|
InsuranceSpecialists Blog your source for insurance information
|
 Subscribe RSS Feed
Comments Feed
|
Three months after the passage of the health care insurance reform plan, people are still complaining that we don’t need universal health care. Some state governments are even suing the feds because they feel universal health care is somehow unconstitutional. Rather than going into a long-winded explanation of why we’re for universal health care, we offer this video, gleaned from YouTube.
Tags: friday filmstrips, health care reform, health insurance
Anyone who is, or has a parent who is, covered by medicare knows that healthcare fraud is a tangible risk. Some good news, then, on this Monday, is that Attorney General Eric Holder and HHS Secretary Kathleen Sebelius announced last Friday at a healthcare fraud summit in Miami, that the feds are in the process of the largest fraud takedown ever, with 94 defendants charged in five different cities (Baton Rouge, LA, Detroit, MI, Houston, TX, Miami FL, and New York, NY)
Also in conjunction with the Miami summit, which gathered together insurance providers, consumer advocates, and patients as well as federal, state, and local authorities, came the announcement from HHS that the state of Florida has been granted a Medicaid waiver which will help fund a program allowing the state’s Medicaid Fraid Control Unit to scan insurance claims for patterns that are red flags for insurance scams. Currently, Federal law prohibits federal matching funds from being used in such fraud control efforts.
As of Friday morning, 36 alleged participants had been arrested in connections with schemes involving over $250 million in fraudulent claims, according to the Justice Department. The suspects include insurance company owners, medical assistants, and doctors, and the allegations against them fit the profile of the kind of healthcare fraud typical of South Florida over the last several years – fraud that is now spreading across the country, with scammers filing false claims for HIV infusion services, home healthcare, durable medical equipment, and physical therapy, and beneficiaries getting monetary kickbacks for their Medicare numbers.
There are plans for additional, similar healthcare fraud summits to be held in Boston, Detroit, Las Vegas, Los Angeles, New York, and Philadelphia.
Source: Modern Healthcare
Tags: Fraud Insurance fraud, medicare
Lieutenant Governor Peter Kinder of Missouri filed a lawsuit today to block federally mandated health insurance in his state, claiming that Congress’s health care overhaul has overstepped governmental authority, and infringed upon state sovereignty. Kinder’s suit, filed by himself and three other Missouri residents, asserted that the federal government may not force people to purchase a product nor can it require state officials to participate in enforcing a “federal scheme.”
Missouri is not the first state to challenge the federal health care plan since it was signed into law in March.
In a written statement, Kinder, a Republican said, “Many Missourians will lose the options for health insurance they currently enjoy. Missourians have less health care coverage after the federal law was passed than they did before it was passed.”
Insurance changes sparked by the new federal health care law include the expansion of health insurance coverage, so that thirty million people currently without insurance will be covered. Parents will be able to keep dependent children on their policies to the age of 26, and Medicaid coverage will be expanded. There is a period of roughly four years before insurance is required or tax penalties will be levied.
In other lawsuits, the Justice Department has maintained that the federal health care law fits within Congress’s authority over the regulation of interstate commerce and providing for the general welfare of the American people. Further, it argued, the choice to opt out of health insurance affects everyone, insured or not.
On Wednesday, U.S. Department of Justice spokeswoman Tracy Schmaler said that it will defend the federal health care law from challenges over constitutional or other grounds.
“We are confident that this statute is constitutional and that we will prevail,” Schmaler said.
Tags: health care, health care overhaul
The Associated Press office in Chicago is reporting that healthcare overhaul may mean even longer waiting times in emergency rooms around the country. ERs are often the only choice for patients who don’t have access to walk-in clinics or primary care physicians, but under the new health law, more may be turning to emergent care providers. This may seem counter-intuitive – shouldn’t more people with insurance mean shorter wait times? Here’s why 32 million more people with health insurance will mean longer lines instead, as explained by AP medical Writer Carla K. Johnson:
-There’s already a shortage of front-line family physicians in some places and experts think that will get worse.
-People without insurance aren’t the ones filling up the nation’s emergency rooms. Far from it. The uninsured are no more likely to use ERs than people with private insurance, perhaps because they’re wary of huge bills.
