MedWorm: Insurers

Study Examines Misconceptions Of Who Picks Up Tab When Patients Walk Out

Health News from Medical News Today — Wed, 08 Feb 2012 08:00:00 +0100

There are ways in which patients who leave the hospital against medical advice wind up paying for that decision. Being saddled with the full cost of their hospital stay, however, is not one of them. Insurance companies know this. Patients who walk out may know this. But many physicians, according to a study published in the Journal of General Internal Medicine, do not... (Source: Health News from Medical News Today)

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White House defends contraception rules as criticism mounts

Reuters: Health — Wed, 08 Feb 2012 01:50:55 +0100

WASHINGTON (Reuters) - The Obama administration is willing to work with Catholic universities, hospitals and other church-affiliated employers to implement a new policy that requires health insurers to offer birth control coverage, a top adviser to the president's re-election campaign said on Tuesday. (Source: Reuters: Health)

White House defends contraception rules as criticisms mount

Reuters: Health — Tue, 07 Feb 2012 22:49:42 +0100

Justifying insurance coverage for orphan drugs

EurekAlert! - Medicine and Health — Tue, 07 Feb 2012 05:00:00 +0100

(The Hastings Center) Can insurers justify spending hundreds of thousands of dollars per patient per year on "orphan drugs" - extremely expensive medications for rare conditions that are mostly chronic and life-threatening -- when this money could provide greater overall health benefits to many other patients? Those spending decisions reflect the "rule of rescue," the value that our society places on saving lives in immediate danger at any expense. Will the rule of rescue become more difficult to support? (Source: EurekAlert! - Medicine and Health)

Expert: Healthcare mandate constitutional

Health News - UPI.com — Tue, 07 Feb 2012 02:09:42 +0100

NEW HAVEN, Conn., Feb. 6 (UPI) -- When people cannot afford healthcare, billions of uncompensated healthcare costs are shifted to private insurers who pass on the costs, a U.S. researcher said. (Source: Health News - UPI.com)

Coventry renews contract with CEO Allen Wise

bizjournals.com Health Care:Biotechnology headlines — Mon, 06 Feb 2012 22:35:22 +0100

Coventry Health Care Inc. has extended CEO Allen Wise's contract for two years, securing his services through Dec. 31, 2013, and boosting his compensation to new heights. Effective Jan. 1, Wise earns $900,000 in base salary annually and will be eligible for up to $1.8 million in bonuses each year, according to a Securities and Exchange Commission filing made public Monday. Furthermore, Wise will receive $7.6 million worth of stock awards in both 2012 and 2013 that would become payable upon the the health insurer's reaching earnings-per-share and revenue targets... (Source: bizjournals.com Health Care:Biotechnology headlines)

Humana's Net Jumps 86%

WSJ.com: Health — Mon, 06 Feb 2012 21:38:48 +0100

Humana's earnings surged 86% as the health insurer continued to benefit from membership growth and light use of health benefits. (Source: WSJ.com: Health)

UPMC Health Plan membership rises 14.5%

bizjournals.com Health Care:Physician Practices headlines — Thu, 02 Feb 2012 05:01:03 +0100

UPMC Health Plan has been racking up membership gains since July while battling rival health insurer Highmark Inc. over member access to University of Pittsburgh Medical Center doctors and hospitals, the health system reported on Wednesday. Total UPMC insurance division membership rose 14.5 percent to 1.78 million during the six-month period ending Dec. 31, including an 11.1 percent, or 373,621, gain in commercial health plan members, CFO Robert A. DeMichiei said. Boosting the increase was the acquisition of Hamot Medical Center in Erie, which employs nearly 3,000 people, and Erie Physicians Network, the county’s biggest multispecialty group... (Source: bizjournals.com Health Care:Physician Practices headlines)

Willingness to Pay for Obesity Pharmacotherapy.

Obesity — Thu, 02 Feb 2012 05:00:00 +0100

This study aimed to assess preferences and willingness to pay (WTP) for obesity medications among people seeking weight loss in the United States and United Kingdom. An online survey was developed based on literature review, clinician interviews, and profiles of available therapies. Participants indicated their preference for hypothetical treatments which varied by seven attributes: percentage of weight loss, long-term health risk reduction, time to noticeable weight loss, delivery mode, side effects, lifestyle modification, and cost; 502 obese participants completed the survey (mean BMI 37.12 kg/m(2) (±4.63); 73.5% female; 47.7 (±12.9) years of age). The participants deemed weight loss of >21 kg (United Kingdom) and >28 kg (United State) as "acceptable". All treatment attributes w...

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[Reliability of morbidity data reported by GPs : Results of a longitudinal study in primary care].

Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz — Wed, 01 Feb 2012 05:00:00 +0100

CONCLUSION: Data on morbidity collected in epidemiological studies and reported by physicians should always be checked for validity and reliability. Appropriate options (e.g., an investigator collecting the data directly in the field or the comparison of the data with health insurance companies' claims data) are presented and discussed. PMID: 22290171 [PubMed - in process] (Source: Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz)

Health insurer could boost PCP pay by half

Modern Medicine — Wed, 01 Feb 2012 05:00:00 +0100

National insurer WellPoint announced a medical home program that could raise your compensation by 50%. Eligibility won’t be easy and could affect your whole practice. (Source: Modern Medicine)

A Decision-Tree Approach to Cost Comparison of Newborn Screening Strategies for Cystic Fibrosis

PEDIATRICS — Wed, 01 Feb 2012 05:00:00 +0100

CONCLUSIONS: The IRT/IRT screening algorithm reduces the costs to laboratories and insurance companies but has more system failures. IRT/DNA offers other advantages, including fewer delayed diagnoses and lower out-of-pocket costs to families. (Source: PEDIATRICS)

The Challenges Ahead for Accountable Care Organizations (ACOs).

The American Journal of Managed Care — Wed, 01 Feb 2012 05:00:00 +0100

Authors: Chernew ME, Fendrick AM, Ginsburg PB, Pawlson G, Scanlon D, Sennett C, Sweet B Abstract Besides offering financial incentives to both physicians and healthcare organizations, accountable care organizations (ACOs) are designed to offer quality patient care while keeping costs down. The law states that an ACO must manage all of the healthcare needs for a minimum of 3 years for at least 5000 Medicare beneficiaries. In February 2012, the first round of applications for the ACO Shared Savings Program were accepted. Practices and insurers are announcing plans to create ACOs. By making providers equally responsible for their respective patients while giving financial incentives to avoid unnecessary procedures, ACOs aim to raise the quality and value of patient care. However, ther...

WellPoint Bets (A Bit) On Primary Care

Forbes.com Healthcare News — Tue, 31 Jan 2012 22:10:15 +0100

A news article on the front page of Friday’s Wall Street Journal described how WellPoint, the nation’s second largest insurer, will begin paying extra bonuses to primary care doctors in its network. These bonuses will add $100,000 in revenue for participating physicians. WellPoint, which runs Blue Cross and Blue Shield plans in 14 states, says that the change is needed because the health system devalues internists and family doctors. A chart accompanying the article compares median salaries of primary care doctors ($200,000) to specialists like orthopedists ($500,000), and urologists ($375,000). (Source: Forbes.com Healthcare News)

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Wide Use of Doc ID Numbers Makes Fraud Easy

MedPage Today Public Health — Tue, 31 Jan 2012 21:23:30 +0100

(MedPage Today) -- Widespread distribution of physician identifiers makes it easy to fraudulently bill insurers in the doctor's name, two MDs who work at the Centers for Medicare and Medicaid Services charged. (Source: MedPage Today Public Health)

Worker's compensation bill has support in Florida House

bizjournals.com Health Care:Biotechnology headlines — Tue, 31 Jan 2012 14:51:10 +0100

TALLAHASSEE—A bill to allow workers compensation insurance companies to keep about $25 million a year instead of returning the windfall to the businesses that pay the premiums passed a House committee on Monday with the support of two of the state's biggest business advocates. By a party-line vote, the House Insurance and Banking Subcommittee approved a measure (HB 4169) that would repeal a law that's been on the books since 1979 that requires workers' compensation insurance companies to refund premiums to policyholders if their profits consistently exceed the allowable rate of return... (Source: bizjournals.com Health Care:Biotechnology headlines)

WellPoint to Boost Pay for Primary Care Docs

MedPage Today Campaign '08 — Tue, 31 Jan 2012 14:00:00 +0100

WASHINGTON (MedPage Today) -- One of the nation's largest insurers, WellPoint, said it will begin paying primary care doctors more money for participating in a care coordination program. (Source: MedPage Today Campaign '08)

Anthem refuses to repay claims

American Medical News - BUSINESS — Tue, 31 Jan 2012 13:15:16 +0100

The Blues plan says it paid a fine to resolve mishandled claims. California regulators say the insurer also must pay doctors and hospitals. (Source: American Medical News - BUSINESS)

Financial Responsibility of Hospitalized Patients Who Left Against Medical Advice: Medical Urban Legend?

