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

By ROBERTA FUGATE

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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Senators Compliment CMS Website - But Want More Transparency

Senators Compliment CMS on Nursing Website but Push Bi-Partisan Bill for More Info

Democrat Kohl, Republican Grassley push bill to expand transparency

April 28, 2008 – Two U.S. Senators from different parties came together last Friday to compliment the Centers for Medicare and Medicaid Services for increasing the information available on their Website, Nursing Home Compare, but they say the agency has a ways to go to achieve the transparency and information for consumers called for in the Senate bill they have crafted.

Senators Herb Kohl (D-WI) and Chuck Grassley (R-IA) complimented CMS Acting Administrator Kerry Weems for identifying on the site the most troubled nursing homes. They have been designated as Special Focus Facilities (SFF) by CMS.

Kohl and Grassley said that CMS still has a long way to go to meet the demands called for in their bipartisan bill, the Nursing Home Transparency and Improvement Act (S. 2641), which would require Nursing Home Compare to display accurate, timely information in a format that can be easily understood by consumers across the country.

“Americans should have access to as much information about a nursing home as possible," said Kohl.

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AMA Committed to Enforcement of BCBS Settlement

The American Medical Association (AMA) announced that it will begin enforcement of the national Blue Cross and Blue Shield (BCBS) settlement as a signatory medical society to the agreement. The AMA joins 27 other participating medical societies that are able to provide direct assistance to physicians when a BCBS plan or subsidiary has failed to comply with the national BCBS settlement.

The AMA's participation in enforcement of the BCBS settlement was initiated yesterday when a Miami federal court finalized the settlement of a nationwide physician class action lawsuit brought against Blue Cross and Blue Shield Association and more than 30 affiliated plans and subsidiaries.

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Doctors Agree: We Need Single-Payer Health Insurance

It's the only system that offers affordable quality care

By LEONARD A. ZWELLING and ANA MALINOW

We have all heard it before. The health care system in the United States is broken. We have all heard it, but when is someone going to do something about it?

Physicians for a National Health Program (PNHP) is a group of 15,000 physicians who believe that there is a solution and it is currently working for Americans — if they are over 65. It is, of course, Medicare, part of the 60 percent of our current health care system that is paid for and administered by the government.

We believe a single-payer system (Medicare for everyone) would be less costly, more efficient and provide all Americans with the health care they need without an increase in overall dollars spent (an amount that is increasing at a rate of 7 percent per year). This would include the 47 million who are currently uninsured and the estimated 50.3 million who are "underinsured" (spending 10 percent or more of their pretax income on health care).

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Senior Care in Minnesota at Risk From Budget Cuts

Kim Winnegge, The ForumPublished Sunday, April 13, 2008

With Minnesota facing a projected deficit of $935 million, area advocates warn that program cuts to the health and human services sector will drastically affect the most vulnerable people in the community.

Gov. Tim Pawlenty has proposed a $32 million cut in long-term care funding, with no cost-of-living increases in 2008.

He also wants to repeal rebasing for nursing homes, a process that would phase in rate adjustments over eight years to reflect actual costs in providing services.

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