HHS Secretary Kathleen Sebelius on Growing List of Insurers That Will Provide Coverage for Young Adults under Age 26

I welcome the Blue Cross Blue Shield plans, Kaiser Permanente, and Humana to the growing list of insurers who are offering to continue health insurance for young adults graduating from college or aging out of their parents’ plan.  This initiative, complementing the permanent policy in the Affordable Care Act, will enable young people to retain insurance coverage at an important moment as they begin their adult lives and launch their careers.

Many young adults under the age of 26 have traditionally had a difficult time getting access to – and affording – health coverage.  The Affordable Care Act, and the voluntary actions of insurers to eliminate the coverage gap for young adults on their parents plans, will give greater health security to millions of American families.

Insuring younger Americans is a top priority for the Administration and we will continue working to expand the opportunity for children and young adults to have access to quality, affordable care.

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Maximize Your Insurance Dollars in 2010; Avoid the Five Biggest Insurance Mistakes

/PRNewswire/ -- As the new year begins many consumers will be making resolutions, including about saving money. There are several ways to save money on insurance, but consumers should be careful about the ways in which they cut their insurance costs, according to the Insurance Information Institute (I.I.I.).

"Money is tight right now and many people are looking for ways to cut costs," said Jeanne M. Salvatore, senior vice president and consumer spokesperson for the I.I.I. "However, there are smart ways that savvy consumers can save on their home and auto insurance, and there are mistakes that can result in being dangerously underinsured."

Following are the five biggest insurance mistakes consumers should avoid:

1. Insuring a home for its real estate value rather than for the cost of
rebuilding. When real estate prices go down, some homeowners may think
they can reduce the amount of insurance on their home. But insurance is
designed to cover the cost of rebuilding, not the sales price of the
home. You should make sure that you have enough coverage to completely
rebuild your home and replace your belongings. A better way to save:
Raise your deductible. An increase from $500 to $1,000 could save up to
25 percent on your premium payments.
2. Selecting an insurance company by price alone. It is important to
choose a company with competitive prices, but also one that is
financially sound and provides good customer service. A better way to
save: Check the financial health of a company with independent rating
agencies and ask friends and family for recommendations. You should
select an insurance company that will respond to your needs and handle
claims fairly and efficiently.
3. Dropping flood insurance. Damage from flooding is not covered under
standard homeowners and renters insurance policies. Coverage is
available from the National Flood Insurance Program (NFIP), as well as
from some private insurance companies. Many homeowners are unaware they
are at risk for flooding, but in fact 25 percent of all flood losses
occur in low risk areas. A better way to save: Before purchasing a
home, check with the NFIP to check whether it is in a flood zone; if
so, consider a less risky area. If you are already living in a flood
zone area, look at mitigation efforts that can reduce your risk of
flood damage and consider purchasing flood insurance.
4. Only purchasing the legally required amount of liability for your car.
In today's litigious society, buying only the minimum amount of
liability means you are likely to pay more out-of-pocket -- and those
costs may be steep. A better way to save: Consider dropping collision
and/or comprehensive coverage on older cars worth less than $1,000. The
insurance industry and consumer groups generally recommend a minimum of
$100,000 of bodily injury protection per person and $300,000 per
accident.
5. Neglecting to buy renters insurance. A renters policy covers your
possessions and additional living expenses if you have to move out due
to a disaster. Equally important, it provides liability protection in
the event someone is injured in your home and decides to sue. A better
way to save: Look into multi-policy discounts. Buying several policies
with the same insurer, such as renters, auto and life will generally
provide savings.


"By taking a few simple steps, it is possible to cut costs and still be protected should disaster strike," pointed out Salvatore. "When money is tight, it extremely important to be financially protected with the right amount and type of insurance.

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Insurance Industry Facing Uncertain Regulatory Environment, Competitive Shake-Up, Says PricewaterhouseCoopers Report

/PRNewswire/ -- The insurance industry may not see a return to relative stability and certainty for a few years as it reacts to the effects of regulatory reform, increased government intervention and potential tax law changes in the aftermath of the financial crisis, said PricewaterhouseCoopers LLP in a report released today. Within five years, the industry landscape could look markedly different, and Americans may find their insurance policies underwritten by a handful of large, well-capitalized firms that can demonstrate financial strength and economies of scale.

The PricewaterhouseCoopers report, entitled "Emerging from the Storm: The Day After Tomorrow for Insurance," outlines nine key developments that are expected to reshape the insurance industry and their strategic implications during the next five years. The most significant of these developments for U.S. insurers will likely be sweeping regulatory changes resulting from proposed legislation to reform health insurance and increase federal oversight of insurance and financial industries.

The majority of regulation of insurance firms in the U.S. occurs at the state level, but there is political pressure to expand federal oversight. Creation of a Federal Insurance Office could provide federal policymakers with the information and resources to better respond to crises, mitigate systemic risks and help ensure a well-functioning financial system, but it could also lead to dual regulation at both the state and federal levels.

