Zeno Swijtink
03-07-2010, 11:22 PM
I have good experiences with the doctors and nurses at Kaiser.
But have the financial guys at Kaiser lost it?
The experiences of a friend seem to tell so: For years he has had a monthly injection for a chronic, permanent condition that cost him $45 each month as a co-payment.
Then, without warning or telling him, Kaiser "redefined" this procedure and charged him $1000+ for the very same procedure.
I can barely fathom his shock when he was presented with the bill. It is criminal and has to be illegal.
The financial guys told him that they wanted to drain his deductible every year.
Isn't the deductible meant for unexpected and costly medical emergencies?
This shows what Obama's health care reform is up against!
***
Health insurers seeking rate hike (https://www.boston.com/business/healthcare/articles/2010/03/06/health_rate_hikes_flout_new_state_cap?mode=PF)
Requests test Patrick’s resolve
By Robert Weisman, Globe Staff | March 6, 2010
Three weeks after Governor Deval Patrick warned that his administration might turn down health insurance premium increases it deemed excessive for individuals and small businesses, insurers have asked the state to approve rate hikes of 8 to 32 percent for April 1.
Patrick last month said the state Division of Insurance would review rate increases exceeding 4.8 percent as part of a broader effort to rein in health care expenses. If the insurers’ latest round of increases is rejected, it would mark the first time Massachusetts has capped health insurance rates.
Insurers say such a move would cause confusion in the marketplace, as they already have negotiated contracts with many individuals and small businesses at the new rates. Capping the rates would also result in immediate financial losses, insurers assert, forcing them to cut payments to health providers and threatening the viability of weaker hospitals.
Executives from Blue Cross and Blue Shield of Massachusetts, the state’s largest health insurer, have asked state officials to delay their decision on rates. And the Massachusetts Association of Health Plans, a trade group representing 11 other insurers in the state, has asked for time to let insurers propose cost-savings alternatives of their own.
“Rushing into this could be perceived as putting price controls on health costs rather than making decisions based on sound actuarial data,’’ said Blue Cross-Blue Shield vice president Jay McQuaide, who blamed the increase in premiums mostly on the rise in medical spending. “This would cause significant disruption in the providing of health services.’’
But small businesses say years of double-digit increases have strained their finances, crippling their ability to expand and create jobs. State regulators have long been empowered by law to disapprove health insurance rates, but have never done so. The past practice has been for insurers to file premium rate increases with the Division of Insurance as a courtesy on the day they take effect.
Under an emergency regulation put in place by Patrick, health insurers were required to submit their rate plans to the insurance division this week, 30 days in advance of April 1, the most common policy renewal date for small business and individuals, a customer base of more than 600,000 people. The division, which has beefed up its internal staff and contracted with outside actuarial firms to review the filings, is set to rule on the rate plans in the next two to three weeks.
“People are angry’’ with the proposed increases, said Joseph G. Murphy, who became the state’s insurance commissioner last month. “We’re moving ahead, as the governor has directed us, to scrutinize these rate filings.’’
Murphy said the governor has instructed him to review any rate increases over 4.8 percent, a benchmark that is one and a half times a federal inflation estimate that gauges some medical costs for consumers.
If state regulators turn down the proposed hikes, rates would remain at April 1, 2009, levels. Kevin Beagan, deputy insurance commissioner, said insurers would have the right to appeal the state’s ruling.
Many small businesses and individuals are urging the Patrick administration to stand firm and reject the premium rate increases. “We keep scratching our heads, wondering how these increases can be justified,’’ said Jon B. Hurst, president of the Retailers Association of Massachusetts, which represents 3,100 small businesses. “Our members are seeing their sales drop, and they’re wondering how health care costs can grow by double digits.’’
Shishir Mehta, owner of Fastsigns Inc. of Waltham, which has five employees who make signs and banners for corporations and trade shows, said he received a 30 percent premium increase effective April 1, while other small business owners he knows have been hit with 40 percent increases. “It’s very frustrating,’’ Mehta said.
In a letter to employees of Watertown-based Tufts Health Plan yesterday, obtained by the Globe, chief executive James Roosevelt Jr. said insurers must do what they can to keep costs reasonable. “Nonetheless,’’ he wrote, “the governor’s actions, by being one-sided and not considering medical expense, have the potential for creating chaos in the marketplace as 4.8 percent covers roughly only one-third of the current provider rate increases. Those actions address the symptom without addressing the disease’’ of rising health costs.
