/PRNewswire/ -- Several nationally recognized healthcare experts have joined forces to create HIPAA.com, a single-source resource site where visitors will find access to HIPAA regulations, American Recovery and Reinvestment Act (ARRA) updates, and practical guidance on what to do to meet new regulations.
"Most of our readers are seeking help on ARRA's requirement that Business Associates become covered entities, effective February 20, 2010," says Edward D. Jones, III, founding partner of HIPAA.com and leading authority on healthcare, insurance, electronic remittance/payments, and electronic health record (EHR) issues. Jones also was a founding commissioner of the Electronic Healthcare Network Accreditation Commission (EHNAC) and served as the Chair of the Workgroup for Electronic Data Interchange (WEDI).
While HIPAA.com serves as a single-source search site, the founders are clear about not offering legal advice. "We refer these inquiries to our health law partners, many of whom will soon be listed on our site," says David Cargile, co-founder of HIPAA.com. Cargile is CEO of Cargile Consulting, Inc. and previously served as the CEO of the Centris Group, U.S. Benefits, and USF Reinsurance Company and Reinsurance Facilities Corporation.
"HIPAA.com is the go-to resource for all information and services related to privacy laws and policies. [HIPAA.com] has expanded to guide health systems and providers in benefiting from the new Health Information Technology stimulus dollars. HIPAA.com is now a great source for both privacy and HIT," says Joseph E. Scherger, MD, MPH, Vice President of Primary Care at the Eisenhower Medical Center in Rancho Mirage, CA.
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Wednesday, June 10, 2009
Monday, June 01, 2009
HHS Releases $30 Million to Help Medicare Beneficiaries Access Their Benefits
HHS Secretary Kathleen Sebelius today released $25 million in grants to
help older people, individuals with disabilities and their caregivers
apply for special assistance through Medicare, and an additional $5
million for a national resource center to support these important
efforts.
These grants, made possible by the Medicare Improvements for Patients
and Providers Act of 2008 (MIPPA), will provide valuable support at the
state and community levels for organizations involved in reaching and
providing assistance to people likely to be eligible for the Low-Income
Subsidy program (LIS), Medicare Savings Program (MSP), the Medicare Part
D Prescription Drug Program and in helping beneficiaries to apply for
benefits. This initiative also includes special targeting efforts to
rural areas of the country and to Native American elders.
"Medicare is essential to our effort to provide high-quality health care
to all Americans," said Secretary Sebelius. "Many people could be
eligible for extra help through Medicare and not even know it. We know
that beneficiaries with the greatest needs are often the most difficult
to reach," said Secretary Sebelius. "Through these new collaborations at
the federal, state and local levels, we will better be able to target
and provide one-on-one assistance to our most vulnerable citizens."
This MIPPA funding, which is jointly administered by HHS' Administration
on Aging (AoA) and the Centers for Medicare & Medicaid Services (CMS),
is being awarded to State Health Insurance Assistance Programs (SHIPs),
State Agencies on Aging, Area Agencies on Aging (AAAs), Aging and
Disability Resource Centers (ADRCs), Native Americans Tribal
Organizations and local communities to help seniors, caregivers and
those with disabilities on Medicare. These organizations are important
members of HHS' national network of state, tribal and community-based
organizations that assist seniors, caregivers and those with
disabilities with health benefits information and information on other
services, and enable them to remain independent and living in their
communities as long as possible.
"HHS is working hard to reach people who are unaware, unsure or unable
to apply for assistance for the benefits they deserve," said Charlene
Frizzera, acting administrator for CMS. "Through this collaboration
between AoA and CMS, state and community-based organizations will be
able to work in partnership and make maximum use of these federal funds
to help seniors and those with disabilities on Medicare." CMS and AoA
have worked closely together on this and other outreach efforts to
assist older Americans, those with disabilities and their families to
access important benefits and services.
"MIPPA presents a new opportunity to build on the successful partnership
between AoA and CMS through the Medicare Part D outreach efforts, our
Chronic Disease Self-Management Programs, ADRCs, and the National
Clearinghouse for Long-Term Care Information," said Edwin L. Walker,
acting Assistant Secretary for Aging. "This new effort allows us to
team up again so that we can leverage federal, state and local resources
to deliver health and long-term care services and information to those
who need it most."
The National Center for Benefits Outreach and Enrollment, administered
by the National Council on Aging (NCOA), will help inform beneficiaries
about benefits available under federal and state programs, utilize
cost-effective strategies to find older individuals with the greatest
economic need, coordinate state and local efforts by providing a best
practice clearinghouse, data collection, training and technical
assistance.
-----
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help older people, individuals with disabilities and their caregivers
apply for special assistance through Medicare, and an additional $5
million for a national resource center to support these important
efforts.
These grants, made possible by the Medicare Improvements for Patients
and Providers Act of 2008 (MIPPA), will provide valuable support at the
state and community levels for organizations involved in reaching and
providing assistance to people likely to be eligible for the Low-Income
Subsidy program (LIS), Medicare Savings Program (MSP), the Medicare Part
D Prescription Drug Program and in helping beneficiaries to apply for
benefits. This initiative also includes special targeting efforts to
rural areas of the country and to Native American elders.
"Medicare is essential to our effort to provide high-quality health care
to all Americans," said Secretary Sebelius. "Many people could be
eligible for extra help through Medicare and not even know it. We know
that beneficiaries with the greatest needs are often the most difficult
to reach," said Secretary Sebelius. "Through these new collaborations at
the federal, state and local levels, we will better be able to target
and provide one-on-one assistance to our most vulnerable citizens."
This MIPPA funding, which is jointly administered by HHS' Administration
on Aging (AoA) and the Centers for Medicare & Medicaid Services (CMS),
is being awarded to State Health Insurance Assistance Programs (SHIPs),
State Agencies on Aging, Area Agencies on Aging (AAAs), Aging and
Disability Resource Centers (ADRCs), Native Americans Tribal
Organizations and local communities to help seniors, caregivers and
those with disabilities on Medicare. These organizations are important
members of HHS' national network of state, tribal and community-based
organizations that assist seniors, caregivers and those with
disabilities with health benefits information and information on other
services, and enable them to remain independent and living in their
communities as long as possible.
"HHS is working hard to reach people who are unaware, unsure or unable
to apply for assistance for the benefits they deserve," said Charlene
Frizzera, acting administrator for CMS. "Through this collaboration
between AoA and CMS, state and community-based organizations will be
able to work in partnership and make maximum use of these federal funds
to help seniors and those with disabilities on Medicare." CMS and AoA
have worked closely together on this and other outreach efforts to
assist older Americans, those with disabilities and their families to
access important benefits and services.
"MIPPA presents a new opportunity to build on the successful partnership
between AoA and CMS through the Medicare Part D outreach efforts, our
Chronic Disease Self-Management Programs, ADRCs, and the National
Clearinghouse for Long-Term Care Information," said Edwin L. Walker,
acting Assistant Secretary for Aging. "This new effort allows us to
team up again so that we can leverage federal, state and local resources
to deliver health and long-term care services and information to those
who need it most."
The National Center for Benefits Outreach and Enrollment, administered
by the National Council on Aging (NCOA), will help inform beneficiaries
about benefits available under federal and state programs, utilize
cost-effective strategies to find older individuals with the greatest
economic need, coordinate state and local efforts by providing a best
practice clearinghouse, data collection, training and technical
assistance.
-----
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Thursday, May 21, 2009
Blue Cross and Blue Shield of Georgia and Piedmont Healthcare Announce Contract Renewal
/PRNewswire/ -- Blue Cross and Blue Shield of Georgia (BCBSGA) and Piedmont Healthcare announced today that they have reached agreement on a three-year contract, effective August 1, 2009.
Under the agreement, BCBSGA HMO/POS and PPO members can continue to access Piedmont Healthcare as an in-network provider, including services from Piedmont Clinic physicians, Piedmont Hospital in Atlanta, Piedmont Fayette Hospital in Fayetteville, Piedmont Mountainside Hospital in Jasper, and Piedmont Newnan Hospital in Newnan.
"We are pleased to continue our relationship with Piedmont Healthcare," said Amy Cheslock, vice president of health services, BCBSGA. "As the state's largest health benefits provider, this new contract allows us to continue offering our members a wide range of choices and continued access to affordable, quality health care."
"We are pleased to renew our participation in the BCBSGA provider network that serves so many of our patients," said Gregory A. Hurst, executive vice president and chief operating officer for Piedmont Healthcare. "Piedmont has a long-standing commitment to the residents of Georgia and the communities we serve. This agreement ensures that BCBSGA members will continue to have access to the highest quality healthcare and the physicians and hospitals they have come to trust."
