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Posts tagged ‘Aetna’

Insurers Dubious About New Obamacare Fix for January Health Plans.


Image: Insurers Dubious About New Obamacare Fix for January Health PlansKen Statz, a health insurance broker, at his office in Brecksville, Ohio on Dec. 3. Statz said he had been stymied in his efforts to enroll clients through HealthCare.gov.

Insurance companies are struggling with a new request by the Obama administration to make sure people receive medical benefits under healthcare reform come Jan. 1, even if they miss a sign-up deadline set for next Monday.The government has sought to reassure consumers, already frustrated by technical problems that stalled access to its HealthCare.gov enrollment website in October and November, that those who need coverage starting on New Year’s Day will be able to sign up.

Last week, the administration appealed to the insurance industry to accept people who sought benefits past the Dec. 23 enrollment deadline for Jan. 1, and to consider approving retroactive coverage for consumers who signed up during the month of January.

So far, the answer has amounted to a big “maybe.”

Insurers are worried that some consumers will sign up for retroactive January plans only if they have incurred a hefty medical bill. It is unclear what the costs of that would be or how many shoppers might take advantage of the policy.

“It creates a situation where someone might be able to apply for insurance when they have already had services” such as in the emergency room, said Mary Beth Chambers, spokeswoman for Blue Cross Blue Shield of Kansas. “It’s like calling for homeowners insurance when your house is already on fire.”

Chambers said that such cases would probably be “few and far between.”

BCBS of Kansas, the largest insurer in a state where about 14 percent of the population is uninsured, has decided to give people until Jan. 10 to pay their premiums and receive retroactive coverage beginning Jan. 1. They are still hewing to the Dec. 23 enrollment deadline while they study the feasibility of allowing retroactive sign-ups as late as Jan. 31.

Some of these changes and the technical problems associated with the rollout of the Affordable Care Act, commonly called Obamacare, could lead to people facing a gap in coverage next month. It could also create new political problems for President Barack Obama over his signature domestic policy, which opposition Republicans have tried to derail for years.

Aetna Inc, one of the biggest players on the exchange, is going to extend the payment date until Jan. 8, make service workflow changes to support the deadline shift to Dec. 23 from Dec. 15 and already planned to ensure customers will not miss important appointments, such as cancer treatments. But it said some of the administration’s suggestions would require systems changes and more service support people, which was not viable.

“We are concerned that changing the rules at this late date and allowing for this degree of variability will lead to significant consumer confusion about the marketplace,” Aetna spokeswoman Cynthia Michener said.

Cigna Chief Executive David Cordani said the company will decide this week which measures to pursue. The company, which has only a small business catering to individuals, said that its employer-based plans already offer similar programs to ensure continuity of coverage.

Other insurers, including Molina Healthcare Inc which is selling Obamacare plans in 9 states, have said they will be extending the payment deadline but are stopping there.

The request has raised concerns among some Wall Street analysts over a steady stream of changing regulations. Moody’s, which reviews credit ratings of companies, said the additional conditions are a negative influence on insurers’ business, requiring administrative changes to track new customers, and will be confusing for doctors and consumers.

Enrollment in Obamacare plans has picked up in December, due to fixes for HealthCare.gov, which serves 36 states, and as consumers nationwide anticipate the Dec. 23 deadline for Jan. 1 benefits. The Congressional Budget Office has estimated that 7 million people will sign up for coverage by the time enrollment for all of 2014 ends on March 31.But the pace of enrollments so far – 365,000 people by the end of November – has cast doubt on the government’s ability to reach that many people in the program’s first year.

Wall Street analysts have lowered their estimates for enrollment to almost half the CBO estimate, or less. Insurers have tempered their expectations as well. For the larger players like Aetna, WellPoint and Humana, the exchange market is just a fraction of their total membership, which range from more than 10 million people to 40 million at UnitedHealth Group Inc.

More than 150 million people receive insurance through their employers and 100 million others have health coverage through government programs – Medicare for the elderly and Medicaid for the poor.

