10. March 2008 by Jon Moss.

New York Attorney General Andrew Cuomo’s office has issued subpoenas to eight health insurance company CEO’s, including UnitedHealth Group Inc. Stephen Hemsley, according to media reports.

The measure is an expansion of Como’s investigation into reimbursement practices of health insurers.

We previously blogged that New York’s attorney general planned to sue Minnetonka-based UnitedHealth Group (NYSE: UNH) and its subsidiary Ingenix, calling the insurer part of an industrywide effort to defraud consumers by manipulating reimbursement rates.

In February, Cuomo’s office issued 16 subpoenas to health insurance companies including Aetna, Cigna and Empire BlueCross BlueShield as part of a six-month investigation into how the insurance industry handles reimbursements for physicians who are outside of a health plan’s network.

A spokesman for Cuomo’s office told Bloomberg News that it has issued another 20 subpoenas that included demands for depositions of the CEOs, including those at Cigna Corp, Aetna, and WellPoint Inc., the news service reported.

A spokesman for UnitedHealth told Bloomberg, “We’ve been in ongoing discussions with the attorney general and we are continuing to cooperate fully.” UnitedHealth has refused to specifically confirm or deny the subpoenas.

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27. February 2008 by Jon Moss.

The Department of Justice (DOJ) has filed an antitrust lawsuit in U.S. District Court in Washington in an effort to impede UnitedHealth Group Inc.’s proposed $2.6 billion acquisition of Sierra Health Services Inc.

According to the Department, UnitedHealth must sell portions of its business first to ensure competition.

Although UnitedHealth has agreed to those conditions, the DOJ’s antitrust lawsuit cited concerns that the merger would reduce competition in the Medicare health insurance market in Nevada, according to reports.

The Department’s proposal, which must be approved by the court, asks that UnitedHealth sell portions of its Medicare Advantage business in the Las Vegas-area for the merger to proceed, according to reports.

Otherwise, officials with the Department argue, the new company would control 94 percent of the Medicare Advantage market in that area.

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27. February 2008 by Jon Moss.

Aetna announced today that it has launched a secure, provider Web site with NaviMedix, a leading innovator in automating health care provider communications.

Through NaviNet, NaviMedix’ s multi-sponsor health care communication platform, health care providers have easy, one-stop access to most major payers and select regional carriers, improved security options and improved electronic administrative transaction capabilities, according to reports.

Aetna’s secure provider Web site via NaviNet offers many easy-to-use features to both participating and nonparticipating physicians, hospitals and other health care professionals, the company says.

Free, real-time transactions are available with Aetna as well as other payers including major health plans and the Medicare program and enhanced administrative options provide one-stop service, as only one user name and password is needed to interact with Aetna or other health plans.

Meanwhile, health care providers can check eligibility and benefits in real time, submit or inquire about claims, review claim payment policies, view and print explanation of payments online within 24 hours of claims processing, obtain electronic remittance advices, access Aetna’ s education site and conduct many other activities, according to Aetna.

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26. February 2008 by Jon Moss.

Humana Inc. is realigning its subsidiary that comprises ancillary insurance benefits such as dental coverage and life insurance and renaming the division Humana Specialty Benefits.

The former HumanaDental Insurance Co., based in Green Bay, Wis., has served as a sort of “holding place” for products that fall outside of the company’s traditional medical offerings, said Jeffrey B. Bringardner, president of Humana’s Kentucky market.

With recent acquisitions of CompBenefits Corp. and KMG America Corp., both of which closed during the fourth quarter of 2007, Humana’s ancillary-product offerings have expanded significantly.

Membership in the specialty benefits division has more than tripled following the two recent acquisitions, to 6.8 million from 1.9 million

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19. February 2008 by Jon Moss.

Humana has a nifty little tool allowing for the access and analysis of small employer group plan utilization.  Would it be helpful for you as a small business to be able to know how often your employees:

• visit the doctor
• purchase prescription drugs
• meet deductibles & out-of-pocket maximums

 That type of information is extremely important to employee benefit specialists.  It allow us to determine which benefits are more important to the employees, and which ones are less used.  When implementing an HSA or HRA knowing this type of data is crucial to the success of the plan.

