beneficiaries

> Aetna has announced plans to expand a program under which it waives six months of co-payments for beneficiaries who switch to certain generics. Article

> Giving up a measure of its independence, the California Nurses Association has joined up with the AFL-CIO. …

Hanging tough in the face of furious physician criticism, Blue Cross and Blue Shield of Texas has kicked off a program allowing beneficiaries to compare physician ratings. The health plan is the largest in the state, with more than 40,000 participating physician and 3.4 million beneficiaries, so its decisions have a significant effect on the market as a whole, making the ratings a major issue for the state's doctors.

The BCBS quality score currently uses 38 measures, and will add …

Blue Cross of California has settled a lawsuit challenging its policy-cancellation practices, agreeing to stop rescinding individual policies unless it can prove that a beneficiary intentionally lied on their application. The agreement brings the curtain down on a class-action lawsuit involving 6,000 policyholders, who argued that the health plan had improperly canceled their coverage in a manner violating state law. The managed care company had contended that they have the right to …

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.

A proposed merger between Pennsylvania-based health plans Independence Blue Cross and Highmark drew criticism yesterday, with politicians and consumer groups raising questions about the impact of the deal. The proposed merger, which has already been approved by the boards of the two plans, would create the nation's third-largest health insurer, with 9 million beneficiaries and more than …

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 …

> UnitedHealthcare has kicked off a program under which it rates U.S. hospitals on emergency cardiac care and makes the ratings publicly available. Article

> A bill banning genetic discrimination by insurers continues to progress through the House. Article

> Pennsylvania's …

U.S. governors aren't taking no for an answer. Despite pressure to drop the matter, the National Governors Association (NGA) is continuing to press for Congressional help with keeping several State Children's Health Insurance Programs (SCHIP) afloat. The NGA is demanding that Congress authorize $745 million in new federal funding to keep SCHIP programs afloat. Otherwise, programs in as many as 14 states could be on the skids, NGA projects. HHS secretary Mike Leavitt told the NGA that the …

Last month, a "data processing error" at CMS caused the agency to incorrectly refund 231,000 Medicare recipients a total of $50 million--an average of about $215 per beneficiary. At the time, CMS said it would reclaim the cash, but critics observed that some cash-strapped recipients might have difficulty returning the money. Now a federal judge has quashed CMS's attempts to reclaim the money, ruling that …

CMS has granted a $7.5 million award to organizations developing Programs of All-Inclusive Care for the Elderly (PACE) in rural areas. The PACE program currently provides care to elderly individuals living in urban areas, and the award will extend care to rural beneficiaries. Release