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Several health insurance companies agreed to improve the accuracy of the provider directories they post on their websites, according to the New York attorney generals office including:

• Empire Blue Cross & Blue Shield



• HIP of New York
• United HealthCare
• Oxford Health Plans
• Vytra Health Plans

As part of the settlement, the health insurers agreed to remove providers who no longer participate with the plans and correct listing errors for providers who are in the plans as part of a settlement over allegations that their online directories were inaccurate.

Attorney General Eric T. Schneiderman said the settlements also require insurers to implement new business practices for updating their online provider directories in a timely manner going forward, and to pay restitution to consumers who paid more than they should have because they went to providers their insurers erroneously listed as in-network.

This settlement follows an investigation that found inaccurate listings that wasted consumers’ time and delayed access to medical care by forcing consumers to find another physician after discovering — through a phone call or sometimes upon arriving at an appointment — that their physician was no longer participating in the plan.

Consumers also experienced delays in accessing medical care when participating doctors were listed with incorrect contact information, or when their doctors referred them to providers on the list who were no longer participating in the plan.

The insurers also agreed to pay a total of $60,000 to cover the cost of the attorney general’s investigation.

A similar agreement was reached with Aetna, CIGNA, GHI, and with Magnacare and Multiplan, in December 2010.

If you aren’t sure whether your doctor is participating in your health plan, or in a plan you are considering, please call Small Business Benefit Solutions, LLC.  We can not only search for your doctor’s availability, but also suggest they best way to use your medical plan when accessing that doctor.

Thanks to a grant provided by the Obama Administration, the NY Department fo Financial Services will be analyzing the administration systems of insurance companies and health maintenance organizations for cost efficiency.

The department said it will conduct on-site audits of health insurers and HMOs selling health insurance plans regulated by the state reviewing selected rate requests that have already been filed.

The DFS will be looking specifically at:

• claims
• insurer administrative expenses
• premiums
• claims reserves

Insurers will not know beforehand whether they will be the subject of this audit.

“At a time when spiraling health insurance costs are an incredible burden for working people, it is essential that we ensure that rate requests are based on fair, accurate information that has not been manipulated,” said Benjamin M. Lawsky, superintendent of the DFS, in a statement. “These in-depth audits will allow us to drill down underneath the numbers to make sure they are accurate. For example, we can look at whether insurers are accurately allocating administrative costs and broker commissions.”

The audits are funded by a $4.4 million grant awarded by the U.S. Department of Health and Human Services (HHS) in September 2011 and funded by provisions of ObamaCare , issued specifically to enhance premium rate review, improve public access and lend more transparency to the processes used to establish health insurance premiums.

Under a new law, health insurers must submit their proposals to increase their premiums to the insurance department to be approved, reduced or rejected in 60 days.

For contracts which started on or after Jan. 1, health insurers increase requests averaged 12.7% for small business health insurance plans, but the NYDFS only granted average increases of 8.2%.

If you believe your rate increase is unfounded, please call Small Business Benefit Solutions, LLC for a free, no obligation review of your plan and your premiums.

Next year your health insurance carrier will be taxed to find out which drugs, medical procedures, tests and treatments work best, but those costs are going to be passed onto you.

This little-known provision of the present administration’s health care reform law, was created to answer basic medical questions such as whether a new prescription drug advertised on TV really works better than an old generic costing much less.

But in the politically charged environment surrounding health care, medical effectiveness research is eyed with suspicion. Even former Vice Presidential candidate Sarah Palin labeled this effort “death panels”, expecting the findings to result in rationing of medical care for sick people.

Beginning in 2012, every health insurance policy will be taxed $1 to fund the agency, that fee doubles in 2013, then increases will be tied to inflation in subsequent years.

The federal government will change these fees directly to the insurance carriers who need little reason to increase policy premiums and will use this as more fuel for that fire.

The research is to be compiled by a new quasi-governmental agency created by Congress called the Patient-Centered Outcomes Research Institute.

However, concerns abound, and Kathryn Nix, a policy analyst for the conservative Heritage Foundation is just one of the voices speaking out.

“The more concerning thing is not the institute itself, but how the findings will be used in other areas,” Nix said. “Will they be used to make coverage determinations?”

But Dr. Joe Selby, a primary care doctor, medical researcher and director of the PCORI expects patients and doctors to make the decisions, not his organization,
“We are not a policy-making body. Our role is to make the evidence available.”

To whom, how and under what privacy protections are questions yet to be answered, but there is hope that some good will come of the data they compile.

Much of the medical research that doctors and consumers rely on now is financed by pharmaceutical companies and device manufacturers, who have a large stake in the outcome. Presently, a drug maker only has to show that their new medicine is more effective than a placebo, usually a sugar pill, and not a competitors product, to win government approval for marketing.

And Insurance companies say they expect to use the research and work with employers to fine-tune workplace health plans. But will this be a good thing or a bad thing for employees and their families, especially ones seeking regular care.