"Insurers are in the business of managing risk and measuring probability. They don't like uncertainty, yet they are facing two massive reform initiatives, the outcomes of which are unknown but could alter their destiny," said Bill Chrnelich, partner, PricewaterhouseCoopers' insurance sector. "Some insurers are taking a cautious, wait and see approach, while others see this period as a once-in-a-generation opportunity to shape their future."

According to PricewaterhouseCoopers, the insurers most likely to succeed once regulatory changes are enacted are those that closely monitor developments and create business strategies that anticipate the most likely possibilities for reform. In addition, they will carefully factor the following considerations into their business decisions:

-- Insurance Industry consolidation: The U.S. insurance market remains
highly fragmented, and the strong underlying rationale for
consolidation and restructuring means that merger and acquisition
activity may be set to accelerate rapidly, particularly as larger,
better-capitalized firms consume smaller firms. Consolidation is
expected to help to deliver the capital stability and economies of
scale that will be important in attracting customers and demonstrating
financial strength not only to ratings agencies but also to
third-party distributors whose "ownership of the customer" makes them
a key determinant of an insurers' fate.

-- The end of innocence for retail investors: The faith of investors, who
had become accustomed to high yields but were unaware of the related
risks, appears to have given way to shock, disillusionment and
caution. The pursuit of innovation appears to have been displaced by
a focus on stability, risk management and demand for simpler, more
straightforward and transparent policies and investment products such
as index-linked investments. An example of this is the recent
resurgence in demand for whole life insurance. The apparent desire
for guarantees, however, could create dilemmas for insurance companies
that want to scale back such products as they seek to limit risk.
Potentially higher costs of risk and guarantees, along with what may
be higher commission payments to distributors, could change product
economics, and insurers will need to better understand component
costs, pricing and profit profiles.

-- Mounting uncertainty over tax: As debts and fiscal deficits mount,
governments are looking for ways to increase their tax revenues. They
will look closely at insurance companies, as the industry is a major
source of potential tax receipts and has moved significant business
capacity to other jurisdictions in recent years. Accordingly,
insurers can expect renewed scrutiny of their tax planning techniques,
as well as more stringent requirements for transparency and
information exchange relating to clients.

-- Organic restructuring: As a result of the financial crisis, many
insurers have been forced to raise prices, restrict the pursuit of new
business or withdraw from high risk and peripheral markets. As
insurers withdraw from some of their geographic markets and scale back
particular lines of business, the market shares and opportunities for
those that remain could sharply increase, leading to a significant
reconfiguration in the list of leading players. Companies with a
better understanding of their risks are likely to be in a stronger
position to capitalize on potential openings that less-informed and
less-assured competitors may miss.

-- Rethinking insurance financial reporting: Many insurance executives
justifiably complain that their share prices fail to reflect the true
level of value being created within their business. Without an
industry consensus on a genuinely relevant, intelligible, and
comparable basis of accounting and disclosure, insurers may find it
increasingly difficult to compete for capital. With funds
constrained, many portfolio investors could simply choose to put their
money elsewhere, leaving the insurance industry with major challenges.
According to PricewaterhouseCoopers, it seems imperative that the
industry come together to develop a basis of relevant disclosures that
reflect the nuances of their business and satisfy analyst and investor
demands.

-- Blurring the lines between the public and private sector: The
relationship between the public and private sectors could change as
the government exerts a stronger influence over the insurance market
as a result of bailouts, regulatory reform, and greater control over
pensions, healthcare, trade credit and mortgage support.

-- Greater scrutiny of executive compensation: Two concerns raised by the
financial crisis were the lack of understanding of risk at the board
of directors' level and compensation for senior executives. With
appointment of the Special Master for TARP Executive Compensation, in
the United States, insurers are likely to base much more of their
performance-related pay on risk-adjusted measures, aligned to their
business strategy. They also are expected to face tougher regulation
over how compensation is governed.

-- Challenging prospects for reinsurers: While demand for reinsurance is
likely to increase within emerging markets, this is unlikely to offset
the decline in reinsurance buying in developed markets and may force
many reinsurers to rethink how they sustain profitability and growth.
The trend toward higher retention of straightforward risks could
accelerate. As companies become more risk-aware through advances in
enterprise risk management, they will be better able to choose what
risks to retain and which to reinsure.


"There is only one certainty for the insurance industry: change is coming and, as a result, the competitive landscape will be very different in five years from what exists today," added Chrnelich. "This will jeopardize some insurers' business, but it should also enable those who are better prepared to excel in a new environment. Success will likely depend on close monitoring of developments and the ability to quickly capitalize on opportunities as reforms and changes within the industry become clearer."

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Rite Of Passage: The Plight Of Uninsured Young Adults

(NAPSI)-The health insurance coverage issue may uncover some surprises for certain Americans.

One segment of the population that's particularly affected by the uninsured problem is young adults between the ages of 19 and 29. They represent 31 percent of the nation's uninsured.

