A Closer Look at Non-Network Services

Evaluating health plans can be tough, especially when it comes to provider networks and managed-care plans like HMOs and PPOs. A major factor to consider when choosing an insurance plan is the out-of-network service coverage.
Any kind of medical care sought outside the network arranged by your managed-care plan is categorized as non-network services. Even though most networks try to include all sorts of providers - from family doctors to pediatricians - not all types of specialists can be included. Things could become tricky especially when the type of service you are looking for is not covered by the network.
HMO members pay for out-of-network services by themselves since HMOs don’t cover out-of-network services. Since PPO plans cost more than HMO plans, members can get partial coverage for out-of-network services as long as the services required were eligible and pre-approved by the insurer.
For example, a PPO member’s visit to a doctor who is part of the network will be shouldered by the insurance company. The member only needs to make a co-payment. However, seeking the services of a doctor who is not part of the network could be covered only up to 80%. The plan holder would have to pay for the remaining 20% out of his own pocket.
Obviously, it would be wise for managed-health-care plan holders to avoid out-of-network treatments. Luckily, many managed-health-care providers are responsive to the plight of their customers when it comes to out-of-pocket expenses. Some providers have managed to deflect the expenses by creating a payment plan, since they are willing to do anything to keep their customers in the network.

A Closer Look at PPOs

The health insurance system is full of complexities. The more choice that you have in terms of doctors, hospitals, and treatments, the more costly it will be it. And if you choose a cheaper premium over an expensive one, your freedom to choose is compromised. Before deciding to purchase a plan that should be perfect for your needs, you should be aware of the different kinds of medical insurance plans that are available and the benefits that they offer.
Nowadays, Preferred Provider Organizations (PPOs) are the most popular type of health plan. Within this year alone, around 158 million Americans were enrolled in PPOs. Here are some of the reasons why PPOs have become popular as a health insurance option.
In the PPO system, doctors, hospitals, and other health providers agree on a deal with insurance companies to provide substantial discounts to plan members. Health insurance firms benefit from discounts given by health care providers. In return, the providers get to bill more patients.
In this way, the plan holder benefits from discounted rates from the doctor’s office, while the doctor, on the other hand, benefits from a guaranteed pool of patients, and finally, the insurance provider benefits from the premiums purchased by a larger group of customers. This system is similar to the “you scratch my back and I'll scratch yours" concept.
PPOs have some advantages over other health insurance options. Unlike other health care organizations, PPOs don’t require the members to retain primary care physicians (PCP). It means that members can consult specialists even without referrals. PPO plan holders also have the freedom to choose any provider–even those that are outside the provider network.
PPOs have a lot more to offer their customers. But what makes them very popular to a lot of people is the balance between cost and freedom.

A Little Truth, a Lot of Clarity
by Senator Larry Craig During a visit to Indiana, Ronald Reagan once said, "If the federal government had been around when the Creator was putting His hand to this state, Indiana wouldn't be here. It'd still be waiting for an environmental impact statement." Although this comment was made in good humor, I have long found the logic beneath it to be true. While often well-meaning, the federal government is rarely as competent and efficient as the private sector in solving problems. A great example of this principle is the prescription drug benefit known as Medicare Part D.

A pain in the wallet
Concerns over rising health care costs are leading some companies to embrace new programs that promise to hold down costs. Others have simply dropped coverage for their employees, a trend that has grown dramatically this decade. These moves have helped control premium growth, which the Kaiser Family Foundation estimates at 9.2 percent this year, down a full 2 percentage points from last year and 4.7 percentage points from its 2003 peak. Rob Ikard, president of the National Federation of Independent Businesses' Tennessee chapter, says the slowing-growth data complements what he's hearing anecdotally from small businesses.

A quick look at Health Maintenance Organizations

Health Maintenance Organization (HMO) is an umbrella term referring to any organized health plan aside from those offered by traditional health insurance firms. It is a prepaid health plan that requires a member to pay a monthly premium in exchange for comprehensive health care. Some of the basic services offered by HMOs are doctor’s visits, emergency care, hospital stays, laboratory tests, x-rays, surgery, and therapy.
HMO members are given access to primary care providers. These primary care providers will examine you and assess your condition before referring you to a specialist. HMOs also ensure lower medical expenses.
Because of the fixed monthly premium, an HMO ensures that its members are provided with basic health care before their conditions deteriorate. Examples of the preventive care HMOs provide are office visits, well-baby checkups, immunizations, physicals, and mammograms.
Many people prefer HMOs to other health plans because of their efficient service. Claim forms are not required for hospital stays or hospital visits; members use cards instead.
If you plan to choose an HMO, you have to consider many factors. First, you have to think about the kinds of services that you will need in the future. If you have special needs, it is important to take note of them. If you already have a health care provider, consider the benefits to know if you need to switch to another provider.
When it comes to the actual provider, reputation and reliability are very important. The quality of service that HMOs provide should tell you what provider to choose. You can also talk to acquaintances enrolled in the particular HMO you are considering and ask them what they think of the services that are provided.

A raise instead of a medical plan
So A&D is considering another option: Letting employees take cash or other incentives instead of signing up for the company's medical plan at all. "We're considering it," Hartsell says, even though he's not yet sure just how to how to go about it or what the incentives would be. Encouraging employees not to participate in the company's healthcare plan may be a growing trend among small businesses, says Richard J. Cellini, the head of research at Salary.com Inc. in Needham, Mass., which helps companies manage employee expenditures. In a survey it released last week, Salary.

AccessTN Open Enrollment Begins
Home > Resource Center > News AccessTN Open Enrollment Begins Feb 26, 2007 AccessTN is the high-risk health insurance pool in the state of Tennessee that provides medical insurance options for those residents of the state that are unable to secure personal health coverage due to a pre-existing medical condition. The State of Tennessee announced earlier this week that it has begun its open enrollment period for AccessTN, the state's new high risk health insurance plan.

AETNA U.S. HEALTHCARE AND OUR LADY OF THE LAKE REGIONAL MEDICAL CENTER SIGN NETWORK AGREEMENT NEW ORLEANS, LA, November 19,1997 -- Aetna U.S. Healthcare announced today that it has signed a full-service agreement adding Our Lady of the Lake Medical Center to its Baton Rouge area hospital network, effective Dec. 1, 1997. Through this contract, Aetna U.S. Healthcare members in the Baton Rouge area will be able to access care from the comprehensive array of services at Our Lady of the Lake and its affiliated facilities.

Affordable Health Insurance > Massachusetts Insurers Set Out to Enroll Working Poor
On January 2, Massachusetts kicked off the second wave of enrollment for its individual health insurance mandate, signed into law last April by then-Gov. Mitt Romney (R). The second wave, aimed at the state's 100,000 working poor, netted only a few hundred people during its first week, despite the incentives insurance companies are offering--proof that many state residents either don't want or don't believe they need health insurance, critics say.

All about PPO

PPO stands for Preferred Provider Organization. It is a care system that provides members with health benefits and medical coverage within a structured, medical professional network and facility. This care system is typically sponsored by employers or insurance companies to help subsidize the medical costs that members would otherwise have to carry themselves.
The organization selects the doctors, health care providers and hospitals in the network that provide members with medical assistance and health care coverage. While a PPO encourages its members to avail themselves of the services of the doctors and hospitals within the network, it also allows members to visit medical services that are outside of the network. A PPO covers more of the medical costs of a patient if an in-network, health service provider is visited.
In a PPO, the member costs involved are determined by a member’s specific needs. Thus, a PPO member pays only for the medical expense incurred from the actual medical services that were rendered. This contrasts the health maintenance organization (HMO) for which a member pays a monthly coverage. Like an HMO, however, a co-payment is often required in a PPO. This refers to the amount paid at the time of treatment to cut the medical costs. This amount is not fixed and depends on the particular medical treatment received.
The major advantage of a PPO is that is offers more choices than other health care insurance systems. If a patient has a medical need that, for some reason, cannot be addressed by health care providers within the network, he or she may avail him or herself of the services of those outside the network while still having a certain degree of their cost covered.

Anthem urged to reconsider rate increase

Last Monday, Connecticut Senator Christopher J. Dodd asked Anthem Blue Cross to review its proposed rate increase. The proposal constitutes an increase of 23% on the average, while in Connecticut the proposed rate increase is 32% for individual health insurance plans.

Last Wednesday, Anthem Blue Cross and Blue Shield asked the Connecticut Insurance Department to approve the increases. Once approved, the majority of the 56,000 residents below 65 years of age who bought health and medical insurance from Anthem will be affected.

The proposed increases will not affect Anthem’s group and business health insurance policies. However, some employers complained about recent premium increases.

In a letter addressed to David R. Fusco, Anthem’s president in Connecticut, Senator Dodd stated that Anthem’s proposed individual policy rate increase “runs counter to the goal of providing all Americans with quality, affordable health care,” especially now that the insurance industry is taking part in federal efforts to reform America’s health care system.

Considering that 322,000 residents are uninsured, the senator said, "Should these new rates kick in, there is no question that additional Connecticut families will join the ranks of the uninsured."

Back in January, Dodd started a “listening tour” to hear what constituents think about health care reform. And according to the senator, Fusco was “kind enough” to attend the kickoff.

In Monday’s letter, Dodd requested that Fusco "reconsider the proposed rate increases in Connecticut and instead join me once again in my efforts and those of the Senate and the House to enact comprehensive health reform legislation this year."

