RIP Davy Jones

Not health insurance-related, but I wanted to acknowledge the passing today of Monkees singer and actor Davy Jones. In the 60's millions of American girls wanted to grow up and marry him, and millions of boys wanted to grow up and be him. May the stars shine brighter now that you are up there, Davy.

Health Net and Cigna Settle with CDI over Autism

California Insurance Commissioner Dave Jones announced today that he has reached a settlement with Health Net and Cigna regarding coverage of Applied Behavioral Analysis Therapy (ABA) for autism.

This makes three carriers who have reached settlement with the CA Dept of Insurance with regard to appropriately covering ABA and autism in California.

Last month CDI reached a settlement with Blue Shield of California to provide ABA coverage for autism. See my Jan 31 blog post: (http://davefluker.blogspot.com/2012/01/blue-shield-ca-agrees-to-settlement.html)

Of interest is Dave Jones' comment regarding Anthem Blue Cross of California (which was not forced to settle any issues with regard to autism and ABA coverage). Per Dave Jones:

"And we are pleased to reconfirm and acknowledge Anthem Blue Cross of California for providing this treatment as the Department of Insurance has directed since November 2009."

Link to the full announcement from CDI: http://www.insurance.ca.gov/0400-news/0100-press-releases/2012/release017-12.cfm

If there any further settlements with regard to ABA therapy and autism, I will let you know in a future blog.

Dave
www.davefluker.com

"Five Myths About Medicare"

I recommend you read John Rother's recent op-ed in the Washington Post, "Five Myths About Medicare."John argues that each of these statements is a myth:Medicare is inefficient and fails to control costs--the CBO has projected that per capita spending will grow only 1% more than inflation over the next decade.The well-off don't pay enough for their Medicare benefits--working age premiums as well

Bill adding consumer and small business voices to Exchange Board passes Insurance Committee unanimously

Yesterday the legislature’s Insurance Committee unanimously passed HB-5013 with substitute language. The new bill language adds one consumer and one small business representative to the CT Health Insurance Exchange Board and makes the State Health Care Advocate a voting member. The bill will be effective upon passage. The bipartisan bill partially addresses concerns raised by advocates, small businesses, editorial boards and others about the lack of consumer and small business voices on the Exchange. The bill now goes to the House floor.

Blue Shield CA To Reduce April Premium On DMHC Settlement

Blue Shield of California has announced to agents that they will be providing a premium reduction (March 1 increase) for those subscribers currently seeing a March 1 rate increase on their DMHC-registered health plans.

Instead of a regular premium increase reduction (say that three times fast) Blue Shield of California has agreed instead to pay the overall reduction at one time. Subscribers currently on DMHC-registered Blue Shield plans will receive a premium credit for the month of April, 2012 on average approximately 62%.

The rate increase goes into effect March 1, 2012 so those on DMHC-registered plans need to make sure and pay the full March premium. Letters regarding the April premium credit have been sent to affected subscriber.

Those on DMHC-registered plans who are currently in their initial six-month rate guarantee period will receive the premium credit the first month after the end of the rate guarantee period.

DHMC-registered plans include:

*Shield Spectrum 5500 PPO
*Access+ HMO
*Access+ Value HMO

This premium credit only applies to underwritten health plans and does not apply to HIPAA plans nor Conversion plans.

Dave
Find Me Here

Advocates speak up in Exchange Board meeting

Yesterday, advocates spoke out during the CT Health Insurance Exchange Board meeting to protest the lack of consumer voices on the Board. The Board has been widely criticized for lacking any voting consumer members, despite federal regulations that call for consumers to comprise a majority of voting members. Several members of the Board called for more transparency, better communication and regular opportunities for public comment. Jeanette DeJesus, Special Advisor to the Governor on Health Reform, expressed support for the protestors. The Board is quickly staffing up and expects to have most of the important operational pieces in place by the next meeting scheduled for March 15^th. Advocates have called for legislation, effective immediately, to add consumer and small business votes to the Board before the next meeting to ensure stakeholder input into those critical decisions. CT is among a small minority of states moving this quickly to establish exchanges; most states have not yet decided whether to run their exchange themselves or let the federal government do it. The Board has hired a public relations firm to collect input from stakeholder groups including consumers, brokers, small businesses, insurers and providers. The consultants will be holding meetings across the state in the next week.  Those meetings were to be invitation-only but Board members at the meeting insisted in opening them to the public.

Ellen Andrews

New press on insurance exchange’s problems

The Hartford Business Journal has published a series of articles on the problems and challenges facing CT’s insurance exchange.

