I'm a little late on this, but it's interesting: two weeks ago, NY Attorney General Andrew Cuomo announced the creation of a database of doctor's fees and insurance reimbursement rates, designed to help patients who want to see an out-of-network health care provider anticipate what it will cost.
The New York Times reports that insurers often reimburse only a percentage of the cost of an out-of-network provider. However, sometimes that cost is not what the provider has billed, but rather what the insurance company has determined is "reasonable and customary" based on the fees other providers in the same area charge for similar services. In the past, insurance companies have been accused of systematically lowballing the "reasonable and customary" number, leaving patients to make up the difference. The purpose of the database is both to help the insured estimate what they will be reimbursed before seeing the out of network specialist, and also to assess the fairness of their insurance company's "reasonable and customary" estimate.
The database is being funded by several insurance companies, in particular UnitedHealth Group, as part of a settlement with Mr. Cuomo reached last January when he brought suit against them for deflating their "reasonable and customary" estimates.
Showing posts with label insurance. Show all posts
Showing posts with label insurance. Show all posts
Monday, November 9, 2009
Friday, October 30, 2009
insurance and women's health
Few people realize pregnancy is one of those pesky "preexisting conditions" we've heard so much about. But the push/pull between insurance companies and reproductive health does not stop there. My roommate Ella, a labor and delivery nurse in the Bronx, sent me this blog post which features a woman who was denied coverage due to a previous (completely unremarkable) Cesarean section, and told she could only eligible for coverage if she was willing to have her tubes tied.
Monday, April 27, 2009
what the what?!?
A recent New York Post article begins with the provocative assertion that "It now costs more to buy health insurance than it does to rent a two-bedroom apartment in the Financial District."
The article then goes on to discuss the rise in health care costs for New York City dwellers in the past year. According to the newspaper's analysis, the average monthly premium has risen 13% since April 2008; then, the average family paid $3,866 per month, now, they pay $4,354. That, according to the Post, "exceeds the $3,947 monthly rent for a place in a no-doorman building downtown."
The Post breaks down the rise by insurance company; the company that raised its rates the most was GHI HMO select, whose out of network fees went up 35%, followed by Aetna, who raised rates 27%. Rates should go up even more, the article says, since companies are expected to pass along an $853 million dollar insurance-related tax in this year's state budget. The Post also noted that there are fewer insurers in New York now than in the past; in 2004, thirteen companies offered insurance in NYC, now eight do.
Finally, the cheery article noted that things will almost certainly get worse before they get better, since more and more New Yorkers are opting out of health insurance, leaving the pool of contributors smaller and sicker.
Blerg.
The article then goes on to discuss the rise in health care costs for New York City dwellers in the past year. According to the newspaper's analysis, the average monthly premium has risen 13% since April 2008; then, the average family paid $3,866 per month, now, they pay $4,354. That, according to the Post, "exceeds the $3,947 monthly rent for a place in a no-doorman building downtown."
The Post breaks down the rise by insurance company; the company that raised its rates the most was GHI HMO select, whose out of network fees went up 35%, followed by Aetna, who raised rates 27%. Rates should go up even more, the article says, since companies are expected to pass along an $853 million dollar insurance-related tax in this year's state budget. The Post also noted that there are fewer insurers in New York now than in the past; in 2004, thirteen companies offered insurance in NYC, now eight do.
Finally, the cheery article noted that things will almost certainly get worse before they get better, since more and more New Yorkers are opting out of health insurance, leaving the pool of contributors smaller and sicker.
Blerg.
Monday, February 23, 2009
two things
One, three more patient on Thursday who were losing their health insurance, and one who was developing an ulcer because he is stressed at work, since half his group got fired. Awesome.
Two, make sure you check out the Idealist in NYC blog. It's got a potpourri of stuff that might be of interest. Today's post is on PlaNYC, an NYC development project.
Two, make sure you check out the Idealist in NYC blog. It's got a potpourri of stuff that might be of interest. Today's post is on PlaNYC, an NYC development project.
Wednesday, February 18, 2009
discouraging, but with a silver lining
As I have mentioned in a previous post, part of my MS in Nursing involves working with a nurse practitioner one day per week. The NP I work with is in private practice in downtown Manhattan, and has a healthy HIV caseload. On a typical day, I see about 12 of her 20ish patients, and my participation in the visit can range from being the primary provider (as in cases where someone is there for their annual exam) to just observing (as when someone needs a pap smear, something I haven’t been trained in yet.) Last week, I saw eleven patients. They were a diverse group, representing a wide range of ages, backgrounds, and health conditions. Three had one thing in common: they were about to lose their health insurance.