 Humana has recently updated BUD to allow brokers, and the small businesses they advise, access to actionable, group-specific benefit information previously available only to large companies, allowing employers to model the impact of different benefit designs, track health plan usage, and ultimately better budget for employee health care – a large and growing bottom-line expense for many small firms.

“BUD empowers brokers to deliver an unparalleled level of guidance to small companies as they make critical decisions about their health coverage,” said Jerry Ganoni, president, Humana Small Business. “Many companies unknowingly provide richer benefits than their employees use or want. With knowledge gleaned from BUD, small businesses are better able to choose the most appropriate health benefits solution for their workforce.”

Designed with the help of Humana’s actively-appointed brokers and agents, BUD features two primary tools to help employers choose and use their health plan with confidence: the Health Utilization Tool and the Contribution Strategy Tool, both of which protect the privacy of employee health information by removing identifying data.

The Health Utilization Tool offers employers information about employee usage of key services, including doctor office visits, prescription drug purchases, inpatient admissions, outpatient surgery and emergency room visits. Brokers can show small employers how the usage of these services by their own employees compares with that of similar accounts in the same geographic area and industry. Brokers can help employers track deductibles and out-of-pocket expenses to see how many employees have satisfied zero percent, 50 percent or more, and 100 percent of their in- and out-of-network limits.

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19. February 2008 by Jon Moss.

AvMed Health Plans announced recently it is adding several new small group plans, some of which are 50 percent less than their existing plans.

The lower-priced plans offer low co-payments for routine visits to primary care physicians and specialists and low co-pays for prescription drugs. The company is also adding new pairing choices to allow small group employers more flexibility.

Gainesville-based AvMed Health Plans provides health care coverage to both small and large employer groups in Florida and has offices in Orlando, Miami, Fort Lauderdale, Tampa, Gainesville and Jacksonville. The company also provides Medicare in Miami-Dade and Broward counties.

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19. February 2008 by Jon Moss.

Florida’s HMOs had a healthy combined profit of $540 million for the first nine months of 2007.

That’s a whopping 33.3 percent increase when compared with a $405 million profit for the same period in 2005, according to data just released by the Florida Office of Insurance Regulation. Third-quarter 2006 numbers were unavailable.

The state’s 37 HMOs brought in a combined $12.4 billion in premiums, or a 4.5 percent profit margin, for the first nine months of 2007, compared with $8 billion in premiums, or a 5 percent profit margin, for the same period of 2005.

The slightly lower profit margin is due to costs continuing to grow faster than premiums, says Doug Sherlock, president of Sherlock Co., a North Wales, Pa., firm that provides financial analysis for health plans and investors.

Posted in insurance companys, medical | No Comments »

15. February 2008 by Jon Moss.

Posted in health insurance reform, insurance companys, medical | No Comments »

15. February 2008 by Jon Moss.

by Kathleen Kerr 

State Attorney General Andrew Cuomo said Wednesday he plans to sue UnitedHealth Group — the country’s largest health insurer — and its subsidiary, Ingenix, after the company allegedly manipulated data to cheat consumers out of adequate reimbursements for medical care.

Cuomo said he has launched an industrywide investigation into health care reimbursements and estimated that some companies have been lowballing payments to customers for a decade. A six-month probe found two United subsidiaries — United HealthCare Insurance Co. of New York Inc. and United Healthcare of New York Inc. — used Ingenix data to severely under-reimburse customers and cheat them out of millions of dollars, he added.

Cuomo has not charged the companies with wrongdoing but he said investigators found United lied about data and manipulated numbers to keep its reimbursements low. The probe is ongoing.

The attorney general said he would file a civil lawsuit that would include three other subsidiaries of United and will seek restitution for consumers.

Additionally, Cuomo has subpoenaed 16 of the country’s largest insurers, including Aetna, CIGNA and Empire BlueCross BlueShield.

