S&S Benefits.....Opinion, Hearsay & News Review

Why be like everyone else?

We must see at least three items a month about various HMO’s going under. Tufts and Harvard in the east are having serious problems, although the Massachusetts plans seem to be insulated from their indiscretions in other states.

AS we move into the year 2000 you may want to consider that many employees spend considerable time and energy trying to arrange for eldercare or childcare on company time! A recent study said that 84% of the respondents made at least one formal adjustment to their work schedule to give care to family members. This of course is after the time spent on company phones and time making arrangements for care. Why not make your employees more productive and their lives easier through a national referral service? Contact S&S Benefits for details.

UNited Healthcare’s big splash in the media for their stance on "eliminating" UR got far more attention than a recent statement calling their policies a "sham." That came from the Medical Society of New Jersey, who draws attention to the fact that the UHC physician guide says that "Claims will be be adjudicated retrospectively, according to a five step process." Furthermore, the docs in NJ say United is still requiring pre-certification for MRIs, CAT-scans, physical therapy and other procedures. Bet you won’t hear big Willie talking about that, and the media is not going to draw attention to their over enthusiasm either!

The going rate for health plans may interest your company. It appears that Wellpoint acquired Rush Pru for about $660 per member, well below prices a few years ago. Of course, the aquirer-ers appear to have figured out why these plans are up for sale.

TOwers Perrin has released their study that annually tells us that HMO’s are more "efficient" than most PPO or traditional plans. Not surprising given where we’ve seen them going with their clients. We are sure there is a study to justify every bias. However, none of the news reports define just what is meant by efficiency in the eyes of TP.

Employers are estimating their health plan costs will rise by 10% in Y2K according to a Hewitt study quoted in BI.

A Houston US District court judge has denied a motion for a class action suit in Texas which claimed Aetna, UHC and NYLCare failed to disclose practices such as capitation, UR and case management as part of their advertising. My, my my….makes you wonder what the disclaimers would be on HMO ads compared to car ads if that suit went through.

IN an EBRI study we find that 57% of respondents who have received medical care in the last two years are extremely or very satisfied with the quality. 32% are somewhat satisfied. Of the uninsured/employed, 33% were offered coverage but declined. 61% of those were covered by another plan and 20% said the cost was too much. Overall, 84% of Americans have some form of health insurance according to EBRI.

WE can’t pass up this one. Big splash article in BI. Hewitt held on-line bids for HMOs for IBM and IKON and one other company. They SAY they got 2% better rates than the normal bid process in the article. Wonder how much more was paid for consulting than the normal bid process? Wait, what’s that? Isn’t this just another spreadsheet without recommendations? Does anyone stand up and say what is good and what is not? Are they sure the bidder and buyer can get along? Or do we just assume that because they are on the spreadsheet or part of the auction that all are equal except for price?