Tag Archives: HMO

Physicians

California’s Answer to Long Wait Times: Outlaw Them

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The regulations by the California Department of Managed Health Care…will require that patients be treated by HMO doctors within 10 business days of requesting an appointment, and by specialists within 15.

Patients seeking urgent care that does not require prior authorization must be seen within 48 hours. Telephone calls to doctors’ offices will have to be returned within 30 minutes, and physicians or other health professionals will have to be available 24 hours a day.

Full report on California’s new limits on HMO wait times.

Health Insurance

Massachusetts Update

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Couple fined: Must pay Massachusetts $1,000 fine because IBM’s health insurance is not generous enough.

Premiums double: for former health care speechwriter for Edwards, Obama and Clinton:

For the first time in my life, I am without health insurance and it is a terrible feeling… In D.C., I had a policy with a national company, an HMO, and surprisingly I was very happy with it. I had a fantastic primary care doctor at Georgetown University Hospital. As a self-employed writer, my premium was $225 a month, plus $10 for a dental discount. In Massachusetts, the cost for a similar plan is around $550, give or take a few dollars. 

Doctor search for a Boston cab driver:

I get my health care through MassHealth [Medicaid in Massachusetts] and I went through 20 names before I finally found a doctor who would see me. I wasn’t going through the Yellow Pages. I was going down a list that MassHealth gave me!

Health Care Costs

Mass. Commission Calls for Rationing via HMOs and Global Budgets; the state cuts subsidies

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A special commission designed to evaluate the Massachusetts Health Plan says costs cannot be controlled without European-style global budgets and HMO-type medical care. Primary care doctors should be given $8,000 per patient and then allowed to decide which patients get which care. Markets don’t work and can’t work in health care, the report says. Meanwhile, the state is cutting premium subsidies for needy residents by 12%.

Health Insurance

Half the Employers Offer Consumer Directed Health Care Plan

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A Watson Wyatt report finds that:

Just more than half (51 percent) of companies now offer workers a CDHP, up from 47 percent in 2008. Another 8 percent are expected to adopt a CDHP by 2010. CDHPs are helping employers control costs – companies with at least half of their workers enrolled in a CDHP have a two-year cost trend (4.6 percent) that is 25 percent lower than non-CDHP sponsors (6.1 percent).

The cost of coverage for CDHPs is considerably lower than for either PPO/POSs or HMOs for 2009. Employee-only coverage for CDHPs is $852 lower than for other plan types. For family coverage, CDHP rates are $2,146 below the median PPO/POS plan rates and $2,350 lower than the average HMO plan costs.

Health Alerts

CIGNA Announces New Study Results

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CIGNA reports that its consumer driven plans "reduced medical cost trend by 13 percent relative to HMO and PPO plans, even as individuals enrolled in CDHPs use more preventive services and comply with their medical treatments."  The study covered medical claims for 440,000, including 22,000 individuals who have either hypertension or diabetes.

  • Cost trend was reduced by 20% for people with diabetes and 18% for people with hypertension, compared to people with the same conditions in non-CDHP plans.
  • Overall medical trend was down by 3.3%, compared to an increase of 10.6% for HMO and PPO enrollees.
  • Pharmacy costs for new enrollees were 10% lower;
  • Yet preventive care visits were 8% higher for CDHP enrollees and 15% higher for renewing CDHP enrollees.