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Under the agreement, BCBSGA HMO/POS and PPO members can continue to access Piedmont Healthcare as an in-network provider, including services from Piedmont Clinic physicians, Piedmont Hospital in Atlanta, Piedmont Fayette Hospital in Fayetteville, Piedmont Mountainside Hospital in Jasper, and Piedmont Newnan Hospital in Newnan.
"We are pleased to continue our relationship with Piedmont Healthcare," said Amy Cheslock, vice president of health services, BCBSGA. "As the state's largest health benefits provider, this new contract allows us to continue offering our members a wide range of choices and continued access to affordable, quality health care."
"We are pleased to renew our participation in the BCBSGA provider network that serves so many of our patients," said Gregory A. Hurst, executive vice president and chief operating officer for Piedmont Healthcare. "Piedmont has a long-standing commitment to the residents of Georgia and the communities we serve. This agreement ensures that BCBSGA members will continue to have access to the highest quality healthcare and the physicians and hospitals they have come to trust."
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Tuesday, May 12, 2009
Sebelius Statement on New Medicare Trustees' Report
President Obama understands that Medicare is an essential program that
provides care for millions of our seniors and the disabled. We will do
whatever it takes to protect it.
But today's report should trouble anyone who is concerned about the
future of Medicare and health care in America. Just as families,
communities and businesses are struggling under the crushing burden of
skyrocketing health care costs, so too are our Medicare Trust funds.
This isn't just another government report. It's a wake up call for
everyone who is concerned about Medicare and the health of our economy.
And it's yet another sign that we can't wait for real, comprehensive
health reform.
I want to highlight two examples of the problem we're facing. First, the
Hospital Insurance Trust Fund helps cover the cost of beneficiaries'
hospital stays and related care. Today, the fund spends more than it
takes in and we make up the difference using assets from the fund. But
in 2017 - eight years from now - those assets will be exhausted if we
don't do something. Second, the Supplementary Medical Insurance Trust
Fund helps pay for medical care and prescription drugs. This fund is
solvent, but only because premiums and general revenue financing are
reset every year, requiring seniors and the Federal budget to pay more
for their care. If health care costs keep going up, our beneficiaries
will continue to see their premiums rise at unsustainable rates.
I know this alarm has been sounded before. Politicians have been
worrying about the growth of Medicare spending for many years.
The Obama Administration isn't just worrying; we're doing something
about it. And if we want to bring down the cost of health care in this
country and strengthen our economy, then we all must show leadership and
take action to control costs.
At the Department of Health and Human Services, we have started using
our administrative authorities to keep Medicare costs in check.
The President's budget is another crucial step. It includes new
incentives that put quality first, make Medicare more efficient and save
taxpayer dollars. The President's budget also fights fraud in Medicare
that costs us billions each year by providing a 50 percent increase in
funding to help crack down on anyone who tries to cheat the system.
We are working with Congress on legislation that includes and goes
beyond the cost-savings policies in the President's budget. The only
way to slow Medicare spending is to slow overall health system spending
through comprehensive and carefully crafted legislation.
But we cannot do it alone. Yesterday the President stood with the
health care leaders from the private sector who have come together to
pledge to cut health care spending by $2 trillion over 10 years, which
would result in savings of $2,500 for a family of four.
Medicare is central to the effort to promote high-quality, affordable
health care for all Americans. As the nation's largest insurer, its
success will both improve the lives of seniors and disabled
beneficiaries and set the standard for other insurers. But we know that
its success in becoming a strong and sustainable program depends on our
ability to fix what's broken in the rest of the system. When previously
uninsured Americans join Medicare, they are less healthy and cost the
system more. Giving the uninsured coverage before they join Medicare
will improve their quality of life and save money for Medicare.
If we fail to take action, health care costs will only get worse and
Medicare spending will increase. Businesses will see more of their
profits consumed by health care. Families will continue to struggle.
We know that bending the cost curve is an important component of health
care reform, and key to strengthening Medicare.
And this report makes it clear: reform can't wait. All of us in the
Administration look forward to working with Congress to make reform a
reality.
-----
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provides care for millions of our seniors and the disabled. We will do
whatever it takes to protect it.
But today's report should trouble anyone who is concerned about the
future of Medicare and health care in America. Just as families,
communities and businesses are struggling under the crushing burden of
skyrocketing health care costs, so too are our Medicare Trust funds.
This isn't just another government report. It's a wake up call for
everyone who is concerned about Medicare and the health of our economy.
And it's yet another sign that we can't wait for real, comprehensive
health reform.
I want to highlight two examples of the problem we're facing. First, the
Hospital Insurance Trust Fund helps cover the cost of beneficiaries'
hospital stays and related care. Today, the fund spends more than it
takes in and we make up the difference using assets from the fund. But
in 2017 - eight years from now - those assets will be exhausted if we
don't do something. Second, the Supplementary Medical Insurance Trust
Fund helps pay for medical care and prescription drugs. This fund is
solvent, but only because premiums and general revenue financing are
reset every year, requiring seniors and the Federal budget to pay more
for their care. If health care costs keep going up, our beneficiaries
will continue to see their premiums rise at unsustainable rates.
I know this alarm has been sounded before. Politicians have been
worrying about the growth of Medicare spending for many years.
The Obama Administration isn't just worrying; we're doing something
about it. And if we want to bring down the cost of health care in this
country and strengthen our economy, then we all must show leadership and
take action to control costs.
At the Department of Health and Human Services, we have started using
our administrative authorities to keep Medicare costs in check.
The President's budget is another crucial step. It includes new
incentives that put quality first, make Medicare more efficient and save
taxpayer dollars. The President's budget also fights fraud in Medicare
that costs us billions each year by providing a 50 percent increase in
funding to help crack down on anyone who tries to cheat the system.
We are working with Congress on legislation that includes and goes
beyond the cost-savings policies in the President's budget. The only
way to slow Medicare spending is to slow overall health system spending
through comprehensive and carefully crafted legislation.
But we cannot do it alone. Yesterday the President stood with the
health care leaders from the private sector who have come together to
pledge to cut health care spending by $2 trillion over 10 years, which
would result in savings of $2,500 for a family of four.
Medicare is central to the effort to promote high-quality, affordable
health care for all Americans. As the nation's largest insurer, its
success will both improve the lives of seniors and disabled
beneficiaries and set the standard for other insurers. But we know that
its success in becoming a strong and sustainable program depends on our
ability to fix what's broken in the rest of the system. When previously
uninsured Americans join Medicare, they are less healthy and cost the
system more. Giving the uninsured coverage before they join Medicare
will improve their quality of life and save money for Medicare.
If we fail to take action, health care costs will only get worse and
Medicare spending will increase. Businesses will see more of their
profits consumed by health care. Families will continue to struggle.
We know that bending the cost curve is an important component of health
care reform, and key to strengthening Medicare.
And this report makes it clear: reform can't wait. All of us in the
Administration look forward to working with Congress to make reform a
reality.
-----
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Thursday, April 30, 2009
Oxendine: Can Your Health Insurance Cope with Swine Flu?
Insurance Commissioner John W. Oxendine wants Georgians to be prepared for a possible swine flu outbreak by reviewing whether their health insurance policies will cover possible contingencies like hospitalization and prescription medications.
The Commissioner suggested that you take a few minutes and consider these questions:
* Does your policy have a preauthorization requirement for hospital admission or other services?
* What is your co-payment for the most common H1N1 treatments? The two drugs doctors can prescribe to treat H1N1 flu are Tamiflu and Relenza. Also find out if there are any coverage limitations that apply to the distribution of the medication. Some policies will restrict coverage on the number of doses per prescription or per year.
* What is your out-of-network co-payment? If your area is heavily affected by the spread of the H1N1 flu outbreak, your regular physician may not be able to see you in a timely manner. If you have to go out-of-network, be aware you will have to pay a higher co-payment for your office visit and possibly any tests run during the visit. Get prepared for any eventuality with the following checklist:
-- Have your health insurance I.D. card handy.
-- Review your health insurance policy provisions. Know which doctors and hospitals are in your network.
-- Make note of your co-payments. Know how much a doctor's office visit will cost. Check to see if your co-payments go up if you go out-of-network.
-- Find the list of pharmacies covered by your health insurance policy.
-- If you have plans to travel, make sure you check to see if there are any doctors or medical facilities in-network where you will be visiting.
