The Health Shopper

The Wisconsin Association of Health Plans announced that many of the state's carriers will provide plan members with tools to estimate out-of-pocket costs before seeking treatment. Anthem Blue Cross Blue Shield, Humana, and UnitedHealthCare Wisconsin are among the 17 participating insurance carriers that will be rolling out this program by September 1. Association officials note that providing these estimates is becoming increasingly important as more people move to high deductible plans.

Consumerist has a useful item for health consumers about how to appeal denied insurance claims. After getting the exact reason for the denial, the industry expert suggests:

• Asking for a "1 time ‘pay and educate' exception," where the insurance company will pay for the claim on this one occasion.
• If the insurer says that the policy has an exclusion that prevents it from covering the expense, ask for the company to clearly point out the policy exclusion in writing.
• Work with your doctor and the office staff to collect evidence that you believe supports your position and present this evidence to your insurance company.

As the piece notes, following these steps and others listed in the piece can help consumers make sure they receive a fair hearing when interacting with their insurance companies.

 According to the Los Angeles Times, as many as 40 percent of 18 to 29 year olds are uninsured-a number that has been growing as students graduate and find jobs that often do not offer health benefits, or as people age out of their parents' health coverage. The Times notes that in most instances, younger people can find coverage on the individual market at reasonable rates. It also notes that for individuals with significant pre-existing conditions, many college alumni associations allow graduating students the opportunity to buy insurance through the alumni group.

Business Week has a long feature that suggests that many colleges and universities offer inadequate coverage to their students. Many insurance plans have low caps on insurance reimbursements-for example, Connecticut College enrolls its students in an Aetna sponsored plan that caps its reimbursements at $10,000, while other colleges, such as Ross University, have plans with daily reimbursement limits that don't cover hospital expenses. According to a recent report by the General Accounting Office, more than 50 percent of college students have health plans with benefit limits of $30,000 or less.

Business Week also notes that in many instances, college students and their families are spending nearly as much on these inadequate plans as they would spend buying coverage in the individual market.   

A new study from Consumer Reports finds that prices for prescription drugs can differ by more than $100 for a prescription, even at different individual stores within the same chain. Consumer Reports researchers shopped at 163 pharmacies for four different drugs and found that, in general, Costco stores tended to offer the best prices while Walgreens and Rite-Aid were typically the most expensive. Kmart and Shopko offered the best prices on brand name medication, while Target and Wal-Mart offered low-cost generic medicine.

Wal-Mart announced that it is introducing further price reductions for generic medications to consumers. Consumers will now be able to purchase 90-day supplies of generic medicine for $10 and will continue to be able to buy $4 a month prescriptions for generics. Additionally, Wal-Mart stores will be lowering prices on a number of women's health drugs-such as generic medicine to treat osteoporosis-and will be offering most over-the-counter medicines at $4 or less. Wal-Mart officials say that "Up to 95 percent of the prescriptions written in the majority of therapeutic categories are included in the $4 Prescription Program" and claim that consumers have now saved $1,163,726,502.08 by purchasing generic medications through the company.

Health insurance costs for employer-based insurance rose by 30 percent from 2001 through 2005, according to a study by the University of Minnesota's State Health Access Data Assistance Center. Insurance costs jumped from $8,271 to $10,778 for the average family. Rising insurance costs drove 36,000 employers to drop insurance coverage for employees altogether, causing 4 million people to lose employer-sponsored insurance.

As we previously noted, families-not employers-suffer the most when insurance costs increase. Employers continued to pick up the same percentage-about 76 percent-of insurance premiums between 2001 and 2005. At the same time, average family incomes during this period grew at an anemic three percent, suggesting that rather than give employees more money, employers gave more money to insurance companies instead.