In response, Anthem expressed its appreciation for the senator’s concerns, but stated, “Our proposed rate increase is a reflection of increasing health care costs." The company explained that some of its policies will not be affected by the increase. However, those policies would require buyers to shoulder more of the health expenses.

Basics of Health Insurance

With the soaring costs of hospitalization and medicines, health care has become too expensive to bear personally. Thus, it is necessary to purchase health plans and thereby save money.
Insurance companies offer a wide range of options in terms of health insurance plans. The two most common types of health insurance are reimbursement or indemnity plans and managed care plans, such as preferred provider organizations (PPO), health maintenance organizations (HMO) and point of service (POS) plans.
With the indemnity plan the insured can choose his or her own physician and pay for health care expenses in full or on an installment basis. Managed care plans offer wider coverage, involving an arrangement between the insurance company and a selected network of health care providers, such as hospitals and doctors. Some HMOs require that a doctor in the network manages the entire health-care needs of the patients, referring the patients to specialists within the network as and when required.
If you are enrolling in a medical insurance plan, it is necessary to completely understand the type of coverage offered by health insurance companies. Insurance companies offer different types of insurance, such as hospital expense insurance, which covers expenses for room, board and incidental service costs if the insured is hospitalized; surgical expense insurance which provides coverage for surgeon’s fees and other fees associated with surgery, and physician’s expense insurance which pays for doctors' visits.
Major health insurance plans provide extensive coverage and benefits designed to protect the insured from the costs associated with injury or illness. When purchasing a health plan, one should always examine the policy carefully and read between the lines. Check for additional benefits, such as preventive care, coverage for prescription drugs, mental health benefits, vision care, maternity care and others.

Blue Cross agrees to lower rate increases

Attorney General Mike Cox and Blue Cross Blue Shield of Michigan reached a tentative agreement last Thursday to lower the health insurance rate of increase from up to 56% to just 22%, effective October 1.
The deal would include the company’s non-group and group conversion policies that were bought by individuals 65 years old and below who have no employer-based or government plans. The proposed agreement still needs the backing of state regulators.
The deal replaces the earlier proposal of Blue Cross that included a 56% increase for every policy. The company said that they needed the increase because of the economic recession. Cox contested the proposal, which led to rate hearings. The company covers about 200,000 people with its medical insurance.
Moreover, the rate increase hearings set for the company’s Medicare supplemental or ‘Medigap’ policies will continue, since these are not part of the tentative agreement.
Cox called the tentative deal "a victory for families who are struggling to afford access to health care". He also said that Blue Cross’ rates would be higher if he had not intervened. Cox is a Republican and he will be running for a gubernatorial position in 2010.
Blue Cross Blue Shield of Michigan would be allowed to increase their monthly premiums by $47 for non-group policies according to Cox. The original request of the company was as high as $122 monthly.
Blue Cross says that the state has a “broken regulatory system” that should be changed to guide the insurance market. According to Andrew Hetzel, the spokesperson of Blue Cross, "Because of financial losses and the prospect of a lengthy rate-setting process, we determined new rates were needed sooner rather than later".

Blue Cross Blue Shield
That works out to roughly $10.32 per year for each of the nonprofit's 3.1 million customers - almost 72 percent more than the average amount being spent for advertising and promotion by 42 other Blues around the country, concludes a Pennsylvania research firm that sells its work to the state Blue entities across the country. According to North Carolina regulators, and confirmed by Blue Cross officials, the company's advertising and promotional spending rose from $10 million in 2002 to $15 million in 2003 and to $32 million in 2004.

Blue Cross CEO gets hefty raise
Blue Cross and Blue Shield of North Carolina, which has come under fire for big profits and premium increases, paid its top executive $3.1 million last year, a 22 percent raise. Several senior executives also received double-digit raises. Three earned more than $1 million in annual compensation for the first time, according to the company's annual report, which The News & Observer obtained from state regulators Friday. The increases were driven by bonuses that chief executive Robert J. Greczyn Jr. and other executives earned for boosting Blue Cross' financial performance, said spokesman Mark Stinneford.

Blue Cross starts new prescription drug network - 2005-04-15
The Eagan-based health insurer's network is among the first health plans in the country to allow workers to buy their supply of prescription medications at local drug stores -- even though many insurance plans across the country use mail-order service as a way to control costs. Blue Cross officials say their new network, called 90dayRX, will remain cost effective for members while allowing "face-to-face consultation" with their pharmacists. Al Heaton, director of pharmacy for Blue Cross, said pharmacists have embraced the network.

BlueCross Offers Newest Low-Cost Product
BlueCross BlueShield of Tennessee, a leader in innovative product design, has developed a new low-cost product to help meet the needs of Tennesseans seeking affordable coverage. The product, SimplyBlue, is a traditional deductible and coinsurance benefit plan that can be tailored to customers' needs and budgets. SimplyBlue, which became effective Aug. 1, offers coverage for basic medical services including well-child care, adult preventive screenings, care received at a doctor's office, hospital or outpatient facility, and emergency care. For enhanced benefits, BlueCross is also introducing SimplyBluePlus.

Breaking Travel News: Jetstar, AIG launch web travel insurance
Jetstar and AIG Australia have formed a strategic alliance to offer Jetstar customers an affordable web based travel insurance solution to seamlessly add to their purchased flight itineraries. The online insurance offering comes as Jetstar continues development of its "one stop shop" for online travel related products at Jetstar.com, consistently one of Australia's most popular travel websites. During 2006, Jetstar launched Jetstar holidays through Jetstar.com and its web portal remains a key plank in its distribution of both domestic and international fares and travel products.

Brief Analysis: Health Insurance Choice
A citizen who lives in any one state can buy a toaster produced in any other state. The same citizen can also buy a lawnmower, a sofa, an automobile or virtually any other product - regardless of the state where the product is made. This same freedom does not exist in the market for health insurance, however. Take Texarkana, a city that straddles the Texas-Arkansas border. People who live on the Texas side of the city cannot buy insurance sold to people who live on the Arkansas side and vice versa - even though all Texarkansans can see the same doctors and get treated at the same hospitals.

BW 50: WellPoint Profile
Company Snapshot WellPoint, Inc., through its subsidiaries, operates as a health benefits company in the United States. It serves as an independent licensee of the Blue Cross and Blue Shield Association and serves its members as the Blue Cross licensee for California; the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio, Virginia, Wisconsin; and through HealthLink and UniCare.

California docs bullish on performance
";The whole premise of our program is to have the revenue stream passed on to the medical groups and IPAs to finance IT projects to better capture data for quality improvement,"; said Donald Rebhun, MD, regional medical director of HealthCare Partners and chairman elect of IHA';s board of directors. Aetna, Blue Shield of California, Blue Cross of California, Cigna, Health Net of California, PacifiCare and Western Health Advantage are the participating health plans.

California Health Insurance Agency Announces Fast and Easy Quoting Website for Individuals of All Ages
California Health Insurance Agency Announces Fast and Easy Quoting Website for Individuals of All Ages McClerkin Insurance Services now offers instant California health insurance quotes for every age group through its new site, http://www.mcclerkinins.com [mcclerkinins.com title California Health Insurance]. Sacramento, CA (PRWEB) March 2, 2007 -- McClerkin Insurance Services, based in California, has announced today that it will now be offering instant, free health insurance quotes for California residents through their new quoting system at http://www.mcclerkinins.com [mcclerkinins.com title california health insurance quotes].

California Health Insurance Agency Announces Fast and Easy Quoting Website for Individuals of All Ages
McClerkin Insurance Services now offers instant California health insurance quotes for every age group through its new site, mcclerkinins.com. Sacramento, CA (PRWEB) March 2, 2007 -- McClerkin Insurance Services, based in California, has announced today that it will now be offering instant, free health insurance quotes for California residents through their new quoting system at mcclerkinins.com. We want to eliminate this by constantly updating our site with the newest and best plans available. We want people to feel free to contact us and let us guide them in picking the very best plan for them and their families.

ChoicePoint to Allow People Access to Personal Records
"You will receive the reports that we have on you," Don McGuffey, the firm's vice president for data acquisition, told the state's Senate's Banking, Finance and Insurance Committee in Sacramento on Wednesday. ChoicePoint's announcement comes a month after it disclosed that thieves used previously stolen identities to create what appeared to be legitimate businesses seeking personal records. The bandits, who operated undetected for more than a year, opened up 50 accounts and received vast amounts of data on consumers, including their credit reports.

Choices in Medicare Coverage

Medicare offers various options aside from the Medicare Supplemental Insurance. The original, or default, Medicare plan is a fee-for-service plan. This means that it offers a certain amount of flexibility to its policyholders, with different types of prescription medication coverage and health care services. Policyholders can also avail themselves of the services of doctors or hospitals of their choosing, as long as these health care providers accept payment from Medicare for the services they render.
There are other choices that can either replace or augment the original Medicare plan, including Medicare Special Need Plans, Medicare PFFS (Private Fee-for-Service) plans, Medicare PPO (Preferred Provider Organization) Plans, Medicare HMO (Health Maintenance Organization) Plans, PACE (Programs of All-inclusive Care for the Elderly), and others.
Policyholders are advised not to make any alterations to their current coverage if they are covered by a trade union, employer, TRICARE, the Department of Veteran Affairs, a special program or plan, or Medicare supplemental policy until they consult with a benefits administrator or a licensed insurance provider.
Before a person decides on which Medicare coverage to choose, he or she must consider the plan’s benefits, cost, choice of hospitals and doctors, the location of medical facilities, and other important matters. If needed, assistance can be received in order to get advice regarding prescription medication coverage and health care policy is best for a particular person’s needs. Persons with queries can call Medicare’s hotline at 1800-633-4227 to talk with a service representative, or they can visit www.medicare.gov. Medicare personnel will respond via email with the requested information in approximately three weeks.

