Mass Plan turns 1 and raises prices in celebration

Posted on: June 30, 2008  |   Author: Felicia
Filed Under: Access to Care, HMOs & Health Plans, Other, Public Health Policy   |   Leave a Comment

As the Massachusetts health plan begins its second year of mandated coverage, many residents are concerned about the dramatic increase in premium costs. The Commonwealth’s health plan has experienced a number of complications including a shortage of health professionals and costs that are much higher than anticipated. Now that this cost increase is being passed on to the residents, people are starting to feel an even harder money pinch when it comes to paying for health insurance and health care costs.

Its my birthday and I’ll raise costs if I want to.

Insurance Coverage of Eating Disorders: Finding the Road to Recovery but at What Cost?

Posted on: June 30, 2008  |   Author: Megan
Filed Under: HMOs & Health Plans, Other   |   Leave a Comment

In a land breaking settlement, Aetna Inc. agreed to pay $250,000 in reimbursements to around 100 New Jersey policyholders whose insurance claims were denied.[1] Their claims were denied because the insurance company refused to cover their eating disorders. If the settlement agreement is approved, it would bring a close to a federal class-action suit brought by individuals seeking the same insurance benefits for bulimia and anorexia that insurance companies typically offer for biologically based mental illness such as schizophrenia.

The debate centers around whether eating disorders are considered biologically based conditions. In the past, researchers thought anorexia was mostly an environmental disorder, brought on by cultural pressures surrounding body image. Recently, however, researchers are finding links to suggest there may be a “powerful biology” involved in causing anorexia. It appears that further research must be done before there will be an answer to this classic nature vs nurture debate. There is also the possibility that anorexia is only triggered when an individual has a genetic predisposition and is also faced with external environmental events which cause the disorder to manifest.

According to the New Jersey Law Journal article, “Insurer Settles Class Action Seeking Health Coverage for Eating Disorders,” biological based mental illness treatments have been covered by insurance providers for many years. The Aetna settlement would now hold insurance companies more accountable for biological eating disorders as well.

The struggle of one family was highlighted in the People Magazine Article, “An Anorexia Victim Fights Back.” The Meiskin’s daughter Marisa suffered from anorexia. To treat her disorder, the family had to put their daughter in long term residential care. Their insurance company, Aetna, would only cover thirty days of inpatient treatment a year. Experts say that anorexics typically need ninety to one hundred-twenty days to fully restore weight and receive relapse-prevention treatment. The Meiskin’s were fortunate in that they were able to take out a line of credit and had the financial ability to keep their daughter in treatment. Many families have no way to pay for the treatment their child requires. The Aetna settlement will not only pay back the Meiskin family the $60,000 they paid out of pocket, but the settlement also provides hope. Individuals suffering from eating disorders who may not have had access to long-term treatment now have the opportunity for a more complete recovery.

In response to the class-action settlement, the New Jersey state senate is considering legislation that would mandate equal insurance coverage for anorexia and bulimia. This is likely an issue that will continue to gain national exposure as other state senators engage in similar debates. Already insurance companies and doctors argue over the treatments which qualify as “medically necessary.” Insurance companies will often cover the cost of hospital treatment of individuals suffering from anorexia, but draw the line at recommended post-hospital treatment. Even after anorexia victims have reached a stable health level they still suffer from psychological issues which require long-term treatment. Left untreated, anorexics have a high rate of suicide.

The effects of the Aetna settlement could be far-reaching. First, this could lead to an increase in plaintiffs who may now institute suits against insurance companies. Second, for individuals struggling with eating disorders, this judgment could bring some much needed relief. Hopefully, it will lead to more individuals receiving the treatments they require which will lead to lives being saved. Finally, from an insurance company perspective, the judgment could be unsettling. Many eating disorders require long term recovery treatments at great cost. To cover additional long term expenses, insurance companies may need to raise premiums. This in return could affect the ability of individuals to become insured. Ideally, insurance companies will find a way to balance the rising need of individuals struggling with eating disorders who need long term treatment without raising the cost of their coverage. By covering individuals suffering from these disorders, countless lives could be saved.

[1] Sources utilized for this blog: Henry Gottlieb, “Insurer Settles Class Action Seeking Health Coverage for Eating Disorders”, New Jersey Law Journal, 192 N.J.L.J. 621, June 2, 2008; Charlotte Triggs, “An Anorexia Victim Fights Back”, People Magazine, July 7, 2008.

US House votes to eliminate Medicare reimbursement cuts for doctors

Posted on: June 30, 2008  |   Author: Will
Filed Under: Hospitals & Health Systems, Medicare   |   Leave a Comment

Now an annual event, the United States House has sent a bill to the Senate eliminating a proposed 10.6% cut in Medicare reimbursement for physicians (HR 6331). The rate cut is scheduled to be effective July 1, assuming the bill is not passed by the Senate and signed by the President.
Other important provisions in the bill include a reduction of the Medicare co-payment for mental health services from 50% to 20%. Also, the bill requires private insurers to reimburse pharmacies within two weeks of billing.

For more details, click here.

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