Archive for the ‘UPMC’ Category

Highmark’s New iPhone App

Sunday, August 29th, 2010

phoneHighmark health insurance and A.D.A.M. have come out with a new iPhone application called Health@Hand.  A.D.A.M. provides health information and innovative solutions for benefits technology in the health industry.  They partnered with Highmark to launch this application which will be available to all members of Highmark through the online iTunes store.  Health plan members can now get a wealth of information right from their iPhones including articles, information on first aid, discounts on services, and local provider and facility information.

The Pennsylvania-based health insurance company’s Health@Hand was based off of their member’s specific plan and provider information.  It is possible that other Pennsylvania-based health insurers like UPMC health insurance could come out with similar plans through A.D.A.M. in the future.  Current Highmark plan members can use the GPS in their phone to locate specific doctors, specialties and facilities near them.  They can even get a map of the location and connect directly to the office via their phone.  Another unique option members have is the availability of information by simply touching a specific body part.  Members can even change the gender or age for specific information.  The product can also be downloaded by non-Highmark members through A.D.A.M. and iTunes.

UPMC Covers High Risk Pools

Tuesday, August 10th, 2010

obama2In the past month approximately 2,400 Americans have signed up for President Obama’s high risk health insurance pools.  This information comes from Gene Rickman’s “2,400 Apply for High Risk Health Insurance Pool,” in Top News. The exact state by state data is not yet available, but this number includes members in both states that are running their own high risk pools and states like South Carolina that are letting the government run the high risk pools for them.  Beginning in 2014, health insurance companies like UPMC will not be able to deny insurance coverage because of any preexisting conditions.  To bridge the gap between now and then, the U.S. federal government has required these high risk health insurance pools.

The Affordable Care Act passed earlier this year calls for the mandatory stop to preexisting condition denials by health insurers in less than four years.  Preexisting conditions can include cancer, asthma, diabetes, HIV or AIDS, and even pregnancy.  It is currently almost impossible to get health insurance coverage from companies like Fallon Health Insurance if you have one of these or another preexisting condition.  Within the last month, Americans have been able to sign up for individual state high risk health insurance pools where they will be able to obtain some type of health insurance coverage.  The federal government offers the states subsidies for this program, but states do have to utilize their own government funds as well.

UPMC Health Insurance Could Suffer From Reform

Friday, July 30th, 2010

kill the billWhile the health care reform bill passed by President Obama means well, the state of Massachusetts has already tried something similar without much success.  According to The Washington Post article “As Massachusetts health ‘reform’ goes, so could Obamacare,” columnist Robert J. Samuelson doesn’t believe that Obama’s plans will do much to solve the health care crisis.  By putting caps on premium increases for companies like UPMC health insurance and other small and large insurers, it could easily put them out of business or into bankruptcy.

Massachusetts started by expanding the state-subsidized insurance coverage, but failed to get health care costs under control or make sure that people’s overall health actually is improving from this policy.  Currently, the federal government plan has begun the same way.  Most individuals in Massachusetts are required to compare health insurance coverage and purchase some form.  Middle class families earning too much to qualify for Medicaid but with incomes less than three times above the poverty level receive state subsidies.  Insurance coverage has increased from 87.5% of the (non-elderly) population in 2006 to 95.2% in 2009.

It’s hard to tell whether there has been any improvement in health since many uninsured people were young and healthy.  It will likely take many years to determine that.  But emergency rooms are still full, workers are taking home less pay because of their insurance costs, and less money is being spent on schools, police, prisons, roads, and more because of the increase in health care spending.  While ideas have come about to help decrease overall health care costs and spending, such as per-patient fees combining doctors to make treatments higher quality rather than quantity, nothing has had enough of a blueprint to actually be tried.  There is a dangerous possibility that this unchecked spending on healthcare will increase taxes and budget deficits and hardly show any health gains.

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.

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.

Fallon Health Insurance Individual Plans

Friday, May 28th, 2010

pie chartThe Patient Protection and Affordable Care Act contains a provision that may force smaller insurance companies like Fallon Health Insurance out of the individual insurance market completely.  According to “Actuary: Act Fast, Or Individual Health Insurers Will Flee,” Allison Bell of Life and Health National Underwriter summarizes the dilemma.  The minimum medical loss ratio requires health providers to spend 80% or more of their premium revenue on paying the medical claims of their insureds.  Experts recommend regulators come up with a way for companies to make this transition.  They worry that smaller companies will opt out of providing individual health insurance because of this new provision.  If that is the case, they would most likely have to let insureds know by June to give them a 6 month warning that they won’t offer individual coverage next year.

Those hoping for some transitions to be spelled out would like to see them immediately so companies know before making the decision to leave the individual market.  The idea behind the 80% medical loss ratio is that insurance companies like UPMC would just reduce administrative costs and other costs they have not related to claims.  It might be hard for insurers to reduce those costs so quickly, not to mention the fact that it will likely hurt smaller insurers much more.  In order to stay competitive, smaller insurance companies offer lower rates for the same coverage as larger companies and have higher marketing and administrative costs.  One suggested solution is to make the minimum medical loss ratio smaller for insurance companies with less market share or for those who sell low-cost plans like high deductible insurance.  Without any changes it is very possible that more smaller insurers will stop selling individual health plans.

Doctors Get Pay for Performance: Will UPMC Health Insurance Be Next On Board?