Journal of General Internal Medicine — Tue, 31 Jan 2012 07:11:12 +0100

CONCLUSIONS Contrary to popular belief, we found no evidence that insurance denied payment for patients leaving AMA. Residency programs and hospitals should ensure that patients are not misinformed. Content Type Journal ArticleCategory Original ResearchPages 1-6DOI 10.1007/s11606-012-1984-xAuthors Gabrielle R. Schaefer, Pritzker School of Medicine, University of Chicago, Chicago, IL, USAHeidi Matus, Internal Medicine Residency Program, University of Chicago, 5841 S. Maryland Avenue, MC 2007, AMB W216, Chicago, IL 60637, USAJohn H. Schumann, Department of Internal Medicine, University of Oklahoma School of Community Medicine, Tulsa, OK, USAKeith Sauter, Patient Financial Services, University of Chicago Medical Center, Chicago, IL, USABenjamin Vekhter, Department of Me...

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The impact of health insurance mandates on drug innovation: evidence from the United States

The European Journal of Health Economics — Tue, 31 Jan 2012 07:09:29 +0100

Abstract An important health policy issue is the low rate of patient enrollment into clinical trials, which may slow down the process of clinical trials and discourage their supply, leading to delays in innovative life-saving drug treatments reaching the general population. In the US, patients’ cost of participating in a clinical trial is considered to be a major barrier to patient enrollment. In order to reduce this barrier, some states in the US have implemented policies requiring health insurers to cover routine care costs for patients enrolled in clinical trials. This paper evaluates empirically how effective these policies were in increasing the supply of clinical trials and speeding up their completion, using data on cancer clinical trials initiated in the US betwe...

Bill Seeks Surcharge for Utah Smokers on Medicaid

RWJF News Digest - Public Health — Tue, 31 Jan 2012 05:00:00 +0100

If private health insurers can add a surcharge for smokers, why not Medicaid? That's the argument behind a bill Utah Republican Rep. Paul Ray has proposed that could become a first-in-the-nation state law imposing a higher co-payment for tobacco-using residents enrolled in Medicaid. (Source: RWJF News Digest - Public Health)

Exploring and Comparing the Characteristics of Nonlatent and Latent Composite Scores: Implications for Pay-for-Performance Incentive Design

Medical Decision Making — Tue, 31 Jan 2012 05:00:00 +0100

This study compared several nonlatent and latent composite quality scores to evaluate the quality of care using diabetes mellitus (DM) P4P data and discusses their characteristics and implications for P4P policy. The authors describe a cross-sectional study of the DM P4P data collected from the claims data of the Bureau of National Health Insurance (NHI) in Taiwan from January 2007 to December 2007. The DM patient outcome data, such as hemoglobin A1C values, were retrieved from the P4P database sponsored by the Bureau of NHI in Taiwan. The composite scores were derived from the following methods: 1) nonlatent scores methods (e.g., the raw sum score and the all-or-none score methods)and 2) latent scores methods (e.g., item-response theory-based Models I and II and the PRIDIT model). These s...

Opinionator: The End of Health Insurance Companies

NYT Health — Tue, 31 Jan 2012 02:00:16 +0100

Accountable care organizations will shift the focus of medicine away from treating sickness and toward keeping patients healthy. (Source: NYT Health)

Mental Health Weekly — Mon, 30 Jan 2012 05:00:00 +0100

AbstractCalif. Advocates Bask in Court Successes to Retain Mental Health ServicesWith Virginia Hospital Bed Decline, Can Community Services Keep up?California Court Rules Insurer Must Provide Residential Treatment CoverageAPA Proposes Change to Autism Criteria for DSM‐5 InclusionMental Health Counselors Provide Multiple ServicesLetter to the EditorBriefly NotedState NewsNames in the NewsComing up (Source: Mental Health Weekly)

Vaccine discontinuation and switching following regulatory interventions in response to rotavirus vaccine contamination with porcine circovirus DNA fragments

Pharmacoepidemiology and Drug Safety — Mon, 30 Jan 2012 05:00:00 +0100

ConclusionsRecommended suspension of RV1 use led to a substantial decrease in use and extensive switching to RV5. The announcement that RV5 was similarly contaminated, but without a corresponding recommendation to suspend use, had little effect on use. Copyright © 2012 John Wiley & Sons, Ltd. (Source: Pharmacoepidemiology and Drug Safety)

Medicare Overpaid Billions in 2010, GAO Says

MedPage Today Public Health — Fri, 27 Jan 2012 22:11:21 +0100

WASHINGTON (MedPage Today) -- The U.S. government overpaid private insurance companies administering Medicare Advantage plans by as much as $3.1 billion in 2010, according to a new report from the Government Accountability Office. (Source: MedPage Today Public Health)

WellPoint Shakes Up Doctors' Pay

WSJ.com: Health — Fri, 27 Jan 2012 18:09:25 +0100

The nation's second-largest health insurer, WellPoint, is shaking up its approach to paying doctors, putting a major investment behind the idea that spending more for better primary care can save money down the road. (Source: WSJ.com: Health)

Insurer WellPoint to Revamp Primary Care Pay

RWJF News Digest - Quality/Equality — Fri, 27 Jan 2012 15:13:53 +0100

Health insurer WellPoint Inc. plans to improve primary care doctor payments and start reimbursing physicians for care management it doesn't currently cover as a way boost treatment and save money. (Source: RWJF News Digest - Quality/Equality)

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An Rx? Pay More to Family Doctors

WSJ.com: Health — Fri, 27 Jan 2012 05:28:51 +0100

Blue Shield California looks to mobile to engage members

mobihealthnews — Thu, 26 Jan 2012 01:45:21 +0100

Blue Shield of California (BSC) announced this week a five-year contract with HP Enterprise Services to help the insurer to more cost-effectively bring products and services to members quicker, while helping the health plan better manage its membership and claims processing systems. Blue Shield of California told InformationWeek that it is also moving to a [...] (Source: mobihealthnews)

Device makers urge coverage of weight-loss surgery

Reuters: Health — Wed, 25 Jan 2012 18:17:51 +0100

CHICAGO (Reuters) - Device manufacturers are pushing the government and health insurers to cover weight-loss surgery, an effort that could give millions more obese Americans access to the treatments. (Source: Reuters: Health)

WellPoint Profit Drops 39% as Costs Rise

WSJ.com: Health — Wed, 25 Jan 2012 15:50:34 +0100

WellPoint's fourth-quarter earnings fell 39% as investment losses and higher costs hurt the health insurer. (Source: WSJ.com: Health)

New think tank wants government to see gold in health technology

ICMCC: The International Council on Medical and Care Compunetics — Wed, 25 Jan 2012 14:11:43 +0100

Source: Olga Khazan, The Washington Post Content: “A new think tank launched in the District Monday with the goal of reducing the cost of health care through research and entrepreneurship. The West Health Policy Center is the latest project of Gary and Mary West, the two billionaire philanthropists behind the West Wireless Health Institute and [...] (Source: ICMCC: The International Council on Medical and Care Compunetics)

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'Just say no' policy can be good medicine

Modern Medicine — Wed, 25 Jan 2012 05:00:00 +0100

The author has seen a troubling rise in fraud, graft and discount doctoring since insurers have raised premiums, copays, and deductibles to maddening heights. (Source: Modern Medicine)

Consumers Tell Insurers to Cover Experimental DrugsConsumers Tell Insurers to Cover Experimental Drugs

Medscape Medical News Headlines — Wed, 25 Jan 2012 00:53:14 +0100

When a health insurer denies an experimental treatment or a high-cost drug, how much will patients pay for the care they believe they need? Reuters Health Information (Source: Medscape Medical News Headlines)

Device makers urge coverage of weight-loss surgery

Reuters: Health — Tue, 24 Jan 2012 22:32:31 +0100

CHICAGO (Reuters) - Device manufacturers are pushing the U.S. government and health insurers to cover weight-loss surgery, an effort that could give millions more obese Americans access to the treatments. (Source: Reuters: Health)

Children’s and Blue Cross Blue Shield usher in new age of quality-based benchmarks in pediatrics

Thrive, Children's Hospital Boston — Tue, 24 Jan 2012 13:27:29 +0100

Sandra Fenwick, president and COO I’ve worked at Children’s Hospital Boston for more than a decade, and I’m still inspired every day by the hope and strength I see on the faces of our patients and their families. As Children’s navigates a challenging and evolving health care landscape, I draw on that inspiration and determination, especially when many in our industry seem to imply that cost is the only measure of a hospital’s worth. At Children’s, our worth—our value—is so much more than just dollars and cents. It means being treated by pediatric experts—doctors, nurses and support staff—who understand that children are not small adults and their care needs to reflect that fact. It’s a commitment to care and innovation that produces programs like our Community As...