Choosing and Using a Health Plan
Contents Your Health Plan Affects Many ThingsWhat Are Your Choices?How to Make Decisions Based on QualityRate Your Health Plan ChoicesSources of Additional Information Today there are more health plans to choose from than ever before. Not everyone has a choice. But if you do, this section can help you choose the plan that offers the best quality for you and your family. The quality of health plans varies widely.

Choosing short-term medical insurance

The current financial crisis has created many “in-betweens”— average people who need immediate health insurance coverage for short and limited periods of time. To answer the needs of the “in-betweens,” private insurance companies have designed short-term medical insurance policies. This quick fix is perfect for consumers who seek insurance coverage for one to six months just to avoid getting into a difficult financial situation.
Through short-term health policies, healthy individuals are able to benefit immediately from family or individual health insurance. Coverage can start after 24 hours of processing. Once a consumer determines the total coverage period required the insurance provider can opt to allow a plan holder to make a one-time payment depending on the period of coverage.
Most of the time, these types of policies include a range of deductibles and premiums. They are promoted as 35% cheaper than regular private health plans. Some of the most common services covered by short-term policies are outpatient and in-patient treatment, as well as surgery. Plan holders can also select their preferred doctor or medical facility without limitations. However, using the services of in-network providers can lead to financial incentives.
As for the drawbacks, short-term medical insurance won’t cover everything. It could be perfect for healthy consumers who need to be temporarily insured; however, short-term plans don’t cover preventive care and routine office visits. Pre-existing medical conditions are also not included in the coverage. In addition, short-term medical insurance is not available nationwide.
So if you need temporary insurance coverage while waiting for new insurance to kick in, you can choose between different short-term major medical plans. However, before choosing any type of insurance, practice responsible consumerism. It is always best to know your needs and analyze the benefits of your possible insurance choice before enrolling in a plan.

CIGNA Plans - Dental
Register for myCIGNA.com Log in to myCIGNA.com Medical: CIGNA Choice Fund CIGNA Choice Fund gives you a wide variety of programs and services that can help you get the most from you plan while improving your health and well-being. Pharmacy: Managed Pharmacy Program Our prescription drug plans give you access to more than 57,000 national and independent participating pharmacies to get your prescriptions filled. Life: Term Life Term Life offers valuable coverage during a period of greatest need-while you are still working and earning an income and building for your future.

Consumer-Driven Health Care Plans Aren't For Everyone
Employers cannot ignore the savings that are being presented by insurers and other underwriters of Consumer Driven HealthCare Plans (CDHP). Some profess premium savings of up to 35% when a CDHP is implemented with a high deductible health plan (HDHP), a Health Savings Account (HSA) and or Health Reimbursement Account (HRA). In addition, insurers contend equally substantial claims that savings will result with the use of their web-based research tools. These web tools will assist consumers in accessing information on conditions, treatments and relative cost of care, thereby yielding more prudent and controlled utilization.

CSRwire.com - Press Release
(CSRwire) WASHINGTON, D.C.- March 13, 2007- The Munich Re Group, a global market leader in property-casualty, life and health reinsurance, and Germany's second largest primary insurer, has today announced its decision to become a member of the World Environment Center, a global non-profit, non-advocacy organization that is a leader in advancing sustainable development business practices. In 2006, The Munich Re Group wrote over 37 billion euros in insurance premiums and employs over 37,000 people.

Different Types of Health Insurance

Health insurance can be split into two general groups: managed care and traditional. There are four main types of plans within these groups, namely, traditional enmity plans (fee-for-service plans), Preferred Provider Organizations (PPO), Point-Of-Service Plans (POS), and Health Maintenance Organizations (HMOs).
For many years, up to the 1960s and ‘70s, traditional enmity (fee-for-service) plans were the common coverage. These plans are like car insurance – the policyholder pays a particular amount of his or her medical expenses (deductible), and after that, the insurance company covers the majority (around 80%) of the bill. Over all, fee-for-service plans offer flexibility to policyholders, wherein they can freely consult and choose their doctors and hospitals without getting permission from the insurance company. However, these plans also involve higher out-of-pocket costs, higher premiums, and more paperwork.
Managed care has boomed recently, together with the advancement of medical technology. Of all the types of managed care coverage, Health Maintenance Organizations (HMOs) are the least flexible, but they are also the least expensive. In exchange for minimal paperwork and low premiums, HMOs require policyholders to see only their prescribed network of doctors. Meanwhile, Preferred Provider Organizations (PPO) offer a bit more flexibility. PPOs also have their own network of health providers. Policyholders are given financial incentives to stay within the network, but they are not completely restricted to it. The third type of managed care is the Point-Of-Service plans (POS). These plans are like a combination of a PPO and an HMO plan, because of the Primary Care Physician (PCP) feature. Policyholders choose their PCP from the POS’ doctor network.
In summary, no health insurance type can be considered the absolute best - it all depends on a person’s preferences and needs.


Health insurance plans are about as unique as the people who purchase them.  With so many options to choose from it is hard to know which is the right fit.  Being informed about your choices is the first step to deciding wisely.
Health Management Organizations (HMO):  These plans are characterized by a range of services provided through a network of doctors, hospitals, labs and clinics who agree to treat members at predetermined rates.  Members need to arrange all care with specialists through their primary care physician—who acts as sort of an overseer of treatment.  Patient choice is often restricted under HMOs, as those who wish to use out of network providers or services may face additional costs; in some cases, patients are required to pay total expenses out of pocket.  HMO premiums are usually very low and plans cover most routine preventative procedures like mammograms, vision exams, immunizations, and physicals.
Preferred Provider Organization, PPO, is another kind of managed care plan that allows members to visit any in-network doctors without a referral from a primary care physician.  Though members do not need to see a primary care doctor and are free to see a specialist of their choice, there is generally better coverage for in-network providers.  PPOs sometimes require co-pays for office visits, and most plans require members to pay the annual deductible in full before coverage begins.  These policies also oblige members to obtain approval before receiving any major medical treatment or services.
Point of Service, or POS, are managed care plans with varying benefit levels based on where care is obtained—in the plan network or out of it.  Most POS plans combine benefits from HMOs and PPOs.  Patients are required to name a primary care physician, but are free to seek out of network care for greater personal expense if they choose.  Some POS plans may ask patients to cover office visit co-pays, an annual deductible or coinsurance out of pocket.  Coinsurance is the percentage of the total cost of care that a patient has to assume once the insurance company has paid their share.  For example, if an employer health plan covers 80% of the total allowable cost of treatment then an employee with that plan would have to come up with the additional 20% of the cost from their personal financial accounts.  
A health savings account, or HSA, is a personal savings plan with tax benefits.  Used in conjunction with policies that have high deductibles, these low premium plans provide an account that can be accessed at any time with the withdrawn funds going to pay for qualifying medical care.  Additional funds can be deposited tax-free, and funds remain in the accounts from year to year.  Funds can also be invested according to the account owner’s discretion.  Interest and dividends build up without tax penalties.  In fact, the only time penalties are assessed is when the withdrawn funds are used to pay for things other than medical care.
With so many options it is always a good idea to take your time and carefully consider risks and benefits before committing to a policy.

eHealth Insurance and its Services

eHealth Insurance is a top Web site for people searching for the best health insurance. It is a certified, health-insurance company that caters to persons, families and small companies that want to purchase health insurance. They have about 800,000 policy-holders throughout the US, and they offer a wide-ranging selection of health insurance plans from the major health insurance companies in the country. To top that off, they also deliver exceptional customer service. With their well-informed and professional representatives, easy-to-follow online tools, and pioneering Web site, people will discover that getting health insurance doesn’t have to be expensive and difficult.
The easy access to eHealth Insurance helps people get the health insurance they want, and at the same time understand what they need. Just by supplying the zip code and basic information about the applicant, he/she can receive free quotations, figure out the plan appropriate for him/her, and gather enough data to make the correct decision on which health insurance to buy. There are certified insurance agents that will accommodate those who are in need of clarification and further explanations regarding their policy.
After the online application has been submitted for the plan or coverage, eHealth will work with the insurance company that the applicant has chosen, to speed up the approval process. eHealth Insurance will still continue forwarding the applicant’s concerns and questions to the health insurance company to ensure that any small glitch or query will not be left unnoticed. This ongoing service also helps the applicant with any future needs from the health insurance department. 
eHealth Insurance offers a wide range of options in health insurance products that applicants can choose from.
They have individual and family health insurance, which can benefit singles or families that weren’t able to acquire health insurance coverage through their employer. This kind of health plan is the most appropriate for individuals and families. They also offer Small Business Health Insurance, which is good for companies and/or organizations that have two to fifty employees. eHealth also offers short-term health insurance, which is good for temporary coverage. This is applicable to those who are between jobs or are fresh graduates, since the term of the policy is not that long, and therefore not that pricey. They also have offer student health insurance, which is good for full-time college students living far from home who are no longer covered by their parents’ policy. eHealth offers affordable dental insurance. They also have dental discount cards, which are another option for standard dental coverage. This is not considered an insurance plan, but it can give the applicant discounts to any dentist in the local area on several dental procedures. Lastly, eHealth Insurance offers health savings accounts.  


