Valuable and Interesting Facts About Utah Insurers – for Individuals and Families
Altius Health Plans – Now offers Utah residents the option to apply for a plan online. Altius has very competitive pricing for a single parent with one or two children.
Assurant Health – Offers a $2,500 maternity deductible, the lowest in Utah, (with the exceptions of HIPUtah, Medicaid, and employer sponsored insurance with a maternity rider). Assurant is also the only company in Utah to offer a 24 and 36 month rate guarantee, so you can rely on your rate staying the same for longer than 12 months. On top of those, Assurant is the first company to offer a decreasing deductible on their high deductible plans. For each six month period that you don’t meet your deductible, it goes down by 10% (the amount it goes down is limited, but it can be nearly cut in half after around 3 years).
HumanaOne – Allows you to carry over the amount you paid toward your deductible during the last quarter of the year, crediting that amount to your deductible for the next year.
Regence Blue Cross Blue Shield of Utah – Offers their members a high quality website account where members can view claims information and research average costs for specific procedures at different facilities.
SelectHealth – Just rolled out a dental insurance plan for individuals and families and changed their maternity insurance deductible from $5,000 to $6,500.
The Health Insurance Pool of Utah – HIPUtah (state funded insurance for uninsurable Utah residents) – is offering a premium subsidy program with lenient income requirements. The subsidy pays up to 50% of your monthly premium for a limited number of months, if you qualify.
How to Appeal a Denied Health Insurance Claim – for Utah Residents
If you are not satisfied with how a claim was handled, if it wasn’t paid as you thought it should have been, or if it was denied, you do have the right to file an appeal.
Sometimes you can call your health insurance company to start the appeal. However, it’s often best to file a written, formal appeal. In your appeal, include you group and individual ID number, your name, address, phone number, specific dates and dollar amounts. Explain exactly why you believe your claim was paid incorrectly and attach supporting documents such as bills etc…
Here is the address and phone number for appealing claims for each major health insurance company that offer plans in Utah.
- Aetna- Attn: Appeal Dept., 151 Farmington Avenue, Hartford, CT 06156. Phone: (860) 273-0123.
- Altius Health Plans – Attn: Claims Appeals, P.O. Box 7147, London, KY 40742. Phone: 800-377-4161.
- Assurant Health – Appeals Dept., One Chase Manhattan Plaza
New York, NY 10005. Phone: 800-553-7654. - HumanaOne (Individual) – Attn: Claims Appeals, 500 West Main Street, Louisville, KY 40202. Phone: 800-448-6262.
- Humana (Group) – Attn: Claims Appeals, 500 West Main Street, Louisville, KY 40202. Phone: 800-448-6262.
- Regence Blue Cross Blue Shield of Utah – Attn: Appeals Dept, 2890 E Cottonwood Parkway, Salt Lake City, UT 84125-0956. Phone: 801-333-2100.
- SelectHealth – Attn: Appeals Dept, PO BOX 30192, Salt Lake City, UT 84130-0192. Phone: 801-442-4684.
- United HealthCare – Attn: Appeals Dept, 2525 Lake Park Blvd , Salt Lake City , UT 84120 . Phone: 800-624-2942.
Once you submit your appeal, be sure to call and follow up on a regular basis until your appeal has been processed and a decision has been made.
2009 Utah Healthcare Bills – What Passed?
Here are the Utah health insurance related bills that passed this year:
- HB 165 (House Bill 165) – Health Reform – Administrative Simplification
- HB 178 (House Bill 178) – Health Insurance and Program Amendments
- HB 188 (House Bill 188) – Health System Reform – Insurance Market
- HB 331 (House Bill 331) – Health Insurance Coverage in State Contracts
Highlighted below are the three bills that will have largest impact on Utah residents. Click HB 331 to learn more about this bill.
House Bill 165 – Administration Simplification. This bill…
-Amends the timing of the requirement that a hospital sends an itemized bill to a patient.
-Creates a system-wide, broad based demonstration project between health care payers and health care providers for innovating the payment and delivery of health care in the state.
