Syracuse Post-Standard - October 13, 2003

by JAMES T. MULDER

Q. Has Medicare placed a limit on how much it will pay for outpatient therapy?
A Yes. On Sept. 1, Medicare placed an annual limit of $1,590 on physical therapy and speech therapy combined, and $1,590 on occupational therapy. Medicare pays up to 80 percent of the limits, or $1,272. After the limits are reached, you must pay the full cost of the services until Jan. 1 of the following year. The limits apply to outpatient therapy received at outpatient rehabilitation facilities, doctors' or therapists' offices, nursing homes if the patient's stay isn't covered by Medicare, and at home from home-care agency therapists if the therapy isn't part of a Medicare-covered home health benefit. The limits don't apply to outpatient therapy received at hospital outpatient departments. Consumer Reports criticizes long-term care policies A recent Consumer
Reports magazine investigation concluded that for most people, long-term care insurance is too risky, too expensive and is so complicated it can stymie the most conscientious consumer. Details of its investigation appear in the magazine's November issue.

Long-term care insurance pays for expenses associated with nursing home care or other forms of long-term care. By the year 2021, the average rate for a private room in a nursing home will be about $175,000 annually, according to the article. Lawsuit challenging change at BlueCross moves ahead A state court has decided to allow a lawsuit challenging the conversion of Empire BlueCross and BlueShield from a nonprofit company to a for-profit company to go forward.
The state Supreme Court recently rejected a motion to dismiss the lawsuit filed by consumer groups and policyholders. The suit alleges the state Legislature violated the state's constitution when it passed a law last year strictly for the benefit of a single corporation, Empire BlueCross and BlueShield. The legislation was negotiated in secret by Gov. George E. Pataki and officials of Local 1199 of the Service Employees International Union, which represents health care workers. The law allowed the state to take the proceeds from the conversion and use them to give raises to health care workers. State law helps cancer patients keep life insurance The state has enacted a law designed to protect individuals who have had cancer from being discriminated against when they apply for or renew a life or disability insurance policy.

The law prohibits insurers from refusing to issue, canceling or declining to renew life or non-cancelable disability policies to people just because they have had cancer. About 245 New Yorkers are diagnosed with cancer every day, representing more than 89,000 new cases a year. Compare plans using state guide to health insurers The state has released the fifth annual edition of the New York Consumer Guide to Health Insurers. The guide allows consumers to compare health plans based on the number of complaints, grievances
and utilization review appeals. It also allows consumers to compare plans by evaluating a series of quality of care indicators. The report can be viewed on the state Insurance Department's Internet Web site, www.ins.state.ny.us, or by calling (800) 342-3736. Heart failure is No. 1 hospital
diagnosis Chronic lung disease cases in U.S. hospitals experienced a significant
increase between 1996 and 2001, while childbirth-related cases and heart failure
remained the top reasons for patient hospitalization, according to Solucient, a
health-care business information company.
Among Medicare patients in 2001, heart failure was the top diagnosis with 672,618
patient discharges. Chronic obstructive pulmonary diseases cases jumped from 343,751
discharges in 1996 to 389,291 in 2001.