Biggest Flash Points In The Graham-Cassidy Health Care Bill

Biggest Flash Points In The Graham-Cassidy Health Care Bill

From www.npr.org: If Senate Republicans vote to repeal and replace the Affordable Care Act this week, it would affect the health care of pretty much every American.

Here’s a recap of four key flash points in the health overhaul debate with links to NPR coverage over the past six months, and our chart laying out how the Graham-Cassidy bill under consideration in the Senate addresses those issues compared with the Affordable Care Act.

Pre-existing conditions. One of the biggest issues in the repeal/replace debate has been coverage for pre-existing conditions, genetic risks and chronic illness. Before the Affordable Care Act, insurers could deny coverage to people with diseases like diabetes or charge them much higher premiums. The ACA requires insurers to cover pre-existing conditions without charging more. The GOP bills passed or proposed would give states the power to waive that requirement. People with disabilities or chronic diseases, people who have had cancer, and parents of children born with health problems like late-night host Jimmy Kimmel say that could make insurance unaffordable.

Medicaid. The federal/state insurance program provides health care for 20 percent of all Americans, including 40 percent of children, half of all births, 60 percent of nursing home expenses and 25 percent of mental health care. The Graham-Cassidy bill would transform the structure of Medicaid, giving states control over how they spend federal funds. The bill cuts Medicaid funding over time. States that expanded their Medicaid programs, including California and New York, would face the biggest cuts, while Texas and some states in the Deep South and West would fare better.

Essential Health Benefits. The Affordable Care Act requires that insurers cover 10 “essential health benefits,” including maternity care, mental health,Health Advocates hospitalization, prescription drugs, emergency care, and children’s health. The GOP proposals would let states opt out of those requirements, affecting insurance sold on the exchanges and employer-based coverage. But economists say that won’t lower health costs as much as the bills’ backers may hope, since the three biggest drivers of health costs are hospital care, doctor visits and prescription drugs — three things states may be most reluctant to cut.

Uncertainty And Market Instability. As far back as April, insurers were worried that they wouldn’t have enough time to set rates for 2018. That fear has only increased. Earlier this month, entrepreneurs said the lack of clarity is interfering with hiring. Enrollment on the federal exchanges opens Nov. 1, though the Trump administration has cut advertising for open enrollment by 90 percent. Some private insurers are stepping up to fill the gap.

The full article is available by clicking here: NPR

Who Wins, Who Loses With Senate Health Care Bill

Who Wins, Who Loses With Senate Health Care Bill

Would you like to have a clearer picture of the tremendous negative effects of the proposed  Republican Health Bill(“Better Care Reconciliation Act”)? Review the following chart and article from NPR for some clearly-presented information. There is nothing BETTER about this than the ACA! This provides LESS CARE than mandated by the ACA! This will cost patients MORE than under the ACA! This will cause more than 20,000,000 people to lose coverage! This is barbaric! Congress has no soul.

PLEASE—WRITE AND CALL YOUR Senators and tell them to VOTE NO!  It’s not too late.  It’s just plain wrong to take away insurance from tens of millions, reduce coverage, and raise costs—all so people that can afford great insurance can pay less taxes. Health care should be a right—available to all—regardless of economics or politics! SPEAK UP NOW! Later might be too late.

CLICK HERE for full NPR article.

This chart illustrates how the plans compare:

People under 26
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
Can get insurance through a parent’s plan or buy independently. Stays the same. Stays the same.
Adults under 65
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
Can buy insurance on health exchanges, with tax credits and subsidies if they meet income requirements up to 400 percent of poverty level. Cost of insurance is based on tobacco use and age, with the people nearing 65 paying no more than three times what the youngest pay. Premiums can’t cost more than 9.5 percent of income. Those with very low or no income qualify for Medicaid. Will see tax credits to pay premiums based on age, not income, and that max out at $4,000, much less than under the ACA. The oldest people under 65 can be charged five times more than the youngest, and maybe more depending on state rules. Medicaid cut after 2020. The CBO report says 22 million people would lose health insurance over the next 10 years, with people between 50-64 disproportionally impacted. The oldest people under 65 would pay five times more than younger people on the exchanges.Subsidies to help pay for insurance would be less and end at incomes of 350 percent of poverty level. Federal contributions to Medicaid start to decline in fiscal year 2020.
Low-income nursing home residents
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
Skilled nursing care covered by Medicare up to 100 days. Medicaid is available based on income. Skilled nursing care covered by Medicare up to 100 days. Medicaid services could be cut as states see federal funding decline. Skilled nursing care covered by Medicare up to 100 days per illness. Medicaid coverage for nursing home services could be cut as federal payments to states decline.
People with pre-existing medical conditions
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
Coverage cannot be denied or cost more. States can get permission to let insurers charge more for some pre-existing conditions and to exclude some people altogether. States would have access to federal money to help those with expensive policies or conditions. Insurance companies would be required to accept all applicants regardless of health status. But the draft bill lets states ask permission to reduce required coverage, also called “essential health benefits,” which would give insurers some discretion over what they offer in their plans. That could result in “substantial increases” in costs for people who want those services, according to the CBO. If a particular benefit is no longer classified as essential, insurers could impose annual and/or lifetime limits on what they spend on patients for that benefit. And caps on the annual out-of-pocket costs for patients would no longer apply.
People who go to Planned Parenthood
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
Federal programs reimburse for most Planned Parenthood services. A one-year block will be placed on federal reimbursementsfor care provided by Planned Parenthood. A one-year block will be placed on federal reimbursementsfor care provided by Planned Parenthood. The CBO estimates 15 percent of women would lose access to family planning care, increasing birth rates and Medicaid spending for childbirth and children’s insurance. But those increases would be offset by Planned Parenthood cuts.
People with disabilities
The majority of Medicaid dollars go to people with disabilities.
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
May qualify for Medicare and also Medicaid. Services covered by Medicaid could be cut as federal funding to states declines over time. Services covered by Medicaid could be cut as federal funding to states declines over time. The CBO report suggests that by 2026, Medicaid enrollment would fall by more than 15 million people.
People who use mental health services
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
Covered by all plans under essential health benefits. Could lose coverage in states that get waivers from covering essential health benefits. States could request waivers to opt out of requiring essential health benefits. If a state opted out of coverage for mental health care, the CBO says insurance that includes mental health care coverage could become “extremely expensive.”
Working poor on Medicaid
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
Thirty-one states and the District of Columbia offer expanded Medicaid coverage. Federal funding for Medicaid expansion phases out, potentially affecting millions of people who are currently enrolled under the expansion. Federal funding for Medicaid expansion phases out between 2021 and 2023. In addition, eight states would have a trigger clause — if the federal matching rate declines below the ACA-promised rates, the expansion goes away immediately in Arkansas, Illinois, Indiana, Michigan, Montana, New Hampshire, New Mexico, and Washington. Further reductions would start in 2025. In a separate provision, states could impose a work requirement on recipients. Most able-bodied adult Medicaid recipients already work.
The wealthy
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
Pay extra taxes to support ACA. The bill would repeal ACA taxes on corporations and cut taxes for the wealthy by about $592 billion. Similar to the House bill; would repeal ACA taxes on corporations and the wealthy that pay for insurance subsidies. That would add up to about $563 billion in tax cuts over 10 years, according to the CBO.
Navigating the Medical Billing Process

Navigating the Medical Billing Process

Kenneth Klein, manager of Human Health Advocates, was recently the featured guest on WLRN Public Radio’s popular Topical Currents show. There was an excellent discussion of many aspects of patient advocacy as it relates to medical billing and health insurers. Give a listen.

(3-7-2017) It’s a common assumption that if one has health insurance; the company routinely covers the bulk of medical charges.

Correct? The answer is only a “maybe.”

Today’s Topical Currents looks at the confusing aspects of navigating the medical billing process, with patient advocate Kenneth Klein, Founder/Manager of Human Health Advocates, LLC, in Boca Raton. He provides assistance to patients with medical bill and health insurance related concerns.

Click here to listen to the full interview.

www.humanhealthadvocates.com

CBS12 Investigates: Cash vs Insurance

CBS12 Investigates: Cash vs Insurance

There are times when it is less expensive to pay cash for medical procedures than submit claims having your doctor/medical provider seek payment from your health insurer.