Health Net to sell Medicare Part D business to CVS

American Medical News - BUSINESS — Tue, 24 Jan 2012 13:11:25 +0100

At least one stock analyst believes the deal positions the company to be acquired by another health insurer. (Source: American Medical News - BUSINESS)

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U.S. consumers tell insurers to cover experimental drugs

Reuters: Health — Mon, 23 Jan 2012 14:42:33 +0100

NEW YORK (Reuters) - When your health insurance provider denies an experimental treatment or a high-cost drug, how much are you willing to pay for the care you believe you need? (Source: Reuters: Health)

Big insurers investing in mobile health apps

American Medical News - BUSINESS — Mon, 23 Jan 2012 11:45:21 +0100

Health plans are moving past the "basics" of taking insurance functions mobile and developing wellness and diagnostic apps. (Source: American Medical News - BUSINESS)

Health insurance company preys upon the poor with junk food reward program for vaccinating your baby

NaturalNews.com — Mon, 23 Jan 2012 06:00:00 +0100

"Will vaccinate my baby for food!" That seems to be the goal of a program launched last year by the UnitedHealthcare health insurance company of Michigan. It has resorted to enticing parents with junk food to convince them to inject their infants with potentially deadly... (Source: NaturalNews.com)

March of Dimes launches Prematurity Prevention Network

EurekAlert! - Medicine and Health — Mon, 23 Jan 2012 05:00:00 +0100

(March of Dimes Foundation) The March of Dimes and its partners launched a Prematurity Prevention Network, a virtual network made up of health care providers, insurers, policy makers, and business leaders -- who will work together to achieve the March of Dimes goal of lowering the preterm birth rate to 9.6 percent of live births. (Source: EurekAlert! - Medicine and Health)

Changing insurance company claims handling processes improves some outcomes for people injured in road traffic crashes. - Schaafsma F, De Wolf A, Kayaian A, Cameron ID.

SafetyLit: All (Unduplicated) — Sat, 21 Jan 2012 12:05:52 +0100

BACKGROUND: Regaining good health and returning to work are important for people injured in road traffic crashes and for society. The handling of claims by insurance companies may play an important role in the rate at which health recovers and return to wo... (Source: SafetyLit: All (Unduplicated))

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Administration Rules Insurers Must Cover Contraceptives

NYT — Sat, 21 Jan 2012 06:24:38 +0100

In ruling for free coverage for women, the administration rejected a broad exemption for employees of Roman Catholic hospitals, colleges and charities. (Source: NYT)

Termination Of Benefits Was Reasonably Supported By Record

LexisNexis® Mealey's™ Disability Insurance Legal News — Sat, 21 Jan 2012 00:05:53 +0100

ST. LOUIS - An ERISA-governed disability insurer that terminated benefits to a claimant with osteoarthritis and other ailments acted reasonably, the Eighth Circuit U.S. Court of Appeals ruled Jan. 11, finding that the insurer did not abuse its discretion in relying on its record reviews (Don Carrow v. Standard Insurance Co., No. 10-3206, 8th Cir.; 2012 U.S. App. LEXIS 604). Full story on lexis.com (Source: LexisNexis® Mealey's™ Disability Insurance Legal News)

Claimant Petitions For En Banc Review Over 8th Circuit Finding

LexisNexis® Mealey's™ Disability Insurance Legal News — Sat, 21 Jan 2012 00:05:53 +0100

ST. LOUIS - A claimant with severe back pain on Dec. 20 filed a petition for en banc review with the Eighth Circuit U.S. Court of Appeals, asking for his appeal to be heard by all the justices despite a ruling last month by an Eighth Circuit panel upholding a disability insurer's reliance on record reviews and video surveillance in its decision to deny benefits (Troy J. Daigle v Hartford Life and Accident Insurance Co., No. 11-1847, 8th Cir.; 2011 U.S. App. LEXIS 24349). Full story on lexis.com (Source: LexisNexis® Mealey's™ Disability Insurance Legal News)

Kentucky Federal Judge Finds Benefit Denial Not Reasonably Supported

LexisNexis® Mealey's™ Disability Insurance Legal News — Sat, 21 Jan 2012 00:05:53 +0100

LOUISVILLE, Ky. - An ERISA-governed disability insurer that relied on record reviews in its decision to terminate benefits to a claimant with a heart condition and joint disease acted arbitrarily, a Kentucky federal judge ruled Jan. 6, ordering the claim remanded to the plan administrator for further review (Robert Bragg v. Hartford Life and Accident Insurance Co., et al., No. 4:11CV-00002-JHM, W.D. Ky.; 2012 U.S. Dist. LEXIS 1356). Full story on lexis.com (Source: LexisNexis® Mealey's™ Disability Insurance Legal News)

Judge: Insurer's Reliance On Record Reviews, Video Surveillance Reasonable

LexisNexis® Mealey's™ Disability Insurance Legal News — Sat, 21 Jan 2012 00:05:53 +0100

BOSTON - An ERISA-governed disability insurer that relied on record reviews and surveillance video in its decision to deny benefits to a claimant with reflex sympathetic dystrophy (RSD) and fibromyalgia acted reasonably, a Massachusetts federal judge ruled Jan. 6 (Diahann L. Gross v. Sun Life Assurance Company of Canada, No. 09-11678, D. Mass.; 2012 U.S. Dist. LEXIS 1595). Full story on lexis.com (Source: LexisNexis® Mealey's™ Disability Insurance Legal News)

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Insurer Conducted Full and Fair Review, Judge Holds

LexisNexis® Mealey's™ Disability Insurance Legal News — Sat, 21 Jan 2012 00:05:53 +0100

BROOKLYN, NY - A New York federal judge on Dec. 30 ruled that an ERISA-governed disability insurer that relied on record reviews and surveillance video in its decision to terminate benefits acted reasonably (Joseph E. Duncan v. Cigna Life Insurance Company of New York, No. 10-CV-1164, E.D. N.Y.; 2011 U.S. Dist. LEXIS 150546). Full story on lexis.com (Source: LexisNexis® Mealey's™ Disability Insurance Legal News)

4th Circuit: Plan Administrator's Benefit Calculation Reasonable

LexisNexis® Mealey's™ Disability Insurance Legal News — Sat, 21 Jan 2012 00:05:53 +0100

RICHMOND, Va. - A plan administrator's interpretation of its policy language in calculating benefits was reasonable, the Fourth Circuit U.S. Court of Appeals ruled Jan. 11, upholding a grant of summary judgment to the insurer (Kenneth Fortier v. Principal Life Insurance Co., No. 10-1441, 4th Cir.; 2012 U.S. App. LEXIS 557). Full story on lexis.com (Source: LexisNexis® Mealey's™ Disability Insurance Legal News)

SPD Appeal Procedures Are Not Part Of Plan, Judge Holds

LexisNexis® Mealey's™ Disability Insurance Legal News — Sat, 21 Jan 2012 00:05:53 +0100

CONCORD, N.H. - Appeal procedures cited in the summary plan description (SPD) but not written in the actual plan are not enforceable, a New Hampshire federal judge said Jan. 5, ruling that the claimant did not fail to exhaust her administrative remedies by failing to file an appeal within the 180-day time frame specified in the summary plan description (Deborah J. Kaufman v. Prudential Insurance Company of America, No. 11-cv-119, D. N.H.; 2012 U.S. Dist. LEXIS 1154). Full story on lexis.com (Source: LexisNexis® Mealey's™ Disability Insurance Legal News)

Breach Of Agreement Claim Against Employer Barred, Judge Says

LexisNexis® Mealey's™ Disability Insurance Legal News — Sat, 21 Jan 2012 00:05:53 +0100

SACRAMENTO, Calif. - A California federal judge on Dec. 29 granted an employer summary judgment in a breach of agreement claim, finding that the claim was based on the company's group insurer's denial of long-term disability benefits and was therefore preempted by the Employee Retirement Income Security Act (James Burchett v. Life Insurance Company of North America, Apple Computer Inc., No. 2:11-CV-0696-GEB-DAD, E.D. Calif.; 2011 U.S. Dist. LEXIS 149452). Full story on lexis.com (Source: LexisNexis® Mealey's™ Disability Insurance Legal News)

11th Circuit's Structural Conflict Of Interest Ruling Will Not Be Reviewed

LexisNexis® Mealey's™ Disability Insurance Legal News — Sat, 21 Jan 2012 00:05:53 +0100

WASHINGTON, D.C. - The U.S. Supreme Court on Dec. 12 declined to review an 11th Circuit U.S. Court of Appeals ruling that a disability insurer possessed a reasonable basis for its decisions to terminate benefits and its structural conflict of interest did not render those decisions arbitrary and capricious under the Employee Retirement Income Security Act (Frank Blankenship v. Metropolitan Life Insurance Company, No. 11-444, U.S. Sup.). Full story on lexis.com (Source: LexisNexis® Mealey's™ Disability Insurance Legal News)

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Federal Judge Remands Case To Administrator Where Time Limits Violated

LexisNexis® Mealey's™ Disability Insurance Legal News — Sat, 21 Jan 2012 00:05:53 +0100

LOUISVILLE, Ky. - Remand to the disability plan administrator, not de novo review, is the appropriate remedy when the administrator failed to make a benefits determination within the deadlines prescribed by the Employee Retirement Income Security Act's regulations because of a procedural error by the administrator's employee, a federal judge ruled Jan. 4 (James W. Hackney v. The Lincoln National Life Insurance Company, No. 3:11-CV-268, W.D. Ky.; 2012 U.S. Dist. LEXIS 694). Full story on lexis.com (Source: LexisNexis® Mealey's™ Disability Insurance Legal News)

Administration Rules Insurers Must Cover Contraceptives

NYT Health — Fri, 20 Jan 2012 20:37:23 +0100

In ruling that health insurance plans must cover contraceptives for women without charge, the administration also rejected a broad exemption for employees of Roman Catholic hospitals, colleges and charities. (Source: NYT Health)

Lies, damned lies and PR

Guardian Unlimited Science — Fri, 20 Jan 2012 13:59:42 +0100

A story about the Welsh being the UK's biggest liars was an insurance firm's cynical bid for publicity backed by dodgy dataYou can say what you like about us Welsh, and people do. We are gossips, short, miserable, damp and so on. We've even embraced losing to such an extent that we've turned wooden spoons into an art form. But the biggest liars in the UK? Really?Quite a bold, controversial statement, whatever your nationality. Undoubtedly that was the aim of marketeers selling an insurance company via a manufactured news story via a press release titled "The Welsh are the UK's biggest liars!"A provocative statement, indeed. But one that is is also bogus, because the flimsy online survey "data" used to back it up doesn't support it. More of that later.Why is science so attractive to the PR ...

