Source(google.com.pk)
Personal Health Insurance
Last week the President waded directly into the national debate over "ObamaCare" by calling a big media event in the East Room of the White House to talk about the $100 rebates a small percentage of potentially eligible people are getting under the new health law.
Senate Republican Leader Mitch McConnell countered, "If you’re a family in Covington facing a $2,100 premium increase under ObamaCare, then, really, what would you rather have: a check for $100 or so, or a way to avoid the $2,100 premium increase in the first place?”
NPR's Julie Rovner had a story on Friday––"White House Muddles Obamacare Messaging Again"––that caught my eye.
She drew a distinction between how the administration has been going about unsuccessfully selling the new health law and the way the Republicans have been more successfully attacking it:
Still, there's a major difference in the way Republicans talk about the law and the way the president does, says George Lakoff, a professor of linguistics at the University of California, Berkeley and an expert on political messaging.
Lakoff says Republicans talk about the law as a moral issue. "Basically ... they say that democracy is about liberty, the liberty to pursue your own self-interest without you having to take care of anybody else's interests or anybody else having to take care of yours."
But when Obama talks about the health law — at least this week, says Lakoff — "his message was all about money."
And Lakoff says that's pretty much been the president's problem: He's mostly shied away from talking about health care on the same moral terms as have the Republicans.
I have been very surprised at the way the Obama administration has seemingly stood by helplessly while half of the states have rejected the Medicaid expansion. Here we have the opportunity to uniformly bring people who live under 138% of the federal poverty level into a rational system of insurance and the administration has not been able to paint that failing in moral terms.
And, yes I understand the Medicaid system is not sustainable. But Republican Medicaid reform proposals allowed to play out in the state laboratories could have shown the way to sustainability. See: The Medicaid Controversy––The Republican Governors Should Put Up or Shut Up
So, while the Republicans consistently win on the Big Idea––albeit in almost entirely negative terms because they don't have a comprehensive alternative to "ObamaCare," Democrats play small ball.
Perhaps Democrats can't get past small ball because The Affordable Care Act ("ObamaCare") itself is small ball.
It is not health care reform––it is an attempt at health insurance reform at a time when all of our health care system––Medicare, Medicaid, and private health insurance––is not sustainable.
"ObamaCare" is also lots of pages of health insurance market micro management––small ball if there ever was any. Now, the administration is tying itself up like a pretzel trying to figure out how to make it all work with time running out. All the while individuals, small employers and large employers are fretting over how the new law will impact them.
It shouldn't be a surprise that this administration, now buried in the minutia of injecting an extraordinary amount of micro management into a sixth of our economy, would think a $100 rebate for someone already paying thousands of dollars in health insurance premiums would be a major accomplishment.
I opposed "ObamaCare" in the first place because I thought it was a clumsy attempt at insurance reform and certainly not health care reform. Most importantly, I thought it was wrong to make promises––"The Affordable Care Act"––the law was never designed to keep.
Now the administration is in the final phase of trying to convince people this was all a good idea.Since last year's summit, all I could think about was going to Paris Casino and buying one of those Eiffel Tower strawberry daiquiris. The reason why, is because last year I was in no position to buy one of those daiquiris. It was my first year going to a conference that would connect me with other young adult cancer survivors, actually discuss my feelings as a young adult cancer survivor, and find resources I didn't know existed to help me as a young adult cancer survivor.
Last year's summit was amazing, but all encompassing for me. I had never been to Las Vegas, so I tried to cram way too many things into the weekend.
This year, I wasn't going to let that happen. I purposefully didn't schedule tickets for theatre productions or attractions. I didn't even focus on finding the "best buffet on the strip." I went all in for this summit. I decided to be fully present. That was the best decision I could have possibly made.
This year, I went to break out sessions I didn't think I wanted to go to last year. I went to cancer as chronic, survivors guilt, and the just for girls session. You see last year, I was in the middle of writing my book and completely focused on health care legislation and insurance issues regarding my journey. I published the book last year, so this year I was free to focus on my emotions surrounding my journey.
And boy did those emotions pop out of nowhere. I actually cried for the first time in a long time. I even caught myself with wobbly voice when I spoke to others.
This year was cathartic for me-- but it was also incredibly fun. If you're even remotely considering going to this conference next year-- Do It! You'll meet great people, you'll reconnect with yourself, and you'll learn so much that you didn't even realize you might have wanted to know.Maybe part of the reason Americans have a difficult time healing after a traumatic medical event is because of the potential non-health related aftermath.
As some of you are aware, I was in active monthly treatment for an arteriovenous malformation (AVM) from 2005-2010. Since that time my doctors are in a holding pattern, watching the condition with annual MRIs. Although those annual tests do remind me of the rough patch I've been through regarding those treatments, I usually try and not think about them. They were a huge financial burden, physically/emotionally draining, and although there are residual issues from the built up scar tissue etc... I really try and focus on my life now rather than living in the past.
Focusing on the present is difficult, however, when just yesterday I received a statement for one of those treatments done in May of 2008!
I'm not sure why a single bill from almost 5 years ago, that should have long ago been paid by my primary and secondary insurance (from that time), would just now resurface. Looking at the statement it appears my 2008 insurance companies were only first billed this past November (2012). That doesn't make any kind of sense to me though.
