Back in 1984 I kept having a series of strep throat issues. My doctor at the time said that I needed to have my tonsils out. I wasn’t happy with the possibility of surgery and I wasn’t a kid anymore, so I knew it wasn’t going to be easy. However, 20 days before I was to have my surgery, my employer changed insurance companies, and suddenly I was hit with a pre-existing condition clause that had nothing to do with me and told I’d have to wait a year. I called my doctor and canceled, since I knew it would cost me about $1,000 if I had to pay for it, and that wasn’t happening. I still have my tonsils.

Although my surgery wasn’t critical, it turns out that many people over the years have had to have very crucial surgery or had other medical issues to deal with, including pregnancy, who suddenly lost their insurance coverage through some fluke that tossed them into the pre-existing category. When you’re crucial you don’t have much of a choice in saying you don’t want surgery, and suddenly you’re in financial distress, which causes stress, and thus makes it harder to heal and get healthy.

Insurance companies have used this trick for years, with condition time periods ranging anywhere from 6 months to a year. It’s always been pretty unfair to consumers, who were hanging onto a rock that wouldn’t budge. Obviously surgery is important but it’s also expensive, like medication and other health care. It’s tough enough for new employees to have to wait for insurance coverage to kick in at some companies for the first 90 days to pass, which I also understand because it’s expensive to cover an employee that might not make it through a probation period, but making someone wait a year or even longer for their legitimate insurance coverage to reach an arbitrary date for coverage is punitive.

It doesn’t matter whether people like the overall health care plan that’s coming from the government or not; this turns out to be one of the best things that’s come from the bill already. There are many images like the one above highlighting people who have benefited from this bill. My bet is that even people against the bill know someone who’d had this problem. When you have money, this is never a problem; when you don’t…
 

Copyright secured by Digiprove © 2012 Mitch Mitchell

This is an editorial post from Mitch Patridge, Chairman and CEO of CSI Financial Services

For American drivers, the recent spike in the price of crude oil has evoked painful memories of the summer of 2008, when the average price for regular gasoline reached an all-time high of $4.11 per gallon.

What does this have to do with healthcare? Well…everything. As instability continues in the Middle East and America’s fragile economy tries to right itself, consumers are having a difficult time budgeting the cost of daily necessities.

Now, add to this developing budget strain healthcare payments, which are oftentimes the result of an unexpected medical event and it’s easy to see how self-pay hospital bills can fall to the bottom of consumers’ “Bills to Pay” list.

Consider the following statistics:

• Approximately 50 percent of personal bankruptcies are due to medical expenses. (Source: Health Affairs)

• Based on a recent survey from the Employee Benefit Research Institute, 41% of organizations said they were “likely” to pass on increased costs of health care coverage to their employees, whether directly or indirectly related to health reform, while 23% of organizations said they were “highly likely” to pass on these costs.

What is the solution? Avoid necessary treatment and run the risks associated with this decision? Hopefully this is not the case. As consumers take on the burden of higher self-pay balances and many healthcare providers struggle with having to write-off billions of dollars in bad debt, the list of viable solutions for both consumers and providers is limited.

However, dual solutions do exist. According to Ken Ursin, Corporate Director of Patient Financial Services for Adventist Health System, both groups have benefitted from the implementation of a healthcare bank loan program. “It has been a win for our financial counselors in that they have an excellent tool to resolve the patient’s balance,” Ursin said. “And, it’s a win for our patients because they have a program that is more suitable for their budget.”

Knowledge is power. So as prices for most consumer products and services continue to rise, it is important for consumers to understand that healthcare payments are on the rise as well. The worst decision an individual could make is to not seek treatment for a medical condition. If a patient is sick or injured and requires medical attention, they can go see a doctor. With the right loan system in place, both patients and providers can be at ease knowing that they can put the bills behind them.

Copyright secured by Digiprove © 2011 Mitch Mitchell

By now everyone in the country knows that there’s an assault on Medicare as we know it. Just the words I used above probably tells my opinion on all of this. But a little background is necessary.

Representative Paul Ryan of Wisconsin, the same state that just emasculated unions in an illegal fashion, has come up with a financial plan that he says will stabilize the government’s finances and lead the country towards prosperity. I will give him credit for this; at least he’s come up with a plan, sometimes Republicans have been loathe to do for so long.

However, one of the biggest caveats to me is what he wants to do with Medicare. For those unfamiliar with it even now Medicare is a program that takes care of the medical bills, for the most part, for the elderly and disabled. It’s not a 100% solution, as there are copays and deductibles, depending on which plans a person opts in for, but it’s a major help for anyone on the plan.

Ryan basically wants to change it over. In essence, he wants to give vouchers to people that reach Medicare age starting in 2022 instead of their immediately having access to health care. He wants us to use those vouchers to shop for our own insurance and offset any extra costs the rest of us might have to pony up for the coverage.

