Health insurers are learning that they can save medical costs by getting people to have dental care at the right time in their lives. Aetna and the Columbia University College of Dental Medicine released a two-year study of 144,000 insured patients that finds early periodontal treatment reduces overall medical care costs by 9% for diabetes, 16% for coronary artery disease and 11% for strokes.

Another study, published in the Journal of Periodontology, finds that early treatment of pregnant women with serious gum disease reduces preterm births by 84%.

Aetna has expanded dental coverage offerings for enrollees who would most benefit -- such as pregnant women and people with cardiac disease -- to include such services as an additional third cleaning per year and scaling and root planing to remove plaque around the tooth root.

America's Health Insurance Plans (AHIP) surveyed member companies offering coverage in the small-group health insurance market including premium and benefit data from more than 650,000 small groups (those with 50 or fewer employees), covering 4.0 million workers and 3.2 million dependents.

Of workers offered an HSA plan, approximately one-third also had a choice of a PPO or HMO/POS plan. Almost half (46%) of enrollees in small groups chose HSA/HDHP plans when offered a choice of HSA plans and other types of health plans.

However, less than 10 percent of small groups offer health savings account (HSA) benefit, with a qualifying high deductible health plan (HDHP).

Aetna, Wellpoint and other insurance companies are offering free generic drugs and are waiving copays for members. Other insurers, including Blue Cross and Blue Shield of Illinois, are "stepping up direct-mail marketing of generics to consumers to combat direct-to-consumer ad spending on television and magazine ads by brand-name manufacturers. Aetna is paying to install vending machines in medical offices that allow doctors to dispense up to 30 days of free generic drugs. The machines track what drugs have been dispensed and send an alert when they need to be refilled.

The campaigns by insurers come during a year in which brand-name drugs representing an estimated $20 billion in sales are losing patent protection. The brand-name drug industry spends billions marketing drugs to doctors and the general public, and health insurers are now "fighting back" by promoting generic drugs.

More than half of workers in the United States -- 54 percent -- said that health benefits are more important to them than higher wages, according to results from the American Payroll Association's 2006 "Getting Paid In America" online survey.

Most of those with employment-based health benefits view them favorably and value them highly. "Getting health coverage through employers is convenient and reassuring," said Jeff Lemieux, Senior Economist, Progressive Policy Institute. "Employers handle the paperwork and payroll deduction of premiums, and can help resolve disputes with health plans."

The online survey was held in conjunction with APA's annual National Payroll Week campaign. More than 33,000 employees provided opinions on payroll-related issues.

The Florida Health Care Coalition - FHCC - a coalition of Florida employers including Macy's, county governments and school boards -- studied the state's six largest insurers. Insurers' services were measured using a tool called eValue8, a quality measuring system developed by the National Business Coalition on Health. Cigna ranked highest among Florida insurers in four categories: overall profile, consumer satisfaction, disease prevention and behavioral health. Aetna ranks first for chronic disease management, Humana is first for information on health care providers and Blue Cross and Blue Shield of Florida leads for adoption of information technology, and UnitedHealthcare ranks No. 1 for prescription drug benefits, the report finds

We offer our clients an annual review of their health insurance coverage because things change. To make the best decisions about your benefits, go through this checklist:

1. Review the benefits you used last year and evaluate the money you allocated to those various benefits.

2. Take into account any major life event, such as marriage, divorce or childbirth. Those events affect your needs.

3. Make a list of the major preventive and diagnostic procedures you're likely to need, and make sure your health and dental plans cover those services.

4. Consider any job related benefits your spouse may have so you don't pay for double coverage if you don't need it. Compare coverage levels and cost to get the best plans.

5. Since health insurance premiums go up every year, your coverage may become unaffordable. If so, it's probably time to consider a higher deductible plan.

In the first sanction of its kind, California's top HMO regulator fined Blue Cross on Thursday for illegally canceling a woman's medical policy because she did not disclose corrective surgery she had 23 years earlier. In announcing the fine, Cindy Ehnes, director of the Department of Managed Health Care, said that insurers are prohibited from canceling health policies unless a policyholder lied.

