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Showing posts with label Health. Show all posts
Showing posts with label Health. Show all posts
Thursday, February 6, 2014
Health Care Costs and Spending in New York State
Tuesday, February 4, 2014
St. Elizabeth Medical Center,Faxton St. Luke’s Healthcare receive Grant Funds for Affiliation Expenses
(Utica, NY – Jan. 2014) St. Elizabeth Medical Center (SEMC) and Faxton St. Luke’s Healthcare (FSLH) have each received
grant funding of $50,000 from The Community Foundation of Herkimer & Oneida Counties, Inc. to assist with the legal and consultant services for their joint affiliation project.
“Both organizations are grateful for The Community Foundation’s support of our affiliation plans,” said Scott H. Perra, FACHE, president/CEO of FSLH. “Our strategic plans focus on meeting the needs of our community now and into the future. The grant is a tremendous benefit to both organizations and helps us to defray some of the significant costs that come with this type of collaboration.”
The Honorable Norman I. Siegel, Chair of SEMC’s Board of Trustees, agreed. “In these challenging economic times for healthcare, we have an obligation to area residents to ensure the long-term fiscal health of both St. Elizabeth and Faxton St. Luke’s while continuing to meet our collective mission,” he said. “We appreciate this generous assistance with our plan.”
Tuesday, November 12, 2013
Locally, state's health care exchange going well
Nationally, the Affordable Care Act’s website problems have caused numerous headaches for consumers — and politicians.
Locally, however, it’s a different story.
Three area nonprofits are trying to guide consumers through the state’s health plan exchange.
Two say things are going well. The third is stuck in limbo waiting for state action.
“It’s going great,” said Steve Wood, community health coordinator for ACR Health where state-funded navigators have helped 120 people sign up for health coverage in the agency’s nine-county service area since the state health plan exchange opened Oct. 1. And the nonprofit has 200 appointments scheduled this month, he said.
“It’s really going quite well,” agreed Diana Haldenwang, executive director of the Mohawk Valley Perinatal Network. The network’s state-funded navigators have had more than 100 appointments with people looking at plans, helped more people fill out paper applications for Medicaid, fielded more than 450 phone calls and scheduled another 100 appointments in Oneida and Madison counties, she said.
“We knew we’d be busy, but I think I was a little surprised by the sheer volume of people and the calls that we’re getting,” Haldenwang said.
At the Utica Community Health Center, though, things are moving slowly. The center mostly serves patients without insurance who should benefit the most from the Affordable Care Act and the tax subsidies it offers to help people buy health plans, said Janine Carzo, chief operations officer of Regional Primary Care Network, which oversees the center.
The act requires everyone to enroll in a health plan by Jan. 1.
So far, though, the center’s federally funded certified application counselors have helped only a few consumers. That’s because one counselor, who trained the first week of October, didn’t receive her portal password from the state until Nov. 1, Carzo said. She did help a few people who signed onto the exchange on their own, but the center was waiting for the password to advertise the service.
The staff has a list of patients who should qualify for Medicaid under its expansion next year and many other patients will qualify for subsidies, she said. Now, the advertising will begin.
A second counselor, who was hired in September, didn’t get into a state training session until this week and will have to wait for her password, Carzo said.
For Haldenwang, the biggest drawback has been consumer confusion. A few seniors have called, not realizing people on Medicare can’t use the exchange, she said.
CLICK HERE FOR ARTICLE LINK
Thursday, September 26, 2013
October Events
Mental health Conference (Radisson-Utica NY)
CONFERENCE SCHEDULE :
REGISTRATION 8:30-9:00 AM
MORNING SESSIONS 9:00-11:30 AM
LUNCH 11:30-1:00 PM
AFTERNOON SESSION 1:00-4:30 PM
Presentation topics will include:
▪ TRAUMA
▪ FOSTER CARE
▪ EMPATHIC THERAPY
▪ LONG-TERM EFFICACY STUDIES
▪ PSYCHIATRIC MEDICATIONS
▪ DSM—ADHD, BIPOLAR, ODD
▪ PEER SUPPORT
▪ SOCIAL-EMOTIONAL LEARNING
▪ NUTRITION
▪ SAFE & EFFECTIVE APPROACHES
A one-day symposium for clinicians, educators, researchers, students, and parents.
Radisson Hotel Utica Centre Special Rate $89/night
200 Genesee Street 1-315-797-8010
WE MUST DO BETTER
TOGETHER WE CAN
REGISTER ON-LINE: www.2013educationsummit.eventzilla.net
_________________________________________________________
Education Summit (OCC - Syracuse NY)
Friday 10/11 - Film & Panel 6:00pm—9:00pm
Saturday 10/12 - Symposium 9:00am—4:00pm
A must attend for educators, students, and parents
Experts from across the state will present on topics such as:
▪ COMMON CORE STANDARDS
▪ HIGH STAKES TESTING
▪ SOCIAL-EMOTIONAL LEARNING
▪ TEACHER EVALUATION (APPR)
▪ STUDENT PRIVACY/DATA-MINING/inBLOOM
▪ STATE TEST REFUSAL
▪ SYSTEMS CHANGE/REFORM
▪ IMPACT OF POVERTY, TRAUMA, STRESS
▪ SPECIAL EDUCATION AND ESL STUDENTS
REGISTER ON-LINE: www.2013educationsummit.eventzilla.net
______________________________________________________________
NHA Seminar (Salina St - Syracuse NY)
Saturday OCTOBER 19
9:00-3:00 PM
LOCATION:
SSIC BUILDING
2610 South Salina Street
Syracuse NY 13205
ON-LINE REGISTRATION
www.nha-syracuse.eventzilla.net
The Nurtured Heart Approach (NHA) is a very pragmatic and easily understood system
designed to turn the challenging child around to a new pattern of success. The approach has
been found to produce substantial success in helping children flourish at higher than
expected levels of achievement. The NHA teaches significant adults how to positively
support experiences of success in children while not accidentally energizing their
experiences with failure. NHA offers a means of adult-child communication that results in an
increased pattern of positive interactions which promotes a sense of healing and healthier
relationships. The Nurtured Heart Approach will teach you how to stop nagging, lecturing,
yelling, and feeling overwhelmed with parenting and help you build solid, and respectful
relationships with your children. The Nurtured Heart Approach will benefit children in all
ages and stages from the easy going child to the strong-willed and intense child.
