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Weekly health insurance roundup: October 18-22, 2010 Posted: October 22nd, 2010

By Maryalene LaPonsie

After last week's love-fest for Blue Cross Blue Shield, you would think that the warm fuzzies for the company had run out. However, this week is no different. More praise is being rained down on the association's affiliates, except in Michigan where the Department of Justice is investigating Blue Cross Blue Shield. There's that plus more in this week's health insurance roundup.

Aetna and The Chester County Hospital share a bond

In Pennsylvania, Aetna and The Chester County Hospital are embracing one another and quality initiatives for the next three years. The insurance company and the hospital system agreed to a three year contract that sets great expectations for several key areas of health care. Along with remaining an in-network provider for Aetna, The Chester County Hospital will work to meet and maintain high-performance goals in core measure areas such as:

  • Heart failure
  • Pneumonia
  • Surgical case improvement
  • Urinary tract infections related to catheter use

Americhoice health insurance is helping bring up baby

Expectant mothers in Tennessee are the guests of honor at baby showers being sponsored by Americhoice health insurance. TENNderCARE Healthy Mom Baby Showers are being coordinated by Tennessee health departments with support from Americhoice. Open to pregnant women and mothers of children younger than 24 months, the showers feature information on child care, immunizations and nutrition. Of course, it wouldn't be a shower without goodies from participating vendors and door prizes. The hands-down favorite prize among moms? A diaper cake to keep those little baby behinds clean and dry.

Blue Cross Blue Shield: under the microscope in Michigan

It's always nice to be the center of attention…unless that attention is coming from the Department of Justice. The department is turning up the heat on Blue Cross Blue Shield of Michigan for alleged anti-competitive practices. Namely, the insurer has negotiated 'most favored nation' provisions with at least 70 of the 131 acute care hospitals in the state. The provisions mean that hospitals can't give any health insurance companies greater discounts than what are extended to Blue Cross Blue Shield. The Justice Department has one word on the subject--illegal.

Fortunately, things are looking better for Anthem Blue Cross Blue Shield in Kentucky and Indiana. Both affiliates were ranked as top insurance companies in their respective states by the National Committee for Quality Assurance (NCQA).

There is also good news on the Blue Cross Blue Shield front for children and seniors. First, in Maryland, CareFirst Blue Cross Blue Shield announced that it would continue to offer child-only insurance policies in the state. Other companies have threatened to drop the plans in response to health reform changes.

Then, Vermont seniors will have new Medigap options come 2011. The state's Blue Cross Blue Shield affiliate is unveiling Medicare supplemental health insurance policies that will be available at the start of the new year.

Finally, rounding out the Blue Cross Blue Shield news for the week is a Patient Centered Medical Home pilot program being debuted in New York. Empire Blue Cross Blue Shield is working with the New York Department of Health to create a program that will improve the coordination of care for patients with complex medical needs.

UnitedHealthcare says good-bye to New Mexico

Last week, it was Molina Healthcare and Idaho that were having problems. This week, UnitedHealthcare and New Mexico have decided to part ways after a string of billing issues. Problems began in 2009 when the state was notified that it had been undercharged. Tensions mounted when UnitedHealthcare claimed not to have received the state's premium payments this spring. New Mexico responded by saying enough is enough, arrivederci.

As a result, state employees who subscribe to UnitedHealthcare plans will need to pick a new provider now that the state is terminating its contact with the insurance company.

On another front, UnitedHealthcare is trying out a new way to reduce its costs. Instead of paying for cancer treatments based upon the actual doses of chemotherapy administered by an oncologist, the company will pay a lump sum based upon a standardized regimen pre-approved by doctors. The pilot program is being tested in five locations before going nationwide.