Brian Hale, a senior vice president for health policy at Jackson Hewitt Tax Service in Nashville, Tennessee, said that he believes the number of people trying to sign up for Jan. 1 Obamacare coverage is a fraction of the 10 to 20 million people in the market for individual insurance this year.

Out of that, the number who may be truly displaced is “a much smaller number of people then it’s been made out to be,” Hale said.

Ron Williams, the former CEO of Aetna who now advises private equity firm Clayton, Dubilier & Rice, said he believed insurers could allow for retroactive coverage for a few more days in January and still mitigate the risk of high costs.

“There is some risk there; it is a limited risk,” Williams said.

Funding under the healthcare law may help cover some of that risk, or the costs that come when very sick people sign up at a disproportionate rate versus healthy people.

Vantage Health Plan in Louisiana is planning to extend the deadline for people to enroll for Jan. 1 coverage, but has not decided how long to do so, according to Billy Justice, Vantage’s marketing and sales director.

Justice said that the law prohibits insurers from denying coverage to someone with a prior illness “and there should be risk adjustments at the end of the year for insurance companies that get the highest risk.”

© 2013 Thomson/Reuters. All rights reserved.

Source: Newsmax.com

Issa Investigates Obama’s Broken Promise.


Image: Issa Investigates Obama's Broken Promise

By Cathy Burke

House investigators are demanding to know just when President Obama realized he couldn’t keep his oft-repeated promise to let people keep the doctor they like under his signature health care law.

House Government and Oversight Committee Chairman Darrell Issa, R-Calif., wrote to 15 insurance companies Monday — including big carriers like Aetna, BlueCross BlueShield and Cigna — demanding by Dec. 13 “all communications” between company workers and the Obama administration dating since March 2010, when the health care reforms became law, the Washington Examiner reported.

In the letterIssa said millions of dropped health care plans, followed by the news oflimited access to doctors under the health care law,  “raise serious questions as to the origin and nature of the president’s assurances.”

Obama repeatedly pledged that people could keep their insurance plans as well as their doctors under the Affordable Care Act. But since Oct. 1, when the new health care exchanges opened, millions of individual policy holders have received cancellation notices, while others are discovering their doctors are no longer included in their coverage.

Issa’s letter to the insurers highlights a page on the government’s Affordable Care Act website that promises “health insurance reform will not affect the choice of doctors you have today and it won’t affect your relationship with your doctor,” the Examiner reported. But many insurers have cut the number of providers they offer to control costs under the new law, which expands benefits and allows people with pre-existing conditions to sign up.

Issa’s office wants insurers to document all plan cancellation notices each sent to policy holders as a direct result of the health care law, as well as any provider cancellations.
Issa also wants to know if the insurers tried to warn Obama about the impending cancellations and changes to coverage.

His request includes all documents showing “whether employees or agents” of the insurance companies objected to the administration’s claim, either within the company or to the administration, the Examiner reported.

The loss of preferred doctors is the latest restriction of the new law that has caught policy holders off guard, discovered as they began shopping for plans on insurance exchanges, only to find out their choice of MDs and hospitals is restricted.

And it’s causing a backlash, the Washington Post reported.

For example, Seattle Children’s Hospital has filed suit against Washington’s insurance commissioner after a number of insurers kept it out of their provider networks. “It is unprecedented in our market to have major insurance plans exclude Seattle Children’s,” Sandy Melzer, senior vice president, told the Post last month.

© 2013 Newsmax. All rights reserved.

Corrupt Obamacare Data Infecting Over A Dozen Insurance Providers.


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Emerging errors include duplicate enrollments, spouses reported as children, missing data fields and suspect eligibility determinations, say executives at more than a dozen health plans. Blue Cross & Blue Shield of Nebraska said it had to hire temporary workers to contact new customers directly to resolve inaccuracies in submissions. Medical Mutual of Ohio said one customer had successfully signed up for three of its plans.

The flaws could do lasting damage to the law if customers are deterred from signing up or mistakenly believe they have obtained coverage.