The subpoenas request the companies provide documents that show how they computed reimbursement rates, copies of member complaints and appeals, and communications between members and Ingenix and the insurers.

Cuomo’s office said the probe found that the Ingenix reimbursement database — owned by United but used by most major health insurers — used data that resulted in smaller payments to consumers.

Dr. Nancy Nielsen, president-elect of the American Medical Association, who attended the Manhattan news conference at which Cuomo announced the investigation, indicated the fraudulent reimbursement system was widespread, noting: “United has a track record that stretches from Monterey to Montauk.”

Those potentially affected were people with “out-of-network” insurance that allows them to seek care from any doctors they choose. About 28,000 Long Island residents have out-of-network policies with United, a Cuomo spokesman said. “When insurers like United receive convoluted and dishonest systems for determining the rate or reimbursement, real people get stuck with excessive bills and are less likely to seek the care they need,” Cuomo said.

In a statement, Minneapolis-based United said it is in discussions with Cuomo and that: “The reference data is rigorously developed, geographically specific, comprehensive and organized using a transparent methodology that is very common in the healthcare industry.”

And Empire Blue Cross Blue Shield president Mark Wagar said the company would continue to work with Cuomo’s office to determine whether any of the information used was inaccurate. “If that is found to be the case,” Wagar said, “Empire would consider any and all remedies available to protect the interests of our members, their families, our group customers and providers in the New York marketplace and to maintain our company’s historic commitment to fair and reasonable coverage.”

Consumers have become accustomed to receiving reimbursements based on what insurance companies call “reasonable and customary” prices for the area where they live.

But Cuomo said that while the United companies that used the database knew customary charges for a doctor’s visit might average about $200, the reimbursement was based on a charge of $77 per visit. Using those numbers, customers who receive 80 percent reimbursements would receive only about $61 for a visit that cost them $200.

“Based on the findings in this investigation,” Consumers Union program director Chuck Bell said, “it appears that United Health failed to fulfill the promises it made to cover a fair portion of medical expenses and consumers were stuck with the bill.”

Dr. Nielsen said, “The investigation launched today by New York Attorney General Andrew Cuomo calls into question the validity of a system that health insurers have used for years to reimburse physicians and their enrolled members.”

And Dr. Robert Goldberg, president of the Medical Society of the State of New York, indicated support for the probe, saying there will be “long-term benefits to health care in New York” as a result of cracking down on reimbursement pricing.

Posted in health insurance reform, insurance companys, medical | 2 Comments »

14. February 2008 by Jon Moss.

The following acquisition enhances the MetLife offering in California, Florida & Texas only:

NEW YORK – MetLife Inc. (NYSE:MET), one of the largest providers of life insurance in the United States, has completed its acquisition of Aliso Viejo, Calif.-based SafeGuard Health Enterprises Inc. Terms were not disclosed

SafeGuard is a provider of ancillary benefits – such as preferred provider organization (PPO), administrative services-only (ASO) and dental health maintenance organization (DHMO) dental and vision plans – to 1.8 million members. It focuses on the California, Florida, Texas and Nevada markets.

“I am very pleased to welcome SafeGuard into the MetLife organization,” Bill Mullaney, president of MetLife’s Institutional Business division, said in a statement. “The company’s solid reputation and dental expertise are an ideal enhancement to MetLife’s benefits offerings, particularly in those areas where employers are looking for dual-option dental benefits, such as a dental health maintenance organization (DHMO) and preferred provider organization (PPO).”

MetLife, a provider of dental benefits for more than 45 years, administers dental plans for about 21 million people through its subsidiaries and affiliates.

“It is exciting to leverage the successes of our two organizations – now all part of the same family of companies – to provide customers with additional choice and flexibility in achieving their benefits objectives,” added Mike Schwartz, vice president of MetLife’s Dental Product Management division. “I look forward to a smooth transition as we continue to ensure customers receive best-in-class service and support.”

MetLife Inc. (NYSE: MET), based in New York City

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