Insurance Dispatch

The new column is up, and available at The Medical Blog Network.

This week, we look at how quickly and accurately health insurance carriers pay claims. There's even an interactive online tool to help out.

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WeekEnd LinkFest

If you haven't checked out some of the other great sites on our blogroll, here's a sampler of what you're missing:

Joe Kristan at Roth & Co makes sense of the whole Estate Tax controversy (now that's an accomplishment!).

Over at the Health Business Blog, Eric Zimmerman has a great piece on how health care "consumerism" and internet-based information come together.

Jon Coppelman, co-host of Workers Comp Insider (which, BTW, plays host to the current Cavalcade of Risk), shows us that Mom was right when she told us to "stop that before someone gets hurt!"

And Bob Coffield at the Health Care Law Blog fills us in on the new Health Information Technology Promotion Act (now there's a mouthful).

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High Risk Coverage

Premiums for the state's health insurance plan for high-risk people will rise in October - an increase that could force even more Nebraskans out of the program.

Premiums are expected to jump an average 23 percent - even more for older people buying lower-deductible coverage.

The plan is for people who do not have access to health insurance through employers and can't get coverage from private insurers, or would have higher premiums through private insurance

High risk pools, usually considered the answer to uninsurable conditions, are becoming more costly to run. Even with taxpayer subsidies the premiums paid by the insured is becoming cost prohibitive.

In 2004, more than 6,000 Nebraskans bought insurance through the state's Comprehensive Health Insurance Pool. By June, the number had dropped 10 percent, to 5,400

As the number of participants drop, the cost of providing cover for the rest of the pool increases as fewer dollars are available to pay claims. This results in even higher premium increases for those who remain in the pool.

State Insurance Director Tim Wagner said rising claims could exceed revenue in a couple years. The program is paid for by people's premiums and a subsidy from the state tax on insurance premiums.

With the increase, Nebraska will have some of the highest premiums for any state high-risk program in the nation, said Holly Whelan with the American Diabetes Association.

At least one state (Florida) closed their risk pool a few years ago to new entrants. Other states may follow and Nebraska may very well be the next.

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Don't Buy Health Insurance

From the Indianapolis Star . .

The Aug. 1 editorial, "Do-it-yourself fixes for high health costs," neglected one significant step consumers can take to hold down costs: If you are relatively young and healthy, don't buy health insurance. Learn to distinguish between the cost of health insurance and the cost of treatment, and be aware that for the large majority insurance premiums are approximately five to 10 times the actual cost of medical care in any given year. For a family of four, the break-even point is about $4,000 to $5,000.

Great advice!

Only buy health insurance in the years where your expenses will exceed $5,000.

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Dr. Goofy Look's at Reality

The University of Miami's 1-year-old primary-care practice in Key Biscayne, run by internist Dr. Pamela Merino, will close Sept. 1, leaving some village residents and employees looking for a new doctor.

Even though the university expected Merino's office to lose $50,000 to $80,000 a year, in the past 12 months it was almost $250,000 in the red, said Jerry Broderick, assistant chairman of the university's department of medicine.

''The loss was far greater than what we'd planned for,'' Broderick said. ``Professional fees and patient revenues were never at the level we had hoped to achieve.''

The university will keep its concierge practice, which charges $1,500 a person for more personalized services and preventive care not covered by typical insurance plans.

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Paging Dr. Goofy

The sage green carpet and décor in the lobby are welcoming and restful to the eyes. The woman behind the counter, concierge Arlene Dullaghand, greets visitors with a smile. After acknowledging their arrival, she tells a mother and her children someone will be with them soon to “shepherd them” to the area of service. The children head to the PlayStations in the game room while the woman helps herself to the coffee bar.

“I love everything here,” said Laurie Wheeler, who came with sons Justin, 10, and David, 12. The boys couldn’t wait to play their favorite video game. Wheeler, if she wants, can check her e-mail in the patient library/computer room.

“This is really fancy. They deserve fancy,” Ronda Woods said of the Parkview Medical Group clinic she manages, and of the people who come through its doors at 10515 Illinois Road, just west of Scott Road. Her staff benefit from the lessons she’s learned from people running such places as Disney World, Ritz-Carlton hotels and M.D. Anderson Cancer Center in Houston.

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