The current problems getting providers to participate in the new Charter Oak/HUSKY plans have been hot news lately. A sampling:
The Day
ctnewsjunkie.com
Hartford Courant
Journal Inquirer
New Haven Register
Waterbury Republican American
Kaiser Daily Health Reports
Medical News Today
CT Post
WTIC News Talk 1080
Fox News 61
News Channel 3
Norwich Bulletin
According to DSS, as of Friday there were only 314 total primary care providers enrolled statewide in Aetna’s plan (only 2 in Windham county) and 225 in Americhoice’s panel (5 in Middlesex County). On Friday, there was still only one hospital signed up with Aetna and none had signed on with Americhoice.
Ellen Andrews
Tuesday, August 5, 2008
Thursday, July 31, 2008
Charter Oak/HUSKY/PCCM update
DSS Comm. Mike Starkowski met with the Appropriations and Human Service Committees yesterday delivering a 72 page program update. The big news (from our perspective) is that the PCCM concept paper, drafted by a working group of DSS staff and advocates (including the CT Health Policy Project), will be submitted to the legislature next week. The committees will then hold a public hearing on the draft plan, and approve, reject or modify it. In response to a question from Rep. Villano, the Commissioner also announced that the per-member-per-month payment to Primary Care Providers in PCCM will be $7.50, not $5 as was previously reported. The working group had recommended $7.50 after animated negotiations. The bad news is that PCCM may not start until Jan. 1st. Legislators urged DSS to do everything possible to have it ready as another option at the same time that consumers have to choose between HMOs.
There was a great deal of discussion about the 24% increase in rates to the HUSKY/Charter Oak HMOs that seemed “awfully high” to Sen. Harp, with the committees asking DSS to get back to them with more detail. Sen. Harris and others asked about the lack of providers in the new HMOs’ panels. DSS says the HMOs are actively recruiting providers and the plans will pay the out-of-network costs for care to members through November. Legislators expressed concerns that if out-of-network services are not paid at reasonable levels, consumers may still have difficulty accessing care. The Commissioner emphasized that no consumers will be defaulted into any plan until November 25th and the current ASO arrangement, that by all accounts is working well and possibly saving money, will continue until at least the end of the year.
Overall, the committee members expressed a lot of frustration with DSS – in delays to implementing programs, selectively cutting legislative priorities, and numbers that “change every time we meet”. Rep. Merrill said, “We will keep having hearings until we get answers.”
Ellen Andrews
There was a great deal of discussion about the 24% increase in rates to the HUSKY/Charter Oak HMOs that seemed “awfully high” to Sen. Harp, with the committees asking DSS to get back to them with more detail. Sen. Harris and others asked about the lack of providers in the new HMOs’ panels. DSS says the HMOs are actively recruiting providers and the plans will pay the out-of-network costs for care to members through November. Legislators expressed concerns that if out-of-network services are not paid at reasonable levels, consumers may still have difficulty accessing care. The Commissioner emphasized that no consumers will be defaulted into any plan until November 25th and the current ASO arrangement, that by all accounts is working well and possibly saving money, will continue until at least the end of the year.
Overall, the committee members expressed a lot of frustration with DSS – in delays to implementing programs, selectively cutting legislative priorities, and numbers that “change every time we meet”. Rep. Merrill said, “We will keep having hearings until we get answers.”
Ellen Andrews
Wednesday, July 30, 2008
Troubling Charter Oak call
We’ve received calls from many consumers about Charter Oak – and it is a good option for some. However yesterday we got a troubling call on our Consumer Helpline (888) 873-4585. Leslie Dmowski called the Charter Oak application number to find out how to apply. She was injured in a car accident and can no longer work. She has applied for disability and is now paying for COBRA – a considerable burden on her family when she is without an income. When she called Charter Oak, she was told she was not eligible because she has insurance coverage. She was told nothing about the financial hardship exception. DSS has stated that if someone is now paying 10% or more of their income for health coverage, they do not have to drop coverage for six months to qualify for Charter Oak. Leslie is paying over 20% of her family’s income for coverage. Thankfully she called us, told her about the financial hardship exception, and sent her an application.
She also waited a long time on the phone after calling Charter Oak and got lost in the phone tree before she spoke to an actual person who was rushed and not helpful. She wanted to make sure that callers know not to press any numbers at the phone prompts to get a real person.
Leslie’s troubles point out a common problem with translating policies to the real world. We at the CT Health Policy Project have been very concerned about the six month uninsured requirement for Charter Oak – we feel it is unfair to people like Leslie who are sacrificing to pay for coverage now and it is bad public policy – excluding those who need health care is an odd way to build a health care program. We advocated with DSS and the legislature to remove the six month exclusion. Policymakers decided not to change it, but assured us that there would be generous exceptions. However it really doesn’t matter how fair the policies are on paper when they don’t get translated to the real world Leslie and her family live in. Advocates have to be especially vigilant – our job is only starting when we get policies passed in Hartford. And policymakers should be realistic when designing programs.