What a Difference a Year Makes

Young adults usually begin with health insurance coverage under their parents' plan or a public insurance program. But the 19th birthday is a crucial milestone for the health coverage of many young adults in the U.S.

Public programs such as Medicaid usually end eligibility at the 19th birthday. Employer-sponsored health insurance plans often won't cover young adults as dependents under their parents' policy after 19 years of age unless they are enrolled in college.

Young people, even working full-time, may not be offered or able to afford health insurance. Others believe in their own "invincibility" when it comes to future health concerns.

The Myth of the Not-So "Invincibles"

Actually, young adults are more susceptible to some illnesses than any other population. Over 40 percent of uninsured young adults have characterized their health as only fair or poor.

To address the problem, health care reform legislation includes a variety of provisions to help young Americans gain quality, affordable coverage, including proposals to allow young adults to remain on their parents' insurance through the age of 27. Young adults could also benefit from proposed sizable tax credits. According to a report by Jonathan Gruber of MIT, the tax credits could save young adults as much as $685 off their health insurance premiums.

It is time that all Americans, regardless of age, receive timely, affordable, quality health care. It is time for the enactment of systemwide health care reform that provides coverage to all citizens, slows down health care costs and improves the quality of medical care.

To learn more, go to www.nchc.org or call (202) 638-7151.

By Ralph G Neas and Henry E Simmons, MD

• Mr. Neas is chief executive officer of the National Coalition on Health Care; Dr. Simmons is its president. The Coalition is the Nation's oldest and most diverse alliance working for the achievement of comprehensive health care reform.

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National Survey Finds Many Consumers Missing Out on Insurance Discounts

Trusted Choice® recommends consumers maximize little-known discounts to ‘nickel and dime’ their way to big savings.

As millions of Americans look for ways to stretch their budgets to survive these tough economic times, too many are not utilizing all of the discounts that may be available to them in their homeowner and auto insurance, according to a new national survey conducted for Trusted Choice® and the Independent Insurance Agents & Brokers of America (the Big “I”).

The survey asked home and auto owners if they believed they are taking full advantage of all the discounts they qualified for on their homeowners and auto insurance policies. More than 34% of respondents, representing 53 million households, admitted they are probably not taking advantage of all homeowners insurance discounts or said that they simply didn’t know. Regarding auto coverage, more than 20% of car owners either didn’t know or said they were not maximizing all the car insurance discounts available to them.

“The latest survey shows what we suspected: many Americans could be foolishly throwing money away because they fail to ask about insurance discounts for which they may qualify,” says Madelyn Flannagan, Big “I” vice president of agent development, education and research. “Companies often offer some unique, regional, very specific and, at times, quirky discounts. In these economic times, every dollar counts—some consumers may be able to nickel and dime their way to big savings.”

And those who stand to benefit most from the discounts are often those who aren’t taking advantage of them: nearly 38% of respondents with a household income of less than $25,000 said they weren’t taking advantage of all possible homeowners discounts or said they didn’t know.

The survey also found that the largest percentage of respondents, about 26%, estimated they save 6-10% on their insurance premiums by using discounts. In reality, many consumers could be saving significantly more—as much as 30%.

“One of the biggest advantages to using an independent insurance agent is that they can explore the various companies and find the best possible coverage for each individual family or business,” says Robert A. Rusbuldt, Big “I” president & CEO. “Finding specific discounts can be time-consuming and confusing, so we advise consumers to consult with their Trusted Choice® independent insurance agent and ask questions.”

HOME INSURANCE
The Big “I” and Trusted Choice offer the following tips that may lead to substantial homeowners insurance savings.

· LIFE IN A GATED COMMUNITY? Some homeowners are entitled to gated community discounts.

· WHAT’S YOUR HOUSE WEARING? Some insurers give hail resistant roof discounts for Class 4 roofs and credits can be sizeable in some territories.

· “EVERYTHING OLD IS NEW AGAIN:” Some companies are coming out with new rating models that are oriented toward offering lower rates to new customers. Sometimes, a customer can even save money by applying for a new policy with the same company.

· ‘FOR BETTER OR FOR WORSE’ MAY ALSO APPLY TO YOUR CREDIT SCORE: For married couples, sometimes one person will have a better credit score than the other. Since some companies will use the score of the first person named on the application, putting the spouse with the best credit score on first can result in a lower rate.

· GOT NEW WIRES? Depending on the age of newer electrical wiring in your home, you may qualify for an age of wiring discount.

· HAS IT REALLY BEEN 10 YEARS? If you have not filed any home insurance claims in the last 10 years, ask about a discount. “Claims-free” homeowners can often save up to 20%.

AUTO INSURANCE
The Big “I” and Trusted Choice provide the following tips and considerations that may lead to big auto insurance savings.

· IS YOUR TEEN A SCOUT? Some insurers give credits to young drivers who are involved in organizations such as Boy Scouts or Girl Scouts.