In the current health insurance system, Americans who are in employment pay for their portion of employer-sponsored coverage with pre-tax dollars that are automatically withheld from the workers’ paychecks.  For those who do not have access to employer-sponsored health insurance and must pay for policies on their own, they almost always use after-tax dollars to pay premiums.  This creates an unfair tax benefit for workers who take advantage of medical insurance through an employer and makes private health plans unaffordable for many working Americans.  One proposed solution to this problem is state-sponsored health insurance exchanges.
Statewide health insurance exchanges are a way to make healthcare more affordable for a wider audience of working people as federal lawmakers debate tax code reforms that would improve access to health insurance for more Americans.  Like the stock market, these exchanges would include all different kinds of insurers and provide a single market for all different kinds of insurance plans—traditional indemnity policies, HMOs, health savings accounts, PPOs and other options.  Exchanges could also include federal insurance programs like Medicare and Medicaid, thus protecting low income families and those with special medical needs.  Instead of offering health insurance from a single source, employers would designate the exchange as their preferred “plan” and pay their contributions directly to the exchange.  Workers would then be free to choose any of the participating plans in the exchange, thereby offering the opportunity to find coverage that best fits their circumstances.
Supporters of health insurance exchanges insist the system would save small businesses significant administrative costs as processes like enrollment, claims services and premium payments would be centralized and simplified.  This would allow businesses who have never been able to provide health insurance for employees the chance to extend this coverage to workers.  Furthermore, because employers would make fixed payments to the exchange rather than to individual companies, the possibility of coverage non-renewal, group coverage cancellations, and ballooning premiums are eliminated. 
Employees would benefit financially because all contributions to the exchange would come before taxes.  This would level the field for workers who currently have to provide their own insurance with after-tax dollars.  Because coverage would never be tied to a particular employer, people would have the freedom to carry a health plan from job to job without penalty or lapse in coverage.  Continuity of care and policy portability have been hailed as some of the most attractive options with statewide health insurance exchanges.
Statewide health insurance exchanges would ease the financial burden for many working individuals and families without requiring extensive intervention from the federal government.  The system would be a relatively easy transition from the existing model, a quick solution to the healthcare crisis, and would create significant improvement in access to healthcare for millions of working Americans whose employers do not currently offer group health insurance or for those who simply cannot afford personal insurance on their own.  If the federal government fails to enact widespread tax reform to remedy the predicament of healthcare coverage for working Americans, health insurance exchanges could be the answer.

Getting Your Insurer to Pay for Denied Claims

Unfortunately, having your health insurance claim denied is a common occurrence in the U.S. While there is always hope that your claim was denied due to a misunderstanding, a resolution of the issue is never easy.
Never assume that the first “no” answer you receive from your insurance company is final. You are always legally allowed to appeal the insurer’s decision. If you do choose to appeal a denied claim, you need to act quickly. Usually, insurers will only give you 40 days after the denial to start the process of your appeal.
The first thing you should do is to outline your argument as to why the insurer should honor your claim. Read your health plan policy document carefully in order to determine exactly which treatments are included in your coverage and which are not. Insurance companies usually cover treatments that are explicitly included in the health plan policy.
During your appeal process, your physician may be able to write a letter of appeal on your behalf. Many denied claims also get resolved by changing the method by which they are billed. The billing department of your physician may be able to modify the method of billing and resubmit it.
You may also seek help from non-profit organizations, such as the Patient Advocate Foundation. Since 1996 the foundation has assisted more than 21 million people, involved in disputes with their insurers. It also assists those searching for affordable treatments who are not insured.
Your physician and foundations such as Patient Advocate can help you phrase your arguments in a way that is acceptable to the health insurance companies. The process of appeal usually takes up to four business days, but for claims of more than $10,000, the process may take up to 30 days.
Even with repeated denials, determination always tends to get the best results.

Health care mergers: Reaction mixed
When Anthem acquired WellPoint Health Network last year, the deal created the largest private health insurance provider in the nation with about 28 million members. Now UnitedHealth Group wants to take over Pacificare Health Systems to create an entity nearly as large, with roughly 26 million members. Consumer advocates are worried about the trend. "This is the second domino of what is expected to be more mergers, which will lead to higher prices and, we fear, less consumer choice," said Anthony Wright, executive director for health consumer rights group Access California.

Health costs get close look
The position statement includes 16 ways in which physicians can help control costs. They range from avoiding duplicative tests and prescribing generic drugs, to emphasizing healthy lifestyles and not accepting gifts from pharmaceutical companies. It also includes 10 recommendations, ranging from equitable access to essential health care for everyone to standardizing electronic information. The number and range of recommendations indicates the challenges in slowing the rise in health care costs. No one solution will solve the problem.

Health Insurance
Eligible state, local education and local government employees may enroll in health coverage through the state group insurance program. Available options include the Preferred Provider Organization (PPO) which is available statewide or a Point of Service (POS) or Health Maintenance Organization (HMO) if available in your service area. There are specific guidelines regarding the time frame in which you and your eligible dependents must enroll. Please see the Insurance Handbook for specific information regarding eligibility and enrollment.

Health Insurance Comparisons

It is very tempting to just scan through the fine print and the jargon when reading about health insurance. However, this will surely not help when you are performing health insurance comparisons. Take the time to study carefully the different options that are available to you. Doing so can help you save money.
It is not difficult to perform health insurance comparisons. This is particularly true today. You don’t have to make a lot of phone calls as with the advent of the internet gathering information has become much more convenient. There is a huge of amount of information available online. You can find information on many insurance companies with just a click of a mouse button. Finding information is also no longer confined to business hours. As well as visiting individual company websites, you can also visit websites that have information on a wide range of health insurance providers and their plans.
You will be spending your time wisely when you take time to make health insurance comparisons. Health plans from different companies may be similar, but the prices can differ significantly. It is also important to take your time when comparing health insurance plans because each person has different health needs. A plan may have an option that you don’t need. Comparing health insurance plans will help you select a plan that features the options that you need.
When making health insurance comparisons, take the time to read the fine print and to understand the jargon. It is important to do this before you choose your provider. The time you spend researching can certainly make a big difference when it comes to the costs that you will eventually have to pay.

Health Insurance Comparisons

With a multitude of health care plans available, choosing the appropriate one can be tough and tedious. That’s why it is important to understand the different considerations before choosing a health insurance policy.
Some of the health care providers require you to use treatments and services within their network. If you already have a personal doctor, you can inquire whether he is included in the health provider’s network. If you need a new doctor, you can ask your health provider for a list of doctors within their network.
Specific medical conditions need specialists. Just like doctors, you must check whether your specialist is part of your provider’s network. If you don’t have one, and you feel that you’re going to need a specialist in the future, ask your health care provider if you need to consult with your primary-care physician before seeing a specialist.
Pre-existing medical conditions are also a vital factor to consider when making health insurance comparisons. Even though this is common sense, some people still forget to ask their insurance providers about the coverage for pre-existing conditions. Others just assume that they are covered. For those who join a new group health insurance plan, the Health Insurance Portability and Accountability Act or HIPAA makes sure that their pre-existing conditions are covered, provided they have had insurance for the past 12 months.
By taking into consideration some of the important factors in choosing the right health insurance plan, you will have a rough estimate of the cost of your insurance plan. When it comes to cost, you must take into consideration variables such as deductibles and co-payments.
Following these tips will help you find the type of insurance that suits your needs.

Health Insurance Options

Health insurance options used to be limited as the health insurance industry was dominated by only a small number of companies. Back then, the insurance companies had the power in their hands. Today, there are more insurance companies from which consumers can choose. Legal protection has also been given to the consumer. Recent laws ensure fairness when it comes to costs and the quality of service.
Looking at the health plans available today, one can also see that there is more flexibility given to the consumer. Before, the coverage plans that were offered were the same no matter what company was offering it. However, today there are more options available to the consumer. They can now choose a plan that is able to meet their specific needs.
The flexibility enjoyed by consumers significantly affects the cost of their health insurance coverage. For example, they can opt to have a high deductible so that they can have low monthly payments. They can also choose a plan that focuses on emergency care and care for illnesses instead of a plan that focuses on general care.
For people who used to find it difficult to pay for health insurance, the legal protection measures that have been enacted in the past ten years have given them a wider and more varied set of health insurance options. Many states have programs available that provide health insurance options at a very low cost.
The health insurance system has seen many improvements. These are the result of the increase in the number of health insurance providers, as well as the enactment of legal protection. To choose a health insurance plan that is perfect for your needs, you only need to spend some time on research.

Health Insurance Providers

The health insurance industry can appear very intimidating and unfriendly. You might be wondering what qualities a health insurance provider should have. You might also be unsure about how to understand the language of your policy. Choosing a health insurance provider is not easy. However, you only need to educate yourself to know what to do.
There are a number of things to look at when choosing a health insurance provider. First, a health insurance provider should have stable monthly premiums. A provider whose premiums change every month should be avoided. Unstable premiums make it difficult to manage your expenses; in addition, it is very possible that the provider is shady.
Efficient claims processing is another thing to look for. You would not want to receive collection notices asking you to pay your medical bills because your provider has delayed payments. Also, you don’t want to have to follow up your claim several times before they process it. It is time to look for a new provider if your current provider has claims processing and customer service that is very poor.
When requesting quotes, ensure that your provider gives you several options. A provider should not bully you into purchasing a specific policy or health plan. Consider talking to an independent agent rather than a company agent. An independent agent will normally show you quotes from different providers.
During your health insurance comparisons, evaluate each provider’s network of facilities and doctors. Avoid providers with a limited network. Most doctors know details about the health insurance providers located in your area. There must be a reason why they did not choose to work with certain companies.