What can we learn from patient claims? - A retrospective analysis of incidence and patterns of adverse events after orthopaedic procedures in Sweden.

Patient Safety in Surgery — Fri, 20 Jan 2012 05:00:00 +0100

CONCLUSIONS: We conclude that patients undergoing spinal surgery run the highest risk of being severely injured and that these patients also experienced a high degree of serious disability. The most common adverse event was related to hospital acquired infections. Claims data obtained in a no-fault system have a high potential for identifying adverse events and learning from them. PMID: 22264241 [PubMed - as supplied by publisher] (Source: Patient Safety in Surgery)

UnitedHealth Rises 21%

WSJ.com: Health — Thu, 19 Jan 2012 17:26:07 +0100

UnitedHealth's profit rose a stronger-than-expected 21% as the health insurer booked a large jump in revenue at its Optum business and increased enrollments. (Source: WSJ.com: Health)

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Aetna wellness programs available for purchase on Best Buy shelves

American Medical News - BUSINESS — Thu, 19 Jan 2012 13:02:17 +0100

The insurer hopes customers buying pedometers, fitness DVDs or electronic scales also will be willing to pay for access to a health coaching program. (Source: American Medical News - BUSINESS)

Finding and fixing diagnosis errors: can triggers help?

Quality and Safety in Health Care — Thu, 19 Jan 2012 05:00:00 +0100

Imagine conferring with your clinician colleagues and being handed a plateful of all of your missed and delayed diagnoses. But, imagine further that, rather than a nightmare of ghosts returning to haunt you in the form of malpractice claims, sanctions by regulatory boards, insurers pouncing on needless expenditures or hordes (yes, there would be large numbers) of angry finger-pointing patients and families, the experience would instead bring a dream of supportive feedback and learning. Imagine the ways such an idealised non-threatening consultation and conference might be designed to minimise defensiveness and maximise introspection, learn lessons, and rethink habits and standard practices. Rather than prompting incredulous exclamations of "you missed that?!" or "what were you thinking?!",...

Programs to address child obesity emerge

Health News - UPI.com — Tue, 17 Jan 2012 20:57:54 +0100

PROVIDENCE, R.I., Jan. 17 (UPI) -- As part of healthcare reform, U.S. health insurers and employers must cover screening children for obesity and providing them with counseling, officials say. (Source: Health News - UPI.com)

Health Sector Takes On Childhood Obesity

NYT Health — Tue, 17 Jan 2012 14:10:19 +0100

Health insurers and employers must now pay to screen children for obesity and provide them with counseling. Experts say creating such programs will be a challenge. (Source: NYT Health)

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The economic pressures for biosimilar drug use in cancer medicine

Targeted Oncology — Tue, 17 Jan 2012 07:15:53 +0100

Abstract The main rationale for using biosimilar drugs is for cost saving. The market development for biosimilar drugs will therefore depend on the degree to which cost saving measures are required by nations, medical insurers and individuals and the absolute savings that could be gained by switching from original drugs. This paper is designed to discover the degree to which financial constraints will drive future health spending and to discover if legal or safety issues could impact on any trend. A structured literature search was performed for papers and documents to 27 August 2011. Where multiple sources of data were available on a topic, data from papers and reports by multinational or national bodies were used in preference to data from regions or individual hospitals...

Learning to Be Lean

NYT Health — Tue, 17 Jan 2012 05:09:25 +0100

Health insurers and employers must now pay to screen children for obesity and provide them with counseling. Experts say creating such programs will be a challenge. (Source: NYT Health)

The Sleep Apnea Business Is Booming, And Insurers Aren't Happy

NPR Health and Science — Mon, 16 Jan 2012 05:01:00 +0100

Sleep apnea is a condition that can raise the risk of several serious illnesses, including heart disease. Testing for the condition is a lucrative business, and sleep labs have sprung up across the country. But as spending skyrockets, insurers are rethinking how they pay for testing to curb costs.» E-Mail This » Add to Del.icio.us (Source: NPR Health and Science)

Changing insurance company claims handling processes improves some outcomes for people injured in road traffic crashes

BMC Public Health - Latest articles — Mon, 16 Jan 2012 05:00:00 +0100

Conclusion: We found a few positive effects on health from a new claims handling method by a large insurance company. It may be most effective to target people who report low general health and low expectations for their health recovery when they file their claim. (Source: BMC Public Health - Latest articles)

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Learning to Be Lean

RWJF News Digest - Childhood Obesity — Mon, 16 Jan 2012 05:00:00 +0100

As one of the many outgrowths of the sweeping federal health care law, health insurers and employers must now pay the cost of screening children for obesity and providing them with appropriate counseling. The early results of efforts [from UnitedHealth and YMCA of the USA] are promising, according to the insurer, which said that 84 percent of the 155 children and teenagers who completed the program had an average 3.5 percent reduction in weight after six months. Parents also lost weight, according to UnitedHealth. The insurer says it is expanding the program, even as it continues to study its longer-term impact. (Source: RWJF News Digest - Childhood Obesity)

The Anesthesia Patient Safety Foundation at 25: A Pioneering Success in Safety, 25th Anniversary Provokes Reflection, Anticipation.

Anesthesia and Analgesia — Mon, 16 Jan 2012 05:00:00 +0100

Authors: Eichhorn JH Abstract The Anesthesia Patient Safety Foundation (APSF) was created in 1985. Its founders coined the term "patient safety" in its modern public usage and created the very first patient safety organization, igniting a movement that is now universal in all of health care. Driven by the vision "that no patient shall be harmed by anesthesia," the APSF has worked tirelessly for more than a quarter century to promote safety education and communication through its widely read Newsletter, its programs, and its presentations. The APSF's extensive research grant program has supported a great many projects leading to key safety improvements and, in particular, was central in the development of high-fidelity mannequin simulation as a research and teaching tool. With its p...

Hospital group GHG teeters on the brink

FT.com - Drugs and Healthcare — Sun, 15 Jan 2012 16:54:38 +0100

Burdened with a £1.65bn gross debt at its property arm, General Healthcare Group is also missing income from Bupa, the UK's biggest health insurer (Source: FT.com - Drugs and Healthcare)

Earn their trust, earn their cash

Managed Healthcare Executive Magazine Online — Sun, 15 Jan 2012 04:07:37 +0100

Managing consulting firm Peppers & Rogers Group released the results of its Trustability in Health Care study, which showed that consumers are willing to pay more for services from trustworthy health insurers. Respondents said they would be willing to pay on average $30 a month more to do business with a health insurer they trust, with some willing to pay up to $100 a month total (Source: Managed Healthcare Executive Magazine Online)

Using Simulation to Perform Root Cause Analysis of Adverse Surgical Outcomes

Journal of Surgical Research — Sat, 14 Jan 2012 22:29:02 +0100

Conclusions: This study demonstrates that simulation-based RCA of adverse surgical outcomes is better at identifying root causes that are amenable to making changes in the healthcare setting than traditional RCA. Simulation-based RCA is therefore a more effective method of improving patient safety. the additional information simulation-based RCA provides can facilitate implementation of more appropriate corrective measures, decreasing the risk of error recurrence. (Source: Journal of Surgical Research)

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[Viewpoint] What are the lessons from the USA for clinical commissioning groups in the English National Health Service?

