Thursday, May 1, 2008

Book Review - "My Mother, Your Mother"

'My Mother, Your Mother' speaks to many baby boomers who find themselves caring for their parents

Date published: 4/27/2008

THIS BOOK will literal- ly speak volumes to many baby boomers who find themselves helping aging parents through their late-life journey. Geriatrician Dr. Dennis McCullough recommends a new approach to elder care, "Slow Medicine," and his thoughtful observations bring a glimmer of hope to an often bleak scenario.

He focuses on the fastest growing group of elders, those over 80, and notes that there is a "looming tsunami of elder care needs."

McCullough laments the fast, often aggressive pace of American medicine, and points out the incongruity of a diagnosis-based, cure-focused approach to someone who is dying simply because they are old and at the end of their life. He points out the difference between disease and illness. He questions the unlimited use of tests and procedures for elders, and advocates a gentle approach that assesses the patient's mental state, remaining abilities, family situation and quality of life.

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Local Doctors' Actions Reflect Nationwide Trend

by T.M. Shultz at the Daily Courier
Saturday, April 26, 2008

What primary care doctors are doing in the Prescott area reflects what primary care doctors are doing across the country.

They are:

• Retiring.

• Changing careers.

• Not taking new patients.

• Converting to cash-only practices.

• Refusing to accept new Medicare patients or dumping them when they reach a certain age or, in at least one case, opting out of the Medicare payment system altogether.

• Limiting the insurance they'll take to one or two major companies. In Prescott, it's typically Blue Cross Blue Shield and the Arizona Foundation for Medical Care, which is a provider network for Yavapai Regional Medical Center's employees.

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In Delaware - Blue Cross must Pay Fines for Late Claims

Judge upholds $100,000 ruling by Del. insurance commissioner

The News Journal, April 26, 2008

A Superior Court judge has upheld a $100,000 fine against Blue Cross Blue Shield of Delaware, which the state insurance commissioner assessed last year after finding the company failed to process thousands of medical claims within a state-mandated time period.

The decision by Judge Peggy Ableman affirms a September ruling by Insurance Commissioner Matt Denn, which found that in the first six months of 2006, Blue Cross Blue Shield of Delaware, the state’s largest health insurer, failed to process 10,467 health insurance claims within the required 30 days.

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Blue Cross spends big to promote legislation


Blue Cross Blue Shield of Michigan has spent $1.1 million since Jan. 1 on TV ads in seven major Michigan cities to promote a legislative agenda that would allow the nonprofit to set its own rates for individuals buying health insurance policies.

The money bought more than 2,600 TV spots, airing as often as 10 times a night, usually in prime time, including pricier buys during "American Idol," "CSI Miami" and the late-night Jay Leno and David Letterman shows.

By comparison, Put Michigan People First, one of three coalitions of commercial insurers, HMOs and others opposed to the legislation, has spent $65,000 on radio and print ads, according to Mike Nowlin, a Lansing public relations specialist who serves as the coalition's spokesman.

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Michigan Attorney General Pursues Investigation of Blue Cross

Michigan Attorney General Michael Cox sent a fax on Thursday night to Dan Loepp, president and CEO of Blue Cross Blue Shield of Michigan, asking Loepp to explain by June 2 whether the company violated state laws by purchasing a for-profit insurance company for one of its subsidiaries.

Crain’s reported Thursday that Cox was looking into allegations made Wednesday at the Michigan Senate Health Policy Committee that the Blues may have violated state laws in acquiring several out-of-state insurance companies.

In the letter to Loepp, Cox asked nine questions related to the Nov. 20, 2007, purchase of CWI Holdings Inc., the parent company of CompWest Insurance Co. in San Francisco.

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Governor Schwarznegger joins opponents of Blue Cross Blue Shield rescission practices.

Blue Cross of California, BC Life, HealthNet, and other large California health care coverage providers have been accused of improperly dropping (rescinding) thousands of health insurance customers using an illegal practice called "post claims underwriting". They do little or no investigation when they issue the policy, but if you run up big bills they scour your medical records to find reasons to rescind your coverage based on alleged "misrepresentations" in a confusing and complicated application. The charge is that they loan you an umbrella and want it back as soon as it starts raining!

Now California's Governor has joined proponents of regulatory action and class action lawsuits in condemning this practice. According to the Sacramento Bee, Schwartznegger said it is "outrageous that innocent patients have to live in fear of losing their health care coverage. I look forward to working with my partners in the Legislature to ensure this egregious practice is stopped."

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Hospital, Blue Cross Talks Stall


from the New Jersey Herald

NEWTON — Newton Memorial Hospital patients insured by Horizon Blue Cross/Blue Shield received notice late last week that the hospital intends to terminate its contract with Horizon.

"It is the bigger picture that brings us to this point with Horizon. It is the environment of hospitals in the state," said Newton Memorial's Sean O'Rourke, chief operating officer. "Everybody in New Jersey is dealing with it."

The decision came about after several attempts were made by the hospital to negotiate a contract that would provide what it considers more appropriate payment rates for its services.

"This is not new," O'Rourke said, "We have talked with more than 20 insurance companies over the last 18 months. Getting to this point helps both parties focus on the task at hand."

The letter, signed by President and Chief Executive Officer Thomas Senker, stated, "Although this letter will alert Horizon of our intentions, Newton Memorial will continue to negotiate in good faith for rate adjustments to sustain high quality care and accessibility to modern and efficient health care facilities for you and your family."

Horizon Blue Cross/Blue Shield executives did not return phone calls seeking comment.

Under the terms of the current contract, the hospital is in-network with Horizon. The hospital said it will continue to negotiate rate adjustments so that it can sustain care and accessibility to health care facilities for its patients.

The contract states that those who subscribe to Horizon still will be able to utilize their in-network benefits at Newton Memorial Hospital for 90 days, until July 22. After that, Horizon members can continue to go to Newton Memorial Hospital to receive out-of-network services. The reimbursements will depend on individual health plans.

Patients who have HMO coverage will remain in-network for four months after the termination of the contract, until Nov. 22.

BCBS Round-Up

Let's get caught up on some of this weeks Blue Cross / Blue Shield stories.

Senate panel chief may trim Blues bills provisions
By Jay Greene

The Senate Health Policy Committee is expected Wednesday to vote on four controversial bills that seek to reduce premium rates and expand access in the individual health insurance market and give a for-profit workers' compensation insurance subsidiary of Blue Cross Blue Shield of Michigan the right to enter other insurance lines.

But in response to testimony the past two weeks, Sen. Tom George, R-Kalamazoo, who chairs the committee, said last week that he may drastically reduce the number of provisions in the proposed legislative package.

While Blue Cross opposes eliminating major portions of the proposed legislation approved last October in the House, George said he is inclined to push for the following:

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