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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.

ACA Court Challenge: What’s At Stake For Connecticut

Tens of thousands of Connecticut residents who receive federal subsidies to help pay for health insurance won’t be affected immediately by the latest challenge to the Affordable Care Act before the U.S. Supreme Court. But experts say there’s a good chance Connecticut residents will experience some political fallout from the court decision – which could come as soon as Thursday – challenging the validity of federal premium tax credits to 6.4 million Americans in 34 states with federally operated insurance marketplaces (also known as exchanges). Nearly 74 percent (74,682) of the 101,294 people who purchased commercial health insurance plans through Access Health CT (AHCT) received federal subsidies, as of June 2015. Connecticut is among the 16 states – along with the District of Columbia – that established their own state-based marketplaces through the health law. A court decision that blocks health insurance subsidies in the federally-operated marketplaces could lead to “some crazy maneuvering at the federal level from a legislative perspective that could impact Connecticut” if Congress moves to repeal or significantly modify the law, said James Wadleigh, chief executive officer of AHCT.

Diligence Pays Off When Shopping For Health Insurance

Connecticut consumers who carefully consider their health status and financial needs stand to reap the greatest benefits when shopping for insurance during the 2015 open enrollment period. The enrollment period to purchase coverage at Access Health CT (AHCT), the online marketplace created by the Affordable Care Act, runs from Nov. 15, 2014, to Feb. 15, 2015. The law requires most Americans to carry health insurance or pay a fine when they file their federal income taxes.

C-HIT, Yale Breast Center Team Up For Unique Forum, Oct. 21

US Rep. Rosa DeLauro and leading breast cancer experts from The Breast Center-Smilow Cancer Hospital at Yale-New Haven and the Hospital of Central Connecticut will be the featured panelists at a unique community forum organized by the Connecticut Health I-Team (www.c-hit.org), a non-profit news service that provides in-depth coverage of health care issues. The forum – “Beyond The Pink Ribbon: New Frontiers In Screening, Treating and Preventing Cancer” – will focus on the latest inroads and challenges in breast cancer detection and treatment. The event is open to the public, and early registration (at www.c-hit.org) is encouraged. Proceeds from ticket sales will benefit The Breast Center – Smilow Hospital and C-HIT’s ongoing health journalism. Speakers include: Dr. Anees Chagpar, director of The Breast Center – Smilow Cancer Hospital at Yale-New Haven, who led the effort for Yale to become the first NCI designated Comprehensive Cancer Center in the Northeast to have a nationally accredited breast center; Dr. Regina Hooley, a radiologist and researcher at the Yale Cancer Center who specializes in ultrasound screening, mammography and breast density; and Dr. Kristen Zarfos, a renowned surgeon and women’s health specialist at the Hospital of Central Connecticut who led a successful grassroots campaign to ban “drive-through” mastectomies in Connecticut.