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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                                               http://www.ssbenefits.net/   November 2007 Issue


BC/BS of IL and Rush University Medical Center have agreed to a contract through 2011. About 7,400 BCBSIL members received inpatient care at Rush with about 67,000 receiving outpatient care at the facility. While Condell Medical Center in Libertyville , Il continues to slug it out with Blue Cross, they do have a new three year agreement with Humana for both PPO and HMO.

Average premiums for stand-alone Medicare prescription drug plans will increase about 8.7% to $40 monthly in 2008 according to a study by Avalere Health in USA Today. Medicare beneficiaries have the ability to switch Rx plans or enroll for the first time between Nov.15 and Dec. 15th.

Sara Collins, AVP for the Commonwealth Fund, in a recent speech cited research showing that 51% of HDHP users and 44% of CDHP users spent 5% or more of their income on health care in 2006, compared to 22% of users in traditional plans spending that much. She also said that 38% of CDHP users and 33% of HDHP users reported delaying or avoiding care, as opposed to 19% in traditional plans.

Segal has completed their 2008 trend cost survey. Indemnity medical plan trend is projected at 12.1%, HDHP trend at 10.9%, POS at 10.6%, PPO at 10.5% and HMO at 10.7%- all including Rx. Rx carve out is at 10.7%, Dental indemnity is at 6.8%, dental PPO at 5.8% and DMO at 4.3%. Historically, actual trend has been lower than projected trend for this survey.

PPOs are going to submit quality data to NCQA to receive NCQA accreditation via the same standards as HMOís. We find this to be a ridiculous exercise with meaningless results, since the patient is not controlled by a primary care doctor in a PPO environment and the PPO does not dictate care, so how can a PPO be rated as providing quality or not? The NCQA would provide more service if it actually published individual doctor quality data in mass, since most HMO doctors also have PPO contracts.  For instance, only 99 physicians are in the Recognized Physician Directory for Illinois at the NCQA web site. Thatís useful.

HealthMarkets, a Texas based insurance carrier is facing charges from Delaware and Massachusetts regulators for allegedly deceiving patients and denying state-mandated care. Subsidiaries of HealthMarkets include MEGA Life, which markets heavily to the self-employed and sole-proprietor market, along with Chesapeake Life and Mid-West National. The company is reported to be under investigation in 36 states.

Wellpoint is reportedly turning to Zagat (of dining guide fame) to launch an on-line survey tool in January that will allow consumers to share their experiences with physicians. The consumers will be able to rate docs on a 30 point scale in the categories of trust, communication, availability and office environment. Ratings will become active after a doc has been rated 10 times. There is no word on whether the NCQA is also planning a dining guide.

In the 2007 Health Confidence Survey by EBRI, 63% of Americans with health insurance reported they experienced an increase in premium cost for coverage. This has apparently caused an increase by 10% to 81%  of people who are reportedly taking better care of themselves and who talk to their doctor more about treatment costs and options (up 9% to 66%). However, there is also about a 10% increase in the number of people who delay going to the doctor and a 7% increase in the number of people who do not fill or skip prescription doses due to cost. 76% of those with employment based health coverage would rather have $7,500 in coverage than the same amount in taxable income. 29% rated the health care system as fair and 30% rate it as poor, but 51% remain extremely or very satisfied with health care quality. Only 18% are satisfied with the cost of insurance. Can you imagine what the 82% who are not satisfied with insurance costs would say if they knew what the cost of coverage was, instead of the cost that they pay?

A Fidelity study found that although 61% of employees considered their understanding of health insurance terminology to be very good, 56% did not know what a HSA is, 50% could not define a flexible spending account or HRA and 13% did not know what a co-payment is. Fidelity estimates that a retired couple at age 65 will need $215,000 to cover the cost of health care, but the median employee answer to the need was $100,000.