-- Make sure you have contact details for your health insurance company available in case you have questions. Your employer may gather all pertinent health insurance information together for you in one simple-to-reference form. If they do, post the information where it can easily be accessed by you and your family.
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---
The Commissioner suggested that you take a few minutes and consider these questions:
* Does your policy have a preauthorization requirement for hospital admission or other services?
* What is your co-payment for the most common H1N1 treatments? The two drugs doctors can prescribe to treat H1N1 flu are Tamiflu and Relenza. Also find out if there are any coverage limitations that apply to the distribution of the medication. Some policies will restrict coverage on the number of doses per prescription or per year.
* What is your out-of-network co-payment? If your area is heavily affected by the spread of the H1N1 flu outbreak, your regular physician may not be able to see you in a timely manner. If you have to go out-of-network, be aware you will have to pay a higher co-payment for your office visit and possibly any tests run during the visit. Get prepared for any eventuality with the following checklist:
-- Have your health insurance I.D. card handy.
-- Review your health insurance policy provisions. Know which doctors and hospitals are in your network.
-- Make note of your co-payments. Know how much a doctor's office visit will cost. Check to see if your co-payments go up if you go out-of-network.
-- Find the list of pharmacies covered by your health insurance policy.
-- If you have plans to travel, make sure you check to see if there are any doctors or medical facilities in-network where you will be visiting.
-- Make sure you have contact details for your health insurance company available in case you have questions. Your employer may gather all pertinent health insurance information together for you in one simple-to-reference form. If they do, post the information where it can easily be accessed by you and your family.
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---
Wednesday, April 29, 2009
30 Days to Hurricane Season: FEMA Advises to Prepare Now With Flood Insurance
/PRNewswire/ -- June 1, 2009 marks the beginning of Atlantic hurricane season. In addition to knowing appropriate safety precautions, FEMA recommends protecting your property now with a flood insurance policy. It typically takes 30 days from the time of purchase for a policy to become effective.
"Past hurricane seasons have shown that storms can form as early as the beginning of June, so property owners can't afford to wait to buy flood insurance," said Ed Connor, Acting Federal Insurance Administrator and Acting Assistant Administrator, FEMA Mitigation Directorate. "Homeowners insurance doesn't cover flood damage and, without flood insurance, property owners may have to absorb the financial losses on their own. Just a few inches of water can cost thousands of dollars in repairs and, in this economy, few can afford that potential drain on their savings."
Flood insurance is affordable and available through about 85 insurance companies in approximately 20,600 participating communities nationwide. National flood insurance is available to renters, business owners and homeowners, even if it is not required by the terms of a mortgage. While the average flood insurance policy is around $540 a year, homeowners can protect their properties in moderate-to low-risk areas with lower cost Preferred Risk Policies (PRPs) that start at just $119 a year.
Individuals can learn how to prepare for floods, how to purchase a flood insurance policy and the benefits of protecting their properties against flooding by visiting Floodsmart.gov or calling 1-800-427-2419.
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"Past hurricane seasons have shown that storms can form as early as the beginning of June, so property owners can't afford to wait to buy flood insurance," said Ed Connor, Acting Federal Insurance Administrator and Acting Assistant Administrator, FEMA Mitigation Directorate. "Homeowners insurance doesn't cover flood damage and, without flood insurance, property owners may have to absorb the financial losses on their own. Just a few inches of water can cost thousands of dollars in repairs and, in this economy, few can afford that potential drain on their savings."
Flood insurance is affordable and available through about 85 insurance companies in approximately 20,600 participating communities nationwide. National flood insurance is available to renters, business owners and homeowners, even if it is not required by the terms of a mortgage. While the average flood insurance policy is around $540 a year, homeowners can protect their properties in moderate-to low-risk areas with lower cost Preferred Risk Policies (PRPs) that start at just $119 a year.
Individuals can learn how to prepare for floods, how to purchase a flood insurance policy and the benefits of protecting their properties against flooding by visiting Floodsmart.gov or calling 1-800-427-2419.
-----
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Tuesday, April 21, 2009
On-Line Petition Launched in Support of a National Health Insurer Code of Conduct
(BUSINESS WIRE)--In an effort to ensure and protect patient access to approved medical treatments, a petition in support of a Health Insurer Code of Conduct was launched today by the Alliance for Patient Access (AfPA). The petition calls for the adoption of a Code of Conduct, currently being drafted by the American Medical Association, which will address restrictive practices of the managed care industry which undermine the integrity of doctor-patient relationships.
The AMA House of Delegates passed a resolution in November of 2008 to draft and adopt a National Health Insurer Code of Conduct. According to the resolution, the AMA code will set forth clear and concise principles addressing both medical policies and payment issues, as well as create a mechanism to monitor compliance by managed care companies.
Currently, while many managed care organizations maintain appropriate focus on quality measures, some managed care plans and pharmacy benefit managers employ aggressive tactics to cut costs, while at the same time shifting blame for consequences of actions such as premium increases and cost-sharing strategies onto other parties in the healthcare industry.
“In Georgia, the cost-control efforts implemented by managed care health plans have created the widespread perception that such plans are more interested in saving money than providing quality health care,” said Dr. Christina Mayville, a neurologist in Macon, GA. “Unlike many other stakeholders in the health care industry, however, there is no overarching standard of conduct for health plans. The Alliance for Patient Access is taking the lead to collect support for a Code of Conduct to empower health plans to voluntarily agree to abide by principled guidelines and specific protocols regarding certain issues that are particularly prone to abuse.”
AfPA’s petition calls for autonomy between doctors and managed care companies, as well as full transparency regarding a patient’s prescribed course of care. This includes any relationships with outside parties that might influence doctors’ decisions. AfPA also calls for upholding business integrity, with fees reflecting acceptable rates and prescribed courses of treatment resulting from medically-based, not fiscally-driven, decisions. Finally, AfPA’s first priority remains patients’ access to quality medical care that ensures their safety and welfare.
“A Code of Conduct for the managed care industry is highly overdue,” said Dr. David Charles, AfPA Chairman. “The petition is a way for us to show managed care companies that we will not stand by as they attempt to interfere with the course of treatment prescribed to patients by their doctors. A Health Insurer Code of Conduct will help protect patients by regulating the practices of managed care companies and holding them accountable to the same standards to which the rest of the healthcare industry already adheres.”
The American Medical Association (AMA) passed a resolution in November 2008 to adopt a Health Insurer Code of Conduct, which it is currently drafting. The AMA will vote to adopt the code in June.
The AfPA petition for a Health Insurer Code of Conduct can be found at www.insurepatientaccess.org.
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The AMA House of Delegates passed a resolution in November of 2008 to draft and adopt a National Health Insurer Code of Conduct. According to the resolution, the AMA code will set forth clear and concise principles addressing both medical policies and payment issues, as well as create a mechanism to monitor compliance by managed care companies.
Currently, while many managed care organizations maintain appropriate focus on quality measures, some managed care plans and pharmacy benefit managers employ aggressive tactics to cut costs, while at the same time shifting blame for consequences of actions such as premium increases and cost-sharing strategies onto other parties in the healthcare industry.
“In Georgia, the cost-control efforts implemented by managed care health plans have created the widespread perception that such plans are more interested in saving money than providing quality health care,” said Dr. Christina Mayville, a neurologist in Macon, GA. “Unlike many other stakeholders in the health care industry, however, there is no overarching standard of conduct for health plans. The Alliance for Patient Access is taking the lead to collect support for a Code of Conduct to empower health plans to voluntarily agree to abide by principled guidelines and specific protocols regarding certain issues that are particularly prone to abuse.”
AfPA’s petition calls for autonomy between doctors and managed care companies, as well as full transparency regarding a patient’s prescribed course of care. This includes any relationships with outside parties that might influence doctors’ decisions. AfPA also calls for upholding business integrity, with fees reflecting acceptable rates and prescribed courses of treatment resulting from medically-based, not fiscally-driven, decisions. Finally, AfPA’s first priority remains patients’ access to quality medical care that ensures their safety and welfare.
“A Code of Conduct for the managed care industry is highly overdue,” said Dr. David Charles, AfPA Chairman. “The petition is a way for us to show managed care companies that we will not stand by as they attempt to interfere with the course of treatment prescribed to patients by their doctors. A Health Insurer Code of Conduct will help protect patients by regulating the practices of managed care companies and holding them accountable to the same standards to which the rest of the healthcare industry already adheres.”
The American Medical Association (AMA) passed a resolution in November 2008 to adopt a Health Insurer Code of Conduct, which it is currently drafting. The AMA will vote to adopt the code in June.
