under insured

How Not To Get “Hurt” Giving Birth: Medical Billing Tips for Parents

Maria Montecillo Leave a comment

The Cost of Giving Birth: What Expecting Parents Should Know About Medical Billing

Giving birth in America comes with a lot of costs, some disclosed and some not. It is possible to manage the cost of childbirth through informed, careful decision-making. The key is to plan ahead. The below article includes quotes by Medical Cost Advocate and appeared on Fatherly.com on August 16, 2019

By Adam Bulger – Fatherly.com

Giving birth

Moments after my daughter’s birth, I basically had to negotiate the cost of a timeshare.

My first job as a new dad was choosing a recovery room at a Manhattan hospital known for luxury accommodations. It was the dead of night. I was exhausted and unsure about our insurance coverage, so I opted for a lower-tier option. Months later, our insurance covered the room but, because of a billing error that took months to resolve, didn’t cover basic care.
Sorting out the cost of birth was confusing and stressful. But compared to other parents, my family had it pretty easy. Giving birth in America is an expensive, confusing process where parents often feel like they have no choices or negotiating power. But medical billing experts and maternity care advocates say it’s possible to manage the cost of childbirth through informed, careful decision-making.

In a 2013 national study of inpatient care costs, pregnancy and childbirth hospitalizations accounted for five of the 20 most expensive conditions for hospital stays covered by Medicaid and three of the 20 most expensive conditions for hospital stays covered by private insurance. The mean hospital stay expense is $18,000. All told, a standard birth could run you roughly $30,000. If a C-Section is required? It’s considerably more. But despite the price tag, births aren’t big money-makers for hospitals. Sean P. Lillis, founder and CEO of New York City–based medical billing services firm Billing Geeks, notes that the high cost of birth for parents doesn’t translate into enormous profits for hospitals.

Per Lillis, hospitals don’t make money off of obstetrics. Hospitals have to devote considerable time, resources, and staff for labor. Despite the overhead, private insurance pays hospitals according to fee-for-service schedules, meaning insurance pays more to hospitals for some types of patients, like the ones undergoing short stay surgical procedures requiring a battery of tests and procedures, than others, like the ones giving birth. “They can’t make their maximum reimbursement charge rate,” he says.

While the real action of having a kid happens in the delivery room, that’s not what you pay for. Most labor costs happen later, during the mom’s short hospital stay following birth.
“Four out of five of all dollars paid on behalf of the mother and the baby across that full episode from pregnancy through the postpartum and newborn period go into that relatively brief hospital window,” says Carol Sakala, Director of Childbirth Connection Programs at the National Partnership for Women & Families.

Some of the hospital costs, like medical tests for the baby and mother, can’t be avoided. Others you might be able to work around. Some hospitals reportedly impose fees for using their TVs; others can charge as much as $20 for an Ibuprofen. Packing an iPad and a bottle of Advil in your go-bag can defray some of those gotchas. But, honestly, saying no to these add-ons is chump change compared to what you can save by doing a little homework ahead of time.

How to Avoid the High Costs of Child Birth
Maria Montecillo, a healthcare insurance and billing advocate for the New Jersey medical billing advocacy firm Medical Cost Advocate, says parents should get in the weeds of their health plan as soon as they know they’re expecting. Knowing what health care providers are in your network makes a huge cost difference. And if your network’s too small, you may be lucky enough to be able to expand it. While it isn’t easy to time a pregnancy, the months leading up to your company’s health care enrollment period are an ideal time to make informed coverage changes.

“If you know you’re going to be pregnant this year, think about changing your insurance coverage,” Montecillo says. “You’ll pay a higher premium now but it’ll work out later.”
And when you’re getting close to the due date, taking your time can save a lot of money. Hospitals often try to slot births into a timetable that benefits the institution but may harm its patients, as there’s evidence early admission correlates with higher rates of labor induction and C-section births.
“The system is, for its convenience, pushing women into giving birth at weekday, daytime, non-holiday hours,” Sakala says. “A vast number of labor inductions, which add costs, could be avoided, a vast number of Caesarians, which add costs, could be avoided.”