Health Net Inc.
The settlement includes $40 million for general settlement and up to $20 million to cover plaintiffs' legal fees. The company recorded a pretax charge of $66 million against first-quarter earnings, which were also announced Tuesday. Under the settlement, Health Net also agreed to change its practices involving claims payment, expedited playment of electronic claims and billing disputes. The settlement will be presented May 6 for court approval in the Southern District of Florida located in Miami, with final approval expected to take 5 to 6 months. For the first quarter, the company reported a 42 percent jump in profits.

Health Net wins extended Medi-Cal contract
The new contract to provide benefits for Medi-Cal, California's Medicaid program, will last up to eight years, and the estimated annual revenue is $560 million. Health Net serves 600,000 beneficiaries throughout California, with 500,000 of those being in Los Angeles County. The company also provides Medi-Cal benefits in Fresno, Kern, Stanislaus, Tulare, Riverside, Sacramento, San Bernardino and San Diego counties. Woodland Hills-based Health Net (NYSE: HNT) is one of the nation's largest publicly traded managed health-care companies.

Health Plan Rankings

The health care insurance industry in the U.S. is quite complicated. There are so many health plans available that many Americans find it difficult to select the best one.
Every year, ‘U.S. News & World Report’ collects and publishes the rankings of the country’s top health insurance plans. In spite of this, there is no insurance plan that can be considered the absolute best. Rankings of health insurance plans can be a helpful starting point, but rankings should not be the single source of information when you are looking for the best plan.
Rankings have a number of problems and disadvantages. For one, the rankings can become useless when a listed plan has already become unavailable. If it still is available, it is possible that the benefits included in the plan have changed as well.
Also, rankings are usually not based on data; instead, they are most often based on surveys. Rankings are therefore more subjective. The results are influenced more by the opinions of consumers than by the coverage provided by the plan itself.
The main reason why rankings shouldn’t be taken at face value is that each person has different insurance needs. The highest ranked plan may be ideal for one person but completely inappropriate for another.
Instead of consulting rankings, consider carefully the benefits that you need when choosing your plan. For example, if you do not have a pre-existing health condition, you can choose a plan that has low premiums. On the other hand, you may want a plan that covers prescription drugs, has benefits related to mental health, and has low deductibles.

Health Plans what is the difference
by Michelle Martin, InsWeb All health plans are not created equal. And there's no rule of thumb for which ones are good and which ones aren't. The best plan for one person may not work at all for another. The best plan for you will depend on just what kind of health care you need, whether you have family members and what their needs are, and a few other personal factors. Features and options vary widely among types of plans more so than among companies providing the plans. Where things vary among companies is usually cost - depending on your personal circumstances, some companies' rates may be less than others.

HMSA costs exceed premiums
But health services costs rose more than that, 7.5 percent, and the result was a net underwriting loss of $39 million. Most of that was covered by investments that HMSA maintains for precisely this purpose, investments that appreciated by millions of dollars in 2006. HMSA is also reaping a tax gain from the settlement of a dispute with the IRS. A key factor in the higher than expected costs was higher payments to health care providers -- doctors, hospitals, and the like. "Payments to health care providers in 2006 represented 93.4 percent of revenue, which is higher than HMSA's historical average of 92.

How Hybrid Insurance Works

In response to consumers’ demands, the insurance industry has created linked, or ‘hybrid’, health insurance policies. These policies offer health benefits provided by annuity or life insurance and traditional long-term health plans. Hybrid policies also guarantee that the insured’s long-term health coverage that has not been used can be used by beneficiaries.
Hybrid health insurance functions in many ways. One type of hybrid health insurance that links a life insurance policy to long-term care insurance requires the insured to deposit a premium into a policy to create a pool of money for health care benefits.
Another type of hybrid insurance policy works like a fixed annuity that does not have a premium rider. Instead, a part of the internal return is used to pay for the health coverage. Insurance companies typically provide a payout of up to 300% of the aggregate value of a policy for up to three years after the value of the account is depleted. For example, a policy owner, who has a $100,000 annuity and has chosen a two-year benefit factor and aggregate coverage limit of 300%, would immediately create a pool of money worth $200,000 to cover long-term care expenses and another $200,000 of life insurance benefits. This only takes effect after the initial policy value, which is $100,000, is depleted. But, if the policy holder is healthy and does not need health care, the unused benefits will be paid out as a lump sum to the policy holder or to any named beneficiary.
The cost of these new policies differs from one person to another depending on the person’s health condition, age, gender, benefits requested, and premiums.

How PPOs Differ from other Health Plans

There are many health care plans available to consumers depending on their needs and budget. Even though many health plans seem to offer the same thing, the coverage and benefits they offer are very unique.
Preferred Provider Organizations (PPOs) are one of the popular health insurance options today. Although PPOs basically work like HMOs, or Health Maintenance Organizations, the two provide different benefits.
Even though their networking methods work in much the same way, PPOs have a wider network. They also impose a smaller fine for services acquired outside the network. For a higher cost, PPOs allow their members to choose their preferred providers. HMOs, however, do not cover out-of-network services.
Point of Service (POS) plans integrate the formulas utilized by PPOs and HMOs. In this type of plan, members shoulder a co-payment when utilizing the services of providers that belong to the network. However, there are no deductibles. POS plans function like a PPO regarding out-of-network services. POS plans allow their members to seek services from providers outside their network. However, customers must initially pay deductibles and coinsurance.
PPOs don’t have one single plan. The differences in coverage and benefits are due to the differences in the needs of customers. Some of the factors people might want to consider include the cost of monthly premiums, the coinsurance they need to pay even if they don’t seek out-of-network services, and the size of the annual deductible.
There are still other factors to consider before choosing the appropriate plan. Perhaps the best thing to keep in mind is that the benefits you receive will depend on the amount you pay.

Ignagni retaliates against Insurance industry, gently

Karen Ignagni, president and CEO of the insurance industry’s trade group – America's Health Insurance Plans – tactfully responded to House Speaker Nancy Pelosi’s recent comments about insurers.
House Speaker Pelosi just recently commented that health insurance providers were the “villains” and they have been “immoral” in the Congress debate regarding the health care system’s overhaul.
Karen Ignagni told reporters in a conference call, “For a country that's trying to accomplish what it has failed to do for a century, pass health care reform, the same old Washington politics ... is a major step backward.”
“This is the playbook of consultants, not of consensus.”
In 1994, the insurance industry helped kill off health care legislation by financing and backing the “Harry and Louise” television advertisements. However, this time around, the health insurance group has taken a nuanced approach toward legislation and reform. Now, it is agreeable to certain ideas with bipartisan support, like doing away with the practice of denying insurance to persons with pre-existing conditions. The trade group has also stayed at the lobbying table as President Obama’s government and Congress work on the matter.
Ignagni has carefully stood by that message during the conference call, and has avoided any intimidating statements that the influential group could again turn into negative TV ads if provoked any further.
"For our part, we will set the record straight," Ignagni asserted. “The American people wouldn't know it based on the rhetoric that has been used over the past week or so.”
Ignagni also denied that the health insurance industry has anything to do with the protest groups turning up at the town hall meetings.
“That's not us,” she remarked.
Around 25% of population in Charlottesville does not have health insurance, says census.
According to the United States Census Bureau, almost 25% of Charlottesville’s population does not have health insurance.
There are a few renowned hospitals in Charlottesville, including Martha Jefferson and the University of Virginia Medical Center. Still, one in four people living in Charlottesville does not have individual health insurance. According to exports, college towns usually have more people who are uninsured.
When Brittany Burgess, a resident of Charlottesville, turned 19, she decided to stop getting individual health insurance. She chose not to have insurance because she says she is healthy.
“I've never tried looking into getting everything. I'll just deal without it until I really need it,” she said.
Charlottesville’s free clinic tends to hundreds of patients every day who do not have insurance. According to Charlottesville Free Clinic Executive Director Erika Viccellio, more than 30% of the youth are uninsured.
“A lot of that has to do with trying to find jobs, or they might have beginning jobs that don't offer health insurance,” she said. “They're typically healthy, and they decide not to pay for expensive health insurance.”
Another reason for the high number of uninsured, according to Viccellio, is that many students do not leave Charlottesville immediately after they finish school. However, that is not the sole reason.
“Charlottesville has more small employers than large employers, and it's hard for small employers to offer health insurance. It's expensive,” she said.
Students of the University of Virginia are usually well-insured. In order to enroll, students are required to have health insurance for their first school year; however, they can drop their coverage after that. According to Dr. James Turner of the university’s Student Health, the university’s students are the largest group of insured people in Charlottesville.

Insurers attracted to mature markets
At the same time a Bermuda insurance company enters the Bahamian life and health market, local giant ColinaImperial is chasing business outside of the country. "From our perspective, we understand that the market is mature and we have to look for opportunities outside of this market," said ColinaImperial VP of Finance Catherine Williams. The company is an affiliate of The Nassau Guardian. "But, we're not giving up this market or anything," she added. Indeed, not. For the nine months ending Sept. 30, 2006, Colina Holdings realized net premium revenues of $98.7 million, an increase of 3.6 per cent over the same period a year previous.