The year, 2022 is significant, at least to someone like me. Since Medicare doesn’t kick in until one turns 65, it pretty much grandfathers everyone else that reaches Medicare age before that into the current program. However, for someone like me, it means that I’ll have contributed to the current Medicare plan for more than 40 years and just barely miss out. Frankly I’m trying to figure out how that’s fair and economical. It’s like saying to me “yeah, I know you paid the mortgage on your house for 28 years, but we’re taking it from you now and we’ll give you a check for $5,000 so you can go find an apartment to live in.”

Frankly that stinks, and there’s no way I’d ever support anyone that came up with a plan like that. Of course, Ryan is young and rich, and it’s another plan that favors the rich, many of whom opt out of the entire Medicare program and thus don’t have to worry about the effects of a program that might not be funded properly. Under the guise of saying it’s a financial plan for the country, the way I see it is that it’s just another plan to hurt the middle class.

And, at least at this juncture, 56% of the population seems to agree with me, even those people who will make it into Medicare under this plan. They’re saying the same thing I am, how fair is it to their kids when they reach 65? At least someone’s thinking about someone other than themselves.

Copyright secured by Digiprove © 2011 Mitch Mitchell

At some point in your life you’re going to have to deal with a hospital bill. Hopefully you’ll have insurance to take care of the bulk of the bill, but whether you do or don’t, there are some options you have that can help you with your bill and possibly even get it taken care of. Of course, you have to be willing to work with the people at the hospital, but at least it can help to relieve some of the tension associated with health care costs.

The first thing to know is that every hospital has a charity care process. Well, let me rephrase that; every “not-for-profit” hospital has a charity care process. If your hospital participates in the Medicare and Medicaid plans, they’re required to have charity care options, and some “for profit” hospitals don’t participate in those plans.

I guess we should start with a quick definition of “not for profit” and “for profit”, just to get them out of the way. Truthfully, the main difference between the two is that any profits made by a “not for profit” hospital goes back into the hospital, while profits at “for profit” hospitals goes to the stock holders, who hopefully allow those profits to be reinvested back into the hospital. Usually “for profit” hospitals are actually part of large systems of hospitals, though there are some independent facilities as well, whereas “not for profit” hospitals will sometimes have affiliations with other hospitals but are independent, with the exception often being large Catholic hospital systems.

Anyway, charity care is used as a way to give free care of some type to those people who qualify for it. It’s based on income, amount of money you owe to the hospital, and the ability to NOT qualify for Medicaid. Most hospitals will try to qualify you for Medicaid if your income is borderline. The process is that you’ll fill out proof of income and be asked to show either the previous year’s tax form if you’re not employed or 3 or 4 pay stubs from every member of the family that presently works; that would actually be the adults in the household, not the children. Depending on the hospital, if you qualify you could have one of these things happen for you:

      * all debts absolved within a certain time period;
      * debts associated with the largest balances absolved
      * a sliding scale discount of absolved debt based on income

If all of your debt isn’t absolved, or if you don’t qualify for a charity care discount, hospitals are always willing to allow you to go on a payment plan. Payment plans are standard, but how they manifest themselves isn’t. Some hospitals will accept very small payments even on large balances over time. Some will require that the amount have the balance paid off within 3 to 6 months, no matter what the outstanding balance is. Something most hospitals probably don’t want you to know is that if you send in at least $20 a month often the staff doesn’t pay attention to the bills, no matter what the balance is, as long as the computer system keeps registering some kind of regular payment within a 30-day period. Thus, if you’re paying every 25 days you might stay under the radar. That’s not a guarantee, but it often works.

A few hospitals will have other plans to help you with your hospital bill, including having companies that will purchase your debt and allow you to treat it as a loan of sorts, so that they can set up payment plans with you along that front, like credit cards of a sort.

The last thing you want to do is to totally ignore your hospital debt. It doesn’t go away, and unlike 20 years ago it will hit your credit report and it doesn’t go away. That plus hospital records will always know if you skipped out on them, and other than emergency care, they can turn you away if you don’t settle up on old debt, or at least have never attempted to address it.

People who work collections at hospitals are some of the nicest people around, and they really are trying to help you. Give them a call if you need help.

Copyright secured by Digiprove © 2011 Mitch Mitchell

There’s a new Congress in Washington, and one half of that Congress is trying to emasculate the health care bill that passed last year. The House actually wasted everyone’s time by having a vote to overturn the bill and sending it to the Senate in a move that was ceremonial than productive, since they knew the Senate wasn’t going to change their mind.

I keep wondering just what it is that has people scared of national health care coverage. I always knew that insurance companies wouldn’t like it, but I find it strange that people who aren’t rich would have a problem with it. Let’s take a logical look at this, shall we?

First point, more than 10% of our population has no health insurance coverage at all. Another 25% are under-covered by insurance. This means, obviously, that 35% of the population will have problems paying their health care bills, no matter the cost. Studies have shown that 61% of people who file for bankruptcy have a significant health care bill on their credit report; this isn’t good for anyone.

Second point, at least for now, if you’re employed and your employer gives you health insurance, even if you have to pay something out of pocket, that’s your only liability. If your household income is less than $250,000, you don’t pay anything extra.