Delayed admission to labor, where the mother doesn’t enter the delivery until they’re in active labor, is a simple way to reduce the cost of birth. Under delayed admission, the mother, ideally with the guidance of a midwife, doula, or other birthing professional, monitors the frequency and intensity of her contractions.

If the expectant mother has a hearty constitution or advanced skills in pain management, forgoing an epidural can avoid billing surprises.
“One of the places where people are getting into trouble with out-of-network providers is with the anesthesiologist,” Sakala says. “You didn’t choose that person, and the person who’s on call at that time could very well be out-of-network and those charges could be sky-high.”

It might be possible to skip the hospital — and its price tag — altogether. Sakala is a big proponent of birth centers, non-hospital labor facilities that offer natural births, without epidurals, inductions, or Caesarians or the high costs associated with those procedures. “They’re avoiding many things that are avoidable and pulling in beneficial practices that might be kind of low-tech, like being up and about, as opposed to staying in bed,” she says. “Or being in a tub or being in a shower. Those kinds of things can make a huge difference.”

The first month after the birth, parents have a small window of opportunity to shuffle around their insurance coverage. If the mother and father have separate insurance coverages, a baby’s birth is automatically billed under the mother’s insurance. They have 30 days to add the newborn to either the mother or father’s policy. Tracking the vagaries of insurance coverage can easily slip down the priorities list when you’re dealing with a newborn but ignoring it can court disaster.
“I once had a case where the parents ‘forgot’ to add the baby into their insurance plan, and they had to wait until open enrollment for the baby to be added,” Montecillo says. “As luck would have it, the baby developed complications and needed surgery. The insurance company stuck to their guns and refused coverage for the baby, as this was clearly stated on the policy and the parents were hit with a huge medical bill.”

When your insurance company’s bill for the birth arrives, don’t rush out to the post office with a check. Take your time and scrutinize the charges. Insurance coverage is complicated, even for insurance professionals. Mistakes happen. An insurer may have calculated a payment on the basis of an incorrect fee schedule for your plan or charged you for something that wasn’t performed.
“Look over the bill carefully,” Montecillo says. “It’s just like at a restaurant. You want to see that if you ordered chicken nuggets that they charged you for chicken nuggets.”

Spotting a costly error can be infuriating. Nonetheless, overt hostility is the wrong approach to the discovery. Montecillo says that everything is negotiable — she chiseled down a $60,000 triplet birth to a $1,300 final bill, for example — but only when the person on the phone wants to negotiate. And that means being not just polite but persuasive. “Start with sweetness but if you’re not getting anywhere, ask to talk to a manager,” she says.

And Montecillo speaks from experience. Before working on behalf of consumers, she spent 14 years as billing manager for a large private medical practice.
“I was on the other end of those calls and I know that I can make changes,” she says. “But if you’re nasty or you’re saying mean things about the doctor, I can say no.”

Read More

Americans don’t know what’s in Obamacare, do know they don’t like it

admin

By Sarah Kliff, Washington Post

Fifty percent of Americans now say they oppose the Affordable Care Act. This is the highest number that Kaiser Family Foundation’s poll has seen since October 2011, when Republicans were in the midst of a primary cycle and lots of anti-Obamacare rhetoric was in the air. The easiest explanation for the recent upswing in negative sentiment would be that lots of Americans tried, but failed, to buy insurance through HealthCare.gov. They ran into technical barriers that plagued the site in October and November. But Kaiser’s data don’t really bear out that thesis. There’s actually only been a tiny uptick in the number of Americans who say the health-care law has affected their lives over the past three months. A full 59 percent of Americans still report no personal experience with the law. 

Most Americans don’t know that Obamacare has, at this point, pretty much fully taken effect. When surveyed in January, after the insurance expansion began, 18 percent said they thought “all” or “most” provisions of the Affordable Care Act had been put into place.

There’s lots of confusion, too, about what policies are and aren’t part of the health-care law. Most Americans know there’s a mandate to purchase health insurance. A lot fewer are aware that the law provides financial help for low- to middle-income Americans (the tax subsidies) or gives states the option of expanding Medicaid.

