Priority Health Opens One-Stop Insurance Shops in Michigan

Last week we reported here that Blue Cross Blue Shield of Michigan (BCBSM) had announced that it is re-focusing its 10 welcome centers located across the state of Michigan to help consumers understand and navigate ACA marketplace changes. Today, another Michigan health insurer, Priority Health has has opened three new information centers to provide resources for the uninsured and others needing to purchase insurance coverage.

“Priority Health is committed to improving the health and lives of those we serve,” said Joan Budden, chief marketing officer for Priority Health. “That’s why, as the health care landscape continues to change, we are making sure that we are positioned to answer questions and provide information to help consumers make informed decisions when choosing a health plan.”

Transparent Health Network Introduces Novel Plan to Provide Working Uninsured/Underinsured Access To Affordable Health Care.

Continuing with the thread about what might happen if healthcare reform does not pass, here is an interesting product that is emerging in the New York City area.

Innovation Alert

The growing numbers of uninsured and underinsured now have a new low-cost option for obtaining health care services and prescriptions at significantly reduced prices. Transparent Health Network, a unique non-insurance health care access plan was introduced this week in the New York metropolitan area.

For a low monthly fee — $39 for an individual; $54 for a family — Transparent Health Network members gain access to a provider roster that includes primary care, specialist and ancillary health care providers who have contracted to care for them at reduced fees. Members also gain access to extensive discounted pharmacy benefits, available exclusively at 400 Rite Aid stores across the New York area.

Transparent Health Network is not insurance, so in return for the reduced fees, members pay the providers directly, at the time they receive care.

Transparent Health Network was designed to be an affordable option for individuals who are working and either uninsured or underinsured and cannot comfortably afford health insurance, but whose incomes exceed the maximum limit for government assistance programs. In addition, Transparent Health Network is a viable companion to high deductible, or catastrophic, insurance plans.

Transparent Health Network is, quite simply, a health care access model that makes sense. More and more people have been losing their insurance coverage or finding themselves unable to afford the premiums. Now, for the first time, theres a way for providers to help them, said Leon Smith, MD, past chairman of Medicine, St. Michaels Medical Center, Newark, NJ.

Transparent Health Network negotiates fees with providers in much the same way as insurers do, but with two significant differences: With Transparent Health Network, contracted rates are the same from one provider to the next within a specified geographic area; and, for complete transparency, the contracted fee schedules are posted online, at where members and providers can access them easily. Members can look up the price of common procedures before seeking care, so they can make educated decisions about when and where to seek care, and maximize the value of their health care dollars.

Transparent Health Network is currently available in the New York metropolitan region, including the five boroughs of New York City, Westchester and Long Island.

Non-Profit Group Helps Make Sense of Government-Sponsored Health Coverage

A press release issued today by the Foundation for Health Coverage Education (FHCE) noted that studies have shown that nearly 33% of the 47 million uninsured in America are eligible for government-sponsored health insurance but aren’t signed up for them. Why? The number of bureaucratic steps needed to apply for government-paid health coverage is simply overwhelming.

“In Los Angeles County, for example, it usually requires two scheduled appointments at a social services agency and the time and ability of an applicant to answer a 100-question document as a first step to getting enrolled in California’s Medi-Cal program. This arduous process in addition to possible transportation issues and literacy challenges keep thousands of people from enrolling,” said Phil Lebherz, founder and executive director of FHCE in the press release.

The solution initiated by FHCE is ambitious. They are providing access to online applications for every state in the country though a website ( According to the news release, visitors can go to the FHCE website and click on the State by State application link where they can identify government health coverage offerings for the three federal programs (Medicaid, Medicare and Veterans) in addition to each state’s individual program applications.

Website visitors can first take a simple 5-Question Eligibility Quiz or phone the U.S. Uninsured Help Line at 800-234-1317 and talk with a live counselor to learn about their health coverage options. The series of questions is used as a starting point for the Fresno, California-based call center’s staff who then guides each caller through their options and to the appropriate state-sponsored program.

It is interesting that government-sponsored programs already in place could provide healthcare to 15.5 of the 47 million uninsured, but rather than making these programs more accessible, we debate the creation of even more government-sponsored programs to solve the problem – including the idea of making us all get our healthcare coverage in this fashion through a single payer system.

Wasn’t it Einstein who said that repeating the same action over again expecting different results is the definition of insanity?

We should all applaud the work of groups like the non-profit FHCE who are trying to break the insanity cycle and make sense of the crazy patchwork of existing government programs to the effect of actually delivering promised healthcare to people in need.

Likewise, we should all take note of the failure of the current government-sponsored programs to provide promised care and be wary of repeating this action while expecting different results.

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