Blue Cross Blue Shield of Michigan ahead of pack with long-standing policy regarding insurance rescissions

Imagine planning to undergo surgery thinking you are well protected by your health insurance only to find out, just one day before you go under the knife, your coverage was dropped. That’s just what happened to a Dearborn man, and it’s a practice that needs to end here in Michigan now.

Blue Cross Blue Shield of Michigan never drops people from coverage when they become sick – a much-maligned practice called rescission – except in cases of fraud or intentional material misrepresentation.

This is yet another example of how the Blues stand as a model for health reform.

CNBC’s ‘American Greed’ features Michigan health care fraud case cracked by Blues

A dark side of health care fraud will be revealed tonight on CNBC’s “American Greed” when the program reports on a Michigan doctor who bilked insurers, Medicare and patients out of at least $1.9 million.

The program profiles Dr. Robert Stokes, who ran a thriving dermatology practice in East Grand Rapids. Dr. Stokes had a dark secret. He was stealing patients’ money. He reused medical supplies and endangered patients.

Blues Vice President Greg Anderson (left), a former detective sergeant with the Michigan State Police, describes to an “American Greed” reporter how the Blues work with law enforcement agencies to fight health care fraud.

The program includes an interview with Greg Anderson, vice president of Blue Cross Blue Shield of Michigan’s Corporate and Financial Investigations unit, who explains how the Blues’ investigative team worked with law enforcement agencies to convict Stokes of health care fraud.

Stokes, who bilked the Blues out of more than $600,000, is serving a 10½-year sentence in a federal prison.

“American Greed” is narrated by award-winning actor Stacy Keach. The program airs tonight on CNBC at 9 p.m., 10 p.m., 12 a.m. and 1 a.m.

For a preview of tonight’s episode, go to “American Greed online. Or check out a preview of the episode in this trailer below.

http://plus.cnbc.com/rssvideosearch/action/player/id/1479384195/code/cnbcplayershare

National Walk@Lunch Day® celebrates the power of walking

The Michigan Blues will participate in National Walk @ Lunch Day on April 30th. This event, championed by the Blue Cross and Blue Shield Association, encourages people to take steps toward better health—even in the midst of a busy work day.
http://www.youtube.com/v/HN-Ft_-lJ_Q&hl=en_US&fs=1&color1=0x006699&color2=0x54abd6Thirty Blues plans across the U.S. will celebrate National Walk @ Lunch Day this year. Participants are invited to extend their lunch break and walk for 30 minutes. The truth is, walking away from work—for at least a few minutes—has the potential to re-energize employees and increase productivity. Walking also keeps the heart healthy, burns calories and increases energy levels.
The Blues have a long history of encouraging people to walk. With the formation of WalkingWorks, the Blues have spread the word that walking provides significant health benefits. This Walking Works web site encourages people to begin a walking regimen and offers the tools necessary to make it happen. People can log their steps online, purchase pedometers, find health tips, and more.
So, grab your co-workers, friends and/or family members and take a walk during lunch on April 30th. And then, keep it going! Find the time to walk as much as possible. Your body and mind will thank you for it.

2009 National Walk@Lunch Day

Breathe easy – Michigan goes smoke-free

Beginning May 1, smoking won’t be allowed in most public places in Michigan. What does this mean for Michigan residents? The Dr. Ron Davis Smoke Free Air Law prohibits smoking in public places such as businesses, restaurants, bars, shopping malls, bowling alleys, concert halls, arenas, museums, mechanic shops, health facilities, nursing homes, education facilities and child care centers.

http://www.youtube.com/v/zBdhAvGciFo&hl=en_US&fs=1&color1=0x006699&color2=0x54abd6

For non-smokers, it’s good news. It means enjoying dinner at a favorite restaurant or bowling with the family without being exposed to secondhand tobacco smoke. For smokers, the news may be a little irritating for those who enjoy smoking a cigarette while watching the big game at a bar or while spending an evening at a night club.
Whatever the case, non-smoker or smoker, everyone should agree that smoke-free air is cleaner air, and clean air is fundamental to good health. So, why not use this as an opportunity to stop smoking altogether? Easier said than done, right?