For many Americans – particularly the 68 percent who get coverage through their work, Medicare and Medicaid — the launch of the exchanges probably doesn’t affect their coverage situation. They’ll continue getting insurance in 2014 just the same way they did in 2013. For them, an expansion of Medicaid or an end to the denial of coverage for people with pre-existing conditions isn’t a big change (unless, of course, they lose their current coverage).

So what’s driving the negative opinions of Obamacare? The Kaiser survey does point to one potential culprit: negative news coverage. More Americans say they’ve seen stories about people having bad experiences with the Affordable Care Act than good ones.

Politico’s David Nather had a great line on this recently, in a story about the very high bar for success stories about the Affordable Care Act.

“Here’s the challenge the White House faces in telling Obamacare success stories: Try to picture a headline that says, ‘Obamacare does what it’s supposed to do,’ ” Nather writes. “Somehow, the Obama administration and its allies will have to convince news outlets to run those kinds of stories — and to give the happy newly insured the same kind of attention as the outraged complainers whose health plans were canceled because of the law.”

We don’t have a great sense yet of what type of experience Obamacare’s new enrollees are having — whether they’re disproportionately bad or if the bad stories are just more interesting to cover. But the more negative news coverage does seem to have played some role in the recent uptick in negative opinions about the new law.

Read More

High Medical Bills Driving Some Americans to Extreme Measures

J Roberts

Have you ever delayed, put off or just gone without seeing a physician because of the cost? You would not be alone if you did. A recent study found that many Americans are juggling the high cost of health care by delaying non-essential or non-critical care. In one study, stories of credit card debt and cutting back on food and heating were common, even for the insured.

By Karen Pallarito – HealthDay Reporter

Jan. 18 (HealthDay News)

Insured Americans with serious medical conditions say the financial stress of rising out-of-pocket health care costs is forcing them to juggle household budgets, delay or skimp on care and even run up credit cards or dodge debt collectors, a new study reveals.

The report, published in the January/February issue of the journal Annals of Family Medicine, provides a snapshot of “life disruptions” people experience as a result of their medical expenses and the sometimes extreme measures they take to keep their heads above water.

One study participant was prescribed a drug to alleviate nausea and vomiting caused by his cancer chemotherapy. Insurance picked up $900 of the $1,200 cost, but he could not even afford the co-payment and went without the medicine. “I said, you know what, I’d rather be sick,” he told researchers.

Another paid all her bills but relegated her grocery budget to “whatever’s left.”

“Sadly, our experience with thousands of patients over the last decade has shown us that many of them have to make heartbreaking decisions about following doctors’ orders or putting food on the table for themselves or their families,” said Sarah Di Troia, chief operating officer of Health Leads, a Boston-based organization that works with hospitals and clinics to connect patients to basic resources.

David Lipschutz, policy attorney for the Center for Medicare Advocacy in Washington, D.C., said the study is important, timely and “reinforces a lot of the other literature out there” examining the effects of out-of-pocket spending.

Medicare has considerable cost-sharing requirements, and many people who have Medicare “simply don’t earn the income in order to afford it,” Lipschutz added.

Consider this: Half of the nation’s Medicare beneficiaries live on less than $22,000 a year, and 45 percent have three or more chronic conditions, according to data compiled by the Henry J. Kaiser Family Foundation.

Medicare beneficiaries spent a median of more than $3,100 of their own money on health expenses in 2007, the most recent comprehensive data, according to the AARP’s Public Policy Institute. Four million beneficiaries, or 10 percent of the Medicare population, shelled out much more. Their out-of-pocket spending topped $7,800.

With health care costs outpacing income growth, study lead author Dr. David Grande, assistant professor of medicine at the University of Pennsylvania Perelman School of Medicine, wanted to know how families are coping financially.

“My sense is that we focus so much on whether people are covered or not, which is extremely important, we forget how important it is that the coverage is adequate,” he said.

For the study, researchers interviewed 33 insured, chronically ill adults who were applying for financial assistance at a nonprofit foundation to help pay for their treatment costs. People were asked about illness-related financial challenges and their impact on housing, food, utilities, savings, borrowing and health expenses. The interviews were recorded, transcribed and coded for analysis. (more…)

Read More

Health Insurers Raise Some Rates by Double Digits

J Roberts
Insurance premiums are on the rise for 2013! It doesn’t appear that the Affordable Care Act has stemmed the double-digit increases in premium rates charged by health insurers for 2013.
By REED ABELSON

The New York Times – Online

Health insurance companies across the country are seeking and winning double-digit increases in premiums for some customers, even though one of the biggest objectives of the Obama administration’s health care law was to stem the rapid rise in insurance costs for consumers.