It's possible I still have an EOB (explanation of benefits) somewhere in the stack of paperwork I tossed into a file cabinet so many years ago--- but to be honest with you, the idea of having to dig through all of that to find one single piece of paper sounds like a punishment I wouldn't wish on anyone. Don't get me wrong, if I have to do it I will do it. However, the fact that this is even a topic for discussion seems inherently incorrect.
Perhaps I'm wrong, but by this point if there was an unpaid charge wouldn't the hospital have written it off on their books?
I live at the exact same home address since before this billed treatment and I never received a bill until now for it. I also haven't received a bill for any of the other treatments I had done within that year. So why this bill? Why now?
I am not the only one who has received medical bills for a surgery/treatment years after the fact, but I do not understand how this occurs. No one can tell me with a straight face that the hospital simply "forgot" I had a treatment and only remembered 5 years later.
No wonder Americans (particularly-because we are the only ones with an insurance system like ours) often times are unable to pick themselves up after a medical trauma. How can someone completely move on when they are unexpectedly reminded of it again and again years after the fact?In a landmark class action lawsuit, Seattle based Swedish Hospital, now part of the Providence Hospital Group is being sued for charging an uninsured Issaquah man who visited the emergency room much more than what it charged privately insured patients or those covered on government health insurance programs. Though this disparity in hospital billing phenomenon is not new, what is raising the level of accountability is the class action lawsuit, because this will allow the courts to examine the billing of all uninsured patients for all seven of Swedish Hospital’s emergency departments. Though class action lawsuits often end in relatively small settlements for the plaintiffs in the suit, they are big money for the attorneys, at least those with the cojones to see them through to the end.
Lifting the Veil on Hospital Billing
Basically here is how hospital billing works, there are different reimbursement levels for services for different contracts, including the various insurers, as well as Medicare, and Medicaid. The government plans of course, by virtue of their bully pulpit actually pay the least for services and private insurers pay more of the reduced gross hospital charges, per patient. As in the Puget Sound Business Journal Article[1], the uninsured person was charge $10,000 for the same services(found in legal discovery) for which the insurance company contracts paid $3,500.
Why charge the patient without health insurance more than the insured person? The answer is two-fold, first there is no underlying contract to secure payment for the hospital, so the facility takes on the risk(as required by the government under Emergency Medical Treatment Act) of providing potentially costly services. Secondly, often the uninsured person is not able to pay the normal fees for services, so there are charitable discounts or write offs for this patient demographic. Is this method of billing legal, yes, ethical, well that is where it gets to be a sticky wicket. The hospital can charge 100% of gross prices for services to anyone without insurance coverage, but it rarely gets that amount of money from the uninsured patients, so the hospital offers a charitable discount to entice the patient to pay the services, and then the hospital takes a charitable deduction for the unpaid portion of the gross charges. Though this may seem reasonable from an accounting standpoint, the hospital is able to take a deduction for gross charges it never expects to receive, because the gross charges are inherently designed to provide at least enough payment from the other payers, including Medicare, Medicaid, and private insurers to keep the facility solvent. Thus, in the case of an uninsured patient who actually pays his bill, even if it is paid at a higher rate than the hospital normally would receive for those services, the hospital still deducts any portion of the unpaid gross charges as their charitable discount. This may even make the reimbursement from the uninsured patient better than from the other contracts, just not as consistent. So, is it fair that we allow hospitals to charge the uninsured patients more than what they get from patients with greater resources?
At various times when I have been uninsured and forced to access services at hospitals, I found quite a variance in the charitable care discount I was offered, and the billing practices of different facilities. One hospital required a 40% payment based on gross charges and the other wanted 60%. If one hospital requires the patient to pay 60% of gross charges for services, this is greater reimbursement than most insurance contracts, and hence a very good deal for the hospital. This is also enhanced by the fact the hospital can claim the 40% as charitable care, assuring political fodder for future negotiations with state and federal regulators.This is yet another example of a health system failure in the United States, because of our bifurcated financing system, and social inequities. Of course it isn’t right that the uninsured are charged more than those with insurance plans, but it is legal, and hospitals develop their fee schedules based on a complex mix of patient demand, high marginal cost for services, and regulatory requirements. The class action lawsuit will be costly and in the end just add to the hospital fees, but it does shine a light on this inequity. One of the things we all could use is transparency in the prices of health care services in this country. Though we are making progress on patient safety outcomes and reporting, thanks in large part to the IOM’s report more than a decade ago, we still have a huge battle ahead to fully inform and empower health care consumers as they navigate the black box of the American health care system.
For more information on this hospital conundrum and how to negotiate with a hospital should you need services and lack health insurance(fifty million at last count), go to Chapter Nine of Unraveling U.S. Health Care-A Personal Guide, out this month by Rowman and Littlefield.
For practical advice on resourcing your health care, read more of what the healthpolicymaven has to say. This article was written by Roberta E. Winter, MHA, MPA, someone who has negotiated insurance contracts for private employers, analyzed network reimbursement data for hospitals, and advocated for the empowerment of health care consumers.Here's a brief explanation of PCCS and what a PCCS-enabled EHR system would do:
Clinicians have a “virtual patient” in mind—a conceptual model of an actual patient that reflects their understanding of the patient’s problems and needs
This virtual patient model (VPM) consists of multiple submodels reflecting the interaction between biomedical and psychological subsystems in the real patient
New findings—raw data—are used to refine the VPM
PCCS-enabled software provides clinical decision support by:
Simulating and predicting the likely reaction of the VPM to different care interventions
Identifying the interventions most likely to benefit the actual patient
Without PCCS-enabled software to help make decisions, clinicians may:
Spend considerable time and energy searching and sifting through all the raw data
Have to integrate ill-structured, uncertain, and potentially conflicting information
Experience information overload, confusion, uncertainly and doubt
With PCCS-enabled software, a clinician:
Has much less cognitive burden
Makes decisions supported by deeper &; clearer understanding of the patient
Can stay focused on implementing the patient’s care plan
Patients should also have a version of PCCS software available.