LANCET — Sat, 14 Jan 2012 05:00:00 +0100

The UK coalition Government's plans to make groups of general practices responsible for commissioning health services have attracted much attention. Investigation of the experiences of other countries in which doctors control budgets could help the UK to understand how these plans might work. We visited the USA in March 2011 to learn how medical groups manage the budgets that they negotiate with health insurers and how they work with hospitals to control costs and improve outcomes. Our report describes what we learnt and identifies several lessons for the National Health Service (NHS), as the government's plans to establish clinical commissioning groups are taken forward. (Source: LANCET)

Controversial Pinnacol board member resigns

bizjournals.com Health Care:Pharmaceuticals headlines — Fri, 13 Jan 2012 21:24:53 +0100

John Cevette has resigned from the Pinnacol Assurance board, less than a year after the outspoken critic of the company’s leadership was appointed to try to change the culture of the state-chartered workers’ compensation insurer. Cevette, who works as chief of staff to Senate President Brandon Shaffer, said he submitted his resignation letter on Sept. 29 to Gov. John Hickenlooper, citing a pending conflict of interest if the Legislature is asked to vote to privatize Pinnacol. Hickenlooper announced Friday that he had replaced Cevette, as well as two other board members who were term-limited... (Source: bizjournals.com Health Care:Pharmaceuticals headlines)

White House Calls Increases in Health Insurance Rates Too High

NYT — Fri, 13 Jan 2012 06:13:09 +0100

The Obama administration ordered a health insurance company to rescind the rate increases it sought or justify its refusal to do so. (Source: NYT)

Affordable Care Act Holding Insurers Accountable for Premium Hikes

News stories via the Rural Assistance Center — Fri, 13 Jan 2012 06:00:00 +0100

Health insurance premium increases in five states have been deemed unreasonable by the U.S. Department of Health and Human Services, HHS Secretary Kathleen Sebelius announced yesterday. (Source: News stories via the Rural Assistance Center)

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White House Calls Increases in Health Insurance Rates Too High

NYT Health — Fri, 13 Jan 2012 02:50:46 +0100

The Obama administration ordered a health insurance company to rescind the rate increases it sought or justify its refusal to do so. (Source: NYT Health)

Dentist Admits $400,000 in Fraudulent BillingDentist Admits $400,000 in Fraudulent Billing

Medscape Today Headlines — Thu, 12 Jan 2012 21:35:06 +0100

A Virginia dentist has pled guilty to billing insurance companies for more than $400,000 in procedures he never performed. Medscape Medical News (Source: Medscape Today Headlines)

Statins Cost Four Times More in US Than UKStatins Cost Four Times More in US Than UK

Medscape Today Headlines — Wed, 11 Jan 2012 22:52:24 +0100

Based on 2005 numbers, American private insurers paid as much as 400% more for statins than the UK government was paying over the same period. Even for statins sold as brand-name drugs in both countries, US costs were at least double. Heartwire (Source: Medscape Today Headlines)

Statins cost four times more in US than UK

theHeart.org — Wed, 11 Jan 2012 20:00:38 +0100

UPDATED // Based on 2005 numbers, American private insurers paid as much as 400% more for statins than the UK government was paying over the same period. Even for statins sold as brand-name drugs in both countries, US costs were at least double. (Source: theHeart.org)

AMA Unveils Improved Practice Management Website

Medical News (via PRIMEZONE) — Wed, 11 Jan 2012 19:40:00 +0100

CHICAGO, Jan. 11, 2012 (GLOBE NEWSWIRE) -- The American Medical Association (AMA) today unveiled a redesigned website for its Practice Management Center, featuring a new layout that is easier to navigate and faster to use. The improved website offers physicians easy access to the AMA's wealth of resources, tools and guidance for enhancing the operation of a medical practice. "About 7,000 monthly visitors access the Practice Management Center website for valuable resources designed to help physicians more efficiently and effectively manage their practices," said AMA President Peter Carmel, M.D. "With that level of interest it is critical to make sure the AMA's tools are easy-to-find when physicians need them." The AMA's Practice Management Center was created in 2006 and has developed ...

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Is driving with a cold as dangerous as driving drunk?

Health News: CBSNews.com — Tue, 10 Jan 2012 16:14:19 +0100

British insurance company Young Marmalade says driving with a cold cuts drivers' abilities by 50 percent (Source: Health News: CBSNews.com)

Yes, Mitt, You Should Be Able to Fire Your Insurance Company

Physicians Practice — Tue, 10 Jan 2012 12:00:00 +0100

Insurance companies are not people. But, otherwise, the Romney criticism of the Affordable Care Act is spot-on. (Source: Physicians Practice)

Pennsylvania insurer and health system agree on patient access

American Medical News - BUSINESS — Mon, 09 Jan 2012 12:00:00 +0100

Both sides credit state lawmakers and the governor with helping to reach an accord regarding the contract's expiration. (Source: American Medical News - BUSINESS)

A Nationwide Community-Based Lifestyle Program Could Delay Or Prevent Type 2 Diabetes Cases And Save $5.7 Billion In 25 Years [Lifestyle Interventions]

Health Affairs — Mon, 09 Jan 2012 05:00:00 +0100

The increasing health and economic burden of diabetes has made preventing the disease a public health priority. But investing in such chronic disease prevention programs requires a long-term horizon because many years may be required for the downstream savings to fully offset the up-front intervention cost. Using a simulation model, we projected the costs and benefits of a nationwide community-based lifestyle intervention program for preventing type 2 diabetes. Accounting for all costs to the US health care system, our results indicate that the program would break even in fourteen years. Within twenty-five years, the program would prevent or delay about 885,000 cases of type 2 diabetes in the United States and produce savings of $5.7 billion nationwide. If restricted to people ages 65...

HHS Issues Rule on Electronic Payments from Insurers

MedPage Today Campaign '08 — Sun, 08 Jan 2012 22:30:40 +0100

WASHINGTON (MedPage Today) -- The Department of Health and Human Services has released a final rule on the electronic transfer of funds between insurers and healthcare providers that the agency says will save millions of dollars and millions of pounds of paper. (Source: MedPage Today Campaign '08)

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Vendor Notebook: IBC taps Kony for mobile app platform

Healthcare IT News — Fri, 06 Jan 2012 14:12:18 +0100

Kony Solutions announced that Independence Blue Cross (IBC), southeastern Pennsylvania’s largest health insurer, has selected Kony Solutions as its mobile application platform. Kony’s Platform Write Once, Run Everywhere technology enables mobile deployment across more than 9,000 mobile smartphones/tablets/kiosks and operating systems. read more (Source: Healthcare IT News)

Massachusetts Plaintiffs Denied Certification In Action Seeking Explosion Damages

LexisNexis® Mealey's™ Emerging Toxic Torts Legal News — Fri, 06 Jan 2012 00:03:24 +0100

BOSTON - Class certification was denied Dec. 13 to two residents of Danvers, Mass., and an insurance company in a putative class action pending in the U.S. District Court for the District of Massachusetts under the typicality and adequacy standards for class treatment (Deborah Riva, et al. v. Ashland Inc., No. 09-12074, D. Mass.). Full story on lexis.com (Source: LexisNexis® Mealey's™ Emerging Toxic Torts Legal News)

Insurance Companies Seek Determination Of Liability, Damages For Explosion Losses

LexisNexis® Mealey's™ Emerging Toxic Torts Legal News — Fri, 06 Jan 2012 00:03:24 +0100

BOSTON - Insurance companies representing the insured from a Danvers, Mass., neighborhood who experienced a chemical explosion in November 2006 filed a declaratory judgment and compensatory damages complaint Dec. 20 in the U.S. District Court for the District of Massachusetts against the company that provided the chemicals to the operators of the factory that exploded (Vigilant Insurance Co., et al. v. Ashland Inc., No. 11-12269, D. Mass.). Full story on lexis.com (Source: LexisNexis® Mealey's™ Emerging Toxic Torts Legal News)

Pennsylvania Federal Judge Declines Jurisdiction Over Declaratory Judgment Action

LexisNexis® Mealey's™ Emerging Toxic Torts Legal News — Fri, 06 Jan 2012 00:03:24 +0100

PHILADELPHIA - A U.S. District Court for the Eastern District of Pennsylvania judge declined to exercise discretionary jurisdiction over a declaratory judgment action arising from a carbon monoxide exposure personal injury lawsuit pending in state court in a Dec. 9 order granting summary judgment against an insurance company seeking relief from alleged duties to the defendant in the state lawsuit (General Casualty Co. of Wisconsin v. Shirley Guzikowski, No. 11-5154, E.D. Pa.; 2011 U.S. Dist. LEXIS 141654). Full story on lexis.com (Source: LexisNexis® Mealey's™ Emerging Toxic Torts Legal News)

Insurer: Apps may help unravel complexity of health insurance

mobihealthnews — Thu, 05 Jan 2012 11:17:05 +0100

David Passavant, the senior director of consumer innovation at UPMC Health Plan, which is owned by the University of Pittsburgh Medical Center, sees the advent of mobile health apps as an important tool for unraveling the “incredibly complex and confusing” world of health insurance for consumers. In an interview with Smart Business, Passavant noted that by [...] (Source: mobihealthnews)

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Judging Hospital Quality Via Death Rate May Be Misleading

Health News from Medical News Today — Thu, 05 Jan 2012 08:00:00 +0100

Hospitals, health insurers and patients often rely on patient death rates in hospitals to compare hospital quality. Now a new study by researchers at Yale School of Medicine questions the accuracy of that widely used approach and supports measuring patient deaths over a period of 30 days from admission even after they have left the hospital. Published in the Annals of Internal Medicine, the study has wide implications as quality measures take on more importance in the healthcare system, notes Elizabeth Drye, M.D... (Source: Health News from Medical News Today)

Independence Blue Cross gears up to launch apps

mobihealthnews — Wed, 04 Jan 2012 16:07:50 +0100

Philadelphia-based insurer Independence Blue Cross (IBC) will release multiple mobile applications using Kony’s middleware development platform, called KonyOne. The platform enables developers to create scalable apps that work across a number of devices and operating systems. Kony’s Write Once, Run Everywhere technology churns out apps that natively run on various operating systems, including iOS, Android, BlackBerry, [...] (Source: mobihealthnews)

