Tag insurance

Elmira Star-Gazette: Let doctors negotiate with big health insurers

By Dr. Michael Herceg, 10/22

The recently proposed consolidation of health insurance giants Anthem and Cigna, and Aetna and Humana, is cause of great concern to the medical profession in New York. It should be of greater concern to patients.

The move comes amid a time when medical practices are already struggling with greatly increased practice costs and administrative hassles. More and more physicians are finding they have no choice but to become absorbed into large health care systems to deliver quality patient care.

Times-Union: Cuomo urged to sign bill giving doctors final say in Medicaid Rx disputes

By Claire Hughes, August 4

Supporters of a bill that would ensure doctors have the final say in prescription disputes with Medicaid managed care plans are urging Gov. Andrew Cuomo to sign the measure into law.

The measure, one of about 700 bills passed by the state lawmakers this year and under review by counsel, has not reached the governor’s desk, according to Cuomo spokesman Rich Azzopardi.

Given the administration’s past stance on language in the bill, however, supporters are concerned over the chance of a veto.

“The Health Department opposed this language when it was raised during budget discussions,” said Assembly Health Committee Chairman Richard Gottfried, D-Manhattan, a bill sponsor.

Times-Union: Patients, medical groups call on Albany to limit ‘fail first’ insurance policies

By Claire Hughes, May 29

Patient advocates and medical groups on Thursday were at the state Legislative Office Building to support a bill that would curb so-called “step therapy” or “fail first” policies among health insurers.

Groups representing patients with cancer, mental illness and chronic pain appeared with lawmakers to call for a clear and concise appeals process, and limits to health insurers’ right to require that less expensive treatments be used before more expensive ones are approved.

Health insurers oppose the bill. Step therapy encourages the use of effective medication, while keeping a check on the rising cost of prescription drugs, said Paul Macielak, CEO of the New York Health Plan Association, a trade association.

“Without efforts to control rising drug costs, consumers and employers would not be able to afford prescription drug coverage,” Macielak said.

The problem with the current appeals process, said bill sponsor Assemblyman Matthew Titone, is that the insurance companies control the process. Some delay approving the proper treatment indefinitely. The bill would not eliminate step therapy, but require insurers to make their appeals process transparent and easy to follow, and limit the length of time it takes to complete, he said.

Assembly Health Committee Chair Richard Gottfried, D-Manhattan, who supports the legislation, acknowledged that step therapy can be appropriate and effective under many circumstances. These include times when doctors are not sure which remedy might work best for a particular patient and the most prudent action is to try something inexpensive first.

Capital NY – Health chairs predict problems with coming ‘Cadillac’ tax

By Katie Jennings, 5/18/15

State legislators from both sides of the aisle are concerned that a soon-to-take-effect Affordable Care Act tax will have a “devastating effect” on health plan coverage for both public and private employees.

The so-called “Cadillac tax” provision of the Affordable Care Act isn’t set to kick in until 2018, but Assembly health committee chair Richard Gottfried and Senate health committee chair Kemp Hannon both raised concerns over its impact during a event on Friday organized by the fiscally conservative Manhattan Institute.

The controversial Cadillac tax, or excise tax on high-premium insurance plans, imposes a 40 percent tax on health premiums above a threshold of $10,200 a year for individuals and $27,500 for families. It is expected to bring in $87 billion in federal revenue by 2025, according to the most recent Congressional Budget Office analysis.

Gottfried, a Democrat from Manhattan, said “the approach of the Cadillac tax ought to be regarded by almost everybody as an oncoming train or worse.”