Archive for June, 2010

Fallon Health Insurance: Sleeve Gastrectomy Coverage

Tuesday, June 29th, 2010

The laparoscopic sleeve gastrectomy is a new weight loss procedure available to treat obesity and diabetes.  According to “Insurers Divided Over Experimental Stomach Surgery to Treat Obesity,” Matthew Sturdevant of The Hartford Courant says that some insurers are not covering the procedure while others are.  The procedure has the same goal as gastric bypass and gastric banding.  It shrinks the stomach to 15% of the original size so that you eat less.  Fallon health insurance and other insurers have had to make a tough decision whether or not to cover the newer procedure.  Some companies believe that more research should be done, while others are already covering the costs to help avoid the other long term costs related to obesity and diabetes.

UnitedHealthCare and Aetna decided to cover the sleeve gastrectomy at a cost of $16,000-$25,000 for the procedure.  CIGNA Corp. and Anthem Blue Cross Blue Shield of Connecticut are not covering the procedure currently because they believe it is experimental and needs more research to be proven effective and safe.  The sleeve gastrectomy procedure turns the shape of the stomach into a sleeve rather than the natural kidney bean shape.  It is deemed better than gastric bypass by some people because it doesn’t skip over the small intestine where important nutrients are absorbed.  The benefit over gastric banding is that you don’t have to have repeat surgeries like you do to adjust the gastric band.  Some advocates believe that the sleeve gastrectomy pays for itself in about two years because of the obesity related health costs that are avoided.

Infertility Insurance From Mercy Health Plans

Thursday, June 24th, 2010

statueLawmakers in the House and Senate are hoping to make it mandatory for insurance companies to cover infertility treatments.  In The Washington Times article “Insurance-plan coverage for infertility urged,” Cheryl Wetzstein says that Resolve: The National Infertility Association is pushing for the insurance coverage.  Florida Representative Debbie Wasserman Schultz is cosponsor of a bill requiring insurance companies to cover clients’ infertility treatments.  Fifteen states already require insurance companies like Mercy Health Plans to cover the treatment needed by 1 in 8 couples trying to conceive.  Maryland and West Virginia are two of the states that already have infertility coverage.

In the Senate, Kirsten Gillibrand of New York has a companion bill on the table.  Resolve is also hoping that the government will allocate $1 million for a “national action plan” on infertility, which the CDC is developing.  They want to learn more about what is causing infertility so that it can be detected and treated earlier.  With 7.3 million women struggling either to conceive or carry a pregnancy, it is important to compare health insurance offerings from state to state and see what can be done nationally with insurance.  Sexually transmitted diseases and simply waiting too long to have kids are some of the main culprits causing infertility.  The more that the topic is discussed by women dealing with it, the more lawmakers and insurance companies will be forced to deal with this pressing issue.

Humana Medicare Health Plans Through EHealth

Friday, June 18th, 2010

According to National Underwriter’s article “EHealth To Distribute Humana Medicare Products,” EHealth will make it even easier to obtain Humana Medicare health plans.  Through the internet, EHealth will sell Medicare Advantage, Medicare supplement, and Medicare Part D prescription benefits from Humana, Inc.  EHealth of California is the parent company to  Humana is based in Louisville, Kentucky.

Many tools will be available through the website.  You can compare plans online and choose one that fits best with your needs.  There are also applications that can be filled out and filed online.  With a calculator to figure out your out-of-pocket costs, you’ll be better able to determine the real expenses to you and your family.  The website also offers a formulary tool as well as a tool to locate physicians in your area.  Medicare agents will run a toll-free customer service system as well.

Compare Health Insurance with Dental

Thursday, June 17th, 2010

One-fourth of Americans do not have dental insurance, according to a U.S. News & World Report article.  In “1 in 4 Americans Under 65 Lacks Dental Insurance,” this survey from 2008 shows that race, employment, and even education all play a roll in whether Americans have dental coverage.  Compare health insurance with dental coverage and many people think dental is something they can cut back on to save money.  Unfortunately this leads to dental problems and other health issues since dental health is directly related to overall health.

This U.S. National Center for Health Statistics report was released last week and showed that having dental insurance is the main indicator of whether or not you receive regular dental care.  Eighty-percent of people who have employer sponsored health care had dental coverage included in that care.  Unfortunately, only thirty percent of those who had directly purchased their own insurance from a company like Golden Rule health insurance had included dental coverage.

Black Americans were more likely to have dental coverage than white Americans, Asian Americans, or Hispanic Americans.  People with less than a high school education only had dental insurance in forty percent of the cases studied.  Americans are more likely to have dental insurance as their income gets higher, along with most other types of insurance.  Taking care of your teeth, mouth, and gums is very important to your overall good health.  Search for dental insurance coverage to take care of you and your family.

Premature Births: Fallon Health Plans

Saturday, June 12th, 2010

preemieWith half a million premature babies born each year in the United States, it’s amazing that the cause of many of these early births is still a mystery in the medical world.  In “Premature births still a medical mystery” by Rachael Rettner of Live Science, Rettner discusses recent developments about the combination of factors leading to premature labor and delivery.  A traditional pregnancy lasts between 38 and 42 weeks, or approximately 9 months.  Any birth at 37 weeks or before is considered a premature baby, often resulting in underdeveloped systems and medical issues.