Health Insurance AdvocateWEST PALM BEACH, Fla. (CBS12) — When you go to the doctor, do you ever think about not using your health insurance?
Some patients are now negotiating the price and paying in cash. They say cutting out insurance is like cutting out the middle man.
As a consumer, when you think about negotiating costs, you probably think about buying a car or a home – not negotiating with your doctor.
But, as we found out, paying out of your pocket instead of going through insurance could save you money.

PAID THE CASH PRICE
When James Tow needed to pay for a tonsillectomy, he knew it would be expensive. Instead of just handing over his insurance card and trusting that would be the best price, James asked the doctor’s office if they had a cash price. “If I go through insurance, I’m going to have to pay the insurance price,” said Tow. “Whereas if I do the cash price, I pay less.”

That’s right. For example, if he went through his insurance, the anesthesiologist would have charged $656. James’ insurance would only pay $136, leaving him with an out-of-pocket bill for $520. While just paying cash, the anesthesiologist would only charge $464. So, by paying cash and not going through his insurance, James saved $56.

PATIENT ADVOCATE
So why would the doctor’s price vary depending on whether or not a patient has insurance?
We took our question to patient advocate Kenneth Klein. He said one reason doctors charge more for insurance is that it costs them money to file the paperwork, and that can run as much as 20% more. “If they are presented with a situation where they can get cash up front and not do anything else, file any papers, that is great,” added Klein. Klein said there’s nothing in state law that requires you have to use your insurance. “In many situations, it may be disadvantageous to submit this through your insurance,” Klein explained. Although, paying cash isn’t a guarantee that you will always save money.
You will have to decide on a case by case basis. It can vary based on your level of insurance coverage, whether the provider is in or out-of-network and your deductible.

Klein said it pays to treat going to the doctor like any other consumer transaction, and ask, “How much is this going to cost?’ “You are not locked in, and one can always try to negotiate. The worst thing that can happen is the person on the other side says, ‘No’. You are no worse off than you were. In many cases, you may be surprised,” said Klein.

WHEN TO CONSIDER CASH
According to Klein, the best places to ask for a cash price are hospitals, imaging centers, sole practitioners, eye doctors, surgical centers and pharmacies.
James said he’s learned from this experience to always ask the doctor for both the cash price and the insurance price and to not assume using insurance is the financially prudent way to go.

“Just paying cash, it seems to me it’s far better,” said Tow. If you decide to negotiate a cash price, get it in writing with the full agreed upon price.
Also, ask for an itemized bill for your records. Klein suggests submitting that bill to your insurance. Some companies may apply it towards your deductible at a reduced rate.

 

Tips for Your Health Insurance and Medical Bills in 2017 (Part 1)

Tips for Your Health Insurance and Medical Bills in 2017 (Part 1)

by Kenneth Klein, Human Health Advocates

In 2017 brings a new insurance year cycle. There are several things you can do at this time to make your life easier down the road – avoid surprise bills and costs – and ensure that you are maximizing the benefits of your health insurance policy while minimizing the associated costs. For example:

networkcareUse In-Network Providers. Many of us are unaware of the fact that most health insurance policies contain different deductibles and co-pays for in– network providers and out-of-network providers, respectively. The cost of each are drastically different. This is the time to verify that your providers are, in fact, in network (and, as to ongoing providers, still in network). Sometimes providers migrate in and out of network based upon their contracts with the insurance companies. I would suggest the following:

• Verify and Document the status of your physicians. Contact each of your physician’s office manager or billing manager and verify that the practice is still in network for 2017. Make a note of the person with whom you spoke, the date, time, and the substance of the conversation. Also, go to your insurance company website and cross – check by verifying with the tools there. Finally, take the time (yes it will take the time but it’s worth it) to call the customer service number of your health insurance company and get clarification that were provider is in – network. Again, it’s a great practice to take notes – the date, the time, the person with whom you spoke, and the substance of the conversation. Many insurance companies provide a reference number – be sure to ask for one. Each time you schedule an appointment with the provider, and you should “double check” prior to treatment.

Perform the same verification for your pharmacy. Pharmacies also leave and join the insurance company networks. For example, as of January 1, 2017, CVS, which had been – network for Florida Blue will no longer be recognized. Any prescriptions filled there by Florida blue member after that date will surely cost substantially more than those filled at an – network pharmacy.

