Colorado Health Insurance: Helpful Information

The Colorado health insurance marketplace can be difficult to navigate. If you’re looking for health insurance on your own, you may be wondering, “Where can I find the right health plan for me? Where can I turn if I am denied health coverage? What are my rights as a consumer in Colorado?”

To help answer those questions, we have researched and compiled important information regarding Colorado health insurance. By taking the following tips into consideration, you’ll be able make a more educated health insurance purchase.

Things to Remember When Shopping for Health Insurance

Colorado health insurance consumers should follow the following recommendations when purchasing health insurance:

  • Read the insurance policy and contact the insurance company or insurance agent if you have any questions.
  • Make sure you review the section of your health insurance policy entitled “exclusions and limitations.”
  • Find out how rates will increase as you age, and how often an insurance company can increase rates.
  • If you are looking for a managed-care plan, check the provider’s directory to make sure there are suitable doctors, hospitals and other health care providers available.
  • Find out if there are any “health plan report cards” available that assess consumer satisfaction/quality of care with various health insurance plans.
  • Call the insurer’s customer service number to see how quickly you are able to get help.
  • If you have special needs or preexisting conditions, make sure you contact a doctor or support organization for health insurance recommendations.

Colorado Health Insurance Subscriber’s Rights

Colorado health insurance consumers have certain rights through Colorado state law. Regardless of the type of health insurance coverage you hold, you have a right to:

  • Insurance coverage for certain mandated benefits
  • Know what your health insurance plan does and does not cover
  • Contact your insurer to complain or appeal any decisions with which you disagree
  • Receive a standard form outlining health insurance benefits for comparison between companies and health plans
  • A written explanation of why an insurance company denies your health insurance application, or excludes a health condition from insurance coverage
  • Coverage of emergency room care, if you believe you are facing a life- or limb-threatening injury (even if it turns out you were not)
  • Prompt payment of claims

What to Do If You Are Denied Health Insurance Coverage

If you have been denied health insurance coverage in the state of Colorado due to preexisting medical conditions, you may qualify for the Colorado Uninsurable Health Insurance Plan (CUHIP). CUHIP gives uninsurable Colorado residents the ability to be insured through the state-subsidized CUHIP program. However, due to the higher risk levels of CUHIP patients, CUHIP subscribers pay about 30 percent more for health insurance than most healthy people. If you are uninsurable due to a preexisting health condition, you may contact the CUHIP administrator at 1-800-672-8477 for more information.

Remember to Shop Around

Health insurance plans can vary widely in both price and coverage. Make sure you take the time to shop around, ask questions and learn as much as you can about potential health insurance policies.

Reliance On Drugs Has A Human And Economic Cost

When too many of us take too many drugs, there are consequences. These are both economic and human. The solution is to use drugs judiciously and not as a replacement for being responsible for what we put in our mouths.

Human inventions are not intrinsically good or bad. It is how they are used which determines this. For example a knife is useful to cut your food but can also be used to stab someone. Fire can warm us on a cold night but has the potential to burn the house down if not used correctly.

And so it is with pharmaceutical agents. They have the capacity to do enormous good when used correctly. However when misused or used inappropriately or when they are not really needed problems can and do occur.

Figures from the USA show that almost one in two Americans take at least one prescription drug per month, an increase of 10% over ten years. A staggering one in five children 11 years and younger were in the same boat. Spending on prescription drugs more than doubled to $US 234 billion over the decade to 2008.

Amongst the commoner medications used were those for cholesterol and depression in adults and for A.D.H.D. in adolescents.

British researchers have previously noted that 7% of N.H.S. spending on drugs went on drugs for diabetes. Between 2000 and 2008 the number of prescriptions had risen 50% but costs had risen 104%. This reflects use of newer and more expensive (but not always better) medications. One of these is rosiglitazone.

The fundamental question that never gets asked is whether the best way to manage a problem is with medication? The second question which also is rarely asked is what other consequences might occur if medications are used?

We have just seen the withdrawal of diabetes drug rosiglitazone (Avandia) from sale in Europe and severe restrictions on its use in the USA. A report in the British Medical Journal (B.M.J.) had earlier called for the drugs withdrawal and questioned whether its use should ever have been approved.

The drug has been shown to lead to an increase in rates of heart attack and strokes in people taking the drug compared to those not. In 2007 a study showed a 43% increased risk of heart attack.

John Yudkin of University College London said in the B.M.J. “We need to be absolutely certain that our long term treatments for type 2 diabetes are not causing the very harm they are meant to prevent”.