Kicking the habit is not easy but, a Blue Cross Blue Shield of Michigan program called Quit the Nic can help. Quit the Nic matches Blues members with registered nurse health coaches to help them develop action plans to quit smoking.


Interested in Quit the Nic? Blue Cross Blue Shield of Michigan members call
1-800-775-BLUE (2583).  Blue Care Network members call 1-800-811-1764.
To learn about Michigan’s smoke-free law, visit www.michigan.gov/smokefreelaw.

Michigan Blue Cross helps kick off Cover the Uninsured Week

Michigan Blue Cross is hosting a free seminar about how to apply for free or low-cost medical insurance programs such as MIChild, Healthy Kids and Medicaid for adults today. Blue Cross Blue Shield of Michigan and Blue Care Network are committed to ensuring access to quality health care coverage to all ages.


The expo is being held at Cobo Arena in Detroit. 


Expo attendees can also receive the following for free:

·         Health screenings
·         H1N1 vaccinations
·         HIV/AIDS and STD testing
·         Screenings for diabetes and dental care
·         Mental health services
·         MIChild, Healthy Kids and Medicaid enrollment
·         Information about Head Start

The event runs from 8 a.m. to 5 p.m. today, Friday, April 23, 2010, in the Ambassador Room at Cobo Hall in Detroit. Parking is free. Click here for more information.

What to expect from health care reform if you buy a new individual policy today

Our customer service representatives at Blue Cross Blue Shield of Michigan are getting lots of questions from members who buy individual plan coverage asking about changes in store from health care reform.
We take a look at some of those changes as we conclude our week-long series exploring what reform means to you.

Q: If I enroll in a new policy today, what benefits can I expect based on the language in the Patient Protection and Affordable Care Act?
A: If you bought a new policy after March 23, 2010 in the individual market, some things appear unlikely to change until your next new plan year begins,. At that point, the following changes occur:
  • No lifetime limits on your policy
o   Your policy will no longer have a lifetime dollar limit for benefits.
  • Restrictions on allowable annual limits on your policy
o   The Department of Health and Human Services will post regulations about what annual limits health insurers will be allowed to place on benefits.
  • No pre-existing condition exclusions for children under 19
o   Note: The Department of Health and Human Services has clarified this to mean that health insurers can no longer reject children under the age of 19 based on a pre-existing condition. The Michigan Blues have long followed the same policy.
o   Pre-existing condition exclusions are still permitted for persons over the age of 19.
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  • Coverage of dependents until their 26th birthday
o   The Department of Health and Human Services will post regulations about the definition of “dependent.” Currently, the only requirements are that the person must be under the age of 26 and cannot have an offer of coverage from their employer (the dependent can be married).
  • Coverage of select preventive services without any cost-sharing
o   The Department of Health and Human Services will post regulations outlining which services must be covered without cost-sharing.
Starting in January 2014, other changes will occur:
  • No pre-existing condition exclusions for anyone
  • Rating will be based only on age, family size, geography and tobacco use
  • Charging for age restricted so that the oldest policy holder is charged no more than three times the youngest policy holder
  • No annual limits on your policy
  • Required minimum benefits
  • Coverage for at least 60 percent of expected health care costs
Things that will not change for Michigan Blues members:
  • No health status rating – while this is required by health care reform, Blue Cross Blue Shield of Michigan never rates based on health status.
  • No gender rating – while this is required by health care reform, Blue Cross Blue Shield of Michigan never rates based on gender.

More on what health care reform means to you:

Health care reform targets Medicare ‘donut hole’, includes disability benefits

The new health care reform law targets the “donut hole” in Medicare Part D prescription drug coverage and provides community living assistance for people with disabilities. We explore the measures here as part of our series on what reform means to you.