More valuable tips will follow.

Human Health Advocates wishes each of you a healthy 2017 and beyond.

STAY IN NETWORK: Avoid Surprises, Save Money, Stay out of Debt!

STAY IN NETWORK: Avoid Surprises, Save Money, Stay out of Debt!

Health insurance concept. Tag cloud.One of the most common (and most of expensive mistakes) to make when using your health insurance is to use “out-of-network” physicians, labs, hospitals, etc. Whether you are in a PPO or an HMO, your insurance company has providers with whom they have negotiated reduced rates. That’s why the total bill (let’s say for a doctor’s office visit) is $300—but the “allowed amount”—negotiated rate is only $80. If you use this “in-network” doctor, the insurer pays 80% of the $80($64) and you 20% coinsurance share would be only $16.

BUT, if you saw the same type of doctor with the same fee doctor who was NOT part of your insurer’s network (an out-of-network doctor), the insurance company would pay its 80 %( of the SAME) allowable amount-$64.00 and you could be billed $236. BIG DIFFERENCE. You would save $172 merely by staying in-network.

You can typically locate in-network providers on your insurance company’s website. The best practice is to also verify with both the provider and your insurance company verbally (get a reference number of the call), as sometimes a provider leaves a network and the website isn’t updated quickly.

Be informed. Knowledge is Power! Save Money, Avoid Surprises, and Headaches. USE IN-NETWORK HEALTH PROVIDERS!

California Now Requires Timely Updates For Insurers’ Doctor Directories

medical bill helpIt seems that everyone has problems with medical bills and insurance claims. There are many ways way to improve this. Access to information empowers patients. One of the greatest traps insured patients can avoid is incurring sky-high fees by unnecessarily using the services of out-of-network providers. California’s new law has gone a long way in addressing this problem. Florida did so, as well-when it outlawed balance billing ion July 1st and required insurers to maintain current identification of in-network providers on their websites.

Many medical bill problems can be avoided by observing that simple distinction. The claims for a visit to an internist may be $300.00. The in-network internist has a negotiated rate of $90.00—of which you might pay 20% ($18.00). The same internist, were she out-of-network might cost you as much as $228(her $200 fee less the $78 paid by the insurer).An insurance appeal wouldn’t help. But having information posted informing both of the identities of in-network providers and the distinction in costs between using their services and those of out-of-network providers can go far in avoiding medical bill problems.

Please see:

http://www.npr.org/sections/health-shots/2016/09/06/492804674/california-requires-timely-updates-for-insurers-doctor-directories

New Florida Law Shields Patients from Surprise Medical Bills

florida-capitolThe Florida Legislature recently passed(signed by Governor Rick Scott) a bill that may be the most consumer-friendly in the country concerning “Balance Billing. “ Yes—FLORIDA.

Balance Billing was previously illegal in Florida for both Medicare and HMO patients, but led to financial havoc for thousands of Floridians with PPO coverage. Simply, a patient went to an in-network hospital’s emergency room. However, many doctors, although affiliated with the hospital, were not “in-network” for the patients

The treating emergency room doctor(whom the patient had no option in choosing) submits a “full-price bill—say $1,200 to the insurance company. It would cover it’s normal negotiated rate-say $300. The patient would be billed the balance($900.00),hence the term Balance Billing.

As a result of having no way to choose their doctors, thousands of patients were pursued by billing companies (many of which were ruthless about pursuing the patient into collections, negative credit reporting, and sometimes lawsuits. This doesn’t mean that medical bill claims will not be vigorously pursued. But they will no longer be pursued as the product of balance billing.

That has changed- Thank you Florida Legislature for “doing the right thing.”

Please see full story in Modern Healthcare

Beware of the Trap of Pre-Authorizations (Part 2)

Earlier, I mentioned that insurance companies place the burden upon the insured to verify Pre-Authorization of certain services and procedure. Some physicians are beginning to do so, as well—placing language to that effect in their intake papers. I also mentioned that doctors’ offices sometimes make inadvertent mistakes. Well, this is what happened to me a few months ago…..

My shoulder hurt terribly. What ended being an impingement (fortunately nothing structural), almost cost me many thousands of dollars—a pain in both the shoulder and the pocketbook.

(more…)