Private insurers forming their own health insurance exchanges

American Medical News - BUSINESS — Wed, 04 Jan 2012 12:59:59 +0100

They will compete against state-run counterparts established under health system reform. (Source: American Medical News - BUSINESS)

Death rate measure used to judge hospital quality may be misleading

EurekAlert! - Social and Behavioral Science — Tue, 03 Jan 2012 05:00:00 +0100

(Yale University) Hospitals, health insurers and patients often rely on patient death rates in hospitals to compare hospital quality. Now a new study by researchers at Yale School of Medicine questions the accuracy of that widely used approach and supports measuring patient deaths over a period of 30 days from admission even after they have left the hospital. (Source: EurekAlert! - Social and Behavioral Science)

Be mindful of state law regarding arbitration clauses

Managed Healthcare Executive Magazine Online — Sun, 01 Jan 2012 05:00:00 +0100

Despite the Federal Arbitration Act's general rule favoring arbitration provisions in written agreements, state laws may pose challenges for health insurers. (Source: Managed Healthcare Executive Magazine Online)

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Insurers seek measures to manage MLRs

Managed Healthcare Executive Magazine Online — Sun, 01 Jan 2012 05:00:00 +0100

In healthcare's dire situation, cutting back benefits and services is simply not an option, and managed care organizations are expected to rein in costs some other way. (Source: Managed Healthcare Executive Magazine Online)

Oral implant care for dependent persons

Dental Abstracts — Sun, 01 Jan 2012 05:00:00 +0100

The use of endosseous oral implants to support mandibular dentures is considered the preferred treatment for edentulous patients with retention problems related to conventional mandibular dentures. There is no age restriction as to when oral implants can be inserted to support overdentures, as this is a good treatment option for all ages. Implant-supported prosthodontic rehabilitation of functional and esthetic oral problems is being used more and more often with very favorable results in independent subjects who can perform the required level of oral self-care. However, for patients who have become dependent on others for daily oral health care, these restorations represent a challenge. Specific oral care is not always available for patients with implant-supported dentures, or in some ins...

Prescriptions Blog: Walgreen Girds for Fight Over Pharmacy Customers

NYT Health — Fri, 30 Dec 2011 18:19:52 +0100

Walgreen to introduce a national plan it hopes will minimize customer disruption from its contract battle with its pharmacy benefits manager, Express Scripts. (Source: NYT Health)

Blue Shield wins one, settles another on canceling policies

bizjournals.com Health Care:Hospitals headlines — Thu, 29 Dec 2011 23:01:05 +0100

Blue Shield of California has agreed to pay $2 million to settle one lawsuit over the controversial practice of canceling coverage after a client gets sick — but the company has won vindication at the appeals court level on different case. Legal action on both cases were announced Wednesday, suggesting facts are key in the complicated issue of whether insurers can cancel policies for lack of disclosure on insurance applications. Both lawsuits have been in the works for years. A federal ban on so-called “recissions” for unintentional application errors was included in federal health care reform and took effect in September 2010... (Source: bizjournals.com Health Care:Hospitals headlines)

The High Cost of Failing Artificial Hips

NYT — Thu, 29 Dec 2011 17:28:30 +0100

The widespread failure of all-metal hips may cost taxpayers, insurers and employers billions of dollars in the coming years. (Source: NYT)

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Clinical Cancer Advances 2011: Annual Report on Progress Against Cancer From the American Society of Clinical Oncology [ASCO SPECIAL ARTICLE]

Journal of Clinical Oncology — Thu, 29 Dec 2011 05:00:00 +0100

A MESSAGE FROM ASCO'S PRESIDENT It has been forty years since President Richard Nixon signed the National Cancer Act of 1971, which many view as the nation's declaration of the "War on Cancer." The bill has led to major investments in cancer research and significant increases in cancer survival. Today, two-thirds of patients survive at least five years after being diagnosed with cancer compared with just half of all diagnosed patients surviving five years after diagnosis in 1975. The research advances detailed in this year's Clinical Cancer Advances demonstrate that improvements in cancer screening, treatment, and prevention save and improve lives. But although much progress has been made, cancer remains one of the world's most serious health problems. In the United States, the disease is ...

Loophole in U.S. law means not all preventive care free

CTV Health — Wed, 28 Dec 2011 22:43:59 +0100

Despite the fact that the new health-care law in the U.S. calls for all preventive screening to be covered, a loophole allows insurance companies to charge for certain tests if they turn into diagnostic procedures. (Source: CTV Health)

Major Insurers Still Accept 4010 Claims

Blogged_Arteries — Wed, 28 Dec 2011 06:00:00 +0100

Three major insurers now say they still accept and pay physicians' claims in both the HIPAA 4010 and 5010 formats through April 1, even though Jan. 1 was the deadline for physicians to begin using the 5010 claims standards. They are Medicare, Medicaid, and Blue Cross and Blue Shield of Texas. (Source: Blogged_Arteries)

The High Cost of Failing Artificial Hips

NYT Health — Wed, 28 Dec 2011 05:29:10 +0100

The widespread failure of all-metal hips may cost taxpayers, insurers and employers billions of dollars in the coming years. (Source: NYT Health)

Aetna sues Michigan Blues over contracting practices

American Medical News - BUSINESS — Tue, 27 Dec 2011 16:27:51 +0100

The case is the second accusing the insurer of anti-competitive activity by using "most-favored-nation" language in its hospital contracts. (Source: American Medical News - BUSINESS)

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New legislation to clamp down on outstanding hospital bills

The Irish Times - Health — Tue, 27 Dec 2011 00:09:42 +0100

MINISTER FOR Health James Reilly has told health insurers he intends to press ahead with new legislation that would make it easier for hospitals to be paid for procedures. (Source: The Irish Times - Health)

Highmark looks to expand hospital and physician ownership

American Medical News - BUSINESS — Mon, 26 Dec 2011 12:00:00 +0100

The Pittsburgh-based insurer, in a dispute with the area's largest hospital system, wants to occupy what it calls the "provider space." (Source: American Medical News - BUSINESS)

Health plans look to save on each patient visit

American Medical News - BUSINESS — Mon, 26 Dec 2011 12:00:00 +0100

Insurers are looking to work directly with physicians to figure out how to make the cost of a single encounter less expensive. (Source: American Medical News - BUSINESS)

Effect of working conditions on non-work-related sickness absence

Occupational Medicine — Mon, 26 Dec 2011 05:00:00 +0100

Conclusions Hazardous physical working conditions are associated with longer duration of non-work-related sickness absence. Workplace ergonomic interventions could conceivably shorten the length of sickness absence that has not originated at work. (Source: Occupational Medicine)

'Consent to settle' clause a must in malpractice policy

Modern Medicine — Sun, 25 Dec 2011 05:00:00 +0100

Don't let your malpractice insurer settle a case without your agreement. (Source: Modern Medicine)

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Payers buying practices: What the doctor ordered?

Modern Medicine — Sun, 25 Dec 2011 05:00:00 +0100

In an unstable managed care market, many large health insurers are expanding, diversifying and strategically acquiring additional lines of business. (Source: Modern Medicine)

Thiopurines prevent advanced colorectal neoplasia in patients with inflammatory bowel disease

Gut — Sat, 24 Dec 2011 05:00:00 +0100

Conclusion Thiopurine use protects IBD patients against the development of AN. The effect of 5-ASA appeared to be less pronounced. (Source: Gut)

EDiscovery For Financial Services Conference, 6-7 February 2012,

Health News from Medical News Today — Fri, 23 Dec 2011 09:00:00 +0100

This winter, Q1 Productions brings together leaders from commercial banks, investment firms, insurance companies and other financial services professionals to address advancements in internal investigation methods, discovery tactics, and what the unique implications are from today's financial services regulations. Held over February 6th and 7th in financial capital, New York City, this conference will discuss the direction discovery is rapidly moving into - electronic discovery - and how to best manage as well as streamline the process... (Source: Health News from Medical News Today)

IBM’s Watson to Help Doctors Diagnose, Treat Cancer

ICMCC: The International Council on Medical and Care Compunetics — Thu, 22 Dec 2011 08:30:07 +0100

Source: Brian T. Horowitz, eWeek Content: “The next assignment for IBM’s Watson supercomputer is to evaluate treatments for cancer. Health insurer WellPoint, which is looking into real-life applications for Watson, has announced that a leading cancer institution in Los Angeles, Cedars-Sinai’s Samuel Oschin Comprehensive Cancer Institute, will provide expertise to the company on developing applications [...] (Source: ICMCC: The International Council on Medical and Care Compunetics)

Considering WellPoint's Decision to Cover CT Lung Screening

Diagnostic Imaging — Wed, 21 Dec 2011 12:00:00 +0100

WellPoint’s decision earlier this month to cover CT scans for heavy smokers may encourage other insurers to follow suit, paving the way for imaging sites to set up screening programs. But, for now, payers and practices alike are waiting to see what happens next. (Source: Diagnostic Imaging)

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Prescription for Disaster

Psychology Today Sex Center — Tue, 20 Dec 2011 17:58:26 +0100

Secretary Sebelius is correct in her statement that there are "behavioral and cognitive differences" between adolescent girls and adults. However, these differences are exactly the reason why emergency over-the-counter contraception should be made available to young teens. Primary Topic: Child Development read more (Source: Psychology Today Sex Center)

The medical home: what health care needs now

Thrive, Children's Hospital Boston — Tue, 20 Dec 2011 13:18:36 +0100

Claire McCarthy MD You may have heard the term “medical home”—it’s been bandied about recently as something we all should have. No, it’s not a nursing home. Nor is it a house well-stocked with Band Aids and Tylenol, or one where doctors live. The American Academy of Pediatrics defines medical home as “a model of care that is accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and culturally effective.” Well, that sounds exceedingly lovely. Of course we’d all want that. But still, what does it really mean? Let’s get more concrete. You have a medical home if: You can get the care you need when you need it You can easily get the health advice or information you need You can easily get the specialty care, services, or equipment you need Your ...