· WHAT’S YOUR ALMA MATER? At least one insurer gives a 5% credit if a driver is a graduate of a university on the company's approved list.

· DO YOU HAVE A COMPANY CAR? Many carriers will give a multi-car discount to consumers who have a company car even if they only own one personal vehicle.

· HAVE YOU BEEN WIDOWED? Some insurers give "married" discounts to widows and widowers.

· ARE YOU SHOPPING FOR NEW WHEELS? Before you buy a car, make a short list of the ones you're considering and ask your agent to estimate the difference in insurance premiums. The difference could save you thousands of dollars.

· ARE YOU A GREEN COMMUTER? Consider car pooling to reduce your commute frequency and ask your agent if that will impact your auto premium. In addition to reducing your carbon footprint, you may also be fattening your wallet.

· HOW YOUNG ARE YOU? In some states, if you're 55 or older, and you're the principal driver of your insured car, you could save on your premiums by taking an approved defensive driving class.

· GOT A TRACTOR? If you're a full-time farmer or rancher, and you're insuring a farm or ranch vehicle used exclusively for work on your property, a farm vehicle bonus could help keep your costs down.

MORE WELL-KNOWN DISCOUNTS:
While there are plenty of quirky discounts your independent agent can investigate, there are many ‘tried and true’ discounts that many, but not all, insurance consumers know.

· UNEMPLOYED? People who are out of work should qualify for a low-mileage discount or lower rating factor that can save 5-10% on their auto premium.

· MULTIPLE POLICIES? If you have property insurance with ONE company, you may qualify for a multiple policy discount to lower both your auto and your home insurance premiums by as much as 10-15%.

· SOUND THE ALARMS! Alarm credits are often available if your home is equipped with two or more of the following: fire alarms, smoke detectors, fire extinguishers, sprinklers, deadbolt locks and a burglar alarm. Savings can be up to 15%. (Criteria vary in some states. An agent can help determine what applies in your area.)

· ACCIDENT-FREE FOR THREE YEARS? If you've been safe on the road and accident-free for the past three years, and you haven’t received any moving violations, you might qualify for a good record discount. To be eligible, you and all additional drivers also need to have carried continuous, standard automobile liability insurance during those same three years. If you're a new driver and received your license within the past three years, you, too, could be eligible. Just make sure you meet the above qualifications from the date your license was issued.

· DOES YOUR CAR HAVE SAFETY FEATURES? Auto insurance discounts apply in many states, if your car comes equipped with approved anti-theft devices, anti-lock brakes, and/or passive restraint systems such as airbags.

The survey was conducted for Trusted Choice® via telephone by International Communications Research (ICR); an independent research company in Media, Pa. Interviews of a nationally representative sample of 1058 U.S. households were conducted in Oct. 28 – Nov. 1, 2009. More information about ICR can be obtained at http://www.icrsurvey.com.
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Selecting Medicare Coverage: Four Considerations to Help Seniors Choose

/PRNewswire/ -- Open enrollment, the six-week period during which seniors can select healthcare coverage for 2010, begins Nov. 15. Health plans have begun sharing their costs and coverage, but making a choice can be a daunting task. Here are four considerations to help Medicare-eligible seniors select which Medicare coverage best meets their individual needs:

1. Understand the A, B, C and Ds of Medicare. There are four primary parts
to Medicare. Parts A and B cover hospital and medical expenses,
respectively. Parts C and D provide benefit and prescription drug
coverage through health insurance companies that are approved by
Medicare. Medicare Advantage plans include all of the coverage offered
by Parts A and B and can include prescription drug coverage under Part
D.
2. Compare costs. Premiums can range for $0 to hundreds of dollars per
month, depending upon the type of organization (nonprofit or
for-profit) and the type of coverage. Total plan costs include
premiums, co-payments and deductibles for everything from preventive
care to hospitalization.
3. Compare benefits and doctors. Does the plan have a large network of
doctors and specialists for you to choose from? Is your doctor and
preferred hospital in that network? Does the plan cover your
prescription medications?
4. Compare quality. Call the customer service number for the plans you're
considering. Does a live person answer the phone? Are they friendly,
helpful and knowledgeable? Does the plan offer value-added programs
that help you maintain or improve your health and independence? Does
the plan offer services to help your loved ones take care of you if
needed? Will the plan coordinate your care between doctors and
specialists?

Selecting Medicare coverage is an important decision, especially since Medicare rules indicate that members must maintain the coverage they've chosen for an entire year. Seniors currently enrolled in Medicare Advantage plans will soon receive letters from their health plans explaining any changes in coverage for 2010. "We recommend that people read this letter thoroughly to avoid any surprises in the coming year," said Tom Lescault, president of SCAN Health Plan Arizona. "Changes in government funding has forced many health plans to reduce benefits or increase costs. People need to make sure they are able to make informed decisions during open enrollment."