The AfPA petition for a Health Insurer Code of Conduct can be found at www.insurepatientaccess.org.
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Friday, March 13, 2009
The Amputee Coalition of America and Nearly 200 Amputees and Patient Advocates Go to Washington
(BUSINESS WIRE)--On Tuesday, March 10, the Amputee Coalition of America had nearly 200 amputees and patient advocates from 34 states in Washington, D.C., to urge members of Congress to support fair insurance coverage for artificial arms and legs. Their message was simple: Arms and legs are not a luxury!
These citizen lobbyists made this trip to tell lawmakers that they need their own “bailout.” Many of them have nightmarish stories of fighting with insurance companies to try to get the prosthetic devices they need to work and live.
“Insurance companies are unrealistically limiting reimbursement of prosthetic arms and legs or summarily electing not to cover them at all,” said Kendra Calhoun, Amputee Coalition president and CEO. “We intend to turn this tide, and this event is a great example of the grassroots support we have from across the country. Arms and legs are not luxury items. Mobility is a serious issue for amputees who want to keep their jobs, take care of their families, and live healthy, active lives.”
Jeffrey Cain, MD, is a bilateral lower-limb amputee and a member of the Amputee Coalition’s Board of Directors and Medical Advisory Committee. Dr. Cain is an excellent example of how prosthetic devices can help amputees function in their daily lives and contribute to society rather than become dependent on it.
“Being able to have prosthetic devices means that I can take care of my patients and teach medical students,” said Dr. Cain.
Unfortunately, working people with employer-provided health insurance plans are often the ones with the biggest problems, Dr. Cain noted. “Because employer-provided insurance plans are increasingly introducing unreasonable limits and caps, if you have a job in America – if you are a hardworking member of society – you can’t afford a leg to stand on. It’s gotten that bad.”
In fact, some insurance companies are providing coverage for only one prosthesis per lifetime or eliminating coverage completely.
“Even for older adults, it is absurd to expect them to use only one prosthesis in their lifetime,” Calhoun said. “No one would expect a person to wear a single pair of shoes their entire life, and prosthetic devices should be no different.”
These types of insurance company practices pose especially grave challenges for families of children with limb loss.
Rick Castro, of Connecticut, took two of his children to the event because he wanted to try to get better prosthetic coverage for all families, including his own. Castro’s 4-year-old daughter Jennifer was born missing part of her arm below the elbow, and Castro is well aware that, as she grows, she’ll need several highly expensive prosthetic devices.
“When people find out that their insurance company doesn’t provide fair coverage for prosthetic devices, what do they do?” asked Dr. Cain. “They mortgage their homes, raid their children’s college fund, go into debt, turn to government programs for assistance, or are forced to have bake sales to try to pay for these medically necessary and often very expensive devices. That’s pretty sad, especially when they’ve paid their insurance premiums for years for this very purpose.”
David Ross, of New York City, lost part of his right hand and his right leg above the knee after he was mugged and thrown in front of a subway in 1997. He’s seen what happens when amputees have to settle for devices that are not really what they need because of the limitations in their insurance policies, and that’s what brought him to Capitol Hill.
“It’s so unfair that prosthetics are not covered by health insurance plans to the same degree that other conditions are,” Ross said. “It’s a shame that a lot of my fellow amputees who have already had to get over a traumatic accident or being born without a limb have to fight for something that should already be included in their insurance policy.”
Robert D. Doty, Jr., MD, who lost his left arm as a result of a car falling on him, has had problems with his insurance company not understanding – or not acknowledging – his prosthetic needs.
“My carrier did not want to cover a body-powered prosthesis after covering a myoelectric prosthesis,” Doty said. “The company said that one prosthesis is as good as another and that they can do the same thing, which is not true. I can’t do anything around water, liquids, chemicals or heavy machinery or do any heaving lifting with my myoelectric prosthesis without damaging it. It’s great for doing fine, precise work, but if I’m going to be doing heavy lifting or working around water or liquids, a body-powered prosthesis is better. I really need both.”
As these nearly 200 citizen lobbyists hustled from office to office, they made it clear that they want change. In a single day, they made more than 60 Senate visits and more than 100 House visits. In addition, 26 organizations, including disability rights groups and O&P [orthotic and prosthetic] professional organizations, have now signed on with the Amputee Coalition of America to help move this legislation forward.
“We are thrilled with the results of the day,” said Morgan Sheets, the Amputee Coalition’s national advocacy director. “We are already hearing from House and Senate members who are interested in co-sponsoring our bills and supporting our efforts for fair coverage of artificial arms and legs. The turnout exceeded our expectations, and the great enthusiasm of the participants has certainly encouraged us to continue this important fight for fairness.”
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These citizen lobbyists made this trip to tell lawmakers that they need their own “bailout.” Many of them have nightmarish stories of fighting with insurance companies to try to get the prosthetic devices they need to work and live.
“Insurance companies are unrealistically limiting reimbursement of prosthetic arms and legs or summarily electing not to cover them at all,” said Kendra Calhoun, Amputee Coalition president and CEO. “We intend to turn this tide, and this event is a great example of the grassroots support we have from across the country. Arms and legs are not luxury items. Mobility is a serious issue for amputees who want to keep their jobs, take care of their families, and live healthy, active lives.”
Jeffrey Cain, MD, is a bilateral lower-limb amputee and a member of the Amputee Coalition’s Board of Directors and Medical Advisory Committee. Dr. Cain is an excellent example of how prosthetic devices can help amputees function in their daily lives and contribute to society rather than become dependent on it.
“Being able to have prosthetic devices means that I can take care of my patients and teach medical students,” said Dr. Cain.
Unfortunately, working people with employer-provided health insurance plans are often the ones with the biggest problems, Dr. Cain noted. “Because employer-provided insurance plans are increasingly introducing unreasonable limits and caps, if you have a job in America – if you are a hardworking member of society – you can’t afford a leg to stand on. It’s gotten that bad.”
In fact, some insurance companies are providing coverage for only one prosthesis per lifetime or eliminating coverage completely.
“Even for older adults, it is absurd to expect them to use only one prosthesis in their lifetime,” Calhoun said. “No one would expect a person to wear a single pair of shoes their entire life, and prosthetic devices should be no different.”
These types of insurance company practices pose especially grave challenges for families of children with limb loss.
Rick Castro, of Connecticut, took two of his children to the event because he wanted to try to get better prosthetic coverage for all families, including his own. Castro’s 4-year-old daughter Jennifer was born missing part of her arm below the elbow, and Castro is well aware that, as she grows, she’ll need several highly expensive prosthetic devices.
“When people find out that their insurance company doesn’t provide fair coverage for prosthetic devices, what do they do?” asked Dr. Cain. “They mortgage their homes, raid their children’s college fund, go into debt, turn to government programs for assistance, or are forced to have bake sales to try to pay for these medically necessary and often very expensive devices. That’s pretty sad, especially when they’ve paid their insurance premiums for years for this very purpose.”
David Ross, of New York City, lost part of his right hand and his right leg above the knee after he was mugged and thrown in front of a subway in 1997. He’s seen what happens when amputees have to settle for devices that are not really what they need because of the limitations in their insurance policies, and that’s what brought him to Capitol Hill.
“It’s so unfair that prosthetics are not covered by health insurance plans to the same degree that other conditions are,” Ross said. “It’s a shame that a lot of my fellow amputees who have already had to get over a traumatic accident or being born without a limb have to fight for something that should already be included in their insurance policy.”
Robert D. Doty, Jr., MD, who lost his left arm as a result of a car falling on him, has had problems with his insurance company not understanding – or not acknowledging – his prosthetic needs.
“My carrier did not want to cover a body-powered prosthesis after covering a myoelectric prosthesis,” Doty said. “The company said that one prosthesis is as good as another and that they can do the same thing, which is not true. I can’t do anything around water, liquids, chemicals or heavy machinery or do any heaving lifting with my myoelectric prosthesis without damaging it. It’s great for doing fine, precise work, but if I’m going to be doing heavy lifting or working around water or liquids, a body-powered prosthesis is better. I really need both.”
As these nearly 200 citizen lobbyists hustled from office to office, they made it clear that they want change. In a single day, they made more than 60 Senate visits and more than 100 House visits. In addition, 26 organizations, including disability rights groups and O&P [orthotic and prosthetic] professional organizations, have now signed on with the Amputee Coalition of America to help move this legislation forward.