Jury Awards $7.4 Million in Wrongful Death Lawsuit Against Humana HMO
SAN ANTONIO, July 21 /PRNewswire/ -- In a verdict that will have widespread long-term implications for HMOs (Health Maintenance Organizations) across the nation and the estimated 130 million HMO enrollees they serve, a local jury on July 1 awarded $7.4 million in actual damages in a wrongful death lawsuit against Humana Health Plan of Texas Inc., a physician, and his physicians group under contract to provide health care services. Jurors were to consider punitive damages in the second phase of the trial, but attorneys for Humana and the plaintiffs reached an out-of-court agreement that capped those damages at $1.

Karen Barkley appointed president and CEO of ACE Canada
ACE INA Insurance and ACE INA Life Insurance, part of the ACE Group of Companies, has appointed Karen Barkley as president and CEO of ACE Canada. She succeeds Daniel Courtemanche, who is now the president and CEO of GCAN Holdings Inc., part of the Ontario Teachers Pension Fund's Ontario teachers Private Capital. Barkley was previously the chief operations officer for ACE INA Insurance. She will now be responsible for managing ACE's operations in Canada. In her new role, she will report to John Lupica, president and CEO of ACE USA. "Karen is a proven leader within our organization and the Canadian market," Lupica said in a press release.

Key Senate Democrats cut cost of medical insurance bill
Key Senate Democrats presented a modified health care bill, calling for private insurance companies to compete with insurance options offered by the government. In a letter, Senators Edward Kennedy and Christopher Dodd said their improved bill dramatically decreases the costs of the earlier incomplete proposal.  The two senators stressed that the Congressional Budget Office’s estimate of the proposal’s cost is now down to $611.4 billion over 10 years from $1 trillion. In a press conference, Senator Dodd said the revised plan is closer to the “historic health care reform.” This bill, he added, offers the public options on a health plan that is run by “what functions best for Americans, not by what makes enormous profits.”The revised bill also calls for a $750 annual fee for each full-time worker and $375 for each part-time worker at large companies not subsidizing health coverage for their employees. Small companies with only 20 employees would be exempt from penalties. It is estimated that the fee would raise $52 billion in 10 years. This would be used to subsidize those who cannot afford to pay for medical insurance. The government’s budget would be coming from higher taxes and trimmed Medicaid and Medicare spending. The two senators also emphasized that the legislation aims to reduce the number of employers who want to drop their workers’ health coverage next year due to high health care costs.  The bill also urges private insurance companies to provide medical coverage to any applicant at a lower cost, especially to those with pre-existing medical conditions. The revised proposal is also projected to advance President Barack Obama’s proposal that aims to cover an estimated 47 million people who lack health coverage.

Kindred Healthcare Press Release
Consolidated revenues for the fourth quarter ended December 31, 2006 increased 14% to $1.1 billion from $971 million in the same period last year. Net income from continuing operations for the fourth quarter of 2006 totaled $21.5 million or $0.54 per diluted share compared to $25.5 million or $0.58 per diluted share in the fourth quarter last year. Operating results for the fourth quarter of 2006 included certain items that, in the aggregate, increased net income by approximately $2.0 million or $0.05 per diluted share. These items included pretax income of $6.

Life After Average Wholesale Price
Two fairly recent laws and a pending out-of-court settlement will have an effect on how much the government and health plans pay for drugs. The current pricing model is a Rubik's cube of jargon and formulas that artificially inflate costs. Based on so-called average wholesale price, it results in pricing condemned by health plans as arbitrary and excessive. Drugs move from manufacturer to mouth through wholesalers and pharmacists, and everyone gets a cut. Manufacturers play the biggest role in determining price, but the wholesalers - who purchase drugs in bulk and distribute them to pharmacists - affect final pricing.

Mandates may have caused nearly 300,000 to lose health insurance
the 16 states (including Ohio) which passed health insurance regulations in the 1990s experienced a 25.6 percent increase in the number of uninsured. The other 34 states experienced an increase in the number of uninsured of just 7.2 percent. the 16 states which passed insurance regulations saw a 6.7 percent decrease in the number of privately insured while the 34 states which did not enact such health insurance regulations saw a decrease of just 3.3 percent. Ohio saw the number of uninsured increase 24.3 percent and the number of privately-insured decrease 6.3 percent during the same period.

Many Insurers Offering Additional Benefits To Attract Medicare Beneficiaries to Prescription Drug Plans, USA
Companies that offer Medicare Advantage plans -- "all in one" insurance plans offered by private companies for Medicare beneficiaries and paid for by the government -- are boosting benefits and reducing premiums for enrollees because of increased government funding, the Wall Street Journal reports. According to the Journal, the 2003 Medicare law increased government payments to Medicare Advantage plans by $46 billion over 10 years in an effort to shift enrollees into privately run plans.

Marketplace: Fixing the Medicare formula
HELEN PALMER: Medicare links what it pays doctors to the rise in the Gross Domestic Product. Medical costs are rising much faster than GDP, so the formula means doctors get squeezed. Physicians cry "foul," and every year Congress rolls back the proposed cuts. Cecil Wilson heads the American Medical Association Board. CECIL WILSON: When my patients get sick, they don't check to see if the economy's growing well enough for them to get care. And so we need something that actually reflects inflation. Wilson testified today before the Senate Finance committee.

Medicare Reform Putting Strain on Pharmacies
Penny Wise Drug Pharmacist Stephen Rosati fills a prescription in the downtown store that has served Hollister since 1948. Photo by: Nick Lovejoy/Photographer Hollister - When Stephen Rosati began working in his family's Penny Wise Drug store in high school, there were three other pharmacies within a block on San Benito Street. Now, more than 30 years later, Penny Wise is the only independent pharmacy left in Hollister, and one of only a handful left in the central coast area.

Metavante Clients Drive Growth With Comprehensive Health Savings Account Solution
MILWAUKEE, Nov. 16, 2005 - Metavante Corporation today announced that Bridgeview Bank Group, a $1.25 billion commercial bank headquartered in Bridgeview, Ill., is the latest financial institution using Metavante's health savings account (HSA) solution. To date, over 100 financial institutions, including one of the nation's largest financial institutions, are leveraging the Metavante HSA solution. Metavante, the financial technology subsidiary of Marshall & Ilsley Corporation (NYSE:MI), is a leading technology solution provider to the financial services industry.

MHA Link: News: Archive 2007
The Commonwealth Health Insurance Connector Authority released this 18-page document explaining the methodology behind its approval of plans from seven health insurance companies that vied for the chance to provide coverage for Massachusetts residents qualifying for ";Commonwealth Choice."; Read more. 03/07/07 Lowell General Hospital is helping Trinity Emergency Service (EMS) get the word out to urge more people to learn how to administer cardiopulmonary resuscitation (CPR).

Montana, Blue Cross Blue Shield Near Agreement on Administration of SCHIP Program
Montana, Blue Cross Blue Shield Near Agreement on Administration of SCHIP Program Category: Public Health News Article Date: 28 Oct 2005 Montana health officials and executives at Blue Cross and Blue Shield of Montana are "close" to reaching an agreement on a contract for the company to administer the state's SCHIP program, the Billings Gazette reports. Since 1999, the state has paid the insurer a per-child premium to provide insurance for medical services under SCHIP. Officials for the state and the insurer are in discussions over whether to continue the contract for a seventh year.

Mother and father know best
NEVER go without health insurance -; it will just give companies a reason to deny you coverage later. Yes, the premiums are ridiculous if you are between jobs, so find a freelance group you can join for major medical. You may not be worried about making doctor visits; worry instead about being blindsided by a truck on a Tuesday afternoon. If you have a mortgage or children, you MUST get life insurance for both of you, even if one spouse is not working full-time. If that spouse died, you would need a full-time employee just to handle the childcare he or she is now providing for free.

New HMO wins bid for $17B Tricare contract

Health Net Inc. suffered a major disappointment when the U.S. Department of Defense awarded its $2.8 billion annual military Tricare contract to Aetna Inc, another Health Maintenance Organization (HMO).
Estimated to be worth around $17 billion, the contract includes five one-year options along with a 10-month base period. The contract will provide service to millions of personnel in the military, National Guard and Reserves, dependents, and retirees in 20 Midwest and East Coast states.
The Tricare military health care program involves 900 of Health Net’s 2,500 employees. The devastating news had a negative effect on the company’s stock, which fell by around 15%. However, it managed to close at $145.13, down only 3%.
In a press statement, Health Net Federal Services president Steve Tough expressed the company’s disappointment about the decision of the Department of Defense.
“We anticipate that a debriefing will be conducted within the next couple of weeks. We will consider the information provided at the debriefing, and within two weeks following, we will determine whether we will accept or challenge the award decision.”
Another health care provider that lost a government contract is Humana Inc. After an extensive bidding attempt, the company lost its $3.73 billion annual contract that covers 10 southern states. The contract was awarded to California PacifiCare’s parent company, United Health Group Inc.
TriWest Healthcare Alliance Corp. was the only company to retain its $2.9 billion annual contract. It provides services to military personnel located in 21 Western states.
In 1988, Health Net won a pilot contract to provide service to military personnel, retirees, and dependents in Hawaii and California. Aetna got the contract in 1993 and, after three years, Health Net won it back. 

New HMO wins bid for $17B Tricare contract

Health Net Inc. suffered a major disappointment when the U.S. Department of Defense awarded its $2.8 billion annual military Tricare contract to Aetna Inc, another Health Maintenance Organization (HMO).

Estimated to be worth around $17 billion, the contract includes five one-year options along with a 10-month base period. The contract will provide service to millions of personnel in the military, National Guard and Reserves, dependents, and retirees in 20 Midwest and East Coast states.

