I-Team In-Depth

Report: Private Insurers Deny More Claims For Mental Health Care

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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.

Free Event

Doctors, Nutrition Experts And Local Chef Team Up For C-HIT Forum On Diabetes

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For those living with diabetes, eating healthy and knowing how foods affect blood sugar levels is crucial to managing the disease. The Conn. Health I-Team, (www.c-hit.org) in collaboration with ConnectiCare and the Hispanic Health Council, is hosting a panel discussion on Thursday, April 7, in Hartford, where experts will discuss the latest developments in early screening and treatment of diabetes and offer advice about how adopting a healthy lifestyle can help combat the disease. The free event, called “Beating Diabetes: Food, Fitness and Focus,” will include a social hour and food tasting starting at 5 p.m. featuring famed local chef Jay Lewis, who will present healthy foods choices. Lewis, who was nominated as “best chef” in the state in 2012 by Hartford Magazine, has been a sous chef, as well as the banquet chef for the Goodwin Hotel.

Fines & Sanctions

Access Health Enrollment Starts Sunday; Uninsured To Face Steeper Fines

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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.

Disparities

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

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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.

Women's Health

Report: Women In CT Denied Some Mandated Health Benefits

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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.

Disparities

ACA Court Challenge: What’s At Stake For Connecticut

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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.

Access Health CT

Diligence Pays Off When Shopping For Health Insurance

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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.

Women's Health

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

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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.

I-Team In-Depth

Top Execs At “Big Five’’ Health Insurers Each Pull In Millions

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Health care reform, new Wall Street regulations and outrage over large pay packages are likely to put pressure on compensation for health insurance executives. But it doesn’t seem to have happened yet. The highest-paid executive at each of the “Big Five’’ health insurers – UnitedHealth Group, Aetna Inc., WellPoint Inc., Humana Inc. and Cigna Corp. – made more than $8 million in 2012, according to filings this spring with the Securities and Exchange Commission. The CEO of EmblemHealth Inc., a nonprofit that owns ConnectiCare, also had total compensation at that level in 2011, the last year for which information is available.