As part of an ongoing commitment to improving the lives of seniors, SCAN Health Plan Arizona is an exclusive sponsor of "Healthy Tips for Successful Aging" with ABC 15. Each week, the station airs 30-second health tips provided by SCAN. The health plan also is the exclusive studio sponsor for KOY radio and co-hosts "Senior Focus," a broadcast dedicated to senior-related issues.

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Overriding State Insurance Protections Should Not Be Part of Financial Re-Regulation Package, Writes Consumer Watchdog to Geithner, Frank

/PRNewswire/ -- Consumer Watchdog sent a letter to Treasury Secretary Geithner, House Financial Services Committee Chair Barney Frank, and Financial Services Subcommittee Chair Paul Kanjorski today, arguing that legislation intended to undermine state insurance protections (H.R. 2609) is inconsistent with the re-regulatory promise of the financial reform package. The bill will be marked up in the House Financial Services committee today.

"We are at a loss to understand why you have proposed a measure to deregulate the insurance industry by preempting state laws as part of the financial re-regulation package," wrote Consumer Watchdog. "Each version of the bill would restrict the ability of state lawmakers and regulators to protect insurance consumers by granting the Treasury Department and a new Federal Insurance Office the authority to preempt state laws and regulations on prudential matters on behalf of foreign insurance firms."

"This proposal is even more perplexing in light of the strong fight, on the part of both the administration and majority members of the Financial Services committee, to preserve states' ability to protect their citizens during the debate over the Consumer Financial Protection Agency," the letter continued.

As Assistant Treasury Secretary Michael Barr put it to the Washington Post last week:

"'Washington doesn't always know what's best'... He said the administration wanted to restore the right of states 'to protect their citizens with the rules that they think make sense.'"

"If Washington doesn't always know what's best for American consumers, why would you expect foreign diplomats and regulators to know what's best for American insurance policyholders?" asked Carmen Balber, Washington Director for Consumer Watchdog.

The letter concludes: "Wall Street firms are again riding high a year after the crash, but the rest of the country continues to suffer rising foreclosures, increased unemployment, and a dearth of credit. With American homes, jobs and businesses already on the line, now is hardly the time for Congress to place our insurance policies at risk as well."

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Isakson, Dodd Introduce Legislation Requiring Child Care Providers to Disclose Insurance Status

U.S. Senators Johnny Isakson, R-Ga., and Chris Dodd, D-Conn., both members of the Senate Health, Education, Labor and Pensions Committee, today introduced legislation that would require child care providers to disclose whether they have liability insurance.

The legislation was prompted by the story of Anthony DeJuan Boatwright, also known as Juan. In 2001, when he was 14 months old, Juan fell into an unattended bucket of mop water at his child care center in Augusta, Ga. As a result of the accident, Juan has remained semi-comatose and dependent on a ventilator for the past eight years. The center where Juan was injured was licensed, but not insured. At the time, there was no provision in place to let parents know the insurance status of child care providers.

“I hope the Senate will quickly pass this straight-forward, bipartisan legislation to simultaneously honor young Juan and provide parents with much-needed information about child care facilities,” Isakson said. “Juan’s mother Jackie deserves considerable credit for her efforts to ensure all parents know whether or not their child care provider is insured.”

“As the father of two young daughters, I understand the need for parents to be well informed when making decisions about child care,” said Dodd. “This bill will help to protect children and give parents peace of mind. I’m proud to support this important legislation, and look forward to future opportunities to improve the quality of and access to child care in this country for children, families, and providers.”

Specifically, the Anthony DeJuan Boatwright Act would require child care providers that receive Child Care and Development Block Grant funds to disclose whether or not they carry liability insurance for the operation of their facility. The bill also would require that states recommend such coverage in their licensure process.

Senators Saxby Chambliss, R-Ga., and Roland Burris, D-Ill., also are co-sponsors of the bill. A companion bill passed in the House of Representatives on June 2, 2009.
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Senate Bill to Protect Patients' Healthcare by Amending Medicare Coverage

/PRNewswire/ -- The U.S. Senate has introduced a bill, S. 1221, "The Medicare Prompt Pay Correction Act," a companion bill to H.R. 1392, which was introduced in the U.S. House of Representatives and currently has 45 co-sponsors.

The Senate bill was introduced by Senators Arlen Specter (D-PA) and Pat Roberts (R-KS). The bill is a step forward in addressing problems with Medicare reimbursement for cancer drugs and in alleviating a national problem affecting the delivery of cancer care treatment to patients, almost all of whom are treated in community oncology clinics close to their homes.

"Community cancer clinics play a critical role in our nation's fight against cancer, especially in rural areas where families do not have access to larger centers," said U.S. Senator Arlen Specter (D-PA). "I am pleased to introduce this legislation which will help ensure access for Medicare beneficiaries' to potentially life-saving cancer treatments."