Around half of premature deliveries can be easily explained.  When a mother is carrying multiple children at once, there is a much greater chance that she will not carry the babies full term.  Many labors are also induced or c-sections performed because of complications with the pregnancy.  In those early labors that don’t fall into either of these categories though, science is working to determine what is causing them.  The three things that they believe are important to further research are genetics, infections, and a woman’s social and lifestyle environment.

Pathogenic infections are believed to cause preterm births because they make a pregnant woman’s immune system work in overdrive, which can trigger labor.  Scientists think that infections may actually cause up to a quarter of premature births.  It’s also believed that a woman’s genetics may play a significant role in determining whether they will have a premature labor and delivery.  Premature births run in some families and women are more likely to have subsequent premature births if they already have had one.  Environmental factors also play a role in premature birth rates.  Areas with high poverty levels tend to have more women delivering prematurely based on healthcare availability, housing, their jobs, and social norms.  Income, stress levels, and eating and drinking habits may also play a role.

As scientists learn more about normal pregnancies and labor, they will better be able to translate that knowledge to premature labor and birth cases.  The main goal is avoiding premature births to help babies and children be healthier and reduce insurance costs for Fallon Health Plans and other health insurance companies.

Golden Rule Insurance Dental Care

Wednesday, June 9th, 2010

Your health insurance and dental insurance companies can only hope that you follow guidelines to take preventative care of yourself.  Health Key has listed some important tips on basic dental care.  Regularly brushing and flossing your teeth are important, as is seeing the dentist twice a year to get your regular cleanings and look for any issues.  It is also helpful to eat a diet rich in whole grains, dairy, and fruits and vegetables.  Taking care of your health allows insurance companies like Golden Rule Insurance to spend less on problem care and charge less for policies.  Taking care of your teeth helps to avoid tooth decay, prevents gum disease, saves money, avoids bad breath, helps your teeth last a lifetime, and improves your overall health.

Following basic dental care is the best way to avoid problems.  Brush your teeth twice a day and floss once a day to keep plaque away.  By using a toothpaste with flouride, you help prevent cavities and tooth decay.  Avoiding sugar as much as possible is important for your teeth.  Do not smoke or use other tobacco products which can cause gum disease and cancer.  Clean your tongue with a special scraper or soft toothbrush.  Find out how often your dentist would like to see you and check with UPMC, or your insurer, to see how often visits are covered by insurance.  Most experts believe that children should start seeing the dentist at one year of age and go every six months after that.  Check with your dentist for their particular guidelines for taking care of your teeth, mouth, and overall health.

Assurant Health: High Risk Insurance Pools

Sunday, June 6th, 2010

Eighteen states will let the government run their high-risk health insurance pools, according to The Washington Post’s “18 states refuse to run insurance pools for those with preexisting conditions” by David Hilzenrath.  Beginning in 2014, health insurers like Assurant Health will not be able to deny health insurance coverage or charge increased premiums to people with preexisting medical conditions.  A provision in the health-care bill has extended this coverage temporarily beginning this year.  High-risk health insurance pools will run coverage programs for these high risk people almost immediately.  Some states already have high-risk pools, but for those who don’t and those whose current programs don’t meet the new federal requirements, a decision had to be made whether to run the pools themselves or let the government do it.

Five billion dollars has been allocated to run these high-risk pools, but many governors don’t think the money they will be given is going to last very long.  Because of this and other reasons, at least eighteen states are leaving it up to the Department of Health and Human Services to run the high-risk pools.  Many of these states have Republican governors, though not all do.  It’s possible that the federal government will hire a nonprofit health insurance company to run the high-risk pools for those states not running their own.  High-risk pools are expensive to run and many people, like the actuary for the Centers for Medicare and Medicaid Services, think the federal government’s $5 billion could be spent by next year.  If that happens, state and federal governments could have to increase premiums, decrease benefits, or limit enrollment.  Maybe the government will come up with more money for these pools…it remains to be seen.

UPMC Health Insurance Stores

Thursday, June 3rd, 2010

retail storeHighmark health insurance currently operates two retail health insurance stores in Pennsylvania.  They are the only company to offer such a service in the state and because of the stores’ success they’ll be opening four new Highmark Direct locations.  The current stores in Pittsburgh and Mechanicsburg have been operating just over a year and have seen tremendous success.  Highmark Inc.’s President and CEO says that the goal of these retail locations is to help Pennsylvania residents get the health insurance information that they need in order to make informed decisions about their care.  With the success of Highmark’s retail stores, it is possible that other Pennsylvania insurers like UPMC Health Insurance might take interest in offering similar services to their clients.

All of Highmark’s new stores are slated to open this year.  Their locations will be in Monroeville, Robinson Township, South Hills, and Harrisburg.  Customers have been requesting more one-on-one service from companies for years; Highmark is meeting this request with their retail stores aimed at explaining the health insurance options that are available and helping customers decide what will be best for them.  Highmark sells individual plans, senior plans, and small business plans to customers located in their service area.  They also sell dental care through their subsidiary iDental.  This innovative way to sell health insurance may catch on in surrounding states.  Ohio’s Aultcare could be the next company opening retail stores to help their customers get one-on-one health insurance service.