The Tricare military health care program involves 900 of Health Net’s 2,500 employees. The devastating news had a negative effect on the company’s stock, which fell by around 15%. However, it managed to close at $145.13, down only 3%.

In a press statement, Health Net Federal Services president Steve Tough expressed the company’s disappointment about the decision of the Department of Defense.

“We anticipate that a debriefing will be conducted within the next couple of weeks. We will consider the information provided at the debriefing, and within two weeks following, we will determine whether we will accept or challenge the award decision.”

Another health care provider that lost a government contract is Humana Inc. After an extensive bidding attempt, the company lost its $3.73 billion annual contract that covers 10 southern states. The contract was awarded to California PacifiCare’s parent company, United Health Group Inc.

TriWest Healthcare Alliance Corp. was the only company to retain its $2.9 billion annual contract. It provides services to military personnel located in 21 Western states.

In 1988, Health Net won a pilot contract to provide service to military personnel, retirees, and dependents in Hawaii and California. Aetna got the contract in 1993 and, after three years, Health Net won it back.

NHBA Insurance Agency
In 2002, the NH Bar Association established NHBA INSURANCE AGENCY, INC., a subsidiary corporation, to act as an insurance resource and to assist members in obtaining professional liability insurance. Since that time, the agency has grown and now provides coverage to hundreds of members. The initial focus on professional liability insurance has broadened to include discounted long-term care insurance for members, their employees and families. The agency will soon be offering life and disability insurance and is currently evaluating other insurance products for members. NHBA Insurance Agency benefits Bar members in several ways.

Outperforming Aviva fails to please
Richard Harvey, the chief executive of Aviva, claimed that the UK's biggest insurer was outperforming the domestic competition - and its own internal targets - as annual operating profits rose 12 per cent to 3.2 billion. In his last presentation to the City before handing over to Andrew Moss, his successor, Mr Harvey reported that profits from life insurance were 12 per cent higher at 2 billion, on an embedded-value basis. Operating profits from general and health insurance were up 8 per cent at nearly 1.7 billion. Norwich Union, Aviva's UK arm, had a record year, increasing sales by almost a third to 13.


One of the most common types of managed care health insurance plans are Preferred Provider Organizations (PPOs).  A PPO supplies medical services for members at discounted prices by providing a network of approved providers and facilities for patients to choose from.  However, PPOs also allow group members to seek covered care outside of the network for slightly higher fees.
The main advantage of a PPO over other kinds of managed care health insurance is the flexibility patients have to manage their own care.  Policyholders do not have to designate a primary care physician or coordinate referrals for specialized care, nor are they limited to seek treatment within the plan’s network.  This means that patients can typically choose any doctor, hospital, clinic, or lab they want.  Though the cost of obtaining care outside of the health plan’s network is slightly higher, non-network services are still covered and the PPO will pay a portion of the cost of care.  For example, a PPO might cover 90 percent of the cost of heart surgery if performed by a doctor in the plan’s network.  If a patient chooses to use a surgeon outside the network, the PPO might pay only 70 percent of the cost.  The patient would then be responsible for the remaining balance.  Another advantage of the PPO model is that patients can refer themselves to specialists at any time, for any reason.  With other managed care plans, a primary care physician must first deem a procedure medically necessary before issuing a referral for treatment with a specialist.  In a Preferred Provider Organization, members are free to decide if and when they see a specialist without needing approval from another doctor or the plan.
Perhaps the biggest disadvantage of PPOs is the cost.  These types of plans usually cost more than other managed care options because of the increased flexibility the PPO offers.  Deductibles and premiums are usually higher as well.  Most PPOs require patients to pay a small amount out of pocket for medical services like doctor visits and prescriptions, whether care is obtained in-network or out.  These co-payments can range from just a few dollars to more than $30 depending on the service.  Furthermore, there is little room for negotiation in seeking treatment outside of the plan’s network.  Even if the care you need is not offered by a PPO network provider, you will still have to pay more to use an out-of-network doctor.
As you consider which health plan is best for you and your family, your budget and specific medical needs will determine the type of insurance you choose.  If specialized care is something you use frequently, or if you want to have the freedom to manage your own medical care, a PPO might be your best option.  If you can manage a slightly higher monthly premium and yearly deductible, a Preferred Provider Organization will provide the flexibility and expanded choice in coverage that will help you get the care you need.

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Sanford plans to join the fray in ND health plan market

The Sanford Health Plan intends to join the competitive North Dakota insurance market if approved.
Blue Cross Blue Shield of North Dakota is currently the leading health plan provider, controlling over 90 percent of the health plan market and covering over 475,000 people.
“I think it’ll be a minor tremor, but I think it’ll shake things up a bit,” said David Middaugh, president of Middaugh & Associates, referring to the possibility of Sanford entering the fray. “They’ll have a presence right away.”
Sanford, based in Sioux Falls, South Dakota, has been a health coverage provider since 1998, and has become one of the top private health insurance firms in South Dakota, second to Wellmark, the Blue Cross Blue Shield plan.
The Sanford plan is now covering 51,000 people in Minnesota, Iowa and South Dakota, and it hopes to increase enrollees to 100,000 in five years.
The Sanford plan is affiliated with Sanford Health, a major health care provider network; it is poised to merge with Fargo-based MeritCare before the year ends. Executives of both health systems look forward to offering their insurance program, with coverage starting January 1, but Sanford is still waiting for regulatory approval.
“In North Dakota we have already started getting requests for information about Sanford’s insurance plan,” MeritCare spokesman Darren Huber said. “It’s clear people want additional high-quality options for insurance.”
North Dakota insurance commissioner Adam Hamm said his staff is still evaluating Sanford’s application to join the health insurance market in the state.
 “They’re a significant player in South Dakota,” Hamm said of Sanford. “They’ve indicated a strong intent to expand in our state. I’m obviously interested in seeing more choice and competition in North Dakota.” 

Should Wellness Be an Option or a Mandate?
Virtually every company health plan sold includes at least a few members that tilt the scales of risk to the danger zone. Anyone who is obese or smokes is an automatic member of the club. Until now, trying to pry them away from that high-cost group has often been an exercise in gentle persuasion. They might get a small bonus for joining a health club, gift cards for shedding weight, or perks for eating healthy food at a company cafeteria. However, last spring, a Michigan HMO intensified the campaign for personal fitness when it rolled out a plan that's aimed right at their pocketbooks.


If you choose to enlist the help of a professional insurance agent in deciding on a health plan, the following are some important questions to ask before committing to a policy:
1.  What kind of agent are you, and what company or companies do you represent?  Some agents are “captive”, meaning they are only licensed to sell products from a single company. Other agents are independent, which means they can represent a variety of companies.  An independent agent usually has more flexibility in helping you find coverage to suit your needs.
2.  What is this plan’s deductible? Does this amount apply to each individual on the policy or my family as a whole?  Most plans have a per person/per year deductible, which means each person in your family has his and her own deductible that has to be met before coverage kicks in.  Some plans offer a “worst case scenario” deductible, which applies if your family is in a serious accident together or everyone gets sick at the same time.  In these cases, the deductible only applies to one or two people before coverage takes over for the entire family.
3.  What is this plan’s patient responsibility and stop-loss?  Patient responsibility, or coinsurance, is the percentage of the cost of services that the policyholder is responsible for paying.  A stop-loss number sets the maximum dollar amount that an insured’s coinsurance percentage can be applied to. It basically works to set a limit on a patient’s out-of-pocket expenses for a calendar year.  Once this stop-loss number has been reached, the insurance company will pay 100 percent of the cost of services for the remainder of that year.
4.  What is this plan’s yearly maximum out-of-pocket expense?  This will include things like co-payments, deductibles, coinsurance percentages, and other fees.
5.  What is the lifetime maximum benefit, and does this plan have a per-illness maximum?  Most plans have either a $2 or $5 million lifetime maximum, which is the ultimate amount the insurance company will pay if you or someone in your family becomes seriously ill.  Per-illness caps are restrictions placed on how much an insurance company will pay for individual illnesses or serious injuries.  Some plans require patients to stay within these limits in order to qualify for the lifetime maximum benefit.
6.  Is this a scheduled plan?  Some health insurances stipulate a scheduled structure—fixed costs for procedures—even if those procedures cost more than the policy allows.  Patients are responsible for paying any remaining balance out of pocket.
7.  Are yearly doctor visits limited?  Most quality plans let you visit your doctor as many times as you want, but some plans restrict how often you can see a physician in a single year.
8.  Does the plan offer prescription drug coverage?
9.  Are there any other fees associated with this plan?  Hidden fees can add up quickly and may become seriously burdensome if you or one of your dependents requires long term care, a lengthy hospital stay, or emergency room care.      

State attorney pushes for rejection of health plan cost increase

Connecticut state attorney general Richard Blumenthal is pushing for the rejection of Connecticut insurance companies’ request for a health care rate increase of 30% by October this year.

In response to Anthem Blue Cross Blue Shield’s request for a rate increase of 22%–30%, Blumenthal commented, “This request is legally or factually unjustified by anything this company has submitted.”

In Anthem’s submitted increase request, the premium for the $250-deductible Century Preferred PPO, one of Anthem’s popular health plans, will increase by $62 monthly, from $264 to $326.

Sarah Yeager, the company’s director of corporate communications, said that increased claim costs have exceeded the insurance premium enough for the company to demand for higher rates.

A spokesperson of Anthem Blue Cross Blue Shield also said that the finances and rates of the company are regularly evaluated to ensure that the premium fees can cover claim expenses and costs.

