The White House released new guidance that offers some leeway to people who had policies cancelled and found that their options under the new law were more expensive. They will now be able to qualify for catastrophic coverage (previously only available to those under 30 or who could demonstrate financial hardship), and avoid the penalty.
You can read the full article, from Modern Healthcare, here. Within the article, you can access the actual .pdf that is the document issued directly by CMS.
There are only 4 more days left to enroll for those who need coverage to be in force by January 1, 2014. Premium payments (which originally were required to be received by the insurance company prior to January 1), must arrive no later than January 10. Blue Cross Blue Shield of Kansas City requires their first payment no later than January 7. If you are unsure, check directly with the carrier for clarification.
Enrollments after the 23rd will be processed for a 2/1/2014 effective date. Enrollments processed after 2/15/2014 will be for plans effective on March 1, and those processed after 3/15/2014 will be effective on 4/1/2014.
Anyone who hasn't enrolled in a policy during this initial enrollment period, will have to wait until next year's enrollment to sign up or to make changes to existing plans.
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Friday, December 20, 2013
Friday, December 13, 2013
Obamacare Week 10––A Dearth of Enrollment In the States and Continuing Backroom Problems
Here's an update from Bob Laszewski regarding the current status of the enrollments through the Federal Marketplaces, and in the states that currently have a state run marketplace. There is also data here about how various aspects of system corrections and development are going.
The one point here that I found very troubling was the item that notes that the federal government hasn't built a payment system that would provide insurance companies with the premium subsidy payments. They are expecting the insurance companies to bill them for these amounts. It makes me wonder how long it will take them to get paid, and how that money will be tracked through the various private & government systems.
Also troubling was all of the confusion and inability to deal with Medicaid enrollments.
We'll see how the end of the year plays out. I am hearing from people I deal with that they are actually able to get through the process now using Healthcare.gov, so at least they've made improvements there and some are getting approved for subsidies and enrolled. Let's hope the improvements continue.
To read Bob's blog entry, please click here.
The one point here that I found very troubling was the item that notes that the federal government hasn't built a payment system that would provide insurance companies with the premium subsidy payments. They are expecting the insurance companies to bill them for these amounts. It makes me wonder how long it will take them to get paid, and how that money will be tracked through the various private & government systems.
Also troubling was all of the confusion and inability to deal with Medicaid enrollments.
We'll see how the end of the year plays out. I am hearing from people I deal with that they are actually able to get through the process now using Healthcare.gov, so at least they've made improvements there and some are getting approved for subsidies and enrolled. Let's hope the improvements continue.
To read Bob's blog entry, please click here.
Monday, November 11, 2013
Correction to Previous post regarding Hospital Subsidies . .
The article referenced in the previous post was from the New York Times (not the Wall Street Journal) - I apologize for the error.
Some Little Known Subsidy Cuts to "Safety-Net" Hospitals, May Leave Some Without Care . . . . .
As various subsidies to hospitals that provide care to the uninsured, especially those that do not qualify for Medicaid, are implemented - some could be left with nowhere to go for much needed medical care.
The Medicaid expansion under the Affordable Care Act would have provided coverage to many of these people. But - since Supreme Court ruled that the states would have to be given the ability to "opt out" of the Medicaid expansion, many did. That leaves a gaping hole in the body of people who would have been covered by the expansion. Without the expansion, many of these individuals will not qualify for Medicaid - AND - they may not qualify for a federal subsidy to purchase health insurance through the new health insurance marketplaces. An individual must have a Modified Adjusted Gross income of $11,490 to qualify for a subsidy. If you make less, but do not qualify for Medicaid coverage, you will have no options other than to pay full price for a health insurance policy - which many cannot possibly afford.
Hospitals that previously might have cared for these patients because they were subsidized for doing so, will now have those subsidies cut and may need to begin to refuse care or turn people away.
The Wall Street Journal published a good article that explains the predicament very well. Read more here . . . .
Obviously, some adjustments will need to be made to the health care law to compensate for these unexpected situations arising out of modifications in the law to date. A lot of delivery of care and coverage issues were hoped to be solved with the Medicaid expansion. Since that was limited significantly, large groups of people who had counted on it as a mechanism for health care coverage will be left behind once again and will remain uncovered, unless something is done to correct that.
The Medicaid expansion under the Affordable Care Act would have provided coverage to many of these people. But - since Supreme Court ruled that the states would have to be given the ability to "opt out" of the Medicaid expansion, many did. That leaves a gaping hole in the body of people who would have been covered by the expansion. Without the expansion, many of these individuals will not qualify for Medicaid - AND - they may not qualify for a federal subsidy to purchase health insurance through the new health insurance marketplaces. An individual must have a Modified Adjusted Gross income of $11,490 to qualify for a subsidy. If you make less, but do not qualify for Medicaid coverage, you will have no options other than to pay full price for a health insurance policy - which many cannot possibly afford.
