ANTHEM CONTRACTOR LEAKS DATA OF 18,000 MEDICARE MEMBERS

Anthem BlueCross BlueShield has been hit with a data breach affecting more than 18,000 Medicare members, it reported on July 24.

The data breach came from Anthem’s Medicare insurance coordination services vendor LaunchPoint Ventures. An employee stole and misused data including Social Security numbers, Health Plan ID numbers, names, and dates of enrollment.

In a 2015 security breach at Anthem, hackers stole as many as 37.5 million records containing personally identifiable information. A settlement was reached that called for Anthem to improve its data security safeguards and required a credit protection program for the children affected by the breach. Senators also demanded Anthem release notifications on data breaches more swiftly after 2015.

In an analysis done by Comparitech.com in July, it was discovered that following a data breach, a stock falls on average 0.43% and recovers in a little over a month, and that share prices grow more slowly for three years after a breach. The study also found that "breach fatigue" may be lessening the impact of a breach on a company's stock performance.

In the February 2015 data breach, Anthem advised affected Medicare members that they could expect to be individually notified by Anthem if their information was accessed.

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OUR CONVOLUTED HEALTH CARE PAYMENT SYSTEM

By Cory Michael, MD

Three men walk into a deli for lunch, take a number, and sit quietly until called. There are no prices on display, nor is the food visible. The first man, Ron, is called to the counter and states that he is hungry when asked what brings him in. He presents his food insurance credentials, and five minutes later, he walks out the door with a 12-inch gourmet sandwich, a side salad, and a smoothie in exchange for a co-pay of $1. The following week, Ron’s insurance company sends him an explanation of benefits in which the deli’s charge for the food was $15, but the large size of the company allowed them to negotiate a price of $9. The remaining $8 was covered as a benefit.

The next customer, Bill, is called and presents with the same complaint. Review of his credentials shows what he is eligible for, a 6-inch generic sandwich and a bottle of water. He gets his food after twenty minutes. His co-pay is $3. The food is unsightly and unsatisfactory in taste. Bill leaves and pays cash for lunch elsewhere. His explanation of benefits later reads that the charged price was $10 negotiated to $7 by the insurance company, but only a $3 benefit is possible for lunch. The deli later sends him a bill for the remaining $1 even though his lunch was inadequate.

The third customer, George, waits thirty minutes until served. His food insurance does not cover primary lunch, and the deli initially refuses to serve him as a result. After some discussion, they agree that he can have a 4-inch mini sandwich and a water cup for a cash price of $15. Hungry, he agrees.

Ridiculous as it sounds, the scenario presented approximates the U.S. health care system, and I have actually been on the customer side of all three types of plans in addition to being uninsured for the first nine years of my adult life. My current insurance is a “mid-level” product similar to Bill’s plan.

Enter my latest health care issue: hypertension. My blood pressure crept up on me about a year ago, but it wasn’t until I sacked my internal medicine physician and opted for a nurse practitioner that I learned sleep apnea may be contributing to my elevated blood pressure, as I had been told that I snore horribly and sometimes stop breathing. I decided to test the possibility by sleeping in my hospital overnight with a pulse oximeter (oxygen monitor) on my finger with a nurse checking in on me periodically. To my surprise, my oxygen levels dropped down to 70 percent (normal is around 95 to 100 percent) during episodes of apnea (cessation of breathing).

I next sought out a continuous positive airway pressure (CPAP) device to remedy the situation and found one I liked fo...

SURPRISE MEDICAL BILLING IS A SCAM BY INSURANCE COMPANIES

By Don R. Read, M.D


Surprise billing is a big problem — physicians agree with our patients.

It’s easy to understand why someone with health insurance gets frustrated with an unexpected bill for dozens or even thousands of dollars from a physician, hospital or medical provider.

“Why did I get this bill?” the patient asks. “I have insurance. I’m covered!”

Why indeed?

People receive surprise bills because that’s what their insurance companies want to happen.

It’s part of their business plan: Make their insurance look valuable.