-The biggest users of emergency rooms by far are Medicaid recipients. And the new health insurance law will increase their ranks by about 16 million. Medicaid is the state and federal program for low-income families and the disabled. And many family doctors limit the number of Medicaid patients they take because of low government reimbursements.
-ERs are already crowded and hospitals are just now finding solutions.
What do hospitals say about this likelihood? Well, Dr. Arthur L. Kellerman, a researcher with Rand Corp explains it thusly, “More people will have coverage and will be less afraid to go to the emergency department if they’re sick or hurt and have nowhere else to go…. We just don’t have other places in the system for these folks to go.”
What does this mean to you? If you are insured, start looking for a family practitioner, general practitioner or primary care physician now, before you actually NEED an appointment; most offices will squeeze in regular patients. Also, see if your insurance covers wellness care, which helps you use preventative measures to stay healthy, minimizing the likelihood of using an emergency room at all.
In a positively scary move against women’s right to choose – one that is medically risky – the Louisiana state legislature has decided that doctors who provide elective abortions should not be covered under medical malpractice laws.
With a 31-2 vote, the Louisiana Senate passed the bill, which was sponsored by Representative Robert Johnson (D – Marksville). The bill would prohibit doctors and other health care providers and doctors from receiving coverage under state or private Medical Malpractice Acts when performing an abortion of an “uncomplicated viable pregnancy” that is not being performed in order to save the life of the mother.
Despite the concerns raised by some lawmakers over the denial of coverage for a legal medical procedure, the bill, House Bill 1453, is being sent to the governor’s desk for approval or veto. Representative Johnson admitted that he wasn’t aware of any other medical procedures that had no-coverage clauses.
No one spoke against the proposal on the Senate floor.
Theories about cell phone use being hazardous to our health have been around nearly as long as the phones themselves, but now one city wants to help protect citizens. Specifically, the city of San Francisco, California could soon start requiring retailers to post notices showing how much radiation is emitted by the cell phones they sell.
In a 10-1 vote, the Board of Supervisors gave preliminary approval to the ordinance, which would require cellular phone retailers to provide the “specific absorption rate” – a measure of radiation registered with the FCC – for each phone offered for sale.
It is expected that Mayor Newsom will sign the measure into law after a ten-day comment period.
Supervisor Sophie Maxwell, chief sponsor of the legislation says this measure is all about “…helping people make informed choices,” but representatives of the cell phone industry disagree. They feel such an ordinance could mislead customers into believing that some phones are less dangerous than others. As well, there are issues about how such disclosures might affect cell phone manufacturers’ liability.
Tags: cell phones, health insurance
The Christian Science Monitor reports that the number of underinsured Americans increased by over a third between 2003 and 2007, from 15 million to 25 million, and despite the passage of the health care reform bill earlier this year, there may be even more people who have some health insurance, but not enough to cover their medical costs.
A 2008 study by the nonprofit, nonpartisan Commonwealth Fund says that these underinsured citizens, working people who have to buy their own insurance, or whose employers only offer plans with high copayments and thousand-dollar deductibles are increasingly found among the middle class, and that they’re acting more and more like the 47 million Americans who have no insurance at all: skipping recommended care because they’re afraid they can’t pay for it. It is the often-ignored preventative care that medical experts say is the key to keeping healthcare costs down across the board.
According to the study, a total of 75 million working adults where either un- or underinsured in 2007, or about 42 percent of the total US population between the ages of 19-64 – increased from roughly a third of the population just four years earlier.
Cathy Schoen, senior vice president of the Commonwealth Fund, and a co-author of the study explained, “This erosion in insurance protection is putting patients, families, and the nation’s health and economic security at risk. As a nation we are losing ground. We need to move in new directions.”
The good news – at least for some, is that we’re nearing the time when some of the reforms passed last March will come to fruition. For example:
By September, insurers will no longer be able to deny coverage to a child because of a pre-existing condition, and they will no longer to be able to insure a child but exclude treatment for pre-existing conditions.
Expected by the end of this month, companies who offer health plans to employees will be required to provide coverage to retired workers between the ages of 55 and 64, who do not yet qualify for Medicare, though this plan is a temporary measure.
In addition, it is expected that the creation of the federal high-risk insurance pool will still happen by the beginning of July.
Will all of this mean an end to all underinsured and uninsured Americans? Sadly, no, but reform comes slowly, and as more measures fall into place we will see those numbers begin to drop.