The whole product companion applications I've described in previous posts in this thread will focus, in part, on developing, evolving, and deploying EHR companion applications that are PCCS-enabled. Toward this end, we are prepared to offer:
A novel, robust software development platform that uses off-the-shelf software tools to create and continually evolve next-generation analytical decision models
A communication architecture that promotes collaboration in loosely coupled social networks
The means to combine the development platform and communication architecture to provide:
“Technological glue” that connects companion app components via the CP Split method
“Model ecology networks” in which teams of collaborators build, share, evaluate, and evolve analytical decision models, which they may sell.
Implementing this strategy will be done through collaboration among a widespread alliance of business partners. We are compiling lists of people and companies we believe may be interested in receiving an invitation to join the alliance. They include clinicians of all types, informaticists, analytical decision model-builders, and EHR vendors.It has been said that the road to Hell is paved with good intentions. It is hot, really hot, in New York. Years ago it was decided that all adults under age 65 should pay the same premium. Twenty-two or sixty-two, the price is the same. That sounds great if you are in your sixties, but it only works if you can drag the twenty-somethings to the table. In the beginning your average participant age is in the mid-forties. As the young drop out, the average age, and the price, increases.
But age wasn’t the only pricing determinant abandoned in the interest of fairness. New York insurers were forbidden to underwrite the risks. The sicker you are the better that deal. An insulin dependent diabetic with AIDS pays the same premium as someone who is perfectly healthy. The system, in essence, welcomed pre-existing conditions and penalized the young and healthy.
And of course, the cost of living is higher in New York, especially in NYC.
As we have noted previously, Ohioans, on average, pay a lot less for health insurance for all of the reasons that New Yorkers pay more. I have lots of clients, male and female, under the age of 30. Some of these young adults shopped for this coverage and pay for it themselves. The rest of these cases have some degree of parental involvement. It is much easier for a parent to come up with $70 to $120 a month in Ohio than hundreds more in New York.
Why are there millions of uninsured New Yorkers? The 2.6 million number is actually from six years ago. That number hasn’t gone down. New Yorkers weren’t required to purchase insurance. There was no Individual Mandate. Penalized for their health and youth, many New Yorkers simply chose to not participate. Making insurance affordable might get them back into the market. Making insurance mandatory will have more impact.
It has been announced that the New York rates will be plummeting under the Patient Protection and Affordable Care Act (PPACA). Governor Cuomo is ecstatic. The President is pointing to New York as a model for the future. And it is true, at least for the moment, that New York rates are coming down. A lot. But if you consider $1,000 per month normal, your great bargain may still sound awful to consumers in Ohio. This link is to an article that dreams of young people paying only $190 for a basic policy, one that a guy living in Cleveland might buy today for $70!
Will the New York rates stay cheap? There are two major speed bumps ahead. The first is the PPACA. The 2014 New York rates are certainly much less than the current pricing, but are they cheap enough? Will the subsidies be enough to spur sales when the penalty (tax or fee depending on your political persuasion) is only $95 or about 1% of income? With the penalty so low, enforcement challenging, and the entire process confusing, the prediction is that many of the currently healthy uninsured will sit out a year or two. Lose the young and healthy and New York is right back where it was.
The second speed bump facing New York is the U S House of Representatives. The Republicans sensed weakness in the Obama administration’s decision to shelve the employer mandate for a year. (See previous blog) Last week the Republicans attempted to put the individual mandate on hold, too. Of course the bill passed the House. And you might think that the bill will never see the light of day in the Senate, but don’t be so sure. Punting the individual mandate might seem like a good idea to a group of people who are used to putting off important decisions and deflecting responsibility.
Both the Democrats and the Republicans have a reason to kill the individual mandate. As New York already proved, if we create super health policies that do everything but drive you to the doctor, don’t factor in the health conditions of the insureds, and don’t weigh the premiums properly for the ages of the participants, the rates will go through the roof if you can’t corral the young and healthy into the insurance pool. Without an individual mandate forcing participation, you create a death spiral. As the rates increase to reflect the claims, the young and healthy leave. First the twenty somethings jump out. Eventually the average age of the participants will be over 50. Prices will be out of control and there will be only one answer – Single Payer.
Your friends in New York and California are celebrating the health insurance rates they expect to see in 2014. It would be tacky to point out that their new rates will still be significantly more than the rates we pay today. And it is just sad to think that our new rates and their new rates are going to be about the same.
It has been said that the road to Hell is paved with good intentions. It is hot, really hot, in New York. Years ago it was decided that all adults under age 65 should pay the same premium. Twenty-two or sixty-two, the price is the same. That sounds great if you are in your sixties, but it only works if you can drag the twenty-somethings to the table. In the beginning your average participant age is in the mid-forties. As the young drop out, the average age, and the price, increases.
But age wasn’t the only pricing determinant abandoned in the interest of fairness. New York insurers were forbidden to underwrite the risks. The sicker you are the better that deal. An insulin dependent diabetic with AIDS pays the same premium as someone who is perfectly healthy. The system, in essence, welcomed pre-existing conditions and penalized the young and healthy.