Third point, there’s a provision of the current health care bill that I admit I don’t like. I don’t think it’s fair that the government has people that don’t have insurance either having to get it or pay some dollar amount in taxes. That’s inherently unfair, violates President Obama’s pledge that he wouldn’t hurt the middle class when he was running for president, and and has enough states whose supreme courts have said that part is unconstitutional that it will eventually end up in the U.S. Supreme Court, where it will be found unconstitutional thanks to a conservative court.

Having said that, it still means your options are limited if you don’t have insurance and you’re not considered poor enough to qualify for Medicaid. You can go to the emergency room, where they have to treat you, but only so far. If you need heart surgery they don’t have to provide it for you; I’m betting you didn’t know that. Unless you’re having a heart attack in the emergency room and surgery is your only option they can stabilize you and send you home, and there’s nothing you can do about it because that’s the law. They can give you a prescription that might help, but you probably won’t be able to afford it. Is that the option you want for yourself and your family? I hope your life insurance is paid up.

Fourth point, medical debt is now considered in the same manner as every other debt you have. If your bill is high enough, you’re going to be taken to court, and you’re going to lose, and you’re going to have some of your wages garnished by the medical entity to the tune of 10% per pay period. Now you’ve just gone from having the ability to pay for some kind of health care coverage to paying the hospital or physician and getting nothing in return; that’s a horrible option. You’d be better allowing the government to add a 10% tax on your salary but allowing you to get unlimited health care coverage whenever you need it. What, you never get sick; keep believing that will happen to you for the rest of your life.

Fifth point, pharmacy costs. Medication is the most expensive regular medical issue you’ll ever have to deal with. Without insurance, you’re going to pay through the nose if you want to be healthy or live longer. Right now there’s a medication I pay 1 $5 co-pay for every month that, if I didn’t have insurance, would cost me $150. Another medication I pay $20 for would cost me $500. And that’s monthly as well. You think health insurance is high, look at these rates. Even a government option will help you cover most of the cost of medication for most illnesses.

Sixth and final point for now; the government isn’t going to raise rates to make a profit. Health care costs are always going up. Some states have insurance companies that have raised premiums at least 50% multiple years in a row. That’s because they have stockholders to take care of, and have to make profits. The federal government might raise their contribution here and there, but it will be manageable. And think of this; if there ended up being national health care coverage, there wouldn’t be a need for Medicare and probably wouldn’t be a need for Medicaid either, except for extreme circumstances such as taking care of the disabled and nursing home coverage.

To me, this is a financial no-brainer. You might be okay now, but who knows what the future will hold. Who here doesn’t know someone who got hit with a major medical bill, either because they didn’t have insurance, their insurance company said they wouldn’t cover it, or their deductibles are so high that it ends up being financially punitive? Think about it; it’s got to come sooner or later.

Copyright secured by Digiprove © 2011 Mitch Mitchell

Last February I wrote an article here titled Are You Sure You Don’t Want National Health Care Coverage? At that time, I was alluding to the fact that in California an insurance company had put in a bid to raise insurance premiums 39%, and how another one was looking to raise it’s rate 346%.

This year it’s Blue Shield of California saying they’re going to raise their premiums 59%, and they say they’re still going to lose tens of millions on the deal. And it turns out there’s nothing the state can do because the Insurance Commissioner there doesn’t have the authority to stop it. Neither does the federal government at this time. Only with the Health Care Reform bill will insurance companies have to eventually justify, by July, any requested increase of more than 10%.

What’s interesting is that the insurance company is saying that this increase has nothing to do with the pending health care legislation or the new portion of the bill that came out stating that insurance companies had to pay between 80 and 85% of their premium revenue out in claims to medical providers. That’s nice, but if it’s the case then it seems the insurance company needs to review its overall policies and issues in the same way that the U.S. Postal System was told to do when they requested another increase in rates, only to be turned down because they didn’t have a plan for breaking even, let alone making a profit, even with the increase.

All this on the day when Republicans in the House of Representatives are wasting time having a repeal vote of the health care bill that they know won’t be overturned instead of trying to figure out ways to fix the portions they don’t like. I’m sorry people, but if you’re not a millionaire you’ve been lied to as far as what’s coming down the road with this health care bill. True, I’ve had some issues with it as well that I hope are addressed (actually, one was by the Supreme Court of Virginia), but it looks like insurance coverage in this country will eventually only be affordable by the very rich or by those in corporations making multiple millions or billions of dollars a year. And even those companies will possibly start paring down coverage.

So, I ask again here, early in 2011; are you sure you don’t want health care coverage?

Almost a year ago I wrote a post titled How To Mess Up A Health Care Bill. One of my main points in that post was talking about how people who didn’t get health care coverage yet didn’t qualify for something like Medicaid would end up paying out of pocket costs that they probably couldn’t afford, and how I thought it was unfair to the middle class, the group that was going to be affected the most.