Dave Jones, the California insurance commissioner, said some insurance companies could raise rates as much as they did before the law was enacted.

Particularly vulnerable to the high rates are small businesses and people who do not have employer-provided insurance and must buy it on their own.

In California, Aetna is proposing rate increases of as much as 22 percent, Anthem Blue Cross 26 percent and Blue Shield of California 20 percent for some of those policy holders, according to the insurers’ filings with the state for 2013. These rate requests are all the more striking after a 39 percent rise sought by Anthem Blue Cross in 2010 helped give impetus to the law, known as the Affordable Care Act, which was passed the same year and will not be fully in effect until 2014.

 In other states, like Florida and Ohio, insurers have been able to raise rates by at least 20 percent for some policy holders. The rate increases can amount to several hundred dollars a month.

The proposed increases compare with about 4 percent for families with employer-based policies.

Under the health care law, regulators are now required to review any request for a rate increase of 10 percent or more; the requests are posted on a federal Web site, healthcare.gov, along with regulators’ evaluations.

The review process not only reveals the sharp disparity in the rates themselves, it also demonstrates the striking difference between places like New York, one of the 37 states where legislatures have given regulators some authority to deny or roll back rates deemed excessive, and California, which is among the states that do not have that ability.

New York, for example, recently used its sweeping powers to hold rate increases for 2013 in the individual and small group markets to under 10 percent. California can review rate requests for technical errors but cannot deny rate increases.

The double-digit requests in some states are being made despite evidence that overall health care costs appear to have slowed in recent years, increasing in the single digits annually as many people put off treatment because of the weak economy. PricewaterhouseCoopers estimates that costs may increase just 7.5 percent next year, well below the rate increases being sought by some insurers. But the companies counter that medical costs for some policy holders are rising much faster than the average, suggesting they are in a sicker population. Federal regulators contend that premiums would be higher still without the law, which also sets limits on profits and administrative costs and provides for rebates if insurers exceed those limits. (more…)

Read More

Analysis: Employees to face healthcare sticker shock

J Roberts

Here we go again. Health care premiums and out-of-network costs are expected to rise in 2013. Read  more about the increases and what they mean for you.

Sun, Oct 28 2012

By Caroline Humer

NEW YORK (Reuters) – Visit to New York City orthopedist: $223. One X-ray: $50. One follow-up magnetic resonance imaging test: $766. Total bill for checking out that aching shoulder: $1,039 – all to be paid by the patient, rather than the insurer.

Healthcare has gone retail.

Over the next 18 months, between one quarter and one half of Americans who get insurance coverage through their employers will pay more of their doctor bills themselves as companies roll out healthcare plans with higher deductibles, benefits consultants say. The result: sticker shock.

“They have huge out-of-pocket costs before they get any insurance coverage, it’s a real slap in the face,” said Ron Pollack, the executive director of Families USA, a healthcare advocacy group.

High-deductible plans set a threshold for medical expenses that an individual must pay for, often in the thousands of dollars, before insurance kicks in. Studies show people on these plans are three times more likely to delay or skip care than people on traditional plans, where doctor or emergency room visits are covered by a relatively low co-payment.

These plans have been around for years, pushed by employers, insurers and industry experts who believe that consumers with “skin in the game” will drive demand for better quality care at a lower cost. It is a rationale also backed by President Barack Obama’s Republican challenger Mitt Romney.

But now corporate America’s adoption of high-deductible plans is accelerating, partly because of Obama’s healthcare reform, which requires insurance plans to provide more expansive coverage such as preventive care.

Several industry surveys forecast a two-percentage-point increase in the number of companies offering only high-deductible plans in 2013 to about 19 percent, and a larger jump of anywhere from 5 to 25 percentage points in 2014.

“2013 is almost a calm period before a period of intense change in 2014,” according to Randall Abbott of Towers Watson & Co, a Boston-based senior consulting leader at the human resources firm.