This bill will amend title XVIII of the Social Security Act to ensure more appropriate payment amounts for drugs and biologicals under Part B of the Medicare Program. It excludes customary prompt pay discounts extended to wholesalers from the manufacturer's Average Sales Price (ASP). These discounts artificially reduce Medicare Part B drug reimbursement rates for community oncology clinics, jeopardizing the viability of these providers and thus endangering patient access to affordable, quality cancer care in their communities.

Excluding distributor prompt pay discounts from the ASP methodology is consistent with existing policy and will create greater uniformity among federal healthcare programs. The Medicaid Average Manufacturer Price (AMP) methodology already excludes these terms.

This legislation is an effort to improve the delivery of cancer care treatment to patients. Cancer care must be understood as different from general healthcare in that it is catastrophic in its threat to life, its potency of treatment and its cost. The cancer care delivery system is now in first-stage crisis because Medicare has substantially cut payment for cancer drugs and essential services.

Almost all Americans are currently treated in community cancer clinics, many of which have had to cut staff and close satellite facilities.

Patients with insufficient or no insurance, especially seniors and the swelling ranks of the unemployed, are increasingly being sent elsewhere for treatment and some patients are actually foregoing treatment.

"Especially during these tough economic times, millions of patients should not have to opt-out of quality cancer treatment because they can't afford it," said U.S. Senator Pat Roberts (R-KS).

The problem not only centers on payments for cancer drugs, but also on essential services provided to cancer patients, such as treatment planning, which are not reimbursed by Medicare.

The Community Oncology Alliance (COA) has aggressively advocated for the prompt pay solution.

"We appreciate the leadership of Senator Specter, who has long supported cancer care funding issues, and Senator Roberts for cosponsoring this important legislation," said Patrick Cobb, M.D., president of the Community Oncology Alliance (COA) and managing partner of Hematology-Oncology Centers of the Northern Rockies in Billings, Montana.

"This bipartisan bill is a welcomed and needed first step in supporting community cancer clinics," he continued. "The passage of these congressional bills will enable community oncology clinics to continue providing patients with cancer care treatments currently not properly reimbursed by Medicare."

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Blue Cross and Blue Shield of Georgia and Piedmont Healthcare Announce Contract Renewal

/PRNewswire/ -- Blue Cross and Blue Shield of Georgia (BCBSGA) and Piedmont Healthcare announced today that they have reached agreement on a three-year contract, effective August 1, 2009.

Under the agreement, BCBSGA HMO/POS and PPO members can continue to access Piedmont Healthcare as an in-network provider, including services from Piedmont Clinic physicians, Piedmont Hospital in Atlanta, Piedmont Fayette Hospital in Fayetteville, Piedmont Mountainside Hospital in Jasper, and Piedmont Newnan Hospital in Newnan.

"We are pleased to continue our relationship with Piedmont Healthcare," said Amy Cheslock, vice president of health services, BCBSGA. "As the state's largest health benefits provider, this new contract allows us to continue offering our members a wide range of choices and continued access to affordable, quality health care."

"We are pleased to renew our participation in the BCBSGA provider network that serves so many of our patients," said Gregory A. Hurst, executive vice president and chief operating officer for Piedmont Healthcare. "Piedmont has a long-standing commitment to the residents of Georgia and the communities we serve. This agreement ensures that BCBSGA members will continue to have access to the highest quality healthcare and the physicians and hospitals they have come to trust."

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Oxendine: Can Your Health Insurance Cope with Swine Flu?

Insurance Commissioner John W. Oxendine wants Georgians to be prepared for a possible swine flu outbreak by reviewing whether their health insurance policies will cover possible contingencies like hospitalization and prescription medications.

The Commissioner suggested that you take a few minutes and consider these questions:

* Does your policy have a preauthorization requirement for hospital admission or other services?

* What is your co-payment for the most common H1N1 treatments? The two drugs doctors can prescribe to treat H1N1 flu are Tamiflu and Relenza. Also find out if there are any coverage limitations that apply to the distribution of the medication. Some policies will restrict coverage on the number of doses per prescription or per year.

* What is your out-of-network co-payment? If your area is heavily affected by the spread of the H1N1 flu outbreak, your regular physician may not be able to see you in a timely manner. If you have to go out-of-network, be aware you will have to pay a higher co-payment for your office visit and possibly any tests run during the visit. Get prepared for any eventuality with the following checklist:

-- Have your health insurance I.D. card handy.
-- Review your health insurance policy provisions. Know which doctors and hospitals are in your network.
-- Make note of your co-payments. Know how much a doctor's office visit will cost. Check to see if your co-payments go up if you go out-of-network.
-- Find the list of pharmacies covered by your health insurance policy.
-- If you have plans to travel, make sure you check to see if there are any doctors or medical facilities in-network where you will be visiting.
-- Make sure you have contact details for your health insurance company available in case you have questions. Your employer may gather all pertinent health insurance information together for you in one simple-to-reference form. If they do, post the information where it can easily be accessed by you and your family.
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The Amputee Coalition of America and Nearly 200 Amputees and Patient Advocates Go to Washington

(BUSINESS WIRE)--On Tuesday, March 10, the Amputee Coalition of America had nearly 200 amputees and patient advocates from 34 states in Washington, D.C., to urge members of Congress to support fair insurance coverage for artificial arms and legs. Their message was simple: Arms and legs are not a luxury!