FOR PARENTS, TEACHERS, & OTHER PROFESSIONALS
Seminar Schedule :
8:30 Registration begins
9:00 Foundational Principles
10:30 Interaction & Communication Techniques
12:00 Lunch ($10 or on your own)
1:00 Limit Setting and Consequences
2:30 Q&A
3:00 Seminar ends
This Seminar is for you if…
• You notice that techniques that work with other children
continue to make your situation worse, despite the best of
intentions
• You want the intense children/adolescents you know to
flourish
• You want to reserve the use of medications as a last
resort, or you want an approach that will give you the
strong probability of shifting the child off medications
• You want to gain a new perspective on your life and the
children/youth in your life
CONFERENCE SCHEDULE :
REGISTRATION 8:30-9:00 AM
MORNING SESSIONS 9:00-11:30 AM
LUNCH 11:30-1:00 PM
AFTERNOON SESSION 1:00-4:30 PM
Presentation topics will include:
▪ TRAUMA
▪ FOSTER CARE
▪ EMPATHIC THERAPY
▪ LONG-TERM EFFICACY STUDIES
▪ PSYCHIATRIC MEDICATIONS
▪ DSM—ADHD, BIPOLAR, ODD
▪ PEER SUPPORT
▪ SOCIAL-EMOTIONAL LEARNING
▪ NUTRITION
▪ SAFE & EFFECTIVE APPROACHES
A one-day symposium for clinicians, educators, researchers, students, and parents.
Radisson Hotel Utica Centre Special Rate $89/night
200 Genesee Street 1-315-797-8010
WE MUST DO BETTER
TOGETHER WE CAN
REGISTER ON-LINE: www.2013educationsummit.eventzilla.net
_________________________________________________________
Education Summit (OCC - Syracuse NY)
Friday 10/11 - Film & Panel 6:00pm—9:00pm
Saturday 10/12 - Symposium 9:00am—4:00pm
A must attend for educators, students, and parents
Experts from across the state will present on topics such as:
▪ COMMON CORE STANDARDS
▪ HIGH STAKES TESTING
▪ SOCIAL-EMOTIONAL LEARNING
▪ TEACHER EVALUATION (APPR)
▪ STUDENT PRIVACY/DATA-MINING/inBLOOM
▪ STATE TEST REFUSAL
▪ SYSTEMS CHANGE/REFORM
▪ IMPACT OF POVERTY, TRAUMA, STRESS
▪ SPECIAL EDUCATION AND ESL STUDENTS
REGISTER ON-LINE: www.2013educationsummit.eventzilla.net
______________________________________________________________
NHA Seminar (Salina St - Syracuse NY)
Saturday OCTOBER 19
9:00-3:00 PM
LOCATION:
SSIC BUILDING
2610 South Salina Street
Syracuse NY 13205
ON-LINE REGISTRATION
www.nha-syracuse.eventzilla.net
The Nurtured Heart Approach (NHA) is a very pragmatic and easily understood system
designed to turn the challenging child around to a new pattern of success. The approach has
been found to produce substantial success in helping children flourish at higher than
expected levels of achievement. The NHA teaches significant adults how to positively
support experiences of success in children while not accidentally energizing their
experiences with failure. NHA offers a means of adult-child communication that results in an
increased pattern of positive interactions which promotes a sense of healing and healthier
relationships. The Nurtured Heart Approach will teach you how to stop nagging, lecturing,
yelling, and feeling overwhelmed with parenting and help you build solid, and respectful
relationships with your children. The Nurtured Heart Approach will benefit children in all
ages and stages from the easy going child to the strong-willed and intense child.
FOR PARENTS, TEACHERS, & OTHER PROFESSIONALS
Seminar Schedule :
8:30 Registration begins
9:00 Foundational Principles
10:30 Interaction & Communication Techniques
12:00 Lunch ($10 or on your own)
1:00 Limit Setting and Consequences
2:30 Q&A
3:00 Seminar ends
This Seminar is for you if…
• You notice that techniques that work with other children
continue to make your situation worse, despite the best of
intentions
• You want the intense children/adolescents you know to
flourish
• You want to reserve the use of medications as a last
resort, or you want an approach that will give you the
strong probability of shifting the child off medications
• You want to gain a new perspective on your life and the
children/youth in your life
Wednesday, September 18, 2013
NY State of Health - Starting Today, Customer Service Center is Open
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Thursday, June 27, 2013
Oswego County Business: St. Elizabeth Medical Center in Utica Cuts Staff
Tuesday June 25, 2013
St. Elizabeth Medical Center in Utica cuts staff
Major employer in Oneida County eliminates 40 vacant positions
St. Elizabeth Medical Center in Utica announced today that a staff reduction is being implemented to ensure the hospital’s long-term sustainability.
“The delivery of safe, high-quality patient care remains the primary focus and patient care will not be affected,” a spokesperson said.
St. E's is a nonprofit private organization sponsored by the Sisters of St. Francis of the Neumann Communities.
St. E's employs 1,951 people. Ten employees were laid off and approximately 40 vacant positions will be eliminated. It is ranked among the top-5 employers in Oneida County.
The employees worked in all areas of the medical center and ranged from executive leadership to administrative to those with direct-care responsibilities.
