A University of Pennsylvania study in which callers posed as mothers seeking pediatric specialty care found that two-thirds of publicly insured children were refused a doctor’s appointment, compared with only 11 percent of privately insured children.

Even the low-income children who were not rejected had to wait an average of 42 days for appointments for urgent conditions such as diabetes, seizures, asthma, or a bone fracture – 22 days longer on average than children with private insurance.

“I was disturbed to find this level of disparity,” said senior author Karin V. Rhodes, a Penn emergency-medicine physician and health-policy researcher.

The study was commissioned by state officials in Illinois and conducted in the Chicago area. But the authors and other experts say it adds to evidence that the 37 million children covered by Medicaid and the Children’s Health Insurance Program (CHIP) too often face discrimination from providers.

The study also has implications for the Affordable Care Act, the federal law that aims to expand coverage to 32 million uninsured people by 2014. Half are expected to be covered by Medicaid.

Read the rest of the story at Inquirer

“Pennsylvania is leading the nation with enrollments in the new federally funded high-risk insurance program for medically uninsurable people, a distinction that has attracted the attention of other states looking to duplicate its success.

As of Nov. 1, more than 1,650 state residents were part of the PA Fair Care program, nearly one-quarter of the roughly 8,000 people nationwide enrolled in the new temporary pools created under the Affordable Care Act.

That is more than twice the 664 participants in Illinois’ high-risk pool, which ranked second in enrollment, though the two states started providing coverage Sept. 1.

Neighboring New Jersey, which started offering coverage in mid-August, had 108 people enrolled as of Nov. 1. The state’s two plans have a $5,000 out-of-pocket limit, and monthly premiums range from $218.74 for people ages 25 and under to $790.02 for people age 65 and older.

The combination of a single low monthly premium, comprehensive benefit package, easy online application process, and an intense outreach campaign are cited as reasons that Pennsylvania has seen interest where other states haven’t, health reform experts said.

Read more of the article:  State leads nation in high risk health enrollments

The new changes in insurance regulations provide an opportunity for scammers to take advantage of consumers. Several insurance scam cases in Pennsylvania have been reported and there is an expected increase in the near future. 

 The Intelligencer reports:

“One consumer group found more than one-third of state insurance bureaus reported “much higher” health insurance fraud last year. Scammers are seeking to exploit consumer confusion over coming changes involving insurance coverage.

A person bearing a government ID badge appears at your door with a sales pitch that goes something like this:

By law, all Americans are now required to obtain health insurance. You have 30 days to comply or face jail time. Sign here to buy your coverage.

The claim sounds legitimate. Most people have heard something, somewhere, about the new federal health care law and how it requires that everyone carry health insurance. But those coverage requirements don’t kick in for another four years. The law also carries no criminal penalties for not obtaining health insurance. And one more thing, the government won’t offer insurance policies under the law. But crooks are counting on people not knowing these things, or anything about the Affordable Health Care Act, consumer rights and protection advocates say.”

Read the full article: Health insurance scams flourishing

Tips on avoiding medical insurance scams

 Currently, there are different types of scams that exist. Educating the community on the 2011 expectations of the Affordable Care Act is will aid in eliminating the scams. The National Association of Insurance Commissioners’ have published tips and reminders on how to avoid scammers.

The Intelligencer reports:

“The National Association of Insurance Commissioners’ tips on how to avoid being a scam victim:

Be aware: Beware of fax, e-mail, telephone poll solicitations. For seniors, Medicare officials contacting you should have your account information on record so don’t give it out.

Check if insurer is legit: Don’t give out any personal information until you verify with your state insurance department that the insurer and agent are licensed to write insurance in your state. Generally, health insurance companies that sell policies to individuals or to employers must be licensed in each state where they do business; the producers (agents or brokers) who sell policies must also be licensed in the states where they sell policies.

Keep paperwork: Ask for copies of all paperwork you sign. Keep a copy of the payment receipt or check for your initial premium payment.

Follow up: Call the insurer if you don’t receive a copy of your insurance policy outlining your coverage within 30 days of your purchase.”

Read the full article: Avoid the new health law scams

COURTHOUSE — Montgomery Hospital Medical Center (MHMC) in Norristown has seen a steady rise in birthrates in the past decade, but the pace quickened after nearby Mercy Suburban Hospital stopped delivering babies in February.

