health insurance

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Vermont Gov. Won’t Pursue Single Payer Health Care This Year

Gov. Peter Shumlin earlier this year (Wilson Ring/AP)

Gov. Peter Shumlin earlier this year (Wilson Ring/AP)

Gov. Peter Shumlin of Vermont announced on Wednesday that his state would not pursue single payer health care in this coming legislative session.

Shumlin blamed a sluggish economy for his decision. The taxes required for single payer would prove too burdensome for Vermont, a state that has downgraded its revenues twice this year.

The taxes required to implement single payer would include an 11.5 percent increase in payroll taxes and up to a 9.5 percent increase in income taxes for every Vermonter.

Shumlin added: “Making fundamental changes in our health care system — nearly 20 percent of our economy — is a huge undertaking, and one that must be done with care.”

You can read Shumlin’s prepared remarks here.

Related:

Health Care Leaders Call For Closer Scrutiny Of Partners Deal

In an unusual, perhaps unprecedented move, leaders from across the health care industry are calling for closer scrutiny of a deal that would cap prices for Partners HealthCare in the short term but would let the state’s largest hospital network add four more hospitals.

Massachusetts Attorney General Martha Coakley (Steven Senne/AP/File)

Massachusetts Attorney General Martha Coakley (Steven Senne/AP/File)

The deal that is fueling letters, analysis, statements and meetings is between Partners HealthCare and Attorney General Martha Coakley. She says it will limit Partners’ clout and the health care “Goliath’s” (her word) ability to drive up costs. That might be true. But no one has seen any details. The only thing made public is a press release. The public deserves to have more information about such a significant health care industry transaction, says Health Care for All director Amy Whitcomb Slemmer.

“There are a number of unknowns that have a direct impact on the care that will be delivered in Massachusetts and on costs, particularly, the impact to people’s pocketbooks,” Whitcomb Slemmer said.

Coakley has said that the details would be available when the agreement is filed in court. That was supposed to be next week. But Health Care for All, the Massachusetts Association of Health Plans, the National Federation of Independent Businesses/Massachusetts, the Retailers Association of Massachusetts and the state’s largest employer group, Associated Industries of Massachusetts, are all calling for a delay that would allow time for a public review.

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Know Your Mental Health Coverage Rights? Probably Not, Study Finds

Former Congressman Patrick Kennedy testifies at a Massachusetts hearing on mental health parity. (Courtesy of Scott Bryson)

Former Congressman Patrick Kennedy testifies at a Massachusetts hearing on mental health parity in 2013. (Courtesy of Scott Bryson)

No one could ever blame for you failing to grasp all the Byzantine ins and outs of your health insurance plan. But here’s a simple concept that everyone should know, and that most of us don’t: Under federal and state law, your health insurer must treat mental health on a par with physical health, covering care for mental illness and addiction no less than they cover physical care.

How do I know that most of us don’t know this? From a survey of more than 1,000 adults just released by the American Psychological Association (which, yes, may have a vested interest in spreading the word that therapy should often be covered.) It found that only 4 percent knew about the 2008 law that guarantees mental health coverage “parity” with physical health, no higher than in 2010. From the press release:

“More access to mental health care is the rallying cry, but the simple fact is many people may already have coverage and not know it or not understand how to use it,” said Katherine C. Nordal PhD, APA’s executive director for professional practice. “The mental health parity law, together with the Affordable Care Act, has expanded mental health treatment opportunities to many Americans in need who may otherwise have gone untreated. But laws don’t have the intended effect when people don’t know that they exist. Continue reading

Mass. To Drop Contractor Behind Flawed Health Insurance Website

Massachusetts is negotiating an end to its contract with CGI, the Canadian vendor that built the state’s flawed health insurance website.

The site was supposed to be up last October, offering one-stop health insurance shopping for anyone in Massachusetts. But six months later, only a few functions work but have glitches, and a few are not usable at all.