Health Plan Members could be steered to hospitals and doctors who follow the most effective treatment methods, but if they decide to use another facility or provider, they could face higher co-payments, similar to added charges they now pay for “non-preferred” drugs on their insurance plans.

And you though Health Care reform was supposed to make medical care cheaper and more readily available.

With this one of many taxes to come, is that eve really possible?

As you pour over your medical coverage options, call us at Small Business Benefit Solutions, LLC.  Let us examine what you have, what your using and how you’re using it to see if you have the right plan or if a better plan exists for you.

Six health insurance companies have agreed to end the secrecy over their requests for rate increases, according to the superintendent of New York’s new Department of Financial Services.

According to Benjamin M. Lawsky, of the newly formed DFS, United HealthGroup announced their agreement to transparency in their financials with the Department of Financial Services last week, while five other carriers including Aetna Health, EmblemHealth (also operating as GHI and HIP), Empire HealthChoice (known in NY as Empire Blue Cross and Blue Shield), Excellus Health Plan and HealthNow, agreed two days later. The companies represent about 85% of the prior-approval segment of the state’s insurance market, covering 2.4 million New York residents.

The health insurance carriers that continue to object to transparency are Capital District Physicians’ Health Plan, Connecticut General Life Insurance Co., Independent Health and MVP Health Care.

Now, when a carrier asks for price increases, all parts of their applications, including required information and exhibits, will be made available to the public.  At least that will be true for the carriers who have agreed to share this information. Only contractual matters that involve payments to providers and hospitals will be excluded as both sides agreed that it would not be valuable for consumers who would choose to file objections to carrier rate requests.

“This is a great day for transparency and the public’s right to know how their health insurance premiums are set,” Lawsky said in a statement. “Transparency will promote competition and allow the public to make effective comments as part of the rate review process. I applaud these companies for their decision and hope the remainder of the industry will soon see the light.”

For contracts that start on or after Jan. 1, 2012, health insurers requested weighted average increases of 12.7% and the Department granted increases of only 8.2% below the expected increase in medical costs. The lower increase will save consumers more than $400 million in 2012, officials said.

However, some carriers have responded by withdrawing plans they think aren’t going to earn enough money which may mean fewer choices, especially for small businesses in the Metro NY City area.

Elisabeth Benjamin, Vice President of Health Initiatives at the Community Service Society and co-founder of Health Care For All New York, said, “It’s gratifying to see the domino effect actually playing out in favor of New York’s consumers and small businesses. The past decade’s secret system of hidden rate filings is a thing of the past-now New York’s consumers and small businesses finally have the opportunity to understand why insurance costs are so steep, and as a result, now will be able make well informed decisions about which carrier they trust to provide their coverage.”

If you’ve received a rate increase from your health insurance carrier and want to explore options with that carrier or with other carriers that may be available to you, Small Business Benefit Solutions, LLC can shop around for you at no cost or obligation.  Be informed! If nothing else, you will be able to confirm that the plan you have is the right plan for your company.

 

Walgreens Pharmacies has elected to stop participating with Express Scripts, the pharmacy benefits manager of Wellpoint Blue Cross plans at the end of the year.

Walgreens and it’s affiliated pharmacies, including Duane Reade Pharmacy in the New York City metro region, Happy Harry’s Pharmacy in several northeastern states and OptionCare, will stop processing Anthem and Empire Blue Cross member prescriptions on an in-network bases effective on January 1st, 2012. 

Access to other retail pharmacies within the pharmacy provider network will be available, as the Express Scripts pharmacy network contains more than 56,000 pharmacies without Walgreens.  On average, there is another network participating pharmacy within one-half mile of any Walgreens pharmacy.

You can find other participating pharmacies in your area at www.anthem.com or www.empireblue.com and then you can search by pharmacy name or by your geographic location.

If you are unsure whether your small business health plan or your individual medical insurance plan will be effected by this change, contact your carrier, your agent, or call Small Business Benefit Solutions, LLC and we’ll look up your pharmacy for you.

 

For those small businesses that filed a tax extension for 2010, the deadline for the health care tax credit is fast approaching.

Small businesses paying at least half of their employees’ health insurance coverage may be eligible for the health care tax credit.

Be sure to take advantage; the deadline is September 15th for corporations or partnerships and October 17 for other small business filers.

Small businesses that have already filed and want to claim the credit can amend their returns using Form 1120X for corporations or Form 1040X for other small businesses.

Eligible tax-exempt organizations can claim the credit on Form 990-T.

Small businesses without taxable income to offset should remember that the credit is part of the general business credit for Tax Year 2010, meaning they may be eligible to carry back the credit for five years or forward for 20 years.

The credit is worth up to 35 percent of the health insurance premium costs a small business incurred for insuring its employees in 2010.

Eligible small businesses that do not yet provide insurance can start providing insurance and claim the credit for 2011 forward.

