Health Insurance / HMOs
Articles and Resources
Date Fairness.com Resource Read it at: Jul 15, 2009 College Athletes Stuck With the Bill After Injuries
QUOTE: . While some colleges accept considerable responsibility for [athletes'] medical claims, many others assume almost none, according to a review of public documents from a cross section of universities and interviews with current and former athletes, trainers, administrators and N.C.A.A. officials.
New York Times Jul 08, 2009 In Retooled Health-Care System, Who Will Say No? Questions About Cost And Limits Linger
QUOTE: How will tough decisions be made about what to spend money on?
Washington Post Jul 06, 2009 Familiar Players in Health Bill Lobbying: Firms Are Enlisting Ex-Lawmakers, Aides
QUOTE: The nation's largest insurers, hospitals and medical groups have hired more than 350 former government staff members and retired members of Congress in hopes of influencing their old bosses and colleagues.... public interest groups and reform advocates complain that the concentration of former government aides on K Street has distorted the health-care debate,
Washington Post Jul 06, 2009 Paying for healthcare overhaul may fall unevenly on states: States such as New York are most likely to pay higher taxes to fund expanded coverage but have less to gain, policy analysts say.
QUOTE: Some of the "bluest" states that propelled Obama into the White House are among those most likely to pay more in taxes to fund expanded health insurance coverage and make other changes to the system, analysts say.
Los Angeles Times Jul 01, 2009 Autism patients' treatment is denied illegally, group says
QUOTE: State regulators are violating mental health and other laws by allowing health insurers to deny effective treatment for children with autism, consumer advocates contend.
Los Angeles Times Jul 01, 2009 Insured, but Bankrupted by Health Crises (The Work-Up)
QUOTE: an estimated three-quarters of people who are pushed into personal bankruptcy by medical problems actually had insurance when they got sick or were injured.
New York Times Jun 26, 2009 Getting Insurance for One’s Frailest Years
QUOTE: Long-term care insurance, something that wasn’t so common back when my dad could have bought it, seems like one solution. These policies are offered as a way to pay for a nursing home, assisted living, home health care and other costs associated with growing older. But where to begin?
New York Times Jun 25, 2009 Big Health Firms Underpay Claims
QUOTE: Congressional investigators have discovered that large health insurers in every region of the country are relying on faulty databases to underpay millions of valid insurance claims.
Wall Street Journal, The (WSJ) Jun 23, 2009 Bringing Down the House: The sobering lessons of health reform in Massachusetts. (Prescriptions)
QUOTE: Despite having health insurance, roughly one in 10 [Massachusetts] state residents still failed to fill prescriptions, ended up with unpaid medical bills, or skipped needed medical care for financial reasons. Hundreds of millions of dollars were spent to insure more Massachusetts citizens, but many people still weren't getting necessary care.
Slate Jun 02, 2009 Health Insurers Balk at Some Changes
QUOTE: Insurers... have agreed to sell policies even to people with pre-existing medical conditions....Industry has made no such promises about another segment of the health insurance market...the market for small employers.
New York Times May 11, 2009 'I do' also means 'I'll pay': After you're married, it's too late. You're just as responsible for his debts as you are for your own.
QUOTE: once you are married, you will be joining your two lives together financially and otherwise. Even though you may not be financially responsible, you will be intimately involved with the person who is. In other words, if there is no money to pay them, the medical bills that need to be paid and the stress that accompanies being in debt will affect your life, too.
Bankrate.com May 08, 2009 For Gay Couples, Obstacles to Health Insurance (Patient Money)
QUOTE: “For the vast majority of gay couples,” she [Mary Jo Hudson, director of the Ohio Department of Insurance] said, “getting health insurance for a domestic partner is still a challenge.”
New York Times Jan 04, 2009 Stuck in Paradise, Needing Medical Help (Practical Traveler)
QUOTE: As premium American Express card members, we are eligible to receive emergency medical transportation assistance. But a fractured ankle does not require an air ambulance, I was informed.
New York Times Dec 09, 2008 Uninsured Put a Strain on Hospitals
QUOTE: As increasing numbers of the unemployed and uninsured turn to the nation’s emergency rooms as a medical last resort, doctors warn that the centers — many already overburdened — could have even more trouble handling the heart attacks, broken bones and other traumas that define their core mission. Even before the recession became evident, many emergency rooms around the country were already overcrowded, with dangerously long waits for some patients...
