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CMS has just released data on the differences in medical cost from different hospitals. This is a very big story in the medical community because now the hospital groups have to justify what they charge. This information has always been kept out of the public eye but this report will opens everyone eyes that cares.

In the past few years, the national health insurance carriers have released tools to their members to help them research different medical procedures. People have been shocked to see just the difference in cost for diagnostic procedures.

If we look at a tool developed by Anthem. This comparison tool will allow you to research multiple procedures. If we look at the cost of a MRI on your Knee in the 46278 zip code. It is listed that Alliance Health Care Services is charging $490 for that MRI. Now if we look at what St. Francis charges for the exact same procedure the cost is $1,612.  It’s the same procedure and they are using the same equipment. So why is it that a hospital is charging so much more?

With the release of the data from CMS, this may create more questions for the health care industry.

Health insurance premiums are directly related to what the cost of care is. When the cost of care continues to rise so do our health insurance premiums.


Anthem Care Comparison

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Well there is not much information floating around about tax credits for small groups on the health insurance exchange.

If a small group employer was to purchase health insurance from the exchange they may be eligible for tax credits. That tax credit could be as high as 50% of the total premium the company contributed toward the employee portion. 50% is a big tax credit.

There are eligibility requirements for this tax credit. An employer cannot have more than 25 full time employees and the average salary cannot exceed $50,000.

In 2014 there are going to be new options in the small group health insurance market. One of the options every business owner should look at is the tax credit through the Federal Exchange.

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Politico just released a story about talks of exempting Congress staffers from the Insurance mandate.

You can’t make this up!  These are very people that are suppose to understand the laws they pass.  Come to find out, very few of them have any understanding of the law.

Congress is worried about “brain drain” by losing young staffers and old staffers.  They think that these staffers are going to have to pay $7,000 a year for health insurance.

These staffers and aids are going to have the same options as the everyone else. The 1st option would be to purchase a health insurance plan through an Exchange. If the exchange is state based or Federal, then these people could apply for subsidies. If they qualify for subsidies then they would only pay a percentage of their household income for a health insurance policy.

So instead of Congress actually sitting down and trying to understand the law, they are discussing just exempting staffers and aids from the health insurance mandate.

It’s not very hard to figure out that we already have a “brain drain” going on in Congress.


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Subsidy Calculator

Here is a calculator for federal subsides through the health insurance exchange.

The calculator is will estimate the cost of the insurance plan under the silver option.

The tax credit that is available and the estimated monthly premium the insured will incur.


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The Hill has posted an interesting article about Senator Max Baucus.

It looks like the Senator is worried about the communication of the health insurance laws. The Senator has had public conversations with HHS about getting actual information and not just concepts.  Since the Senator was one of the main authors of the bill he has a lot of concerns.

If the Senator is have problems getting information, how do you think the public feels?

Anyone in the industry has predicted this would happen.

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New information has been released about health insurance exchange policies and premium payments. Under the new law, if you buy a policy from the health insurance exchange, you have a 90 day grace period to pay premiums. This is going to have a huge impact on how doctors treat exchange policyholders.

Doctor may be reluctant to treat exchange policy holders. If a doctor treats you while your policy is in the grace period, and then that policy lapses, the doctor may be force to try to collect from the patient. This will create major problems for the medical practice.

Let’s say the patient goes to have an outpatient surgery. The medical practice would file a predetermination of benefits. The insurance company comes back and states the policy is active. They perform the surgery and file the claim. Then let’s say that policy was at the end of the grace period and the insured loses the policy because of lack of payment. The insurance company is not going to pay that claim because the procedure happen during the grace period and the insured did not pay the back premium.  Now the medical provider is stuck trying to collect a $30,000 fee. The probability of them collecting this is very low.

This new information could have a big impact on how doctors treat patients that have an exchange policy.



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The Society of Actuaries released a study on the projected increases for health insurance premiums under the new health care laws.

It does not look good. Our health insurance premiums are projected to go up 67% under the new health care laws.  This is a huge jump because of health care reform.

We are one of the states getting the highest increase. The SOA believes these increased premiums will be on new policies purchased in 2014.

They state that self funded group plans should not be affected in this manner.


This study should be getting more attention.

With these kinds of rate increases projected, Hoosiers are going to be more dependent of Federal Subsidies through the health insurance exchange.


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Health insurance companies continue to create online tools and apps to help insured have better control of their health care.

United Health Care has launched a new app call Smart Patient. This app is for either IPhone or Droid.

The app will hold of the patient medical information and more.

The application tracks 5 numbers that are essential to good health.

• Blood pressure
• Blood sugar
• Body mass index (BMI)
• Cholesterol
• Weight circumference

Smart patients are prepared with questions throughout their care.
• At a doctor visit
• Before a test
• After a diagnosis
• When filling prescriptions
• Before surgery
• When leaving the hospital
• If you need to go to the emergency room or urgent care

It also track Doctors Orders:

Once you have advice from your doctor, you’ll want to keep track of it. Store text notes or voice notes to refer to later, and delete them when you’re ready.

The app also has access to video that address certain health issues.

Get tips on when to have screenings, how to talk with your doctor, how to tell if it’s a cold or the flu, what to ask your pharmacist, and much more with short videos from UHC TV.

These types of tools are becoming more available to insureds. These tools come along with the policy so it does not cost you anything to use them. Why not take advantage of these tool to better control your health.

Smart Patient


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Under the new Health Care Reform laws, all breast pumps must be covered at no cost to the insured.

As you can imagine this has created some shortages.

If you find yourself in need of breast pump, look on the back of your insurance card for a phone number for member services.

This number will put you in contact with durable medical suppliers in the network. From there you should be able to find a breast pump.

You may want to ask your doctor if they have any in stock.

Be sure to utilize any online services that your insurance company provides. The online services can be a great source for information on durable medical equipment.


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The Essential Health Benefits have been released by the federal government. This dictates that Insurers must cover 10 broad categories of care. This includes maternity services, doctor and medical services, mental health and substance abuse, and prescription drugs.

Why is this important?

All individual and small group will be effected by this ruling. This document is 149 pages long.  Even Medicaid will have to cover the essential benefit.

Out of pocket max will be dictated to all health plan even self funded. For an individual the out of pocket max can not be more than $6,250 and for family $12,500. In 2014 you will not be able to get a policy that has a higher out of pocket. This could have a big impact on a lot o plans.

There has been a large amount of individual plans sold online, that have a higher out of pocket. Those plans will have to comply with the new rule or you could pay a penalty.

The benefits does allow people to get drugs that are needed but not on the drug formulary. So if you need a certain cancer drug then you should be able to obtain it. This is viewed as a positive thing.

The best news, is that insurance companies cannot charge for colonoscopy even if a polyp is found. This has been one of the most frustrating coverages for Hoosiers. You go in to have a colonoscopy and it is covered at 100% by the insurance plan, under preventive care. Then the doctor finds a polyp and now you have a diagnosis code and a bill for $1,200. So under the law the entire procedure is coverage at 100% with no cost to the insured.


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