The company, which filed its request on June 9, agreed to waive the 30-day deadline for the state Insurance Department to continue its evaluation. Based on state law, the changes in the company’s rates would have been automatically instated on Thursday without the department’s implied disapproval. The changes in rates could affect 56,000 insured Connecticut residents. According to the Insurance Department’s records, the population covered by the company comprises 4% of the 1.4 million residents of Connecticut.

An increase of this magnitude, Blumenthal said, is clearly against the statutory standard. “The current economic condition and the October 1 implementation also make it necessary for the state to reject this request.”

Insurance rate increases and the insurance companies’ compliance with regulations and laws involving insurance business are regulated by the state Insurance Department.

Ten Questions for Your Managed Care Plan
Before enrolling in a new managed care health plan, you need to be sure that you're comfortable with the services that it will provide. Sometimes your employer will pick a plan for you, in which case you should be aware of its rules. Sometimes you can choose a plan yourself, but not without answers to some pointed questions which you should pose. Here are ten questions (and some appropriate answers) to help you choose the right plan. Which doctors can I choose? A managed care network can't be any better than the doctors and other service providers that it uses. Check to see if you recognize any of the providers' names on the network list.

The Capital City's Newspaper Online
Blue Cross also pays for a $2,500-a-year ''personal dining allowance'' for Babin instead of a golf country club membership that some past CEOs had received as a perk. He gets an annual physical at company expense, and Blue Cross paid for him to see an estate and tax planner. When the Babins are out of town on his business, Blue Cross Blue Shield pays someone $25 a night to dog-sit the Babins' three dogs at their Jefferson County home. Babin also is covered by the company's benefit restoration plan, the lucrative retirement plan for a few current and former top executives.

The Standard partners with Health Advocate to offer a more efficient healthcare system

Standard Insurance Company (“The Standard”) recently signed a partnership agreement with Health Advocate, one of the leading health advocacy and assistance companies, in a bid to simplify healthcare plans and services. The Standard, a subsidiary of StanCorp Financial Group, Inc., announced today its new offering—the Health Advocacy Solution—in collaboration with Personal Health Advocates.

Luce Giroux, Second Vice President of Product Management at The Standard, said that the Health Advocacy Solution would help increase worker productivity by reducing the employees’ stress in navigating the healthcare system. “The Health Advocacy Solution offers direct access to our Personal Health Advocates who will provide more efficient ways of solving healthcare-related issues.”

Giroux said the Health Advocates are mostly nurses or well-trained assistants who will help workers navigate the usually complex healthcare system. They will help locate doctors, explain and clarify billing statements and negotiate fees, explain benefits plans and healthcare-related terminology, and even give assistance on issues related to prescription drugs. Moreover, the Health Advocates, backed by medical doctors and other health experts, also extend their help to their client’s spouse, parents, parents-in-law, and dependent children.

Regardless of industry, groups with at least 10 employees can avail themselves of the Health Advocacy Solution at a discounted rate, in addition to The Standard’s other health insurance plans and services.

David Rocchino, Chief Sales Officer of Health Advocate, Inc., also expressed his gratitude for The Standard’s partnership with his company. “We are indeed very pleased to be part of The Standard’s offering. Our advocacy complements their services and programs… This new service can help clients save time and money,” he added.

The Sun-Times News Story
Jerry Jackson: Improving health coverage What is your reaction to a recent report that a single individual living in Pennsylvania pays $1,400 for health insurance coverage while someone living next door in New Jersey or New York pays $4,000 to $6,000 for basically the same coverage? The reason for this is that states such as New York or New Jersey have "mandated coverage" for podiatry, acupuncture, massage therapy, osteopathy and even aromatic therapy (treatment by odors). This means that insurance companies have to include all of these exotic items if they sell insurance to residents of these states.

Understanding Company Benefits
There are an infinite number of different benefit packages being offered to college students today, and each of them has its strong and weak points. The key to choosing the best package is to know the options available and the many terms used to describe them. One important point is that you should never choose a job based solely on the benefit package it offers. This is because benefit programs can change at any time. There are no laws that require companies to maintain any level of benefits, so plans can and do change.

UnitedHealth offers $510 million deal to Health Net

UnitedHealth Group plans to acquire Health Net’s subsidiaries in the Northeast for $510 million.

Announced by the two companies on Monday, the acquisition will strengthen UnitedHealth’s networks in New York, New Jersey, and Connecticut. Based in Minnetonka, the health plan and medical insurance provider generates the most revenue among health insurers in the nation.

Jay Gellert, chief executive of Health Net in Los Angeles, expressed his confidence about the deal. "For our members, this offers a very, very good alternative. We have confidence [UnitedHealth] will do first-rate by our members."

Health Net will continue its operations in Arizona and in western United States. The deal, which needs regulatory approval, is expected to be completed within a year.

New York, New Jersey, and Connecticut have around 578,000 Health Net members combined. 437,000 of them are risked-based commercial members and 35,000 are self-insured commercial members. Another 55,000 are Medicare Advantage members, while the remaining 51,000 are Medicaid members. Operations in those areas are expected to generate $2.7 billion in revenue.

Jeff Alterm, UnitedHealth chief executive in the Northeast, talks about the company’s reputation in the region. "We have a long, successful history of serving people in the Northeast and are committed to responding to local market needs while also providing people with access to the innovative health care products, programs and technology applications of a company with a national scale."

Health Net’s Medicaid and Medicare businesses, along with the commercial membership renewal, will cost UnitedHealth around $60 million. Once the deal is closed, UnitedHealth will pay Health Net another $290 million. The remaining $160 million will be paid within a span of two years.

UnitedHealth offers $510 million deal to Health Net

UnitedHealth Group plans to acquire Health Net’s subsidiaries in the Northeast for $510 million.
Announced by the two companies on Monday, the acquisition will strengthen UnitedHealth’s networks in New York, New Jersey, and Connecticut. Based in Minnetonka, the health plan and medical insurance provider generates the most revenue among health insurers in the nation.
Jay Gellert, chief executive of Health Net in Los Angeles, expressed his confidence about the deal. "For our members, this offers a very, very good alternative. We have confidence [UnitedHealth] will do first-rate by our members."
Health Net will continue its operations in Arizona and in western United States. The deal, which needs regulatory approval, is expected to be completed within a year.
New York, New Jersey, and Connecticut have around 578,000 Health Net members combined. 437,000 of them are risked-based commercial members and 35,000 are self-insured commercial members. Another 55,000 are Medicare Advantage members, while the remaining 51,000 are Medicaid members. Operations in those areas are expected to generate $2.7 billion in revenue.
Jeff Alterm, UnitedHealth chief executive in the Northeast, talks about the company’s reputation in the region. "We have a long, successful history of serving people in the Northeast and are committed to responding to local market needs while also providing people with access to the innovative health care products, programs and technology applications of a company with a national scale."
Health Net’s Medicaid and Medicare businesses, along with the commercial membership renewal, will cost UnitedHealth around $60 million. Once the deal is closed, UnitedHealth will pay Health Net another $290 million. The remaining $160 million will be paid within a span of two years.

UnitedHealth to Buy PacifiCare in Push Into Medicare - New York Times
If shareholders and state and federal regulators approve the deal, PacifiCare, based in Cypress, Calif., would operate as a wholly owned unit of UnitedHealth, which is based in Minneapolis. UnitedHealth would gain an array of services for the rapidly growing Medicare population, including private Medicare-subsidized insurance plans, Medigap supplemental coverage for people who subscribe to conventional fee-for-service Medicare and the new Medicare drug coverage benefit that begins next January. During the next decade, 10 million people will join the ranks of Americans 65 and older, who now number 36.7 million, Dr.

UnitedHealthcare becomes presenting sponsor of the Administaff Small Business Classic
"The Administaff Small Business Classic is more than a golf tournament to UnitedHealthcare. It’s also an opportunity to reaffirm our long-standing relationship with Administaff and work together to support charities that impact people’s lives in meaningful ways," said Robert Sheehy, CEO of UnitedHealthcare. "And as the presenting sponsor, we are especially honored to support the wonderful research of M.D. Anderson Cancer Center, regarded as one of the best cancer hospitals in the nation. M.D.

Vitria announces Blue Cross Blue Shield Of Arizona will be first Smart Gateway customer
New Solution Addresses Payer-Provider Administrative Interoperability Sunnyvale, November 9, 2005 -- Vitria (NASDAQ: VITR), a leading provider of Business Process Integration solutions, today announced that Blue Cross Blue Shield of Arizona (BCBS of Arizona) has entered into a definitive agreement to license and implement Smart Gateway, a business process application (BPA) that is the newest component of Vitria's Healthcare BPA Suite.

webwire.com News Story
Today, Sprint provides an array of cost-effective mobile solutions that help healthcare providers balance patient care, operational efficiency, cost management and regulatory compliance. Information that was previously available only within the walls of hospitals can now be viewed remotely, in real-time on Sprint smartphones, saving critical minutes in life-threatening situations and enabling caregivers to function more effectively and efficiently.

Worcester Telegram & Gazette News
Both sides say safety is their goal. "Weight loss is so extremely unsuccessful for patients in the morbidly obese category that even with intense behavioral and nutritional counseling, the chance of success is remote," said Dr. John J. Kelly, surgical director of the Weight Center at UMass Memorial Medical Center. "Less than 2 percent would ever lose substantial weight and ever maintain that weight loss. Unfortunately, surgery is the only life-saving measure for this. Subjecting them to diet and nutritional counseling is like prescribing a therapy that will fail.