Based on a report published in June 2008 by Families USA, it’s hard to find a state that does less than Illinois to protect consumers purchasing individual health insurance.

Families USA is an advocate for universal health care and a frequent critic of the insurance industry. But its research is well-respected. Families USA’s latest analysis explores the extent to which consumer protections are available for people who purchase individual insurance. This is the kind of policy people buy when they’re between jobs, working for themselves or employed by a company that doesn’t offer employer-sponsored group insurance.

Illinois has adopted a “hands-off” regulatory policy toward individual insurance, according to the report, which is based on a survey of insurance commissioners in all 50 states. There’s no guarantee here that insurance companies sell coverage to all applicants, a policy known as “guarantee issue.”

Admittedly, this isn’t common: only five states (Maine, Massachusetts, New Jersey, New York and Vermont) require insurance companies take all comers, including those with pre-existing conditions.

Nor are there any restrictions here on companies’ ability to raise premiums based on an applicants’ health status. In other words, even if policies are available in Illinois, the price may be out of sight.

By contrast, Maine, Massachusetts, New Jersey, Oregon, New York, Vermont, and Washington won’t let insurance companies vary premium prices for consumers based on their health. Minnesota and New Hampshire allow premium prices to rise a maximum 25 percent.

Often, insurers will sell policies to consumers with pre-existing conditions but exclude covering for those conditions for a specified period. Many states have regulations that limit how long these exclusions can last, typically requiring full coverage after six months to one year. Illinois doesn’t.

Half the states also limit the period of time that insurers can go back in someone’s medical history looking for evidence of pre-existing conditions that can be excluded from coverage. Illinois has no such limitation.

Illinois is among 44 states that don’t intervene when insurance companies decide to limit or revoke coverage for individual policyholders. The state gets credit, however, for ensuring policyholders have the right to appeal when coverage is revoked. Similarly, Illinois guarantees that consumers’ disputes with insurers will be reviewed by a third party and that reviewers’ decisions will be binding.

For its part, the insurance industry often argues that state regulation tends to drive up the cost of coverage and impair consumers’ access to affordable policies. But there’s growing conviction in health policy circles that individual insurance is ripe for an overhaul.

Families USA doesn’t indicate which states are “best” or “worst” when it comes to protecting individual insurance policyholders in its reports. But high marks go to Connecticut, Massachusetts, which recently overhauled its insurance market and enacted universal coverage, New York, and Oregon, among others.

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Tags: illinois health insurance, Illinois health insurance protection, illinois individual health insurance

Blue Cross and Blue Shield of Illinois, the state’s largest health insurer, soon will no longer administer claims and provide customer service to employees of Wal-Mart Stores Inc., the world’s largest retailer, losing the business to another Blue Cross plan in Arkansas.

Starting in January 2010, Illinois Blue Cross won’t be performing administrative functions, such as staffing customer-service call centers, for employees of Wal-Mart, the health plan confirmed. Wal-Mart employees in the state still should be able to access benefits through Illinois Blue Cross because the new contract is largely related to behind-the-scenes work, the insurer said.

Such administrative tasks will begin in 2010 to transition over to Arkansas Blue Cross and Blue Shield, Illinois Blue Cross said.

Illinois Blue Cross would not disclose the financial impact of this change. Bentonville, Ark.-based Wal-Mart has more than 1.4 million U.S. employees and is known for its clout in negotiating with its many vendors.

“The membership in our four states will still be captured as part of our market share,” Illinois Blue Cross spokesman Jack Segalsaid of its parent, Chicago-based Health Care Service Corp., which also operates three other Blue Cross plans in Oklahoma, Texas and New Mexico.

In its new role, Health Care Service’s four Blue Cross providers will “become what’s known as ‘host plans’ for Wal-Mart’s approximately 200,000 members that live in our four states,” Segal said. “As host plans, we’ll provide our [medical-care provider] networks and our discounts, continue to reimburse providers and continue to determine claims pricing.”

As a home plan, Illinois Blue Cross has 445,000 members at Wal-Mart.