Hospitals that previously might have cared for these patients because they were subsidized for doing so, will now have those subsidies cut and may need to begin to refuse care or turn people away.
The Wall Street Journal published a good article that explains the predicament very well. Read more here . . . .
Obviously, some adjustments will need to be made to the health care law to compensate for these unexpected situations arising out of modifications in the law to date. A lot of delivery of care and coverage issues were hoped to be solved with the Medicaid expansion. Since that was limited significantly, large groups of people who had counted on it as a mechanism for health care coverage will be left behind once again and will remain uncovered, unless something is done to correct that.
Friday, November 1, 2013
"Bad Apples?" - Really?
Although there were some policies sold in the individual insurance market in the past that were not what I'd term "real major medical insurance", I know that those of us in the agent community did our best to educate our consumers and make sure they understood the differences and what to look for in a legitimate policy.
My clients all had policies that offered them a good amount of financial protection for the money. Yes - there were trade offs - if you wanted a lower premium, you could raise the deductible, or forgo other benefits. But my clients made those choices after discussing the ramifications of those decisions, so that they would buy a policy that would protect them in the ways that they thought were important to them.
The President made it sound as if the individual market was the wild, wild west and this total overhaul was the only way to protect the public.
Also, in the hearings on Capital Hill, they never once advised that people could get advice, or help from independent agents (like myself), while they try to fix their broken system and can't handle the phone traffic coming into their call centers with questions.
As Bob Laszewski sites in his post that follows, you begin to wonder if they understood anything about our insurance system at all. I never would have dreamed that to be the case, considering that Kathleen Sebelius ran the Dept. of Insurance in Kansas before she was Governor. I guess memories are short . . . . .
Health Policy and Marketplace Review
Personally, if my policy loses its "grandfathered" status, I have no idea how I'd ever afford an ACA compliant plan that would be comparable. Hopefully, I won't have to ponder that decision (or "non-choice") for awhile . . . . .
My clients all had policies that offered them a good amount of financial protection for the money. Yes - there were trade offs - if you wanted a lower premium, you could raise the deductible, or forgo other benefits. But my clients made those choices after discussing the ramifications of those decisions, so that they would buy a policy that would protect them in the ways that they thought were important to them.
The President made it sound as if the individual market was the wild, wild west and this total overhaul was the only way to protect the public.
Also, in the hearings on Capital Hill, they never once advised that people could get advice, or help from independent agents (like myself), while they try to fix their broken system and can't handle the phone traffic coming into their call centers with questions.
As Bob Laszewski sites in his post that follows, you begin to wonder if they understood anything about our insurance system at all. I never would have dreamed that to be the case, considering that Kathleen Sebelius ran the Dept. of Insurance in Kansas before she was Governor. I guess memories are short . . . . .
Health Policy and Marketplace Review
Personally, if my policy loses its "grandfathered" status, I have no idea how I'd ever afford an ACA compliant plan that would be comparable. Hopefully, I won't have to ponder that decision (or "non-choice") for awhile . . . . .
Sunday, October 20, 2013
Missouri Exchange Rates - A Snapshot
Many of my clients in MO have been wondering what rates for the new ACA compliant insurance plans will cost. Here is a quick snapshot of what the rates currently look like.
Snapshot of Missouri Exchange Rates
Those who are eligible for a subsidy, would be able to have some help paying for these plans. You can use the calculator below to determine how much help you might receive. I've posted this before, but here it is again.
Kaiser Foundation Subsidy Calculator
Since Healthcare.gov hasn't been accessible, using the tools above may be a quick way to estimate what your premiums might be under the new system.
If you don't need the federal money, there are plenty of plans that you can buy "off-exchange" if you need to purchase insurance.
If you already have insurance, you may want to keep your current plan, if you are able to do so.
As always, my clients can always e-mail me or call with questions.
Snapshot of Missouri Exchange Rates
Those who are eligible for a subsidy, would be able to have some help paying for these plans. You can use the calculator below to determine how much help you might receive. I've posted this before, but here it is again.
Kaiser Foundation Subsidy Calculator
Since Healthcare.gov hasn't been accessible, using the tools above may be a quick way to estimate what your premiums might be under the new system.
If you don't need the federal money, there are plenty of plans that you can buy "off-exchange" if you need to purchase insurance.
If you already have insurance, you may want to keep your current plan, if you are able to do so.
As always, my clients can always e-mail me or call with questions.
Saturday, October 19, 2013
Should the Administration shut down Healthcare.gov?
Bob Laszewski asks that very question in his blog post today. Another insightful entry from Bob about the computer system and its continued failing.
As I've stated before, if you do not need the federal subsidy money and can keep your current individual health insurance policy, do so for as long as you're able. Based on what I've seen, the new ACA compliant plans are more expensive overall in this geography (Kansas City metro).
If you do have to shop - there are plenty of "off exchange" plans (plans sold outside of the federal marketplace) where you can purchase an ACA compliant plan for individuals and families. The carriers have plans up on most of their own websites now, and eventually, I'll be able to run side by side quotes for these new plans. To date, it's been impossible to do so, since most data resources at the insurance carriers and other entities (like the quoting engines most agents use) have been overwhelmed.