Monday, May 17th, 2010

philadelphiaThere’s an interesting concept coming out of Philadelphia where doctors are being rewarded for helping to improve your health.  In “Philadelphia Insurer To Implement Pay-for-Performance Model” from The Philadelphia Inquirer, the plan is detailed.  Independence Blue Cross is Philadelphia’s biggest health insurer.   Their newest program is a pay-for-performance model where doctors will get paid more as their patients’ health improves.  They want to reward those primary care physicians who are offering higher quality care at a lower cost.  These are the doctors who use “patient-centered medical homes” which give patients better access, follow guidelines for treatment, educate people to manage their own health, and easily prescribe needed medications.

With Philadelphia’s largest health insurer implementing this new plan, maybe other Pennsylvania insurers like UPMC health insurance will follow with similar programs.  Doctors are happy with this new plan because their primary and preventative medical care will be strengthened as will the way they finance it.  Many doctors are worried that the increased administrative burden will be high though and they hope the plan will help to pay for that.  According to Independence, patients’ health has already improved.  The diabetics seeing doctors in the program improved their blood sugar levels and even their blood pressure by nearly twenty-five percent.

UPMC Health Insurance Plan will Host ‘We Can!’ Event

Tuesday, April 20th, 2010

kids soccerUPMC health insurance plan is going to host a training event to teach community leaders from its surrounding region about the We Can! program.  The workshop will take place on April 27-28 at the Marriott City Center Hotel in Pittsburgh, according to UPMC press release “UPMC Health Plan to Host We Can! Regional Training Event.”  The We Can! program stands for ‘Ways to Enhance Children’s Activity & Nutrition’.  It was started by the National Institutes of Health (NIH), which is part of the U.S. Department of Health and Human Services.  This nationwide movement of both families and communities to promote a healthy weight for children aged 8-13 is crucial right now.  We Can! entails reducing television, gaming, and computer time; eating healthier foods in appropriate quantities; and increasing kids’ physical activity.

The program will be run by representatives from the NIH.  They’ll teach community leaders about helping the children through their parents, teachers, and other members of the community.  Local Pittsburgh organizations that have already run successful We Can! programs will also speak at the event to help new communities start their own programs.  Compare health insurance companies’ community outreach and UPMC definitely is tops in their industry helping the community.  As a co-sponsor with Subway restaurants, UPMC hopes this We Can! training event will help combat childhood obesity in their community.  The NIH and UPMC health insurance plan hope that parks and recreation departments, schools and after-school programs, hospitals and other health care systems, churches, public health departments, and anyone else dealing with kids will come learn about the We Can! program.

Compare Health Insurance for Women After Health Care Reform

Saturday, April 3rd, 2010

According to “Health Law Cuts the Cost of Being a Woman” by Denise Grady of the New York Times, health insurance companies can no longer treat women as a liability.  House Speaker Nancy Pelosi and other women in government are advocating for women’s health by ensuring that being a woman is not considered a pre-existing condition.  The new health care bill forbids all health insurance companies, like UPMC, from sex discrimination.  In the past, companies took advantage of women with unfair health care and health insurance policies towards them.

Companies who sell individual insurance policies, usually bought by people who have lost jobs or other group coverage plans, had been charging women more than men for the same health insurance coverage.  Many plans did not even include maternity care.  Insurance companies argued that women use doctors more than men.  The National Women’s Law Center found that men who smoked were actually being charged less than women who did not.  Even group plans when you compare health insurance were affected.  Although sex discrimination laws didn’t allow the excess costs to be passed down to female employees, smaller business and those heavy in female employees have been forced to make sacrifices including discontinuing coverage in some cases.

Gender rating is now outlawed and maternity coverage has to be included as an “essential health benefit” like heart attacks and cancer.  Women should no longer have to be concerned about getting fair treatment in the health care industry from companies like Golden Rule Insurance.  There are people who worry that insurance companies will be able to find ways around the new laws to protect themselves from financial costs, but the Law Center’s co-president doesn’t currently see any loopholes and is confident that the health care bill will better protect women.

Fallon Health Insurance: Health-Care Bill Timeline

Friday, March 26th, 2010

calendarThe passing of the health-care bill on Sunday will bring about changes in the industry for individuals and companies like Fallon Health Insurance.  In The Washington Post’s article “When does the health-care bill go into effect,” the newspaper summarizes the timetable.  The first change should happen within the year, offering a rebate of $250 for Medicare recipients whose initial prescription drug coverage has run out.  Within 90 days, people who were denied insurance based on preexisting conditions will have access to high-risk pools.  Changes that will come about for insurance companies within 6 months include a requirement for children to remain on their parents’ policies until age 26 if they desire and the banning of insurance companies imposing lifetime coverage caps, denying coverage when people get sick, and denying children with preexisting conditions coverage.

By 2011, individual and small group insurance plans like UPMC Health Insurance are required to use 80% of premium money towards medical services while large group plans must use 85%.  The Medicare payroll tax will be increased and expanded by 2013.  Families who earn 400% or less of poverty level income will receive subsidies to buy health insurance by 2014.  Also that year, most employers will have to provide insurance coverage or will receive penalties and most Americans will have the same stipulation for obtaining health coverage.  High-end insurance policies will have an excise tax of 40% imposed in 2018.  And by 2019, health insurance will cover 32 million more people than it does today.