And of course, the cost of living is higher in New York, especially in NYC.
As we have noted previously, Ohioans, on average, pay a lot less for health insurance for all of the reasons that New Yorkers pay more. I have lots of clients, male and female, under the age of 30. Some of these young adults shopped for this coverage and pay for it themselves. The rest of these cases have some degree of parental involvement. It is much easier for a parent to come up with $70 to $120 a month in Ohio than hundreds more in New York.
Why are there millions of uninsured New Yorkers? The 2.6 million number is actually from six years ago. That number hasn’t gone down. New Yorkers weren’t required to purchase insurance. There was no Individual Mandate. Penalized for their health and youth, many New Yorkers simply chose to not participate. Making insurance affordable might get them back into the market. Making insurance mandatory will have more impact.
It has been announced that the New York rates will be plummeting under the Patient Protection and Affordable Care Act (PPACA). Governor Cuomo is ecstatic. The President is pointing to New York as a model for the future. And it is true, at least for the moment, that New York rates are coming down. A lot. But if you consider $1,000 per month normal, your great bargain may still sound awful to consumers in Ohio. This link is to an article that dreams of young people paying only $190 for a basic policy, one that a guy living in Cleveland might buy today for $70!
Will the New York rates stay cheap? There are two major speed bumps ahead. The first is the PPACA. The 2014 New York rates are certainly much less than the current pricing, but are they cheap enough? Will the subsidies be enough to spur sales when the penalty (tax or fee depending on your political persuasion) is only $95 or about 1% of income? With the penalty so low, enforcement challenging, and the entire process confusing, the prediction is that many of the currently healthy uninsured will sit out a year or two. Lose the young and healthy and New York is right back where it was.
The second speed bump facing New York is the U S House of Representatives. The Republicans sensed weakness in the Obama administration’s decision to shelve the employer mandate for a year. (See previous blog) Last week the Republicans attempted to put the individual mandate on hold, too. Of course the bill passed the House. And you might think that the bill will never see the light of day in the Senate, but don’t be so sure. Punting the individual mandate might seem like a good idea to a group of people who are used to putting off important decisions and deflecting responsibility.
Both the Democrats and the Republicans have a reason to kill the individual mandate. As New York already proved, if we create super health policies that do everything but drive you to the doctor, don’t factor in the health conditions of the insureds, and don’t weigh the premiums properly for the ages of the participants, the rates will go through the roof if you can’t corral the young and healthy into the insurance pool. Without an individual mandate forcing participation, you create a death spiral. As the rates increase to reflect the claims, the young and healthy leave. First the twenty somethings jump out. Eventually the average age of the participants will be over 50. Prices will be out of control and there will be only one answer – Single Payer.
Your friends in New York and California are celebrating the health insurance rates they expect to see in 2014. It would be tacky to point out that their new rates will still be significantly more than the rates we pay today. And it is just sad to think that our new rates and their new rates are going to be about the same.
Recent months have brought travel risks to the forefront of consumers’ minds: the economic downturn, safety risks overseas due to political unrest, and a potential new strain of influenza that has emerged from Mexico.
There are two broad types of travel-related coverage for those leaving the United States:
Travel insurance covers the loss of the prepaid travel costs of a trip should it be canceled, interrupted, or postponed. It also can reimburse unexpected expenses incurred due to a sudden change in travel plans due to illness or other causes.
Specialty medical coverage protects against personal insurance risks when someone is outside the United States.
Travelers can buy travel coverage in conjunction with their travel tour, hotel bookings or flight reservations. It’s also available from providers that specialize in the international insurance market. For example, Continental, a major international airline, offers trip cancellation and interruption coverage through its reservations Web site. The coverage reimburses the traveler for “prepaid, unused, non-refundable travel expenses should your trip be cancelled or interrupted due to any covered reason.” Such reasons include: inclement weather, an unexpected illness, death of a traveler, and travel delays.
The Insurance Information Network of California notes that trip insurance providers sometimes require a physician’s verification if a trip must be canceled before it occurs. It advises buyers to check whether the travel coverage is “cancel for any reason protection,” or more limited coverage.
Trip interruption insurance is another variation. It can provide reimbursement for extra food and lodging costs if a traveler becomes ill during the course of a trip. Some plans cover medical costs. Trip delay insurance covers expenses a traveler incurs in resuming a planned trip or returning home after being quarantined in another country. Often these various coverages are bundled and sold together in a package.
Short-term medical insurance may be appropriate for the millions of U.S. residents who travel outside the U.S. every year. Those who travel outside of America may be going beyond the boundaries of their medical insurance without knowing it, according to Clements International, a provider of international insurance policies.
The unpredictable nature of the spreading of swine flu that began in April 2009 has heightened awareness of health risks while traveling around the world. Travelers may wish to consider short-term medical insurance if they’re traveling outside of the United States for an extended vacation or business trip. To determine whether it’s necessary, it’s advisable to check if a domestic health insurance policy covers out-of-country travel. If not, short-term medical insurance provides coverage for illnesses or medical evacuation that occurs while traveling outside of the United States.
International travelers face the same insurance risks (and sometimes additional risks) while outside the country that they do while stateside. Life insurance issued in the U.S. may not be available on the same basis while a person is traveling for an extended period as when not traveling. It’s prudent to check on the validity of life insurance coverage as part of the travel-planning process.