New York Times Oct 29, 2008 Women Buying Health Policies Pay a Penalty
QUOTE: "Striking new evidence has emerged of a widespread gap in the cost of health insurance, as women pay much more than men of the same age for individual insurance policies providing identical coverage, according to new data from insurance companies and online brokers."
New York Times Oct 29, 2008 Solutions to the health care problem
QUOTE: Is health care a right or a responsibility? During the third presidential debate, Barack Obama declared it to be a right, while John McCain called it a responsibility.
Bankrate.com Oct 14, 2008 Equal Treatment for the Uninsured? Don't Count on It. Lack of Compensation Can Tempt Doctors to Tailor Their Care to a Patient's Coverage
QUOTE: It's not uncommon for patients with no insurance or poor insurance to receive different treatment. A 2006 study of 25 primary care private practices in the Washington area showed that in nearly one in four encounters, physicians reported adjusting their clinical management based on a patient's insurance status; nearly 90 percent of physicians admitted to making such adjustments.
Washington Post Sep 29, 2008 Crisis of Care on the Front Line of Health
QUOTE: The problem is that in this era of managed care and reimbursements dictated by Medicare and other insurers, doctors don’t get much compensation for talking to patients. They get paid primarily for procedures, from blood tests to surgery, and for the number of patients they see.
New York Times Aug 28, 2008 Medical Bills You Shouldn't Pay: In a controversial practice known as "balance billing," health-care providers are going after patients for money they don't owe
QUOTE: As health-care costs continue to soar, millions of confused consumers are paying medical bills they don't actually owe. Typically this occurs when an insurance plan covers less than what a doctor, hospital, or lab service wants to be paid. The health-care provider demands the balance from the patient....this common practice, known as balance billing, often is illegal.
BusinessWeek Jun 12, 2008 Buyer beware: Understand what 'medical discount plan' means (The Tough Customer)
QUOTE: Medical discount plans are not insurance plans. A health insurer agrees, for a premium, to assume responsibility for a portion of your medical expenses. Medical discount plans, on the other hand, grant access to a network of providers who have agreed to give participants a discount on their services, but the plan itself assumes no liability. In their marketing, however, these plans use the buzzwords of insurance plans...
Hook May 10, 2008 Illegal Farm Workers Get Health Care in Shadows
QUOTE: The people [immigrants] need help because they are in the United States illegally and because they are poor. Few have health insurance, but the backbreaking nature of their work, along with the toxicity of American poverty, insure that many are ailing.
New York Times May 07, 2008 Identity thieves prey on patients' medical records
QUOTE: Pam Dixon, executive director of the World Privacy Forum, an advocacy group, says "sophisticated crime rings" often can make more money by stealing medical identities than by going after individuals' bank accounts or credit cards. "If you steal someone's medical identity, then multiply that by 100 or 1,000" other thefts "and do fake billings, you can make hundreds of thousands, if not millions, of dollars," Dixon says.
USA TODAY Apr 23, 2008 High court: Do health insurance plans have conflict of interest? MetLife withdrew the long-term disability benefits of an Ohio woman after she got better.
QUOTE: On Wednesday, the justices are set to examine how judges should approach policyholder disputes involving companies that both evaluate and pay medical disability claims administered under a federal retirement income law. Do such companies operate in a conflict of interest between caring for their policyholders and enriching their shareholders? If such a conflict exists, how rigorously should federal judges examine decisions to deny benefits?
Christian Science Monitor Mar 31, 2008 Insure Me, Please: The Murky Politics of Mind-Body
QUOTE: This month, the House passed a bill that would require insurance companies to provide mental health insurance parity....Parity raises all sorts of tricky questions. Is an ailment a legitimate disease if you can’t test for it?
New York Times Feb 25, 2008 Insurance Fears Lead Many to Shun DNA Tests
QUOTE: The first, much-anticipated benefits of personalized medicine are being lost or diluted for many Americans who are too afraid that genetic information may be used against them to take advantage of its growing availability.