Consultants urged to sign off on payments

The Irish Times - Health — Tue, 20 Dec 2011 00:07:23 +0100

THE SITUATION where hospitals are owed €200 million from health insurance companies is no longer tolerable and must be dealt with as soon as possible, Minister of State Róisín Shortall has said. (Source: The Irish Times - Health)

Feds give states power to define health benefits

bizjournals.com Health Care:Biotechnology headlines — Mon, 19 Dec 2011 21:58:06 +0100

A surprise decision by the Obama administration to give states flexibility to define the minimum benefits health insurers must offer under federal health reform lobs a big decision about affordability to states, too. Business groups may lobby for minimum benefits to save money, while consumer advocates push for extensive coverage. The bulletin released by federal health officials on Friday requires states to include coverage in 10 areas but it offers scant details and lets states pick the model they choose to follow — including the largest HMO plan offered in the state’s commercial market... (Source: bizjournals.com Health Care:Biotechnology headlines)

Feds: Florida insurers must offer rebates

bizjournals.com Health Care:Pharmaceuticals headlines — Mon, 19 Dec 2011 18:14:58 +0100

The U.S. Department of Health and Human Services denied Florida’s request for relief from the medical loss ratio, according to a report on The Hill. The medical loss ratio requires insurers to spend 80 percent of their premiums on medical costs or issue rebates. Florida was asking to phase in the medical loss ratio requirement in the insurance market for individuals, not group policies, starting with 68 percent in 2011, 72 percent in 2012 and 76 percent in 2013. The Florida Office of Insurance Regulation asked for the request, saying that without relief from the provision, the insurance market would destabilize. (Source: bizjournals.com Health Care:Pharmaceuticals headlines)

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The Romanian healthcare system is set switch from a state-based health insurance scheme to one based on private insurance companies

PharmacoEconomics and Outcomes News — Sat, 17 Dec 2011 03:21:49 +0100

(Source: PharmacoEconomics and Outcomes News)

Feds deny Florida insurers medical loss ratio relief

bizjournals.com Health Care:Pharmaceuticals headlines — Fri, 16 Dec 2011 17:00:12 +0100

The federal government has rejected the effort by Florida officials to exempt commercial health plans in the state from the medical loss ratio requirements within the Affordable Care Act. In late 2010, the Florida Office of Insurance Regulation asked the U.S. Department of Health and Human Services for a waiver to hold off on enforcing the MLR requirements for three years. On Thursday, HHS told the OIR no. “We have determined that the evidence presented does not establish a reasonable likelihood that the application of the 80 percent MLR standard will destabilize the Florida individual market,” HHS said in its denial letter... (Source: bizjournals.com Health Care:Pharmaceuticals headlines)

Feds: Florida insurers must offer rebates

bizjournals.com Health Care:Pharmaceuticals headlines — Fri, 16 Dec 2011 16:45:28 +0100

Oops! Another Flawed, Biased Review Article in British Journal of Psychiatry

Psychology Today Depression Center — Fri, 16 Dec 2011 13:06:04 +0100

Has British Journal of Psychiatry sunk to being an international dumping ground for junk science? Primary Topic: Therapy read more (Source: Psychology Today Depression Center)

Evidence Supports Finding Of Disability, Michigan Federal Judge Says

LexisNexis® Mealey's™ Disability Insurance Legal News — Fri, 16 Dec 2011 12:37:53 +0100

DETROIT - An ERISA-governed disability insurer that terminated benefits to a claimant with chronic back problems acted arbitrarily, a Michigan federal judge ruled Nov. 17, ruling that the evidence does not support a finding that the claimant is able to work 25 hours a week (Edward Fura v. Federal Express Corporation Long Term Disability Plan, et al., No. 10-13298, E.D. Mich.; 2011 U.S. Dist. LEXIS 132644). Full story on lexis.com (Source: LexisNexis® Mealey's™ Disability Insurance Legal News)

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8th Circuit: Reliance On Record Reviews, Video Surveillance Was Reasonable

LexisNexis® Mealey's™ Disability Insurance Legal News — Fri, 16 Dec 2011 12:37:53 +0100

ST. LOUIS - A disability insurer's reliance on record reviews and video surveillance in its decision to deny benefits was not an abuse of discretion, the Eighth Circuit U.S. Court of Appeals ruled Dec. 7 (Troy J. Daigle v Hartford Life and Accident Insurance Co., No. 11-1847, 8th Cir.; 2011 U.S. App. LEXIS 24349). Full story on lexis.com (Source: LexisNexis® Mealey's™ Disability Insurance Legal News)

Issues Of Fact Preclude Judgment, Florida Federal Judge Holds

LexisNexis® Mealey's™ Disability Insurance Legal News — Fri, 16 Dec 2011 12:37:53 +0100

MIAMI - A Florida federal judge on Dec. 2 allowed a claimant to proceed with a bad faith action against her disability insurer, finding that issues of fact exist over how the insurer handled his claim (Gaby Kafie v. Northwestern Mutual Life Insurance Co., No. 11-21251, S.D. Fla.; 2011 U.S. Dist. LEXIS 138956). Full story on lexis.com (Source: LexisNexis® Mealey's™ Disability Insurance Legal News)

Medical Malpractice in Endourology: Analysis of Closed Cases From the State of New York

The Journal of Urology — Fri, 16 Dec 2011 05:00:00 +0100

Conclusions: Urologists are not immune to the current medical malpractice crisis. Endourology and urological oncology generate the greatest number of lawsuits against urologists. Most malpractice claims involving endourological procedures result from urolithiasis and alleged technical errors. Therefore, careful attention to surgical technique is essential during stone procedures to reduce the risk of malpractice litigation. (Source: The Journal of Urology)

Independence Blue Cross Rallies Community to Help U.S. Marines Save "Toys for Tots" Drive

Medical News (via PRIMEZONE) — Thu, 15 Dec 2011 19:53:00 +0100

PHILADELPHIA, Dec. 15, 2011 (GLOBE NEWSWIRE) -- In the wake of the unprecedented donation crisis facing the U.S. Marine Corps' Toys for Tots program in the Philadelphia region, Independence Blue Cross (IBC), the leading health insurer in Philadelphia, PA, today announced its immediate gift of 1,000 toys and a toy-for-toy match donation program. For every new, unwrapped gift donated to the drop-off center in the courtyard outside IBC's Center City offices, IBC will match that gift for Toys for Tots with up to 2,500 gifts. This effort could ultimately result in 6,000 toys being donated within the next week. (Source: Medical News (via PRIMEZONE))

5010 Compliance Two Weeks Away

Blogged_Arteries — Thu, 15 Dec 2011 06:00:00 +0100

Physicians must begin using the new HIPAA 5010 transaction standards on Jan. 1 to submit claims or run the risk of private insurers, Medicare, and Medicaid refusing to pay them. (Source: Blogged_Arteries)

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Aetna lifts earnings outlook for 2011, 2012

Reuters: Health — Thu, 15 Dec 2011 00:17:32 +0100

(Reuters) - Aetna Inc, the third largest U.S. health insurer, raised its estimate for 2011 and 2012 operating earnings per share and said it bought back 40 million shares through Dec 9 this year. (Source: Reuters: Health)

Univera members may be affected by coding snafu

bizjournals.com Health Care:Hospitals headlines — Wed, 14 Dec 2011 19:47:49 +0100

Univera Healthcare says members in the Buffalo area could be affected to a coding glitch that resulted in over-charges for some members around the state. The health insurer identified a coding error in September that impacted commercial members in its high-deductible product lines. Univera has 66,365 members in the Western New York region enrolled in commercial products, with 22,403 enrolled in high-deductible health plans. The error causes the claims-processing system to fail to recognize when customers have reached their deductibles... (Source: bizjournals.com Health Care:Hospitals headlines)

Republican Tax and Unemployment Bill Would Help Hospitals Owned by Doctors

NYT — Wed, 14 Dec 2011 16:30:36 +0100

The payroll tax and unemployment bill would also repeal and relax limits on doctor-owned hospitals, which tend to raise costs for other insurers. (Source: NYT)

ICD-10 Shouldn’t Dictate Patient Care or EHR Design

ICMCC: The International Council on Medical and Care Compunetics — Wed, 14 Dec 2011 11:11:50 +0100