Q: What is the Medicare Part D “donut hole?”
A: The “donut hole” for Medicare Part D prescription coverage refers to the point in time when a member reaches $2,830 in out-of-pockets costs for medications. Currently, members pay 100 percent toward all medication after their costs exceed $2,830 until their costs reach $6,440, at which time 100 percent of costs are covered.
Q: Who qualifies for the $250 rebate for Medicare Part D? How do I receive my rebate?
A: An individual who reaches the “donut hole,” or Part D coverage gap, will receive a $250 credit payment. The federal government will remit this payment by no later than the 15th day of the third month following the end of the calendar quarter in which the individual reaches the donut hole.
Q: What does the Patient Protection and Affordable Care Act do for people with disabilities?
A: Effective Jan. 1, 2011, the law creates a new national long-term care program for persons with disabilities that provides community living assistance services and supports.
The so-called CLASS Act will provide benefits of at least $50 per day to help persons with disabilities to maintain community living. It will be financed by a new, voluntary payroll deduction – expected to be about $65 per month – by all working adults (persons are automatically enrolled and may then opt-out of the program). These funds may be used for home health care, adult day care, nursing homes and assisted living homes, among other benefits.
However, persons must have contributed for at least five years to be eligible for the benefits.

More on what health care reform means to you:

Tomorrow: What to expect from health care reform if you buy a new policy today

Health care reform: high-risk pool aims to spread insurance to patients with costly medical conditions

One notable feature of the Patient Protection and Affordable Care Act of 2010 – better known as health care reform – is the extension of coverage to high-risk individuals with costly medical conditions through the creation of insurance pools.
The program is designed to help individuals whose pre-existing chronic or other conditions have made it difficult for them to afford or find insurance. As we’ve noted before, Blue Cross Blue Shield of Michigan is unique among insurers in that we never deny anyone coverage based on their medical history. Many other insurers, both non-profit and for-profit deem these people too costly to insure.
As part of our ongoing series of what health care reform means to you, here’s a look at how the new high-risk pool program will impact people with pre-existing conditions.

Access to the new high-risk pool program starts by July for people around the country. While regulations and clarification from the federal government are still forthcoming, the only eligibility requirements are for individuals to have a pre-existing condition and to be uninsured for six months without access to any other qualified coverage options, such as employer coverage.
Insurers that offer coverage under the high-risk pool must comply with the following regulations:
  • A prohibition on pre-existing condition exclusions
  • Adjusted community rating
    • People won’t be charged higher rates based on health status or gender
    • There is a maximum age band of 4 to 1, meaning the oldest people in the pool cannot be charged rates more than four times what the youngest people are charged, , mean
  • They must pay for at least 65 percent of enrollee costs on average
  • Annual out-of-pocket cost for enrollees is to be no more than $5,950 for an individual and $11,900 for a family
More on what health care reform means to you:

Tomorrow: Health care reform for Medicare Part D and members with disabilities

How health care reform impacts ‘Cadillac’ plans, small businesses and group plans

One of the central talking points for health care reform during the long and heated push for its enactment was that if you currently receive health insurance from your employer, and you like your plan, you get to keep it.
But health care reform does make a few important changes to benefit-rich “Cadillac” group plans, and it will incentivize small business owners to begin offering health insurance for workers by providing tax credits.
As part of our weeklong series exploring what the changes mean for Michigan Blues members, we delve into some of your most commonly asked questions. You can also check out yesterday’s post about individual-market policy impacts, or our earlier post outlining the changes more broadly.
And as always, we welcome your comments and questions.