“We are thrilled with the results of the day,” said Morgan Sheets, the Amputee Coalition’s national advocacy director. “We are already hearing from House and Senate members who are interested in co-sponsoring our bills and supporting our efforts for fair coverage of artificial arms and legs. The turnout exceeded our expectations, and the great enthusiasm of the participants has certainly encouraged us to continue this important fight for fairness.”
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Saturday, March 07, 2009
Panel Discussion to Address Impacts of Today's Economy on Retirement
Behind The Headlines: Making the Most of Your Retirement targeted to 70 + age group
WHO: Discussion members include Donna Barwick, J.D., Senior Director of Wealth Management for The Bank of New York Mellon; Henry Bowden, founder of The Bowden Law Firm; John J. Geraghty, Executive Vice-President of SunTrust Bank; Jim Hansberger, Managing Director, The Hansberger Group; and Michael A. Mohr, Managing Director of The Bank of New York Mellon in Atlanta. Emory Schwall, an Atlanta attorney, Certified Estate Planner and Special Assistant Attorney General for the State of Georgia representing the Insurance Commission, will moderate the discussion.
WHAT: Just how has the change in economy affected retirement? What’s it going to take to retire with security, manage long-term health care, and protect one's estate? Where are the financial risks? A panel of financial experts will discuss these questions and more at the discussion, “Behind the Headlines: Making the Most of Your Retirement.” The discussion will address estate planning, asset allocation, health care management, living wills, retirement strategies and other topics of interest to the 70+ age group.
WHEN: Monday, March 16, 2009, from 2:00 p.m. to 4:00 p.m.
WHERE: Woodruff Auditorium of the Atlanta History Center
WHY: The panel discussion is in response to recent news stories about the economy, much of which is aimed at baby boomers and their challenges, but little directly relating to people already enjoying retirement. The event is one in a three-part series hosted by Peachtree Hills Place, a residential community offering a continuum of care in Buckhead for people ages 55 and older, that will discuss the issues directly affecting this demographic.
Please Note: The event is free and open to the public, but registration is required. For more information or to register, call Peachtree Hills Place at 404-467-4900
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WHO: Discussion members include Donna Barwick, J.D., Senior Director of Wealth Management for The Bank of New York Mellon; Henry Bowden, founder of The Bowden Law Firm; John J. Geraghty, Executive Vice-President of SunTrust Bank; Jim Hansberger, Managing Director, The Hansberger Group; and Michael A. Mohr, Managing Director of The Bank of New York Mellon in Atlanta. Emory Schwall, an Atlanta attorney, Certified Estate Planner and Special Assistant Attorney General for the State of Georgia representing the Insurance Commission, will moderate the discussion.
WHAT: Just how has the change in economy affected retirement? What’s it going to take to retire with security, manage long-term health care, and protect one's estate? Where are the financial risks? A panel of financial experts will discuss these questions and more at the discussion, “Behind the Headlines: Making the Most of Your Retirement.” The discussion will address estate planning, asset allocation, health care management, living wills, retirement strategies and other topics of interest to the 70+ age group.
WHEN: Monday, March 16, 2009, from 2:00 p.m. to 4:00 p.m.
WHERE: Woodruff Auditorium of the Atlanta History Center
WHY: The panel discussion is in response to recent news stories about the economy, much of which is aimed at baby boomers and their challenges, but little directly relating to people already enjoying retirement. The event is one in a three-part series hosted by Peachtree Hills Place, a residential community offering a continuum of care in Buckhead for people ages 55 and older, that will discuss the issues directly affecting this demographic.
Please Note: The event is free and open to the public, but registration is required. For more information or to register, call Peachtree Hills Place at 404-467-4900
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Monday, March 02, 2009
Government To Help Pay Health Insurance For Out Of Work Americans
(SPM Wire) Americans who lost their jobs or will lose their jobs anytime between September 1, 2008 and the end of 2009 are about to find it easier to afford health care insurance.
The federal government has announced it temporarily will pay for 65 percent of the cost of health insurance for laid-off workers who lost their jobs during this period.
This provision was signed into law as part of the recent economic stimulus plan and will provide people with up to nine months of partial payments for their health care premiums. The money is available to those whose yearly adjusted gross income doesn't exceed $125,000 or $250,000 for those who file their taxes jointly.
The payments will be made through what is known as COBRA, a federal regulation that allows employees to keep their company health insurance for up to 18 months after they leave their jobs. Now, the government will help subsidize 65 percent of ex-employee COBRA premium payments if they lost their jobs during the qualifying period.
And workers who had turned down COBRA benefits can reapply and receive the subsidy if their layoffs occurred since September 1, 2008.
The new stimulus plan covers premium payments for coverage periods beginning after February 17 - the date the plan was signed into law - and is not retroactive for coverage prior to this date.
Don't wait too long to apply for the new government subsidy, as there is a window during which you are eligible, depending on when you lost your job.
There is some fine print, however, as many Americans who have been recently terminated worked for companies with fewer than 20 employees. These small businesses generally aren't eligible for COBRA, since it only applies to businesses employing more than 20 individuals. Speak with your employer if you have any questions.
For more information about COBRA, which itself became law in 1985, visit the U.S. Department of Labor Web site at www.dol.gov.
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The federal government has announced it temporarily will pay for 65 percent of the cost of health insurance for laid-off workers who lost their jobs during this period.
This provision was signed into law as part of the recent economic stimulus plan and will provide people with up to nine months of partial payments for their health care premiums. The money is available to those whose yearly adjusted gross income doesn't exceed $125,000 or $250,000 for those who file their taxes jointly.
The payments will be made through what is known as COBRA, a federal regulation that allows employees to keep their company health insurance for up to 18 months after they leave their jobs. Now, the government will help subsidize 65 percent of ex-employee COBRA premium payments if they lost their jobs during the qualifying period.
And workers who had turned down COBRA benefits can reapply and receive the subsidy if their layoffs occurred since September 1, 2008.
The new stimulus plan covers premium payments for coverage periods beginning after February 17 - the date the plan was signed into law - and is not retroactive for coverage prior to this date.
Don't wait too long to apply for the new government subsidy, as there is a window during which you are eligible, depending on when you lost your job.
There is some fine print, however, as many Americans who have been recently terminated worked for companies with fewer than 20 employees. These small businesses generally aren't eligible for COBRA, since it only applies to businesses employing more than 20 individuals. Speak with your employer if you have any questions.
For more information about COBRA, which itself became law in 1985, visit the U.S. Department of Labor Web site at www.dol.gov.
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Monday, February 02, 2009
Oxendine Warns of Consequences of Proposed Health Insurance Tax
Insurance and Safety Fire Commissioner John W. Oxendine testified to legislators during his agency’s appropriations hearings that increasing the tax on health insurers and hospitals would lead to higher health insurance rates, more uninsured and could add to the financial hardships facing small hospitals already strapped for cash.
“I felt an obligation to inform the members of the House and Senate subcommittees that the proposal is more than just a 1.6 percent tax on health insurers and hospitals,” Oxendine said. “If passed, this measure will increase the cost of health insurance, and could force more Georgians into the ranks of the uninsured. In addition, the financial problems that hospitals are already facing will only be compounded.”
Oxendine’s remarks were in response to the Department of Community Health’s proposal to raise $317 million in revenue for fiscal year 2010 by imposing a new tax on health insurers and hospitals.
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“I felt an obligation to inform the members of the House and Senate subcommittees that the proposal is more than just a 1.6 percent tax on health insurers and hospitals,” Oxendine said. “If passed, this measure will increase the cost of health insurance, and could force more Georgians into the ranks of the uninsured. In addition, the financial problems that hospitals are already facing will only be compounded.”
Oxendine’s remarks were in response to the Department of Community Health’s proposal to raise $317 million in revenue for fiscal year 2010 by imposing a new tax on health insurers and hospitals.
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Friday, January 30, 2009
Oxendine: Sylvester Peanut Warehouse Fire was Accidental; Loss Estimated at $3.5 Million
Insurance and Safety Fire Commissioner John W. Oxendine announced earlier this week that the fire that gutted the Farm Commodities Peanut Warehouse in Sylvester, GA, last Tuesday was accidental.
Our investigation was able to rule out arson, electrical problems, and weather as causes of the fire," Oxendine said. "We believe acetylene cutting torches used in the warehouse the day before the fire may have sparked the blaze."
The fire, which continued to smolder for several days, caused an estimated $3.5 million loss, Oxendine said: $2 million on the structure and $1.5 million on contents.
More than 2300 tons of peanuts were burning," Oxendine said. "This is a serious economic loss for this community."