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Personal Health Insurance
Last week the President waded directly into the national debate over "ObamaCare" by calling a big media event in the East Room of the White House to talk about the $100 rebates a small percentage of potentially eligible people are getting under the new health law.
Senate Republican Leader Mitch McConnell countered, "If you’re a family in Covington facing a $2,100 premium increase under ObamaCare, then, really, what would you rather have: a check for $100 or so, or a way to avoid the $2,100 premium increase in the first place?”
NPR's Julie Rovner had a story on Friday––"White House Muddles Obamacare Messaging Again"––that caught my eye.
She drew a distinction between how the administration has been going about unsuccessfully selling the new health law and the way the Republicans have been more successfully attacking it:
Still, there's a major difference in the way Republicans talk about the law and the way the president does, says George Lakoff, a professor of linguistics at the University of California, Berkeley and an expert on political messaging.
Lakoff says Republicans talk about the law as a moral issue. "Basically ... they say that democracy is about liberty, the liberty to pursue your own self-interest without you having to take care of anybody else's interests or anybody else having to take care of yours."
But when Obama talks about the health law — at least this week, says Lakoff — "his message was all about money."
And Lakoff says that's pretty much been the president's problem: He's mostly shied away from talking about health care on the same moral terms as have the Republicans.
I have been very surprised at the way the Obama administration has seemingly stood by helplessly while half of the states have rejected the Medicaid expansion. Here we have the opportunity to uniformly bring people who live under 138% of the federal poverty level into a rational system of insurance and the administration has not been able to paint that failing in moral terms.
And, yes I understand the Medicaid system is not sustainable. But Republican Medicaid reform proposals allowed to play out in the state laboratories could have shown the way to sustainability. See: The Medicaid Controversy––The Republican Governors Should Put Up or Shut Up
So, while the Republicans consistently win on the Big Idea––albeit in almost entirely negative terms because they don't have a comprehensive alternative to "ObamaCare," Democrats play small ball.
Perhaps Democrats can't get past small ball because The Affordable Care Act ("ObamaCare") itself is small ball.
It is not health care reform––it is an attempt at health insurance reform at a time when all of our health care system––Medicare, Medicaid, and private health insurance––is not sustainable.
"ObamaCare" is also lots of pages of health insurance market micro management––small ball if there ever was any. Now, the administration is tying itself up like a pretzel trying to figure out how to make it all work with time running out. All the while individuals, small employers and large employers are fretting over how the new law will impact them.
It shouldn't be a surprise that this administration, now buried in the minutia of injecting an extraordinary amount of micro management into a sixth of our economy, would think a $100 rebate for someone already paying thousands of dollars in health insurance premiums would be a major accomplishment.
I opposed "ObamaCare" in the first place because I thought it was a clumsy attempt at insurance reform and certainly not health care reform. Most importantly, I thought it was wrong to make promises––"The Affordable Care Act"––the law was never designed to keep.
Now the administration is in the final phase of trying to convince people this was all a good idea.Since last year's summit, all I could think about was going to Paris Casino and buying one of those Eiffel Tower strawberry daiquiris. The reason why, is because last year I was in no position to buy one of those daiquiris. It was my first year going to a conference that would connect me with other young adult cancer survivors, actually discuss my feelings as a young adult cancer survivor, and find resources I didn't know existed to help me as a young adult cancer survivor.
Last year's summit was amazing, but all encompassing for me. I had never been to Las Vegas, so I tried to cram way too many things into the weekend.
This year, I wasn't going to let that happen. I purposefully didn't schedule tickets for theatre productions or attractions. I didn't even focus on finding the "best buffet on the strip." I went all in for this summit. I decided to be fully present. That was the best decision I could have possibly made.
This year, I went to break out sessions I didn't think I wanted to go to last year. I went to cancer as chronic, survivors guilt, and the just for girls session. You see last year, I was in the middle of writing my book and completely focused on health care legislation and insurance issues regarding my journey. I published the book last year, so this year I was free to focus on my emotions surrounding my journey.
And boy did those emotions pop out of nowhere. I actually cried for the first time in a long time. I even caught myself with wobbly voice when I spoke to others.
This year was cathartic for me-- but it was also incredibly fun. If you're even remotely considering going to this conference next year-- Do It! You'll meet great people, you'll reconnect with yourself, and you'll learn so much that you didn't even realize you might have wanted to know.Maybe part of the reason Americans have a difficult time healing after a traumatic medical event is because of the potential non-health related aftermath.
As some of you are aware, I was in active monthly treatment for an arteriovenous malformation (AVM) from 2005-2010. Since that time my doctors are in a holding pattern, watching the condition with annual MRIs. Although those annual tests do remind me of the rough patch I've been through regarding those treatments, I usually try and not think about them. They were a huge financial burden, physically/emotionally draining, and although there are residual issues from the built up scar tissue etc... I really try and focus on my life now rather than living in the past.
Focusing on the present is difficult, however, when just yesterday I received a statement for one of those treatments done in May of 2008!
I'm not sure why a single bill from almost 5 years ago, that should have long ago been paid by my primary and secondary insurance (from that time), would just now resurface. Looking at the statement it appears my 2008 insurance companies were only first billed this past November (2012). That doesn't make any kind of sense to me though.