Many individuals will be offered the opportunity to apply for any vacant position for which they qualify. Due to a prolonged decrease in hospital inpatients, one medical/surgical unit, 2D, was closed effective yesterday.
“These are extremely difficult decisions in challenging economic times,” said Richard Ketcham, president/CEO. “We have a responsibility and an obligation to the community we serve, the medical center and its board of trustees to ensure the long-term fiscal health of the organization, while continuing to meet our mission. This further demonstrates the importance of success in our affiliation plans with Faxton St. Luke’s Healthcare, which we are still pursuing diligently.”
Numerous factors led to the reduction of the medical center’s workforce, including the decreased reimbursement to hospitals by New York state Medicaid over multiple years. In addition, Medicare reimbursements have not kept pace with the high cost of care, the spokesperson added.
St. E's has experienced over $11 million of New York state Medicaid cuts in the past three years. New York state’s ongoing budget crisis presents immense financial challenges to patient-care providers, who continue to receive cuts to their payments, the spokesperson said.
“We will continue to work with our elected officials on achieving Medicaid reform that includes the redesign of the Medicaid system,” Ketcham said.
“The delivery of safe, high-quality patient care remains the primary focus and patient care will not be affected,” a spokesperson said.
St. E's is a nonprofit private organization sponsored by the Sisters of St. Francis of the Neumann Communities.
St. E's employs 1,951 people. Ten employees were laid off and approximately 40 vacant positions will be eliminated. It is ranked among the top-5 employers in Oneida County.
The employees worked in all areas of the medical center and ranged from executive leadership to administrative to those with direct-care responsibilities.
Many individuals will be offered the opportunity to apply for any vacant position for which they qualify. Due to a prolonged decrease in hospital inpatients, one medical/surgical unit, 2D, was closed effective yesterday.
“These are extremely difficult decisions in challenging economic times,” said Richard Ketcham, president/CEO. “We have a responsibility and an obligation to the community we serve, the medical center and its board of trustees to ensure the long-term fiscal health of the organization, while continuing to meet our mission. This further demonstrates the importance of success in our affiliation plans with Faxton St. Luke’s Healthcare, which we are still pursuing diligently.”
Numerous factors led to the reduction of the medical center’s workforce, including the decreased reimbursement to hospitals by New York state Medicaid over multiple years. In addition, Medicare reimbursements have not kept pace with the high cost of care, the spokesperson added.
St. E's has experienced over $11 million of New York state Medicaid cuts in the past three years. New York state’s ongoing budget crisis presents immense financial challenges to patient-care providers, who continue to receive cuts to their payments, the spokesperson said.
“We will continue to work with our elected officials on achieving Medicaid reform that includes the redesign of the Medicaid system,” Ketcham said.
Via Oswego County Business (link)
Monday, February 25, 2013
Did You Know: Dental PPO Balanced Billing?
Dental Benefits: What is Balanced Billing?
This year, once a month, Council Services Plus will be bringing you tid-bits of helpful and interesting facts and information about insurance.
Last month we discussed Dental Benefit Maximums; so keeping with that theme, this month we
we'll focus on another term that often is associated with dental benefits: PPO Balanced Billing.
Many times employees choose a dentist that may not participate in the "network" of dentists approved by the plan offered by the employer. Many dental plans offer out-of-network benefits and still pay claims submitted by dentists that do not participate with that plan. If your plan has out-of-network coverage (usually associated with Point of Service (POS) or Preferred Provider organization (PPO) plans) you need to be aware of the fees charged by that dentist, and what your plan deems as reasonable and customary (R&C) charges that they will pay for.
When you use a participating (or preferred) provider, that dentist has agreed to accept the company's R&C fees as the basis for their billing. For example, if a filling R&C fee is $100, then the participating dentist must charge that for a filling. If your coinsurance is 80%, then you pay $20 (20% of $100) and the company pays $80.
Let's now assume you go to a non-participating provider and they charge $150 for the same filling. The insurance plan will still base the amount they pay at 80% of R&C ($100) and you must pay the "balance" of the bill due to the non-participating dentist. Under this situation, your cost is $70 ($150-$80). You can see why you may "prefer" to see a "preferred" provider in a PPO plan to help keep your costs down.
Broker News
Patient-Centered Outcomes Research Tax Update
The Patient-Centered Outcomes Research Tax, also known as the Comparative Effectiveness Research Fee, is a fee paid to the government to fund Patient-Centered Outcomes Research Institute (PCORI) research. One of the main goals of the Patient Protection and Affordable Care Act (PPACA) is to foster a healthier population through improvements to the health care system.
Read more >>
Read more >>
W-2 Reporting Requirement for Employers Update
The Patient Protection and Affordable Care Act (PPACA) contains a requirement for employers to report the cost of health coverage under an employer sponsored group health plan on an employees' W-2 form. The cost includes both the cost paid by the employer and contributions from the employee.
Read more >>
Read more >>
Did You Know...You Can Get Dedicated Client Consulting Through the New Blue Honors Program?
If your agency qualifies for the Blue Honors program, you will be eligible to utilize Excellus BlueCross BlueShield's Information Connection. Information Connection is an online tool that allows brokers to pull specific information, whether it be by book of business or individual groups.
Read more >>
Read more >>
Creditable Drug Coverage and Medicare Part D – What It Means to Employer Groups
Creditable coverage is non-Medicare Part D prescription drug coverage that is at least as good as (i.e., pays, on average, as much as or more than) standard Medicare Part D prescription drug coverage. When a person becomes eligible for Medicare Part D, they must maintain creditable drug coverage, and not have a break in coverage for 63 or more days.
Read more >>
Read more >>
Excellus BCBS Awards Hospitals $26 Million for Quality Improvements
Fifty-four upstate New York hospitals and health centers last year earned $26 million in quality improvement incentive payments from Excellus BlueCross BlueShield as part of their Hospital Performance Incentive Program (HPIP). In the past nine years, quality performance incentives from Excellus BCBS have exceeded $145 million.