That said, I do believe visibility to plans outside of the federal marketplace will increase greatly during the coming month or so. So - for those who have been unable to buy health insurance in the past due to medical conditions, you'll definitely be able to fulfill the requirement to carry insurance. The jury is still out as to whether or not you'll be able to get online at the Healthcare.gov website.
Read Bob's blog post here . . . .
As I've stated before, if you do not need the federal subsidy money and can keep your current individual health insurance policy, do so for as long as you're able. Based on what I've seen, the new ACA compliant plans are more expensive overall in this geography (Kansas City metro).
If you do have to shop - there are plenty of "off exchange" plans (plans sold outside of the federal marketplace) where you can purchase an ACA compliant plan for individuals and families. The carriers have plans up on most of their own websites now, and eventually, I'll be able to run side by side quotes for these new plans. To date, it's been impossible to do so, since most data resources at the insurance carriers and other entities (like the quoting engines most agents use) have been overwhelmed.
That said, I do believe visibility to plans outside of the federal marketplace will increase greatly during the coming month or so. So - for those who have been unable to buy health insurance in the past due to medical conditions, you'll definitely be able to fulfill the requirement to carry insurance. The jury is still out as to whether or not you'll be able to get online at the Healthcare.gov website.
Read Bob's blog post here . . . .
Friday, October 11, 2013
Healthcare.gov Offers New Shopping Feature - Sort of . . . .
Here's a link to the Kaiser Foundation Blog describing the new "shopping feature" on Healthcare.gov.
Read the Kaiser Foundation Blog Entry here . . . .
Limited as the shopping feature is, I guess it's better than nothing. How they could have developed a huge system like Healthcare.Gov and not understood that people want to see rates & plan information before deciding to create an account and then load a ton of personal information into the system blindly.
They wasted a lot of money on a dysfunctional system and are now having to spend more to remedy it without having to totally dismantle it. In the meantime, people who may have wanted to purchase insurance there, cannot. I guess people may have to phone in applications or do them on paper - you know, just like in the "good old days" . . .
Read the Kaiser Foundation Blog Entry here . . . .
Limited as the shopping feature is, I guess it's better than nothing. How they could have developed a huge system like Healthcare.Gov and not understood that people want to see rates & plan information before deciding to create an account and then load a ton of personal information into the system blindly.
They wasted a lot of money on a dysfunctional system and are now having to spend more to remedy it without having to totally dismantle it. In the meantime, people who may have wanted to purchase insurance there, cannot. I guess people may have to phone in applications or do them on paper - you know, just like in the "good old days" . . .
Friday, October 4, 2013
System Glitches? Really?
Haven't been able to get into the Federal Exchange to peruse pricing or see if you qualify for a subsidy? Most people haven't. The website & the press keep saying it's due to traffic and I say - not so. Now, there's finally confirmation in print of what some agents have been saying all week.
Read the Story Here . . . .
The Center for Medicare and Medicaid Services (CMS), who is running the Federal Marketplaces in 36 states could barely handle agent training, and then had a security breach after some agents completed the coursework - sending agent information along with related social security numbers "into the wind" by "accident".
I would advise anyone who feels they need Federal Subsidy money to pay for their plan, to wait and see through the month of October. Wait to see how this plays out and to be sure that the systems are working and have some level of security before putting in all of your personal information.
You have plenty of time - if you want your insurance policy to take effect on January 1, 2014, you need to apply no later than December 15. Then, you still have until March 31 during this initial enrollment for plans to begin with effective dates after that.
No hurry - believe me, they need time to work this out.
For those who feel they won't qualify for the Federal money, and still need or want to buy a new ACA compliant plan for 2014, the options are actually greater outside of the exchange. You have more choices of companies and plans, and the plans have slightly different benefits than those on the marketplaces.
If you'd like any help in looking at those in MO and KS, I'd be happy to assist, as always.
Read the Story Here . . . .
The Center for Medicare and Medicaid Services (CMS), who is running the Federal Marketplaces in 36 states could barely handle agent training, and then had a security breach after some agents completed the coursework - sending agent information along with related social security numbers "into the wind" by "accident".
I would advise anyone who feels they need Federal Subsidy money to pay for their plan, to wait and see through the month of October. Wait to see how this plays out and to be sure that the systems are working and have some level of security before putting in all of your personal information.
You have plenty of time - if you want your insurance policy to take effect on January 1, 2014, you need to apply no later than December 15. Then, you still have until March 31 during this initial enrollment for plans to begin with effective dates after that.
No hurry - believe me, they need time to work this out.
For those who feel they won't qualify for the Federal money, and still need or want to buy a new ACA compliant plan for 2014, the options are actually greater outside of the exchange. You have more choices of companies and plans, and the plans have slightly different benefits than those on the marketplaces.