“The longer this takes to resolve . . . the harder it will be to get people to [come back and] sign up,” said Aetna Inc. AET -0.06% Chief Executive Mark Bertolini. “It’s not off to a great start,” he said, though he believes the marketplaces are “here to stay.” source – Market Watch.

by NTEB News Desk

Aetna Pulls out of New York Health Insurance Exchange.


Aetna Inc, the No. 3 U.S. health insurer, said on Thursday it has decided not to sell insurance on New York‘s individual health insurance exchange, part of the country’s healthcare reform.

New York is the fifth state where Aetna has pulled its application to sell the plans that go on sale on Oct. 1 and into effect on Jan. 1, 2014. It has also reversed course in Maryland, Ohio, Georgia, and Connecticut, where it is based.

Aetna spokesman Cynthia Michener said it made the move after assessing its business strategy, following the acquisition of smaller insurer Coventry Healthcare in May. Coventry also filed applications to sell plans in more than 10 states.

“Our goal for 2014 is to participate in a limited number of state exchanges where we can be competitive and add the most value to the market,” she said in an emailed statement.

She said the company will continue to serve small business and large business customers in New York and will offer individual products outside of the exchanges.

New York’s market for individuals is currently only about 17,000 people, but the exchange is expected to bring in 1 million people during the first three years. The exchange announced insurance participants on Aug. 20. Aetna was not on the list.

© 2013 Thomson/Reuters. All rights reserved.

Source: NEWSmax.com

States Overwhelmed by Obamacare Exchanges’ Complex Rules, Bureaucracy.


Image: States Overwhelmed by Obamacare Exchanges' Complex Rules, Bureaucracy

Peter Lee, executive director of Covered California, the state agency running the state’s new health exchange, announced the plans and prices that will be offered by private insurers during a May 23 news conference in Sacramento, Calif.

While politicians in Washington argue over the Affordable Care Act, its ultimate fate is being decided far from Capitol Hill.

Amid the periodic repeal votes in Congress and activist campaigns on both sides of the debate, states from New York to California are striving to meet an Oct. 1 deadline to implement the heart of the healthcare law, the online insurance “exchanges” meant to enroll millions of Americans.

The law has already had a major impact on U.S. healthcare since its passage in 2010. Millions of young adults up to age 26 have received coverage under their parents’ policies, seniors are receiving expanded drug coverage, and hospitals are experimenting with incentive programs designed to improve care and cut costs.

Editor’s Note: Should ObamaCare Be Repealed? Vote in Urgent National Poll 

Yet the success of Obamacare will ultimately rest on how well it delivers on its promise to extend coverage to the 49 million Americans who currently don’t have health insurance. With the deadline just four months off, the prognosis is mixed.

“It is going to be a slow start,” said Ana Gupte, a Dowling & Partners insurance analyst in Farmington, Conn. “I don’t think the exchanges are fully ready to take in large numbers overnight. This is not going to be ‘Turn this on and everybody’s in the exchange tomorrow.'”

Even those states most on target have had to scale back consumer-friendly offerings in their effort to meet the deadline. Others are giving up running their own markets. New Mexico and Idaho this month said they would cede control of parts of their exchanges to the federal government.

States are rushing to solve technical hurdles even as they scrap features deemed too complex to set up by the deadline, said Jon Kingsdale, a Boston-based consultant advising exchanges. That risks making it harder for people to sign up. California, for one, won’t directly enroll poor Americans in Medicaid, the joint federal-state health program. New York and 10 other states have put off plans to negotiate lower premiums with insurers.

Some exchanges “are going to barely make it,” said Kingsdale, former director of the Massachusetts exchange that became a model for President Barack Obama’s overhaul.

Fourteen states and the District of Columbia are building their own exchanges, which will offer health plans for small businesses and people not insured through work. The other states will become partners with the federal government or leave the job entirely to the Obama administration. By law, the markets must open in October to sell coverage that starts in January.

The idea behind the new system is simple: Offer one-stop shopping and aid, making insurance easy and affordable.

In theory, people will go to one of the websites and key in basic information about income, family and employment. They can determine eligibility for government programs like Medicaid or for federal subsidies for private insurance. Those not covered by public programs will see a menu of private options selected by each state.