Read more >>
Read more >>
Neighbors Helping Neighbors Build Healthier Communities – Learn More About Our Service to the Community
Neighbors Helping Neighbors Build Healthier Communities - 2012 Annual Report of Caring tells how we collaborate with other nonprofits, providers and government and civic agencies to make a difference where we work and live.
Read more >>
Read more >>
Wednesday, February 13, 2013
Employer Notice of Health Insurance Exchange to Employees – Delayed
Employer Notice of Health Insurance Exchange to Employees – Delayed
The Departments of Labor, Health and Human Services, and U.S. Treasury issued new guidance on January 24, 2013 delaying the requirement that employers notify all employees about the existence of the new health insurance exchanges.
Originally scheduled to take effect by March 1 of this year, the notice requirement has been put on hold until late summer or early fall of 2013. A new effective date has not yet been determined. Once a new effective date is announced, it is expected that employers will be required to distribute the notice to all existing employees, as well as to new employees upon hire.
The Department of Labor may issue model language for employers to use in satisfying the notice requirement.
It is expected that the notice must include:
A description of what Exchanges are, what they provide, and where employees can go to find more information about them; Information regarding available tax credits if the employer doesn’t provide minimum essential coverage and the employee purchases health insurance on the Exchange; and A statement that employees who purchase coverage on the Exchange may lose any employer contributions and that these contributions may be excludable from employees’ income when they file their Federal income tax
We will keep you informed when new guidance becomes available.
Please visit our Health Reform page often for the latest information and updates
Sunday, February 10, 2013
How Are You and Your Clients Impacted by Health Care Reform?
How Are YOU and Your Clients Impacted by Health Care Reform?
Health care reform is intended to overhaul the health care system, expand affordable coverage, change insurance rules and create an online marketplace (exchange) in each state for the individual and small group markets.
Health care reform will affect individuals, families, businesses, physicians, hospitals and health insurance carriers.
Some aspects of the law are already effective and others will be phased in over the next few years. Regulations will continue to be issued as implementation of the health care reform law is not yet complete. To help you understand the law, the most important provisions and dates are outlined in a new brochure (PDF), "How are YOU Impacted? An Employer's Guide to Health Care Reform."
To request printed copies of the brochure, please contact your Account Consultant and reference form number B-4280.
View Brochure (PDF) >>
Sunday, February 3, 2013
Comptroller Thomas P. DiNapoli's Weekly News
Comptroller Thomas P. DiNapoli's Weekly News
DiNapoli Finalizes Fiscal Monitoring System
State Comptroller Thomas P. DiNapoli announced Monday his office has finalized plans to implement a statewide fiscal monitoring system that would publicly identify local governments experiencing financial strain.
DiNapoli: Inappropriate Payments Cited In Kingston Audit
The city of Kingston made $23,000 in improper payments to employees for unearned leave time, according to an audit released Thursday by State Comptroller Thomas P. DiNapoli. As a result of the audit, former fire chief Richard Salzmann was arrested and charged by Ulster County District Attorney D. Holley Carnright with offering a false instrument for filing in the second degree, a class A misdemeanor.
DiNapoli: Empire BlueCross BlueShield Paying Hospitals Windfalls For Special Medical Items
New York State health insurance provider Empire BlueCross BlueShield has routinely allowed hospitals to charge excessive amounts for special medical items such as implants, drugs and blood, because they did not sign agreements to limit reimbursement for those items, according to an audit of the New York State Health Insurance Program released Friday by State Comptroller Thomas P. DiNapoli.
DiNapoli: Utica Facing Continued Fiscal Challenges
The city of Utica continues to struggle with recurring budget gaps and has nearly depleted its fund balances, according to a fiscal report issued Tuesday by State Comptroller Thomas P. DiNapoli. The report is the latest in a series of fiscal profiles on cities across the state.
State Comptroller Thomas P. DiNapoli announced Monday his office has finalized plans to implement a statewide fiscal monitoring system that would publicly identify local governments experiencing financial strain.
DiNapoli: Inappropriate Payments Cited In Kingston Audit
The city of Kingston made $23,000 in improper payments to employees for unearned leave time, according to an audit released Thursday by State Comptroller Thomas P. DiNapoli. As a result of the audit, former fire chief Richard Salzmann was arrested and charged by Ulster County District Attorney D. Holley Carnright with offering a false instrument for filing in the second degree, a class A misdemeanor.
DiNapoli: Empire BlueCross BlueShield Paying Hospitals Windfalls For Special Medical Items
New York State health insurance provider Empire BlueCross BlueShield has routinely allowed hospitals to charge excessive amounts for special medical items such as implants, drugs and blood, because they did not sign agreements to limit reimbursement for those items, according to an audit of the New York State Health Insurance Program released Friday by State Comptroller Thomas P. DiNapoli.
DiNapoli: Utica Facing Continued Fiscal Challenges
The city of Utica continues to struggle with recurring budget gaps and has nearly depleted its fund balances, according to a fiscal report issued Tuesday by State Comptroller Thomas P. DiNapoli. The report is the latest in a series of fiscal profiles on cities across the state.
Comptroller DiNapoli Releases Municipal Audits
New York State Comptroller Thomas P. DiNapoli Thursday announced his office completed audits of:
Comptroller DiNapoli Releases School Audits
New York State Comptroller Thomas P. DiNapoli Thursday announced his office completed audits of:
Tuesday, September 4, 2012
Impacts of the Health Law on New Yorkers
Many of you have questions about health care reform in New York and what its implications are for both you and your clients. Here is an article that clearly explains some of the main questions people are asking. These answers come from James Knickman, a knowledgeable and reputable source, who is the President and Chief Executive Officer of the New York State Health Foundation (NYSHealth), a private, statewide foundation dedicated to improving the health of all New Yorkers.