Today a federal judge stated pretty much the same thing in a ruling that said it’s unconstitutional for Congress to try to force people to buy health insurance. His actual words were:

“Neither the Supreme Court nor any federal circuit court of appeals has extended Commerce Clause powers to compel an individual to involuntarily enter the stream of commerce by purchasing a commodity in the private market. In doing so, enactment of the [individual mandate] exceeds the Commerce Clause powers vested in Congress under Article I [of the Constitution.]“

I’m one of those people who believes this country needs universal health care, but I’ve been on record as saying I wasn’t crazy about parts of this bill, and this was my biggest complaint. Of course, without this provision it’s now going to be interesting to see what happens because portions of the bill were going to be funded by these people who ended up not having health insurance, and now that source of revenue is potentially gone. Where will the federal government find the money to actually institute this bill now, if they still follow through with it? Will there be major modifications in coverage or some other area that will help the government save money?

I’m not necessarily happy that this bill might have problems being implemented, but I am happy that regular people won’t be penalized for something they can’t afford. In a weird way it’s forcing President Obama to stand by his statement as a candidate that he wouldn’t sign any bill that hurt the middle class. I’m not sure how I feel about that either.

I’m not someone who supports outsourcing most things to other countries. It’s not that I’m against other countries sharing the wealth, so to speak. My reasons are twofold.

One, I see many jobs performed in America going to other places, and I see how it’s hurt our economy. American companies create products elsewhere, then bring them back here to sell for the same money as before, but make bigger profits because they can pay foreign workers less.

Two, because the work isn’t any better than what Americans can do, and is sometimes more deficient and doesn’t fully follow the rules. Two things I can point to are Dell customer service and the medical billing company that threatened to post the private records of American citizens in a dispute with the American company that had contracted them to handle the billing. We may have HIPAA privacy laws in the United States, but there’s nothing the American government could have done to this Indian company.

With that said, I have to change my tune when it comes to having medical services done in other countries to save money. It’s hard to complain against an individual or company deciding that it makes sense to try to save money on major health care procedures for their employees. If a company can spend only $20,000 to send one of their employees to India or Mexico for a heart procedure that would cost $100,000 in the states at a minimum, while knowing that the medical facilities are high quality, then that’s a smart and intelligent move that frankly I can’t go against.

Last year I did research for an article concerning Mexico medical travel and that research showed that not only could patients save anywhere between 100% and 500% for medical procedures, including elective surgeries (laser eye surgery, plastic surgery, etc), but there were full medical packages at resort style hospital / hotels that fully integrated all the costs to save even more money.

The same goes for India, where the preponderance of very well American-trained physicians have set up extensive and specialized medical practices that offer nothing but the best as far as medical procedures are concerned. And the costs can be even less than doing them in Mexico, though getting there might cost a little bit more. But there are more physicians in India, so the concept of having to wait for quality paid medical care is nonexistent.

This is important news to know about as health care costs keep going up. Not only employers, but some insurance companies are realizing that they need to find ways to keep costs down since, at some point, there has to be a cap on the cost of insurance premiums. To see another perspective on this, check out this CNN Money story on the same subject.

A recent story on CNN Money mentioned that states could face a $12 billion shortfall if Congress doesn’t pass a bill to help them out. Four states in particular will see shortfalls in money of more than $1 billion each.

While this is a scary figure, especially with the way the economy is working, it seems no one has attempted to explain why there’s such problems with Medicaid. I’m going to answer that question for you, or at least give you an idea of what states are up against, and I’m going to base it on New York, the state where I live.

First off, the problem certainly isn’t how medical entities are paid. To use the easiest term most people will understand, Medicaid pays on a fee schedule. This means they pay a certain amount for procedures and services. That’s pretty much how most insurance companies pay claims, just so you know. In Medicaid’s case, many payment amounts haven’t changed in more than 30 years. However, if you’re a hospital in New York, you must accept both Medicare and Medicaid patients, so hospitals end up losing a lot of money because of Medicaid.

About 15 years ago or more the state added a new feature where they threw in co-pay amounts that patients “had” to pay. That money was taken from the payments medical facilities received, since now they were supposed to get it from the patients. However, that came with a caveat; if a patient told you they couldn’t pay, you had to write it off and you couldn’t bill the patient for the balance. And you were supposed to ask them while they were in the hospital, or any other medical facility. The co-pay amount for the most part is only $3, but multiply that times a couple of million people who probably go for services more than once a year and it all adds up. Anyway, this part is just to show that states aren’t losing money because they’re paying out too much to hospitals or physicians.

What’s the problem then? The problem is in administering the program. It’s unwieldy and unmanageable, both because of the way the state runs it and because of the people who are on Medicaid, though for the second, probably not for the reasons you might expect.

In New York, every county has its own Medicaid program. The way Medicare is run is that the federal government contracts with different companies throughout the country to administer the program in certain states. Medicare is considered a federal program, whereas Medicaid is considered a state program. So, every county has to have people to staff those offices. And sometimes, there are multiple offices handling different aspects of each program. So, there’s a lot of duplication of bodies, which means money gets eaten up fairly quickly.