Type 2 diabetes comes about predominantly from people eating too much processed and sugary foods, being obese and not exercising. Logic would dictate that the primary treatments would be correcting what led to the problem. Some people may still end up needing drugs but it would be far fewer and they may not need drugs as potent (or costly) as rosigltizone.

It has also emerged that another diabetes drug, pioglitazone (Actos) is being investigated as it may increase the risk of bladder cancer. It has also been shown that bisphosphonate drugs used for osteoporosis can double the rate of esophageal cancer.

None of this is to say that there is not a role for drugs. However when we are dealing with conditions that come about from lifestyle choices we make, reliance on drugs in preference to making the necessary lifestyle changes are not without other consequences. These examples show that just “popping a pill” may seem an easy option but may not be.

What You Must Know About Your Health Insurance Plan

Health insurance coverage is something you typically don’t give much thought – that is, until you or someone you love needs it. This very thing happened in my family. My husband, son and I carried group health insurance through my husbands’ employer. Shortly after we married, I persuaded my husband to switch from the Blue Cross plan (80/20) to the HMO offered by his employer. Premiums for the HMO were somewhat lower and there was better coverage for doctor visits and pharmacy.

Within 2 years of switching health plans, my husband was diagnosed with lymphoma, a slow-growing cancer. The prognosis was good, but treatments, medications, and hospital stays were exorbitant. Medical expenses would have been overwhelming had we not switched to the HMO plan. Our HMO health insurance plan covered almost all expenses we incurred with his illness. We basically only paid our co-pays, and, of course, our premiums. In fact, our health plan still pays for his treatments.

Should everyone change to an HMO health insurance plan? Not necessarily. What is important is to know basic facts about our health plan. Important questions to answer include:

What does the health plan cover? Does the coverage meet your needs? Some plans do not include wellness care and preventive care, while others do. If you require many prescription drugs, are these included in your plan?
What does the health plan NOT cover? Health insurance plans usually do not include cosmetic surgery (unless the surgery is reconstructive, repairing damage from burns, an accident, etc.). Major medical insurance plans will only cover hospitalization and other “major medical” expenses.
Who does the plan cover? Family coverage includes immediate family in most cases, spouse and minor children. Are children covered while in college, for example? Are stepchildren or children in custody of the other parent covered? Some health plans cover any child in the family, some cover stepchildren (usually only if they live with you, however). Some plans only cover children who live under your roof. What about foster children, or other children under your care (grandchildren living with you, etc.)
How much are co-pays and deductibles? Most managed care plans require co-pays whenever you receive health services, but may require no deductible. A fee-for-service plan typically includes an annual deductible as well as co-pays for services received.

What health care providers (doctors, pharmacies, durable medical equipment) are covered under your health plan. Most managed care plans (HMOs, PPOs) utilize a “network” of contracted health providers and may not cover providers out of their network. If choice of health care provider is important to you, you should ensure that your providers are in the plan network, or choose a fee-for-service (FFS) plan that covers any provider.

These are just a few questions that you should consider if choosing a health insurance plan. Information about your specific health insurance coverage is very important to have. The last thing you want to be concerned about in an urgent or emergent health situation is “is this covered by my health plan? Be prepared by knowing basic facts of your particular health insurance plan.

Here’s to your continued health!

The Dangers of Diabetic Drugs

Diabetes Drugs Associated with Heart Disease

One common debate is whether diabetes medications increase the risk of heart disease. The Food and Drug Administration (FDA) requires oral diabetes medicines to carry a warning regarding increased risk of heart attack.

Several studies have associated a diabetes drug, Rosiglitazone, with cardiovascular mortality and morbidity. Rosiglitazone belongs to a class of anti-diabetic drugs knows as thiazolidinediones. The generic name of Rosiglitazone is Avandia. It is often referred to as an insulin sensitizer and used to treat people suffering from type 2 diabetes.

Studies Suggest Avandia Poses a Higher Risk of Heart Ailments

According to two extensive studies published in the Journal of the American Medical Association, patients who consume Avandia face a higher risk of developing fatal heart ailments.

The study conducted by Dr. David Graham, the associate director of the FDA, examined the data collected from over 220,000 elderly diabetics in a Medicare health insurance program who were either on Avandia or other diabetes treatment. The study found that patients on Avandia face an increased risk of stroke, heart failure and death, as compared to those not consuming the drug.

The other study headed by Dr. Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic in 2007 raised public concern about the adverse cardiovascular outcomes of Avandia. The researchers performed a meta-analysis of the data collected from 56 different studies. They compared data from 35,000 patients on diabetes treatment. It was found that patients consuming Avandia faced 33 percent more risk of having a heart attack as compared to patients on other treatments. Also, Avandia was associated with increased risk of myocardial infarction and death from cardiovascular ailments.

