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Top Miscues Employers Make When It Comes To Their Health Plans ... And What We All Can Do To Become Health Plan Heroes

On February 15, 2017
Employers who self-fund their health plan act as a traditional employer, a plan sponsor, and a plan administrator. Juggling this many roles, conflicts and contradictions are bound to happen. For instance, an  employee handbook’s handling of disability leave may conflict with the health plan document as it relates to employment and plan coverage.

Thanks for joining The Phia Group’s legal team on February 15, 2017, as they discussed top miscues employers make when it comes to their health  plans, and what we all can do to become health plan heroes; rescuing employers who have blurred the lines, and will without our help soon be stuck between a rock and a hard place.

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First Proposed ACA Rule Changes

On February 15, 2017
By: Jen McCormick, Esq.

Today we got our first new proposed ACA rule changes from the Trump Administration.  One of the proposals was to decrease the open enrollment window for individuals to sign up on the insurance exchanges.  Specifically, the window which is currently November 1 to January 31 would instead be November 1 to December 15.  The thought, it seems, is that this will limit an insurers exposure from individuals only signing up once they get sick… if there is a shorter window. Hold on for the ride because I imagine this will be the first of many revisions to ACA as we know it today.

IRS loosening enforcement of ObamaCare mandate

On February 15, 2017
By Peter Sullivan

The IRS says it will not reject tax forms from people who fail to answer whether they had health insurance, a sign of loosening up on enforcement of ObamaCare’s individual mandate.

Tax forms ask people whether they had health coverage in the previous year to determine whether they need to pay a financial penalty under ObamaCare’s mandate to have coverage.

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A Canadian Pays Cash for Care

On February 15, 2017
In spite of the fact that I did not use insurance at all, we can still take my personal experience as a case study about the benefits of real-time payment for medical care. As I see it, there are three major wins to reflect on: 1) no complicated claims process (for anyone); 2) peace of mind that I settled my ‘financial responsibility’ immediately; and 3) I saved money.

I suppose in a parallel universe, and we all know this old racket, I could have presented with a health insurance card and the hospital would have agreed to bill my insurer directly, and the claim would have been paid and processed eventually, but how would I know? What does this cost, is the price fair?  What if there was an issue of coverage? A coding problem? Request for medical records? Error with repricing? What if the provider gets tired of waiting for payment? As one observer put it, in describing our current claim process “a horse-and-buggy in a world contemplating driver-less cars, the healthcare industry’s consumer billing and payment system is an inefficient antique.”

Humana Plans to Pull Out of Obamacare’s Insurance Exchanges

On February 15, 2017
By REED ABELSON

Humana announced on Tuesday that it would no longer offer health insurance coverage in the state marketplaces created under the federal health care law, becoming the first major insurer to cast a no-confidence vote over selling individual plans on the public exchanges for 2018.

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Land of 10,000 Stories: Cop and Homeless Veteran

On February 15, 2017
wkyc.com

CLEVELAND – Big medical bills are a problem for many Americans.
But few services deliver a bigger surprise hit than a life-saving ride on an air ambulance.
Here in Northeast Ohio, we found dozens of court battles with one of the nation’s largest private, for-profit air ambulance companies.
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The Guilty Shall Remain Nameless – Yet I Shall Shame Them

On February 14, 2017
By: Tim Callender, Esq.

I recently had a sinus infection.  No, I’m not a doctor, but I’m intelligent enough, and know my sinuses well enough to know when it’s either a sinus infection or that my head is full of concrete.  In this case – I figured it was the former.  In the spirit of true healthcare consumerism and responsible utilization of my health plan, I did not go to the E.R.  I went to the ever famous, “doc in the box.”  Prior to walking into the reception area, I told myself I would report as self-pay, not tap my health insurance, and see how it all might shake out.  I figured it couldn’t cost too much and it would give me something interesting to talk about in my field (hence today’s blog).  Long story short, I walked into the clinic, approached the receptionist and said, “Hi!  I’m pretty sure I have a sinus infection, but I’m no doctor!  Can you let me know how much it might cost to see the doctor, and, I’m guessing I’ll end up with some antibiotics.”  The receptionist stared at me as though I’d said, “Tightrope coffeemaker last Tuesday the river swelled and I’ve always wanted to see Greece!”  As you can imagine, I was asked numerous questions about “my insurance.”  I repeatedly told the receptionist that I didn’t want to use my insurance, that I wanted to pay their clinic cash, “today,” and simply wanted an idea what it might cost.  I emphasized, numerous times, “I want to pay you – real money – today – you won’t have to bill me.”  Again, I’m fairly certain my words came across as, “I bought a boat and my cousin plays fiddle on a cloud dressed like Dracula!”  The communication breakdown was clearly my fault.  Long story short, the receptionist finally circled up with a handful of clinic employees and they were finally able to tell me that my doctor’s visit would probably cost me anywhere from “$150.00 to $700.00.”  Figuring I couldn’t lose with such a specific quote, I charged ahead.  While in the doctor’s office, he told me he wanted to give me a cortisone shot to “get things moving in the right direction.”  When I asked him how much the shot might cost, he replied, “don’t worry about that – your insurance will cover it.”  I quickly dropped the mic in the middle of the exam room by letting him know I would be paying cash, out of my pocket, for any billing received that day.  Suddenly, the cortisone shot was not necessary, I was given a prescription for an antibiotic, and I was quickly ushered from the premises like a free-market trouble maker.  Of course, I did pay them somewhere between $150.00 and $700.00 before leaving.About the Author

Empower Your Plans!

On February 14, 2017
By: Adam Russo, Esq.The United Benefit Advisors recently came out with the average cost of premiums for health insurance in every state.  Massachusetts has an average monthly premium for single people of $554 and $1320 for family plans.  How is my company, The Phia Group, able to have premiums of $120 for individuals and $220 for families with no co-pay for generic drugs, no deductibles, and no co-pay for urgent care? Simply put, because our employees are educated about the cost of care and are incentivized to identify cheaper, quality options.  We can do the same for you, but you need to act.  Empower your plans!Ab

The Time of Uncertainty

On February 13, 2017
By: Brady Bizarro, Esq.

At a recent Republican retreat, someone secretly recorded discussions regarding the repeal of the Affordable Care Act. While many have condemned the leak, it has revealed that political leaders in Washington are very troubled and seemingly overwhelmed by the prospect of Repeal and Replace. They acknowledged that there is uncertainty and confusion surrounding ACA regulations, enforcement, and the fate of the Medicaid expansion. Patients are also concerned about losing coverage or particular benefits. All of this may be a sign that Repeal and Replace may take longer than most political pundits anticipated.

Ignorance Is Not A Defense

On February 13, 2017
By: Chris Aguiar, Esq.

I wish I could say I was surprised to read the findings of this article – but I’m not.  True or not, the prospect is frightening.  Healthcare is a bill that is oft footed by someone else – so why should we care? We all need to challenge ourselves to be open to viewpoints – listen, learn, and be educated – rather than communicate in and rely on headlines and 140 characters or less.

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