What the state has allowed are Medicaid HMOs, which seems like a good idea except for a problem I’m going to mention now, and a problem I’ll mention later. The “now” issue is that those insurance companies running Medicaid HMOs must have at least one competing insurance company in the state. Otherwise, subscribers don’t have to select a HMO at all, which almost renders them useless in some counties. The reason there aren’t many HMOs is because the money they’re given to try to handle claims is pretty low, and the best a HMO can hope for is that there’s a significant number of people they’re paid for that decide not to use any services. That doesn’t happen often, however.

Medicaid also funds programs through the Department of Social Services whenever they see a need for something extra special. For instance, in Wayne County, there’s a special program for migrant workers that travel into the area to help pick crops, yet don’t speak English. In Westchester County, there are special programs that pay for specific types of things such as psych services or chemotherapy, especially if you’re an undocumented worker. Payments still aren’t great, but it all takes a drain on the money available.

Now, let’s talk briefly about the subscribers. Something not generally known is that probably half of Medicaid subscribers are fairly transient; they move around all the time for whatever reason. And they don’t tell the DSS that they’ve moved, which is problematic in the first place, and then gets worse when they move to another county, because there’s no true state system where someone can just go in and update one system and have everything working great. Subscribers are told they need to go to the local office and do it all over again; that’s an ugly way to do things.

Subscribers are encouraged to sign up for Medicaid HMOs in those counties that have multiples, but they’re also told that they can drop it at any time and sign up with another one. That’s an ugly process as well, as it takes a lot of manpower hours switching people all the time. And when it comes to authorizing services, it can get uglier still.

There’s more detail I could get into, but I’ll stop here. This should be enough information to have a basic understanding of why Medicaid programs might be in trouble. What could states do? I’ll offer only this one bit of advice; standardize the process and have fewer outside offices, which will reduce the number of people needed to do everything, and potentially reduce the amount of paperwork. States have to be willing to move Medicaid services into the 21st century.

You’d think that at this point all conversations about the health care bill would be over. Seems that the discussions are just beginning, and there are two big issues that suddenly are garnering a lot of attention.

The first is the new requirement that kicks in come 2012. It requires any business or person that pays more than $600 in services or supplies to fill out 1099s and report it to the government, as well as making sure to send them to those who provided the services. Not only is this going to create a lot of paperwork for everyone involved, but it’s going to ruin things for people like me, a consultant who does a lot of things for a lot of people for different rates. Suddenly someone paying me $100 a month for a small service is supposed to create a 1099 for me, even if they’re not a traditional business.

But it’s going to impact someone like me in another way as well. Here’s what was reported as an example:

“Under the new rules, if a freelance designer buys a new iMac from the Apple Store, they’ll have to send Apple a 1099. A laundromat that buys soap each week from a local distributor will have to send the supplier a 1099 at the end of the year tallying up their purchases.”

This is where it’s going to get ridiculous. Any capital purchases I make for my business I’m now supposed to send them a 1099. My biggest purchases are computers here and there, but there’s always the possibility that manuals I use for business could get close to that amount, and that’s scary. I’m wondering if this also means that, since Staples is my office store of choice, that if I reach $600 in purchases from them in a year that I need to send them a 1099; can you imagine?

The reason for this is so the federal government can verify that it’s getting all the dollars it’s supposed to be getting for health care. A Democratic aide for the Senate Finance Committee defended the move saying “Information reporting improves tax compliance without raising taxes on small businesses. Health care reform includes more than $35 billion in tax cuts for small businesses… indicating that during these tough economic times, Congress is delivering the tax breaks small businesses need to thrive.”

Okay, that’s the first issue. Here’s the second. It seems that some large corporations have been taking a look at this bill and actually trying to determine if it would be more cost effective to stop providing health care for all of their employees and just pay the penalties instead. Some have found that, indeed, it would save them money up front, yet they haven’t pulled the trigger on it. Four companies records were subpoenaed, AT&T, Verizon, Caterpillar and Deere, and the figures were so shocking that it was decided not to hold an open hearing on it, for whatever reason.

It’s a scary proposition across the board because the health care bill is depending upon large employers to continue covering employees, and probably never really considered that companies might find it more beneficial financially to just pay the fines. It’s estimated that if 50% of the companies decided to follow through with it that it could cost the federal government at least $160 billion a year more. Of course, many large companies have unions to contend with, so part of this could be a moot point, except that not everyone is in the union.

Two more reasons why I say the health care bill needs to be overhauled.

I predict you’re going to be seeing more of this type of thing over the next year, and it’s probably about time.

There’s a battle going on in the lower New York state area between Empire Blue Cross and a hospital group calling itself the Stellaris Health Network, which is a joint venture of four local area hospitals: White Plains Hospital Center, Lawrence Hospital Center in Bronxville, Phelps Memorial Hospital Center in Sleepy Hollow and Northern Westchester Hospital in Mount Kisco. This consortium wants more money and reimbursement from Empire; Empire doesn’t want to pay.

