Author Archives: Reeve Conover

Are you being forced to use mail order?

We have been hearing some issues pop up on this so we wanted to send it back out again.  Members for NY Oxford groups (small and large) are not required to use Mail Order, they are being gently nudged to do so.   If they want to opt out they can either call the Oxford number on their card or log into the oxford website.  Here is the information from Oxford again:


We are extending the Mail Service Member SelectSM program to our Oxford fully insured commercial group members in New York, effective October 1, 2015. The program will be implemented with these members beginning on their group’s renewal date, on or after October 1, 2015. Mail Service Member Select is intended to help members better manage the medication they take on a regular basis through use of the OptumRx® Mail Service Pharmacy. Oxford New York self-funded clients are not affected at this time, although they may elect the program at renewal. Additionally, Mail Service Member Select is not available in New Jersey or Connecticut. 



  • Employers: In addition to the postcard mailing approximately 45-days prior to the affected customer’s renewal date with us, and Account Management email outreach, this information will be posted to the Messages section of the Employer portal. The employer flier will be posted to the Tools & Resources section of the Employer portal.
  • Members: Approximately 30-days prior to the affected group’s renewal date with us, we will inform members who are taking a maintenance medication about the Mail Service Member Select Program.



  • Broker eBulletin
  • Employer Postcard
  • Employer Flier

The program requires members to make a choice – switch to mail service or stay at retail pharmacy

∙       OptumRx will promote the value of Mail Service (Convenience, Safety, Potential Savings and Adherence)

∙       This is NOT mandatory mail and NO financial penalties for staying at retail


Members allowed to fill prescription twice at retail pharmacy while they decide

∙       Initial notification of program and value of mail service sent 30 days prior to effective date for existing customers

∙       Multiple communications with members instructing them to contact OptumRx

∙       At any time, members can move to mail or disenroll from program by either calling customer service or via the web


If member has not notified OptumRx by third fill of a prescription, the pharmacist will instruct member to contact OptumRx before the prescription can be filled

∙       Once member contacts OptumRx and chooses mail service or retail, the third fill prescription can be completed real-time

∙       If member switches to mail, OptumRx will provide a one-time 30 day fill to allow enough time until first OptumRx fill arrives in mail”

Why United healthcare is leaving the PPACA

While its not official, it is very clear that United Healthcare intends to leave the individual health marketplace next January 1.  Here is why:

  1.  Partial year insureds-  they sign up, run up a bunch of claims, and then stop paying premiums.  For example, they join, pay $400 a month for three months, have $100,000 heart surgery, and then stop paying premiums and cancel the insurance.  They are, by the way, free to do this every year!
  2. The exchanges are not attracting healthy individuals.  less than 30 percent of all enrollments are under age 34 – meaning more claims for less premiuns.
  3. Grandfathers Policies- while many states have recently allowed a big increase on these plans, as long as they exist, these (more likely healthy) people are not required to join the PPACA plans.
  4. Risk Corridor Payments- The bill promised a safety net on high claims, but paid only 12.5% of the promised amount.  That leaves a $2.5 billion shortfall – and that assumes the 12.5% ever actually gets paid (not as of today).  This is exactly the problem that put the Co-ops out of business (can you say HealthRepublic and Consumers Choice?)
  5. Pricing models- most people are buying the lowest price plans.

The only question I have is – are they the only major carrier that drops out?


Blue Cross SC Rate increase on grandfathered plans!

2016 Rate Notifications for Under 65 Grandfathered Plans
BlueCross BlueShield of South Carolina is applying a 19 percent rate increase for Under 65, grandfathered plans ONLY (plans and freestanding drug benefits that became effective before March 23, 2010).
Under 65, non-grandfathered plans (plans that became effective between March 24, 2010 and December 15, 2013) WILL NOT receive a rate increase.

The effect of high deductible health plans on your finances

The high deductible plans so prevalent since the advent of ObamaCare are having a dramatic impact on Americans.  The concept that you have to have health insurance, that has a deductible so high you cannot really use it, has been written about alot.

Less than half of all households above the poverty level have enough assets to cover an out-of-pocket maximum of $3,000 to $6,000, considered a moderate level, according to a March analysis by the Kaiser Family Foundation.

Does a high deductible health plan cause people to bypass medically needed care?  Read this article from the Charlotte Observer and learn more.

NYU leaves United Compass Network


We have been advised that NYU is no longer in our UHC Compass Individual exchange network as of 1/1/16 as United Healthcare was unable to agree on an updated contract. Letters have gone out to exchange members to advise them of the change.

For members currently involved in an ongoing course of treatment or pregnancy in their second or third trimester, they may be able to continue to receive covered services through Continuity of Care benefits.

November 2018
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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA. - SIPC - Brokercheck