Consumers can then enroll in a plan and use the exchanges to pay premiums. In some states, such as New York, a separate exchange will cater to small-business employees.

While the goal is simple, the implementation is anything but. States need to set up powerful computer systems that can loop in insurers in real-time while sharing data with the Internal Revenue Service, state tax offices, Medicaid, Medicare, and other agencies in order to verify customer information. Once technical hurdles are cleared, state governments will need to get the word out to millions of people that they arere now eligible for insurance.

“It’s been a Herculean task,” said Ben Nelson, executive director at the National Association of Insurance Commissioners and a former U.S. senator from Nebraska who voted for the law. “There’s so much diversity between the states. Getting that all sorted out has been a major effort.”

Some states look like they’ll be ready. New York hired contractors to prepare its exchange more than a year ago and has 80 staff members dedicated to the effort. It plans to spend $27 million next year training brokers and community groups to guide people through the healthcare law’s new insurance options.

The state is also working with an advertising firm to reach the 2.6 million uninsured New Yorkers and has been modeling the law’s effects on premiums for those who already have insurance. When ready, its website and call center will offer help in more than a dozen languages.

“We have been working hard at this for two years now,” the exchange’s deputy director, Danielle Holahan, said in a phone interview. “There’s a lot of passion about what we’re doing and what we’re going to be able to accomplish.”

California last week said it had chosen WellPoint Inc. and a dozen other insurers to offer plans in its new system. Individuals can expect to pay as much as 29 percent less than what small businesses now pay for coverage, said Peter Lee, the exchange’s executive director, declaring victory over the “doom-and-gloom estimates” of the health-law’s critics.

Some 5.3 million Californians will be eligible to purchase coverage and about half may be eligible for the subsidies.

The exchanges are expected to attract about 7 million people next year, rising to 24 million by 2023, the Congressional Budget Office estimates. Yet that number has been steadily reduced from 34 million in 2011, as states opt out of parts of the health overhaul and the Obama administration eases penalties for people who don’t buy coverage.

Insurers from WellPoint to Aetna, consequently, have been cutting their projections for new business. The stakes for the industry are high: The exchanges represent a potential windfall of $205 billion a year in added sales by 2021, according to an October report from PricewaterhouseCoopers LLP.

WellPoint, the biggest U.S. carrier for those buying their own coverage, slipped 1.3 percent to $76.98 in New York trading on May 24. The Indianapolis-based insurer gained 26 percent for the year through May 24. Aetna, based in Hartford, Conn., fell 1.8 to $59.31 and advanced 28 percent this year.

Editor’s Note: Should ObamaCare Be Repealed? Vote in Urgent National Poll 
While some states will offer “robust” exchanges, “a goodly number will have to make some tough decisions about what they can get done and what will have to wait for version 2.0 or 2015 or beyond,” said Kingsdale, the Boston consultant.

In California, “I expect them to be up and running, but with a lot of glitches,” said Carmen Balber, executive director of Consumer Watchdog, a Santa Monica-based nonprofit. “The websites will be a little funky, and it will be hard for people to get through. The gears won’t all be oiled yet.”

California, Colorado and Vermont are dropping plans for exchanges that directly enroll people in private insurance or public programs like Medicaid, according to data gathered by the National Academy for State Health Policy, a Washington-based research group.

Instead, shoppers will be told what they’re eligible for and transferred to an insurer website or call-in line — or simply told to make the connection on their own. In California, Colorado and Utah, customers will be handed off to private insurers to pay their premiums, adding another step to the process, according to the National Academy.

“That’s a hand-off where somebody could potentially get lost,” Kingsdale, a partner at Wakely Consulting Group, said in a telephone interview. “You’re dealing mostly with the uninsured, who are hard to find and easy to lose.”

States are also putting off plans that could have squeezed insurer profits, bowing to pressure from the industry and the calendar. Maryland, Washington state and the District of Columbia won’t require carriers to standardize deductibles and copays, a step New York and other states are taking to help consumers compare plans.