Sarah Iselin, a special assistant to Gov. Deval Patrick hired to oversee the fixing of the website, has been working with a team of outside contractors from Optum to determine if the CGI project can be fixed.

“That assessment made clear that based on past performance and our current needs, parting ways with CGI is the right course for the commonwealth moving forward,” Iselin said Monday.

In a statement, CGI said it will “work with the Commonwealth to ensure a smooth transition to the next phase of exchange deployment, allowing for the best use of system capabilities already in place.”

Iselin and her team told the Health Connector board they are reviewing two possible remedies: hiring a new vendor to build on working parts of the current site or buying website elements from other insurance exchange sites. Iselin cautions that buying elements will be difficult because Massachusetts has many unique insurance rules, including 263 different factors that determine who is eligible for what type of coverage.

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Lesson Of The $446 Ear Rinse: Medical Bills That Make You Say ‘What?!’

(Photo: Robin Lubbock/WBUR)

(Photo: Robin Lubbock/WBUR)

THIS COMMUNICATION IS FROM A DEBT COLLECTOR. THIS IS AN ATTEMPT TO COLLECT A DEBT.  ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE.

Get your attention, all those upper-case, bold-face letters? They certainly got mine, when they came in the mail recently. It was a virginity-losing moment: My first debt-collection letter in more than a half century of financial clean living.

And of course, it was a medical bill that did it — just as it’s medical care that causes more American personal bankruptcies than any other bills.

My health bills for preventive care had all seemed reasonable until now — or at least, they were bountifully paid by insurance. Mammograms, children’s check-ups, all were fully covered. But I’d shifted recently to an insurance plan with a $500 personal deductible, and I’d made a naive mistake: When my doctor kindly offered to clean my waxy ears during my annual check-up last April, I said, “Okay…”

Well, really, how was I to suspect that three or four minutes of whooshing ear-rinse could add up to $446 out of my pocket? (Correction: $446 upon first billing, but knocked down to $338.03 after several long and tortured phone calls, and a medical re-coding. It still struck me as insane, but I paid it to get the collection agency off my back.)

Doctor, if we’re going to cross the line from preventive to billable, I’d like you to let me know.

It’s an ever-more-common American rite of passage: That shocking moment when you unfold the bill, look at the total that is unpaid by your health insurance, and expostulate, “Are you (expletive) kidding me?!?”

Readers, do you have an eye-popping bill and back-story you’d like to share? We’re hoping to make this a series — “Medical Bills That Make You Go ‘What??!'” You can send in your story — and, if you’d like, scans of your bills that will protect your privacy — by clicking on the “Get In Touch” button at the bottom of this page. Goodness knows, you have few other outlets for your frustration.

In my own case, I’m asking you to brave the numbing tedium of any billing tale because there’s a clear object lesson here: Yes, preventive care, including check-ups, must be fully covered by insurance plans under Obamacare. But that doesn’t mean that everything that’s done during a check-up has to be covered.

And therein lies the rub. The line between “preventive” and “diagnostic” or “procedural” can creep up on you, as WBUR’s Martha Bebinger has reported: When Is Preventive Care Free And When Do You Pay? Her report included this valuable lesson: As one Massachusetts woman was horrified to discover, it’s possible to go in for a free — because it’s preventive — colonoscopy, but then, while you’re still on the table, if the doctor finds polyps and removes them, that transforms it into a non-preventive — and thus potentially billable to you — “surgical procedure.”

I’d read that story but clearly I didn’t take its lesson enough to heart. I also take full blame for my longtime practice of getting routine primary care at an expensive top Boston hospital: You can see in the upper right corner of the image above that the initial charge to my insurer for my check-up — which involved no lab tests and nothing higher-tech than a blood pressure cuff — was nearly $1,192.

