Mandated Appeals and External Review
Effective first of the plan year or after September 23, 2010 , health plans will have in effect internal claims appeal procedures. Each plan must allow the insured to review his or her plan to present evidence and testimony as part of the appeal process. So what this means is if carrier declines a claim […]
Physician-Rating Measures
The major health carriers have developed a kind of efficiency rating for doctors and hospitals. These rating systems are directly communicating with the consumer. The rating systems show price of a procedure and quality of care. So if an insured wants to look up how many times a doctor has performed a certain procedure they […]
Explanation of Health Care Tax Credit for Indiana
This is the clearest explanation that I could find on the health care tax credit. This information was put together by 15 attorneys that specialize in interpreting these types of laws. This is very complicated. What was spun as a simple tax credit is very difficult to qualify and understand. A small business might end up spending […]
Indiana HealthCare Reform
As we move through and have a better understanding of this very complicated health care reform it becomes clearer the disconnect from the white house and real life. This is so complicated and the effects are only going to raise costs. For Small group health plans there is very little chance they can be grandfathered […]
The Changing Cost of Healthcare in Indiana.
Last week there was an article in the Indianapolis Star called Do your home work or pay the price. http://www.indystar.com/article/20100629/BUSINESS/6270392/1003/BUSINESS It was a very interesting article because it address what has been going on in the health care industry locally and the rest of the country. What we are are seeing is hospital groups buying up smaller medical practices. […]
New HHS Website
http://healthfinder.gov/ Was recently launched to help people understand what options they have from a health insurance standpoint. The site also incorporates disease management. So now every0ne has a tool that they can use to look at health insurance options. In the past a % of the population has gone uninsured because they did not know […]
HHS Releases Final Interim Guidance on Several PPACA Provisions
HHS Releases Final Interim Guidance on Several PPACA Provisions On June 22, 2010, the Departments of Health & Human Services, Labor, and Treasury issued new regulations that better define the following PPACA provisions: No Pre-Existing Condition Exclusions for Anyone Under Age 19 No Arbitrary Rescissions of Insurance Coverage No Lifetime Dollar Limits on Coverage […]
Health Care Reform Impacts Indiana Maternity Coverage
Starting in the fall, all new health plans must cover certain preventive screenings and other services for pregnant women at no additional cost to the patient. Those include folic acid supplements, which reduce the risk of neural tube defects in developing fetuses, and counseling to help pregnant women stop smoking. Medicaid will also begin to […]
Enrollment Declines With Top Health Plans in 2009
Mark Farrah Associates (MFA), a leading provider of market data and intelligence solutions to the health care industry reported a huge decline in member ship among eight top health insurers: Aetna, CIGNA, Health Care Service Corporation (HCSC), Health Net, Humana, Kaiser Permanente, UnitedHealth Group and WellPoint. Enrollment declines continued for most of the nation’s leading health […]
Medicare Physician Payment Cuts May Increase Cost Of Private Insurance
Right now there are a lot of people predicting that if the Medicare cuts are not fixed then health care providers will cost shift to private carriers. This means that if the 21% reduction in Medicare reimbursement is not fixed the hospitals will charge private insurance more money. I find this hard to believe. Hospitals can try to […]
