Posts Tagged ‘UPMC’

Health Insurance Rates Only Part of Customer Satisfaction

Friday, April 29th, 2011

map PAPennsylvania health plans ranked higher in customer satisfaction than the national average in J.D. Power & Associates’ U.S. Member Health Insurance Plan Study.  According to “UPMC, Geisinger, Highmark lead Pa. customer satisfaction rankings” by Bob Graham of Insurance & Financial Advisor, UPMC Health Plan ranked the highest in Pennsylvania.  While health insurance rates are important to consumers, this study also looked at the coverage and benefits, customer service, communications, information, provider choice, claims processing, statements given, and the approval process.  UPMC scored 744 out of 1,000, well above the national average of 696 and significantly higher than Pennsylvania’s average of 714.

Geisinger Health Plan and Highmark BlueCross BlueShield followed UPMC in Pennsylvania’s rankings with scores of 737 and 735, respectively.  Capital Blue Cross and Independence BlueCross also scored higher than the state’s average.  Although Pennsylvania’s scores went down slightly in 2011, compared to 2010, four of the seventeen other regions surveyed saw much more significant declines.  Some of the insurance companies that scored lower than average in Pennsylvania were Highmark Blue Shield, CIGNA, HealthAmerica/HealthAssurance, Blue Cross of Northeastern Pennsylvania, Aetna, and UnitedHealthcare.  Of the 34,000 insurance plan members surveyed, 2,684 were in Pennsylvania.

Use Health Exchanges to Get Fallon Health Insurance

Sunday, December 12th, 2010

Starting in 2014, Americans will be using health exchanges to shop for their health insurance.  The exchanges were put into place by the Affordable Care Act of 2010 and are supposed to be one-stop shops for Americans to get affordable insurance coverage from companies like Fallon Health Insurance.  The goal is for the exchanges to allow individuals and small businesses looking for health insurance to join forces and be able to purchase health insurance coverage together.  With larger purchasing power, they should be able to get affordable care at the kind of discounted prices that large businesses can.  Tax subsidies and cost-sharing discounts will also be given to individuals below a minimum income level to help with financial assistance.

According to Insurance Journal’s “Midwest States Getting $1M Each for Health Exchanges,” $49 million will be given out by the U.S. Department of Health and Human Services to help establish the health exchanges in individual states.  Illinois, Nebraska, North Dakota, and South Dakota will each receive $1 million to get their health insurance exchanges up and running.  All states were given the option to run their own insurance exchanges with companies like UPMC.  States that choose not to run their own exchanges will have one created and run by the federal government.  Those states receiving a portion of the $49 million will use that money to start their exchanges and determine how they will actually operate.

Medicare Advantage Changes Will Effect UPMC

Friday, October 1st, 2010

There could be some drastic changes to Medicare Advantage plans after everything is said and done with the Health Care Reform Act of 2010.  According to Texas’ The Daily Tribune author Marcia Davis-Seale, “Obamacare could shut out Medicare Advantage.”  While it seems unlikely that Medicare Advantage plans will go away altogether, the number of Medicare participants enrolled in such plans is estimated to go from 24% of participants down to 14% of them.  Compare health insurance costs related to Medicare Advantage and as the government subsidizes less for insurance companies, doctors, and hospitals, they likely will not be accepting as many Medicare Advantage plans. As many of 50% of current plan participants may have to switch to traditional Medicare.

Currently about a quarter of Medicare recipients have Medicare Advantage plans, accounting for around 10 million seniors.  The plans are alternatives to Medicare and offer a combination of Medicare plans along with extra benefits like dental and vision coverage and even gym memberships.  Since the plans are heavily subsidized by the government, these extras rarely effect plan holders with extra costs.  It costs the government between 13 and 20% more to fund Medicare Advantage plans than traditional Medicare plans.  As the government cuts back the amount it is spending on these costly plans over the next ten years, insurance companies may be more likely to drop the plans.  Insurers also have to comply with the new rule that they spend 85 cents of every dollar on actual medical care for their customers so that may be a cost cutting factor as well.

Everyone on Medicare will continue to receive the same benefits they have always been guaranteed.  The extra $1000 spent per Medicare Advantage recipient has been passed along to all Medicare policy holders over the years.  Now that the government is working to “level the playing field” in regards to Medicare it remains to be seen what insurance companies like UPMC will do.  Gym memberships and other perks will likely be cut by many, but seniors don’t have to worry about losing basic Medicare benefits like hospital and doctor care.  It will continue to be a balancing act for all of those involved to maintain seniors’ health care needs, keep Medicare fiscally afloat, and pay an adequate amount to private health insurers going into the future.

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.

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.

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.

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.

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.

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.

UPMC & Senate Health Care Bill Victory for Obama

Friday, December 25th, 2009

According to “Senate OK’s health care bill in victory for Obama,” Democrats brought President Obama an early Christmas present by passing the health care legislation.  The AP article by David Espo points out that the 60-39 vote was “strictly along party lines.”  This passage allows for the Senate and House to begin talks about this health care plan to help reduce the number of uninsured Americans and bring some control over the insurance industry.  Obama is hopeful that this health insurance reform job will be completed shortly.

What does this mean for health insurance companies like UPMC in Western Pennsylvania?  Speaker Nancy Pelosi said that the likely passage of this health care reform by early next year will provide “affordability for the middle class, security for our seniors, responsibility to our children by reducing the deficit, and accountability for the insurance industry.”  Both the House and Senate bills have many facets that will need to be combined into a working system for the United States, but President Obama ensures Americans that they will only be helped by this health care reform.