| New US scrutiny could curb anemia drugs' use
WASHINGTON (Reuters) - Sales of blockbuster anemia drugs made by Amgen Inc. and Johnson & Johnson face further pressure as U.S. health officials review their risks and how the government pays for them. New warnings of deaths and life-threatening heart problems in some patients have sparked concern at the Centers for Medicare and Medicaid Services (CMS) -- the nation's largest health-care payer. The agency, which covers the poor, elderly and disabled, is examining its coverage of the drugs, called erythropoiesis-stimulating agents. Private insurance carriers could follow suit. .
Private Medicare plan struggling to stay out of receivership
Universal Health Care Insurance Co. Inc., a St. Petersburg-based private Medicare plan provider, is continuing legal efforts to hold off a threat of receivership, while trying to meet a state demand that it increase its financial surplus by about $150 million. Universal has about 80,000 policyholders in its Any, Any, Any Plan, which has been the target of actions by the Florida Office of Insurance Regulation since February. Universal denies that it is insolvent and has stated that it will continue to pay claims for its members while trying to resolve its problems with the OIR. Should Universal go into receivership, members would be able to enroll in other private Medicare plans or, at worst, simply revert to traditional Medicare. Currently, "Universal is not in receivership," said Nina Banister, spokeswoman for the state Department of Financial Services.
Partnership addresses health care needs of the vulnerable
Most Coloradoans have access to basic health care – checkups, immunizations, dental care and mental health counseling – through employer-sponsored insurance, but about 770,000 or 17 percent of residents lack any kind of health insurance. Medicaid is a publicly-funded health insurance program for about 400,000 low-income children, some of their parents, people with disabilities and elders. Likewise, the Child Health Plan Plus (CHP+) program insures about 50,000 children and pregnant women with incomes somewhat higher than Medicaid thresholds. Because of low reimbursement rates, however, Coloradoans enrolled in these publicly-funded programs may have difficulty obtaining care from private doctors and hospitals. Fortunately, there is a health care safety net, a collection of public and private clinics and hospital emergency departments that provides basic health care to these vulnerable populations.
Health insurance plan to face test at polls
Voters on Sunday decide on a proposal to introduce a single health insurance company in Switzerland and premiums based on income and wealth. The plan, which is supported by the centre-left but opposed by the centre-right as well as the business community, parliament and the government, is the latest in a series of attempts to cut increasing costs, notably health premiums. There are currently 87 private insurers providing mandatory coverage for basic health care for residents in Switzerland under a 1996 law. But health premiums have soared spectacularly over the past decade.More than 100,000 people are no longer covered because they haven't paid their premiums.The centre-left Social Democrats and the Greens say a single health insurance scheme would boost the efficiency of the system and allow annual savings of at least SFr300 million ($245 million) in administrative costs."The multitude of insurance firms creates nothing more than high costs, because they all provide the same service and try to win as many young and healthy clients," said Social Democratic Party president and parliamentarian Hans-Jrg Fehr.
Health chief pitches governor's care plan
MACOMB - Dr. Eric E. Whitaker, the state's public health director, was at Western Illinois University Tuesday afternoon to discuss details of Gov. Rod Blagojevich's new comprehensive plan to provide all Illinois residents access to affordable, quality health care insurance.Coming off of his "All Kids" plan to extend health care coverage to all children in Illinois last year, Blagojevich continued to display his dedication to improving state health care when he announced his "Illinois Covered" plan earlier this month.The plan aims to provide affordable health care to the 1.4 million Illinois residents currently uninsured from a private insurance provider by focusing on those populations that most often lack the resources to purchase health insurance. .
Low Premiums Do Not Mean Affordable Health Insurance
Sickness or injury can leave people in serious financial jeopardy even when they have health insurance, according to a report released by The Access Project and Brandeis University. The Illusion of Coverage: How Health Insurance Fails People When They Get Sick, reports findings based on in-depth interviews with dozens of insured Americans in seven states.
"Widespread debt and access problems among insured people represent major product failure in our private health insurance market," stated Carol Pryor, Senior Policy Analyst at The Access Project and co-author of the report. "Confusing and complex insurance policies, routine denial of claims that should be paid, and poor customer service plague the insurance industry. These problems call for the establishment of clearer rules and standards of accountability for health insurers."
"For too many Americans, health insurance fails to protect them from the costs of medical care," said Jeff Prottas, coauthor and professor at The Heller School for Social Policy and Management at Brandeis.
General insurers may cut share of TPA business
MUMBAI: With big names in the insurance industry buying equity interest in third party administrators (TPAs), general insurance companies are planning to withdraw their business from them.
This could blow a Rs 500-700 crore hole in revenues of TPAs like Paramount, Family Health Plan and Medi Assist say experts. A third party administrator works on behalf of an insurance company to manage claims and customers.
Sources said United India and National Insurance have sent out circulars to these TPAs informing them of their decision.
Others like New India Assurance, Oriental Insurance and private players like ICICI Lombard and Iffco Tokio are also expected to follow suit.
At present, TPAs earn over 75% of their business from the public sector companies, with the balance coming from private players.
'I can't afford to get sick'
"I can't afford to get sick," the Hagerstown resident said. "Recently, I had a fever, sore throat and really bad head congestion. But I decided to ride it out." Miller said she works about 30 hours a week in retail. But as a part-timer, she doesn't qualify for health care coverage. And with her wages, she can't afford a private policy of her own. "I hate not having health insurance," she said. "But from the quotes I've received, all of my money would go for premiums. I have rent, utilities and car payments to consider." Miller said she did find a doctor who has put her on an installment plan when she needs medical care. "But there were times when I should have gone to the doctor that I didn't," she said.
If physician opts out, you're on your own
I have Medicare and a federal retiree health insurance plan. The specialist I want to go to has opted out of Medicare, and I had to sign a contract with her that I would accept the full cost of her services which would ordinarily be covered by Medicare. I agreed to this because I thought my federal coverage would pay the bill for me. However, I was billed a lot of money anyway. Is that right? Because you entered into a private contract with your physician, Medicare will not pay any portion of the charges, and your federal plan, which supplements Medicare, won't increase its payment to the specialist, either. The payment from your supplemental plan will be limited to the amount that would have been paid after the original Medicare plan paid. You are responsible for paying the difference between the billed amount and the amount your supplemental plan paid.
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