Sunday, July 22, 2012
Excellus sits on $1.26 billion emergency fund as it seeks double-digit rate increases
As it seeks double-digit rate increases, Excellus BlueCross BlueShield is sitting on a $1.26 billion rainy day fund to cover higher than expected claims.
Even though Excellus has nearly twice as much in reserves than the state requires, the health insurer does not want to use any of that money to offset rate increases, according to documents the company has submitted to the state justifying its request to increase rates by as much as 20 percent next year on some health plans.
Instead, it wants members to contribute even more to that fund.
Under its proposal, Excellus would take anywhere from $5.52 to $11.95 a month from some members’ premium payments and add that money to its reserves. Customers in one plan, the company's direct pay HMO, would pay nothing into the
reserve fund because Excellus is seeing a rate decrease for that product.
“These reserves are the ‘insurance’ that assures payment even when costs run higher than anticipated, or emergencies or disasters occur, and should not be used as an alternative fund to temporarily reduce rate adjustments,” Excellus says in documents filed with the state Department of Financial Services.
Excellus is seeking permission from state regulators to increase rates on some of its community-rated products Jan. 1. Community-rated plans for individuals and groups are policies that charge the same amount regardless of age, sex, health status or occupation. The proposed rate changes will affect about 90,000 of the company’s 700,000 members in Central New York. The increases do not apply to experience-rated large groups or self-insured plans.
The documents related to health insurers’ rate hike requests used to be secret. But late last year the state ordered insurers to make them public so customers can review them and submit comments to regulators who decide whether to grant the increases, reduce or reject them.
Excellus has come under criticism for amassing a big reserve fund while consumers struggle to afford health insurance.
“It’s a disservice to consumers that they’re (Excellus) not using their reserves to defray some of the proposed rate increase,” said Elisabeth R. Benjamin, a lawyer and co-founder of Health Care for All New York, a statewide coalition of more than 130 nonprofit groups pushing for more affordable health insurance options for state residents. “We would submit the state should not permit the rate increase to further allow this carrier to stockpile its reserves.”
Consumers Union, publisher of Consumer Reports, issued a report in 2010 that said Excellus and other BlueCross BlueShield plans across the country were salting away more money than necessary in their reserve funds. At that point, Excellus had $965.1 million in reserves.
Since then its reserve fund has grown by more than 30 percent.
Money in the fund comes from the company’s surplus or profits.
A portion of every rate increase by insurers is usually earmarked as a contribution to reserves, said Laurie Sobel, a senior attorney with Consumers Union. That’s why regulators reviewing a rate increase request need to look at an insurer’s reserve levels, she said. If those levels are excessive, regulators can protect consumers from unnecessary rate increases by disallowing additional contributions to reserves, she said.
The minimum amount of reserves Excellus must have to meet state requirements is $703 million.
That amount would not give Excellus, which has nearly 2 million members, a sufficient cushion, said Elizabeth Martin, a company spokeswoman.
“That’s like saying to someone that they should strive to have a minimum amount in their savings account, but that might not be enough if suddenly they need to cover large unforeseen expenses,” Martin said.
Excellus has about $792 in reserves per member, enough to cover claims for about three months, she said. The average amount of reserves per member held by other upstate nonprofit insurers is $1,179, she said.
Excellus last dipped into its reserves in 2008. It used $244 million from the fund to offset higher than expected medical expenses, declining enrollment and investment losses. If the fund had been at the minimum level the company would have had to impose steep rate increases in 2009, Martin said.
Excellus made a profit of $223 million in 2011 on revenue of $5.7 billion. The 2011 profit was about five times bigger than the $44.5 million profit it made in 2010. It also tripled the pay last year of its top executive to $5.2 million.
In its pending rate filing, Excellus says its proposed increases are designed to allow the company “ ... to achieve a modest operating margin.”
Excellus says it is “... sensitive to the fact that individuals and small businesses struggle to afford higher premiums.” But it warns that failure by regulators to approve the rate hike request would lead to the need for even greater increases in the future.
Excellus says the escalating cost of health care services, equipment and products continues to be the primary reason for rate increases.
In its filing, Excellus says rate increases are being driven by a combination of higher costs and greater use of medical services and equipment by consumers.
Health insurers come up with spending forecasts by multiplying the anticipated increase in cost of a medical service by the rate of consumption or use of the service or product. This is known as the “medical trend,” a measure of medical inflation.
Excellus is forecasting spending next year will increase 9.6 percent to 12.7 percent for hospital outpatient services, 7.8 percent to 8.7 percent for hospital inpatient services, 3.1 percent to 7.1 percent for professional services such as doctor office visits, and 5.7 percent to 7.9 percent for drugs.
The public has until Aug. 11 to submit comments to the state about the proposed rate changes.
Comments can be submitted online, by email to PremiumRateIncreases@dfs.ny.gov or by mail to: Charles Lovejoy, Health Bureau, New York State Department of Financial Services, 25 Beaver St., New York, NY 10004.
Proposed rate increases
Here are the rate increases proposed by Excellus BlueCross/Blue Shield:
High-deductible health plans, Preferred Provider Organization: Up to 19.9 percent
Direct pay indemnity plans purchased by individuals: Up 12.3 percent
Direct pay Health Maintenance Organization and Point of Service: Decrease 3.4 percent.
ValuMed Plus, a policy for individuals on limited incomes: Up 14.1 percent
Healthy New York, another plan for individuals with limited income: Up 3.6 percent.
Medicare Supplemental plans: Down 0.5 percent.
Source: Excellus
Instead, it wants members to contribute even more to that fund.
