S&S Benefits.....Opinion,
Hearsay & News Review
UnumProvident
settled with
California
claim investigators for $8.6M for allegations of improper disability claim
handling without admission of any wrongdoing.
In
a suit brought by AARP, a federal judge had ruled that employers could not tie
their retiree benefit plans to Medicare eligibility. This would have cost
employers millions of dollars and probably forced cancellation of many of the
plans. However, the judge has now reversed her ruling, which allows retiree
benefits for Medicare eligibles to continue with the practice of co-coordinating
with Medicare.
UnitedHealthcare
and its
Georgia
unit face a proposed fine of $2.4M for not promptly paying doctors and
hospitals. A hearing is scheduled for Halloween day to rule on the matter.
Georgia
’s prompt pay law states that an insurer must pay a medical provider’s
claims in 15 working days or explain the delay. UHC claims to be paying 98%
within that time frame and says that it is impossible to reach the 100% standard
set by
Georgia
simply due to improper submissions by providers. In the meantime, UHC has won a
contract to run
Georgia
’s health insurance network for 300,000 state employees and insures more than
500,000 Georgians in private insurance plans. No word as of this afternoon as to
the outcome of the hearing.
Cigna
has teamed with Kmart to offer a Medicare Part D prescription plan, similar to
AARP’s branding relationship with UHC. No word yet on whether blue light
special pricing is going to be available.
Vista
Health has sold its two
Waukegan
hospitals (Victory and St. Therese) to
Tennessee
based Community Health Systems. The two hospitals had lost $90 million on
operations over the last five years.
New
data from EBRI indicates that Americans often view cost as one of the least
important factors when judging health care quality. The study indicates that 90%
of Americans evaluate their doctors on factors other than cost, but 63% do
believe that cost is important. Roughly 57% of Americans are extremely or very
satisfied with the quality of care they received in the last two years, while
only 28% were satisfied with the cost. Among those who experienced an increase
in cost in the last year, 79% switched to generic drugs, 71% claim to be taking
better care of themselves. Further, 40% said they delayed seeing a doctor for
treatment and 21% skipped prescription medications.
As
expected, Adventist Health Systems in the metro
Chicago
area did renew their agreement with PHCS, after initially announcing the
cancellation of their contracts. The hospitals in the system include
Hinsdale
, Glen Oaks and LaGrange Memorial.
A
new report by Express Scripts says that consumers and employers in health plans
in the commercial market could have saved over $20 Billion through increased use
of generic drugs. The study examined six major classes of drugs, including
cholesterol lowering medications and antidepressants. The average generic drug
costs $60 less per script than a brand name drug.
The
nation’s HMOs reported a $3.6 billion profit for the first quarter of 2005, a
21.4% increase over the figures for the first quarter of 2004. The industry
profit margin was 4.6% according to Weiss Ratings.
The
2006 Towers Perrin health care survey of 200 of the largest U.S. employers shows
that those employers are expecting an average 8% increase in their 2006 costs
for health care (up to $8,424 per employee per year) for all types of plans. The
cost sharing continues to average 20% for employees and 80% for employers.
Retirees will contribute about 43% of their costs. Low cost companies average
$6,866 PEPY in costs, while high cost companies average $10,022 PEPY. Lower cost
companies tend to have large differentials in copays for Rx Brand vs. generic
coverage and they also have moved away from copays for other coverage and have
moved towards coinsurance.
HAPPY HALLOWEEN!
