Archive for February, 2010

PostHeaderIcon Insurance company found new way to add administrative burden and increase member cost

Creating new programs to administer more and pay less is an ever growing trend with insurance companies. United Healthcare new specialty medication management program is just that; more hoops to jump for less.

Industry insiders long known that the federal Medicare program is a leader in the creation of more administration and less payment.  Blue Cross and Blue Shield usually follow closely, and then the rest of the pack (insurance companies in general).

Now United Healthcare seems to be taking the leading role of creating an additional program without benefits to its members.  The Specialty Pharmacy Program is designated to put more stops in prescription utilization for high cost drugs. New and renewal members will be forced to obtain certain medications from a participating specialty pharmacy to receive in network coverage. Furthermore this policy eliminates the previous 90 day supply benefits, both as a discount and convenience. Members will be forced to renew prescriptions each month and pay the 30 day co pays.

Typical of insurance policies, coverage by out of network pharmacy is not clearly defined. No one can tell until they visit a local pharmacy.


Consolidated Omnibus Budget Reconciliation Act of 1985, commonly called COBRA, is a federal law providing continuation of group health coverage that would otherwise be lost due to life events such as termination of employment, death of an employee, and divorce. The original bill allows coverage continuation of full employer cost.

Due to economic difficulties and significant job loss across the nation the federal government passed a law which became in effect in February 2009. The American Recovery and Reinvestment Act of 2009 provided subsidy for eligible former employees, enrolled in their employer’s health plan at the time they lost their jobs. This subsidy allows them to pay only 35 percent of the cost of COBRA coverage.

Last December congress passed and the president signed a defense spending bill that included a COBRA subsidy extension through the end of February 2010. This bill provides continues medical insurance coverage for involuntary terminated workers, at a same reduced premium.

A new bill is pending to further extend COBRA subsidy for those still without jobs. Votes expected early next week.
The 65 percent subsidy has been a big help for millions of laid-off employees and their families who, in many cases, would have been hard-pressed to pay the entire monthly premium, which typically is about $400 for individual coverage and $1,200 for family coverage.

Congressional researchers estimate that the new subsidy would benefit about 7 million former employees and their families and cost about $25 billion.