kicked off CDHPs for their employees in January 2006, with one of the two employers seeing more than 20 percent of employees enroll. …