If you'd like any help in looking at those in MO and KS, I'd be happy to assist, as always.
Monday, September 30, 2013
Monthly Premiums For A 'Benchmark' Silver Plan In Federally Run Insurance Marketplaces
Here we are one day before the October 1 enrollment through the Federal Marketplaces begins for those of you who are under the age of 65 and do not receive insurance through your employer.
I still do not have actual pricing from any of my carriers in Missouri or Kansas yet, so advising people as to what to do has been difficult, if not impossible.
Some of you who have "grandfathered" plans - meaning your plan effective date was prior to March 23, 2010 - can keep the plan you currently have.
Those of you who do not have a "grandfathered" plan may be able to keep your existing policy for an additional year, depending on how your existing carrier is handling things. In these cases you may have received a letter already indicating that this option will be available to you and that you'll simply sign an addendum in December, most likely, and agree to a small rate increase at that time. This would allow you to continue with your plan through the end of December 2014.
Depending on what the new plan pricing looks like, the options above may be appealing.
Those of you who feel you will qualify for Federal subsidies will have to apply through the exchanges to receive the federal money.
I am certified to sell policies within the exchanges, but do not know what that process will look like yet, since the exchanges (or marketplaces, as the Federal Government is referring to them) do not exist yet. Supposedly these will be online tomorrow, October 1.
Once I have detailed plan & pricing information, I'll share that with all of my individual and family clients.
The article from the Kaiser Foundation this morning offers an idea of what a Silver plan may cost in various "areas" within a state where the Federal Marketplace will be offering plans. You can see that here . . .Benchmarks for Silver Plans through the Marketplaces.
Simply find your county and you'll see how rates compare with other areas of your state.
Within this article you'll also see the link for the subsidy calculator where you can play around with your numbers to see what might happen in real time once the Federal Marketplaces are operational.
Once I see that enrollments are going smoothly I'll discuss options with my clients. In the meantime, I'd advise waiting to see how the initial launch goes, before making changes. (but, that's just my opinion . . . .)
I still do not have actual pricing from any of my carriers in Missouri or Kansas yet, so advising people as to what to do has been difficult, if not impossible.
Some of you who have "grandfathered" plans - meaning your plan effective date was prior to March 23, 2010 - can keep the plan you currently have.
Those of you who do not have a "grandfathered" plan may be able to keep your existing policy for an additional year, depending on how your existing carrier is handling things. In these cases you may have received a letter already indicating that this option will be available to you and that you'll simply sign an addendum in December, most likely, and agree to a small rate increase at that time. This would allow you to continue with your plan through the end of December 2014.
Depending on what the new plan pricing looks like, the options above may be appealing.
Those of you who feel you will qualify for Federal subsidies will have to apply through the exchanges to receive the federal money.
I am certified to sell policies within the exchanges, but do not know what that process will look like yet, since the exchanges (or marketplaces, as the Federal Government is referring to them) do not exist yet. Supposedly these will be online tomorrow, October 1.
Once I have detailed plan & pricing information, I'll share that with all of my individual and family clients.
The article from the Kaiser Foundation this morning offers an idea of what a Silver plan may cost in various "areas" within a state where the Federal Marketplace will be offering plans. You can see that here . . .Benchmarks for Silver Plans through the Marketplaces.
Simply find your county and you'll see how rates compare with other areas of your state.
Within this article you'll also see the link for the subsidy calculator where you can play around with your numbers to see what might happen in real time once the Federal Marketplaces are operational.
Once I see that enrollments are going smoothly I'll discuss options with my clients. In the meantime, I'd advise waiting to see how the initial launch goes, before making changes. (but, that's just my opinion . . . .)
Friday, September 27, 2013
There Will Be Fewer Medicare Advantage Plan Offerings for 2014
As we head into the Annual Enrollment period for Medicare eligible people, they will ultimately find that in some areas, some Medicare Advantage plans have withdrawn some plans they previously offered. This article is a good synopsis of what's happening in this marketplace:
View the article here . . .
October will be a very busy month!
View the article here . . .
October will be a very busy month!
Tuesday, September 3, 2013
Is the Affordable Care Act Actually Affordable?
I've been wondering that myself as I complete the training associated with being able to assist clients as the law is implemented.
My conclusion is that maybe it won't be - especially for some segments of the population. Even with the federal subsidy money, I've been wondering whether or not people with very limited incomes will be able to afford the portion of the health insurance premium that is left for them to pay once the subsidy is taken into account. Apparently, I'm not the only one.
This article from AlterNet takes a closer look:
Read the full article here.
Enrollment for new, ACA compliant plans is scheduled to begin on October 1 and will continue through 12/31/2013. This is an extended enrollment period, since the government realizes that there will be a lot of confusion in the marketplace about when they must enroll or make changes. After this year, the annual enrollment period for individuals and families under the age of 65 will be from October 15 - December 7 each year.
As new information becomes available, I'll be sure to communicate it.
