Archive for the ‘Fallon Health Insurance’ Category

Pet Insurance From Aultcare?

Wednesday, August 18th, 2010

dogMore and more Americans are looking for health insurance to cover their pets, according to an article highlighted in USA Today.  Megan Neighbors’ “Popularity rises for pet health insurance,” from The Arizona Republic, says that vet bills have increased along with all medical costs and pets become more humanized each year.  Companies like Aultcare could stand to gain a lot by adding the millions of pets in the United States to insurance plans.  Even as we spend less on ourselves, we seem to be spending more on our pets including health insurance and discount plans from vets.  Only 3% of dogs and 1% of cats were insured in 2008, but that number is expected to rise as owners increase the limits they are willing to go to save or help their pets.

While inflation for most services has increased 28.1% since 2000, veterinary expenses have inflated by 80.4% in the same time frame.  Vets say that their costs have increased, as has the amount they need to spend to advance technologically.  With such increasing costs to care for your pets, looking for pet insurance from Fallon Health Plans or a specific pet insurer is becoming a wise way to spend your money.  While most traditional insurance companies do not yet offer pet insurance, it is quite possible that they soon will.  Pet specific insurance plans can vary just as much as human plans, and can range in price from $10 to $100 a month with varying deductibles and lifetime maximums.  There are also discount plans available to help cover preventative care like vaccinations.

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.

Fallon Health Plans Appeals State’s Caps

Friday, July 23rd, 2010

bostonMassachusetts state regulators are trying to get skyrocketing health care costs under control.  According to The Boston Globe article “State caps more health insurance rates” by Robert Weisman, 137 health insurance companies had their rates capped at 2009 levels.  Fallon Health Plans and two others filed appeals on the decision; they will wait until later in the summer to find out what will come of their appeals.

Four companies in the small group market did have premium increases in the single-digits approved.  Three insurers will be providing more information to the state before a decision is made on their requested double-digit increases.  This latest decision is for the three-month period ending in September and is quite a different outcome than the last three-month period where nearly all of the premium increases were rejected.

While officials with the state argue that they are using these rate caps to help small businesses and working families struggling in a tough economy, insurance companies say that the rates officials are forcing upon them are wreaking financial havoc by making them operate at a loss.  Insurers were given the ability to prove their case for increasing customers’ rates.  If they can’t prove necessity, their rate increases will not be approved.

AIDS Treatment From Fallon Health Insurance Helps Stop Spread

Sunday, July 18th, 2010

From the Associated Press’ Marilynn Marchione, “Treating HIV also prevents its spread, study finds.”  A recent Canadian study, partly funded by the United States, found that the rate of AIDS infections decreased in the areas of Canada where more people started taking drugs for the disease.  Infections dropped by 3% in British Columbia, where the study was performed.  Since 1996, the number of new infections has been reduced by half, which correlates with a rise in treatment since Canada has offered free AIDS care and the introduction of modern AIDS drug treatments.  The director of the U.S. National Institute of Allergy and Infectious Diseases states that where there is more drug therapy there is less transmission.  He says that there is really no other explanation for the drop in news AIDS cases in Canada.

While the U.S. does not offer free treatment to everyone, Fallon Health Insurance and other health insurers often cover the cost of drug therapy for AIDS patients.  With 1.1 million HIV infected Americans, AIDS experts hope that the results of this study will help improve U.S. funding for AIDS patients to get drugs.  While there are 55,000 new cases of AIDS each year in the U.S., that is a number that hasn’t increased or decreased in a decade or so.  Since AIDS is incurable, it is crucial to find a way to stop the spread of the disease.  Previous studies in Africa showed similar results, as did studies indicating that pregnant women taking AIDS drugs are less likely to pass the disease on to the unborn fetus.  An increased effort in Washington, San Francisco, and New York to test and give early treatment to more people will hopefully be taken throughout the U.S. soon.

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.

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.

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.