Some of the other side effects of Avandia are upper respiratory tract infection, back pain, headache, fatigue, sinusitis, hypoglycemia, diarrhea and edema.

Do Diabetes Drugs Increase Risk of Cancer?

Conventional drug treatment for diabetes does not have a good track record. Prescription drugs have various side effects and are associated with severe health complications. Several researches have revealed that long-term use of some common diabetes drugs can increase the risk of cancer.

Oral Diabetes Medication May Raise Cancer Risk

An analysis of five-year data collected from an ongoing 10-year study, conducted by Takeda Pharmaceuticals, showed a link between the common anti-diabetes drug Actos and increased risk of bladder cancer. Actos is an oral prescription medication that is used for treating type 2 diabetes mellitus. The generic name of the drug is pioglitazone. It belongs to the class of drug called peroxisome proliferator-activated receptor (PPAR) agonists.

The observational cohort study was conducted on 193,000 diabetics associated with the Kaiser Permanente Northern California health plan. The data was collected between January 1, 1997 and April 20, 2008. Higher incidents of bladder cancer were observed among patients who received pioglitazone for at least 2 years, as compared to those on other medication. Also, the diabetics with longest exposure to the drug and those with the highest cumulative dose experienced higher risk of bladder cancer.

Another study, conducted by Larry L. Hillblom Islet Research Centre at UCLA, associated a diabetes drug, sitagliptin with increased risk of pancreatic cancer and pancreatitis. Sitagliptin is used to treat type 2 diabetes. The study was conducted on 40 human IAPP transgenic (HIP) rats. Both sitagliptin and metformin were given to the rats for 12 weeks. The researchers found that some rats had exceptionally high rates of cell production in the pancreatic ducts. Few rats developed a condition known as ductal metaplasia and pancreatitis.

A few other studies conducted on animals have linked Victoza, another anti-diabetic drug, with increased risk of thyroid cancer.

Bottom Line Health

Choosing a health insurance plan is not as easy as it used to be. The distinctions among health plans have begun to blur as
health benefits companies compete for your business.

Although there is no “best” health benefits plan, there are carriers that are a better fit than others for your business and your employees’ health care needs.

As chief executive officer of VISTA, a health benefits company, I am not immune to the skyrocketing cost of health care. As an
employer, I face the same challenge you do of keeping health care costs affordable for VISTA’s 1,000 Florida employees. My responsibility also extends to more than 10,000 South Florida employer groups and 330,000 VISTA members.

While many CEOs, presidents and CFOs complain about the cost of providing health benefits for their employees, they are rarely
engaged in the process of selecting a health benefits company.
Fortunately, South Florida employers enjoy a highly competitive marketplace when it comes to purchasing health benefits. While
there are many carriers to choose from, the differences among each are few. The network of providers, plan designs and services are all very similar.

So all things being equal, why pay more? How do you know which health benefits company is the right fit for your business?
Ask yourself these questions.

As an employer, how much can I afford to contribute to the premium?

What benefits will serve the majority of my employees?

Will offering employees more choices save or cost me money?

Does the plan have an adequate number of providers?

Evaluating cost

Business owners are searching for ways to reduce their health care expenses. Look for a carrier that administers your health benefits plan efficiently.

Administrative charges are a carrier’s overhead costs. They are included in your premium and can vary significantly. These charges include processing and paying claims, answering
customer calls, marketing and advertising costs, and broker commission payments. Carriers with lower administrative costs usually are much more affordable than those with high administrative costs. When reviewing proposals from health
benefits companies, ask what they will charge you for administrative expenses.

Offering employees a choice

Giving employees the freedom to choose their health plan will help educate them about the valuable benefit you offer, satisfy
their need for health benefits and keep your premium contributions within your budget. Plan choices may vary by co-payment, network access and employee contribution. It will be the employee, not the employer, who is responsible for evaluating and choosing his or her health benefits plan.

Employees will have to determine how often they use health care services, what they estimate those costs to be and how they want
to access and pay for those services.

An adequate provider network

No health benefits plan covers every health expense an employee may have or includes every physician. You are purchasing group
coverage. As a business owner, you must evaluate whether the health benefits pIan you are considering offers an affordable level of benefits and a network that provides adequate
accessibility for your employees.

Your bottom line

In South Florida, there can be as much as a 15 percent difference in cost among the health benefits companies you have to choose from. The health plan you select should be cost-competitive and offer a choice of health plans and an extensive provider network to meet the needs of your group.

Whether your company has 20 employees or 1,000, your level of engagement in the decision-making process is vital in determining how health care costs will impact your company’s
bottom line. Standing on the sidelines could be a price you cannot afford to pay.