My conclusion is that maybe it won't be - especially for some segments of the population. Even with the federal subsidy money, I've been wondering whether or not people with very limited incomes will be able to afford the portion of the health insurance premium that is left for them to pay once the subsidy is taken into account. Apparently, I'm not the only one.
This article from AlterNet takes a closer look:
Read the full article here.
Enrollment for new, ACA compliant plans is scheduled to begin on October 1 and will continue through 12/31/2013. This is an extended enrollment period, since the government realizes that there will be a lot of confusion in the marketplace about when they must enroll or make changes. After this year, the annual enrollment period for individuals and families under the age of 65 will be from October 15 - December 7 each year.
As new information becomes available, I'll be sure to communicate it.
Wednesday, August 21, 2013
UPS Won't Insure Spouses of Some Employees
UPS is getting ready to remove thousands of spouses from their company provided group health insurance, in part due to the new healthcare law. They have cited the Affordable Care Act as one of the reasons for its decision when explaining this to employees and others. Read the article here . . . .
Tuesday, August 6, 2013
Many Consumers With High-Deductible Plans Are Concerned About Health Law Changes
For those of you who didn't know - unless your current individual or family health insurance policy is considered to be a 'grandfathered' plan - meaning, the plan effective date was prior to 3/23/2010 (when the new Health care law was signed) - you'll have to make some changes for plans effective on 1/1/2014. Read more here . . .
Different companies are taking different approaches to this "migration", as they are calling it. Some are simply ending your existing coverage as of 12/31/2013, and requiring you to purchase a new policy during annual enrollment - which takes place beginning October 1, 2013 for plans that will be effective on 1/1/2014.
Other companies are going to allow you to stay on your current 'non-grandfathered' plan, and they'll simply add essential health benefits and other features to make the plan compliant. In those cases, companies will simply have you agree to that and any price changes, through the use of an addendum that the insured will sign, and you'd keep your plan through the end of 2014.
I am beginning to contact my clients to let them know what the options will be this fall. Unfortunately, no pricing is available yet, so I'm only able to discuss potential situations, not real choices. Some people will qualify for subsidies through the exchanges - if you're an individual and make up to $45,960 annually, you'd qualify. The guideline is that there will be subsidies available for those making up to 400% above the poverty level. In some geographic markets, that is a good amount of money, so many may qualify.
You can play around with the subsidy calculator below to get an idea of whether or not you & others in your household might qualify for subsidies being offered to help pay for new plans effective next year.
Health Insurance Subsidy Calculator
Different companies are taking different approaches to this "migration", as they are calling it. Some are simply ending your existing coverage as of 12/31/2013, and requiring you to purchase a new policy during annual enrollment - which takes place beginning October 1, 2013 for plans that will be effective on 1/1/2014.
Other companies are going to allow you to stay on your current 'non-grandfathered' plan, and they'll simply add essential health benefits and other features to make the plan compliant. In those cases, companies will simply have you agree to that and any price changes, through the use of an addendum that the insured will sign, and you'd keep your plan through the end of 2014.
I am beginning to contact my clients to let them know what the options will be this fall. Unfortunately, no pricing is available yet, so I'm only able to discuss potential situations, not real choices. Some people will qualify for subsidies through the exchanges - if you're an individual and make up to $45,960 annually, you'd qualify. The guideline is that there will be subsidies available for those making up to 400% above the poverty level. In some geographic markets, that is a good amount of money, so many may qualify.
You can play around with the subsidy calculator below to get an idea of whether or not you & others in your household might qualify for subsidies being offered to help pay for new plans effective next year.
Health Insurance Subsidy Calculator
Thursday, July 25, 2013
Pay Close Attention!!! You're Probably Being Overbilled For All Things Medical!!
Billing!! Yes, billing is what's bothering me today. I had an episode with poison ivy that landed me in the emergency room on Memorial Day. I went in, saw a doctor for approximately 5 minutes - he looked at me, pulled out a prescription pad & wrote a scrip for prednisone. I walked out & that was it.
When I received the hospital facility bill, the billed amount was $2,115.75! They made a 'contractual adjustment' of $1,344.14. The insurance company paid $498.09, and my portion was $274.52.
Then the separate bill for the physician arrived. That bill was $440.00. Insurance paid $352.00 and my portion is supposed to be the remaining $88.00.
When I called the hospital to ask if I could have an itemized breakdown of how 5 minutes translated into $2,115.75 I was put on hold for a long time. I told them I had a right to understand exactly how anything could cost that much. Was it $1000 for the doctor to stare at me? Maybe $1100 to pull out a pad to write the prescription on? What exactly is the breakdown?
I was then told that they probably overbilled me! (ya think?) Turns out that these bills are coded according to a "level" scheme that is used as a guideline from the American College of Emergency Physicians. My hospital bill was coded as a level 4, while the doctor bill was coded as a level 3.
When I asked what a level 4 encompassed, they said they couldn't share that with me. Why, exactly, I don't know - but apparently everything is a big secret. We're all just supposed to pay & shut up.