In the case at hand, her department found that Blue Cross broke the law in two ways. First, the agency said, the insurer failed to adequately underwrite, meaning scrutinize the woman's medical history before issuing her policy. Second, it found that Blue Cross "failed to prove that the member willfully misrepresented her health history."

The fine comes in the wake of scores of lawsuits filed in California in recent months by consumers. They say they were stuck with medical bills after insurers canceled them for making innocent mistakes on their applications or for leaving out health history details the individuals viewed as insignificant or irrelevant.

Small business tax incentives, along with more Spanish language and Latino-specific health programs, are needed to reduce uninsured rates among the Latino population, according to a report by the Latino Coalition, the Houston Chronicle reports. According to the coalition, many Latinos are employed by small businesses that do not offer health insurance. Most Latino adults lack employer-provided insurance coverage, the report states. In addition, Latinos have the highest uninsured rates among all ethnic groups, and one-fifth of Latino children are uninsured. Meanwhile, Latinos face a higher risk of chronic diseases, such as diabetes and obesity, than non-Latinos.

Government officials should consider these statistics when establishing health programs, the study finds. The group calls for tax incentives for small businesses that would reduce taxes by one dollar for every dollar contributed into health savings accounts. It also urges increased efforts to enroll Latino children into federally funded insurance programs, such as Medicaid and SCHIP, and recommends more funding for community health centers that offer no-cost or low-cost health services in areas with high Latino populations. "These strategies are doable and easy to achieve," Latino Coalition President Robert de Posada said, adding, "We are tired of waiting for people to act" (Tran, Houston Chronicle, 9/14).

Blue Cross of California is being sued by some former policyholders for canceling or rescinding (in insurancespeak) their insurance policies after the policies were issued. Blue Cross claims that their applications for coverage contained errors or omissions that, if divulged, would have caused Blue Cross to deny coverage initially.

Some angry consumers claim that Blue Cross looks for any inconsistencies in the applications of customers who make expensive claims shortly after obtaining coverage. The conspiratory flames have been fanned by Blue Cross employees who have detailed in sworn depositions that look-back underwriting units do indeed exist to look into these applications.

Reacting to the pressure, Blue Cross has announced changes, including creating an ombudsman and revising its appeal process — but maintained that it had done nothing wrong See Los Angeles Times Article "Blue Cross Moves to Quell Furor".

This underwriting issue is a slippery slope for health insurance carriers that sell individual policies. In order to generate more sales, Blue Cross of California is among those insurance companies that make the application process as easy as possible for the applicant, basically accepting whatever the applicant says. Other insurance companies do stringent underwriting before issuing coverage, often requesting medical records, checking on prior claims, and looking into public information like DMV records (any DUIs?). Such intense underwriting hurts sales because often applications are delayed for weeks, causing applicants to shop elsewhere. Consumers and brokers alike prefer the Blue Cross approach to application processing.

Like most horror stories, rescisions are rare. HealthcareShopper.com does more health insurance business in California that any other state. We place most of our business with Blue Cross - that amounts several thousand policies over the past five years. As far as I know, only one policy written by our agency has been rescinded in that period of time.

A new report from the Commonwealth Fund finds that an overwhelming majority--89%--of working-age adults who sought coverage in the individual market during the past three years ended up never buying a plan. A majority (58%) found it very difficult or impossible to find affordable coverage. One-fifth (21%) of those who sought to buy coverage were turned down, were charged a higher price because of a pre-existing condition, or had a health problem excluded from coverage. My own internal numbers here at HealthcareShopper.com mirror these results very closely.

Additionally, the study found that those with high deductible health plans were also more likely to report that they did not get needed health care or prescription drugs because of costs. In addition, many adults with such plans said they had problems with medical bills or were paying off medical debt over time and were more likely to give low ratings to their coverage. This makes me very uncomfortable because the individual health insurance market has been moving toward higher-deductible plans for the past 3 to 4 years. For those who can afford to put aside some savings to cover the higher out of pocket expenses, higher deductible health insurance equates to lower health insurance premiums. For low income people, these high deductible plans may all that they can afford, but the out of pocket expenses may be more than they can handle. We here at HealthcareShopper need to be more sensitive to that issue.