The consortium’s argument sounds a lot like my position on some of these things. Hospitals are hurting, while the parent company of Empire, Wellpoint, had record profits in 2009. They were even singled out during a Congressional hearing for raising premiums while living the high life. Empire’s position is that paying the hospitals what they’re asking for, which is a double digit increase over what was paid in 2009, would make them have to raise rates on all their subscribers even more than what they did raise them.

Usually these things sort themselves out, but not always all that fast. So, what’s happening here is that any patients who are members of Empire and decide to go to these hospitals will end up paying more out of pocket expenses, because the hospitals aren’t going to accept whatever the insurance company decides to pay in full. Empire’s response is to send out a list of other hospitals in the area that they’re still participating with and encouraging patients to go there instead. The problem with that is that some physicians in their network don’t have admitting privileges to some of these other hospitals, which means some patients would have to switch physicians to get proper care.

One of the problems with things like this is that enrollment periods are usually annually, January through December, while contracts with insurance companies are usually signed around April 1st. It’s all a convoluted mess, something else that most people have no clue about and need to consider when they’re trying to decide whether a federal health care reform program is a good thing or not.

By the way, I’m supporting the hospitals on this one because no matter what happens, health premiums are going up next year anyway, and there seems to be little oversight in just how much premiums go up.

Health care took a major beating last year in this country. Sure, I understand that the first thing the President should have concentrated on is the economy, most specifically jobs. I also understand what his position was on health care. I don’t know that either he or the Democrats in Congress explained well enough what the issues were, and the other side didn’t even try. They just wanted to beat it down because it was a Democratic proposal. Sure, I thought what was presented later on was lacking, and probably not the best plan in the world, so I’m not upset it collapsed. But at some point we need to seriously consider health care for all in this country.

Why? Two big things have come out over the past week, and both trump my recent post on Medicare Advantage Plans.

The first concerns Wellspring in California, which is also known as Anthem. It was reported that there’s going to be a rate hike of their premiums that could be as high as 39% for some of their subscribers. What they’re blaming it on, oddly enough, is that more younger people have dropped insurance coverage because it was too expensive or they just determined they didn’t want it, which leaves less money for those who are left, who are supposedly sicker, so they need to raise more money. This is a moronic thing and for them to think anyone believes it is insulting. The why it’s insulting is contained in the next paragraph.

The second thing that came out this week is that across the country, health insurers enjoyed 56% profit margins while the rest of the country’s industries suffered drastic losses. The five largest health insurers enjoyed profits of $12.2 billion. Wellspring, whom I mentioned above, recorded a profit of 91%; you saw that right, 91%!. You can bet they didn’t pass any of that money on to hospitals, otherwise it wouldn’t have been profit. And the number of people they stopped covering dropped only 3.9%; doesn’t seem like much of an offset, does it? This has prompted a call for the CEO of Wellspring to show up and talk to Congress as to how they can justify all of this.

By the way, Wellspring wasn’t even the biggest profiter in the group. Cigna’s profit increased, ready for this… 346%! Humana “only” increased a measly 61%.

I ask one more time, you sure you don’t want any kind of health care reform?

Did you think we were done talking about health care?

A report came out this week saying that, on average, Medicare Advantage plans across the country had gone up an average of 14.2% over the past year. Although my first response is “yawn”, because I’m used to seeing those kinds of jumps o a regular basis for traditional insurance, Medicare Advantage plans don’t usually go up as fast, only increasing 5.2% last year.

For the uninitiated, Medicare Advantage plans are insurance coverage for seniors that goes above and beyond traditional Medicare coverage, or at least that’s the idea. Instead of just sticking with Medicare, which all seniors qualify for (well, that’s not exactly true, but it’s true enough for the moment), a senior can decide to pay a little bit more for an Advantage plan to hopefully gain coverage for services that Medicare might not pay for, such as foot issues. They may also reduce inpatient deductible amounts that Medicare recipients have to find the money to pay.

Medicare in general has one major rule for coverage, that being that a patient must always be getting better in some fashion. Medicare doesn’t pay for maintenance services. If a patient gets physical therapy coverage, has 10 sessions, then the therapists writes that a patient is as good as they’re going to get, but could maintain mobility with more physical therapy, Medicare won’t cover any more physical therapy, but an Advantage plan might.

Still, even with the government ponying up some of the money for the Advantage plans (oh yeah, since these patients opt into the private plan instead of Medicare, the government pays the insurance company some money to help defray the costs, which is why the plans are attractive to both patients and the insurance company), thus helping to keep the amount seniors have to pay down, seeing that there was such a dramatic increase last year points out just how much health care coverage costs are rising, and why some were hoping for an overall government health plan although, to be truthful, it might not have made much of a difference for seniors.

This is why the debate on overall health care coverage in this country still continues.

Every once in a while you read something in your first reaction is “what the heck”. This is one of those stories.

It was reported this week that cigarette makers are trying to find a way to keep the federal government from going to the United States Supreme Court to ask them to uphold racketeering charges against cigarette makers who, for decades, the negative effects of cigarette smoking and decided to keep it quiet rather than warn people about the dangers of smoking. All of this comes on the heels of the federal government finding cigarette makers more than $280 billion in fines and having the lower court determined that the federal government probably didn’t have the right to collect this money. This is strange because the judge had also found that the cigarette makers really were in violation of withholding this evidence.