New York Times Feb 18, 2008 Study Finds Cancer Diagnosis Linked to Insurance
QUOTE: [Authors of a new study say] that “individuals without private insurance are not receiving optimum care in terms of cancer screening or timely diagnosis and follow-up with health care providers.” Advanced-stage diagnosis, they wrote, “leads to increased morbidity, decreased quality of life and survival and, often, increased costs.”
New York Times Feb 13, 2008 New York Investigates Medical Rate Setting
QUOTE: Attorney General Andrew M. Cuomo [is] investigating whether the nation’s health insurance companies [have] systematically forced patients to pay more than they should when using doctors or hospitals outside of their insurer’s networks...“We believe there was an industrywide scheme perpetuated by some of the nation’s largest health insurers to deceive and defraud consumers,” Mr. Cuomo said...
New York Times Dec 17, 2007 For Recipients of Medicare, the Hard Sell
QUOTE: Such experiences help explain why Ms. Barksdale and some of her neighbors here in eastern Mississippi are wary of the sales pitches they are now receiving again. Many said they had been tricked into enrolling in private Medicare plans, sometimes without realizing it.
New York Times Dec 16, 2007 Doctor Ratings Revised (Health Costs)
QUOTE: Several health-insurance companies have recently agreed to improve their existing or planned ratings of physicians....Ratings by some insurers have come under fire for giving top scores to doctors who cost the least -- but who are not necessarily the best in quality or the ones handling the most complex cases. In some plans, there are financial incentives for members to pick high-scoring doctors for their care.
Wall Street Journal, The (WSJ) Nov 27, 2007 In Hospice Care, Longer Lives Mean Money Lost
QUOTE: Over the last eight years, the refusal of patients to die according to actuarial schedules has led the federal government to demand that hospices exceeding reimbursement limits repay hundreds of millions of dollars to Medicare.
New York Times Nov 27, 2007 Lawyers step up to help veterans gratis
QUOTE: The approach marks the first time since the Civil War that attorneys have been recruited in large numbers to represent veterans. The lawyers hope their legal expertise will speed consideration of claims and result in better benefits for veterans, Stichman says.
USA TODAY Nov 18, 2007 Health-Insurance Scams
QUOTE: Small employers and individuals searching for affordable health insurance increasingly are falling victim to scams and misleading offers....The bogus insurers collect premiums, but they don't pay claims.
Wall Street Journal, The (WSJ) Nov 13, 2007 A Health Plan for Wal-Mart: Less Stinginess
QUOTE: But the changes in its policies have accomplished what once seemed impossible. Many of its most ardent critics have put down their pitchforks. Andrew L. Stern, whose Service Employees International Union set up an advocacy group to attack Wal-Mart three years ago, now concedes that “there is clearly a focus on covering more people.”
New York Times Oct 31, 2007 Council Says Some Hospitals Don’t Follow New Law on the Uninsured
QUOTE: “Hospitals are in a fiscal crisis,” he said. “They are being squeezed by the payers and they are being squeezed by the uninsured, and then we have the social and moral imperative to do the right thing for the patient. We really are between a rock and a hard place.”
New York Times Oct 22, 2007 Wounded troops overwhelm care: The current means of caring for returning vets is antiquated, compounding concern over the long-term cost of the war in Iraq and Afghanistan.
QUOTE: The Government Accountability Office (GAO) last week cited "fundamental system weaknesses" on the part of both the Defense Department (DOD) and the VA in how they treat wounded vets – including not enough staff and staff training.
Christian Science Monitor Oct 17, 2007 Children’s Health Bill Dispute Turns to Income Limits
QUOTE: When the House votes Thursday on whether to override the veto, Republicans will insist that the answer is yes. They will express outrage that rich children could get coverage from the government while hundreds of thousands of poor children still go uninsured. Democrats say it is a total distortion for Mr. Bush and his Republican allies to say that the bill allows coverage with family incomes up to $83,000 a year.
New York Times Oct 12, 2007 Minnesota Limit on Gifts to Doctors May Catch On
QUOTE: The interest in legislation to register or limit the food, gifts and money that drug and device makers lavish on doctors stems from growing concerns that these benefits lead doctors to prescribe more, and more expensive, drugs and devices, raising the costs of health care and changing care to patients.