California is one of only five states that is negotiating with insurers to lower premiums, according to the National Academy. Elsewhere, including in states such as Texas and Florida that will rely on a federal exchange, insurance companies won’t face that kind of pressure.

States also are forgoing online tools that would let shoppers filter health plans by provider-network or customer-satisfaction scores. For now, the preference is for “bare-bones” approaches, said Heather Howard, program director at the State Health Reform Assistance Network, a Princeton, N.J.-based group advising 11 exchanges.

For insurance companies, the initial enthusiasm over a surge in business from the exchanges has dimmed somewhat. Growth is looking “much slower” than many had anticipated, WellPoint CEO Joseph Swedish told investors at a May 20 investors conference in New York.

Aetna, the third-biggest health insurer by sales, has cut its projections for the markets next year, CEO Mark Bertolini told analysts on an April 30 conference call.

“This is a two-year ramp to get the individual exchanges up to a level where customers are going to feel appropriate signing up,” Bertolini said. “I think people are going to take a wait-and-see attitude.”
© Copyright 2013 Bloomberg News. All rights reserved.

Source: NEWSmax.com

Premium Surges Could Reach 400 Percent Under Obamacare.


Image: Premium Surges Could Reach 400 Percent Under Obamacare

By Courtney Coren

Some of the nation’s largest insurance providers are estimating that premiums could increase as much as 400 percent under ObamacareThe Washington Examiner reported Tuesday.

Citing internal reports from 17 companies provided to the House Energy and Commerce Committee, the Examiner reported the estimated increases would be tied to the cost of implementing the new regulations, taxes, fees, and mandates in the healthcare reform law.

The average increase is expected to be about 100 percent and could be as high as 400 percent, according to a report released Monday by the committee laying out the estimates from such companies as Aetna, Blue Cross Blue Shield, and the Kaiser Foundation.

Urgent: Is Obamacare Hurting Your Wallet? Vote in Poll 

“The average yearly cost for a new customer in the individual market grows from $1,896 to $3,708 — a $1,812 cost increase,” according to the report.

Adding to the costs, the committee report stated, are requirements that insurance policies cover a wider array of services and that people in poor health be added to the insurance rolls.

One insurance provider, the Examiner noted, calculated a possible 413 percent increase due to new age-rating requirements and other new benefits that will have to be offered.

“Despite promises that the law will lower costs, [Obamacare] will in fact cause the premiums of many Americans to spike substantially,” the report from the Republican-controlled committee concluded.

“The broken promises are numerous, and the empirical data reveal that many Americans, from recent college graduates to older adults, will not be able to afford the law’s higher costs.”

Urgent: Is Obamacare Hurting Your Wallet? Vote in Poll 

© 2013 Newsmax. All rights reserved.

Small Businesses Won’t Have Plan Choices Under Obamacare.


Citing the challenges in establishing a new health insurance marketplace, the Obama administration is delaying a key provision of the Affordable Care Act designed to provide employees of small businesses affordable health coverage.

The New York Times reported Monday that in most states employers will not be able to provide workers with a choice of health plans as the law intended. Instead, they will be limited to a single plan.

One of the health law’s provisions, known as “employee choice,” called for each state to operate a Small Business Health Options Program, known as a SHOP exchange.

ObamacareMassive New Rules Revealed for 2013

The exchange, which was to start operating in January, is designed to allow small businesses and their employees to compare health plans and enroll employees for coverage. However, in 33 states where the federal government will be running the exchanges, the choice option will be delayed until 2015, meaning employees of small firms will only have the choice of one plan. Other states operating their own exchanges will also have the option to only offer a single plan as well.

A number of insurers, including Aetna, had asked the Obama administration to delay the “employee choice” option, citing their experience in Massachusetts, which put through health reforms that were the model for the Affordable Care Act.

Insurers say they asked for the delay because the administration did not provide final rules for the small business exchange until last month. However, a few states including California and Connecticut will begin offering the employee choice option next month.

© 2013 Newsmax. All rights reserved.
By Cyrus Afzali

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