Several local fire departments pitched in to extinguish the blaze, which took most of last week, Oxendine added.
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Our investigation was able to rule out arson, electrical problems, and weather as causes of the fire," Oxendine said. "We believe acetylene cutting torches used in the warehouse the day before the fire may have sparked the blaze."
The fire, which continued to smolder for several days, caused an estimated $3.5 million loss, Oxendine said: $2 million on the structure and $1.5 million on contents.
More than 2300 tons of peanuts were burning," Oxendine said. "This is a serious economic loss for this community."
Several local fire departments pitched in to extinguish the blaze, which took most of last week, Oxendine added.
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Thursday, December 04, 2008
Oxendine Orders Blue Cross to Reimburse $12 Million
OXENDINE ORDERS BLUE CROSS
TO REIMBURSE $12 MILLION
Atlanta – Insurance Commissioner John W. Oxendine announced today that he has ordered Blue Cross and Blue Shield of Georgia, Inc. to make additional claims payments of $12 million for certain ambulance services rendered to its policyholders that were improperly reimbursed.
The consent order is the result of a market conduct exam initiated by Oxendine’s office which revealed that Blue Cross incorrectly reimbursed out-of-network ambulance providers for services rendered. In a number of instances, Blue Cross made inconsistent payments for comparable ambulance services. In other cases, Blue Cross failed to increase its reimbursement rates over a number of years, in spite of the increasing costs of providing ambulance services.
“The proper payment of claims for emergency services is vital to the maintenance of our trauma system and equally important to protect consumers from excessive balance billing. I want insurers to know that I expect providers to be paid according to the requirements of Georgia law,” Oxendine said.
As a result of this action, Blue Cross has also been ordered to increase reimbursement rates for future out-of-network ambulance services. “Resolving prior practices is only part of the solution,” Oxendine said. “We must ensure that insurance companies reimburse medical providers and policyholders in a fair and equitable manner.”
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TO REIMBURSE $12 MILLION
Atlanta – Insurance Commissioner John W. Oxendine announced today that he has ordered Blue Cross and Blue Shield of Georgia, Inc. to make additional claims payments of $12 million for certain ambulance services rendered to its policyholders that were improperly reimbursed.
The consent order is the result of a market conduct exam initiated by Oxendine’s office which revealed that Blue Cross incorrectly reimbursed out-of-network ambulance providers for services rendered. In a number of instances, Blue Cross made inconsistent payments for comparable ambulance services. In other cases, Blue Cross failed to increase its reimbursement rates over a number of years, in spite of the increasing costs of providing ambulance services.
“The proper payment of claims for emergency services is vital to the maintenance of our trauma system and equally important to protect consumers from excessive balance billing. I want insurers to know that I expect providers to be paid according to the requirements of Georgia law,” Oxendine said.
As a result of this action, Blue Cross has also been ordered to increase reimbursement rates for future out-of-network ambulance services. “Resolving prior practices is only part of the solution,” Oxendine said. “We must ensure that insurance companies reimburse medical providers and policyholders in a fair and equitable manner.”
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Wednesday, March 26, 2008
High Court Okays Federal Rule on Cutting Health Benefits
(CNSNews.com) - The Supreme Court has declined to hear an appeal of a federal policy that allows employers to reduce their health insurance expenses for retired workers once they turn 65 and qualify for Medicare. The court turned down an appeal from the AARP, which wanted to reverse a rule allowing employers to reduce medical benefits for retirees depending on their age. On July 14, 2003, the Equal Employment Opportunity Commission (EEOC) proposed to exempt "the practice of altering, reducing or eliminating employer-sponsored retiree health benefits when retirees become eligible for Medicare or a State-sponsored retiree health benefits program" from the Age Discrimination in Employment Act...
http://www.cnsnews.com/ViewNation.asp?Page=/Nation/archive/200803/NAT20080326a.html
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Thursday, November 09, 2006
Controlling Health Insurance Costs
“Health insurance is so expensive!!!” That’s what my clients tell me everyday and I have to agree with them. Many small business owners say the cost of health insurance has risen to the point that it is the second most expensive monthly bill, the first being payroll.
Many people have tried to explain the reasons for this cost trend. The reality is that there are many reasons for it. There is no one thing that can be done to lower the cost, it will take an effort from everyone from the doctors, to the pharmaceutical companies, but most importantly, it will have to start right here with the consumers.
The first step in controlling the cost of health insurance is understanding where the cost comes from. The prices of medical procedures are very well kept secrets. Great West Healthcare commissioned Harris Interactive (2005) to conduct a survey about consumers and their knowledge of health care costs. Some of the statistics that the study brought to light are startling. To offer a reference point respondents were also asked some non health care related questions. When asked about the price of a new Honda Accord, the respondents were over by 1%. When asked the price of a round trip ticket in coach from New York to Los Angeles, they were over by 8%. When asked about the cost of an average four day stay in a hospital, they were off by 56% believing that the cost would be around $6,400.00 instead of the actual cost of $14,500.00. Only 15% of respondents asked about the cost of a procedure before they were treated. They also assumed that a 24 hour hospital stay would only vary by 20% based on the location, instead of the actual difference of 60%. In reality, we have not had to take responsibility for this information in the past. With the escalating cost of health insurance, which closely relates to the cost of health care, it is more important now than ever before to take control of these costs.
Where do we go from here? For the immediate time, it is important to get information on how much our health care costs. The way to press ourselves into this is simply by taking advantage of high deductible health plans (HDHPs) and health savings accounts (HSAs). In a nutshell, this means that you take a lower cost health insurance plan, and put money into a special tax favored fund (HSA). The insurance will not cover doctor visits or medications or any other health care needs until you exhaust a high deductible (HDHP). The money for all those other expenses comes from your own account (the HSA). When the doctor prescribes a medication, you will find yourself asking for a lower priced alternative in order to preserve your account. You may even find yourself asking the doctor about prices. At no point does anyone believe that a person will choose a doctor, procedure or medication based on price alone. We will begin to determine our medical needs the same way we determine everything else in our lives, by the quality versus the price. Right now we have no reason to determine the prices, because we have the notion that the insurance companies will pay whatever the price is. We neglect to remember that we pay the insurance companies, so we are ultimately responsible for the costs anyway.
Another way we can lower our cost is by looking for the company and plan that best fits our needs. Many people are over insured, that is, they pay more out than they will ever get back. Finding an agent that will help you shop is the bottom line on getting the right health plan and company. Many businesses are finding that the insurance companies that they have used for many years no longer offer the best value. They also find out that other companies are much better than they realized. It is important to find an agent who is a thrifty shopper for your health insurance. It is always wise to use an independent agent, because they know all the different companies and the plans offered from each.
Obviously, if you can join a group that offers a true discount on health insurance through a reputable company, that is a great source of savings. The Fayette County Chamber of Commerce has a terrific new arrangement for health insurance through Humana. Qualifying members can save 4% off the street rates for the identical products.
To help with your future costs, you must first look at the culture your company fosters. A good place to start is your vending machines. Are they full of junk food? Consider starting slowly by adding raisins and pretzels and then every few weeks adding another healthy alternative. Look also at the drink selection. Make sure that you offer juices and non carbonated beverages. Increase the healthy choices over time. People will often eat what is most available. If they crave a candy bar, they will find a way to get it, but you don’t need to provide candy. Make it part of the culture of your business to promote good nutrition and make it more difficult to eat unhealthy foods.
Another good idea is to promote a healthy life style. Consider a company bowling team, or softball team. Participate in a walking group or running club as a company. Help pay for gym membership and try to attend aerobics classes as a team. Give out a company t shirt when employees have hit attainable milestones, such as walked for 30 minutes three days out of every week for six months. By making the goals attainable, but challenging, those who have been sedentary as well as those who have been active can achieve them. These ideas can cost anywhere from nothing for a walking club to a small fee for a team or membership. Many gyms will discount memberships for small companies. It is important to find an activity that your employees will enjoy. You must realize that this process may take some time.
Health Fairs are a great way to help your employees discover health issues. Many people have found they have high blood pressure through health fairs, and were able to get on medication before it became a serious health concern. If your business is small, perhaps you can work with other companies in your office complex to put a health fair together. You can even attend a community health fair as a company function. Make sure you add information on smoking cessation and nutrition.
By encouraging your employees to stop smoking, eat more healthy foods, to live a more active lifestyle, and to find medical issues before they escalate to more expensive problems, you can start the process for some future relief on health insurance costs.
