HCPro Health Plan Insider - November 4, 2009 | Insurers Must Pay Promptly or They'll Pay in Other Ways View as a Webpage | Subscribe for Free
Insurers Must Pay Promptly or They'll Pay in Other Ways
Les Masterson, Senior Editor-Managed Care

If your health insurance company is not paying claims promptly, the state may soon come calling. Georgia Insurance Commissioner John W. Oxendine this week fined UnitedHealthcare and three sister companies a combined $750,000 for allegedly not paying thousands of health claims promptly. Payers need to prepare for more states to come knocking on their doors if they are not paying claims in a timely manner. Health plans should also resolve three trouble spots that often lead to delayed physician payments. [Read More]
  November 4, 2009

Editor's Picks
12 New Features in the Latest House Health Reform Bill
The Affordable Health Care for America Act added yet another health reform proposal to the debate, but how is it different from the others? Colleague Jan Simmons provides an overview of 12 new features in the latest bill. Besides paying at a different rate for the public option, the bill would also implement a surcharge on the wealthiest Americans, create insurance cooperatives, and establish a value-based Medicare payment formula. [Read More]
Health insurance mandate alarms some
Though seen as the foundation of the Massachusetts health reform plan, the individual mandate remains controversial among libertarians and conservatives, who see the idea as an infringement on rights. This sets up an interesting battle between two groups that are usually allies—conservatives and health insurance companies. Insurers say requiring all Americans to buy insurance is the only way to get millions of young, healthy Americans to buy insurance, which would allow insurers to accept everyone regardless of pre-existing conditions. Opponents to the idea, however, warn that if it's part of a health reform law, they will challenge the mandate as an infringement on constitutional rights. [Read More]
GOP Health Reform Alternative Looks to Reduce Costs
After months of Democrats complaining that Republicans have become the "party of no," House GOP leaders unveiled their own health reform plan that builds on the employer-based system. The 230-page alternative looks to lower health costs instead of expanding health coverage, which is key to Democratic health reform plans. The Republican plan includes allowing families and businesses to buy health insurance across state lines and letting them pool together to acquire health insurance; implementing medical malpractice reform; guaranteeing access for those with pre-existing conditions and removing high-risk pools and reinsurance programs; promoting employer wellness programs; and creating new incentives for health savings accounts. [Read More]
Insurance discounts for healthy habits spur debate in Washington
Patient advocacy and health groups are speaking out about companies charging lower insurance premiums to employees who meet healthy living benchmarks. The Senate's health reform plan would expand the idea, but there are groups that say charging higher rates for less-fit Americans could price them out of insurance. [Read More]
Democrats see healthcare timetable slipping
Those of you who are political junkies and can't get enough of the health reform debate may be in luck. With the end of the year quickly approaching, Congress now thinks the debate could slip in to 2010. Senate Majority Leader Harry Reid indicated that the chamber may not meet its goal of passing a bill in the next several weeks, adding they are not bound to any timelines. House Democrats are still hoping to vote on health reform before they leave for the Veterans Day break, while the Senate is waiting for cost estimates from the Congressional Budget Office, which may not come until next week. [Read More]
Managed Care Headlines
Proposed Insurance Reforms Could Create a Much Different Marketplace
Janice Simmons, for HealthLeaders Media, November 3, 2009
Democrats say House bill cuts premiums for many
New York Times, November 3, 2009
Obama says health reform could save small businesses premium dollars
Associated Press/Minneapolis Star-Tribune, October 30, 2009
Public option gets a boost from ex-UnitedHealth Group exec
Minneapolis Star Tribune, October 29, 2009
UniCare to pull out of Illinois, Texas
Chicago Tribune, October 29, 2009
U.S. health overhaul could penalize Massachusetts
Boston Globe, November 2, 2009
Insurer told to hold off in Massachusetts
Boston Globe, November 2, 2009
Children's Hospital Boston, three health plans push cost-control effort
Boston Globe, November 4, 2009

Webcasts/Audio conferences
On Demand: Flexible Medical Staff Models of the Future
On Demand: Marketing to Physicians: Build Relationships to Increase Referrals
On Demand: Service Line Strategies Workshop 2009: Spine Care
Listen Up
Insurance Exchange Lessons from New York

Vince Ashton, executive director of HealthPass, a New York City-based health insurance exchange, discusses the exchange and what health insurers and policymakers can learn from the New York experience. [Sponsored by Emdeon] [Listen Now]
Listen Up
Developing Systems of Care

Charlie Baker, former CEO of Harvard Pilgrim, discusses how the industry could be impacted by health reform. [Read More]
From HealthLeaders Magazine
Disease Management's Struggle to Remain Relevant

Disease management, once trumpeted as a way to control costs and improve patient outcomes, has been the subject of a number of recent reports questioning whether it actually reduces health costs. There are four ways disease management can reclaim a vital role in healthcare. [Read More]
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