Ellen Andrews
She also waited a long time on the phone after calling Charter Oak and got lost in the phone tree before she spoke to an actual person who was rushed and not helpful. She wanted to make sure that callers know not to press any numbers at the phone prompts to get a real person.
Leslie’s troubles point out a common problem with translating policies to the real world. We at the CT Health Policy Project have been very concerned about the six month uninsured requirement for Charter Oak – we feel it is unfair to people like Leslie who are sacrificing to pay for coverage now and it is bad public policy – excluding those who need health care is an odd way to build a health care program. We advocated with DSS and the legislature to remove the six month exclusion. Policymakers decided not to change it, but assured us that there would be generous exceptions. However it really doesn’t matter how fair the policies are on paper when they don’t get translated to the real world Leslie and her family live in. Advocates have to be especially vigilant – our job is only starting when we get policies passed in Hartford. And policymakers should be realistic when designing programs.
Ellen Andrews
Thursday, July 24, 2008
What would you tell her?
I just returned from a wonderful trip visiting family. While I was there, I ended up in a conversation that put me in an awkward situation, given my job. I was talking with one of my sisters and some of her friends, about half of whom are uninsured. One friend, who is a self-employed 39 year old, asserted, “I don’t believe in health insurance.”
“How’s that?” I asked, preparing myself to tout the importance of health insurance and primary health care.
The friend said that certainly the cost of health insurance is prohibitive, but her main concern was that you can’t be sure of what you’re getting when you pay your premiums. If you have pre-existing conditions, insurers will likely not cover costs associated with those. If you are diagnosed with some unrelated but expensive condition, insurers will likely fight having to cover those costs. She continued. The small print may exclude a number of common events or conditions. And, you may still have an absurdly high deductible or burdensome co-pays.
I was deflated. She’s right…particularly for people who would be finding their insurance as individuals and especially for those who are unable to afford a Cadillac insurance plan on their own.
Insurance is important, but only when it really protects its clients. Too often, we get calls at the Consumer Health Action Network (toll-free in Connecticut at 888-873-4585) from people who have upheld their side of the insurance contract only to find that the insurance companies have built in loopholes that exclude their conditions or key parts of their treatments, or that their “insurance” is not insurance but simply a Medical Savings Account, which offers little in the way of negotiating power to reduce the cost and nothing in terms of offsetting the cost itself.
As I listened to my sister’s friend, I thought about the calls I’ve taken from people here in Connecticut who have seen significantly higher costs than benefits to having health coverage. In order to convince these people (and my sister’s friend) that health insurance is an important and worthy expense, there must be more meaningful standards for what’s covered, clearer explanations of coverage, and better cost controls. Short of either this kind of regulation or of a system that provides truly universal health coverage, we will always have people who forego preventive care, rely too heavily on safety-net providers, and take their chances that they’ll stay healthy enough. That approach is not good for them and it’s not good for our society.
Connie Razza
“How’s that?” I asked, preparing myself to tout the importance of health insurance and primary health care.
The friend said that certainly the cost of health insurance is prohibitive, but her main concern was that you can’t be sure of what you’re getting when you pay your premiums. If you have pre-existing conditions, insurers will likely not cover costs associated with those. If you are diagnosed with some unrelated but expensive condition, insurers will likely fight having to cover those costs. She continued. The small print may exclude a number of common events or conditions. And, you may still have an absurdly high deductible or burdensome co-pays.
I was deflated. She’s right…particularly for people who would be finding their insurance as individuals and especially for those who are unable to afford a Cadillac insurance plan on their own.
Insurance is important, but only when it really protects its clients. Too often, we get calls at the Consumer Health Action Network (toll-free in Connecticut at 888-873-4585) from people who have upheld their side of the insurance contract only to find that the insurance companies have built in loopholes that exclude their conditions or key parts of their treatments, or that their “insurance” is not insurance but simply a Medical Savings Account, which offers little in the way of negotiating power to reduce the cost and nothing in terms of offsetting the cost itself.
As I listened to my sister’s friend, I thought about the calls I’ve taken from people here in Connecticut who have seen significantly higher costs than benefits to having health coverage. In order to convince these people (and my sister’s friend) that health insurance is an important and worthy expense, there must be more meaningful standards for what’s covered, clearer explanations of coverage, and better cost controls. Short of either this kind of regulation or of a system that provides truly universal health coverage, we will always have people who forego preventive care, rely too heavily on safety-net providers, and take their chances that they’ll stay healthy enough. That approach is not good for them and it’s not good for our society.