New York Times Oct 07, 2007 Medicare Audits Show Problems in Private Plans
QUOTE: Tens of thousands of Medicare recipients have been victims of deceptive sales tactics and had claims improperly denied by private insurers that run the system’s huge new drug benefit program and offer other private insurance options encouraged by the Bush administration...
New York Times Oct 04, 2007 Dental Help for Poor Questioned: Congressional Report Says Some Kids Don't Get Adequate Care
QUOTE: An additional 22,110 poor children had not received dental care in at least two years, according to a review of dental records requested from United Healthcare, a managed-care organization serving Maryland Medicaid beneficiaries. The congressional subcommittee requested billing and service records from United as part of an investigation into gaps in Medicaid care for poor children.
Washington Post Oct 02, 2007 N.J. Wants Rules for Health Plan Blocked: Lawsuit Says Children Would Suffer
QUOTE: Seven other states, including Maryland, promised to do the same if President Bush vetoes legislation that would renew and extend the State Children's Health Insurance Program. The program, known as SCHIP, targets children whose families earn too much to qualify for Medicaid but not enough to buy insurance.
Washington Post Sep 02, 2007 As Home Care Booms, Little Oversight to Counter Fraud
QUOTE: Many in and outside the industry say the incidence of fraud in the home health care system is no greater than that of the medical system at large, and that the complaints are limited to a small portion of agencies and caregivers.
New York Times Aug 28, 2007 Spitzer Talks of Suing to Expand Health Plan
QUOTE: Gov. Eliot Spitzer said Monday that New York would consider suing federal health officials if the state was not granted a waiver to expand its federally subsidized health insurance program for children.
New York Times Aug 21, 2007 New Bush Policies Limit Reach of Child Insurance Plan
QUOTE: New administrative hurdles... are aimed at preventing parents with private insurance for their children from availing of the government-subsidized State Children's Health Insurance Program. But Democrats and children's advocates said that the announcement will jeopardize coverage for children whose parents work at jobs that do not provide employer-paid insurance.
Washington Post Aug 09, 2007 Alliance Seeks to Expand Dental Care to Poor Kids
QUOTE: "Children are suffering every day because we have systematically failed to provide them with the dental care they need," said Rep. Elijah E. Cummings (D-Md.)... federal legislation to enhance pediatric dental care is in the works.
Washington Post Jul 25, 2007 Doctors Rated but Can't Get a Second Opinion: Inaccurate Data About Physicians' Performance Can Harm Reputations
QUOTE: data-driven surveillance offers the prospect of using incentives to steer patients to care that is both effective and sensibly priced. It also raises questions about the line between responsible oversight and outright meddling in the relationship between caregivers and their patients.
Washington Post Jul 20, 2007 Medicaid Funding At Risk In D.C.: City Has Overpaid Firms $97 Million, According to Audit
QUOTE: The District wasted nearly $100 million over the past five years overpaying health care contractors for services that many Medicaid patients did not receive...
Washington Post Jul 19, 2007 U.S. Targets Health-Care Fraud, Abuse: New Medicare Task Force Wins 3rd Conviction of 2007
QUOTE: Law enforcement authorities are stepping up an attack on health-care fraud that they say costs taxpayers more than $60 billion each year. FBI officials yesterday [vowed] to crack down on medical companies...pointing to 2,400 investigations in 2006 and warning that a fresh spate of cases is on the way.
Washington Post Jul 15, 2007 Child Health Insurance Stalls in Congress: Plans to Renew Program Bog Down as Lawmakers Debate Funding, Philosophy
QUOTE: the future of the $5 billion-a-year [decade-old State Children's Health Insurance Program], which serves 6.6 million children and has long enjoyed bipartisan support, has become mired in an ideological fight over the proper role of government in health care...
Washington Post Jul 14, 2007 N.Y. Attorney General Objects to Insurer’s Ranking of Doctors by Cost and Quality
QUOTE: [The New York State attorney general’s office] asked the company to cancel its plan to release the rankings in September, citing a furor over a similar [program in which] the cost rankings primarily reflected the cost of care to the insurer — not to patients.
New York Times Jul 12, 2007 Some Chronically Ill Adults Wait for Medicare
QUOTE: “[The study] shows how unfair our system is,” said Louise Russell, a research professor at the Institute for Health at Rutgers University in New Brunswick, N.J.“These people were not getting care...
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