Still, in hopes that my own financial pain might help others, I asked Blue Cross/Blue Shield of Massachusetts, the biggest health insurer in the state and the one that happens to cover me, for useful pointers. I spoke with Debra Wilson, a senior manager in the Member Service Division. Our conversation, lightly edited:

DW: I think it’s great that you’re highlighting this for people. Folks go in and have preventative visits, and things will invariably come up. The patient is there and having their physical, but they’re also addressing problems. These problems could be longstanding. So it’s important that when something does come up and present itself, that the patient ask questions.

It’s very important that all of us are educated in our health care decisions, and part of that is that we not be afraid to ask, ‘What does that entail and what might the cost be?’

Ask questions beforehand so you’re fully aware of what’s going to be involved, not only with the procedure but the cost. It can generate a liability to the patient, and no one likes an unplanned bill. We’ve also asked our network management team, the folks in the field working with physicians’ offices, if they could also educate the patient at the time — usually after the fact, but let them know, if they were in for a visit and also had a procedure or additional service, that they could receive a balance bill.

We don’t want to discourage these conversations with physicians because it’s probably something they do need to have addressed, and it’s being done all in one trip, so it’s efficient. We just want everyone to be aware of what could happen in terms of cost liability, that that could change depending on services rendered.

The tricky part for the patient is that it can be hard to know whether something is considered preventative or diagnostic or a procedure. For example, at that same checkup of mine, my doctor found that my blood pressure was a bit elevated, so we discussed ways to lower it. Conceivably, that could be billed as not preventive but diagnostic, or an education procedure?

That’s discretionary, based on that particular provider’s office and their billing practices. Certainly, that could be within the preventative visit, but again, I think it’s important not to be afraid to ask those questions.

Would it be reasonable to go into a preventive appointment and say, ‘Doctor, if we’re going to cross the line from preventive to billable, I’d like you to let me know’? Would that be weird? Continue reading

Put Back The Teeth? Why We Separate Dental And Medical Care

Some patients are concerned by a lack of communication between their dentist and primary care physician. (Herry Lawford/Flickr Creative Commons)

Some patients are concerned by a lack of communication between their dentist and primary care physician. (Herry Lawford/Flickr)

My colleague Stef Kotsonis stops me in the hall at work every few weeks with a new pearl of health care wisdom. Last week, it began with the story of three teeth that had to come out.

“I’m getting implants put in, dental implants,” Kotsonis explains, an index finger pulling back his lower lip. “Two down here, bottom left, and one up here.”

He pauses to grin.

“So when they tell you to chew on the other side, it’s a much more subtle dance than that.” Kotsonis is giggling now. “There’s a foxtrot going on at meal time.”

Paying to fix the problem is no laughing matter.

“Our dental plans are awful compared to our health plans,” Kotsonis says. “I’m paying thousands of dollars for these [implants]. It’s, boy, it’s breaking the family bank.”

Should dental health be treated separately from the rest of the body? (US Army Africa/Flickr Creative Commons)

Should dental health be treated separately from the rest of the body? (U.S. Army Africa/Flickr)

Kotsonis is also worried about the lack of coordination between his primary care physician and dentist.

“My own doctor has no idea what’s going on in my dentist’s office,” Kotsonis says. “She doesn’t know if I’m having implants, she doesn’t know if I’m being given these antibiotics, she doesn’t know if these antibiotics clash with anything else she’s doing. And it just seems to me that this is exactly the sort of thing, in this information age, that should be shared.”

How did this happen, this decision to treat the teeth and gums separate from the rest of the body? There is lots of proof that poor oral health is tied to heart disease, diabetes, HIV and can lead to death. So why, in this era of integrated medicine, do we continue to carve out the teeth? And is anyone trying to put them back?

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Health Insurance Limbo: The Latest On Mass. ‘Connector’ Sign-Up

Screenshot of Mass. Health Connector website

Screenshot of Mass. Health Connector website

More than 44,000 Massachusetts residents (as of Dec. 24) who have applied for coverage through the Massachusetts Health Connector are in limbo. The vast majority have applied for subsidized insurance and are waiting to find out:

• If they qualify for free or subsidized coverage
• If they are eligible for a subsidized plan, what are their options?
• If they don’t qualify for government help, do they have to start all over again?

