Excerpt: "This district court opinion holds interest for health care providers and benefit fiduciaries alike. As against a motion to dismiss, the district court holds that the plaintiffs have stated a cause of action against the health care provider for balance billing, i.e., billing the balance 'owed' after their health plan paid the PPO discounted rate." (Attorney Roy F Harmon III in the Health Plan Law blog)
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13 pages. Excerpt: "Health care providers and members of Congress have raised concerns that consolidation in the private health insurance industry may be resulting in less competitive markets and contributing to rising health insurance rates paid by consumers and employers. However, measuring the extent of changes in market competition over time or the effects of changes is challenging. . . . Despite [the] challenges, researchers have used the data available to study competition in health insurance markets, typically using one of two measures of competition: (1) HMO market concentration or (2) the number of HMOs in a market." (U.S. Government Accountability Office)
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3 pages. Excerpt: "On July 29, 2009, New York Governor David Paterson (D) signed into law three health reform bills -- one extending the period for state health coverage continuation rights from 18 to 36 months, one requiring insurers to offer continued coverage for unmarried adults through age 29 under their parent's individual or group health insurance policies, and one instituting a series of managed care reforms." (Buck Consultants)
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Excerpt: "Consumer Driven Health Plans (CDHPs) in the U.S. have surpassed HMO plans in covered employees, according to preliminary results released by United Benefit Advisors (UBA) from its 2009 UBA Health Plan Survey, a plan benchmarking poll with 17,655 plans from 12,316 employers reporting. According to a press release, CDHPs grew at a rate of 33.9% this past year and now cover more employees (15.4%) than HMO plans (13.6%)." (PLANSPONSOR.com; free registration required)
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11 pages. Excerpt: "Specialty prescription drugs are typically used to treat chronic or life-threatening conditions, such as multiple sclerosis and cancer, for which few other treatment options exist. . . . Costs for specialty prescription drugs are usually high, typically ranging from $1,200 to $40,000 for a 30-day supply. . . . To manage the high and rising costs of these drugs, some health plans have begun to require enrollees to contribute a greater share of their costs, such as by increasing the use of coinsurance. You asked us to examine the costs that FEHBP enrollees may incur for specialty prescription drugs." (U.S . Government Accountability Office)
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