Colorado Health Insurance Insider » Boulder

Anthem Blue Cross And Boulder Chamber Offer New Health Insurance

Louise — Fri, 31 Jul 2009 20:17:15 +0000

Anthem Blue Cross Blue Shield and the Boulder Chamber of Commerce have partnered to create a health plan option for Boulder Chamber members that includes coverage for alternative as well as traditional care. The Chamber Plan’s Blue Freedom coverage offers all of the typical benefits we tend to associate with small group coverage, but most of the plans also cover things like accupuncture, chiropractic care, herbology, and massage therapy.

This is a big step forward for health insurance, and one that I hope we’ll see in other areas and from other carriers. Boulder is a great place to start something like this, as Boulder residents do tend to utilize alternative health care more than the average Colorado resident. But over the years, we’ve had inquiries from people all over the state who are looking for a health insurance policy that will allow them to utilize alternative care.

The Boulder Chamber plan is a good start. It’s currently available to Boulder Chamber of Commerce members who have between 1 and 50 employees. Eventually I’d like to see alternative care available as an option for people throughout Colorado, regardless of where they live or work. On a personal note, I’d also like to eventually see plans that offer maternity coverage include midwifery and homebirths in their benefits package.

It’s great to see Anthem Blue Cross Blue Shield recognizing the importance of alternative medicine for some people. Obviously this would not be a benefit for everyone, but no one health insurance benefit will be utilized by everyone who has a particular policy (and the Boulder Chamber is offering several other Anthem plans with various designs, so the alternative care isn’t being forced on anyone who doesn’t want it). Choices and options are important, as everyone has different views on health and wellness. And with the advent of this new plan, a small business owner who is committed to alternative medicine and turned off by traditional health insurance policies might get on board with health insurance for her employees – and that’s a good thing.

Free Health Care For Some Laid Off Workers

Louise — Wed, 01 Apr 2009 21:59:07 +0000

I got a press release today about the Walgreens Take Care clinics offering free health care to people who are laid off between March 31st and the end of the year, and went looking for more information. Michelle Andrews at On Health & Money has some more details about the program that I didn’t see reported in the mainstream news articles.

All in all, this looks like a good deal for everyone involved. The Take Care clinics will get widespread name recognition (already, these news reports are probably driving traffic to the clinics, in the form of people who might not have even been aware of their existance). In addition, it’s likely that if people get good service at a Take Care clinic while unemployed, they may return again later as a paying customer.

For people who have lost their jobs and don’t have health insurance, any opportunity for free health care will help. And even if they have to visit the clinic as a paying patient in order to be eligible for free services, it’s noteworthy that the fee at the Take Care clinics normally starts at $59. This is quite a bit less than a typical office visit charge for someone without health insurance negotiated rates.

For emergency rooms and urgent care clinics (where services are not free, but payment is often hard to collect), the free services at the Take Care clinics might help to alleviate some of the overcrowding and full waiting rooms.

The tactic of requiring that a patient have visited a Take Care clinic in the past in order to be eligible for the free health care program is a good marketing move. It’s laudable that the clinics are offering free health care at all, and obviously they have to structure this in such a way that they don’t end up driving themselves out of business in the process. By requiring that a patient (who might think that a job/health insurance loss is on the horizon) come in for a paid visit first, the clinics will likely boost their revenue in the early phase of this program. Time will tell how much free health care gets handed out at the clinics over the rest of the year, but my guess is that it will be a considerable amount.

Take Care clinics operate in 32 metro areas across the country. I went to their location finder web page and found 12 clinics in Colorado in the Denver/Boulder area, including one just around the corner from us here in Broomfield.

Most Americans Unaware Of PCP Shortage

Louise — Wed, 17 Dec 2008 22:49:12 +0000

In the health care and health insurance blog worlds, there’s plenty of talk about a PCP shortage. But I’m curious about whether the average American – not involved in the health care industry other than as a patient – knows about the PCP shortage or sees it as a problem. Like many of our fellow health industry writers, we’ve addressed the primary care shortage issue, writing about how to attract more docs to primary care, and about how primary care physicians help to keep health care spending and technology use in check. We know that PCPs don’t earn huge salaries. (I know, $130K is a pretty big salary, but keep in mind how long one must spend in school and in residency in order to get the title of doctor.)