Source: Daniel Essin, Physicians Practice Content: “I have recently been excoriated by Carl Natale, the editor of ICD10Watch / Government Health IT, for poking some fun at and criticizing ICD-10. Several of his statements warrant a comment. First, he says that I suggest that “health insurers will be able to reduce reimbursements” under ICD-10. This may [...] (Source: ICMCC: The International Council on Medical and Care Compunetics)

Unreasonable Rate Review for Health Insurance

Forbes.com Health News — Tue, 13 Dec 2011 23:03:22 +0100

If you want to get an understanding of how the health reform law works, both in theory and practice, it would be a good idea to take a look at the process called "rate review." The idea is that health insurance premiums can be restrained by forcing health insurance companies to explain "unreasonable" premium increases ... (Source: Forbes.com Health News)

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Rx Drug Fraud Move Part of HHS Plan to Cut Costs

MedPage Today Geriatrics — Tue, 13 Dec 2011 22:04:28 +0100

WASHINGTON (MedPage Today) -- As part of the Obama administration's cost-cutting efforts, the Department of Health and Human Services announced Tuesday that it is encouraging health insurers to hold up payments for "suspicious" Part D drug claims. (Source: MedPage Today Geriatrics)

Insurers and Testing Laboratories [Capitol Health Call]

JAMA — Tue, 13 Dec 2011 05:00:00 +0100

(Source: JAMA)

Republican Tax and Unemployment Bill Would Help Hospitals Owned by Doctors

NYT Health — Tue, 13 Dec 2011 02:48:16 +0100

The payroll tax and unemployment bill would also repeal and relax limits on doctor-owned hospitals, which tend to raise costs for other insurers. (Source: NYT Health)

Prescriptions Blog: Final Rules Set for Insurers on Spending Ratios

NYT Health — Mon, 12 Dec 2011 18:32:38 +0100

The industry did not get an exemption for brokers' fees under the regulations for how much of a customer's premium must be spent on medical care. (Source: NYT Health)

Cancer survival rates 'threatened by rising cost'

NHS News Feed — Mon, 12 Dec 2011 16:45:00 +0100

“Cancer survival rates could fall because of a rise in the cost of diagnosis and treatment over the next 10 years,” the Daily Express warns today. Other papers, including the Daily Mail claim that treating patients at home instead of in hospital could stop cancer treatments from “bankrupting” the UK’s healthcare system. The papers have each chosen to make stark warnings based on different aspects of the same report. The report, which projects the UK’s cancer treatment costs in 2021, was published by the private healthcare insurance company, Bupa. The report calculates that last year 318,000 people in the UK were diagnosed with cancer, with an overall cost for cancer care of £9.4 billion across NHS, private and voluntary sectors. By 2021 the number of new cancer cases is predic...

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Insurance broker fees must be counted as overhead, HHS says

American Medical News - GOVERNMENT — Mon, 12 Dec 2011 12:00:00 +0100

The decision means insurers will be required to spend more premium dollars on actual medical care. (Source: American Medical News - GOVERNMENT)

Patient Records: Impact on Operational Efficiency

ICMCC: The International Council on Medical and Care Compunetics — Sat, 10 Dec 2011 15:56:15 +0100

Source: Jay Mehta, Express Healthcare Content: “Hospitals, manufacturers, doctors, insurance companies and patients—all are looking forward to efficient means to better these. Each entity faces different kind of challenges. And although there have been significant advancements in allied research, the overheads/bottlenecks do not seem to reduce. On the contrary, they are posing stiffer management difficulties [...] (Source: ICMCC: The International Council on Medical and Care Compunetics)

A former health plan medical director repents for denying care to patients

Modern Medicine — Sat, 10 Dec 2011 05:00:00 +0100

I've read accounts of former health plan medical directors who have confessed the sins they've committed while working for health insurance companies, but I never thought I'd count myself among them. (Source: Modern Medicine)

Interferon Maker to Repay Insurer for MS Relapse Costs

MedPage Today Neurology — Fri, 09 Dec 2011 15:30:00 +0100

(MedPage Today) -- The manufacturer of a major drug for multiple sclerosis has given what appears to be a money-back guarantee that its product will prevent severe relapses when used as directed. (Source: MedPage Today Neurology)

MedWorm: Insurers

Study Examines Misconceptions Of Who Picks Up Tab When Patients Walk Out

White House defends contraception rules as criticism mounts

White House defends contraception rules as criticisms mount

Justifying insurance coverage for orphan drugs

Expert: Healthcare mandate constitutional

Coventry renews contract with CEO Allen Wise

Humana's Net Jumps 86%

UPMC Health Plan membership rises 14.5%

Willingness to Pay for Obesity Pharmacotherapy.

[Reliability of morbidity data reported by GPs : Results of a longitudinal study in primary care].

Health insurer could boost PCP pay by half

A Decision-Tree Approach to Cost Comparison of Newborn Screening Strategies for Cystic Fibrosis

The Challenges Ahead for Accountable Care Organizations (ACOs).

WellPoint Bets (A Bit) On Primary Care

Wide Use of Doc ID Numbers Makes Fraud Easy

Worker's compensation bill has support in Florida House

WellPoint to Boost Pay for Primary Care Docs

Anthem refuses to repay claims

Financial Responsibility of Hospitalized Patients Who Left Against Medical Advice: Medical Urban Legend?

The impact of health insurance mandates on drug innovation: evidence from the United States

Bill Seeks Surcharge for Utah Smokers on Medicaid

Exploring and Comparing the Characteristics of Nonlatent and Latent Composite Scores: Implications for Pay-for-Performance Incentive Design

Opinionator: The End of Health Insurance Companies

Table of Contents

Vaccine discontinuation and switching following regulatory interventions in response to rotavirus vaccine contamination with porcine circovirus DNA fragments

Medicare Overpaid Billions in 2010, GAO Says

WellPoint Shakes Up Doctors' Pay

Insurer WellPoint to Revamp Primary Care Pay

An Rx? Pay More to Family Doctors

Blue Shield California looks to mobile to engage members

Device makers urge coverage of weight-loss surgery

WellPoint Profit Drops 39% as Costs Rise

New think tank wants government to see gold in health technology

'Just say no' policy can be good medicine

Consumers Tell Insurers to Cover Experimental DrugsConsumers Tell Insurers to Cover Experimental Drugs

Device makers urge coverage of weight-loss surgery

Children’s and Blue Cross Blue Shield usher in new age of quality-based benchmarks in pediatrics

Health Net to sell Medicare Part D business to CVS

U.S. consumers tell insurers to cover experimental drugs

Big insurers investing in mobile health apps

Health insurance company preys upon the poor with junk food reward program for vaccinating your baby

March of Dimes launches Prematurity Prevention Network

Changing insurance company claims handling processes improves some outcomes for people injured in road traffic crashes. - Schaafsma F, De Wolf A, Kayaian A, Cameron ID.

Administration Rules Insurers Must Cover Contraceptives

Termination Of Benefits Was Reasonably Supported By Record

Claimant Petitions For En Banc Review Over 8th Circuit Finding

Kentucky Federal Judge Finds Benefit Denial Not Reasonably Supported

Judge: Insurer's Reliance On Record Reviews, Video Surveillance Reasonable

Insurer Conducted Full and Fair Review, Judge Holds

4th Circuit: Plan Administrator's Benefit Calculation Reasonable

SPD Appeal Procedures Are Not Part Of Plan, Judge Holds

Breach Of Agreement Claim Against Employer Barred, Judge Says

11th Circuit's Structural Conflict Of Interest Ruling Will Not Be Reviewed

Federal Judge Remands Case To Administrator Where Time Limits Violated

Administration Rules Insurers Must Cover Contraceptives

Lies, damned lies and PR

What can we learn from patient claims? - A retrospective analysis of incidence and patterns of adverse events after orthopaedic procedures in Sweden.

UnitedHealth Rises 21%

Aetna wellness programs available for purchase on Best Buy shelves

Finding and fixing diagnosis errors: can triggers help?

Programs to address child obesity emerge

Health Sector Takes On Childhood Obesity

The economic pressures for biosimilar drug use in cancer medicine

Learning to Be Lean

The Sleep Apnea Business Is Booming, And Insurers Aren't Happy

Changing insurance company claims handling processes improves some outcomes for people injured in road traffic crashes

Learning to Be Lean

The Anesthesia Patient Safety Foundation at 25: A Pioneering Success in Safety, 25th Anniversary Provokes Reflection, Anticipation.

Hospital group GHG teeters on the brink

Earn their trust, earn their cash

Using Simulation to Perform Root Cause Analysis of Adverse Surgical Outcomes

[Viewpoint] What are the lessons from the USA for clinical commissioning groups in the English National Health Service?

Controversial Pinnacol board member resigns

White House Calls Increases in Health Insurance Rates Too High

Affordable Care Act Holding Insurers Accountable for Premium Hikes

White House Calls Increases in Health Insurance Rates Too High

Dentist Admits $400,000 in Fraudulent BillingDentist Admits $400,000 in Fraudulent Billing

Statins Cost Four Times More in US Than UKStatins Cost Four Times More in US Than UK

Statins cost four times more in US than UK