Environmental and health officials in Louisiana are requesting that federal safety officials take steps to protect the health of those who are helping with the clean-up of the BP oil spill in the Gulf of Mexico, the Insurance Journal reports.
Alan Levine, Health and Hospitals Secretary, and Peggy Hatch, Environmental Quality Secretary, say that daily reports of illness and injuries have them concerned that clean-up workers aren’t getting proper protection. They are worried enough that they’ve asked OSHA (the Occupational Safety and Health Administration) to investigate.
“Reports of injuries and illness among workers hired by British Petroleum and its subcontractors are steadily increasing,” said the letter signed by Health and Hospitals Secretary Alan Levine and Environmental Quality Secretary Peggy Hatch. They continued, “We also are receiving daily reports of other injuries and illnesses that have us concerned that proper protections are not being taken and protocols followed,” but did not provide further details.
BP may bring 3,000 more clean-up workers to their state, the secretaries say, and they want to ensure that every one of them receives the necessary training, supplies, and protective equipment.
In Louisiana hospitals, doctors have reported that some of the workers are seeking treatment for respiratory issues, headaches and nausea. (An unspoken concern is the massive amount of paperwork for health insurance claims.)
The letter to OSHA also said that the Department of Health and Hospitals has begun “an aggressive surveillance and monitoring system to catalog worker-related illnesses and exposure complaints.” It asked for a list of worker complaints made to OSHA and the federal agency’s findings.
Last Friday, June 4th, Gov. Bobby Jindal signed an order to let out-of-state paramedics help with emergency care for oil cleanup workers.
Tags: BP oil spill, health insurance, Louisiana
HealthLeaders-InterStudy, a Nashville, Tenn.-based provider of managed care market intelligence, is reporting that Dallas, Texas area employers are having to pay higher premiums in order to provide health insurance coverage for their employees, because the region has such a high number of uninsured people.
The high uninsured rate in the Dallas region, according to the Dallas Market Overview, is causing the amount of uncompensated care in local hospitals to dramatically increase, which, in turn, makes hospitals pressure health plans for higher reimbursements in order to help them balance some of the losses that are tied to such care. Continuing the cycle, those increased reimbursements make health insurance premiums cost more for everyone else.
How high is the uninsured rate in the Dallas area? Well, as of July, 2009, it was 24 percent. Per data fro the U.S. Census, this makes Texas the nation’s leader in the percentage of uninsured residents, which totals 25 percent.
Throughout the region, efforts to reduce medical costs are emerging. These solutions include the creation of patient-centered medical homes, wellness programs, and a regional health-information exchange.
Tags: health coverage, health insurance
With all the talk of health insurance reform, including much reference to pre-existing conditions, and rules on when coverage may be canceled by an insurer, it’s natural to wonder exactly who is “in charge” of all that information. The answer? The MIB, that stands for Medical Insurance Board, and they’re a membership organization owned by life insurance companies in the United States and Canada.
Their purpose is to maintain a database which allows their member companies to exchange “confidential information of underwriting significance” whenever someone applies disability income, health insurance, life insurance, long term care, or critical illness insurance. This information is submitted to the MIB whenever an insurance application is completed, transmitted in a coded, encrypted format which ensures that confidential information remains so.
What does your MIB file include? If you’ve ever looked at the invoice for a doctor visit, before or after insurance, you’ve probably noticed that there’s a code number attached to every procedure and every complaint. That coded information, which identifies everything from medical conditions to tests to some non-medical items of data like hazardous hobbies or a dangerous job, is reported by MIB members (your doctor or hospital) to the MIB, itemized under fairly general categories. Don’t worry, the MIB doesn’t have the details; they only get a coded “resume” provided by the member.
When you apply for insurance coverage, underwriters at your insurer compare the information on your application to the coded information your file. No decisions – such as declining to offer coverage, or charging you a higher premium – can be made entirely on the basis of these coded reports, but they are used as an alert system.
If you wish to find out if you have an MIB file, and what information it contains, the federal Fair Credit Reporting Act, as amended by the Fair and Accurate Credit Transactions Act of 2003, allows you make an annual request for free disclosure of your report. Only you can make the request, and you’ll be required to answer some identifying information before it’s released.
Follow Our Tweets!