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15 Things to Know About Stark Law
By Ayla Ellison

Enacted more than two decades ago with the simple purpose of curbing physician self-referral, Stark Law has evolved into a complex set of regulations, which some argue impede efforts to transition away from a fee-for-service system.

Here are 15 things to know about Stark Law.

House G.O.P. Leaders Outline Plan to Replace Obama Health Care Act
By ROBERT PEAR and THOMAS KAPLAN

WASHINGTON — House Republican leaders on Thursday presented their rank-and-file members with the outlines of their plan to replace the Affordable Care Act, leaning heavily on tax credits to finance individual insurance purchases and sharply reducing federal payments to the 31 states that have expanded Medicaid eligibility.

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In the Spotlight… Or the Crosshairs? Healthcare Discussion.
By: Ron Peck, Esq.

Yesterday we presented a webinar regarding issues that pop up when employers don’t act with consistency between their plan, handbook, behavior, and law.  We talked about situations where the employer is responsible (by contract) but stop-loss won’t reimburse; because the employer obligates themselves to do something that their plan doesn’t allow.  This is bad for the employer, but more importantly, every time an employer is bankrupt by an issue like this, it’s a black eye for our industry. This is a time of political upheaval, and the powers that be are scrambling to find a replacement for the status quo.  If self-funding is linked to these types of issues, conflict, and loss, we will not be the future of health benefits in America.  That’s bad for us, bad for healthcare, and bad for Americans.

How expensive are knee replacements in the 20 largest US cities?
By Laura Dyrda

Total knee replacement surgery price varies by geographic region.

The total price includes hospital services, physician services and anesthesia, according to Healthcare Blue Book. The hospital services assume a four day admission and the physician fee is for the procedure and routine postoperative care. The anesthesia price assumes average surgery time of 2 1/2 hours.

Here are the prices for the 20 largest cities based on population from the 2010 U.S. Census.

CMS projects next decade of health expenditures: 5 takeaways
By Ayla Ellison

National health spending is expected to grow at an average annual rate of 5.6 percent from 2016 through 2025, with expenditures projected to hit $5.5 trillion in 2025, according to new estimates from CMS’ Office of the Actuary published Wednesday in Health Affairs.

Although congressional Republicans are working on a plan to repeal and replace the ACA, it isn’t possible to determine the impact of potential policy changes on health spending and health insurance at this time. Therefore, the national health expenditure projections are constructed using current law and do not assume potential legislative changes over the projection period.

Here are five takeaways from the CMS report.

IRS loosening enforcement of ObamaCare mandate
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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Humana Plans to Pull Out of Obamacare’s Insurance Exchanges
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
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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Empower Your Plans!
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

From the Waiting Room: Health Insurance
By: Ron Peck. Esq.

I recently found myself in a doctor’s waiting room.  I overheard another patient arguing with the office administrator.  The gist of it was that he was being balance billed for an amount exceeding what insurance paid.  His anger was directed at the insurance.  “How can they say what is medically necessary?  Only the doctor can say what’s necessary.” A nurse emerged, and to her credit, I heard her explain that insurance defines medical necessity as the least costly option likely to resolve the medical issue.  She then explained that the doctor provided the patient with options, and he chose the option that was more intensive. That another, less thorough treatment might have resolved the issue. Well done, I thought. Yet, to my horror, the patient screamed, “Insurance!  Crooks!  How dare they decide what’s necessary!  They aren’t my doctor.”