-Establishes a committee to study and develop a more efficient coordination of benefits process.
-Requires health benefit plans to issue to enrollees a printed card containing health plan information.
-Requires an insurer to provide access to information sufficient for a health care provider to determine the compensation or payment terms for health care services.
-Requires the Insurance Department to convene a group of providers and payers to establish standards for the electronic exchange of health plan information using card swipe technology which is compatible with national electronic standards.
-Prohibits an insurer from requiring less than one business day’s notice of an emergency in-patient hospital admission and amends the period of time in which an insurer can recover an amount paid to a health care provider when the insurer determines the payment was incorrect.
-Requires hospitals sending bills to patients to include the following words in bold “THIS IS THE BALANCE DUE AFTER PAYMENT FROM YOUR HEALTH INSURER,” or other appropriate language.
House Bill 178 – Health Insurance and Program Amendments. This bill…
-Clarifies that the Children’s Health Insurance Program should have access to at least two different provider networks.
-Extends the COBRA premium assistance provided under Section 3001 of the American Recovery and Reinvestment Act of 2009 (Pub. S. 111-5) to state mini-COBRA benefits; and
-Makes technical amendments to the health benefit plan broker disclosure
House Bill 188 – Health System Reform – Insurance Market. This bill…
-Prohibits balanced billing by certain health care providers in certain circumstances.
-Revises the basic benefit plan used for consumer comparison of health benefit products.
-Requires the Insurance Department to include in its annual market report a summary of the types of plans sold through the Internet portal, including market penetration of mandate lite products.
-Allows insurers to offer lower cost health insurance products that do not include certain state mandates in the individual market, the small employer group market, and in the conversion market;
-Creates the Utah NetCare Plan, a low cost health benefit plan as an alternative to current federal COBRA, state mini-COBRA, and conversion products.
-Requires health insurance brokers and producers to disclose their commissions and compensation to their customers prior to selling a health benefit plan.payment reform demonstration projects.
-Modifies the number and type of products an insurer must offer in the small employer group market and the individual market.
-Establishes a defined contribution arrangement market available on the Internet portal, which; 1. Beginning January 1, 2010, is available to small employer groups. 2. Offers a range of health benefit plan choices to an employer’s eligible employees. 3. Beginning January 1, 2012, is available to eligible large employer groups. 4. Beginning January 1, 2012, will offer a wider range of choices of health benefit plans to employees.
-Establishes a board within the Insurance Department that is given the responsibility to develop a risk adjustment mechanism that will apportion risk among the insurers participating in the Internet portal defined contribution market to protect insurers from adverse risk selection.
-Requires insurers who offer health benefit plans on the Internet portal to provide greater transparency and disclose information about the plan benefits, provider networks, wellness programs, claim payment practices, and solvency ratings.
-Establishes a process for a consumer to compare health plan features on the Internet portal and to enroll in a health benefit plan from the Internet portal.
-Requires the Office of Consumer Health Services to convene insurers and health care providers to monitor and report to the Health Reform Task Force and to the Business and Labor Interim Committee regarding progress towards expanding access to the defined contribution market, greater choice in the market, and
-Establishes limited rule making authority for the Office of Consumer Health Services to assist employers and insurance carriers with interacting with the Internet portal and facilitate the receipt and payment of health plan premium payments from multiple sources.
-Authorizes the Office of Consumer Health Services to establish a fee to cover the transaction cost associated with the Internet portal functions such as sending and processing an application or processing multiple premium payment sources; and
-Re-authorizes the Health Reform Task Force for one year.
Utah NetCare Basic Health Care Plan Passes the Senate
The Utah NetCare plan (House Bill 188) passed the Utah Senate on March 5th, 2009.
The bill creates the Utah NetCare Basic Health Care Plan, a guaranteed issue plan that will be offered to Utah residents as an alternative to COBRA, to individuals, and to employees of Utah businesses.
The NetCare plan will have high deductibles, less than state-mandated coverage, and will have fairly high premiums compared to individual and family health insurance plans.