The shift means consumers will have to spend many more hours researching their treatment options and managing costs on websites like Healthcarebluebook.com, which helped budget the cost of examining the shoulder pain mentioned above.

It could also spur lawsuits against doctors whom patients may blame for not making clear whether a test or procedure would spare them future harm, legal experts say. (more…)

Read More

Big Firms Overhaul Health Coverage

J Roberts

Where do the majority of American citizens get their healthcare benefits? From their employer! That may not be the case in the future. Read how two large employers are fundamentally changing the way they provide healthcare benefits to their employees even before implementation of the Affordable Care Act.

Wall Street Journal – HEALTH INDUSTRY September 26, 2012, 8:41 p.m. ET

By ANNA WILDE MATHEWS

Two big employers are planning a radical change in how they provide health benefits to their workers, giving employees a fixed sum of money and allowing them to choose their medical coverage and insurer from an online marketplace.

Two big employers are planning a radical change in the way they provide health benefits to their workers, giving employees a fixed sum of money and allowing them to choose their medical coverage and insurer from an online marketplace.

Sears Holdings Corp. and Darden Restaurants Inc. say the change isn’t designed to make workers pay a higher share of health-coverage costs. Instead they say it is supposed to put more control over health benefits in the hands of employees.

Darden Restaurants, owner of Red Lobster, is giving staff money and allowing them to choose health coverage.

Some Workers Will Choose From Array of Benefits

The approach will be closely watched by firms around the U.S. If it eventually takes hold widely, it might parallel the transition from company-provided pensions to 401(k) retirement-savings plans controlled by workers and funded partly by employer contributions. For employees, the concern will be that they could end up more directly exposed to the upward march of health costs.

“It’s a fundamental change…the employer is saying, ‘Here’s a pot of money, go shop,’ ” said Paul Fronstin, director of health research at the Employee Benefit Research Institute, a nonprofit. The worry for employees is that “the money may not be sufficient and it may not keep up with premium inflation.”

Neither Sears nor Darden would say how much money employees would receive to buy health insurance. Darden says its sum would rise as health-care costs rise. Sears declined to disclose details of its contributions strategy.

Darden did say that employees will pay the same contribution out of their own pockets that they currently do for approximately the same level of coverage. Employees who pick more expensive coverage will pay more from their paychecks to make up the gap. Those who opt for cheaper insurance, which may involve bigger deductibles or more limited networks of doctors and hospitals, will pay less.

“It puts the choice in the employee’s hands to buy up or buy down,” said Danielle Kirgan, a senior vice president at Darden. The owner of chains including Olive Garden and Red Lobster will let its approximately 45,000 full-time employees choose the new coverage in November, to kick in Jan. 1. Darden says that employees with families to cover will be given more money to buy insurance than employees covering just themselves. (more…)

Read More

Billing Errors in Health Care Abound as System Heads for More Complexity

J Roberts

New coding requirements may create even more disarray in an already complex industry. The result could leave consumers with a greater sense of confusion in understanding medical bills.

Written by: Ruth McCambridge

Source: Cleveland Plain Dealer

As health care systems prepare for all of the many changes that the Affordable Care Act will entail, there is one that is relatively hidden from view: the ten-fold increase in billing codes that the federal government is planning to roll out next year (pushed back from a planned launch this year).

Stephen Parente, a professor of health finance and insurance at the University of Minnesota, claims that his research on medical billing found that up to 40 percent of claims sent between insurers and hospitals have errors. These errors, often caused by human error but sometimes the result of alleged fraud, may include double billing, billing for the wrong treatment, unexpected costs, or billing that is more than what an insurance contract allows. The American Medical Association claims these mistakes cost health care providers $17 billion last year and it blames insurance company practices, but others say the blame can be shared, and this article details many problems with hospital billing practices as well.