Connie Razza
Wednesday, July 23, 2008
HUSKY/Charter Oak health plan rates up 24% from last year
After accounting for the impact of dental and prescription drug carve outs, the capitated rates paid to the three HUSKY HMOs – Aetna, AmeriChoice (United) and CHN – are 24% higher than the capitated rates paid to the plans last year before November. This is according to an analysis done July 17th for DSS by Mercer obtained by the CT Health Policy Project through a Freedom of Information request. The 24% rate increase includes a 13.1% increase due to programmatic changes (coverage for HPV vaccines, routine dental exams by PCPs, eligibility expansions, etc.) that some advocates and analysts take issue with. Along with medical trend and case mix adjustments, the rate hike also includes a 5.3% or $36.7 million increase for “negotiations” with the plans. $36.7 million is significantly more than the increase in physician fee-for-service payment rates last January – the first in twenty years. It is important to note that the budget, agreed to by both the legislature and the administration, allowed for a 2% rate increase to the plans.
Ellen Andrews
Ellen Andrews
Friday, July 18, 2008
Mr. Lembo goes to Washington
Yesterday State Health Care Advocate Kevin Lembo testified at a Congressional hearing on health insurance company abuses -- post claims underwriting and policy rescissions. That’s when an insurance company cancels a policy after consumer has been paying premiums faithfully, sometimes for years, and they get sick. The company, when faced with mounting claims, looks back into the patient’s history for reasons to cancel. A consumer who joined Kevin on the panel was cancelled after sustaining back injuries from a mountain bike accident because her husband had previous back problems. It is amazing that this was legal in CT until Kevin’s office advocated to change the law. Unfortunately it is still legal in other states, but hopefully Congress will help change that. We are very fortunate to have our State Health Care Advocate, and now Congress knows how lucky we are as well. Read Kevin’s blog on his odyssey into the Beltway.
Ellen Andrews
Ellen Andrews
Thursday, July 17, 2008
Concerns about new Charter Oak $100,000 annual cap
On Monday, Time magazine posted a story called “Low Health Insurance Caps Leave Patients Stranded.” The article exposes the real impact of caps as low as $1 million on individuals and families who face very serious illnesses. This issue is particularly important as the new state Charter Oak Health Plan rolls out. On the day it was launched we learned that the plan now includes a $100,000 annual cap on services, in addition to the $1 million lifetime cap.
According to the article, “Only 1% of employer-offered group plans – the largest health insurance segment – had caps as low as $1 million last year, according to a survey by the Henry J. Kaiser Family Foundation. But 22% had caps of less than $2 million, and some want to see all these relatively low maximums eliminated.”
The article outlines several cases – a leukemia patient, a child with a virus attacking her heart, another child in need of a heart transplant. In two of these cases, the families surpassed the caps within a year of diagnosis.
People with long-term conditions may not exhaust their benefits in one year, but can clearly see the cap approaching. The National Hemophilia Foundation told the reporter, “People with hemophilia can spend more than $200,000 a year just on drugs that prevent internal bleeding.” If they have any other medical needs, they could reach their cap even more quickly.
Sometimes people call the Consumer Health Action Network (888.873.4585) to get help with choosing an insurer. We always encourage people to weigh their options carefully and to check with the Office of the Healthcare Advocate (866.466.4446) to make sure that the plans they are considering are reputable. We are adding to our list: consider the lifetime coverage cap and any annual caps. Consumers should weigh the advantages and limitations of Charter Oak before signing up.
Connie Razza and Ellen Andrews
According to the article, “Only 1% of employer-offered group plans – the largest health insurance segment – had caps as low as $1 million last year, according to a survey by the Henry J. Kaiser Family Foundation. But 22% had caps of less than $2 million, and some want to see all these relatively low maximums eliminated.”
The article outlines several cases – a leukemia patient, a child with a virus attacking her heart, another child in need of a heart transplant. In two of these cases, the families surpassed the caps within a year of diagnosis.
People with long-term conditions may not exhaust their benefits in one year, but can clearly see the cap approaching. The National Hemophilia Foundation told the reporter, “People with hemophilia can spend more than $200,000 a year just on drugs that prevent internal bleeding.” If they have any other medical needs, they could reach their cap even more quickly.
Sometimes people call the Consumer Health Action Network (888.873.4585) to get help with choosing an insurer. We always encourage people to weigh their options carefully and to check with the Office of the Healthcare Advocate (866.466.4446) to make sure that the plans they are considering are reputable. We are adding to our list: consider the lifetime coverage cap and any annual caps. Consumers should weigh the advantages and limitations of Charter Oak before signing up.
Connie Razza and Ellen Andrews
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