Anyway, the cigarette makers seem to be winning right now, which begs the question why are they so worried about this case going to the Supreme Court. After all, the Supreme Court is mainly filled with conservatives, and it would seem that they would be the favorites in winning a 5 to 4 decision in their favor once again. At the same time however, the cigarette companies are actually appealing to the Supreme Court to get the racketeering charges overturned. This turns into a very interesting Catch-22 situation.

You might be asking what this has to do with finances. The top two things that federal government have to deal with as it pertains to paying money into health care programs for people concerned smoking and diabetes. The problem with smoking is that it is a known contributor towards both lung cancer and target=”_blank”>emphysema, two diseases that once you’ve been diagnosed for you can overcome. As a matter of fact, cigarette smoking is responsible for 90% of all lung cancer deaths, and something close to that for emphysema. This puts a strain on services such as Medicaid in trying to treat people, says lower income people tend to smoke more than people who have higher incomes.

The idea behind the government trying to get the larger pot of money is so they can use that money to distribute to the states to help take care of people who end up having smoking-related illnesses. Personally, I have no sympathy for any company whose products main purpose is to hurt somebody. Sure, someone could try to equate smoking with eating sweets, but there is not even a close comparison. Eating sweets did not relate directly to diabetes; smoking does relate directly to both lung cancer and emphysema. In treating people for both of these diseases cost more than it does to treat people with diabetes, and the diseases caused by smoking are more terminal than anything related to sweets.

No one has any real idea where all of this is going to come out in the end, but my overall hope would be that the cigarette companies will own up to the responsibility they need to show to the American public and the rest of the world and the knowledge Inc. that they withheld information that they knew that their product was killing people and that they will eventually do the right thing. I just don’t have that warm and fuzzy feeling that they will.

You never know where you’re going to find good information. On a blog called But You’re A Girl written by a young lady named Adria Richards was the video I’m posting below that addresses just what’s in the new health care bill, or at least the Senate version. It’s pretty good, and it’s easier to play the video than try to explain everything otherwise. All that, and you get to look at a cute dog from time to time. Learn, enjoy, and thank Adria:

It’s tough being a liberal, wanting a national health care plan, not thinking it could get done, then when it seems it’s done not liking many things about it. That may be a bit much, but there are enough things I don’t like about it that I already know, and trust me I haven’t read the more than 2,000 page report so I might hate even more later on.

What’s good about it? This is the easy one. A majority of people who don’t have health care coverage now will finally have something, and most of the coverage they’ll get will be comparable to health care plans that everyone else who has health care now has. What I haven’t seen is whether there will be deductibles or copays for services, and how they’re going to handle prescription drugs, but the plan says that people will be able to go to whichever doctor they so choose. I wonder if that means no referrals from a primary care provider will be needed for things such as physical therapy and diabetes treatment. I guess we’ll see.

What’s bad about it? Here are 5 gripes I have with the plan as it is known right now:

1. It’s going to hurt the middle class. Didn’t President Obama run on a platform that said any health care bill he signed wouldn’t hurt the middle class? No, it’s not going to hurt everyone, but the people it’s going to hurt the most are middle class. Individuals who don’t have insurance will have to pay a yearly penalty of either $950 or $3,800, depending on whether they’re single or in a family. That’s a lousy deal, no matter who you are.

2. It’s going to hurt small businesses. Now, I’m not one of those people who believes companies shouldn’t be covering their employees as far as health insurance is concerned, but I don’t know that I like some parts of this provision. For instance, though it states businesses of more than 50 employees, the federal government overall considers small businesses as any that have fewer than 200 employees. Also, did you know there’s a new provision that was added that states construction companies get penalized if they have more than 5 employees? At $750 a pop for the year it won’t break the bank, but it’s inherently unfair to isolate one industry like this, even if that industry has had to be reigned in by many states for its lackluster worker’s compensation record.

3. It’s still pricey. Here’s the deal. If you fit in an income class that’s higher than Medicaid but lower than the government’s arbitrary rate, you’ll get your coverage for free. However, if you have to pay into it, it’s going to cost you around $400 or so a month. So, that’s $4,000 a year as opposed to that $3,800 family penalty, but if you’re an individual in good health where’s the deal? It doesn’t take into account medical savings plans that many independent business proprietors have, which pretty much makes medical savings accounts for these folks moot. Yes, they’ll still be able to write off medical expenses over $400 a year, but that doesn’t quite seem balanced.

4. There’s still no plan for electronic medical records (EMR). Has anyone heard any government official talking about EMR lately? This is something President Obama has talked about wanting and having to be in the health care bill, but I haven’t heard anything about it. Of course, my gripe with it is that it’s easy saying all hospitals and physicians must have it. It’s hard for them to help identify just how such a process is supposed to be rolled out, especially in rural areas where neither the hospital nor the physicians have either the money or the technical expertise to get it done.