I asked her what level it would be if I had presented in the emergency room with a heart attack & she said level 5. So, I asked how poison ivy could possibly be only one level below a life threatening condition like a heart attack & she said, again - that I was probably over billed.
I looked up the levels myself (www.ACEP.org), and it turns out that my bills most likely should have been coded as a level 2, which encompasses things like "rashes, sunburn, etc.". Also, probably for a much more reduced charge.
I then called the insurance company so that they can flag the account, since I'm now having both bills audited. Insurance technically should have examined it & potentially denied the claim, but the answer I got from them is that since they didn't know exactly what took place in the emergency room, they often simply pay the bill. And yes, it's true - how would they know exactly what services were provided? They have to trust the provider to some degree, since they are administering the medical care & should be allowed to proceed as needed in an emergency situation.
So, ever wonder why everything is so expensive? The providers are robbing the insurance companies blind, and then that cost is being passed along to YOU the consumer of health care - both in the form of higher premiums and in the form of higher portions of co-insurance. Shameful!!
Take this as a warning - Pay very close attention to any billing you receive - you may not owe as much as you think you do.
When I received the hospital facility bill, the billed amount was $2,115.75! They made a 'contractual adjustment' of $1,344.14. The insurance company paid $498.09, and my portion was $274.52.
Then the separate bill for the physician arrived. That bill was $440.00. Insurance paid $352.00 and my portion is supposed to be the remaining $88.00.
When I called the hospital to ask if I could have an itemized breakdown of how 5 minutes translated into $2,115.75 I was put on hold for a long time. I told them I had a right to understand exactly how anything could cost that much. Was it $1000 for the doctor to stare at me? Maybe $1100 to pull out a pad to write the prescription on? What exactly is the breakdown?
I was then told that they probably overbilled me! (ya think?) Turns out that these bills are coded according to a "level" scheme that is used as a guideline from the American College of Emergency Physicians. My hospital bill was coded as a level 4, while the doctor bill was coded as a level 3.
When I asked what a level 4 encompassed, they said they couldn't share that with me. Why, exactly, I don't know - but apparently everything is a big secret. We're all just supposed to pay & shut up.
I asked her what level it would be if I had presented in the emergency room with a heart attack & she said level 5. So, I asked how poison ivy could possibly be only one level below a life threatening condition like a heart attack & she said, again - that I was probably over billed.
I looked up the levels myself (www.ACEP.org), and it turns out that my bills most likely should have been coded as a level 2, which encompasses things like "rashes, sunburn, etc.". Also, probably for a much more reduced charge.
I then called the insurance company so that they can flag the account, since I'm now having both bills audited. Insurance technically should have examined it & potentially denied the claim, but the answer I got from them is that since they didn't know exactly what took place in the emergency room, they often simply pay the bill. And yes, it's true - how would they know exactly what services were provided? They have to trust the provider to some degree, since they are administering the medical care & should be allowed to proceed as needed in an emergency situation.
So, ever wonder why everything is so expensive? The providers are robbing the insurance companies blind, and then that cost is being passed along to YOU the consumer of health care - both in the form of higher premiums and in the form of higher portions of co-insurance. Shameful!!
Take this as a warning - Pay very close attention to any billing you receive - you may not owe as much as you think you do.
Monday, July 8, 2013
Health Insurance Exchange Subsidies Will Be Granted on the Honor System!––Is There Something Wrong With "ObamaCare's" Federal Data Hub?
Author of the "Health Care Policy and Marketplace Review" blog, Bob Laszewski has reported a whopper of a story on his blog about a little known change to the requirements for determining whether or not an individual applying for health insurance through the exchanges will qualify for a subsidy. Information on income for individuals was supposed to come from the Federal Data Hub, but now that information can effectively be "ignored" if it conflicts with what the applicant is telling the navigator at the exchange! In other words, if I think I need/qualify for a subsidy, they'll just 'take my word for it'. . . .
I think everyone really needs to know & understand that the average, honest tax payer will end up paying for the "free money" that is sure to be given out once some people understand how to manipulate the system. No subsidy money should be given unless incomes & eligibility can be accurately verified.
Read Bob's Post on his "Health Care Policy and Marketplace Review" blog . . .
I think everyone really needs to know & understand that the average, honest tax payer will end up paying for the "free money" that is sure to be given out once some people understand how to manipulate the system. No subsidy money should be given unless incomes & eligibility can be accurately verified.
Read Bob's Post on his "Health Care Policy and Marketplace Review" blog . . .
Tuesday, July 2, 2013
Income -- Not Assets -- Will Determine Subsidies In Online Insurance Marketplaces
As the enrollment for health insurance plans that will begin in January 2014 rapidly approaches, information about subsidies to purchase the insurance that will be offered in the new insurance exchanges that the federal & state governments are setting up, is being clarified.