It's possible I still have an EOB (explanation of benefits) somewhere in the stack of paperwork I tossed into a file cabinet so many years ago--- but to be honest with you, the idea of having to dig through all of that to find one single piece of paper sounds like a punishment I wouldn't wish on anyone. Don't get me wrong, if I have to do it I will do it. However, the fact that this is even a topic for discussion seems inherently incorrect.
Perhaps I'm wrong, but by this point if there was an unpaid charge wouldn't the hospital have written it off on their books?
I live at the exact same home address since before this billed treatment and I never received a bill until now for it. I also haven't received a bill for any of the other treatments I had done within that year. So why this bill? Why now?
I am not the only one who has received medical bills for a surgery/treatment years after the fact, but I do not understand how this occurs. No one can tell me with a straight face that the hospital simply "forgot" I had a treatment and only remembered 5 years later.
No wonder Americans (particularly-because we are the only ones with an insurance system like ours) often times are unable to pick themselves up after a medical trauma. How can someone completely move on when they are unexpectedly reminded of it again and again years after the fact?In a landmark class action lawsuit, Seattle based Swedish Hospital, now part of the Providence Hospital Group is being sued for charging an uninsured Issaquah man who visited the emergency room much more than what it charged privately insured patients or those covered on government health insurance programs. Though this disparity in hospital billing phenomenon is not new, what is raising the level of accountability is the class action lawsuit, because this will allow the courts to examine the billing of all uninsured patients for all seven of Swedish Hospital’s emergency departments. Though class action lawsuits often end in relatively small settlements for the plaintiffs in the suit, they are big money for the attorneys, at least those with the cojones to see them through to the end.
Lifting the Veil on Hospital Billing
Basically here is how hospital billing works, there are different reimbursement levels for services for different contracts, including the various insurers, as well as Medicare, and Medicaid. The government plans of course, by virtue of their bully pulpit actually pay the least for services and private insurers pay more of the reduced gross hospital charges, per patient. As in the Puget Sound Business Journal Article[1], the uninsured person was charge $10,000 for the same services(found in legal discovery) for which the insurance company contracts paid $3,500.
Why charge the patient without health insurance more than the insured person? The answer is two-fold, first there is no underlying contract to secure payment for the hospital, so the facility takes on the risk(as required by the government under Emergency Medical Treatment Act) of providing potentially costly services. Secondly, often the uninsured person is not able to pay the normal fees for services, so there are charitable discounts or write offs for this patient demographic. Is this method of billing legal, yes, ethical, well that is where it gets to be a sticky wicket. The hospital can charge 100% of gross prices for services to anyone without insurance coverage, but it rarely gets that amount of money from the uninsured patients, so the hospital offers a charitable discount to entice the patient to pay the services, and then the hospital takes a charitable deduction for the unpaid portion of the gross charges. Though this may seem reasonable from an accounting standpoint, the hospital is able to take a deduction for gross charges it never expects to receive, because the gross charges are inherently designed to provide at least enough payment from the other payers, including Medicare, Medicaid, and private insurers to keep the facility solvent. Thus, in the case of an uninsured patient who actually pays his bill, even if it is paid at a higher rate than the hospital normally would receive for those services, the hospital still deducts any portion of the unpaid gross charges as their charitable discount. This may even make the reimbursement from the uninsured patient better than from the other contracts, just not as consistent. So, is it fair that we allow hospitals to charge the uninsured patients more than what they get from patients with greater resources?
At various times when I have been uninsured and forced to access services at hospitals, I found quite a variance in the charitable care discount I was offered, and the billing practices of different facilities. One hospital required a 40% payment based on gross charges and the other wanted 60%. If one hospital requires the patient to pay 60% of gross charges for services, this is greater reimbursement than most insurance contracts, and hence a very good deal for the hospital. This is also enhanced by the fact the hospital can claim the 40% as charitable care, assuring political fodder for future negotiations with state and federal regulators.This is yet another example of a health system failure in the United States, because of our bifurcated financing system, and social inequities. Of course it isn’t right that the uninsured are charged more than those with insurance plans, but it is legal, and hospitals develop their fee schedules based on a complex mix of patient demand, high marginal cost for services, and regulatory requirements. The class action lawsuit will be costly and in the end just add to the hospital fees, but it does shine a light on this inequity. One of the things we all could use is transparency in the prices of health care services in this country. Though we are making progress on patient safety outcomes and reporting, thanks in large part to the IOM’s report more than a decade ago, we still have a huge battle ahead to fully inform and empower health care consumers as they navigate the black box of the American health care system.
For more information on this hospital conundrum and how to negotiate with a hospital should you need services and lack health insurance(fifty million at last count), go to Chapter Nine of Unraveling U.S. Health Care-A Personal Guide, out this month by Rowman and Littlefield.
For practical advice on resourcing your health care, read more of what the healthpolicymaven has to say. This article was written by Roberta E. Winter, MHA, MPA, someone who has negotiated insurance contracts for private employers, analyzed network reimbursement data for hospitals, and advocated for the empowerment of health care consumers.Here's a brief explanation of PCCS and what a PCCS-enabled EHR system would do:
Clinicians have a “virtual patient” in mind—a conceptual model of an actual patient that reflects their understanding of the patient’s problems and needs
This virtual patient model (VPM) consists of multiple submodels reflecting the interaction between biomedical and psychological subsystems in the real patient
New findings—raw data—are used to refine the VPM
PCCS-enabled software provides clinical decision support by:
Simulating and predicting the likely reaction of the VPM to different care interventions
Identifying the interventions most likely to benefit the actual patient
Without PCCS-enabled software to help make decisions, clinicians may:
Spend considerable time and energy searching and sifting through all the raw data
Have to integrate ill-structured, uncertain, and potentially conflicting information
Experience information overload, confusion, uncertainly and doubt
With PCCS-enabled software, a clinician:
Has much less cognitive burden
Makes decisions supported by deeper &; clearer understanding of the patient
Can stay focused on implementing the patient’s care plan
Patients should also have a version of PCCS software available.
