medical bills

Study: Despite earlier deaths, obese pay higher medical bills

Tue, 10 Jun 2008 06:59:54 -0400

New research suggests that young adults in their 20s who are as little as 30 pounds overweight may pay lifetime medical bills that are $5,000 to $21,000 higher than their normal-weight. Meanwhile, extremely obese young adults (70 pounds or more overweight) will incur $15,000 to $29,000 more in lifetime medical expenses than healthy-weight peers, according to a study in the journal Obesity. These numbers take into account that heavy people have shorter life expectancies.

The data varied by ethnicity. According to the study, medical expenses are much greater in obese white women than obese black women, probably because white women tend to use more health services at every weight level. Correspondingly, white men's costs at 70 pounds overweight were slightly higher than black men's costs.

To learn more about the study:
- read this USA Today piece

With cancellations, CA health plans show suicidal persistence

Fri, 18 Apr 2008 06:59:59 -0400

I've said this before, but heaven help me, I feel I need to say it again: What on earth do California's health plans think they're going to accomplish by engaging in all-out war with the state's top insurance industry regulators?

I understand that health plans need to protect their interests, and that they certainly can't afford to pay heavy medical bills for people who deliberately try to game the system. But in this case, the plans have gotten extremely clear direction from the state's Department of Insurance and the Department of Managed Health Care (not to mention the courts) that it's just not OK to routinely rescind policies when patients get sick.

However, that hasn't stopped the state's big players from their suicidal determination to fight the power. In feats of derring-do I can only compare to a Fortune 500 CFO flipping off the SEC, they simply keep doing what they're doing and insist that despite all evidence, they're in the right. It's not unlike the posture my five-year-old takes when he's broken the cookie jar and the crumbs and ceramic shards are all over the floor.

Truth be told, things are so extreme out there that it's almost like reality TV. Watch in amazement as HealthNet lies to regulators! Gasp as Blue Cross of California pays a $1 million penalty! Look on in awe as plan executives insist that retroactive cancellations for innocent mistakes are kosher! This is far more intriguing than "Real Life Housewives of Orange County."

The problem is, reality TV is entertainment, while this is a high-stakes game in which there are many losers--doctors, patients and some ways, the health plans themselves. With any luck, California's health plan executives will come to their senses at some point... though at the moment, I'm not very optimistic. - Anne

CA regulators begin broad review of policy cancellations

Fri, 18 Apr 2008 06:59:57 -0400

In a move that could cost health insurers untold dollars, and possibly change the dynamics of the individual coverage market, the California Department of Managed Health Care has begun reviewing thousands of individual policy cancellations by the state's five major health plans. The DMHC will turn over policies dropped by the plans to an independent arbiter, who will determine whether the policies were inappropriately canceled. If the policies were wrongly canceled, the DMHC will require the health plans to reinstate those patients, and what's more, to pay all of the patient's bills incurred while the patients didn't have coverage. Meanwhile, the DMHC is ordering Anthem Blue Cross, Kaiser Permanente and Blue Shield to immediately reinstate 26 patients whose policy cancellations, in its view, were wrong on their face.

This move is perhaps the boldest in a long string of actions the DMHC has taken to prevent the state's health plans from canceling individual policies when individuals incur high medical bills. The DMHC contends that canceling such plans because of innocent mistakes on applications is unlawful.

To learn more about the DMHC's review:
- read this Los Angeles Times article

Related Articles:
BC of California fined $1M for cancellations
Kaiser forced to reinstate coverage
HealthNet set goals, bonuses based on policy cancellations
Kaiser pushes for policy-cancellation rules

Patients cut costs with faith-based health plans

Fri, 14 Mar 2008 07:59:55 -0400

Increasingly, consumer premiums are going up, along with deductibles. In an effort to fight this trend, some consumers are enrolling in faith-based alternatives to health insurance, under which charitable ministries collect monthly contributions and disburse them to pay medical bills. For example, Christian care Medi-Share collects $459 per month, and in exchange, gives members help on costs above $250 and up to $1 million. Unlike traditional health insurance plans, members carry most or all of the choice of day-to-day care, such as primary care visits, but don't seem to mind given their comparative low monthly contributions. This option is particularly attractive to small businesses, which are having great difficulty carrying premiums for traditional insurance.

Other competitors in this arena include Samaritan Ministries and Christian Healthcare Ministries, which serve about 120,000 patients from California to the Carolinas. In each case, officials stress that they're a "ministry," not insurance, which theoretically shields them from the supervision of state insurance regulators. All have come under scrutiny from regulators nonetheless, given that the plans don't guarantee coverage, but rather, only pay out if members faithfully pay in. To date, however, regulators have determined that these groups are not insurance companies, and allowed them to keep operating.

To learn more about such plans:
- read this piece from The News & Observer

Related Article:
Health plan-like "bill sharing ministry" under fire. Report

Mass. launches hospital infection crackdown

Thu, 14 Feb 2008 06:59:57 -0500

Massachusetts regulators have gotten deadly serious about fighting the spread of infections within hospitals. Yesterday, the Public Health Council approved a measure under which state inspectors will regularly visit hospitals to make sure they have appropriate infection-control measures in place--and that they're reporting infections promptly to the state when they do happen. During the same session, the panel also approved a program under which it will collect infection rate information for each hospital, then publish that "report card" to a state government site. The online report will initially include only infections in hip and knee surgery patients and patients who's have central venous catheters, though it's likely to expand over time. The new rules follow on a state report, released last summer, which found that hospital-acquired infections could be costing the state up to $473 million in added medical bills.