Under its proposal, Excellus would take anywhere from $5.52 to $11.95 a month from some members’ premium payments and add that money to its reserves. Customers in one plan, the company's direct pay HMO, would pay nothing into the
reserve fund because Excellus is seeing a rate decrease for that product.
“These reserves are the ‘insurance’ that assures payment even when costs run higher than anticipated, or emergencies or disasters occur, and should not be used as an alternative fund to temporarily reduce rate adjustments,” Excellus says in documents filed with the state Department of Financial Services.
Excellus is seeking permission from state regulators to increase rates on some of its community-rated products Jan. 1. Community-rated plans for individuals and groups are policies that charge the same amount regardless of age, sex, health status or occupation. The proposed rate changes will affect about 90,000 of the company’s 700,000 members in Central New York. The increases do not apply to experience-rated large groups or self-insured plans.
The documents related to health insurers’ rate hike requests used to be secret. But late last year the state ordered insurers to make them public so customers can review them and submit comments to regulators who decide whether to grant the increases, reduce or reject them.
Excellus has come under criticism for amassing a big reserve fund while consumers struggle to afford health insurance.
“It’s a disservice to consumers that they’re (Excellus) not using their reserves to defray some of the proposed rate increase,” said Elisabeth R. Benjamin, a lawyer and co-founder of Health Care for All New York, a statewide coalition of more than 130 nonprofit groups pushing for more affordable health insurance options for state residents. “We would submit the state should not permit the rate increase to further allow this carrier to stockpile its reserves.”
Consumers Union, publisher of Consumer Reports, issued a report in 2010 that said Excellus and other BlueCross BlueShield plans across the country were salting away more money than necessary in their reserve funds. At that point, Excellus had $965.1 million in reserves.
Since then its reserve fund has grown by more than 30 percent.
Money in the fund comes from the company’s surplus or profits.
A portion of every rate increase by insurers is usually earmarked as a contribution to reserves, said Laurie Sobel, a senior attorney with Consumers Union. That’s why regulators reviewing a rate increase request need to look at an insurer’s reserve levels, she said. If those levels are excessive, regulators can protect consumers from unnecessary rate increases by disallowing additional contributions to reserves, she said.
The minimum amount of reserves Excellus must have to meet state requirements is $703 million.
That amount would not give Excellus, which has nearly 2 million members, a sufficient cushion, said Elizabeth Martin, a company spokeswoman.
“That’s like saying to someone that they should strive to have a minimum amount in their savings account, but that might not be enough if suddenly they need to cover large unforeseen expenses,” Martin said.
Excellus has about $792 in reserves per member, enough to cover claims for about three months, she said. The average amount of reserves per member held by other upstate nonprofit insurers is $1,179, she said.
Excellus last dipped into its reserves in 2008. It used $244 million from the fund to offset higher than expected medical expenses, declining enrollment and investment losses. If the fund had been at the minimum level the company would have had to impose steep rate increases in 2009, Martin said.
Excellus made a profit of $223 million in 2011 on revenue of $5.7 billion. The 2011 profit was about five times bigger than the $44.5 million profit it made in 2010. It also tripled the pay last year of its top executive to $5.2 million.
In its pending rate filing, Excellus says its proposed increases are designed to allow the company “ ... to achieve a modest operating margin.”
Excellus says it is “... sensitive to the fact that individuals and small businesses struggle to afford higher premiums.” But it warns that failure by regulators to approve the rate hike request would lead to the need for even greater increases in the future.
Excellus says the escalating cost of health care services, equipment and products continues to be the primary reason for rate increases.
In its filing, Excellus says rate increases are being driven by a combination of higher costs and greater use of medical services and equipment by consumers.
Health insurers come up with spending forecasts by multiplying the anticipated increase in cost of a medical service by the rate of consumption or use of the service or product. This is known as the “medical trend,” a measure of medical inflation.
Excellus is forecasting spending next year will increase 9.6 percent to 12.7 percent for hospital outpatient services, 7.8 percent to 8.7 percent for hospital inpatient services, 3.1 percent to 7.1 percent for professional services such as doctor office visits, and 5.7 percent to 7.9 percent for drugs.
The public has until Aug. 11 to submit comments to the state about the proposed rate changes.
Comments can be submitted online, by email to PremiumRateIncreases@dfs.ny.gov or by mail to: Charles Lovejoy, Health Bureau, New York State Department of Financial Services, 25 Beaver St., New York, NY 10004.
Proposed rate increases
Here are the rate increases proposed by Excellus BlueCross/Blue Shield:
High-deductible health plans, Preferred Provider Organization: Up to 19.9 percent
Direct pay indemnity plans purchased by individuals: Up 12.3 percent
Direct pay Health Maintenance Organization and Point of Service: Decrease 3.4 percent.
ValuMed Plus, a policy for individuals on limited incomes: Up 14.1 percent
Healthy New York, another plan for individuals with limited income: Up 3.6 percent.
Medicare Supplemental plans: Down 0.5 percent.
Source: Excellus
Friday, November 11, 2011
Excellus and 10 other health insurers ordered to repay millions to customers
Bloomberg News Governor Cuomo has ordered 11 health insurers, including those that are “nonprofit,” to pay back millions in customer overcharges. Specifically, Cuomo is ordering the insurers to pay back $114.5 million, because the companies in question spent less than 82 cents of each dollar on health care. The organization with the second highest payback to be made is Excellus Health Plan, a nonprofit Blue Cross organization based in Albany. Excellus will be required to repay $21.4 million. “In this economic climate, every penny counts and in this case, insurance companies were overcharging New Yorkers to the tune of millions of dollars," Governor Cuomo said. "This should serve as a message to companies that we are watching, and we will not tolerate any action that wrongly hurts the finances of the people of New York."
Monday, December 20, 2010
Health center head 'helping people who can't help themselves'
From the UticaOD.com
Janine Carzo first heard about a program using federal dollars to subsidize health care for the uninsured in the mid-1990s.