Mercer recommends letting CBIA run small business exchange

Advocates oppose CBIA role in exchange

Exchange having trouble finding a CEO

Survey finds CT employers cool to exchange

Insurance public hearing to add consumers and small businesses to insurance exchange board

Today, the Insurance and Real Estate Committee held a public hearing on HB-5013 – a very weak bill that would have added only one, narrowly defined consumer advocate and one small business person to the exchange but not before July 1st. It also would have given the State Health Care Advocate a vote But again not until July 1^st – safely after all the important decisions have been made. The Board has been criticized for having three members representing insurance interests and no voting consumer representatives. The Board is now choosing a CEO and a team of other senior management (at eye-popping salaries) and considering whether to cede the small business exchange to CBIA. Many people, including consumers, advocates, brokers, small businesses, providers and labor representatives, spoke to the need for at least two consumer reps and two more small business people on the Board. Speakers also emphasized that the CEO being hired should be independent of the insurance industry, to help build some credibility for the exchange among the people who will rely on it for affordable coverage in 2014 when the individual mandate becomes effective. Speakers also strongly opposed allowing CBIA to run any part of the exchange. CBIA has lobbied against state and national reform in the past; handing the exchange to opponents of reform invites failure. Speakers also asked for the legislature to clarify that the Ethics Commission enforces conflict of interest provisions in the original law, specifically excluding Board members affiliated with insurance companies.

Ellen Andrews

ICD-10 To Be Delayed Indefinitely--Never Mind!

After years of telling us they are serious this time and everyone in the health care system had better be ready on time to implement the new disease coding system, CMS said today the whole project is going to be delayed indefinitely.The new ICD-10 system requires payers and providers to convert from the old system of 13,000 codes to the new system of 68,000 codes.All payers and providers were

There is No Free Lunch and There is No Free Contraception

The otherworldy Obama Administration solution to the contraception firestorm might work politically but it makes no sense in the real world.The President, hoping to quell a growing political firestorm, today announced a new policy that no longer requires religiously affiliated organizations to provide employees with contraception coverage in health-insurance plans.Under the new policy, insurance

HHS Unveils Final Health Plan Label Design

HHS has announced the final regulations regarding the information that health insurers must provide to consumers to explain their health plan.

The labels will simplify the now-complex legalese and fine print associated with health plan benefit summaries. All health plans must follow the same guideline so that plan benefits will be much easier to understand and easier to compare.

I believe that unified plan summaries in this format are a great thing and will help people better understand exactly how their health insurance plan will work for them.

This standardized form will be available in September, 2012.

Here is an article with benefit summary samples.

Dave
www.davefluker.com

Dismantling the Affordable Care Act: The Obama Supreme Court Argument + 51 Republican Senators

I have no idea which way the Supreme Court will rule this year on the Affordable Care Act. Let me go out on a limb and predict a 5-4 vote on the question of whether the individual mandate is Constitutional. Just don’t ask me which way the vote goes.I found the recent Obama administration brief submitted to the Court on the mandate question somewhat ironic. Not surprisingly, the Obama Justice

HPV DNA Screening - A Request

I have a request I want to put out to California women. I am in need of information regarding health insurance medical underwriting of the HPV DNA Screening test.

I have received a few phone calls recently from women needing health insurance who told me that they were declined for individual coverage in California due to the results of the HPV DNA Screening test (indicates potential high risk HPV strains).

I have asked for underwriting clarification from both Anthem Blue Cross CA and Blue Shield of CA concerning how they underwrite this test result. Neither carrier has been able to give me an clear answer and they are asking for specific cases to review to determine how to answer the question.

This test is going to be included in women's expanded preventive benefits as directed by HHS starting August 1, 2012 and I expect it will become more common as a screening tool for HPV strains in the near future. As such, independent agents working directly with California women are pretty much in the dark on how to advise them concerning medical underwriting for individual health insurance.

So....I am asking any woman in California who has been denied individual health insurance by either Anthem Blue Cross (that would be the main carrier of interest) or Blue Shield of California due to the results of the HPV DNA test conducted by their ObGyn. I am particularly interested in denials or rate ups where there were no other risk factors in the underwriting except the HPV DNA test result.

Anyone who is willing to help your information will be kept highly confidential and will only be shared between myself and the denying insurance carrier to help get field underwriting criteria out to agents so that we may do a better job of advising.

If you have been subject to a rate up or denial due to the HPV DNA test result, and would like to help, please contact me via my web site, e-mail or by telephone. Your help would be greatly appreciated.

Dave
www.davefluker.com

Medicare Advantage Premiums Drop an Average of 7% and Enrollment up 10%—That Must Make Republicans Just Want to Cry

Medicare Advantage would appear to be a fantastic success—senior premiums are dropping and enrollment is increasing.Listening to Health and Human Services Secretary Sebelius last week, you would think private Medicare plans were a Democratic idea and this is their success. Many industry observers, including me, have worried that Medicare Advantage benefits would shrink and premiums would rise

CT Health Reform Dashboard -- 10.4% progress to date

How is CT doing reforming our broken health system? Are we making smart choices? Are we taking advantage of opportunities? Having trouble keeping up with the many moving parts? Visit our CT Health Reform Dashboard at www.cthealthreform.org

The Wyden-Ryan Plan Will Be the Foundation for Serious Medicare Reform—and Maybe More

In two companion articles in January’s New England Journal of Medicine, Henry Aaron with Austin Frakt, and Joe Antos critique the Wyden-Ryan Medicare reform proposal.Senator Ron Wyden (D-OR) and Representative Paul Ryan (R-WI) are proposing a hybrid Medicare reform proposal combing both Republican defined contribution free market principles—a premium support scheme—with Democratic defined