Many people submitted applications months ago. The Connector, the Massachusetts health insurance exchange, has had a lot of problems with its website — to the point that the state is reviewing its legal options against the contractor. Here, we address some of the most common questions from Massachusetts residents who’ve applied for insurance assistance. Connector spokesman Jason Lefferts helped us with the answers:

1) I submitted an application for subsidized coverage. When will I find out if I qualify?

The state expects to send most of the more than 44,000 outstanding applicants a letter by January 1st. The letter will say either:

a) You are approved for a subsidy or
b) the Connector hasn’t processed your application yet and is putting you, temporarily, into a MassHealth (Medicaid) plan.

The Connector is giving priority to applicants who may qualify for an insurance subsidy and aren’t already enrolled in Commonwealth Care. Health plans for everyone who is already in Commonwealth Care have been extended through March.

2) If I qualify for subsidized coverage, how do I choose a health plan? Continue reading

Mass. Employers May Sue Feds Over Obamacare Small-Business Premiums

HHS Secretary Kathleen Sebelius

HHS Secretary Kathleen Sebelius

WBUR’s Martha Bebinger reports:

The state’s largest employer group says it may sue the federal government over a provision in Obamacare that will hike premiums for some small businesses.

The federal health care law changes the way individual and small business insurance rates are calculated.

The Obama administration agreed to let Massachusetts phase in the new system, but said in a letter today that the state must eventually comply.

Under the changes, some employers will see their rates drop, but others may see dramatic increases.

The employer group, Associated Industries of Massachusetts, posts its reaction to the letter on its blog here, including this:

Associated Industries of Massachusetts is gravely disappointed with the decision and will now consider other remedies to help employers, including legal action or supporting legislation to de-merge the insurance market for individuals and small companies.

And here’s a chunk of the denial letter from Secretary of Health and Human Services Kathleen Sebelius to Gov. Deval Patrick: Continue reading

New Medical Privacy: You Pay For Care, You Control Who Sees The Record

medical files

(NPR)

As of Sept. 23, a new provision of the federal law on patient rights and medical privacy — affectionately known as HIPAA — takes effect, and it’s sure to please the paranoiac in all of us. It allows patients who pay for a treatment out of pocket to limit access to the medical record of it — and that includes barring your health insurer from seeing it, if you choose.

Now, this may not excite you if you don’t expect to need treatment for a sexually transmitted disease any time soon. But some people feel deeply protective of their medical records — and may not have warm and trusting feelings toward their insurers or employers. For an explanation of the new privacy provision, I spoke with Matt Fisher, chair of the Health Law Group at Mirick O’Connell, a law firm with offices in Worcester, Boston and Westborough. Our conversation, lightly edited:

So this new HIPAA rule that takes effect on Sept. 23 basically says that if the patient pays for their care, they can keep it from the knowledge of their health plan?

The patient can request that services or items provided, that they paid for out of pocket in full, that access to that information be restricted to specific individuals or providers. So that means that they can say, ‘Don’t share it with this insurance company,’ which request previously could be ignored by a provider.  This change modifies the existing rule that a patient can ask for information to be restricted, but doing so is at the provider’s discretion.  It is now not optional with regard to health plans.

So how does this differ from what we already had?

Attorney Matt Fisher (Courtesy)

Attorney Matt Fisher (Courtesy)


You already had protection from just general disclosure of the information, but there were permitted disclosures that can be made between what are called covered entities: a physician, a hospital or an insurance company. So absent the request that the information not be shared if the services are paid for out of pocket, that information can be shared with insurers without the patient’s authorization, if it’s for payment or health care operations. Those three broad categories allow providers and insurers to interact and each perform their functions. So it makes sense you wouldn’t require authorization for that type of sharing.