Speak to your accountant or tax preparer RIGHT AWAY to see if this tax credit is available to you!

For additional information regarding the tax credit deadline please visit the IRS website by clicking here.

 

A simple exercise can help combat the rampant medical fraud epidemic that has swept the US in the last decade.

Medical fraud is ruining hospitals, insurance carriers and the federal government at an alarming rate. Insurance carriers are now spending as much on fraud prevention as they are on advertising, another factor in running up your insurance costs.

The Feds arrested three Syrian nationals recently and charged them with bilking the Medicare program of more than $1.5 million dollars in a podiatry scheme. A Tennessee woman was imprisoned for $1.1 million in fraudulent psychotherapy claims, another 3 Dallas men were charged with $3.8 million in fraudulent ambulance claims and $4 million was lost in fraudulent medical equipment claims made by a CPA in Los Angeles.

That’s a short list from just this year so far.

But there is something you can do to help and it’s something as simple as opening your mail.

Every time you visit a doctor or a hospital, your insurance carrier sends to you a document called an Explanation of Benefits (EOB) detailing the services rendered, when they took place and with whom.

So very often, these documents are ignored, but now, more than ever, you should pay careful attention to each and every one of them.

Follow these simple steps and you have become a key factor in stopping medical fraud from visiting your door:

• Open ever piece of correspondence from your insurance carrier
• Compare Explanation of Benefits (EOB) forms to your calendar of doctor visits and bills you receive from your doctor
• Make sure that the date of service matches
• Make sure that the provider names matches the provider you saw
• Make sure that the service described is what you actually had  - no more and no less than what you recall
• Contact your insurance carrier with any discrepancies you find – they will investigate the claim for you

What you are making sure of is that you are not being charged for services you didn’t receive, and that doctors whom you saw are the one’s actually filing the claims.

Most times, short of human errors, your doctors and their staff are doing everything right. Most of these scams happen when criminals file claims for patients they have never met. If you get an odd looking E.O.B. from your insurance company, it needs to be investigated in case it’s part of a larger scam.

This is especially important for Medicare recipients.  Because of the complex nature of the Medicare reporting system, many seniors feel overwhelmed with paperwork, and crooks know this.  The elderly are targeted much more often because of the likelihood that they will never notice and report discrepancies.

If you have a Medicare insurance plan, an individual health insurance or get group medical plan and you receive a bill you don’t understand or don’t recognize, call your insurance carrier or your agent, they can help explain it to you.  If you can’t get their ghelp. contact us at Small Business Benefit Solutions, LLC. We are committed to helping you understand your E.O.B.s and to prevent and report medical fraud.

 

Cut your finger? Fell and sprained something? Knocked your head and want to get it checked out just in case? Have a sore throat and want to make sure it isn’t strep?

In most of these situations, if you are conscious, can breathe normally, aren’t bleeding profusely,  and are mentally alert, it may be much cheaper for you to visit your local Urgent Care Center rather than your hospital’s Emergency Room.

Typical conditions an Urgent Care Center is fully capable of treating include:

• Cold of Flu Symptoms
• Sore Throat
• Ear Ache
• Rashes
• Sprains, strains or fractures
• Burns
• Minor Eye injuries
• Sports Injuries
• Tetanus vaccinations
• Splinters

Urgent Care Centers generally have much shorter wait times than the ER and generally require you to only pay your medical insurance plan’s office visit co-payment to see a doctor.  Plus, most are open weeknights and weekends.

Urgent Care Centers are designed with a group of doctors who treat various conditions that should be looked at right away but aren’t as severe true medical emergencies.

Urgent care Centers can perform exams on a vast array of medical matters, can take X-rays, perform lab tests and put in stitches.

And you aren’t getting a sub-standard level of care either. Urgent Care Centers are staffed with credentialed primary care doctors or Certified Nurse Practitioners as well as fully trained and licensed support staff.

Once you’ve determined that your situation is not a true emergency, and before you decide to go to the Emergency Room, call your local Urgent Care Center and ask:

• What are your hours?
• Do you have the services I need?
• Give them your medical insurance carrier name and ask them if they participate with your carrier?

Emergency Room rule of thumb

Call 911 or go to the Emergency Room if you think you could put your health at serious risk by not seeking immediate medical attention.  Examples include:

• Unconsciousness of any duration
• Difficulty Breathing
• Chest Pains
• Abdominal Pains
• Dizziness
• Profuse and uncontrollable bleeding
• Signs of Stroke or Heart Attack
• Any loss of mental faculty
• Inability to move all or part of the body
• Any unknown allergic reaction
• Multiple Injuries

In many of these cases, time is of the essence and failure to respond quickly can put both life and limb at risk.  If in doubt, it’s better to go to the ER.

If you’re unsure whether your plan has a separate and less expensive benefit for Urgent Care Centers versus Emergency Rooms, please contact your agent, your insurance carrier, or call Small Business Benefit Solutions, LLC.