The whole product companion applications I've described in previous posts in this thread will focus, in part, on developing, evolving, and deploying EHR companion applications that are PCCS-enabled. Toward this end, we are prepared to offer:
A novel, robust software development platform that uses off-the-shelf software tools to create and continually evolve next-generation analytical decision models
A communication architecture that promotes collaboration in loosely coupled social networks
The means to combine the development platform and communication architecture to provide:
“Technological glue” that connects companion app components via the CP Split method
“Model ecology networks” in which teams of collaborators build, share, evaluate, and evolve analytical decision models, which they may sell.
Implementing this strategy will be done through collaboration among a widespread alliance of business partners. We are compiling lists of people and companies we believe may be interested in receiving an invitation to join the alliance. They include clinicians of all types, informaticists, analytical decision model-builders, and EHR vendors.It has been said that the road to Hell is paved with good intentions. It is hot, really hot, in New York. Years ago it was decided that all adults under age 65 should pay the same premium. Twenty-two or sixty-two, the price is the same. That sounds great if you are in your sixties, but it only works if you can drag the twenty-somethings to the table. In the beginning your average participant age is in the mid-forties. As the young drop out, the average age, and the price, increases.
But age wasn’t the only pricing determinant abandoned in the interest of fairness. New York insurers were forbidden to underwrite the risks. The sicker you are the better that deal. An insulin dependent diabetic with AIDS pays the same premium as someone who is perfectly healthy. The system, in essence, welcomed pre-existing conditions and penalized the young and healthy.
And of course, the cost of living is higher in New York, especially in NYC.
As we have noted previously, Ohioans, on average, pay a lot less for health insurance for all of the reasons that New Yorkers pay more. I have lots of clients, male and female, under the age of 30. Some of these young adults shopped for this coverage and pay for it themselves. The rest of these cases have some degree of parental involvement. It is much easier for a parent to come up with $70 to $120 a month in Ohio than hundreds more in New York.
Why are there millions of uninsured New Yorkers? The 2.6 million number is actually from six years ago. That number hasn’t gone down. New Yorkers weren’t required to purchase insurance. There was no Individual Mandate. Penalized for their health and youth, many New Yorkers simply chose to not participate. Making insurance affordable might get them back into the market. Making insurance mandatory will have more impact.
It has been announced that the New York rates will be plummeting under the Patient Protection and Affordable Care Act (PPACA). Governor Cuomo is ecstatic. The President is pointing to New York as a model for the future. And it is true, at least for the moment, that New York rates are coming down. A lot. But if you consider $1,000 per month normal, your great bargain may still sound awful to consumers in Ohio. This link is to an article that dreams of young people paying only $190 for a basic policy, one that a guy living in Cleveland might buy today for $70!
Will the New York rates stay cheap? There are two major speed bumps ahead. The first is the PPACA. The 2014 New York rates are certainly much less than the current pricing, but are they cheap enough? Will the subsidies be enough to spur sales when the penalty (tax or fee depending on your political persuasion) is only $95 or about 1% of income? With the penalty so low, enforcement challenging, and the entire process confusing, the prediction is that many of the currently healthy uninsured will sit out a year or two. Lose the young and healthy and New York is right back where it was.
The second speed bump facing New York is the U S House of Representatives. The Republicans sensed weakness in the Obama administration’s decision to shelve the employer mandate for a year. (See previous blog) Last week the Republicans attempted to put the individual mandate on hold, too. Of course the bill passed the House. And you might think that the bill will never see the light of day in the Senate, but don’t be so sure. Punting the individual mandate might seem like a good idea to a group of people who are used to putting off important decisions and deflecting responsibility.
Both the Democrats and the Republicans have a reason to kill the individual mandate. As New York already proved, if we create super health policies that do everything but drive you to the doctor, don’t factor in the health conditions of the insureds, and don’t weigh the premiums properly for the ages of the participants, the rates will go through the roof if you can’t corral the young and healthy into the insurance pool. Without an individual mandate forcing participation, you create a death spiral. As the rates increase to reflect the claims, the young and healthy leave. First the twenty somethings jump out. Eventually the average age of the participants will be over 50. Prices will be out of control and there will be only one answer – Single Payer.
Your friends in New York and California are celebrating the health insurance rates they expect to see in 2014. It would be tacky to point out that their new rates will still be significantly more than the rates we pay today. And it is just sad to think that our new rates and their new rates are going to be about the same.
It has been said that the road to Hell is paved with good intentions. It is hot, really hot, in New York. Years ago it was decided that all adults under age 65 should pay the same premium. Twenty-two or sixty-two, the price is the same. That sounds great if you are in your sixties, but it only works if you can drag the twenty-somethings to the table. In the beginning your average participant age is in the mid-forties. As the young drop out, the average age, and the price, increases.
But age wasn’t the only pricing determinant abandoned in the interest of fairness. New York insurers were forbidden to underwrite the risks. The sicker you are the better that deal. An insulin dependent diabetic with AIDS pays the same premium as someone who is perfectly healthy. The system, in essence, welcomed pre-existing conditions and penalized the young and healthy.