The report, Squeezed: Why Rising Exposure to Health Care Costs Threatens the Health and Financial Well-Being of American Families, by Commonwealth Fund Assistant Vice President Sara Collins and colleagues, is based on findings from the Commonwealth Fund 2005 Biennial Health Insurance Survey.

Privately insured consumers seeking treatment for mental health and substance abuse problems still have to pay more out-of-pocket than do patients receiving other medical services.

Researchers compared what consumers paid out-of-pocket for psychotherapy, behavioral counseling, medication management and other outpatient mental health services with what they paid for medical care between 1996 and 2003. They found that consumers' out-of-pocket expenses for mental health was 35 percent versus 21 percent for medical treatment. They note that state mental health parity laws cover only a fraction of privately insured patients and relatively few employers voluntarily moved to full parity.

"Coverage for Mental Health Treatment: Do the Gaps Still Persist?" was published in the September 2006 issue of the Journal of Mental Health Policy and Economics.

My mother, who is 87, suffers from dementia. In addition to memory loss, her IQ is fraction of what it used to be. Having seen the results of dementia, I'm afraid it will strike me as well. My work keeps me mentally active. In addition I do crossword puzzles because I've heard that, "If you use it you won't loose it".

However. there is no empirical proof that brain teasers, crossword puzzles, or any of the other mental exercises out there will slow mental decline, or thwart Alzheimer's disease. Last spring, University of Virginia neuroscientist Timothy A. Salthouse analyzed a large number of studies meant to show that mental challenges arrest brain decline. He found none that proved its thesis. So far, he concluded, "the mental-exercise hypothesis is more of an optimistic hope than an empirical reality."

Salthouse discovered that most brain-training studies suffer from a "chicken or the egg" problem. It could be that people who performed well in studies involving mental exercises were more mentally agile to begin with. It is true that practice makes perfect, says Matthew L. Shapiro, a neuroscientist at Mount Sinai School of Medicine in New York. "The more you try to remember, the better your skill at remembering." Still, he says there is little evidence that those improvements will lead to overall mental improvement, and a brain disease "will ultimately overwhelm any efforts to better your skills."

What do you think?

Employer sponsored wellness programs and HSA plans make a smart combination for employers and employees alike. While HSA qualified health insurance plans immediately reduce employer costs, wellness programs also put a lid on health insurance and workers' compensation claims over time.

Today, many companies offer a spectrum of services to their entire work force: access to workout facilities, informal brown bag health talks, screenings for common conditions such as high blood pressure, and intensive follow-up with a nurse or a health coach for employees with ongoing health issues.

As an added incentive, some employers contribute into a health savings account for each participating employee. That would help cover the health plan's deductible if the employee had a major medical problem. If not, the money would roll over into the tax-free account to be tapped later for medical expenses.

I recently read an article in the Washington Post, reporting on census figures released last week. For the first time since 1998 the number of children younger than 18 without health coverage increased. I find this discouraging because there are resources for children of low income families for low-cost or free healthcare coverage. Visit the Healthcare Options Matrix, a state by state matrix of options for individuals unable to obtain health insurance due to medical conditions or financial need.

It is estimated that 70% of uninsured children are eligible for low-cost or publicly subsidized coverage. Some are not aware that they might be eligible or they don't know how to apply. Pride also is a factor, with some families reluctant to accept government aid.

Uninsured children are less likely to be up to date on immunizations and to receive treatment for sore throats, earaches and other common childhood illnesses. Kids without insurance tend to have more school absences.

It can't be that easy. Can it? Pregnant women should take a multivitamin.

A study published in the Journal of Obstetrics and Gynaecology of Canada finds that pregnant women who take a daily multivitamin reduce the risks of having an infant born with birth defects. The researchers also found that taking a daily multivitamin reduced the chance of a fetus developing cardiovascular defects by 39%, cleft palates by 58%, brain-damaging hydrocephalus by 63%, limb deformities by 47%, neural-tube defects by 48%, and urinary-tract defects by 52%. It is unclear which vitamins and minerals are linked to the reduction in certain birth defects.

Come on ladies, take your daily multivitamin. You've got nothing to loose and everything to gain.

