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English: President Barack Obama discusses his ...

In Indianapolis, the health care law will have a huge impact on Hoosiers health insurance along with the rest of the country. Thursday the Supreme Court is expected to rule on the health care reform law. Many residents are questioning the true impact of the health care.

A famous quote was “We have to pass the bill so that you find out what’s in it” House Speaker Nancy Pelosi. People are starting to realize the health care reform is not living up to expectations.

The main selling points of the law.

1st It would bring down the cost of health care. The President said families would save on average $2,500 a year on their premiums.

According to the Kaiser Family Foundation, The health care law has already increased the cost of health insurance and most of the law in will not go into effect until 2014.  6 out of 10 Americans have seen premiums rise for families on average of $1,300 a year. So the costs are going up and the bill is not even in full force.

2nd  President Obama said “If you like your doctor, you will be able to keep your doctor, period. If you like your health plan, you will be able to keep your health plan, period. No one will take it away, no matter what.” This is not the case. The latest report from The Congressional Budget Office says up to 20 million American could lose their employer- provided health insurance as a direct result of the health care reform. 

3rd The President stated that that cost of the health care reform was under a Trillion dollars. The CBO say the health care will cost $1.76+ Trillion over the next decade.  That is a $800 billion mistake.

When we look at the few positive aspects of the law they are really overshadowed by the negative.

Every resident should be paying attention to the Supreme Court Ruling.

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English: Logo of the U.S. Food and Drug Admini...

Calorie Labeling under the Health Care Law 

Here is one aspect of the health care law that has had really little attention. Calorie labeling!

Under the health care reform law all restaurants with 20 locations must disclose calories on the menus and menu boards. Sodium, fat content and other nutritional information would have to be available upon request. The FDA has been working on the details ever since.  The goal of this provision is to combat obesity by helping the consumer make informed choices of what they are eating.

In 2009, researchers at the Stanford University School of Business analyzed purchases at more than 200 Starbucks stores in the city of New York and found that calorie postings led to a 6 percent reduction in calories per transaction

Everyday more information comes out about the health care law.

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Indianapolis

 

 

Welborn Health Plans announced that they are exiting the health insurance market in Indiana.  They had more than 30,000 members. It comes to no surprise why small health insurance providers pull of Indianapolis. Most of these small companies rent PPO networks. This means they have additional cost in the form of access fees. The rented network also can not deliver as deep of discount vs. a national network.

The last few years we have seen carriers like UnitedHealthcare and Anthem really control the Indianapolis market. In the Southern part of the state Humana is very competitive.  One of the reason these companies have a huge advantage here is they own their own network. This gives them the ability to get the deepest network discount when it comes to claims.

Small companies like Welborn are going to have a difficult time competing now and in the future.  One could go as far to say they cannot compete against national companies.  

The problem with the small health carrier leaving the area is that it reduces the competition.  A lack of competition can only lead to higher pricing.

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English: The Supreme Court of the United State...

The Supreme Court’s ruling should be out very soon on the Affordable Care Act.  If they overturn the individual mandate, you will hear terms like death spiral & adverse selection.

A death spiral is where the healthy people leave the insurance market and there are only sick people left. This would increase premiums and the Insurance industry would have a hard time staying in business.

If the mandate is overturned there are a couple reasons why the insurance industry might stay in business.

The first one is a tax subsidy. If the Federal Government is paying a portion of the premium it could be affordable for most people. Then the insurance pools would have some healthy people to try to offset the high utilization people.

The second one is aged base premium. This is where the premium is based on age. The 20 something’s, would have a lower premium than the 60 something.  The theory behind this is the young people are less likely to have claims.

It all comes down to price. If the premium is affordable then people might join the ranks of being insured. If the premium is more than rent or a mortgage payment people will not buy.

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There have been some changes with Anthem and the treatment of Autism in the state of Indiana.

If you or member of your family is receiving benefits for services for the treatment of Pervasive development Disorder (PDD) and are currently covered with Anthem there are big changes.

This is based in part by the Law on the Individuals with Disabilities Education Act (IDEA), which requires public schools to address the needs of students with PPD by creating, an Individualized Education

US-autism-6-11-1996-2005
US-autism-6-11-1996-2005 (Photo credit: Wikipedia)

Program for each student. The public schools system is suppose to be able to treat children suffering from PDD. 

Anthem is not going to duplicate coverage that is available through the school system.  There can always be exceptions.  The services available through public schools are explained on the Indianapolis Department of Education website.

Don’t panic!

With any coverage there are steps to getting claims paid. All treating physicians are going to need to be involved. Investigate what programs are available through your schools. Then check with current treatments to see if there are any overlapping procedures.  The overlapping procedures are going to be the areas of concerns.  Calculate what the treatments are costing.  