But the new provision says that if the patient has paid for it out of pocket, now you can say, ‘Don’t share it with my insurer — they don’t need to know about it because they’re not paying for it.’ Or there could be some other reason you don’t want it shared.

Can you paint a couple of scenarios of how you expect this to be used once people know about it?

One example I’ve heard about a lot is if an individual goes in for a treatment of a sexually transmitted disease — so there might be a feeling of some type of social stigma or some other instance where you might have the feeling of not wanting it shared.

So anything with stigma? Continue reading

Married To Obamacare: The Soap Opera

Obamacare is hard. It’s a great big behemoth of a health care overhaul, packed with complex changes for a complex labyrinth of a system. No normal person could be expected to stay awake through the law’s 800-plus pages. But it’s important — both as policy and because it could affect your care and your wallet.

So sometimes, we get a little desperate to explain it. And hey, who doesn’t? MIT professor Jon Gruber even turned it into a comic book. The Kaiser Family Foundation made a game-like video, and has just put out a new cartoon: “The YouToons Get Ready for Obamacare.”  We’ve tried “listicles” — 10 Things About Obamacare You May Not Know But Should — and distilling it into a 3-minute video.

But now we’re getting extra desperate because the real Obamacare countdown has begun. The Washington Post even started a 100-day countdown until millions of Americans can start enrolling in the overhaul’s health insurance expansion.

So we’re trying yet another ploy: A cheesy soap opera. Below, CommonHealth intern Sascha Garrey uses her creative powers to sneak a dozen key points you should know about Obamacare into an over-the-top melodrama. For Cliff Notes types, we’ve highlighted the points in bold and listed them at the end. And for aural learners, click on the “play” button above to hear a delicious excerpt as a radio drama, produced by WBUR’s George Hicks.

Image courtesy of Clare Bloomfield / FreeDigitalPhotos.net

Image courtesy of Clare Bloomfield / FreeDigitalPhotos.net

By Sascha Garrey
CommonHealth intern

“I didn’t need that fourth glass of wine,” Cassandra St. James grumbled to herself as she slammed off her wailing alarm. Her headache from last night’s binge was beyond splitting, making her simultaneously grouchy and grateful that, thanks to federal health reform, her health insurance plan was banned from putting annual limits on essential services –  lately, she’d been going through her prescription migraine pills like they were Skittles.

“Uggghh…I cannot face another day at work!”

Cassandra had been feeling the heat at her job lately, perhaps sparking this new interest in multiple glasses of wine per evening. Being a customer service representative at a Boston-based health insurance company during the advent of federal Health Reform was stressful to say the least. But tension at work wasn’t the only reason for Cassandra’s hangover.

Cassandra was engaged to a man she hardly knew, even though she was still heartbroken over the loss of her true love, Dr. Lance Jones. It’s been almost three years since the freak boating accident that took Dr. Jones’ life along the Cape, but his body was never found, leaving Cassandra without closure. Maybe that’s why she’d agreed to marry Chip Montebello.

To be sure, Chip had a good heart, but his health insurance situation left something to be desired. His decision to defy the state’s individual mandate left him with a greater tax burden and no health benefits.

What’s more she had financial woes coming at her in every direction. It didn’t help that the health insurance available to her through her employer was all but affordable, with over 9.5% of her income put towards her premium each month. In more desperate moods, Cassandra fantasized about having the freedom to buy insurance over the Health Connector, but that fantasy was too farfetched even for her. Massachusetts law prohibits anyone with insurance available to them through their job to seek coverage elsewhere, regardless of its affordability.

But it wouldn’t matter even if she could stray to the Connector. Ever since her so-called “big promotion” her salary was boosted to $45,960 and with her household size of one, that boost put Cassandra at 400% of the federal poverty line. With an income at that level, she wouldn’t even qualify for any of the state subsidies for purchasing insurance on the Connector, available only to those with incomes between 133 – 300% of the federal poverty line.

“And then there’s my mother,” Cassandra said under her breath as the phone rang. Continue reading