Q: When will near-term changes to my benefits based on national health care reform take effect?
A: Depending on your employer, changes will take effect either in your new plan year if it begins after Sept. 23, 2010 or at the end of the most recent collective bargaining period. If your employer provided coverage through Blue Cross Blue Shield of Michigan as of March 23, 2010, changes to your policy include:
  • No lifetime limits on your policy
o   Your policy will no longer have a lifetime dollar limit for benefits.
  • Restrictions on allowable annual limits on your policy
o   The Department of Health and Human Services will post regulations about what annual limits health insurers will be allowed to place on benefits
  • Coverage of dependents until their 26th birthday
o   The Department of Health and Human Services will post regulations about the definition of “dependent.” Currently, the only requirements are that the person must be under the age of 26 and cannot have an offer of coverage from their employer (the dependent can be married).
Q: What is the “Cadillac Plan” tax and will my policy be affected?
A: The high-cost plan tax, or “Cadillac” tax, is a 40 percent excise tax on the value of employer-provided health benefits that exceed specified thresholds.
When the tax begins in 2018, the standard thresholds are $10,200 for individual plans and $27,500 for family plans. The thresholds increase to $11,850/$30,950 for retirees and employees in specified high-risk professions. The thresholds are also adjusted for age, gender and health status, and will increase in 2018 if health costs rise more than expected.
The tax only applies to tax-excludable employer-provided benefits, so individual market products are not affected. Since this tax goes into effect in 2018, it is unclear how many group benefit packages will hit the threshold. Beyond 2018, the thresholds are indexed for a cost-of-living adjustment (with an additional percentage point added only in 2019). Since the thresholds will grow more slowly than health expenses, more plans will face the thresholds over time.
Q: I work for a small business – will they be eligible for tax credits to help buy coverage for their workers?
A: Starting Jan. 1, 2010, if an employer has fewer than 25 workers with an average annual wage of less than $50,000, they are eligible for a tax credit to help purchase health insurance. The value of this credit will be based on the number of employees and the average wage and can reduce costs of purchasing insurance by up to 35 percent.
The full value of the tax credit is only for small businesses with 10 or fewer workers with an average annual wage of less than $25,000. These tax credits are available until 2014. There are also tax credits available after 2014 for two years through the insurance exchange.
Nonprofit organizations are also eligible for these tax credits, but at a 25 percent maximum credit.
Tomorrow: High-risk pools and pre-existing conditions.
Tags: Cadillac plans, small business tax credits, health care reform, lifetime limits

What health care reform means for Michigan Blues members who buy individual policies

All this week in this space, we’ll be sharing our responses to many of the most commonly asked questions posed by Blues customers who wonder how health care reform will affect their policies and families.
The series is meant as a deeper dive into changes we first discussed in a previous blog post. While many of the provisions cannot be explained in further detail until we get guidance from the federal government, we’ll share with you what we know now.
We’ll start with changes that will affect customers who get their coverage from one of our individual plans.
Q: What changes will apply to my policy and when will they occur?
If you were enrolled in a policy in the individual market by March 23, 2010, some things will change when your plan year starts anew as we currently interpret the Patient Protection and Affordable Care Act. These changes include:
·              Your policy will no longer have a lifetime dollar limit for benefits.
·              Coverage of dependents is extended until their 26th birthday.
o       The Department of Health and Human Services will post regulations about the definition of “dependent.” Currently, the only requirements are that the person must be under the age of 26 and cannot have an offer of coverage from their employer (the dependent can be married).
Q: What happens to my policy if I or one of my dependents has a pre-existing condition?
A: The Michigan Blues has only a six-month exclusion period for pre-existing conditions. As a result, if you were currently enrolled as of March 23, 2010, your pre-existing condition period will have already expired by the time the new changes from the law are effective.
If you remain on this policy and then add a dependent after the effective date for the pre-existing condition prohibitions, your dependent, regardless of age, will still be subject to a pre-existing condition exclusion period based on the date that the policy holder enrolled in coverage. If you enroll in a new individual product any time after Sept. 23, 2010 and include a dependent under the age of 19, there will be no pre-existing condition exclusions.
Tomorrow: ‘Cadillac’ plans, small-business tax credits and other changes for group customers