In browsing through this week’s Grand Rounds (highly worth the read, it’s a compilation of the best of the health care blogosphere from 2008, hosted by Laurie at A Chronic Dose) I came across this article by Robin at Survive The Journey. Robin writes from the perspective of a patient, and addresses the PCPs who are well aware of the problems facing their industry (a shortage of docs, and highly inequitable reimbursement when compared with what specialists pull in). Robin notes that there are plenty of PCPs in the blog world, and they often write about the issues facing primary care. But she points out that most of the people reading those blogs are also in the health care industry. The information isn’t getting out to patients and the general public. Robin conducted an informal poll of 22 people regarding what is wrong with our health care system, and the most common answer she got was that health insurance is too expensive. This is similar to data obtained on a larger scale by Harris Interactive earlier this fall – health insurance carriers get blamed more than any other group for the state of our health care system. Nobody in her poll mentioned a PCP shortage or reimbursement levels.

Our son’s doctor is a family practice doc in Boulder, Colorado. Last month I called to schedule a well-baby check for him and they booked an appointment for the very next day. No emergency, no illness… just a well check, and they were able to see him the day after I called. This is an established doctor who has been in town for several years. If I didn’t work in the health insurance industry and read health care related articles on a daily basis, I would have no clue that there’s a PCP shortage in this country, since my own experience (n=1) tells me otherwise.

For the purpose of this article, I called our son’s doctor’s office to see if they are accepting new patients with Medicaid. The office manager told me that they take a “limited number” of Medicaid patients, and that it’s up to the doctor to say whether she’ll take a new Medicaid patient on any given day. My guess is that it’s fair to say that patients with Medicaid and those without health insurance are probably acutely more aware of the PCP shortage than their neighbors with private health insurance.

People whose employers pay the majority of their health insurance premiums are often unaware of just how expensive health insurance really is. People with health insurance are often unaware of how expensive health care really is. People who aren’t experiencing a PCP shortage in their own lives tend to be unaware of the overall PCP shortage. And I’d say that it’s safe to assume that most Americans think all doctors (primary care and specialists alike) are rolling in money, driving Mercedes, and vacationing in Tahiti a couple times a year. Robin’s post is a good reminder that in order to remedy the problems facing primary care, the message has to get out to a wider audience. For additional info, her article has some great links to outstanding blogs written by primary care docs – Dr. Rob, Dr. Chan, and PookieMD – who write often and well on the subject of primary care.

The Art And Science Of Choosing Providers

Louise — Fri, 12 Dec 2008 01:36:52 +0000

Duncan Cross and David Williams and Niko Karvounis have all written articles about the Kaiser study that indicates that most people (about 85% of us) aren’t using quality comparison websites when making health care provider choices. All three articles make good points, and it got me thinking about my own family’s choices with regards to health care providers.

We’ve used lots of different criteria for picking doctors; how we go about it depends on the situation. When Jay needed to have a lipoma removed last year, and we knew we’d have to pay for it ourselves since it was excluded as a pre-existing condition on our health insurance policy, he did a lot of shopping around before selecting a doctor. We wanted to use a dermatologist, since we assumed he would get a better outcome with a specialist (we’ve since talked to people who’ve had lipomas removed by primary care docs and had great outcomes and a lower bill. Live and learn). But price was our primary concern, and that was the criteria we used to pick a doctor. Not that it did us any good.

When Jay injured his knee last year, we knew that it would likely need surgery and that we were going to have to meet our health insurance deductible no matter what doctor we saw. It wasn’t a dire emergency, so we had time to compare doctors. When we found out that Dr. Steadman and the Steadman/Hawkins clinic are on our PPO network with Humana, our decision was easy. For his knees, Jay’s primary criteria for picking a provider was quality, and driving back and forth to Vail numerous times this year was worth it to us for the quality of care that he received.

When we were expecting our son last year, we chose a midwife based on a recommendation from a friend. We knew we wanted a homebirth, and we trusted our friend’s recommendation. Our midwife was fantastic. Her price was about average for this area for someone with her level of experience (she’s been a midwife since I was in middle school – this is one area where I’d rather pay a little more for someone with experience).

When our son was born, we asked our midwife if she could recommend a doctor for him. We trusted her, and knew that she worked with a lot of parents with values similar to ours. She recommended a family practice doctor who takes care of a lot of babies that our midwife has delivered over the years. She’s on our PPO network and has been a good fit with our family (all we’ve had so far is well checks, so going to the doctor has been pretty easy). She’s in Boulder, which is a bit of a drive for us, but our midwife’s recommendation mattered to us, so we’re willing to make the trip.

Recently I needed to see a podiatrist. It was a relatively minor issue that ended up needing two office visits of about 15 minutes each. We’ve already met the deductible on our HSA this year, and since I knew that my foot could be fixed by pretty much any podiatrist, my only criteria was to find the one closest to our house and on our health insurance network. I ended up finding a doctor in Broomfield about 3/4 of a mile from our home. He did a great job, although I’m sure any doctor would have done just as well. For me, all that mattered was convenience.