Kaiser foundation published a helpful blog entry today regarding that subject. You can read more about it here: Questions Regarding Subsidy Eligibility
The links within the article are "live", so further information is available there.
Keep in mind that the health insurance plans referenced are for individuals and families- not businesses or people who have Medicare coverage.
There will be plans offered outside of the exchanges or "marketplaces" provided by the government, but if you need to obtain a subsidy to pay for your insurance, you have to buy the insurance through the government run marketplace.
Kaiser foundation published a helpful blog entry today regarding that subject. You can read more about it here: Questions Regarding Subsidy Eligibility
The links within the article are "live", so further information is available there.
Keep in mind that the health insurance plans referenced are for individuals and families- not businesses or people who have Medicare coverage.
There will be plans offered outside of the exchanges or "marketplaces" provided by the government, but if you need to obtain a subsidy to pay for your insurance, you have to buy the insurance through the government run marketplace.
Thursday, June 27, 2013
Implementation of the Health Care Law is Quickly Approaching . . .
As the full implementation of the Health Care law draws near, I'm getting a lot of questions about what may be happening. To date, there's not a lot to report. I'm hoping that more concrete details will be available soon. The carriers are working to develop compliant "qualified" health plans that will be sold inside and outside of the state based exchanges (or marketplaces). One thing that many are not aware of is the fact that there's an "open enrollment" period being established for individual and family plans. This is new -- currently in the individual and family market, people are able to purchase new insurance whenever they want to - they are not bound by 'enrollment periods'.
The initial enrollment period will begin on October 1, 2013 and will last through March 31, 2014. Enrollment will be for plans with an effective date of 1/1/2014 or later. After that, the annual enrollment period will coincide with the Medicare Annual enrollment period - which is from October 15 through December 7 of each year. If a person doesn't sign up during an annual enrollment period, they will not be able to buy a plan again until the next one, unless they qualify for a special enrollment period. Qualification is based on things like major life events/changes - marriage, birth of a child, etc.
There are still many questions to be answered. One is whether or not the exchanges will be open & ready for business on October 1. There was an interesting article about this topic and the software that will be used to sign people up for insurance. Read about it here . . .
As more specifics are communicated to me, I will be sure to post items of note here for my clients and friends.
The initial enrollment period will begin on October 1, 2013 and will last through March 31, 2014. Enrollment will be for plans with an effective date of 1/1/2014 or later. After that, the annual enrollment period will coincide with the Medicare Annual enrollment period - which is from October 15 through December 7 of each year. If a person doesn't sign up during an annual enrollment period, they will not be able to buy a plan again until the next one, unless they qualify for a special enrollment period. Qualification is based on things like major life events/changes - marriage, birth of a child, etc.
There are still many questions to be answered. One is whether or not the exchanges will be open & ready for business on October 1. There was an interesting article about this topic and the software that will be used to sign people up for insurance. Read about it here . . .
As more specifics are communicated to me, I will be sure to post items of note here for my clients and friends.
Saturday, June 1, 2013
Health insurance and Medicare updates: Here's what's "got my goat" today about our Medica...
Health insurance and Medicare updates: Here's what's "got my goat" today about our Medica...: I had a Doctor's appointment scheduled for next week, and today got a call from the office today stating that when I come in I'd hav...
Friday, May 31, 2013
Here's what's "got my goat" today about our Medical system . . . .
I had a Doctor's appointment scheduled for next week, and today got a call from the office today stating that when I come in I'd have to bring $100 "earnest money". I've never been asked for this before, since I have a $40 co-pay to see a specialist. But - since the practice was sold to the adjacent hospital, they are now saying that my doctor is an "outpatient clinic" and the co-pay no longer applies. Therefore, I'd have to pay out of pocket until meeting my deductible.
Basically, they've redefined what an office visit is or is not - simply to suit themselves. No one cares that I've paid for my insurance & included features like co-pays because I was willing to pay the premium for them.
With the advent of health care reform arriving on the scene, I've been seeing more consolidation - on the insurance company side of the business & now on the provider side. As providers begin to consolidate, it seems they are re-defining what certain visits are, as well as, how certain hospital stays can be billed.
One example of what's happening with 'in-facility' stays, is the new phenomenon of keeping someone overnight (mainly after a visit to the emergency room) for "observation", and giving the impression that the patient has been admitted, when in fact, they have not. What happens here can make a huge difference to some of my Medicare Advantage beneficiaries, since they pay a daily hospital rate if they are an inpatient that includes everything that happens while they are there (all tests, surgeries, etc). If they are kept in an outpatient status, that same Medicare Advantage beneficiary would be subject to paying 20% of everything that happens there - so it's very much like 'a-la-carte' billing - resulting in a much higher bill.
Today, the patient has to be ever vigilant & ask very pointed questions about how they will be billed prior to having procedures done. We're entering an age where none of this is about the patient & patient care, but is all about the money and the various corporate entities that are deciding everything about how care will be administered.
