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

S&S Benefits Consulting, Inc. 219 Darien, Dundee, IL 60118 Phone: 847-428-5353, Fax:847-428-9876,

Email: jseiler@ssbenefits.net www.ssbenefits.net March 2004 Issue

The AHA has released a study that says that while healthcare spending rose by $2,254 per capita from 1980 to 2000, the death rate fell by 16%, life expectancy increased by 3.2years, disability rates dropped by 25% for people over the age of 65 and Americans spent 56% fewer days in the hospital.

A Miami judge has approved an estimated $540M settlement between Cigna and 950,000 doctors involved in a class action suit. Cigna agreed to spend $400M on internal changes and $70M on doctors’ claims up to 12 years old, $55M on attorney’s fees and $15M to create a health care foundation. That means that the doctors agreed that they each might have been mispaid by $73.68. We did not hear of one doctor overcharging anyone by that amount.

Aetna has reported it’s quarterly profits have more than doubled in the fourth quarter as the company got a better grip on rising medical costs. Meanwhile, Wellpoint was named as Fortune Magazine’s most admired health insurance company for the sixth year in a row. However, the Justice Department has approved Wellpoint’s merger into Anthem and one wonders whether Anthem can garner the same admiration from Fortune. The merger covers Blues plans in CO, CT, IN, KY, ME, NH, NV, OH, VA, CA, GA, MO and WI.

Compsych Corp. can always find a reason for stress and depression in their press releases. They say finance related calls are up 69% over last year. 22% of callers reportedly say they have less in savings and more in debt than last year.

As we reported in a recent special edition, Lake Forest Hospital has notified PHCS of their intention to terminate from the network as of 3/31/04. PHCS stresses that they have 3 other facilities to serve the area (Evanston Northwestern, Highland Park and Condell Hospitals). We’ll try to let you know as soon as possible if they kiss and make up.

The IRS has approved a tax deduction for doctor approved obesity treatment (generally described as 30 lbs. or more over ideal body weight) including gastric bypass surgery (average cost of $25,000) for amounts that exceed 7.5% of adjusted gross income. Humana has issued notice that they will be excluding coverage for that surgery. Obesity related disabilities have increased ten-fold over the last ten years according to Unum Insurance. The HHS says that obesity related conditions account for 7% of total U.S. health care costs.

HIPAA has just gotten worse from compliance cost standpoint. The CMS has established final regs for health care providers to provide a unique identifier (beginning in May 2005) to use in electronic transmission and receipt of health care claims data. The CMS will create 200 million unique 10 digit identifiers that will need to be incorporated into claim payment systems in 2007 through 2009 at an estimated cost of $427M to claim payers. However, after the initial disruption (which will be considerable), the CMS predicts that payment systems and results will be improved. The HHS and FDA will require prescription drugs and over-the-counter drugs given to patients in hospitals to be bar coded to prevent errors. Drugs on the market will have a two year compliance period and new drugs will need to be coded within 60 days.

An item from Health Affairs-the tax expenditure for health benefits (the amount of money the Feds forego by exempting health benefits and spending from federal taxes including Social Security) is estimated at $188.5 Billion in 2004.

Aon has released a study which shows that 77% of employees rate their employers favorably in terms of providing benefits that meet their needs and 76% say their benefit package does just that. 68% plan to stay with their current employer over the next several years.

The HIPAA compliance date for plans under $5million a year in receipts is April 14, 2004. Fines can range from $100 per violation up to $25,000 for multiple violations of the same standard in a calendar year. Individuals who knowingly violate HIPAA can be fined up to $250,000 and be imprisoned for up to ten years.

While criticizing Howard Dean for allowing captive insurance companies in Vermont, it should be noted that Vermont regulators issued a captive license to Heinz-Noble, Inc. The captive was formed by H.J. Heinz Co. Kerry’s wife was heir to the Heinz fortune. It is not known if regulators issued fries and ketchup with the license.

"Consumer driven" health plans were recently lambasted by Consumer Union who says that "this coverage is misnamed, misguided from a policy perspective and a dangerous distraction from the need to solve the health insurance crisis…" A Mercer consultant testified at a Senate hearing that "up to 40% of current expenditures on health care in America could be dispelled over a 10-year period through consumer-driven plans.."He did not explain how the dollars would disappear. They won’t, but we wonder where he thought they would go. Maybe they’ll go with the ketchup and fries?

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