Health Insurance Consumer Information

Several states are investigating and considering actions to regulate the practices of limited- or scheduled-benefit plans being offered by HealthMarkets and its subsidiaries, Mega Life, Mid-West National and Chesapeake Life. Regulators say they have received a higher-than-normal rate of complaints about poor coverage and deceptive sales practices from these insurers.

While some analysts say that these low-coverage policies are better than nothing for sick consumers, the question remains of whether limited-benefit coverage policies, which set tight limits on what, and how much, the insurer will pay, are offering policyholders enough financial protection to be considered “insurance” at all.

As quoted in a recent USA Today story, Georgetown University Health Policy Institute’s Mila Kofman says: “The idea behind being privately insured is that your insurance company will pick up the bills when you’re sick, not for government programs to pick up the bills after you’ve paid premiums to the insurer … By the time a consumer realizes they don’t have a major medical policy, it’s too late.”

Read the original story at USA Today’s website: Limited policies vex some buyers.

A recent NPR story covered the history of the last decade of health care reform and HIPAA. The law, which was passed in 1997, was intended to allow individuals to keep health care coverage even when their employment status changed. However, most observers say that it hasn’t turned out that way.

“There’s just really not a guarantee that you’re going to have comparable coverage at a comparable price” when you leave your previous employer and go to a new one or go to work for yourself, says Karen Pollitz, the director of Georgetown University’s Health Policy Institute programs on health insurance.

Joanne Silberner’s story was presented on Morning Edition – you can listen at the NPR website.

US News and World Report published a story earlier this week quoting project director Karen Pollitz, which uncovered the unsavory hard truths about health insurers who deny coverage for pre-existing conditions, and deny policies based on pre-existing conditions.

As Pollitz notes, some in the business community say that pre-existing condition exclusions may be intended to encourage people to get insure before they are sick, rather that waiting until they are sick when their conditions will cost insurers more.

“It’s a penalty for waiting to get insurance,” says Pollitz. “But a lot of people didn’t wait. They had coverage, and they lost it.”

The article also contains advice to consumers about keeping group health insurance if at all possible.

Read it at the US News and World Report website: Health: An Ailment Could Delay or Rule Out Healthcare Coverage.

Mila Kofman, Associate Research Professor at Georgetown University’s Health Policy Institute, was quoted in a Wall Street Journal story on one Utah company’s proposal to market discriminatory health insurance practices to US businesses.

Commenting on the entrepreneur’s business idea, which is that employers should drop group health insurance coverage for their employees and instead provide individual insurance policies for eligible employees, Kofman said:

“I think this is blatantly illegal … I would not advise any employer to do this.”

Read the story online: Employers Turn to Alternative for Insuring Staff.

Karen Pollitz, Project Director of the Health Policy Institute at Georgetown University, spoke to USA Today about a new set of high-deductible health care plans being offered by United Healthcare and others.

These plans offer financial incentives, in the form of significantly lower deductibles, for enrollees who submit to health tests that show they fall into generally healthy standards. This is advertised as promoting healthy lifestyles which in turn can lower illness rates in some categories. But do the damaging consequences to privacy and potential discrimination against the less-than-healthy, outweigh the benefits?

“A key protection in the Americans with Disabilities Act is that your employer can’t discriminate against you based on health status,” says Karen Pollitz at the Georgetown University Health Policy Institute. “They can’t even ask about your health, with the only exception being if they ask through a voluntary program. You could argue that this program is not voluntary.”

Read the story at the USA Today website: Plan bases deductible on health tests, sees costs fall.

Assistant research professor Mila Kofman of Georgetown University’s Health Policy Institute was quoted in an Associated Press story about the increasing numbers of hospital patients and health care consumers who use the web to research medical costs and healthcare quality.

Noting that hospitals rarely put the actual charges that insurers pay on their web sites, Kofman is quoted as saying: “There is a certain level of faith that we have to put in other experts to help us make decisions … I think if I was sick, I would want my physician to make recommendations on proper course of treatment.”

healthinsuranceinfo.net has published guides about medical bills and medical debt, which you can download for free online: Managing Medical Bills: Strategies for Navigating the Health Care System

Karen Pollitz, project director for Georgetown University’s Health Policy Institute, spoke on a Kaiser Family Foundation panel about current health insurance coverage for families, pregnant women and newborns, and about current proposals that may change the way maternity charges are covered.

Speaking about consumer-driven health plans, or “CDHPs,” Pollitz was quoted as saying:

“[The medical cost of pregnancy and delivery] is an issue that consumers struggle with from time to time with health insurance regardless of what kind of plan you have … But the stakes are higher with these CDHPs because if you’re wrong or you have a claim you’re on the hook for so much more money.”

Pollitz offers guidance for those looking at family coverage options from health insurers, covered in an article from Dow Jones’s MarketWatch. Read it here: 10 things to consider about your insurer’s maternity coverage.

Read the full report, available at the Kaiser Family Foundation website: “Maternity Care and Consumer Driven Health Plans.”

Read the Washington Post’s coverage of the report: High-Deductible Plans Cost More for Maternity Care

Georgetown University Health Policy Institute Project Director Karen Pollitz appeared as a guest on “Talk of the Nation” on May 11, 2007, on National Public Radio. The show covered recent developments in the health care reform movement in the United States. With 45 million Americans uninsured, this hot topic continues to receive close scrutiny from the authors and experts who provide information on your rights as a health care and insurance consumer, at healthinsuranceinfo.net.

You can read more and listen to the radio show on the NPR website: www.npr.org/templates/story/story.php?storyId=10136885.

Kevin Lucia M.H.P., J.D., Assistant Research Professor at Georgetown University, has co-authored an article in the Winter 2006 issue of the Journal of Insurance Regulation (www.naic.org/store_jir.htm).

Imposition of Durational Residency Requirements by State High-Risk Pools: Constitutional Considerations
Kevin Lucia, M.H.P., J.D.; Susanne Addy, J.D.

Currently, 32 states maintain high-risk pools offering individual health insurance to residents that are otherwise medically uninsurable in the private health insurance market. In many of these states, applicants are required to have resided in the state for a specific period of time, called a “durational residency requirement,” before they can apply for coverage. After reviewing how many states impose a durational residency requirement on new applicants and why, this article discusses the constitutionality of these requirements in light of the 14th Amendment right to travel as interpreted by relevant U.S. Supreme Court rulings.

Without Health Benefits, a Good Life Turns Fragile – New York Times, March 3, 2007

… “In the individual market, the federal protections provide precious little help to people seeking coverage,� said Karen L. Pollitz, a research professor at the Georgetown University Health Policy Institute. …