To be honest, the current economic crisis has not affected me much personally. As a student, I have debt, not savings. My parents, like so many other people who followed the commonsense strategy of long term, diversified investing, have taken a bath, but my finances have been largely unaffected. Only one person I know has even been in danger of losing his job, and ultimately he didn’t. So the crisis has been more or less abstract to me up to this point. That said, for three of my patients, it was very real. Below is a little bit about them, although I should note I have changed some important info in the interest of patient privacy.
One patient lost her job a few months ago and will only have health insurance until the middle of 2009. She was in the office for her annual physical, but she has a significant heart defect, for which she has already had serious surgery, that makes it incredibly risky for her to go without health insurance for any length of time. She is also overweight (although she is using the opportunity unemployment provides to go the gym and cook more). Another patient was in for a quick follow up; he had come in as soon as he lost his job for a bunch of tests, so he would have the chance of dealing with anything that might come up before his insurance ran out. Fortunately, he was in good shape. Finally, there was a young man pursuing a graduate degree who for reason would be dropped from his school’s insurance policy within a month or two; I believe he intended to take a semester off for financial reasons, but the calculus of his decision was obviously affected by the fact he would have to go without health insurance during that time. The third patient’s situation is perhaps not as much a consequence of the recession as the other two, but it does reinforce the point that’s been made over and over, that Americans need to have access to affordable insurance not tied to education/employment.
The silver lining last Thursday was the three patients who presented for a full STI panel. None of them had any signs or symptoms of an STI, or even any reason to think they had been exposed; they just had either recently switched partners or felt “it was time”. All had been tested less than two years ago. As a future provider, I’m sure I’ll wish all my patients were as conscientious and engaged as that group, and they definitely made a frustrating day better.
To be honest, the current economic crisis has not affected me much personally. As a student, I have debt, not savings. My parents, like so many other people who followed the commonsense strategy of long term, diversified investing, have taken a bath, but my finances have been largely unaffected. Only one person I know has even been in danger of losing his job, and ultimately he didn’t. So the crisis has been more or less abstract to me up to this point. That said, for three of my patients, it was very real. Below is a little bit about them, although I should note I have changed some important info in the interest of patient privacy.
One patient lost her job a few months ago and will only have health insurance until the middle of 2009. She was in the office for her annual physical, but she has a significant heart defect, for which she has already had serious surgery, that makes it incredibly risky for her to go without health insurance for any length of time. She is also overweight (although she is using the opportunity unemployment provides to go the gym and cook more). Another patient was in for a quick follow up; he had come in as soon as he lost his job for a bunch of tests, so he would have the chance of dealing with anything that might come up before his insurance ran out. Fortunately, he was in good shape. Finally, there was a young man pursuing a graduate degree who for reason would be dropped from his school’s insurance policy within a month or two; I believe he intended to take a semester off for financial reasons, but the calculus of his decision was obviously affected by the fact he would have to go without health insurance during that time. The third patient’s situation is perhaps not as much a consequence of the recession as the other two, but it does reinforce the point that’s been made over and over, that Americans need to have access to affordable insurance not tied to education/employment.
The silver lining last Thursday was the three patients who presented for a full STI panel. None of them had any signs or symptoms of an STI, or even any reason to think they had been exposed; they just had either recently switched partners or felt “it was time”. All had been tested less than two years ago. As a future provider, I’m sure I’ll wish all my patients were as conscientious and engaged as that group, and they definitely made a frustrating day better.
Thursday, January 22, 2009
new insurance proposal
Governor Paterson is working on a plan to extend the period of time employed adults ae permitted to claim their children as dependents for health insurance, the New York Times reports. Currently, New Yorkers can claim their children up to age 19, unless the child is a full time student, in which case they can claim up to age 22. The new plan would extend that age to 29. The plan is modeled on an NJ law that offered the same option to parents, provided the children are under 31, reside in the state or are enrolled in college, and have no dependents of their own.
Analysts note that the effects of the Jersey law have been "incremental", pointing out that 55% of the nations workers work for companies that self-insure, and are therefore subject only to federal regulations. However, since 800,000 people, or 31% of uninsured New Yorkers, fall into the demographic targeted by this plan, legislators are paying attention. Austin Shafran, a spokeman for new Senate majority leader Malcolm A. Smith, is quoted in the Times as saying: “The plan seems like a very legitimate step in the right direction toward improving access to health care. We’re really taking a look at it.”
Analysts note that the effects of the Jersey law have been "incremental", pointing out that 55% of the nations workers work for companies that self-insure, and are therefore subject only to federal regulations. However, since 800,000 people, or 31% of uninsured New Yorkers, fall into the demographic targeted by this plan, legislators are paying attention. Austin Shafran, a spokeman for new Senate majority leader Malcolm A. Smith, is quoted in the Times as saying: “The plan seems like a very legitimate step in the right direction toward improving access to health care. We’re really taking a look at it.”
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