These citizen lobbyists made this trip to tell lawmakers that they need their own “bailout.” Many of them have nightmarish stories of fighting with insurance companies to try to get the prosthetic devices they need to work and live.

“Insurance companies are unrealistically limiting reimbursement of prosthetic arms and legs or summarily electing not to cover them at all,” said Kendra Calhoun, Amputee Coalition president and CEO. “We intend to turn this tide, and this event is a great example of the grassroots support we have from across the country. Arms and legs are not luxury items. Mobility is a serious issue for amputees who want to keep their jobs, take care of their families, and live healthy, active lives.”

Jeffrey Cain, MD, is a bilateral lower-limb amputee and a member of the Amputee Coalition’s Board of Directors and Medical Advisory Committee. Dr. Cain is an excellent example of how prosthetic devices can help amputees function in their daily lives and contribute to society rather than become dependent on it.

“Being able to have prosthetic devices means that I can take care of my patients and teach medical students,” said Dr. Cain.

Unfortunately, working people with employer-provided health insurance plans are often the ones with the biggest problems, Dr. Cain noted. “Because employer-provided insurance plans are increasingly introducing unreasonable limits and caps, if you have a job in America – if you are a hardworking member of society – you can’t afford a leg to stand on. It’s gotten that bad.”

In fact, some insurance companies are providing coverage for only one prosthesis per lifetime or eliminating coverage completely.

“Even for older adults, it is absurd to expect them to use only one prosthesis in their lifetime,” Calhoun said. “No one would expect a person to wear a single pair of shoes their entire life, and prosthetic devices should be no different.”

These types of insurance company practices pose especially grave challenges for families of children with limb loss.

Rick Castro, of Connecticut, took two of his children to the event because he wanted to try to get better prosthetic coverage for all families, including his own. Castro’s 4-year-old daughter Jennifer was born missing part of her arm below the elbow, and Castro is well aware that, as she grows, she’ll need several highly expensive prosthetic devices.

“When people find out that their insurance company doesn’t provide fair coverage for prosthetic devices, what do they do?” asked Dr. Cain. “They mortgage their homes, raid their children’s college fund, go into debt, turn to government programs for assistance, or are forced to have bake sales to try to pay for these medically necessary and often very expensive devices. That’s pretty sad, especially when they’ve paid their insurance premiums for years for this very purpose.”

David Ross, of New York City, lost part of his right hand and his right leg above the knee after he was mugged and thrown in front of a subway in 1997. He’s seen what happens when amputees have to settle for devices that are not really what they need because of the limitations in their insurance policies, and that’s what brought him to Capitol Hill.

“It’s so unfair that prosthetics are not covered by health insurance plans to the same degree that other conditions are,” Ross said. “It’s a shame that a lot of my fellow amputees who have already had to get over a traumatic accident or being born without a limb have to fight for something that should already be included in their insurance policy.”

Robert D. Doty, Jr., MD, who lost his left arm as a result of a car falling on him, has had problems with his insurance company not understanding – or not acknowledging – his prosthetic needs.

“My carrier did not want to cover a body-powered prosthesis after covering a myoelectric prosthesis,” Doty said. “The company said that one prosthesis is as good as another and that they can do the same thing, which is not true. I can’t do anything around water, liquids, chemicals or heavy machinery or do any heaving lifting with my myoelectric prosthesis without damaging it. It’s great for doing fine, precise work, but if I’m going to be doing heavy lifting or working around water or liquids, a body-powered prosthesis is better. I really need both.”

As these nearly 200 citizen lobbyists hustled from office to office, they made it clear that they want change. In a single day, they made more than 60 Senate visits and more than 100 House visits. In addition, 26 organizations, including disability rights groups and O&P [orthotic and prosthetic] professional organizations, have now signed on with the Amputee Coalition of America to help move this legislation forward.

“We are thrilled with the results of the day,” said Morgan Sheets, the Amputee Coalition’s national advocacy director. “We are already hearing from House and Senate members who are interested in co-sponsoring our bills and supporting our efforts for fair coverage of artificial arms and legs. The turnout exceeded our expectations, and the great enthusiasm of the participants has certainly encouraged us to continue this important fight for fairness.”

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Panel Discussion to Address Impacts of Today's Economy on Retirement

Behind The Headlines: Making the Most of Your Retirement targeted to 70 + age group

WHO: Discussion members include Donna Barwick, J.D., Senior Director of Wealth Management for The Bank of New York Mellon; Henry Bowden, founder of The Bowden Law Firm; John J. Geraghty, Executive Vice-President of SunTrust Bank; Jim Hansberger, Managing Director, The Hansberger Group; and Michael A. Mohr, Managing Director of The Bank of New York Mellon in Atlanta. Emory Schwall, an Atlanta attorney, Certified Estate Planner and Special Assistant Attorney General for the State of Georgia representing the Insurance Commission, will moderate the discussion.