Look alert! Make sure that if you have any type of serious illness or ongoing need for care, you involve a family member or friend to advocate on your behalf. When you become seriously ill, you just won't have it in you to fight the good fight.
As for my situation, I told them to cancel my appointment and that I'd find another doctor who would honor my insurance with the features that I've been paying for. . . .
Basically, they've redefined what an office visit is or is not - simply to suit themselves. No one cares that I've paid for my insurance & included features like co-pays because I was willing to pay the premium for them.
With the advent of health care reform arriving on the scene, I've been seeing more consolidation - on the insurance company side of the business & now on the provider side. As providers begin to consolidate, it seems they are re-defining what certain visits are, as well as, how certain hospital stays can be billed.
One example of what's happening with 'in-facility' stays, is the new phenomenon of keeping someone overnight (mainly after a visit to the emergency room) for "observation", and giving the impression that the patient has been admitted, when in fact, they have not. What happens here can make a huge difference to some of my Medicare Advantage beneficiaries, since they pay a daily hospital rate if they are an inpatient that includes everything that happens while they are there (all tests, surgeries, etc). If they are kept in an outpatient status, that same Medicare Advantage beneficiary would be subject to paying 20% of everything that happens there - so it's very much like 'a-la-carte' billing - resulting in a much higher bill.
Today, the patient has to be ever vigilant & ask very pointed questions about how they will be billed prior to having procedures done. We're entering an age where none of this is about the patient & patient care, but is all about the money and the various corporate entities that are deciding everything about how care will be administered.
Look alert! Make sure that if you have any type of serious illness or ongoing need for care, you involve a family member or friend to advocate on your behalf. When you become seriously ill, you just won't have it in you to fight the good fight.
As for my situation, I told them to cancel my appointment and that I'd find another doctor who would honor my insurance with the features that I've been paying for. . . .
Friday, May 3, 2013
Medicare Seeks To Limit Number Of Seniors Placed In Hospital Observation Care
The "observation care" designation is a thorny one - for the providers, as well as, the Medicare beneficiary. The patient often doesn't realize that they haven't been admitted, and end up with increased financial obligations because of it. If a person has a Medicare Advantage plan, this can be especially troubling, since in many of the plans on the market, the patient would be responsible for 20% of all outpatient services received, rather than a straight 'hospital inpatient' daily co-pay.
The difference between the two can be enormous, especially if expensive tests are done while the person is considered to be an "outpatient". There are other implications as well, related to requirements to be admitted into a nursing home after a hospital stay. The requirement to have coverage in that instance is that the patient has been an "inpatient" for 3 consecutive days. Outpatient status doesn't count. Read more in the Kaiser Foundation & Washington Post article here . . .
The difference between the two can be enormous, especially if expensive tests are done while the person is considered to be an "outpatient". There are other implications as well, related to requirements to be admitted into a nursing home after a hospital stay. The requirement to have coverage in that instance is that the patient has been an "inpatient" for 3 consecutive days. Outpatient status doesn't count. Read more in the Kaiser Foundation & Washington Post article here . . .
Thursday, May 2, 2013
More Insurance Carriers seem to be backing away from Exchanges
In the state of Illinois, fewer insurance carriers than expected are agreeing to participate in the exchanges. I believe the trend will continue, and we may also see those who have committed to the effort drop out at the last minute. Confusion seems to be the only constant as we march toward 1/1/2014 and all of the new requirements that individuals and businesses face concerning implementation of health care reform. Good article today in the Washington Post. Read it here . . .
Wednesday, May 1, 2013
Aetna Cuts Predictions for Obamacare Enrollment
Well, I'd heard the rumblings about some of the largest health insurance carriers not participating within the exchanges, since they think the risk pool may be worse than anticipated - and now that seems to be bearing out. Because of anticipated delays in getting exchanges set up and problems with educating the public on what they will look like, etc., it seems that Aetna is the first major player to express doubts publicly. Read more here . . . .
Monday, March 25, 2013
Brian Klepper's article on "Why Only Business Can Save America From Healthcare"
Once again Brian Klepper raises some interesting points regarding the situation we're in with healthcare & healthcare coverage here in America. I also think that the situation is going to get even more grave than most people believe it will . . . .
He discusses what has led us to this current state of affairs and also points out the effect that lobbying has had on decisions that representatives have made "supposedly" on our behalf. Our elected officials have failed us . . .
See the article here . . .
He discusses what has led us to this current state of affairs and also points out the effect that lobbying has had on decisions that representatives have made "supposedly" on our behalf. Our elected officials have failed us . . .
See the article here . . .
Wednesday, January 23, 2013
Back to the Future? . . . . .
This article from the Kaiser Foundation and USA today discusses possible ways that insurers will manage risk, once they have to accept all applicants regardless of health history. It projects that they may choose to manage risk by limiting the types of services & more costly medical approaches through the introduction of tightly managed plans that have narrower networks.
Read the article here . . .
What are your thoughts on this?
Read the article here . . .
What are your thoughts on this?
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