Obama Plans Health Insurance Appeals

The White House administration announced new federal guidelines for individual and employer health insurance plans which will guarantee consumers the right to an appeal process with an outside neutral party.
The new rules will not take effect until next year because the insurance companies and President Obama’s guidelines is complex. The President is giving state insurance companies time to comply with the new guidelines.
While health insurance companies already have an appeal process in place, these guidelines are more consumer-friendly. If a medical claim is denied, the consumer appeals to the insurance company. If denied again, the consumer has the right to appeal to an outside source at the cost of the insurance company. The ruling of the outside source is binding and if the claim is founded, the insurance company has to pay the claim in full.
Assistant Labor Secretary Phyllis Borzi told reporters the appeals protections do not apply to health plans that were already in place at the time Obama signed the law and are considered "grandfathered." There will be additional guidelines forthcoming for the larger employers hire an insurance company to administer the coverage they pay for directly.
Some opponents of so-called “Obama-care” (the health insurance reform) have said that these guidelines will make health insurance less affordable. If the insurance company has to pay the cost of an outside appeal to a mediator, the costs will be past down to the consumer via increased premiums and the like. One such supporter who does not wish to be identified said, “And you can bet that each denial will come with an appeal just to stick it to the companies any way they can. They aren’t out for health care coverage, they’re mad because they’re poor.”
Supporters disagree, of course. There have been countless cases of denied health insurance that have led to preventable deaths across this nation. It is not the case that these individuals are poor and are out to “stick it” to anyone but that they just want what they feel is owed to them. “I think if I pay premiums for health insurance, I should have coverage, period. It’s what I paid for! If your job hands you a paycheck and then tells you your next job task, and you try and say to them, Sorry, task denied… what do you think they’d do? It shouldn’t work this way and I am glad the President is doing something about it,” says supporter, Tina*.
Either way, most Americans will see the new rules take place by July of 2011.

Montana To Launch Expanded Health Insurance Plan for Children

A plan that combines the Children’s Health Insurance Plan and children’s Medicaid into one entity and in the process broadens free or low-cost health care coverage for young people up to age 19 goes into effect on October 1 in Montana. In November 2008, the initiative that makes this expansion of health insurance for children possible was approved by 70 percent of Montana voters.
Initiation of the new program will make applying for health insurance coverage easier, as it reduces a once 12-page application to nearly half. Parents can also apply for health insurance coverage over the Internet. This is part of the effort to make coverage available to an additional 29,000 children in Montana.
At this point in time, the two separate programs provide health insurance coverage to about 70,000 children. To help ensure the program reaches the additional children who qualify, Montana’s Department of Public Health and Human Services plans to enlist the help of “enrollment partners” that include health care professionals and community-based organizations, and to institute outreach programs in schools and community health clinics.
This new move will bring the total number of Montana’s children covered by health insurance up to about 100,000. Under new income guidelines, a family of four can earn up to $55,125 annually (about 250% of the federal poverty level) and still qualify for the Healthy Montana Kids Plan.
The new health insurance program will cost an estimated $20 to $22 million during the first year, which will bring in additional federal matching monies. A portion of Montana’s insurance premium tax would provide the state’s portion of the cost. Although there are no premiums, some families will have copay requirements.
Items covered under the health insurance plan include office and clinic visits, emergency and hospital services, well-child checkups, mental health services, substance abuse services, dental coverage, vision and hearing exams, and more. Applications for the program are available in all Montana communities in county health departments, health care facilities, WIC offices, Head Start facilities, Indian Health Services, county Offices of Public Assistance, and more.

Pet Owners Upset Over Frustrations with Health Insurance Benefits

Flexcin International, the makers of Flexcin® joint nutrition supplement for people and FlexPet® joint nutrition supplement for pets, reports 12.6 percent more demand for FlexPet this year from people frustrated and disappointed with their pet insurance coverage.
A little more than 150,000 pets are insured and DVM NewsMagazine reported the “stop treatment” threshold for most people is roughly $1,400 in pet health costs. What’s more, a recent analysis by Consumer Reports magazine concluded that pet insurance may not be beneficial to some whose pets never encounter a catastrophic experience.

Pet owners say pet health insurance is not always reliable

More pet owners say they’d be better off providing better preventative care for their pets rather than rely on pet health insurance and wellness programs that often lead to confusing and inconsistent coverage. Demand for FlexPet has increased this year for people looking to nurture their pets’ joints back to good health rather than let insurance cover portions of an expensive joint replacement procedure. Many of these people report their insurance policies are filled with unclear restrictions and confusion surrounding pets with pre-existing conditions.
“With frustrating policy exclusions, fuzzy rules on pre-existing conditions and unclear benefit schedules, pet insurance may no longer be the right decision for my pet and me,” said Christina Fajardo, a pet owner and California resident. “It makes more sense to focus on keeping my pet in good health through regular checkups, proper diet and nutrition. It’s gotten to the point where it’s just as much of a headache as my own confusing heath insurance.”
California ranks as the fifth most popular state in filling FlexPet orders, and demand is expected to rise after Governor Arnold Schwarzenegger recently vetoed legislation AB 2411 calling for better disclosure of pet insurance benefits.
Consumer Reports cited an example in comparing the lifetime cost difference between carrying pet insurance with that of regular veterinary visits and checkups. The analysis showed the pet owner would have paid up to $5,000 more in pet insurance costs compared to the cost of the checkups.