Montgomery Hospital’s marketing director Laura McFarland said there wasn’t any lag time in demand at her already busy medical facility following Mercy Suburban’s closing.

“We felt it almost immediately,” she said.

Follow this issue.

Writes Kaiser in a news release:

The expansion of Medicaid under the new health reform law will significantly increase the number of people covered by the program and markedly reduce the uninsured in states across the country, with the federal government picking up the overwhelming majority of the cost, according to a state-by-state analysis released today by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU).

The analysis, performed by John Holahan and Irene Headen of the Urban Institute for the Foundation, is among the first to show for all 50 states and the District of Columbia the distribution of new Medicaid enrollees and costs, as well as the impact on the uninsured.  Health reform will offer Medicaid coverage to millions of low-income adults for the first time and help establish a national floor for Medicaid eligibility that contrasts sharply with the wide variation in eligibility across state Medicaid programs today.

States with large uninsured populations today are expected to see the biggest increases in the numbers of people who obtain health coverage through Medicaid.  California and Texas, for example, two states with considerable numbers of uninsured residents, are each projected to see 1.4 million fewer uninsured adults in 2019 due to the Medicaid expansion, with the federal government covering 95 percent of the cost in Texas and 94 percent in California.

“For a relatively small investment of state dollars, states could see huge returns in terms of additional coverage for their lowest income residents — with federal dollars covering the bulk of the bill,” said Diane Rowland, executive vice president of the Foundation and executive director of the KCMU.

Nationally, the analysis projects that Medicaid enrollment will climb by 15.9 million more people by 2019 than it otherwise would have, and the number of uninsured will fall by more than 11 million.  The cost of the Medicaid expansion between 2014 and 2019 would be jointly financed with the federal government paying $443.5 billion (or 95.4 % of the total cost) and the states contributing $21.2 billion.  

Find out more, including the results for Pennsylvania.

…

The state Senate today unanimously approved legislation to further advance discussion on establishing an initiative to help develop and expand community-based health care clinics that provide “medical homes” for the uninsured.

Senate Bill 5, sponsored by Sen. Ted Erickson (R-26), establishes the framework for a program under which the growth of community health care clinics would be fostered as a way to provide integrated care to uninsured low-income individuals.”The provisions of the federal health care bill that was recently enacted will only get people insurance, it will not ensure that people can get care,” said Erickson. “Senate Bill 5, on the other hand, seeks to make sure that people get the health care that they need.”Community-based health care clinics provide the uninsured with a medical home that emphasizes a partnership among the patient, physician, nurses, and clinic staff. These health clinics become the place where patients are known, recognized, supported, and where they find a centralized base for medical care and connection to other medical and supportive community services.Erickson noted that health clinics provide high-quality and cost-effective health care regardless of patients’ insurance status or ability to pay. They also help to reduce the use of costly hospital emergency visits and avoidable hospital admissions.”Senate Bill 5 establishes a framework to expand access to health care services to uninsured and low-income working Pennsylvanians more quickly, and at a fraction of the cost of other proposals, including the recently enacted ‘one size fits all’ federal approach,” said Erickson.

Newspapers across the state area reporting on how their counties fared:

In Lancaster County, the rate of the uninsured is high: 13 percent, or 65,000 of the county’s residents, lack coverage.

The rate in York County is slightly better, with 10 percent of residents not having health insurance.

In Lackawanna County, 11.7 percent of residents are uninsured.

Berks County’s rate of uninsured residents is about 8 percent, but the county’s seat, Reading, has a higher rate of 17.5 percent.

Almost 11 percent of Lehigh County residents are without health insurance.

The statewide rate of uninsured people is 9.4 percent.

“The bus will tour the state the week of July 27. So far, the PPA has helped nearly 300,000 Pennsylvanians, including about 26,000 in Philadelphia, 14,000 in Pittsburgh, almost 7,000 in the Wilkes Barre/Scranton region and about 4,500 in Allentown.”

This will be the bus’ 23rd tour in Pennsylvania in four years.

Says PhRMA:  “Patients seeking help can call a toll-free number (1-888-4-PPA-NOW; 1-888-477-2669) to talk to a trained operator or access the PPA Web site (www.pparx.org ). Or, of course, they can work with specialists on board the ‘Help is Here Express’ if it rolls into their town. It only takes 10 to 15 minutes to determine if someone may qualify for free or nearly free medicines.”

Pennsylvania residents should check their local newspapers and TV stations to find out when and if the bus will visit their area.