So my family – with a relatively limited medical history – has run the gamut of decision making protocol that people use to pick providers. Cost, quality, convenience, personal recommendation… we’ve done them all. I think that it depends on the situation. For a serious health problem, it probably pays to search for quality. But then again, a personal recommendation might get you a doctor who makes you feel more comfortable – and that’s hard to quantify. Healthcare is a complicated issue – one that involves reason, emotion, and logic all at once. Obviously we want the best outcome, but we also need convenience and affordability and a doctor with whom we ‘click’. Quality rankings are a piece of the puzzle for sure, but they’re not the only piece. I do think they will get more popular as time goes by and especially if health insurance carriers start actively encouraging patients to choose doctors from among the highest ranking providers on the comparison sites. But there are other factors that go into choosing a provider that can’t be quantified on a spreadsheet or a graph.

Where The Uninsureds Live

Louise — Sat, 11 Oct 2008 00:56:31 +0000

I just came across a map released by the US Census Bureau showing data from their Small Area Health Insurance Estimates (SAHIE) program. It was the first time I had seen a county-by-county depiction of health insurance demographics in America – who has it and who doesn’t.

In Colorado, there are 12 counties with at least 29.7% of their population living without health insurance. Interestingly enough, eight of those counties are clustered in the southwestern portion of the state, including San Miguel county, where Telluride is located. Telluride is a playground for the rich and famous, with multi-million dollar homes and an $1850 season ski pass. But for a good number of the not-so-rich-and-famous who live in San Miguel county, being uninsured is unfortunately a way of life.

The counties with the lowest percentage of uninsureds were mostly clustered along the Front Range, with Douglas County having the lowest overall number. In Broomfield County, where we are located, our uninsured percentage is between 11.8% and 17.1% – lower than the national average of 17.2%. But overall, the percentage of Colorado residents without health insurance is higher than the national average.

I think such micro-analysis of the uninsured population in America is long overdue, and I’m hopeful that the addition of the health insurance question to the US Census forms will help lawmakers and health insurance carriers target the hardest hit areas when new policy designs and future government health care subsidies are introduced.

In other news, the Colorado Health Insurance Insider had an article included in this week’s Cavalcade of Risk, hosted by Wenchypoo. Not surprisingly, a large portion of the articles in the Cavalcade were focused on economic risk and the financial markets. I’m still hopeful that next year will bring about health care reform that will make health insurance more accessible and affordable and reduce the number of dark green counties on that census map. But with all eyes on the global financial situation at the moment, I’m wondering how much further health care reform will be pushed to the back burner as the government works to stave off a financial meltdown. And how much money will be left over for health care reform once all of the bailouts and government buyouts are said and done.

Kaiser Permanente Provider Change for Boulder/Longmont Area

Jay — Thu, 24 Apr 2008 19:14:25 +0000

Effective June 1, 2008, Boulder Valley Individual Practice Association (BVIPA) and the Longmont Clinic will no longer participate in the Kaiser Permanente Private Healthcare Systems (PHCS) provider network. PHCS is the provider network available to Kaiser Permanente Preferred Provider Organization (PPO) and Point of Service (POS) members in Colorado. Kaiser says there have been recent changes to the PHCS network in Colorado, so they are re-evaluating their relationship with PHCS and working on ways to expand their provider relationships in the north metro Denver area. This network change only affects Boulder Valley Individual Practice Association and the Longmont Clinic. It does not affect any other participating providers in the Colorado Kaiser Permanente PHCS network.
To help Kaiser members transition, Kaiser Permanente will treat Boulder Valley Individual Practice Association and the Longmont Clinic as participating providers through a transition period, providing the same level of benefits they have today. This period will extend through August 7, 2008 and applies to all treatments and services received from BVIPA and the Longmont Clinic providers.
Once the transition period ends, any non-emergent care will be covered at the out-of-network benefit level. To be covered at the higher (in-network) benefit level, Kaiser Permanente members should begin making arrangements to change over to “in-network” providers.

Kaiser Permanente Hospital Change for PPO and POS Members

Jay — Fri, 18 Jan 2008 19:11:51 +0000

Effective immediately, Longmont United Hospital will no longer be participating in Kaiser Permanente’s Colorado provider network for Preferred Provider Organization(PPO) and Point of Service (POS) benefit plans in the Private Healthcare Systems (PHCS) health insurance network. [Longmont United Hospital still works with the PHCS network - just not through Kaiser] Kaiser is very disappointed by this decision and they are continuing to pursue ways to reestablish a relationship. This network change only affects Longmont United Hospital. It does not affect any other participating hospitals or physicians in their network. Kaiser Permanente will help members with any transition required as a result of the change.

