Archive for the ‘UPMC’ Category

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.

Compare Health Insurance Reform with Obama & the CEOs

Saturday, March 6th, 2010

white houseIn Sunlen Miller’s ABC News article “Obama: No “Straight Answer” from Health Insurance CEOs, Warns of More Premium Hikes to Come Without Up or Down Vote,” Miller talks about this important meeting.  President Obama met with health insurance CEOs on Thursday and seemed disappointed with the results of the meeting.  When you compare health insurance reform options, the bottom line seems to be that something needs to change.  The President doesn’t see insurance companies as willing to make a change.  He said that if health care is not reformed soon, premiums will continue to increase, people will continue to have their coverage dropped, and denials due to pre-existing conditions will still happen in high numbers.

The White House meeting with executives from the top five U.S. insurance companies had the goal of helping the health care reform effort.  After over a year of debating the issue, President Obama said that Congress owes the American people an up or down vote.  While he believes that the process is close to being complete, health care reform has to be voted up in order for the changes Obama sees for the American people to happen this year.  He says that lives will be helped tremendously and even saved with his health care reform.  Many people disagree with the government takeover of health insurance and wonder where that leaves insurance companies like UPMC.  President Obama had hoped for a more positive outcome from his meeting with the CEOs and his reform in general.  It remains to be seen what will happen with this longstanding debate over health care.

What Would UPMC Health Insurance Think of Pregnant Olympian?

Wednesday, February 17th, 2010

pregnant bellyOne of Canada’s Olympic hopefuls is 5 1/2 months pregnant, according to Yahoo! Sports’ Chris Chase.  Kristie Moore is a 30 year old member of Canada’s curling team.  She is only the third known pregnant Olympian, after a Swedish figure skater in the early 1900′s and a German skeleton athlete in 2006.  Moore says that her pregnancy does not affect her ability to “throw rocks” just yet, although when her belly grows it just might.  Her teammates have been supportive and point out that she is young and fit, which will help her in curling competitions.

I have to wonder what her insurance company thinks about her competing in the Olympics while pregnant.  While companies like UPMC health insurance and Mercy Health Plans don’t have any rules against this, they may be taking on more risk with a pregnant customer competing in high level sports.  Moore is an alternate so she will only actually compete if one of her team members gets injured anyways.  With the Canadian women being favored to win gold in curling, Moore’s unborn baby could be the youngest team member to win a gold medal!

Nancy Pelosi’s Bill Could Help Golden Rule Health Insurance & UPMC, Among Others

Friday, February 5th, 2010

nancy pelosiSince the large health care reform bill has stalled, House Speaker Nancy Pelosi is working to pass smaller bills containing the most popular reforms.  This is according to The Denver Post article “Dems pursue Plan B: lifting health-insurance antitrust shields” by Michael Riley.  Compare health insurance industry rules with other industries and you see that health insurance and Major League Baseball are the only two shielded from antitrust laws.  Pelosi hopes to change that with a new bill sponsored by Reps. Betsy Markey and Tom Perriello.

The bill would simply remove the antitrust exemption that health insurance companies have had for decades.  This would allow smaller  companies like Golden Rule health insurance and UPMC a better chance to compete in the industry.  In nine states, 75% of insureds are covered by one insurer and in thirty-five other states, half of insureds are covered by only two insurers.  Removing the antitrust exemption would increase competition, therefore lowering the cost of premiums to individuals and businesses.  It remains to be seen what the Senate will think of Pelosi’s plans.