And of course, the cost of living is higher in New York, especially in NYC.
As we have noted previously, Ohioans, on average, pay a lot less for health insurance for all of the reasons that New Yorkers pay more. I have lots of clients, male and female, under the age of 30. Some of these young adults shopped for this coverage and pay for it themselves. The rest of these cases have some degree of parental involvement. It is much easier for a parent to come up with $70 to $120 a month in Ohio than hundreds more in New York.
Why are there millions of uninsured New Yorkers? The 2.6 million number is actually from six years ago. That number hasn’t gone down. New Yorkers weren’t required to purchase insurance. There was no Individual Mandate. Penalized for their health and youth, many New Yorkers simply chose to not participate. Making insurance affordable might get them back into the market. Making insurance mandatory will have more impact.
It has been announced that the New York rates will be plummeting under the Patient Protection and Affordable Care Act (PPACA). Governor Cuomo is ecstatic. The President is pointing to New York as a model for the future. And it is true, at least for the moment, that New York rates are coming down. A lot. But if you consider $1,000 per month normal, your great bargain may still sound awful to consumers in Ohio. This link is to an article that dreams of young people paying only $190 for a basic policy, one that a guy living in Cleveland might buy today for $70!
Will the New York rates stay cheap? There are two major speed bumps ahead. The first is the PPACA. The 2014 New York rates are certainly much less than the current pricing, but are they cheap enough? Will the subsidies be enough to spur sales when the penalty (tax or fee depending on your political persuasion) is only $95 or about 1% of income? With the penalty so low, enforcement challenging, and the entire process confusing, the prediction is that many of the currently healthy uninsured will sit out a year or two. Lose the young and healthy and New York is right back where it was.
The second speed bump facing New York is the U S House of Representatives. The Republicans sensed weakness in the Obama administration’s decision to shelve the employer mandate for a year. (See previous blog) Last week the Republicans attempted to put the individual mandate on hold, too. Of course the bill passed the House. And you might think that the bill will never see the light of day in the Senate, but don’t be so sure. Punting the individual mandate might seem like a good idea to a group of people who are used to putting off important decisions and deflecting responsibility.
Both the Democrats and the Republicans have a reason to kill the individual mandate. As New York already proved, if we create super health policies that do everything but drive you to the doctor, don’t factor in the health conditions of the insureds, and don’t weigh the premiums properly for the ages of the participants, the rates will go through the roof if you can’t corral the young and healthy into the insurance pool. Without an individual mandate forcing participation, you create a death spiral. As the rates increase to reflect the claims, the young and healthy leave. First the twenty somethings jump out. Eventually the average age of the participants will be over 50. Prices will be out of control and there will be only one answer – Single Payer.
Your friends in New York and California are celebrating the health insurance rates they expect to see in 2014. It would be tacky to point out that their new rates will still be significantly more than the rates we pay today. And it is just sad to think that our new rates and their new rates are going to be about the same.
Recent months have brought travel risks to the forefront of consumers’ minds: the economic downturn, safety risks overseas due to political unrest, and a potential new strain of influenza that has emerged from Mexico.
There are two broad types of travel-related coverage for those leaving the United States:
Travel insurance covers the loss of the prepaid travel costs of a trip should it be canceled, interrupted, or postponed. It also can reimburse unexpected expenses incurred due to a sudden change in travel plans due to illness or other causes.
Specialty medical coverage protects against personal insurance risks when someone is outside the United States.
Travelers can buy travel coverage in conjunction with their travel tour, hotel bookings or flight reservations. It’s also available from providers that specialize in the international insurance market. For example, Continental, a major international airline, offers trip cancellation and interruption coverage through its reservations Web site. The coverage reimburses the traveler for “prepaid, unused, non-refundable travel expenses should your trip be cancelled or interrupted due to any covered reason.” Such reasons include: inclement weather, an unexpected illness, death of a traveler, and travel delays.
The Insurance Information Network of California notes that trip insurance providers sometimes require a physician’s verification if a trip must be canceled before it occurs. It advises buyers to check whether the travel coverage is “cancel for any reason protection,” or more limited coverage.
Trip interruption insurance is another variation. It can provide reimbursement for extra food and lodging costs if a traveler becomes ill during the course of a trip. Some plans cover medical costs. Trip delay insurance covers expenses a traveler incurs in resuming a planned trip or returning home after being quarantined in another country. Often these various coverages are bundled and sold together in a package.
Short-term medical insurance may be appropriate for the millions of U.S. residents who travel outside the U.S. every year. Those who travel outside of America may be going beyond the boundaries of their medical insurance without knowing it, according to Clements International, a provider of international insurance policies.
The unpredictable nature of the spreading of swine flu that began in April 2009 has heightened awareness of health risks while traveling around the world. Travelers may wish to consider short-term medical insurance if they’re traveling outside of the United States for an extended vacation or business trip. To determine whether it’s necessary, it’s advisable to check if a domestic health insurance policy covers out-of-country travel. If not, short-term medical insurance provides coverage for illnesses or medical evacuation that occurs while traveling outside of the United States.
International travelers face the same insurance risks (and sometimes additional risks) while outside the country that they do while stateside. Life insurance issued in the U.S. may not be available on the same basis while a person is traveling for an extended period as when not traveling. It’s prudent to check on the validity of life insurance coverage as part of the travel-planning process.
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