Many people have tried to explain the reasons for this cost trend. The reality is that there are many reasons for it. There is no one thing that can be done to lower the cost, it will take an effort from everyone from the doctors, to the pharmaceutical companies, but most importantly, it will have to start right here with the consumers.
The first step in controlling the cost of health insurance is understanding where the cost comes from. The prices of medical procedures are very well kept secrets. Great West Healthcare commissioned Harris Interactive (2005) to conduct a survey about consumers and their knowledge of health care costs. Some of the statistics that the study brought to light are startling. To offer a reference point respondents were also asked some non health care related questions. When asked about the price of a new Honda Accord, the respondents were over by 1%. When asked the price of a round trip ticket in coach from New York to Los Angeles, they were over by 8%. When asked about the cost of an average four day stay in a hospital, they were off by 56% believing that the cost would be around $6,400.00 instead of the actual cost of $14,500.00. Only 15% of respondents asked about the cost of a procedure before they were treated. They also assumed that a 24 hour hospital stay would only vary by 20% based on the location, instead of the actual difference of 60%. In reality, we have not had to take responsibility for this information in the past. With the escalating cost of health insurance, which closely relates to the cost of health care, it is more important now than ever before to take control of these costs.
Where do we go from here? For the immediate time, it is important to get information on how much our health care costs. The way to press ourselves into this is simply by taking advantage of high deductible health plans (HDHPs) and health savings accounts (HSAs). In a nutshell, this means that you take a lower cost health insurance plan, and put money into a special tax favored fund (HSA). The insurance will not cover doctor visits or medications or any other health care needs until you exhaust a high deductible (HDHP). The money for all those other expenses comes from your own account (the HSA). When the doctor prescribes a medication, you will find yourself asking for a lower priced alternative in order to preserve your account. You may even find yourself asking the doctor about prices. At no point does anyone believe that a person will choose a doctor, procedure or medication based on price alone. We will begin to determine our medical needs the same way we determine everything else in our lives, by the quality versus the price. Right now we have no reason to determine the prices, because we have the notion that the insurance companies will pay whatever the price is. We neglect to remember that we pay the insurance companies, so we are ultimately responsible for the costs anyway.
Another way we can lower our cost is by looking for the company and plan that best fits our needs. Many people are over insured, that is, they pay more out than they will ever get back. Finding an agent that will help you shop is the bottom line on getting the right health plan and company. Many businesses are finding that the insurance companies that they have used for many years no longer offer the best value. They also find out that other companies are much better than they realized. It is important to find an agent who is a thrifty shopper for your health insurance. It is always wise to use an independent agent, because they know all the different companies and the plans offered from each.
Obviously, if you can join a group that offers a true discount on health insurance through a reputable company, that is a great source of savings. The Fayette County Chamber of Commerce has a terrific new arrangement for health insurance through Humana. Qualifying members can save 4% off the street rates for the identical products.
To help with your future costs, you must first look at the culture your company fosters. A good place to start is your vending machines. Are they full of junk food? Consider starting slowly by adding raisins and pretzels and then every few weeks adding another healthy alternative. Look also at the drink selection. Make sure that you offer juices and non carbonated beverages. Increase the healthy choices over time. People will often eat what is most available. If they crave a candy bar, they will find a way to get it, but you don’t need to provide candy. Make it part of the culture of your business to promote good nutrition and make it more difficult to eat unhealthy foods.
Another good idea is to promote a healthy life style. Consider a company bowling team, or softball team. Participate in a walking group or running club as a company. Help pay for gym membership and try to attend aerobics classes as a team. Give out a company t shirt when employees have hit attainable milestones, such as walked for 30 minutes three days out of every week for six months. By making the goals attainable, but challenging, those who have been sedentary as well as those who have been active can achieve them. These ideas can cost anywhere from nothing for a walking club to a small fee for a team or membership. Many gyms will discount memberships for small companies. It is important to find an activity that your employees will enjoy. You must realize that this process may take some time.
Health Fairs are a great way to help your employees discover health issues. Many people have found they have high blood pressure through health fairs, and were able to get on medication before it became a serious health concern. If your business is small, perhaps you can work with other companies in your office complex to put a health fair together. You can even attend a community health fair as a company function. Make sure you add information on smoking cessation and nutrition.
By encouraging your employees to stop smoking, eat more healthy foods, to live a more active lifestyle, and to find medical issues before they escalate to more expensive problems, you can start the process for some future relief on health insurance costs.
Monday, September 18, 2006
Kaiser Permanente’s Broker Relations Lead, Susan Cook Receives “Kathy Cruce” Award from
The Georgia Association of Health Underwriters is proud to announce Susan Cook, Broker Relations Lead for Kaiser Permanente, received the Georgia Associations of Health Underwriters “Kathy Cruce” Award. An example of what a first class insurance professional should be, Kathy Cruce gave her time not only to her employer, The Benefit Company, but also to the
Susan is the past president of the South Atlanta Association of Health Underwriters and is currently serving as the media relations chair for the 2006 GAHU Board of Directors. She is also serving as the awards chair for the 2006 SAAHU Board of Directors. “I would not be here today without the continued support of my employer, Kaiser Permanente along with many mentors within this organization,” said Susan Cook upon receipt of the award.
Susan resides in
The Georgia Association of Health Underwriters, a chapter of the NAHU that represents more than 18,000 professional health insurance agents and brokers nationwide who provide insurance to millions of Americans. Over 650 members participate in the organization right here in
Friday, July 28, 2006
Challenges of Human Resources: Ask the Experts
Greater Henry County, Southern Crescent and SHRM Atlanta (South GEM) are all pooling their resources to offer a terrific learning experience.
This will be in an interactive roundtable forum, featuring the following discussion groups:
Conducting Thorough Internal Investigations
Wrongful Discharge or Rightful Discharge: You Decide
Immigration Update
Mediation/Conflict Resolution
Workers Comp Made Easy!
Recent Union Organizing Tactics
Understanding Unemployment Insurance Law
Recruiting Metrics for Improved Performance
Lesbian/Gay/Bisexual/Transgender Issues in the Workplace
Understanding the Funding of Healthcare - How to Stand Toe to Toe with your CFO
Not Your Same Old Fashioned Supplemental Insurance Benefits!
Each presenter is a subject-matter-expert in their respective field and will provide you with professional and practical guidelines you can use to assist you with on-going issues and concerns.
Earn up to 3.5 CEU re-certification credits!
Date: August 14, 2006
Time: 8:00 a.m. - 12:30 p.m.
Location: Clayton State University
Continuing Education Center, Morrow, Georgia
(See www.conted.clayton.edu for directions to event)
Registration fee: $25.00 for advance registration/$35.00 same-day registration for Greater Henry County SHRM members; Southern Crescent SHRM members; or SHRM-Atlanta members
$30.00 for advance registration/$40.00 for same-day registration for non-SHRM members advance registration and payment dead-line is August 9, 2006
Seating is limited - Early registration is recommended and encouraged!
* * * Registration, networking and a full breakfast buffet will begin at 7:00 a.m. * * *
Reservation Information:
If you are a Greater Henry County SHRM; Southern Crescent SHRM or SHRM-Atlanta member, you may register through your normal meeting registration process (each respective SHRM group leader will communicate registration procedures directly to its membership).
If you are not a SHRM member from one of these three groups, you may go on-line to the SHRM-Atlanta website (www.shrmatlanta.org) and establish a "guest account" that will enable you to register for this event
This will be in an interactive roundtable forum, featuring the following discussion groups:
Conducting Thorough Internal Investigations
Wrongful Discharge or Rightful Discharge: You Decide
Immigration Update
Mediation/Conflict Resolution
Workers Comp Made Easy!
Recent Union Organizing Tactics
Understanding Unemployment Insurance Law
Recruiting Metrics for Improved Performance
Lesbian/Gay/Bisexual/Transgender Issues in the Workplace
Understanding the Funding of Healthcare - How to Stand Toe to Toe with your CFO
Not Your Same Old Fashioned Supplemental Insurance Benefits!
Each presenter is a subject-matter-expert in their respective field and will provide you with professional and practical guidelines you can use to assist you with on-going issues and concerns.
Earn up to 3.5 CEU re-certification credits!
Date: August 14, 2006
Time: 8:00 a.m. - 12:30 p.m.
Location: Clayton State University
Continuing Education Center, Morrow, Georgia
(See www.conted.clayton.edu for directions to event)
Registration fee: $25.00 for advance registration/$35.00 same-day registration for Greater Henry County SHRM members; Southern Crescent SHRM members; or SHRM-Atlanta members
$30.00 for advance registration/$40.00 for same-day registration for non-SHRM members advance registration and payment dead-line is August 9, 2006
Seating is limited - Early registration is recommended and encouraged!