According to Kevin Theiss, a vice president at the Summa Health System, at the Summa Akron City Hospital, as many as 250 people may take part in the billing process, including intake workers, doctors and nurses and those who assign billing codes. He says that the potential for mistakes at the hospitals is “astronomical.” In the midst of all of this, a change is brewing that is likely to make the whole system even more impenetrable for consumers. That is, the federal government, which requires that all medical billing use the same set of 16,000 universal codes (called ICD-9 codes) to identify medical problems and treatments, is planning to increase the number of codes to 155,000. While rolling out these new codes has been delayed by a year, the project is apparently moving forward apace. Some, including the American Medical Association, are heralding the delay. Even before new codes are introduced, the complexity of the current system has created what the article describes as a “cottage industry” of experts that are there to advocate between institutional players.

“There are certified coders, ‘revenue cycle’ consultants, auditors who check claims, ‘denial management’ experts who step in for hospitals and doctors to help negotiate with payers for more money, and debt collectors who specialize in ‘accounts payable,’ or the bills hospitals and doctors think they can get the patients to pay if they press hard enough.

Consumers, in contrast, have no army of experts. They pretty much just have themselves and their bills.”

Read More

Insurers Alter Cost Formula, and Patients Pay More

J Roberts

Beware of even greater out-of-pocket healthcare costs. Read the following article and learn how insurers are shifting the cost of out-of-network care to consumers.

Doug Benz / The New York Times

Despite a landmark settlement that was expected to increase coverage for out-of-network care, the nation’s largest health insurers have been switching to a new payment method that in most cases significantly increases the cost to the patient.

Jennifer C. Jaff, founder of Advocacy for Patients with Chronic Illness. She has Crohn’s disease.

The settlement, reached in 2009, followed New York State’s accusation that the companies  manipulated data they used to price such care, shortchanging the nation’s patients by hundreds of millions of dollars.

The agreement required the companies to finance an objective database of doctors’ fees that patients and insurers nationally could rely on. Gov. Andrew M. Cuomo, then the attorney general, said it would increase reimbursements by as much as 28 percent.

It has not turned out that way. Though the settlement required the companies to underwrite the new database with $95 million, it did not obligate them to use it. So by the time the database was finally up and running last year, the same companies, across the country, were rapidly shifting to another calculation method, based on Medicare rates, that usually reduces reimbursement substantially.

“It’s deplorable,” said Chad Glaser, a sales manager for a seafood company near Buffalo, who learned that he was facing hundreds of dollars more in out-of-pocket costs for his son’s checkups with a specialist who had performed a lifesaving liver transplant. “I could get balance-billed hundreds of thousands of dollars, and I have no protection.”

Insurance companies defend the shift toward Medicare-based rates under the settlement, which allowed any clear, objective method of calculating reimbursement. They say that premiums would be even costlier if reimbursements were more generous, and that exorbitant doctors’ fees are largely to blame.

But few dispute that as the nation debates an overhaul aimed at insuring everybody, the new realpolitik of reimbursement is leaving millions of insured families more vulnerable to catastrophic medical bills, even though they are paying higher premiums, co-payments and deductibles.

“They’re not getting what they think they’re paying for,” said Benjamin M. Lawsky, the superintendent of the New York State Department of Financial Services, whose investigators recently found that under the switch, 4.7 million New York State residents — 76 percent of those with out-of-network coverage — are facing reimbursement reductions of 50 percent or more.

The switch “certainly creates the appearance that insurers are trying to end-run the settlement and keep out-of-network payments low,” Mr. Lawsky said.

Mr. Lawsky, who worked for Mr. Cuomo when he was attorney general, is seeking legislation in New York State to require that minimum reimbursements be linked to the new database, known as Fair Health. (more…)

Read More

Health care mandate is about personal responsibility

J Roberts

Is ObamaCare dead? The decision lies with the Supreme Court which is expected to rule sometime in June. Onething is for certain, the current model of paying for and subsidizing healthcare can not remain. Whether the law is repealed or not, the current system has to change. This, all of us can agree on.

Issac J.Bailey | The Myrtle Beach Sun

“Now, it is as plain as the spectacles on Antonin Scalia’s nose that opting out of the health-care market is about as realistic as opting out of dying.” – John Cassidy of the New Yorker.

Following the debate over the Affordable Care Act has reminded me of that old saw, everybody wants to get to heaven but nobody wants to die.