But it wasn't until last month that her efforts finally came to fruition, with the opening of the Utica Community Health Center on Oneida Street. The center's construction was funded in large part with federal stimulus money.
Carzo, who is the executive director of the center, answered questions about her new job recently. Those interested in the health center are encouraged to call ahead for appointments at 793-7600.
QUESTION: What are your responsibilities?
ANSWER: I oversee the entire operation. I hire the dental and medical providers. I hire the staff and schedule the staff. I've ordered all the equipment and supplies for the start-up. I've worked with other staff members to develop policy and procedures to get us going. I've helped with the institution of electronic health records.
QUESTION: How will you measure success at the nonprofit health center?
ANSWER: I would measure success by the reduction of the number of people using the emergency room; that we cut down on the people who feel the emergency room is their only source for medical care, for both medical and dental.
QUESTION: How has more than 20 years of experience in the health care industry prepared you for this challenge?
ANSWER: My experience has been primarily in helping people who can't help themselves. I started off as a social worker. So now, having been in the field of health care for 20-plus years, I know who to call, what resources to tap, providers I can call on to help and things that will assist our patients overall.
Janine Carzo first heard about a program using federal dollars to subsidize health care for the uninsured in the mid-1990s.
But it wasn't until last month that her efforts finally came to fruition, with the opening of the Utica Community Health Center on Oneida Street. The center's construction was funded in large part with federal stimulus money.
Carzo, who is the executive director of the center, answered questions about her new job recently. Those interested in the health center are encouraged to call ahead for appointments at 793-7600.
QUESTION: What are your responsibilities?
ANSWER: I oversee the entire operation. I hire the dental and medical providers. I hire the staff and schedule the staff. I've ordered all the equipment and supplies for the start-up. I've worked with other staff members to develop policy and procedures to get us going. I've helped with the institution of electronic health records.
QUESTION: How will you measure success at the nonprofit health center?
ANSWER: I would measure success by the reduction of the number of people using the emergency room; that we cut down on the people who feel the emergency room is their only source for medical care, for both medical and dental.
QUESTION: How has more than 20 years of experience in the health care industry prepared you for this challenge?
ANSWER: My experience has been primarily in helping people who can't help themselves. I started off as a social worker. So now, having been in the field of health care for 20-plus years, I know who to call, what resources to tap, providers I can call on to help and things that will assist our patients overall.
Thursday, July 22, 2010
Report Finds Excellus and Others May Hold Too Much $$ in Reserve
http://www.syracuse.com/ reported that while raising customer rates, Excellus BlueCross BlueShield may be setting aside more money than necessary to protect against potential financial losses, according to a report released today by Consumers Union.
The report said state insurance commissioners looking to curb rate increases should scrutinize the amount of surplus money amassed by nonprofit BlueCross BlueShield plans like Excellus.
Surplus is the excess of an insurance company’s assets over liabilities, which insurers set aside to protect the company and its members from financial losses. Excellus had $965.1 million in surplus at the end of 2009. Its surplus fund grew as high as $1.18 billion in 2007.
The report by Consumers Union, publisher of Consumer Reports magazine, looked at 10 BlueCross BlueShield plans nationwide and found seven of them held more than three times the amount of minimum surplus recommended by the National Association of Insurance Commissioners.
“Consumers are struggling to afford health insurance and BlueCross BlueShield plans have been amassing a lot of surplus over the last 10 years as rates have gone up,” said Lauren Sobel, senior attorney with Consumers Union. “The two should be considered together.” Read more here.
The report said state insurance commissioners looking to curb rate increases should scrutinize the amount of surplus money amassed by nonprofit BlueCross BlueShield plans like Excellus.
Surplus is the excess of an insurance company’s assets over liabilities, which insurers set aside to protect the company and its members from financial losses. Excellus had $965.1 million in surplus at the end of 2009. Its surplus fund grew as high as $1.18 billion in 2007.
The report by Consumers Union, publisher of Consumer Reports magazine, looked at 10 BlueCross BlueShield plans nationwide and found seven of them held more than three times the amount of minimum surplus recommended by the National Association of Insurance Commissioners.
“Consumers are struggling to afford health insurance and BlueCross BlueShield plans have been amassing a lot of surplus over the last 10 years as rates have gone up,” said Lauren Sobel, senior attorney with Consumers Union. “The two should be considered together.” Read more here.
Tuesday, April 20, 2010
Excellus BCBS offers info on health care reform
Excellus BCBS is offering an information section related to the health care reform legislation.
Keeping You Informed
We want to keep you updated on the status of this legislation. While the law was just passed, many activities still have to occur. As the implications and requirements of the legislation become clearer, we will continue to update these pages. You may also Join Our Email Alert to be notified of updates.
Overview
On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act It was modified by the Health Care and Education Reconciliation Act of 2010, signed by President Obama on March 30, 2010.
The following summary explains key health coverage provisions provided in the federal law. In some instances state law may do more.
The legislation will do the following:
Keeping You Informed
We want to keep you updated on the status of this legislation. While the law was just passed, many activities still have to occur. As the implications and requirements of the legislation become clearer, we will continue to update these pages. You may also Join Our Email Alert to be notified of updates.
Overview
On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act It was modified by the Health Care and Education Reconciliation Act of 2010, signed by President Obama on March 30, 2010.
The following summary explains key health coverage provisions provided in the federal law. In some instances state law may do more.
The legislation will do the following:
- Most individuals will be required to have health insurance beginning in 2014, or face a penalty.
- Individuals who do not have access to affordable employer coverage will be able to purchase coverage through a health Insurance Exchange with premium and cost-sharing credits available to some people to make coverage more affordable. Small businesses will be able to purchase coverage through a separate Exchange.