Controlling the cost of healthcare is seldom black and white. How much should we be willing to pay to briefly extend the lives of a few very sick people? For instance, the FDA just approved a mechanical heart for patients who have only a month to live, suffer from failure of both chambers of the lower heart, and aren't eligible for a heart transplant.. The AbioCor system consists of a 2-pound mechanical heart implanted in the chest. The patient's diseased heart is removed during implantation. A power transfer coil across the skin that powers the system and recharges the internal battery from the outside. A controller and battery implanted in the belly. The controller adjusts the artificial heart's pumping rate. The internal battery allows the patient to be free from all external connections for up to 1 hour. During sleep and while batteries are being recharged, the system can be plugged into a normal electrical outlet.

In clinical trials, the device extended patients' lives by only four and a half months, on average. One patient survived 17 months, another 10 months. Only one patient was able to go home. "It is important to recognize that right now the device is a niche device targeted to an extremely sick heart failure population," Bram Zuckerman, MD, director of the FDA's heart device division says. "The vast majority of these patients are bed bound, extremely short of breath, and hooked up to multiple intravenous medications. Just the ability to ambulate, to clearly communicate with loved ones, to take excursions out of the hospital, and to celebrate important family events, were -- in the eyes of the patients and family members -- seen to be an improvement."

I suppose the main reason for going to these great lengths for very little incremental benefit is that these highly restricted applications will give Abiomed, the manufacturer of the device (and its competitors), the experience they need to build smaller, smarter, more elegant artificial hearts for a wider audience at lower cost.

How do you feel about it? Do you think we should continue a long this path?

OB Gyn doctors, who's religious beliefs sometimes conflict with patients who demand certain services, are joining "Natural Family Planning" (NFP) centers, which "tailor" the type of care provided with the religious beliefs of the physicians. At NFP clinics, physicians teach NFP techniques -- including monitoring a woman's temperature and other signals to time intercourse to control pregnancy timing -- while "shunning" birth control, emergency contraception, intrauterine devices, sterilization, in vitro fertilization and abortion.

Advocates, say that the NFP approach provides an alternative to commonly used medicines and devices that some physicians believe can negatively effect a patient's personal life. The American College of Obstetricians and Gynecologists does not have a formal position on NFP. "If women know before selecting [NFP centers], then it's quite a legitimate thing to do and might meet the needs of many women and doctors," Anita Nelson of the University of California-Los Angeles and ACOG spokesperson, said, adding, "But if you hang out your shingle that says 'All-purpose ob-gyn' and don't offer certain services, that's false advertising." Nearly 500 physicians have registered on an Ohio-based Web site to practice NFP. However the actual number of practices that offer only NFP is unknown, according to the Post (Stein, Washington Post, 8/31). View the full Washington Post article.

You may havve heard about walk-in medical clinics in chain stores, supermarkets and shopping malls. They are remarkably consumer friendly. The walk-in clinics require no appointment and little or no waiting for treatment of minor ailments such as flu, bladder infections and sprains. They're open nights and weekends. Prices are posted, and the bills are surprisingly reasonable. More insurance plans are covering retail clinics because the clinics charge less than doctors' offices. The insured patient is charged the plan's co-pay. The uninsured patient pays an average of $50 to $80.

Doctors don't like it. They're afraid this will drive the Family Practice doctor out of business. They complain that the clinics are staffed by nurse practitioners not doctors. However, a landmark 2000 study in the Journal of the American Medical Association found that nurse practitioners performed as well as doctors in a primary-care setting. Researchers randomly assigned 1,316 patients to a doctor or a nurse. After six months, health outcomes and patient satisfaction were comparable in the two groups.

Consumers like it. Among adult clinic patients, 80 percent are satisfied with the cost, 89 percent with the care and 92 percent with the convenience, according to a Wall Street Journal Online/ Harris Interactive poll.

Acceptance of HSA plans has financial institutions racing for a piece of the action. Here's why:

* Each month HSA administrators add 60,000 new accounts.
* Americans have banked nearly $1 billion in HSAs
* The average balance in HSA accounts is $1,181
* 60% of individuals with HSA qualified insurance have opened an HSA

As a consequence, it's easier to find banks and other financial institutions that offer HSAs now compared to a year ago. To see if your bank offers HSAs, try Googling "bank name and HSA". If you call your bank and ask, the person who answers the phone will probably be clueless about HSAs.