If a deal with PHCS is not reached, the closest hospital for many Colorado members will likely be the Good Samaritan Medical Center in Lafayette, which is currently involved in litigation to block a pending sale to the Sisters of Charity of Leavenworth Health Systems. To assist members in transitioning their care, Kaiser Permanente will treat Longmont United as a participating provider through a transition period, giving members the same level of health insurance benefits they have today. This period will extend through April 1, 2008 and applies to all treatments and services received at Longmont United that are covered under their health insurance plan.

Once the transition period ends, any non-emergent care will be covered at the out-of-network benefit level. To be covered at the higher (in-network) benefit level, Colorado members should begin making arrangements to transition their care as early as possible.

Steve Dieckhoff Benefit

Louise — Sat, 26 May 2007 01:01:08 +0000

Update: Steve Dieckhoff died Saturday morning (3/15) just as the sun began to rise, friends said. He was 56 years old. A memorial service in Boulder has not yet been scheduled.

Daily Camera story here
Latest info and pics here

Steve Dieckhoff is a local Boulder rock climber who is battling lymphoma. His friends and fellow climbers are hosting a fundraiser at the Spot gym in Boulder on June 2, at 7pm. His story breaks my heart – cancer sucks, and it can strike even the healthiest of people. I’ve never met Steve, but I share his passion for being active and outdoors, and I really hope that he can win this fight with cancer.

Steve’s story is a perfect example of why health insurance is not an optional product. In his case, he’s had a bad hip all his life, which has made getting health insurance difficult. He lives in Colorado, so I’m familiar with how he would have been underwritten had he applied for individual health insurance. A few carriers would have declined him (the ones that don’t use exclusions or rate increases during initial underwriting). A few others might have offered him a policy with an exclusion on his hip. And a few others might have offered him a policy at a higher price. I don’t know what process Steve went through with health insurance over the years. Maybe he applied and didn’t like the idea of an exclusion or a rate increase. Maybe he applied for one of the companies that just uses straight accept/decline underwriting, got declined, and thought that there weren’t any other options. Maybe he had a choice to have coverage through an employer but felt that it was too expensive. Maybe he felt that if he couldn’t get coverage for his hip (obviously a big expense thus far, as he’s had it replaced), what was the point in getting health insurance at all? Maybe he just thought that he really didn’t need health insurance, as he’s an athlete who obviously takes good care of his body.

Unfortunately, the unthinkable happened. Steve’s cancer bills will make hip replacement surgery look like chump change. I know that the Boulder rock climbing community is large and generous, and hopefully the forums and blogs about Steve will reach enough people to raise the money he needs to pay for his treatment. But without health insurance, he’s going to be facing some very steep bills. For anyone who is on the fence about whether or not to get a policy, please don’t think that you’re immune to serious health issues. It can happen to anybody. You don’t have to have any bells and whistles on your policy. Even if all you can afford is a $5,000 or $10,000 deductible, it’s worth it. $10,000 is a whole lot easier to come up with than half a million, but once you’re already sick, it’s too late. If you are healthy, you have tons of options for individual policies. If you have some pre-existing conditions but are generally ok, talk to a reputable broker who can explain the underwriting rules that each company uses and help you find the best one. If you can’t qualify for any individual policies, take the policy your employer offers (even if it seems way too expensive). Cover Colorado is another option for Colorado residents who don’t qualify for individual health insurance. With health insurance, there are lots of choices – what kind, what level of coverage, what company… but whether or not to have coverage is not an option. We never know what life has in store for us.

Our thoughts are with Steve as he fights this battle. May all the luck in the world be on his side. If you would like to help out, but can’t make it to (or missed) the fundraiser, there is a benefit fund you can donate to:

Steve Dieckhoff Benefit Account
Pueblo Bank and Trust
2950 Pearl Street
Boulder, Colorado 80301

The account number is 1190296.

New Kaiser Permanente Contracts for Longmont and Boulder Valley

Jay — Thu, 01 Feb 2007 04:08:50 +0000

The provider network for Kaiser Permanente of Colorado, Private Healthcare Systems (PHCS), has signed a new contract with Longmont United Hospital (LUH), effective January 1, 2007 through December 31, 2007. In addition, 192 physicians of the Boulder Valley Individual Practice Associates (BVIPA) have agreed to return to the PHCS network. These providers have hospital privileges at PHCS network hospitals other than Boulder Community Hospital.

Employers and members currently enrolled with their health insurance through Kaiser Permanente who are impacted by the new contract will be receiving a letter of notification in the next few days. Employers will also receive a letter of explanation that includes a copy of the BVIPA provider list effective January 22, 2007.

Update: Kaiser Permanente Hospital Change for PPO and POS Members