In filings this week, Blue Cross-Blue Shield proposed premium increases ranging from 10 to 19 percent, Harvard Pilgrim Health Care proposed hikes of 8 to 12 percent, Tufts Health Plan sought increases averaging 15 percent, and Fallon Community Health Plan asked for increases that vary from 18 to 32 percent. Increases for many individuals and small businesses could be even steeper, depending on factors such as the age of their workforce. Employers often limit increases by offering reduced health services or asking employees to pay more.
The tug of war between insurers and individual and small business customers comes amid efforts on several fronts to halt the spiraling cost of health care. Last year, a state commission was formed, supported by key legislators, with the goal of slowing the rise in the use of medical services. It urged scrapping the current fee-for-service system and paying providers a per-patient annual fee, called a global payment, to cover all of a patient’s medical care.
By putting health care providers on a budget, policy makers hope to discourage unnecessary tests and procedures and improve coordination of care, both of which could save money. The administration is drafting a strategy to implement changes, but it’s unclear how quickly it might move toward a global payment system.
In the meantime, health care providers, like insurers, are eyeing the Patrick administration’s moves warily. Many have multiyear contracts with insurers, so health plans would not be able to cut payments until those contracts expired, but others would be vulnerable sooner if their contracts are being renegotiated.
Changes proposed by the Patrick administration “may have unanticipated and unintended consequences not only for insurers and providers, but also for health care services and the state economy,’’ Lynn Nicholas, president of the Massachusetts Hospital Association, said in a statement yesterday. Patrick has also submitted legislation that would allow the state to review contracts between insurers and providers.
Even as businesses and individuals feel the pinch of surging health costs, three of the four largest state health insurers last week posted financial reports showing operating losses for 2009. Forcing insurers to limit their premium increases to 4.8 percent over the next year “would be a significant financial hit,’’ said Thomas Croswell, chief operating officer of Tufts Health Plan. “We’re not in a particularly strong position to absorb something like this.’’
Liz Kowalczyk of the Globe staff contributed to this report. Robert Weisman can be reached at [email protected].
But have the financial guys at Kaiser lost it?
The experiences of a friend seem to tell so: For years he has had a monthly injection for a chronic, permanent condition that cost him $45 each month as a co-payment.
Then, without warning or telling him, Kaiser "redefined" this procedure and charged him $1000+ for the very same procedure.
I can barely fathom his shock when he was presented with the bill. It is criminal and has to be illegal.
The financial guys told him that they wanted to drain his deductible every year.
Isn't the deductible meant for unexpected and costly medical emergencies?
This shows what Obama's health care reform is up against!
***
Health insurers seeking rate hike (https://www.boston.com/business/healthcare/articles/2010/03/06/health_rate_hikes_flout_new_state_cap?mode=PF)
Requests test Patrick’s resolve
By Robert Weisman, Globe Staff | March 6, 2010
Three weeks after Governor Deval Patrick warned that his administration might turn down health insurance premium increases it deemed excessive for individuals and small businesses, insurers have asked the state to approve rate hikes of 8 to 32 percent for April 1.
Patrick last month said the state Division of Insurance would review rate increases exceeding 4.8 percent as part of a broader effort to rein in health care expenses. If the insurers’ latest round of increases is rejected, it would mark the first time Massachusetts has capped health insurance rates.
Insurers say such a move would cause confusion in the marketplace, as they already have negotiated contracts with many individuals and small businesses at the new rates. Capping the rates would also result in immediate financial losses, insurers assert, forcing them to cut payments to health providers and threatening the viability of weaker hospitals.
Executives from Blue Cross and Blue Shield of Massachusetts, the state’s largest health insurer, have asked state officials to delay their decision on rates. And the Massachusetts Association of Health Plans, a trade group representing 11 other insurers in the state, has asked for time to let insurers propose cost-savings alternatives of their own.
“Rushing into this could be perceived as putting price controls on health costs rather than making decisions based on sound actuarial data,’’ said Blue Cross-Blue Shield vice president Jay McQuaide, who blamed the increase in premiums mostly on the rise in medical spending. “This would cause significant disruption in the providing of health services.’’
