United healthcare is pulling itself off the exchange-based SHOP exchange for small businesses, while it will remain in the off-exchange small group market. This comes after the New York State Department of Financial Services cut group rate increases by an average of 50% for 2015.

Adverse selection-  when only the sick join an insurance plan.  Aetna announced that, due to adverse selection, they are reducing their network size dramatically.  Reports are that they will lose $25 million on 5000 patients that have selected them outside of the health care exchange – thats $5000 loss per enrollee!  The new “skinny”network is rumored to only allow access to New York Presbyterian and Mount Sinai Health Systems, which (other than Winthrop) eliminates everyone on Long Island.  Aetna had requested a 20% rate increase and NY State only granted them 5.64%.  All existing clients will have to switch to the new network.

North Shore LIJ has added the CVS minute clinics to its network.  Per NSLIJ:

“Now, CareConnect members won’t have to search for a health care professional or emergency room while in hundreds of locations outside the New York metro area. For an affordable walk-in copay* – lower than the ER copay – they can visit see a MinuteClinic family nurse practitioner for routine and emergent health issues including:

  • ·  strep throat and ear, eye, sinus, bladder and bronchial infections
  • ·  minor wounds, abrasions, skin conditions and sprains
  • ·  common vaccinations such as influenza, tetanus, pneumonia, and Hepatitis A & B
  • ·  administrative physicals including camp, sports, college and DOT

·  wellness services such as diabetes, blood pressure and cholesterol screenings and monitoring”

 

Oscar Healthplans have announced a new “Doctors on Call” program:

Board Certified Physicians At Your Fingertips

Oscar’s Doctor on Call gives our members access to U.S. board-certified doctors who are available on-demand to provide free, unlimited, 24/7/365 treatment of many of our members’ medical issues. Oscar’s Doctor on Call is just a click or call away!

Don’t Take Our Word For It

Check out a current member’s review of the service here: My Review Of Using Oscar Health’s “Talk To A Doctor” Feature