Showing posts with label new york. Show all posts
Showing posts with label new york. Show all posts

Friday, July 19, 2013

Why health insurance premiums are tumbling in New York under Obama-Care

By LAS

The Washington Post of July 17 reports that health insurance premiums in New York state will plummet under PPACA (aka ObamaCare) provisions – some at least by half and some to as little as a third of the cost before controls take effect.

According to the Post, “Individuals in New York City who now pay $1,000 a month or more for coverage will be able to shop for health insurance for as little as $308 monthly,” Roni Caryn Rabin and Reed Abelson report. “With federal subsidies, the cost will be even lower.”

New York has had a law since 1993 that insurers have to accept anyone who applies for a health care insurance policy, no matter what kind of pre-existing condition they might have. That explains the highest premiums in the country. In fact, the Post explains it in scintillating simplicity thus: “New York has, for 20 years now, been a long-running experiment in what happens to universal coverage without an individual mandate. It’s the type of law the country would have if House Republicans succeeded in delaying the individual mandate, as they will vote to do this afternoon. The result: a small insurance market with very high insurance premiums.” (my bold)

However, now that some of the provisions of the PPACA law are taking effect, healthy individuals who had believed that they would always be healthy and never have to have medical care, will now be contributing to the pooled coverage, and bringing the average cost of healthcare (AND insurance premiums) down. Yes, DOWN.

That is why the House attempts to gut the individual mandate are very disturbing and will only serve to undermine the promised savings of the program. So far, the Senate has not caved in to Republicans or to the corporate pressure to delay or delete sensitive provisions of the PPACA program. Let's hope it stays that way!



Sunday, December 23, 2012

NY Dept. Fines Insurer Excellus Nearly $1 Million for Denying ER Claims, etc.

by LAS

The New York Department of Financial Services has fined the health insurance carrier Excellus nearly one million dollars for multiple violations of insurance regulations.

Excellus was caught having denied 166 ER claims, and neglected to send Explanation of Benefits (EOB) as required by law, during a market conduct examination from Oct. 10, 2003 to Dec. 31, 2007.
Excellus, based in Rochester, NY, signed a Stipulation order No. 2012-0047-S and paid a fine totaling $995,000.

The insurer had not included EOBs in response to prescription drug claims. (Such EOBs are required by law, even though the insurer paid most of the claims.) It also omitted claims data on required form Schedule H in 2007.

In all, 166 ER claims were denied, and 337,689 cases of failing to explain coverage or benefits or appeal rights. The State has been informed by Excellus that the ER claims have been reimbursed to consumers.

Excellus claims that a systems error denied the ER claims by mistake.

Excellus is a Blue Cross/Blue Shield carrier in New York state. Its website carries no mention of the fine on its News page for the Rochester office nor for the corporate heading. The page does mention a new CEO-elect, “earns highest national accreditation for quality”, and making a grant to improve disaster preparedness.



SOURCES:
New York State Dept. of Financial Services Stipulation order No. 2012-0047-S, http://www.dfs.ny.gov/about/stip/Excellus_stip_2012-0047-S.pdf
and other industry sources.