But small businesses say years of double-digit increases have strained their finances, crippling their ability to expand and create jobs. State regulators have long been empowered by law to disapprove health insurance rates, but have never done so. The past practice has been for insurers to file premium rate increases with the Division of Insurance as a courtesy on the day they take effect.
Under an emergency regulation put in place by Patrick, health insurers were required to submit their rate plans to the insurance division this week, 30 days in advance of April 1, the most common policy renewal date for small business and individuals, a customer base of more than 600,000 people. The division, which has beefed up its internal staff and contracted with outside actuarial firms to review the filings, is set to rule on the rate plans in the next two to three weeks.
“People are angry’’ with the proposed increases, said Joseph G. Murphy, who became the state’s insurance commissioner last month. “We’re moving ahead, as the governor has directed us, to scrutinize these rate filings.’’
Murphy said the governor has instructed him to review any rate increases over 4.8 percent, a benchmark that is one and a half times a federal inflation estimate that gauges some medical costs for consumers.
If state regulators turn down the proposed hikes, rates would remain at April 1, 2009, levels. Kevin Beagan, deputy insurance commissioner, said insurers would have the right to appeal the state’s ruling.
Many small businesses and individuals are urging the Patrick administration to stand firm and reject the premium rate increases. “We keep scratching our heads, wondering how these increases can be justified,’’ said Jon B. Hurst, president of the Retailers Association of Massachusetts, which represents 3,100 small businesses. “Our members are seeing their sales drop, and they’re wondering how health care costs can grow by double digits.’’
Shishir Mehta, owner of Fastsigns Inc. of Waltham, which has five employees who make signs and banners for corporations and trade shows, said he received a 30 percent premium increase effective April 1, while other small business owners he knows have been hit with 40 percent increases. “It’s very frustrating,’’ Mehta said.
In a letter to employees of Watertown-based Tufts Health Plan yesterday, obtained by the Globe, chief executive James Roosevelt Jr. said insurers must do what they can to keep costs reasonable. “Nonetheless,’’ he wrote, “the governor’s actions, by being one-sided and not considering medical expense, have the potential for creating chaos in the marketplace as 4.8 percent covers roughly only one-third of the current provider rate increases. Those actions address the symptom without addressing the disease’’ of rising health costs.
In filings this week, Blue Cross-Blue Shield proposed premium increases ranging from 10 to 19 percent, Harvard Pilgrim Health Care proposed hikes of 8 to 12 percent, Tufts Health Plan sought increases averaging 15 percent, and Fallon Community Health Plan asked for increases that vary from 18 to 32 percent. Increases for many individuals and small businesses could be even steeper, depending on factors such as the age of their workforce. Employers often limit increases by offering reduced health services or asking employees to pay more.
The tug of war between insurers and individual and small business customers comes amid efforts on several fronts to halt the spiraling cost of health care. Last year, a state commission was formed, supported by key legislators, with the goal of slowing the rise in the use of medical services. It urged scrapping the current fee-for-service system and paying providers a per-patient annual fee, called a global payment, to cover all of a patient’s medical care.
By putting health care providers on a budget, policy makers hope to discourage unnecessary tests and procedures and improve coordination of care, both of which could save money. The administration is drafting a strategy to implement changes, but it’s unclear how quickly it might move toward a global payment system.
In the meantime, health care providers, like insurers, are eyeing the Patrick administration’s moves warily. Many have multiyear contracts with insurers, so health plans would not be able to cut payments until those contracts expired, but others would be vulnerable sooner if their contracts are being renegotiated.
Changes proposed by the Patrick administration “may have unanticipated and unintended consequences not only for insurers and providers, but also for health care services and the state economy,’’ Lynn Nicholas, president of the Massachusetts Hospital Association, said in a statement yesterday. Patrick has also submitted legislation that would allow the state to review contracts between insurers and providers.
Even as businesses and individuals feel the pinch of surging health costs, three of the four largest state health insurers last week posted financial reports showing operating losses for 2009. Forcing insurers to limit their premium increases to 4.8 percent over the next year “would be a significant financial hit,’’ said Thomas Croswell, chief operating officer of Tufts Health Plan. “We’re not in a particularly strong position to absorb something like this.’’
Liz Kowalczyk of the Globe staff contributed to this report. Robert Weisman can be reached at [email protected].