- Employers will be required to pay penalties for employees who receive tax credits for health insurance through the Exchange, with exceptions for small employers.
- New regulations will be imposed on all health plans that will prevent health insurers from denying coverage to people for pre-existing conditions and their health status, and from charging higher premiums based on health status and gender.
- Medicaid will be expanded to 133 percent of the federal poverty level ($14,404 for an individual and $29,327 for a family of four in 2009) for all individuals under age 65. (Medicaid coverage may vary by state.)
- The Congressional Budget Office estimates that the legislation will reduce the number of uninsured by 32 million in 2019 at a net cost of $938 billion over ten years, while reducing the deficit by $124 billion during this time period.
Saturday, April 3, 2010
Nonprofit Resource for Health Care Reform
CDPHP has created a helpful overview of the health care reform and its different aspects. The primary changes for 2010 are the following:
Given the recent signing of the Patient Protection and Affordable Care Act (PPACA), Americans should understand that it may take several years for the changes in the bill to be enacted. CDPHP remains an active advocate in the reduction of health care costs through innovative medical management initiatives.
For a summary of the entire health care reform bill, click here.
Changes effective for plan years beginning six months after the legislation’s enactment (September 23, 2010):
Existing individual and employer-sponsored health plans will be allowed to remain essentially the same; except they will be required to comply with the items below:
Given the recent signing of the Patient Protection and Affordable Care Act (PPACA), Americans should understand that it may take several years for the changes in the bill to be enacted. CDPHP remains an active advocate in the reduction of health care costs through innovative medical management initiatives.
For a summary of the entire health care reform bill, click here.
Changes effective for plan years beginning six months after the legislation’s enactment (September 23, 2010):
Existing individual and employer-sponsored health plans will be allowed to remain essentially the same; except they will be required to comply with the items below:
- Lifetime and annual limits on coverage, based upon dollar value of benefits will be prohibited.
- Prohibits cost sharing (i.e. copays, deductibles, co-insurance) for certain preventive services.
- For plans not in existence prior to March 23, 2010, mandates coverage for preventive services specified by the US Preventive Services Task Force; immunizations recommended by the Advisory Committee on Immunization Practices of the CDC; and preventive services and screenings as provided for in guidelines supported by the Health Resources and Services Administration.
- Young adults to age 26 will be allowed to continue on their parent’s family health insurance if the parent’s plan provides dependent coverage.
- Ensure access to a parent's health plan for children with pre-existing conditions and prohibit limitations on pre-existing conditions for children to age 19.
- Prohibits health plans from rescinding coverage from a member once a plan has been issued, except in cases of fraud or misrepresentation of material fact.
- Waiting periods for coverage will be limited to no more than 90 days.
To review a full outline of provisions of the bill effective in 2010, click here. To view the other resources offered by CDPHP, click here.
Friday, March 26, 2010
Hundreds work to improve health at regional summit
The OD reported that Ideas for increasing the health of the region range from holding more farmers markets, to working with schools to educate children on are health issues, to helping food pantries provide more fresh fruits and vegetables.
More than 200 people gathered at Hart’s Hill Inn Friday for the second regional health summit planned by a Regional Health Advisory Board to discuss areas identified as priorities in the area’s health: healthy mothers, babies and children; access to care; chronic disease and mental health and substance abuse.
“There are so many things we need to tackle together as a region,” said Phil Hayne, executive director of the United Way of the Valley and Greater Utica Area and chairman of the Regional Health Advisory Board. “We need to develop really clear strategies with how to help our communities.”
A recent study by the Robert Wood Johnson Foundation and the University of Wisconsin ranked Oneida County 54th out of 62 counties in the state for health status. Herkimer County placed 41st. Read more here.
More than 200 people gathered at Hart’s Hill Inn Friday for the second regional health summit planned by a Regional Health Advisory Board to discuss areas identified as priorities in the area’s health: healthy mothers, babies and children; access to care; chronic disease and mental health and substance abuse.
“There are so many things we need to tackle together as a region,” said Phil Hayne, executive director of the United Way of the Valley and Greater Utica Area and chairman of the Regional Health Advisory Board. “We need to develop really clear strategies with how to help our communities.”
A recent study by the Robert Wood Johnson Foundation and the University of Wisconsin ranked Oneida County 54th out of 62 counties in the state for health status. Herkimer County placed 41st. Read more here.
Tuesday, March 16, 2010
Excellus board voted itself a 37 percent pay raise
The Syracuse Post-Standard related that the directors of Excellus voted to raise their pay by 37 percent last year after a consultant hired by the insurer determined they were underpaid.
The raises for the 17 outside directors came at the same time the nonprofit insurer lost money on its operations and cut the pay of its top executives.
The same year, Excellus increased health insurance rates on average 8 percent. For 2010, the insurer raised its rates an average of 8.8 percent. Both years, some customers saw substantially higher rate increases.
The company paid the directors $1.08 million in 2009, up from $795,338 in 2008. Director pay averaged $64,040 last year. Pay varies depending on a director’s responsibilities. Read more here.
The article also points out that this is a nonprofit with a compensated (and highly) board, which is a rarity. With rising health insurance costs, this issue seems problematic and worthy of serious examination.
The raises for the 17 outside directors came at the same time the nonprofit insurer lost money on its operations and cut the pay of its top executives.
The same year, Excellus increased health insurance rates on average 8 percent. For 2010, the insurer raised its rates an average of 8.8 percent. Both years, some customers saw substantially higher rate increases.
The company paid the directors $1.08 million in 2009, up from $795,338 in 2008. Director pay averaged $64,040 last year. Pay varies depending on a director’s responsibilities. Read more here.
The article also points out that this is a nonprofit with a compensated (and highly) board, which is a rarity. With rising health insurance costs, this issue seems problematic and worthy of serious examination.
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