The public doesn’t want private insurance companies to be able to throw people off their rolls for the sin of getting too sick, or for denying them coverage because of a pre-existing condition, something they will no longer be able to do under the Affordable Care Act come 2014.

The public wants to keep in place the Reagan-era federal law that compels emergency rooms to treat whoever shows up, no matter if that person has not a dime to his name and won’t pay no matter how many harassing phone calls bill collectors make to their home.

But the public doesn’t want to be compelled to pay for those rights.

According to a variety of studies, from the independent Congressional scorekeeper the Congressional Budget Office to independent health care industry analysts, those with insurance are subsidizing those without to the tune of maybe $43 billion every year.

The annual premiums for those with health insurance are roughly $1,000 higher to make up for the unpaid bills of the uninsured.

According to the National Coalition on Healthcare, hospitals lose about $34 billion a year providing unpaid for care – services they are required to render because of federal law dating back to 1986. The group also said that “private insurance and some public payers pay an additional $37 billion on behalf of those with no insurance.”

What’s worse is that this is probably the least efficient, most wasteful way to operate the world’s most expensive health care system.

Justice Antonin Scalia alluded to it during this week’s debate when he said that one way to solve the problem would be to simply allow insurance companies the to right to throw sick patients off their rolls.

In fact, it is. Another way to solve the problem is to no longer guarantee access to emergency medical care, meaning that if you get into a car accident and can’t speak and your insurance card isn’t visible – or you don’t have insurance – medical officials should be able to deny you care, no matter how urgently you need it.

That’ll learn Americans who are not responsible enough to either purchase insurance without being compelled or have their insurance information tattooed to their forehead in case of an emergency. (Of course, if you suffer an ugly head trauma, that tattoo wouldn’t do any good.)

The Affordable Care Act has already done a variety of things, including slowing the rise in health care costs, convincing more medical institutions to go to a pay-for-quality rather than pay-for-quantity of care model, saving seniors tens of billions of dollars in drug costs and uncovering billions of dollars in fraud.

Because it has become a political lightning rod, all of those things and the contradictions being made by opponents are being overshadowed.

Conservatives have long claimed that they are the party of personal responsibility, yet conservatives have joined with a sizable number of liberals in opposition to the individual mandate, which will require everyone above a certain age who can afford it to buy health insurance.

The individual mandate is designed to make sure as many Americans as possible are paying into a system for which each of us is benefitting, to defray some of that $43 billion bill of annual uncompensated services, to assure that the insured no longer have to pay an extra $1,000 a year to pay for the uninsured.

If not the individual mandate, then something needs to be implemented that will accomplish the same goal – something those same conservatives seem to not want to do.

Or, we can take Justice Scalia’s advice and repeal all federal laws that compel medical officials to provide services to people who can’t pay for them, emergency or not.

The problem we’ve long had with balancing our books is that we too frequently demand things for which we don’t want to pay.

The individual mandate is unpopular largely because it threatens to shift that paradigm.

Read More

Employer Confidence in Future of Health Benefits Declines

J Roberts

Employers are less confident about offering healthcare benefits today compared to the previous year. Still, according to a recent poll by Watson Wyatt the majority of employers will continue to offer healthcare benefits in the years to come. Read the following excerpt to learn more.

Healthcare Financial Management Association (HFMA)

 

Despite rising healthcare costs and other economic worries, a majority of large U.S. employers remain confident they will continue to offer healthcare benefits to workers 10 years from now. However, the level of confidence has slipped from last year because of economic concerns and uncertainty over the implications of potential health care reform, according to a new survey by Watson Wyatt and the National Business Group on Health.

According to the survey, 62 percent of employers are very confident they will continue to offer healthcare benefits 10 years from now, down from 73 percent last year. The survey also found that roughly four in 10 employers (41 percent) are sticking with their current healthcare strategy, while the remaining respondents have either revamped their strategy or expect to do so this year.

The survey of 489 large U.S. employers, conducted in January 2009, also identified a group of “consistent employers” that have maintained a long track record of lower healthcare cost increases over the past four years. These employers have outperformed other employers in five key areas: appropriate financial incentives, effective information delivery, quality care, metrics and evidence, and maximizing health and productivity.

To read the survey in full go to www.Watsonwyatt.com/research

Read More