by healthcaredeciphered | Jun 7, 2015 | Deciphering Healthcare
Good News for people who bought health plans on the exchange or more commonly referred as “The Affordable Healthcare Act” aka “ObamaCare”. The government is adding more guidelines for provider directories for health insurance companies. The changes are directly related to the volume of complaints from you, the member. Why is this good?
The provider directory is your primary source for finding doctors, hospitals, specialists, etc., who participate with your health insurance. The provider directory contains the doctor’s or facility’s hours of operation, location information, specialty, and provider affiliations to name a few. If this information is inaccurate, this may result in misdirected referrals to out-of-network providers or to providers who do not accept new patients. Doctors use the provider directory to refer you to other specialists and facilities for care. Mistakes can often lead to you, the member, paying more for healthcare than necessary.
Health insurance plans will now be penalized for inaccurate provider directories, possibly a $100 a day per impacted member (you). This is a step in the right direction; however, there is a twist!
While insurance companies load the data for the provider directories, the information comes directly from the providers. There are several sources of error, which are not all directly related to health insurance companies. Providers are still not held accountable for providing mistakes in data to health insurance companies. This will likely continue and should also be addressed…. All in time, this is just a start to the Affordable Healthcare Act changes to come.
by healthcaredeciphered | Jun 6, 2015 | Deciphering Healthcare
There are numerous articles about preventive services, but can these initiatives decrease healthcare costs? It might be worth the doctor visit, but we all have to help! In the past few years, there has been an increased emphasis on preventive services. A preventive service is precautionary measure to prevent disease, disability, and death, while promoting healthy lives. The theory is illnesses or problems can be detected early or at onset of ailment in an effort to decrease chronic illnesses.
The truth is 75% of healthcare spending is for Preventable Chronic Diseases! This is reported from numerous studies, but most widely cited by the Centers for Disease Control and Prevention (CDC). This statistic alone tells us, prevention is a must.
The issue is to prevent onset of illness, we all have to receive regular screenings. In the U.S., 9.3% of Americans have Diabetes, which equates to $245B each year. If screenings are covered and detection can reduce illness, why wouldn’t we want to go for the doctor’s visit?
The caveat is to fully prevent illness we must also be accountable for our health. We have to follow the advice provided from our doctors after the visit to really reduce costs. Checking for diabetes is a great tool, but Type II can only be prevented from a combination approach. Preventive services are a great start, but to thoroughly reduce healthcare costs there should at least 2-fold approach.
by healthcaredeciphered | Jun 4, 2015 | Blog, Deciphering Healthcare
It’s true, you can receive certain healthcare services for FREE! The Affordable Care Act, aka ObamaCare, constitutes health insurance companies to provide certain services to you for preventive care. This is great news!
Now what does this mean? Preventive services are vaccinations and screenings that can be rendered to limit the onset or early detection of larger illnesses. For example, screening for cholesterol allows physicians to identify high sugar levels that may lead to Diabetes.
Preventive services are divided into 3 categories: adults, women, and children. All together there are 65 preventive services you can receive each year for Free! If you would like the complete list, email us at healthcaredeciphered@gmail.com.
There is fine print you should be aware of to receive these services. First, you must have active health insurance coverage that is required to provide preventive services. Second, you must use an In-network provider from your participating health plan. Third, the physician can still bill separately for the office visit, which may require co-pays. This may not be the case if the visit is specifically to receive a preventive service.
Before you visit the physician for these services, double-check your coverage. However, the good news most people should qualify.
by healthcaredeciphered | Jun 3, 2015 | Blog, Deciphering Healthcare
Recently, Hobby Lobby filed a lawsuit against the Affordable Care Act (ACA) aka ObamaCare, regarding the Birth Control Mandate. The Mandate required all companies must provide contraceptive coverage to their employees. This may cause some concerns, as the ACA preventive services mandate is designed to promote wellness and to protect employee rights. Nevertheless, here is the result: (more…)
by healthcaredeciphered | Jun 2, 2015 | Blog, Deciphering Healthcare
Great news! Read below for the facts about the Birth Control Mandate. The Federal government just updated the rules and regulations in your favor. Initially, it specified legally state health insurance companies would be required to cover 1 form of contraceptives, but NOW the requirement is to cover all 18 FDA-approved types of contraceptives without cost sharing. This means the costs of the contraceptives must be paid in full by the health insurance company and cannot be applied to co-payments, deductibles, or co-insurance. In other words, there is no patient responsibility. (more…)
