Report: Many CT Consumers Don’t Understand Their Health Insurance Policies

Many consumers who obtain insurance through Connecticut’s health care exchange don’t understand the plans they buy—and can struggle to access care as a result, according to a new report. Insurance plans typically use complicated language that is difficult to understand, according to the Health Disparities Institute, UConn Health. As a result, some patients have trouble accessing care, experience delays in care, encounter administrative hassles and face other hurdles, the study found. The institute conducted a statewide poll last year among 516 adults who enrolled in qualified health plans through Access Health CT (AHCT), the state health insurance exchange created under the Affordable Care Act. Many struggled to understand basic insurance terms like “premium,” “deductible” and “co-pay.”

More needs to be done to educate all health insurance consumers, regardless of where they buy their policies, said Lisa Freeman, executive director of the nonprofit Connecticut Center for Patient Safety.

Inpatient Mental Health Coverage Rare For State Insurance Plans

The state’s top insurers were more likely to approve claims for mental health services in 2015 than the year before, but rates of rejection for residential care remained high, a new state report shows. About 6.4 percent of claims for mental health services were rejected by eight top managed care insurers – down from about 8 percent in 2014 – according to an analysis of the 2016 Consumer Report Card on Health Insurance Carriers in Connecticut. At the same time, insurers continued to deny more than one in six requests for residential behavioral health care. And the percentage of managed care plan enrollees who received any inpatient services for mental health was low, with most companies providing such services for fewer than 0.3 percent of all enrollees. The analysis is based on eight companies that reported the same categories of data in 2015 and 2016 to the state Insurance Department, which changed the reporting format across the two years.

Report: Private Insurers Deny More Claims For Mental Health Care

The rate of denials by the state’s largest managed care insurers of requests for mental health services rose nearly 70 percent between 2013 and 2014, with an average of about one in 12 requests for prescribed treatment initially rejected, a new state report shows. At the same time, the proportion of enrollees in the largest managed care companies who received outpatient or emergency department care for mental health doubled, from an average of 9.4 percent in 2013 to 20.8 percent in 2014, according to an analysis of the 2015 Consumer Report Card on Health Insurance Carriers in Connecticut, issued by the state Insurance Department. The percentage of members who received inpatient mental health care also doubled, although it remained low, with most companies providing inpatient services for less than .5 percent of all enrollees. The rise in rejections by the state’s 10 largest indemnity managed care companies – private health insurers, not including Medicare or Medicaid — came as state officials focused on improving mental health outreach and treatment, in the wake of the Sandy Hook school shooting in December 2012. The managed care organizations include companies such as Aetna Life Insurance Co., Anthem Health Plans, CIGNA Health and Life Insurance Co., and UnitedHealthcare Insurance Co.

Access Health Enrollment Starts Sunday; Uninsured To Face Steeper Fines

Open enrollment for consumers to buy health insurance through the Access Health CT marketplace begins Sunday, and 2016 will bring considerably steeper fines for consumers who lack insurance. Access Health CT (AHCT), now in its third year, enrolled close to 100,000 individuals in private insurance plans in its first two years, according to Andrea Ravitz, director of marketing. About 500,000 enrolled in Medicaid through AHCT, during the first two years. The marketplace aims to enroll between 105,000 and 115,000 in private plans by the end of open enrollment, Ravitz said. AHCT concentrated on attracting new enrollees its first two years but this year it has been focusing on retaining enrollees, she added.

Doctors, Clinicians, Team Up For C-HIT Forum On Preventive Care, Oct. 7

Doctors and clinicians from a wide array of specialties will offer their insights about the importance of preventive care at an upcoming community health forum in Hartford, featuring a keynote address by Dr. Jewel Mullen, commissioner of the Connecticut Department of Public Health. “Get Health Wise: The Benefits of Preventive Care” on Oct. 7, hosted by the Conn. Health I-Team, will give attendees the opportunity to hear presentations from doctors and clinicians at various health care stations. A panel discussion – with a question and answer period – will follow.

Report: Women In CT Denied Some Mandated Health Benefits

Women in Connecticut have been denied health insurance benefits in violation of the federal Affordable Care Act, according to a study by the National Women’s Law Center. Connecticut is one of 15 states included in the study, which analyzed the 2014 and 2015 health plans of companies that provide coverage under the ACA in state marketplaces. It found violations in all 15 states and concluded that they are likely occurring nationwide. According to the report, Connecticut women have been denied coverage for the following: breastfeeding counseling and education after two months following delivery, infertility treatments after the age of 40, sterilization procedures, emergency birth control, and maintenance care for such things as lupus, HIV, and hormones after breast cancer treatment. Coverage was also denied for transgender transitions.