The main attraction of the plan is that Utah residents who have previously been denied coverage will have an option besides the Comprehensive Utah Health Insurance Pool of Utah. The NetCare plan will likely be offered as soon as January 1st, 2010.
House Bill 188 also creates an online insurance exchange, or a website, where Utah residents can go to compare Utah health plans and prices side by side . This technology is currently available in the independent market (see this Utah Health Insurance Instant Quoting System for an example).
To stay updated on the latest Utah NetCare happenings, please visit the Utah NetCare website.
by Jared Balis
Health Savings Accounts – Eligible Expenses
The following expenses are eligible to be paid for out of your Health Savings Account (if you have a qualified high deductible health plan):
- Abortion
- Acupuncture
- Alcoholism Treatment
- Ambulance
- Annual Physical Exams
- Artificial Limbs
- Artificial Teeth
- Bandages
- Birth Control Pills
- Chiropractor
- Contact Lenses
- Dental Treatment
- Diagnostic Services
- Drug Addiction
- Drugs
- Eyeglasses
- Eye Surgery
- Fertility Treatments
- Guide Dog / Service Animal
- Hearing Aids
- Home Care
- Hospital Services
- Medical Equipment (Bandages, Crutches etc…)
- Medicare Part A (Hospital) – Limited
- Medicare Part B (Supplemental Medical) – Limited
- Medicare Part D (Prescription Drug)
- Laboratory Fees
- Lead-Based Paint Removal
- Learning Disability Expenses
- Legal Fees (necessary to authorize treatment for mental illness only)
- Lodging/Meals (if the primary reason is to receive medical care)
- Long Term Care Insurance Premiums
- Medical Conferences (dealing with a chronic illness you or a family member have)
- Medicines
- Non-prescription medicines (other than insulin)
- Nursing Home
- Nursing Services
- Oxygen
- Physical Exams
- Pregnancy Test Kits
- Prosthesis
- Psychiatric Care
- Psychoanalysis
- Psychologist
- Special Education Tuition (doctor recommended)
- Sterilization
- Stop-Smoking Programs
- Surgery
- Telephone (TTY/TDD – for the hearing impaired)
- Television Equipment (for the health impaired)
- Therapy
- Transplants
- Transportation (primarily for medical care)
- Vision Correction Surgery
- Weight Loss Program
- Wheelchair
- Wig
- X-Ray
Here are some items that you cannot pay for with monies in your Health Savings Account:
- Babysitting/Child Care
- Controlled Substances (marijuana, laetrile, etc..)
- Cosmetic Surgery (exceptions include breast reconstruction after breast cancer)
- Dancing Lessons
- Diaper Service
- Electrolysis for Hair Removal
- Flexible Spending Account
- Funeral Expenses
- Future Medical Care
- Hair Transplant
- Health Club Dues
- Health Coverage Tax Credit
- Household Help
- Illegal Operations and Treatments
- Insurance Premiums (with exceptions)
- Maternity Clothes
- Medicare Supplement Premiums
- Medicines and Drugs from Other Countries
- Swimming Lessons
- Teeth Whitening
- Veterinary Fees
- Weight Loss Program (general purpose)
For a complete list (published by the IRS) with further explanation for each item, please see The IRS Guide to Eligible Medical Expenses. Please know that the only exception to this list is that non-prescription medications are eligible to be paid for through your Health Savings Account.
For Wikipedia’s extended definition of Health Savings Accounts, please click here.
Health Savings Accounts – Here’s the Skinny
A health savings account attached to a high deductible health plan just might be the prescription for increasing health insurance costs.
Health savings account shift the cost of everyday health care to the insured, rather than the insurance company. This is accomplished by the insured having a higher medical deductible (ranging from $1,150 to $5,000 for a single person & $2,300 to $10,000 for a family).
The idea (formally recognized as Consumer Driven Health Care) is, that consumers paying for office visits and prescriptions out of their own pockets will create an awareness of how much those things cost. The insured might be a little more cautious before they head off to the urgent care center for something that don’t necessarily need to go there for. On top of that, the hope is, the insured will question and negotiate with the medical provider when the provider orders tests and prescribes name brand drugs.
