Day: October 15, 2012

Below is a redacted email we received this afternoon from Humana:

4^TH QUARTER RATE REDUCTIONS

We took rate reductions up to 13% across Texas for fourth quarter, including Austin, Corpus Christi, San Antonio and Dallas/Ft. Worth.

More than 400,000 state employees, retirees, and their dependents will get a new health insurance company. The Employees Retirement System (ERS) is negotiating a new contract with UnitedHealthcare Services, replacing Blue Cross and Blue Shield of Texas as the party administrator for the self-funded HealthSelect of Texas health plan.

ERS officials say the new contract will save $41 million and that they chose United because of its “winning combination of programs, services, and low administrative fee.”

They added they expect minimal network disruption and project that about 2 percent of HealthSelect members might switch their primary care physician.

TMA’s Payment Advocacy Department advises physicians that because a new carrier will administer the ERS business, they may want to reevaluate their payer mix. Be aware that United has secondary networks and consider those agreements when evaluating the practice’s payer mix.

Blue Cross filed a protest with ERS in March 5 and asked for a review of the competitive bidding process ERS used. Blue Cross contends switching to United will cost the state an additional $450 million because Blue Cross offers better discounts to members of the state plan than does United, and it has a larger network of physicians, hospitals, and other health care professionals.

“Because of our experience with ERS and its participants, providers, and others over the last three decades, we are deeply concerned with the impact ERS’ decision will have on the state of Texas and ERS participants,” a Blue Cross statement said.

Editor’s Note: Does UHC have better pricing than does BCBS? One would think so with a group this large electing to go with the best bid. BCBS representatives are trained to tout “our discounts are better than theirs”, which may be true. But a 50% discount off $100 is not as good as a 45% discount off $80.

Bill, this was in the Dallas Morning News. Dallas area hospitals have a lot of cash to spend and the only way to combat this is competition or cost plus. Amazing as this is the only industry doing so well.

Continue reading Dallas Area In Middle of $6 Billion Health Care Building Boom

 Gary Johnson, Candidate for  President of The United States

The presidential election next month will dramatically affect the future of the health insurance industry, with either the continuation of the health reform law or a likely disruption to some or all of its provisions, according to a side-by-side analysis of the healthcare platforms of President Barack Obama and Gov. Mitt Romney.

“It wasn’t hard to find major distinctions,” said Shana Alex Lavarreda, co-author of the UCLA Center for Health Policy Research policy paper. “All this information was out there, but it wasn’t together in one place.”

If Obama is re-elected, the reform law will move forward as planned, with insurers seeing an influx of individual consumers buying plans through health insurance exchanges and an expansion of Medicaid, reported California Healthline.

But a Romney win could mean private insurers begin to provide more Medicare plans but don’t sell policies through exchanges, which the candidate has promised to eliminate, The New York Times reported. Instead, he wants to establish “public-private partnerships, exchanges and subsidies,” but hasn’t fully fleshed out the details of that proposal.

Romney also would drop the medical-loss ratio provision and eliminate the requirements that insurers provide coverage for individuals with pre-existing conditions and free preventive healthcare. And he’s pledged to repeal the individual mandate, Healthline noted.

Meanwhile, Romney wants to effectively shrink Medicaid by providing a fixed amount of money to states to cover Medicaid members and granting states with more authority to determine their own eligibility and benefits standards, according to the Times.