Share your insurance ideas and expertise. Respond to questions and comments Joslyn [2010-03-09] ... I'm choosing health insurance for the first time. What is the difference between a HMO and a PPO? Reply
If UnitedHealthcare acquires the Northeast operations of its smaller competitor Health Net, the larger insurer won't provide enough coverage in rural areas, will control a lopsided share of the Fairfield County medical market, will likely increase premiums and balk at covering needed services, doctor groups and consumer advocates said Monday.
Opponents of the proposed business deal, who have spoken out in general about the loss of competition among health insurers, took direct aim at UnitedHealthcare at a hearing before the state Insurance Department, which must approve or deny the plan within a month.
"I am concerned that an inadequate provider network in the state's outlying and rural areas will compromise patient care and safety, especially to those high-risk patients with a need for specialized and specialty medical care," said Dr. Michael Deren, who practices in New London.
Deren, a cardiothoracic surgeon and chairman of surgery at Lawrence & Memorial Hospital, said that a "vast majority" of his patients are not enrolled in UnitedHealthcare because the company doesn't have a significant presence in the eastern part of the state, but that many are in Health Net.
The proposed consolidation of major health insurance companies in the state from six to five is occurring against the backdrop of the national debate over how the federal government should reform health care — including a public option to compete with private insurers.
UnitedHealthcare, a unit of UnitedHealth Group, countered that its larger size would help Health Net's customers in Connecticut.
"UnitedHealthcare will broaden choice and access to quality care for Health Net's customers with one of the largest networks, robust clinical programs and a full range of affordable products," said Jeffrey Alter, chief executive officer for UnitedHealthcare in the Northeast.
The company's network of doctors overlaps to include 98 percent of Health Net's primary-care physicians and obstetrics- gynecology providers and 100 percent of hospitals, Alter said. UnitedHealthcare would provide stability to customers who were going to be dropped anyway because Health Net announced more than a year ago that it was considering strategic business options that included pulling out of the Northeast, he said.
UnitedHealthcare announced in July its intent to buy the rights to Health Net membership rolls in Connecticut, New Jersey and New York. Health Net has about 578,000 members in the three states, including 196,000 members in Connecticut. UnitedHealthcare has about 2.6 million customers in those states, of which about 500,000 are in Connecticut.
Health Net members would have the option of renewing with UnitedHealthcare or moving to a competing plan.
Doctor groups and consumer advocates lambasted the proposal as creating a system in which few competitors control the market.
Ellen Andrews, executive director of the Connecticut Health Police Project, a nonprofit, nonpartisan consumer advocacy organization based in New Haven, said, "We are very concerned about the 193,433 state residents, current Health Net members, whose health coverage is at risk in this proposal. The U.S. Government Accountability Office has found that less competition in markets is associated with higher premiums."
She added that "Health Net has traditionally offered the most affordable options in our state," and that the acquisition would leave Medicare Advantage patients — those enrolled in privately run Medicare programs — with only United as an option in Connecticut.
A Boston-based economist hired by UnitedHealthcare said that the acquisition would bring benefits of scale for United.
"The transaction should generate efficiencies by enabling UnitedHealth to achieve lower costs per member ... than either firm could have achieved absent the transaction," said Monica Noether of Charles River Associates, an economist specializing in antitrust and other policy issues in health care markets.
Company officials also said in response to fears that UnitedHealthcare would "cherry-pick" younger, healthier members to improve the company's risk pool that the company "will offer every account the opportunity to be with UnitedHealthcare."
To that assertion, Dr. Kathleen LaVorgna, a breast cancer specialist in Norwalk, said the company's agreement filed with the Insurance Department explicitly grants the right to cherry-pick Health Net's customers based on who will be more profitable to cover. LaVorgna also said that the company would be the dominant insurer in Fairfield County, and that it has the most stringent definition of a medical necessity among companies that cover her patients.
"If United denies 'cherry-picking,' will it go on record today stating that my patients and their employers will have no rate increases in their premiums, either up-front or in later years? Without that promise, I cannot sign this prescription for my patients."
2009-11-24 Was UnitedHealth in error to email the 75000+ employees urging them to contact Representatives, even providing form letters to send opposing a public option and reduction in Medicare/caid paymewnt rates? They sure support the part of the legislation requiring the young, healthy Americans to obtain coverage.
lovin 2009-11-24 United Health Care’s 155 percent profits on Medicare plans must be a company record, especially in a down economy, and an embarrassing fact, particularly as the concervatives on the Senate Finance Committee fight to preserve the present payment structure of United Health Care and its fellow private insurance companies In the last decade there have been more than 400 mergers of managed care companies. Now just 5 companies -- WellPoint, United Health, Aetna, Cigna, and Humana -- account for more than half of the entire U.S. health insurance market. A recent study found that in over half the local markets surveyed, just one insurer provides health care to more than 50% of those with insurance.
The Foundation for Taxpayer and Consumer Rights cited recent figures released by the Centers for Medicare & Medicaid Services that show that health insurance overhead costs -- including profit, advertising, and administration -- are now the fastest growing component of health care spending.
United Health cited the new Medicare prescription drug program as one source of its profits. In the biggest change ever to the 41-year-old Medicare program, the Bush Administration put the nation's largest HMOs in charge of the so-called prescription drug "benefit."
allinsurancecoverage 2009-11-24 That would depend on the contract UnitedHealth have with its employees and the way in which UnitedHeath urge them to oppose the public option. With this public option plan there are so many interest, groups and org. to address that it is had to tell who is right
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Joslyn 2010-03-09 I'm choosing health insurance for the first time. What is the difference between a HMO and a PPO? insure
Kat 2010-03-08 BCBS PPO coverage for weight loss surgery? I have recently been considering having the lap band done. I am wondering would BCBS PPO cover for it. I am a dependent on this insurance and I am 21. I am covered until I am 25. I have heard it depends on what policy the employer agrees upon but I am not sure what kind of policy my parents have. Does anyone know what kind of policy WLS would be covered under. And if not covered all the way would it be covered any? I am a little apprehensive about doing all this but I need to find out if I am even covered at all and I'm not quite sure how to go about finding out how. insure
Jeff Callison 2010-03-04 Thanks for the information. I decided to buy an HSA but I went with another broker in Ohio. Their firm specializes in that type of policy. insure
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