Because deductibles are high and there is little coverage before you meet your deductible, premiums for these plans can be very attractive. On top of that, health savings accounts allow the insured to contribute $3,000 of pre-tax money ($5,950 for a family), every year to the account. This money can be used to pay for surgeries, doctors visits, accidents, prescriptions and much more. Best of all, the money is tax free, the account is in the insureds control, and it’s not a “use it or lose it” account. The money rolls over from year to year.
To illustrate how a high deductible health plan in conjunction with a health savings account can change your families health insurance situation, take a look at the example below. The family in this example includes a 37 year old male, 33 year old female, and two kids, ages 7 and 5.
A Popular Health Insurance Plan -
- A local and well known insurance company
- $500 medical deductible
- $0 prescription deductible
- $15 & $25 office visits (no deductible payment required)
- 80% coverage after the deductible
- $3,500 stop loss (max out of pocket)
- $2,500,000 lifetime maximum benefit
- $596.00 monthly premium
A High Deductible Health Plan + a Health Savings Account -
- A solid insurance company who focuses on high deductible health plans
- $5,000 medical/prescription deductible
- $35 preventive care (annual physical) visit (no deductible payment required)
- 100% coverage after the deductible
- $5,000 stop loss (max out of pocket)
- $5,000,000 lifetime maximum benefit
- $151.00 monthly premium
It’s true that a family of four might have quite a few doctors visits each year and may end up paying quite a bit of out-of-pocket costs during the year. But, to make up for it, medical expenses are paid for with pre-tax monies and the family is saving $5,340 per year in annual premiums.
What is attractive about this, is that the insured has an opportunity to save a large portion of their premiums. With the $500 deductible plan, the family was paying out $7,152, guaranteed, whether they utilized the plan or not. Now, they are only paying out $1,812 in annual premiums. They have an opportunity to save a lot of money each year, as long as they don’t over-utilize their plan.
Because the insured is on the hook for more medical costs, high deductible health plans usually make a lot of sense for individuals and families that are healthy, or don’t utilize their plan much, and don’t have a lot of expensive prescriptions.
An individual or family that has prescription costs, multiple office visits, and other medical expenses throughout each year may want to consider staying on a plan with more benefits up front.
To learn more about Health Savings Accounts, visit the United States Department of the Treasury – Office of Public Affairs – HSA’s.
*All dollar figures above (contributions, deductibles, and example plan premiums) are for the year 2009.
Generics -vs- Brand Name Prescriptions
The push for consumers to choose generic drugs over brand name drugs is stronger than ever.
I took my daughter to the urgent care center today, because she had an ear infection. The doctor wrote us a prescription for an ear drop antibiotic that cost $137 (without insurance). I asked her “Is there a generic version of these ear drops?” The doctor said there wasn’t, but there was a very similar ear drop that was a generic. The total cost (without insurance) was $29.99.
The bottom line is that I saved $45 because my co-pay was only $15, instead of $60. On top of that, my insurance company saved $62.01. The significance of my insurance company saving money, is that consumers saving my insurer money on a large scale, by choosing generics instead of brand name drugs will keep my rates (and everone elses rates) lower when it comes time for my annual renewal.
Some doctors don’t care if consumers buy the generic. In fact, they would rather you buy the brand name. They have pharmaceutical reps in their office, day after day, offering them perks to sell their brand name drugs. Although I have had first hand experiences with doctors that prescribe the generic whenever they can.
There is more than just the cost issue to consider when replacing brand name drugs with generics. How do they stack up quality-wise?
Most everything I have read makes the argument that generics are “the same” as brand name drugs. It’s true that the FDA requires the same amount of the active ingredient to be in the generic, as was in the brand name. However, colors, flavors, and other active ingredients do make them slightly different.
Some articles I have read, and people I have talked to, do leave a little room for concern with a few specific generic drugs. In making a decision to replace a brand name drug with a generic, make sure you get your doctors and/or pharmacists opinion.