WHAT: Just how has the change in economy affected retirement? What’s it going to take to retire with security, manage long-term health care, and protect one's estate? Where are the financial risks? A panel of financial experts will discuss these questions and more at the discussion, “Behind the Headlines: Making the Most of Your Retirement.” The discussion will address estate planning, asset allocation, health care management, living wills, retirement strategies and other topics of interest to the 70+ age group.

WHEN: Monday, March 16, 2009, from 2:00 p.m. to 4:00 p.m.

WHERE: Woodruff Auditorium of the Atlanta History Center

WHY: The panel discussion is in response to recent news stories about the economy, much of which is aimed at baby boomers and their challenges, but little directly relating to people already enjoying retirement. The event is one in a three-part series hosted by Peachtree Hills Place, a residential community offering a continuum of care in Buckhead for people ages 55 and older, that will discuss the issues directly affecting this demographic.

Please Note: The event is free and open to the public, but registration is required. For more information or to register, call Peachtree Hills Place at 404-467-4900
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Government To Help Pay Health Insurance For Out Of Work Americans

(SPM Wire) Americans who lost their jobs or will lose their jobs anytime between September 1, 2008 and the end of 2009 are about to find it easier to afford health care insurance.

The federal government has announced it temporarily will pay for 65 percent of the cost of health insurance for laid-off workers who lost their jobs during this period.

This provision was signed into law as part of the recent economic stimulus plan and will provide people with up to nine months of partial payments for their health care premiums. The money is available to those whose yearly adjusted gross income doesn't exceed $125,000 or $250,000 for those who file their taxes jointly.

The payments will be made through what is known as COBRA, a federal regulation that allows employees to keep their company health insurance for up to 18 months after they leave their jobs. Now, the government will help subsidize 65 percent of ex-employee COBRA premium payments if they lost their jobs during the qualifying period.

And workers who had turned down COBRA benefits can reapply and receive the subsidy if their layoffs occurred since September 1, 2008.

The new stimulus plan covers premium payments for coverage periods beginning after February 17 - the date the plan was signed into law - and is not retroactive for coverage prior to this date.

Don't wait too long to apply for the new government subsidy, as there is a window during which you are eligible, depending on when you lost your job.

There is some fine print, however, as many Americans who have been recently terminated worked for companies with fewer than 20 employees. These small businesses generally aren't eligible for COBRA, since it only applies to businesses employing more than 20 individuals. Speak with your employer if you have any questions.

For more information about COBRA, which itself became law in 1985, visit the U.S. Department of Labor Web site at www.dol.gov.

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Oxendine Warns of Consequences of Proposed Health Insurance Tax

Insurance and Safety Fire Commissioner John W. Oxendine testified to legislators during his agency’s appropriations hearings that increasing the tax on health insurers and hospitals would lead to higher health insurance rates, more uninsured and could add to the financial hardships facing small hospitals already strapped for cash.

“I felt an obligation to inform the members of the House and Senate subcommittees that the proposal is more than just a 1.6 percent tax on health insurers and hospitals,” Oxendine said. “If passed, this measure will increase the cost of health insurance, and could force more Georgians into the ranks of the uninsured. In addition, the financial problems that hospitals are already facing will only be compounded.”

Oxendine’s remarks were in response to the Department of Community Health’s proposal to raise $317 million in revenue for fiscal year 2010 by imposing a new tax on health insurers and hospitals.
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Oxendine Orders Blue Cross to Reimburse $12 Million

OXENDINE ORDERS BLUE CROSS
TO REIMBURSE $12 MILLION

Atlanta – Insurance Commissioner John W. Oxendine announced today that he has ordered Blue Cross and Blue Shield of Georgia, Inc. to make additional claims payments of $12 million for certain ambulance services rendered to its policyholders that were improperly reimbursed.

The consent order is the result of a market conduct exam initiated by Oxendine’s office which revealed that Blue Cross incorrectly reimbursed out-of-network ambulance providers for services rendered. In a number of instances, Blue Cross made inconsistent payments for comparable ambulance services. In other cases, Blue Cross failed to increase its reimbursement rates over a number of years, in spite of the increasing costs of providing ambulance services.

“The proper payment of claims for emergency services is vital to the maintenance of our trauma system and equally important to protect consumers from excessive balance billing. I want insurers to know that I expect providers to be paid according to the requirements of Georgia law,” Oxendine said.

As a result of this action, Blue Cross has also been ordered to increase reimbursement rates for future out-of-network ambulance services. “Resolving prior practices is only part of the solution,” Oxendine said. “We must ensure that insurance companies reimburse medical providers and policyholders in a fair and equitable manner.”
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