Managed care

Spurred by state authorities who said that premiums weren't affordable enough, insurers have done a second round of price-cutting on policies aimed at uninsured but employed citizens. Right now, it's estimated by about 200,000 Massachusetts residents don't get employer-sponsored health coverage, but also earn too much to qualify for state subsidies. To get some of this business, health plans had made bids for participation which came in below standard market premiums. However, Gov. Deval …

Despite criticism from providers, who fear that many patients won't take action, the state of Hawaii has instituted a policy under which enrollees in its Quest health insurance program must re-enroll to be included in managed care plans. Right now, Quest's 165,000 low-income enrollees can participate in Hawaii Medical Association, AlohaCare, Kaiser Permanente and Summerlin managed care plans. However, the new policy taking effect as of April 1 would require them to select a specific …

The California Department of Managed Health Care (DMHC) is bringing the hammer down on Blue Cross of California (BCC). The DMHC has fined BCC $1 million after finding that it systematically and illegally canceled policies held by chronically ill and pregnant policyholders. Under state law, California health plans may only cancel individual policies if a policyholder intentionally lied on an application to cover up a pre-existing medical condition. But BCC violated this standard …

An consumer health advocacy group has concluded that despite having insurance, many Americans face medical costs they cannot afford. A new report by The Access Project suggests that deductibles and co-payments, as well as premiums, are a major source of medical debt for many consumers. Other contributors to medical debt included annual or lifetime benefit caps, out-of-network charges and patient confusion over what they owe. The report's overall conclusions square with another recent …

Contending that the buy would unfairly lock up the Nevada market, the American Medical Association has asked the U.S. Department of Justice to block a planned UnitedHealth Group acquisition. UHG had announced last week that it would acquire Las Vegas, NV-based Sierra Health Services, a $1.7 billion company which operates managed care plans throughout Nevada. The AMA is asking the DOJ to stop $2.6 billion deal, arguing that it would represent an "alarming" consolidation of the state's HMO …

UnitedHealthcare (UHC) has signed on for an HHS program designed to help doctors treat ethnic minorities more effectively, adding its support to a growing industry movement focusing on differences in minority care. While UHC's participation is limited to Web efforts at the moment, the extent of their outreach efforts to doctors suggests that they're taking the issue seriously.

Working with the HHS Office of Minority Health (OMH), the health plan is launching a website which will …

Even if they're insured, many heart patients don't get adequate follow-up care, according to research published yesterday in the Journal of the American Medical Association. The research, which followed 2,498 patients recovering from heart attacks, found that one in five patients felt they couldn't afford follow-up care, and one in eight didn't buy medicine due to the cost. The kicker: more than two-thirds of the patients who reported being worried about expenses actually had …

A new study performed by Harvard Medical School and Harvard Pilgrim Health Care suggests that consumers with high-deductible health plans visit hospital emergency departments less often than patients with traditional health plan designs. The study, which compared 60,000 members of a traditional Massachusetts plan with 8,700 members of a high-deductible plan, found that there was only a slight difference between the groups for first-time emergency room visits. Members of the …

Gearing up for new rules requiring all residents to carry health insurance, Massachusetts has officially approved a group of policies tailored to be accessible to the uninsured. Starting in May, a total of 28 different plans will be offered by seven insurers. Participating health insurers include Blue Cross and Blue Shield of Massachusetts, Harvard Pilgrim Health Care, ConnectiCare, Fallon Community Health Plan, Health New England, Neighborhood Health Plan and Tufts Health Plan. Monthly …

While it's all well and good that Massachusetts has negotiated a low monthly premium for its new bare-bones health plan, the initial numbers publicized by state officials are deceptive, according to the nonprofit Foundation for Taxpayer and Consumer Rights (FTCR). The group, which describes itself as nonpartisan, says that the low monthly premiums touted by state officials seriously understate the actual costs patients will face.

While the state's basic plan comes in at a modest …