The takeaway? Save money and lower your annual health insurance rate increases by buying generic drugs.
To learn more about generics, read Consumer Reports “Guide to Prescription Drugs – Generics.”
How Much Does it Cost to Have a Baby in Utah?
Utah is a unique state.
Because there are so many babies born in Utah, it is nearly impossible for the individual/family health insurers to cover maternity charges. If they did, they would be out of business, or everyone would be absorbing the costs in the premiums.
Individual/family health insurers in Utah have deductibles for maternity related charges ranging from $5,000 per pregnancy to $7,500 or even $10,000 per pregnancy. It’s no wonder that the cost of having a baby in Utah is such a hot topic. You will likely be paying most of the charges out-of-pocket. Determining what the costs are going to be can help you plan for your next baby.
Normal Vaginal Delivery
In Utah, in 2007, the average cost for a vaginal delivery was $4,792. In major or extreme normal vaginal delivery cases, the average cost jumped to $8,089. This doesn’t include the physician’s professional fees throughout the pregnancy, just the hospital charges.
Cesarean Section Delivery
In Utah, in 2007, the average cost for a ceserean section was $8,243. In major or extreme cesear section cases, the average cost jumped to $14,552. Again, this doesn’t include the physician’s professional fees throughout the pregnancy, just the hospital charges.
The Least Expensive Hospitals (for normal vaginal deliveries)
- Beaver Valley Hospital
- Dixie Regional Hospital
- Garfield Memorial Hospital
- Gunnison Valley Hospital
- Heber Valley Hospital
- Kane County Hospital
- Logan Regional Hospital
- Sevier Valley Medical Center
- Uintah Basin Medical Center
- Valley View Memorial Hospital
The Most Expensive Hospitals (for normal vaginal deliveries)
- Davis Hospital & Medical Center
- Intermountain Medical Care
- LDS Hospital
- Mountain View Hospital
- Mountain West Medical Center
- Pioneer Valley Hospital
- Jordan Valley
- Saint Marks Hospital
- Salt Lake Regional Medical Center
- Timpanogos Regional Hospital
- University Health Care
So what about quality? Does going with a less expensive hospital mean that you sacrifice quality and safety?
Not neccesarily.
While one of the least expensive hospitals, Beaver Valley Hospital, had a higher than average rate of vaginal tears (without tools) of 10%, Heber Valley Medical Center, Dixie Regional Medical Center, and Valley View Medical Center all had below average rates of vaginal tearing (with and without tools) and below average incidents of newborn injuries.
On the other hand, some of the most expensive hospitals had higher than average rates of tearing and newborn inujuries.
Although looking at the average maternity costs in Utah can provide a rule of thumb for how much you may end up spending out of pocket, doing some hospital-specific research could pay off in the end.
Download the full report “Maternity Charges and Safety in Utah 2007“, provided and written by the Utah Department of Health. Find out how each hospital stacks up. This is a great planning tool and an accurate way to predict costs and safety.
Auto Accident Worksheet
Download this worksheet as a pdf. Keep one in your car(s) with your insurance information. Print it out and give one to a friend, or email this article to a friend.
If you have an accident, you should do the following:.
1. Ensure everyone is safe.
2. Notify the local authorities (police, ambulance, fire department). Call 911 if it’s an emergency. Discuss the car accident with the police only, not the other driver(s).
3. Document information about the other vehicles involved in the accident:
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Driver’s Name
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Phone Number
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Address
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Insurance Co. Name
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Insurance Policy #
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Driver’s License #
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Vehicle’s License Plate #
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Vehicles Identification # (VIN)
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Vehicle Year
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Make
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Model
4. Leave the following with the other driver(s):
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Driver’s Name
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Phone Number
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Address
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Insurance Co. Name
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Insurance Policy #
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Driver’s License #
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Vehicle’s License Plate #
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Vehicles Identification # (VIN)
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Vehicle Year
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Make
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Model
5. If necessary, stay with your vehicle until it is towed.
6. Contact your insurance agent or insurance company to report the accident and start the claims process.