* * * Registration, networking and a full breakfast buffet will begin at 7:00 a.m. * * *
Reservation Information:
If you are a Greater Henry County SHRM; Southern Crescent SHRM or SHRM-Atlanta member, you may register through your normal meeting registration process (each respective SHRM group leader will communicate registration procedures directly to its membership).
If you are not a SHRM member from one of these three groups, you may go on-line to the SHRM-Atlanta website (www.shrmatlanta.org) and establish a "guest account" that will enable you to register for this event
Thursday, July 13, 2006
South Atlanta Association of Health Underwriters Held Their Annual Awards Breakfast
South Atlanta Association of Health Underwriters (SAAHU) held their annual awards breakfast. This is always a very popular event. The out going board of directors was thanked for their efforts by out going President Susan Cook (Kaiser Permanente). Each one was presented with a nice parting gift. In coming President, Matt Holcomb (Kayda Insurance) welcomed his new board of directors, including President-Elect, Tim Taylor (Benefit Support Inc), Secretary, Donna Hill (DDH Associates), and Treasurer, Mark Phillips (AFLAC).
The featured speaker was Jim Astuto from Verizon Wireless, who spoke on the rising cost of insurance in the workplace. The meeting was held at The Crowne Plaza on
For more information on SAAHU, please call Matt Holcomb at 678 612 3072. The meetings are the third Thursday of most months at 11:45 at the
Thursday, June 08, 2006
3 million HSA/HDHP policies have been sold nationwide!!!
People are really interested in the new Health Savings Accounts (HSAs). There are now three million of them that have been bought nationwide. These are the new policies that have been getting so much attention, including favorable comments from President Bush.
The idea is to get a High Deductible Health Plan, which is lower priced than the regular health insurance plans. These are very specific insurance policies. With the exception of preventive care, they can not cover anything until you hit the high deductible. Once the deductible is met, they either cover a percent of the rest of the medical needs, or they cover all of the rest of the costs for the year. If they cover a per cent, it is usually until another dollar amount has been reached, at which point they cover all the additional costs for the year.
What happens to all the expenses that come up before the deductible has been met? Well, the idea is that you put some money aside into a special Health Savings Account (HSA). These accounts are available from specific institutions that specialize in them. The money goes into the accounts pre tax, and grows tax free. You take money out for your health needs, also tax free. The institutions that specialize in HSAs often offer debit-like cards so that getting your money out is really easy.
It is expected that the renewals for HDHP policies will be lower, because you really don't use much of the insurance part of the plan. With the usage down, the rates have less reason to rise.
This sounds a lot like the old FSA accounts, except it is better. Individuals can take out HSAs and whether you are a group or an individual, your money is always yours. It does not go away if you don't use it, and there are no deadlines for the usage. Also, if you still have money in your account, it rolls over year after year. When you are 65 you can take out the money at your then tax rate. Anytime you use your money for medical expenses it is tax free, and if you need to take it out for a non medical need, you pay the taxes and a ten per cent penalty.
If your account rolls over and you develope quite a lot of money in it, you may feel pretty comfortable raising your deductible even higher. This will result in even less renewal increases.
So, it sounds pretty good so far, right? Well, it gets better. As you are using the high deductible part of the policy, you still get in network negotiated rates. That means that your dollars will go farther than if you didn't have insurance. In order to get these rates, you must use an in network doctor and facility, of course.
The tax savings part of the account is great, but really think for a minute what that means to your wallet. If you go to the doctor, and his normal rate is $150.00, but the in network negotiated rate is $100.00; if you pay for it with tax free dollars and you are in the 25% tax bracket, it will be like you are paying only $75.00 for the visit. The other $25.00 is your tax savings. That is using relatively low numbers. Imagine the impact of a a higher priced medical need.
Lower amounts of money sent to the insurance company, tax favored medical costs and savings accounts, lower renewal rates... What's not to love????
No wonder three million of these have been sold!!!!
The idea is to get a High Deductible Health Plan, which is lower priced than the regular health insurance plans. These are very specific insurance policies. With the exception of preventive care, they can not cover anything until you hit the high deductible. Once the deductible is met, they either cover a percent of the rest of the medical needs, or they cover all of the rest of the costs for the year. If they cover a per cent, it is usually until another dollar amount has been reached, at which point they cover all the additional costs for the year.
What happens to all the expenses that come up before the deductible has been met? Well, the idea is that you put some money aside into a special Health Savings Account (HSA). These accounts are available from specific institutions that specialize in them. The money goes into the accounts pre tax, and grows tax free. You take money out for your health needs, also tax free. The institutions that specialize in HSAs often offer debit-like cards so that getting your money out is really easy.
It is expected that the renewals for HDHP policies will be lower, because you really don't use much of the insurance part of the plan. With the usage down, the rates have less reason to rise.
This sounds a lot like the old FSA accounts, except it is better. Individuals can take out HSAs and whether you are a group or an individual, your money is always yours. It does not go away if you don't use it, and there are no deadlines for the usage. Also, if you still have money in your account, it rolls over year after year. When you are 65 you can take out the money at your then tax rate. Anytime you use your money for medical expenses it is tax free, and if you need to take it out for a non medical need, you pay the taxes and a ten per cent penalty.
If your account rolls over and you develope quite a lot of money in it, you may feel pretty comfortable raising your deductible even higher. This will result in even less renewal increases.
So, it sounds pretty good so far, right? Well, it gets better. As you are using the high deductible part of the policy, you still get in network negotiated rates. That means that your dollars will go farther than if you didn't have insurance. In order to get these rates, you must use an in network doctor and facility, of course.
The tax savings part of the account is great, but really think for a minute what that means to your wallet. If you go to the doctor, and his normal rate is $150.00, but the in network negotiated rate is $100.00; if you pay for it with tax free dollars and you are in the 25% tax bracket, it will be like you are paying only $75.00 for the visit. The other $25.00 is your tax savings. That is using relatively low numbers. Imagine the impact of a a higher priced medical need.
Lower amounts of money sent to the insurance company, tax favored medical costs and savings accounts, lower renewal rates... What's not to love????
No wonder three million of these have been sold!!!!
Thursday, April 13, 2006
Successful Fundraiser by SAAHU
The South Atlanta Association of Health Underwriters had a successful turnout at their most recent fundraiser. Oliver Halle and Associates came and spoke to agents as well as professionals in the south Atlanta area, about allowing their employees to take "The Harder Right". The symposium was about ethics, and how easy it is for good people to get swallowed up by making a series of small, but bad choices. It showed how these decisions can have a "snowball effect". The association used some of the proceeds to donate to the Fayette Samaritans.
SAAHU was founded in 2003 to serve the needs of health insurance professionals on the south side of Atlanta. It is an organization that provides opportunities for agents and vendors to network and to learn about new laws and products that are useful to their clients. It also gives health insurance professionals an opportunity to give back to their community.
SAAHU's first donation to the Samaratins was Thanksgiving 2003. This started a tradition of annual donating that has continued through Thanksgiving of 2005. When the budget was updated in March of 2006 as a result of the fundraiser, the board agreed to make a special donation. The recipients again, were The Fayette Samaritans and, the Cystic Fibrosis Reaching Out Foundation.
Each year the donations have increased as the association has grown in size through membership contributions and fund raising efforts. The South Atlanta Association of Health Underwriters believes that giving back to the community is an important part of their work.
Anyone involved in the field of health insurance is welcome to join the association and attend the meetings. Visit www.saahu.com for more information.
SAAHU was founded in 2003 to serve the needs of health insurance professionals on the south side of Atlanta. It is an organization that provides opportunities for agents and vendors to network and to learn about new laws and products that are useful to their clients. It also gives health insurance professionals an opportunity to give back to their community.
SAAHU's first donation to the Samaratins was Thanksgiving 2003. This started a tradition of annual donating that has continued through Thanksgiving of 2005. When the budget was updated in March of 2006 as a result of the fundraiser, the board agreed to make a special donation. The recipients again, were The Fayette Samaritans and, the Cystic Fibrosis Reaching Out Foundation.
Each year the donations have increased as the association has grown in size through membership contributions and fund raising efforts. The South Atlanta Association of Health Underwriters believes that giving back to the community is an important part of their work.
Anyone involved in the field of health insurance is welcome to join the association and attend the meetings. Visit www.saahu.com for more information.
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