Fallon Health Plans & Pregnancy

Wednesday, May 19th, 2010

mom and babyThere is a lot of planning to do for having a baby before you even become pregnant, according to the article “Pregnancy,” from Health Key.  While most potential moms are thinking about what they’ll need to buy for baby and how to decorate the nursery, there are physical steps you should take before even becoming pregnant.  Make sure that you have health insurance from a company like Fallon Health Plans.  Have an exam with a doctor to discuss medications you take and any immunizations you may need.  Don’t take medicine like ibuprofen or aspirin, but do start taking a prenatal or multivitamin.  Take care of any dental work you need done.  Keep track of your menstrual cycle because it will help you get pregnant and help your doctor figure out your due date.  Live a healthy lifestyle through your diet and regular exercise, along with avoiding caffeine, alcohol, tobacco, illegal drugs and unnecessary medications.

Once you become pregnant, continue with all of the healthy lifestyle changes you’ve already made.  Also, get regular checkups from a doctor or midwife.  Your first exam will probably be the longest and include blood work, a pelvic exam and urine test, weight and blood pressure check and a listen for the baby’s heartbeat.  At your following appointments, your belly and weight will be measured and your blood pressure and urine tested.  It is important to go to all recommended prenatal visits because doctor’s are working to make sure nothing is wrong with you or your baby.  There are optional screenings you can do to test for Down Syndrome and other birth defects.  Near the end of your second trimester, you will be tested for gestational diabetes.  Some of the warning signs that should immediately lead you to call your doctor include bleeding, cramping, stomach or back pain that doesn’t go away, painful urination, bad headaches, a fever, blurred vision, or sudden swelling in your extremities.

Insurance Freeze From Fallon Health Insurance & Other MA Insurers

Wednesday, April 28th, 2010
Governor Deval Patrick

Governor Deval Patrick

The Wall Street Journal article “The Massachusetts Insurance Blackout” explains the fallout from Governor Deval Patrick’s price controls on insurance premiums.  Insurers are not selling small business and individual premiums because they say that the Governor’s rate cap will force them into huge losses.  This small-group market consists of 800,000 Massachusetts residents, many of whom will have to go without health care.  Fallon health insurance, Blue Cross Blue Shield, and Tufts Health Plan are three of the largest four insurers in the state.  All of them had operating losses in 2009 and say that this premium freeze will force another $100 million in losses this year.  All of the major health insurers in Massachusetts operate as non-profits and some are having their solvency threatened by this rate cap.

Governor Patrick says that this is his response to the greed that health insurance companies have shown.  The Boston superior court has heard an emergency case and is expected to make a decision soon.  State officials, however, are demanding the insurance companies go back to selling their policies at last years premiums.  The state’s Attorney General believes that the cost of health care in general is to blame for Massachusetts having the highest premiums in the nation.  He says that if you compare health insurance costs to the cost of the actual health care, the industry is not abusing its customers.  This debate in Massachusetts between political power for candidates and health care will likely happen all across the United States because of President Obama’s so-called ObamaCare.

Coming Soon: Compare Health Insurance Pools

Tuesday, April 6th, 2010

861559957_1d2a7ccdd0_mStates need to decide whether or not they are going to participate in President Obama’s new high-risk health care pools, according to the Chicago Sun-Times article “High-risk health insurance pools set to begin in June.”  Monifa Thomas’ article explains that not all states will even participate, but they have to make their decision within 90 days of the health bill signing on March 23.  Compare health insurance in some states and you find that these high-risk insurance pools already exist in 35 states, although some of their rules will surely change.  These high-risk insurance pools are for people who can’t get other, affordable insurance coverage because of pre-existing conditions.  They are temporary until 2014, when insurance exchanges where consumers can shop for heath insurance will replace the pools.

While federal health officials are unsure how much premiums will cost in these new pools or how many people will now have coverage that didn’t, they are confident that the pools will help many of the uninsured.  Consumers will only have to pay premiums that are 35% of the program cost, compared to Illinois’ current program where consumers pay 2/3 of the cost in premiums.  For six months, certain pre-existing conditions cannot be excluded from coverage.  Most states that already have high-risk pools in place will most likely transition those consumers into the new federal high-risk pools, although that will take time.  Whether you have an easier time getting affordable coverage from companies like Fallon Health Plans or state run high-risk insurance pools, the general idea of the health care reform is for more Americans to be insured.  States opting out of running their own pools will have the Department of Health and Human Services run one for them.