Buffalo-based HealthNow New York fined $1 million for denying claims for infertility treatment and other violations

http://www.buffalonews.com/145/story/396995.html

State insurance regulators on Monday imposed a hefty $1 million fine on HealthNow New York for multiple violations of state law, but the Buffalo-based company said it has already corrected past claims practices.
The state penalized Buffalo’s largest health insurer for improperly denying claims for infertility treatment and for not giving consumers enough notice of rate hikes.

Health insurer executives earn healthy pay

http://www.buffalonews.com/businesstoday/localbusiness/story/370612.html

The CEOs of HealthNow New York, Independent Health Association and Rochester’s Excellus Health Plan, which owns Univera Healthcare, took home more than $6.5 million combined last year in salary and other pay.
That’s a 72 percent increase from $3.77 million in 2006

Highmark settles suit

http://www.bizjournals.com/pittsburgh/stories/2008/01/07/story1.html?b=1199682000%5E1571338

Highmark Inc. will pay $9.9 million and change the way it does business with doctors, including how appeals are handled, to settle a class action lawsuit that was filed in 2003 against Blue Cross Blue Shield plans nationwide, according to terms of a preliminary agreement.

"The news is the reforms Highmark has agreed to adopt," said attorney William Maruca, who practices with the Downtown offices of Fox Rothschild LLC and represents the Allegheny County Medical Society. "The major impact will be in improving the way Highmark deals with physicians."
Among the terms of the proposed settlement is disclosure of fee schedules to participating physicians; expanded arbitration provisions for claim disputes; an end to recovering overpayments after 18 months except in cases of fraud; and establishment of a 12-person physician advisory committee to consult with the insurer on a variety of matters, such as clinical quality improvements. The tentative agreement also requires a committee of physician peers to evaluate medical necessity issues and an external review panel to mediate appeals of insurance claims that have been denied.
"Payments vary sometimes, and it's hard to tell why," Maruca said.

Do Primary Care Physicians Treating Minority Patients Report Problems Delivering High-Quality Care?

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.3.w222

Primary care physicians treating a disproportionate share of black and Latino patients typically earn less, see more patients, provide more charity care, treat more Medicaid patients, and receive lower private insurance payments than their counterparts treating fewer such patients, according to a national study published today as a Health Affairs Web Exclusive. These same physicians also reported more problems providing high-quality care, ranging from inadequate time with their patients to difficulty obtaining specialty care. In addition, the Commonwealth Fund-sponsored study examined how higher Medicaid payments might help physicians treating mostly minority patients provide high-quality care and reduce racial and ethnic disparities.

Two Tier Health Care

State budget includes drug discount cards for seniors, millions more for hospitals

http://http://www.buffalonews.com/home/story/313292.html

ALBANY — The 2008 state budget will prod Medicaid patients into less expensive outpatient and home settings, provide prescription drug discount cards for 400,000 senior citizens and disabled people and restore hundreds of millions of dollars that hospitals and nursing homes were facing in cutbacks.

How Unemployment Affects Families

Job loss doesn't just affect individuals. It impacts families and even whole communities. Stress, uncertainty, and lost income affect children in various ways.

Living in Disadvantaged Neighborhoods is Bad for Your Health

Why is your street address such a good predictor of your health? Increasingly, Southeast Asian immigrants like Gwai Boonkeut are moving into neglected urban neighborhoods where African Americans have long suffered, and now their health is being eroded too. What can be done to create a neighborhood that promotes rather than destroys health?

The Importance of Culturally Appropriate Care for Native Americans

Modern medicine teaches a rigid, scientific approach to disease prevention. Yet practitioners like Dr. Donald Warne argue that to be effective, health care programs must be locally controlled and responsive to the needs and beliefs of diverse individuals and groups. For Native Americans in particular, role models and interventions must come from within the community.

The Impact of Poverty and Stress on Diabetes among Native Americans

As Dr. Donald Warne explains, there is a direct biochemical connection between living in poverty and blood sugar levels. The stress of being poor and of having family members die young creates a complicated web of cultural values and beliefs that make controlling diabetes more difficult. Add to that the lack of availability of healthy food and it's no wonder diabetes rates are high.

The Latino Paradox

Recent Latino immigrants are healthier than the average American, despite being generally poorer. Researchers believe that some aspects of immigrant communities may protect health. But for Latinos, the longer they are here, the worse their health becomes. Why?

How Racism Impacts Pregnancy Outcomes

UCLA obstetrician and gynecologist Dr. Michael Lu believes that for many women of color, racism over a life time, not just during the nine months of pregnancy, increases the risk of preterm delivery. To improve birth outcomes, Lu argues, we must address the conditions that impact women's health not just when they become pregnant but from childhood, adolescence and into adulthood.

Unraveling the Mystery of Black-White Differences in Infant Mortality

Neonatologists James Collins and Richard David specialize in the care of infants born too soon or too small. Their research on differences in birth outcomes between African American and white American women points to a provocative idea: the cumulative stress of racism is taking a toll on African American families even before they are born.

Kim Anderson's Story

When Atlanta lawyer Kim Anderson was pregnant with her first child, she did everything right: she ate a healthy diet, exercised, and got the best prenatal care. But her baby was born almost three months premature. This excerpt from When the Bough Breaks explores racism's impact on pregnancy outcomes.

Unnatural causes is inequality making us sick?

VIDEO EXCERPT: Health in America
The U.S. is one of the richest countries in the world, yet we rank 29th for life expectancy. We spent more than twice what other countries spend per capita on health care. Why aren't we healthier?

African American and Latino Pastor’s unite to combat health care disparities among the minority populations

Pastor Matthew L. Brown, who in November of 2007 challenged Pastors to take a pledge toward healthy living in order to fight diseases such as Diabetes, which is prevalent among African Americans and Latinos, now has another larger issue to champion and has rallied the faith community in support of the poor and their legitimate right for health care services regardless of their economy. Pastor Brown and the local clergy are supporting Dr. Raul Vazquez and other partner physicians, who recently revealed alarming treatment of two patient case studies dealing with the same illness and having different types of health care coverage, yet treated vastly different. In some instances, patients with Medicaid were denied services from the growing number of physicians who do not accept Medicaid.

Pastor Brown says, “the distinction between patients and the disparity of their treatment should not be discriminative. Now that Dr. Vazquez has provided us with the facts, we will not standby and ignore the issues that hinder the communities that we serve and reside in.”

PATIENT COMPLAINT AGAINST MANAGED CARE

Explained how Community Blue targets inner city community

Private plans, public money: Insurers target federal funds

http://www.ama-assn.org/amednews/2008/01/28/bisa0128.htm

The nation's biggest health plans see government business -- not employer-based or other private-pay customers -- as the biggest engine for growth.

Cuomo's reasonable investigation into health plan pricing

http://www.ama-assn.org/amednews/2008/03/10/edsa0310.htm

New York takes on United over an allegedly rigged system for pricing services by out-of-network physicians.

The American Medical Association, which is involved in a separate suit against United over the UCR system, commended the attorney general's efforts. At Cuomo's news conference announcing his investigation, AMA President-elect Nancy H. Nielsen, MD, PhD, said the problems he detailed are pervasive.

Insurers feel backlash over policy cancellations

http://www.ama-assn.org/amednews/2008/03/17/prl20317.htm

A lawsuit and a punitive damage award against a California plan are two of the latest developments.