To learn more about the new regs:
- read this piece from The Boston Globe

Related Articles:
Mass. mulls hospital-acquired infection reporting. Report
MA hospitals forswear payment for preventable errors. Report
By 2008, Medicare won't pay for hospital errors. Report
Business say 'no pay' for major mistakes. Report
Study: Wrong-site surgeries, close calls are common. Report

Blue Cross asks MDs for info to cancel policies

Tue, 12 Feb 2008 06:59:58 -0500

Blue Cross of California has raised eyebrows around the state, and sparked protests from some physician groups, by sending medical groups applications filled out by beneficiaries and asking the doctors, in effect, if the patients lied about their health. With the applications, which went out to large medical groups who have capitation contracts with the health plan, Blue Cross advised doctors to narc on patients who had any conditions not listed on the applications. This is just the latest in the plan's attempts to aggressively weed out sick patients. Blue Cross has already faced the ire of regulators for issuing policies then canceling them when the patients incur big medical bills.

The letter and accompanying application "outraged" the California Medical Association, according to president Dr. Richard Frankenstein. He argues that with doctors in the role of police, patients may be afraid to share their whole medical history with doctors, putting their health at risk. The association has sent a letter to state regulators asking them to order Blue Cross to stop asking doctors for patient information. A spokesperson for the state insurance commissioner said that while their office hadn't gotten any complaints about the letter, they consider it "extremely troubling," in that it effectively places doctors in the role of underwriters.

To learn more about this story:
- read this Los Angeles Times article

Related Articles:
Calif. bars Blue Cross of CA from demanding fee confidentiality. Report
Blue Cross of California pays $31M in P4P bonuses. Report
Blue Cross of CA settles plan-cancellation suits. Report
Blue Cross of California settles another policy cancellation suit. Report
Blue Cross slapped with $200,000 fine. Report
Blue Cross makes changes in face of lawsuits. Report

OIG gives thumbs up to prompt-pay discounts

Mon, 11 Feb 2008 06:59:58 -0500

The HHS Office of the Inspector General has given its approval to a healthcare system's plan to offer prompt-pay discounts to patients who pay their share of their medical bills quickly. The system had asked for the OIG's opinion on whether it would violate the anti-kickback statute for rewarding referrals to offer 10 percent to 15 percent discounts before discharge and 5 percent to 10 percent discounts within 30 days. The system feared that they'd be seen as inducing patient self-referrals by encouraging them to buy medical services that might not be needed.

In its advisory opinion, the OIG noted that a safe harbor already exists to protect waivers of coinsurance and deductibles for inpatient services under some circumstances. Primarily, the government doesn't want hospitals to give a discount and then try to get more money from the government by calling the discounted fees bad debt or otherwise try to collect the discrepancy from payers. It held that outpatient discounts don't add up to patient inducements as long as they merely encourage patients to make smart financial decisions rather than get unnecessary care.

To get more details on the decision:
- read this Modern Healthcare piece (reg. req.)
- read the OIG advisory opinion

Related Articles:
Firm pitches credit scoring for self-pay hospital patients. Report
HHS OKs hospital/physician gain sharing. Report
HHS advisories give guidance on doctor gain-sharing. Report
Calif. opens hospital discount listing site. Report

SPOTLIGHT: Many Americans unsatisfied with care

Fri, 02 Nov 2007 07:59:52 -0400

Despite our high levels of medical spending, many Americans are still unsatisfied with their medical care, a new study suggests. Worse, U.S. patients have the highest out-of-pocket costs among seven Western countries, and the hardest time paying medical bills, according to the study, conducted by The Commonwealth Fund. Article

Insurers, banks keep expanding medical credit offerings

Mon, 24 Sep 2007 06:59:57 -0400

As we've reported here previously, insurers and banks are continuing to expand their credit offerings, which are usually though not always aimed at helping consumers cope with large deductibles.

For example, there's Aetna, which is working with Bank of America to offer a credit card card offering health spending incentives; UnitedHealth Group, which is looking at offering consumer credit lines for use in paying medical bills; and the Blue Cross Blue Shield Association. While some plans have outsourced the credit offering to outside banking industry vendors, and not attempting to profit substantially, others are directly involved and see the credit lines as a new profit center. Analysts and observers say the trend is just emerging--and that health plan execs are "rushing" into this line of business in a race not to lose position in this new niche.

To find out more about this trend:
- read this Orlando Business Journal piece

Related Articles:
Trend: Consumer medical finance market grows. Report
Patients paying medical bills with credit cards. Report

Fla. providers, insurers fight no-fault expiration

Mon, 20 Aug 2007 06:59:55 -0400

Right now, it's beginning to look like a Florida law requiring state citizens to carry medically-related auto insurance is going to go away. The situation has prompted a group of the state's providers, health insurers, auto insurers and first responders to fight for keeping the law.

Right now, Florida drivers must buy at least $10,000 in personal injury protection, which pays medical bills resulting from auto accidents. However, the law requiring this may expire Oct. 1. The Florida Hospital Association says such an expiration could be a "prescription for disaster," as it could leave its members with more uncollectible bills from patients who now have no means to pay. Meanwhile, the state's Blue Cross/Blue Shield plan worries rates will need to go up to cover new accident-related claims.

To learn more about the problem:
- read this piece from The Miami Herald

Related Articles:
Florida hospitals could lose $209 million. Report
HCA hospitals strike Fla. union deal. Report
Fla. health system settles Medicare fraud charges. Report