September 26, 2011

By Mark Wilson

Anthem Blue Cross Blue Shield of Connecticut and New Hampshire have announced that Oct 14th will be the last day new members can join Tonik. This means Tonik will be effective full and anyone hoping to join after October 14th will be out of luck. Those members who have already joined Tonik can keep their plan and no action is required at this time.

The Tonik application page will still be up for new applications until the deadline. We are recommending that all CT and NH applicants submit their application by October 13 as it is unclear at what time on the following day the application will no longer be functioning.

If you have any questions about the above, please contact us at 800.930.7956

December 07, 2010

by Steven J. Bloom

Anthem Blue Cross and Blue Shield of Connecticut will not be able to raise health care premiums up to 19.9 percent on 48,000 members after acting Insurance Commissioner, Barbara Spear, rejected the request calling it “excessive.”  As you may recall Spear replaced Tom Sullivan, who resigned after pressure from many groups that he had a tradition of “rubber stamping” insurance increases. 

Background on the Anthem Rate Increase Request

Anthem recently filed a request in November to increase the monthly premiums on many of their most popular individual plans including Tonik, Lumenous and Century Preferred Direct.  The decision to reject the request was based on the findings of a recent public hearing and an audit of Anthem’s submitted actuarial numbers. The “in-house analysis” by the department of insurance found that Anthem’s projected cost increase of 12.5 should have been closer to 4.1 percent.

Connecticut’s Attorney General Blumenthal commented on the recent Anthem price increase rejection, saying ” This decision hopefully marks the dawn of a new era for the Insurance Department, real scrutiny and service to consumers. The department did what it’s supposed to do, but often has not: Set rates based on facts.”

Anthem responded with the following statement:

“As we review the order, it is important to note that we understand and share strongly the concerns of our members over the rising cost and rate of utilization of health care services and the corresponding adverse impact on insurance premiums,” she said. “The increasing demand for medical services, including the use of new, expensive prescription drugs, and demand for advanced technologies are driving up the cost of health care at an unprecedented rate. Anthem remains committed to our individual market segment customers and to finding ways to manage health care costs.”

November 04, 2010

Mike Solis

Anthem Blue Cross filed a request to raise insurance rates by 20% to existing members for 2011. The 19.9 percent rate increase would affect about 48,000 Direct Pay BlueCare HMO, Century Preferred, Lumenos, and Tonik customers. The Jan 1, 2011 rate increase request is for “grandfathered” insurance plans that are not subject to many of the new requirements of the new Obama Care legislation. A public hearing to discuss these plans will take place later this month.

SULLIVAN RESIGNS AS CONNECTICUT INSURANCE COMMISSIONER

Connecticut Insurance Commissioner Thomas Sullivan was recently criticized by the Obama administration for approving a previous rate hike for “non grandfathered” plans with little transparency and no formal hearing.  Sullivan, who had recently requested and accepted a 1 million dollar grant to help review insurance company rate actions announced Tuesday that he is resigning from his position effective Nov. 12.

In an ironic twist, Hartford Business.com reported that on Nov. 15 Sullivan will start a new job at PricewaterhouseCoopers in Hartford, where he will be a principal in the firm’s national financial services regulatory practice, focusing on assisting clients with complying with the recently enacted federal financial reform legislation.

November 03, 2010

Mike Solis

After awarding Connecticut $1 million to oversee future rate actions, the Obama Administration is asking insurance commisioner Thomas Sullivan to rethink the recent rate hikes of as much as 47 percent by Anthem Blue Cross and Blue Shield.

Jay Angoff from The U.S. Department of Health and Human Services’ director of Consumer Information, sent to Connecticut Insurance Commissioner Thomas Sullivan.

On August 12, 2010, the department gave a $1 million grant to Connecticut “to improve oversight of insurance company rates and to strengthen its ability to determine whether proposed rate increases were excessive.”

The letter said that they were surprised that Sullivan would allow such a large rate action, “without holding a public hearing, without having tested or validated the proposed rates and the assumptions underlying those rates.”

The letter went on to say that “the CID’s approval of the rate increase is particularly troubling in view of Anthem’s acknowledgment that three of the major consumer protections of the Affordable Care Act - prohibiting lifetime limits, prohibiting insurers from cancelling coverage, and requiring insurers to offer dependent coverage to young adults until age 26 - would increase costs by only 0.2 percent. Similarly, another major insurer in Connecticut has acknowledged in its own rate filing that health insurance reform would raise costs by a total of only 1 percent, an estimate consistent with that of Hewitt Associates, the impact analyses of these provisions published in the Federal Register, and those of other insurance industry experts. The Affordable Care Act cannot be used to justify this huge rate hike and, in fact, includes provisions to empower states to shed light on and guard against this type of excessive insurer behavior.

August 21, 2010

By James Wilson Jones

Anthem Blue Cross announced today that it has begun the process to remove lifetime maximum payouts to its health insurance plans. The recent health care reform legislation states that insurance plans can no longer have lifetime and annual dollar limits on “essential health benefits” as soon as September 23, 2010. 

Since the U.S. Department of Health and Human Services (HHS) has yet to clarify its definition of “essential health benefits,”  Anthem Blue Cross has come up with the following list of the services they believe will be affected:

• Alcoholism-related services
• Ambulance services
• Asthma education
• Bariatric surgery
• Chiropractic manipulation and osteopathic manipulation services
• Diabetic supplies
• Diagnostic services
• Durable medical equipment
• Enteral formula and food products
• Hearing aids
• Home health care
• Hospice
• Infusion therapy
• Kidney disease treatment
• Mental health/substance abuse
• Ostomy supplies
• Outpatient occupational therapy
• Outpatient physical therapy
• Outpatient speech therapy
• Pharmacy
• Physician office visit (diagnostic services)
• Preventive services
• Prosthetic devices/limbs
• Skilled nursing services
• Prosthetic devices/limbs
• Skilled nursing services
• Transplant services
• Treatment of temporomandibular joint disorder (TMJD or TMJ)

Anthem states that the listed services still may be subject to copays and other cost shares and will be phased in over time.  Annual dollar limits of at least $750,000 will be allowed for plan years from September 23, 2010, to September 23, 2011. Annual dollar limits of at least $1.25 million will be allowed for plan years from September 23, 2011, to September 23, 2012.Annual dollar limits of at least $2 million will be allowed for plan years from September 23, 2012, to January 1, 2014.  After January 2014 there will be no lifetime limits and annual dollar limits.

August 06, 2010

By Kelly Moders

Hartford Healthcare Corp has alerted Anthem that if they are unable to reach contract agreement they will terminate its participating hospital contracts for Hartford Hospital and Windham Community Memorial Hospital. Without a new contract, starting November 1, 2010, these hospitals will no longer be considered in-network for Anthem. This issue will not affect MidState Medical Center.

Anthem claims that if they were to accept the current proposal that members monthly premium would increase. We will keep you posted on the status of negotiations.