Price the plan as attractively as possible. Enroll policyholders. Collect their premium dollars … then do whatever they can to keep most of those dollars rather than spend them on healthcare.

For patients, insurance is to help them pay for care. But for insurers it’s a business.

They call paying for care a “medical loss.” And they fight to keep that figure in their favor, to pay less for your care.

Insurance companies advertise robust networks full of physicians and facilities “in-network.”

Then they set up small (or narrow) networks of physicians to save themselves money.

Why? Because if the network is small, odds are more policyholders wind up receiving care from an out-of-network physician.

Meanwhile, the insurers pay just a fraction of the charge to those out-of-network physicians. They know the physicians and hospitals will bill the patient for the balance.

But they don’t tell the policyholder that.

The more enlightened of our patients might ask the doctor, “Do you take x Insurance?”

But x insurance might sell hundreds of plans. Just because we are contracted with some of those plans doesn’t mean we are in-network with all of them.

HERE'S WHY A TRUMP PRESIDENCY IS GOOD FOR PHYSICIANS AND PATIENTS

By Dr. Koka

Improbably, a real estate tycoon turned reality TV star with no political experience has been elected president by a fiercely divided nation.

There are a number of questions about the plans of a Donald Trump administration with regards to healthcare, and patients and physicians are understandably fearful. Seismic shifts like this in the political landscape make it difficult to find certitude in predictions on healthcare policy, but there are a number of clues to suggest that the landscape of healthcare may be an improving one for patients and the physicians charged with taking care of them.

At the top of the agenda for both Trump and Congress is repealing the Affordable Care Act (ACA). Clearly, this is much easier said than done. The healthcare reform law is a complex series of expansive regulations that touches payment reform, healthcare delivery and, oh, by the way, also covers 20 million Americans. The easiest to kill of the three would seem to be the Obamacare marketplace covering all those Americans that is propped up by federal subsidies that take the form of “cost sharing” payments to insurance companies. Eliminating funding for these subsidies would make insurers exit the Obamacare marketplace and make it nonviable.

Millions of patients currently with insurance would suddenly lose their health plans. No one wants this, and Trump and the Republican Party now face intense pressure to come up with a replacement. As a result, I find it very unlikely that physicians or patients will suddenly have to deal with a large number of patients without insurance. There are also encouraging signs that the replacement plans being discussed will more than likely include health savings accounts—a Trump/GOP favorite—that will be allowed to directly pay primary care physicians in a subscription model similar to direct primary care. This capitated model puts physicians, rather than insurance companies, in the driver’s seat and would be music to the ears of primary care physicians in desperate need of a lifeline

 The biggest immediate headache is the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which physicians will have to face in less than two months, but it only slightly overlaps with the ACA. The overlap relates to the Center for Medicare & Medicaid Innovation (CMMI) that was funded by the ACA, and created some of the important value-based payment models physicians were going to have to c...

ANTHEM TO ACQUIRE CIGNA, LEAVING ONLY 3 BIG INSURANCE COMPANIES

by CNN Money

In another merger of health insurance giants, Anthem has agreed to acquire Cigna in a $54 billion deal.

Anthem (ANTM), a Blue Cross and Blue Shield insurer, said it would buy all of Cigna's (CI)shares in a cash and stock transaction.

The deal is expected to close in the second half of 2016, if it passes state regulatory approvals and other requirements. The merged insurer would cover 53 million members.

The merger would leave only three major players in the insurance industry.

Earlier this month, Aetna (AET) struck a deal to buy Humana (HUM) for $37 billion, which would cover 33 million members.

The third remaining health insurer is UnitedHealth (UNH), which just completed its own $12.8 billion acquisition of Catamaran, a pharmacy-benefits manager and prescription provider.

There are titanic shifts going on in the entire healthcare space, where pharmacies are undergoing their own wave of consolidation. In May, CVS Health (CVS) agreed to acquire Omnicare (OCR) for $12.7 billion. And back in February, Rite Aid (RAD) agree to acquire EnvisionRx for $2 billion.

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