If your child is receiving 7 different therapies and only 2 of them are covered in the schools system then you only have to be concerned with the 2.

Also beware of Anthem’s appeal process.  There could be situations where the claims are denied but then approved with a detailed appeal process with your Doctor.

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The Star of Life, medical symbol used on some ...
 

What Doctors Think of the Affordable Care Act

This document looks at how the Implementation of the affordable Care act will affect doctors.

The introduction is a snap shot of the uncertainties with the new law. The law it’s self is 2,700 page and the Department of Health & Human Services has already issued over 12,000 pages elaborating on the original document. It is expected there will additional clarifications needed. 

Reimbursement rates are a major economic concern with doctors. There are concerns with both Medicare and Medicaid reimbursement rates as it is. This could create a barrier for Doctors to embrace the ACA. It is estimated that Medicaid reimbursement rates are just 56% of private payment.

The attitude of the medical professional toward the ACA will have a big impact on the public. This article addresses some of those perceptions. One of those perceptions is if doctors feel the ACA will harm their ability to interact and treat patients. Doctors have concerns that medical decisions could ultimately made by the government. An example of this would the Independent Payment Advisory Board.

How will Doctors React to the new law. “If doctors cannot practice as they wish, it raises the question of whether they will practice.”  

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A medical record folder being pulled from the ...

The individual health insurance industry can still decline coverage. These declines come from ongoing health conditions.  The insurance companies are very conservative at this time.

If you are declined coverage you have the option to appeal their decision. During appeal process, medical records will be order from all of your doctors.  These medical records can go back through your entire health history. There might be something within the records that you don’t even know about which can lead to a decline. This can be very frustrating, especially when there is a miss diagnoses that has not been updated. It’s the doctor responsibility to update your medical records. Many times they don’t.

Even if your appeal is denied you do have one option left. File a grievance with the carrier! This can be a very effective method to getting your policy approved.  Once the grievance is filed, now you have additional eyes looking at your case.  These additional eyes can help reverse the initial decline.

The grievance process can be a powerful tool for you wining a appeal.

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House Republican Press Conference on Health Ca...

 

A rule created by the 2010 health care law will rebate about $1.3 Billion in health insurance premiums, according to estimates from Kaiser Family Foundation. The rule known as the Medical Loss Ratio (MLR), mandates that health insurance companies spend 80% of all premiums on health care. The rebates will arrive to Indiana resident no later than August 1st. If you have a health insurance policy and you had little or no claims there is very good chance that you could receive rebate. There is also some debate that you could see a premium reduction from the health insurance carrier.

 

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Obesity Campaign Poster
Obesity Campaign Poster (Photo credit: Pressbound)

 

The rate of obesity in our country has grown drastically and it affects everyone.

Now under the U.S. health care reform law of 2010 employers are able charge obese workers 30 percent to 50 percent more for health insurance if they decline to participate in a qualified wellness program.

There are proven statics showing Obese people have more medical claims than non obese.

Obese men rack up an additional $1,152 a year in medical spending, especially for hospitalizations and prescription drugs, Cawley and Chad Meyerhoefer of Lehigh University reported in January in the Journal of Health Economics. Obese women account for an extra $3,613 a year. Using data from 9,852 men (average BMI: 28) and 13,837 women (average BMI: 27) ages 20 to 64, among whom 28 percent were obese, the researchers found even higher costs among the uninsured: annual medical spending for an obese person was $3,271 compared with $512 for the non-obese.

So now under the new health care laws employers do have an option to try to help employees address obesity.  Obviously, telling someone they have to participate in a wellness program or pay 50% more in premium might not help with morale. 

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A specialist cardiology stethoscope.
A specialist cardiology stethoscope. (Photo credit: Wikipedia)

Local residents are still faced with challenges when it comes to purchasing an Individual or family policy.

One of the biggest challenges is with underwriting.  Currently you still can be declined coverage due to ongoing health condition or what is in your doctors a record.

Most people have very little knowledge what your doctors attending physician statement say about you.   For some reason the Doctors are not real willing to give out this information even though they are your records.  Most medical practices will charge you $25 and only release the records on a certain day of the week.

It is very important that you  discuss with your doctor what is listed. Far too many times the doctor is listing diagnoses without ever telling you.  Some of the times those diagnoses are wrong or no longer valid.

Now you go out to market to purchase a individual health insurance policy. The insurance company requests your attending physician statement.  Next thing you know you are being declined coverage because of something listed in your medical records that you are unaware of. Then you call your doctor and find out well “I just had not updated my records.”

Now you are faced will appealing the insurance companies decision and get your doctor to release correct medical information. This will cost you time and money.

Everyone should request copies of your medical records on an annual basis so you know what is in those records.  This way there are no surprises.

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