Wal-Mart would not confirm the change in the contract or financial terms of its relationships with any of the Blue Cross plans that process its health care.

“We regularly assess the quality and costs of the health-care plans offered by our providers, including those plans owned by Health Care Service Corp., and we don’t have any changes to those plans to announce at this time,” said Greg Rossiter, spokesman for Wal-Mart.

But Illinois Blue Cross said, “Wal-Mart was looking to consolidate into a single platform, so Arkansas [Blue Cross] decided to take this on and become the single home plan or administrator.”

Until the transition, Illinois Blue Cross will continue to share administrative duties with the Arkansas Blue Cross plan and Blue Cross and Blue Shield of Alabama.

Health Care Service had $865 million in net income last year on $14.3 billion in premium revenue. The nation’s fourth-largest insurer, the Chicago company has 12.4 million members, including 7.4 million in Illinois.

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Tags: bcbs, Blue Cross Blue Shield of Illinois, Health Care Service Corp, health insurance illinois, illinois health insurance, illinois insurance, Wal-Mart, Walmart

CHICAGO, Aug. 11 — Blue Cross and Blue Shield of Illinois (BCBSIL) announced today its intent not to pay for costs resulting from hospital-based preventable medical errors known as “serious hospital acquired conditions” and “never events” (errors in patient care that can and should be prevented). BCBSIL said it will work with hospitals in its networks to put this new approach into operation and ensure that members are held harmless financially when these events occur.

In addition, BCBSIL reiterated its longstanding commitment to collaborating with contracted network providers to prevent medical errors before they occur.

“Blue Cross’ goal for years has been to work to prevent medical errors, which often go undetected. To this end, Blue Cross has and will continue to collaborate with hospitals and physicians in our communities to promote quality and safety and prevent medical errors before they threaten patients’ health and add to the cost of care,” Scott Sarran, MD, BCBSIL’s chief medical officer, said.

For years, BCBSIL has participated in initiatives designed to prevent medical errors. In 2001, for example, BCBSIL began an outcomes-based reimbursement program that provides incentives to hospitals when they provide care without complications. Designed to enhance quality and safety, this approach can reduce employer groups’ claims costs if hospitals’ services do not meet established quality criteria.

In addition to payment methodologies, BCBSIL participates in a variety of initiatives designed to help prevent medical errors, including:

* — Rewarding BCBSIL PPO and HMO physicians who complete the American Board of Medical Specialties’ Patient Safety Improvement Program, which addresses a host of inpatient and outpatient safety issues;
* — Encouraging hospitals (through letters, personal meetings, Blue Cross’ “Hospital Profile” scoring, and public reporting) to comply with and make public information about their progress towards meeting The Leapfrog Group’s patient safety standards. The Leapfrog Group’s goal is to reduce preventable medical errors and improve the quality and affordability of health care;
* — Measuring and reporting diverse indicators of hospital quality and patient safety. For the past six years, the results from the BCBSIL profile have been sent to hospital CEOs, and receive the attention of senior management;
* — Annually collecting data from Illinois hospitals on their participation in state and national patient safety and quality improvement programs and their procedures for addressing “near misses;”
* — Making information about hospital quality and safety available to members via our Blue Star Hospital Report, which is available at http://www.bcbsil.com; and
* — Starting up and providing the first $1 million in funding for a statewide e-prescribing system, which is open to network physicians, health insurance carriers, pharmacies, technology providers, professional societies, and others. Since its inception in April 2007, participating physicians have written approximately 467,500 electronic prescriptions – 41,573 in June 2008 alone. Moreover, in June, the system, which is designed to help prevent medication errors, detected more than 4,500 potential negative drug interactions, of which nearly 19% resulted in a change or cancellation of the proposed prescription. In addition, in June, the system detected more than 700 potential allergic reactions. As a result, physicians changed or cancelled more than 8% of prescriptions.

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Tags: bcbsil, Blue Cross Blue Shield, Blue Cross Blue Shield of Illinois, health care, health insurance, illinois health insurance