Monday, August 17, 2009

Rell Offers Hope To Those Without Insurance, And With Pre-Existing Conditions

It’s been a year since Gov. M. Jodi Rell initiated enrollment in the Charter Oak Health Plan, a state-subsidized health insurance program for the uninsured.

For $75 to 259 per month, the plan will accept any individual, including those with pre-existing medical conditions, as long as the individual has been without insurance for six-months or more.

In press release last week Rell hailed the one-year anniversary by touting its enrollment.

“Today that program is covering 10,257 individuals and another 5,884 applicants are eligible for coverage as soon as they select from one of three contracted health plans and begin paying monthly premiums,” she said in a press release. “That means more than 10,000 people who - a year ago - had no health coverage or could not afford the coverage they had now have affordable health care.”

The Department of Social Services which helps administer the program says that over the past year it has approved 19,943 applications and has denied 24,452 applications—mostly because those applicants hadn’t been without insurance for six months.

Another 4,457 individuals have dropped out of the program due to changing health benefit situations such as employment, moving out of state, not paying premiums, and various other factors, David Dearborn, a spokesman for the Department of Social Services, said.

But even with more than 10,000 individuals enrolled in the plan, some lawmakers still wonder what kind of coverage and medical care those residents are receiving.

“The jury is still out on what kind of health care is being provided,” Sen. Jonathan Harris, D-West Hartford, said Monday.

As co-chairman of the legislature’s Public Health Committee Harris said based on enrollment numbers alone he’s not sure he can judge the success of the program. He said he wants to know how many of these enrollees were able to schedule doctors visits and get the medical attention they need.

Public Health Committee Co-Chairwoman, Rep. Besty Ritter, D-Montville, said she was also concerned about “what kind of health care they’re getting or not getting as part of the Charter Oak Plan.” She said getting the number up to 10,000 is impressive, but it doesn’t give you the entire picture.

As of last August only two of the hospitals, St. Raphael’s in New Haven and St. Mary’s in Waterbury, had signed up to participate in the plan. And as few as four or five family doctors had signed up to participate in the Charter Oak Health Plan in all of Hartford County, during its first week last August.

Since last year the insurance companies that administer the Charter Oak Health Plan for the state have made progress in increasing the number of doctors and hospitals that participate in the plan.

According to Dearborn participation by primary care physicians as grown from 3,039 to 6,322 and the number of specialists participating has grown from 4,949 to 8,465. Also the number of hospitals accepting Charter Oak enrollees has increased from two to 16.

“The bottom line is that Charter Oak enrollees are getting access to health care,” Dearborn said Monday. He said it’s even helped individuals with cancer get coverage that they couldn’t get anywhere else.

Here are a few statistics from the Charter Oak program and the three insurance carriers Community Health Network, AmeriChoice, and Aetna:

·Community Health Network of CT (CHNCT) reports paying claims for 3,707 inpatient services, 16,392 outpatient services, 15,318 medical/office services and 28,921 other (lab, durable medical equipment, home care, etc.) over the past year.

·CHNCT reports that it has been case-managing for cancers of all types, heart disease, liver disease, respiratory conditions, diabetes, high-risk pregnancies, etc. Four members have over $50,000 in claims. The health plan reports that it has paid medical claims for about 88% of its members so far.

· Aetna Better Health reports a medical expenses breakdown of about 31% for hospital outpatient; 27% for hospital inpatient; including chemotherapy and dialysis; 27% for physician services; and 15% for other practitioner. The plan reports that about 67% of its members have already accessed health care services.

·AmeriChoice by UnitedHealthcare, as an example of access to services, reports paying 182 claims so far for dialysis treatment and other services for one enrollee’s care since January.

·In any health coverage program or product, not everyone accesses services immediately, as membership grows and new people come on. However, the above information affirms that Charter Oak enrollees do have access to health care services paid for by the program, and are using the services as needed.


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