5. Absolutely no bipartisanship whatsoever. Yeah, I’ll say it, this one is the Republican’s fault totally. Sure, they didn’t want anything to begin with, but to only have one Republican who even participated in the talks, that being Olympia Snowe of Maine (female senators from Maine have always been contrary; gotta love them for that), is a darn shame. It was a farce seeing Orrin Hatch on TV last week saying he wished there had been more bipartisanship on this bill; you have to be in the game to have a chance to play. I keep wondering if things might have played out differently if Bill Frist, who not only was the previous Republican leader of the Senate but a medical doctor by trade, would have had a much different impact on how things played out as the minority leader and one of the few people with a health care background.

I actually do have a number six, that being that almost no health care professionals were a part of this conversation. I’m thinking that the American Medical Association, the American College of Healthcare Executives, the American Association of Healthcare Administrative Management, the Healthcare Financial Management Association and a few independent health care consultants in finance and revenue cycle matters would have really improved what’s on its way.

So be it. Those are my gripes with this bill. I will only say that I hope this bill is enough to overcome medical bankruptcy filings and offer more people quality health care, while not hurting the states.

Copyright secured by Digiprove © 2011 Mitch Mitchell

A recent survey conducted by Price Waterhouse Coopers (PWC) asked hospitals what was the most important thing for them to do in 2010. The number one response was to cut costs.

As soon as my mind saw that, one word immediately popped into my head: “Still?”

Many people believe hospitals are making money hand over fist. The reality is that the overwhelming majority of hospitals are barely scraping by these days because of the consistent cuts to Medicare and Medicaid, lower reimbursement from insurance companies, and more defaults on paying hospital bills because more people are out of work and can’t pay any bills, let alone health care bills. Who remembers earlier this year when it was announced that 60% of bankruptcies were the result of medical bills?

I’ve been in health care for more than 25 years, and since the mid 90′s, every hospital I’ve been at has bee working hard to find new ways to cut costs. Some moves have been way wrong, while others have reduced the type of care patients get. For instance, most hospitals used to have a plethora of registered nurses (RN) and licensed practical nurses (LPN) and the work was divided up nicely so that LPNs took care of patients while RNs took care of all the administrative stuff, but could also take care of patients. Then, because RNs could do so much more, some hospitals started eliminating LPNs and making RNs handle way more work. This meant that instead of a nurse maybe being responsible for 4-7 patients suddenly some nurses were responsible for as many as 20 patients, and still had to try to keep up with all the other work they have to do. Who suffers? Patients.

HealthLeaders Magazine also came up with a study recently showing hospital margins significantly below break even, though supposedly it was getting better. Substitute “budget” for “margin” and suddenly you realize that hospitals are running at a deficit when it comes to expenses versus revenue. At one point in 2007 50% of the hospitals in the nation were running below budget; by the 1st quarter of 2009, the figure had dropped to just below 30%. How have they done it? Pretty much by cutting expenses only. And that’s hard to do as the cost of health care keeps going up, especially pharmaceuticals and supplies.

In good times or bad times, hospitals overall struggle to stay above budget. At some point, cutting costs just isn’t going to get it done. With the pending full passage of health care reform, we’ll see what kind of impact it ends up having on hospitals.

Today the Senate Finance Committee voted against two amendments that were designed to create a government insurance program, which has been called the “government option” in the media. It wasn’t overly surprising that it didn’t pass. What was somewhat surprising is that the main guy trying to push health care coverage through, Senator Max Baucus, voted against it.

His reasoning was sound. He believed that with the public option on the table that the full bill wouldn’t be able to withstand a Republican filibuster, which would have pretty much killed the entire bill without a vote. He’s probably right, since there wasn’t a single Republican who was going to vote for it, including the one Republican who’s on the side of health care, Senator Olympia Snowe of Maine.

I haven’t talked much about whether I support a government health care plan or not. Truthfully, I’m of mixed emotions on it. On one hand, I think it would bring the cost of health care down a degree if insurance companies had to compete against a health care plan that offered lower premiums.

On the other, with all the other problems we’re having with the economy these days, and knowing that at a certain point there will be a tipping point where all health insurance will start going back up anyway, I’m not sure that’s the way to go. Not only that, but not everyone would be eligible for the government public option either. Larger companies with more than 100 employees wouldn’t be a part of the mix, and if insurance companies continued as they usually do, those companies would bear the brunt of higher premiums. Where would the benefit be there?

This must be said, though. The Republican claims that a government option would mean the government would take over health care is a lie, and they know it. Either that or they’re totally clueless, in which case they shouldn’t be senators. If we ever go down that route, as I’ve said in the past, there would still be insurance companies. So that one’s just a scare tactic.

Of course, I’ll still be mad at any health care plan that comes out with that provision about fines, which I think is a slap against the middle class. I hope that sucker is gone from the final bill; I’d hate to be on the side against it.

This is a guest post by Mary Ward

We’re all looking for simple ways to save money. And, for most of us, healthcare has been one of the costs rising the fastest. Since healthcare insurance is one of the items that families rely on most, we’re often faced with just accepting cost increases as they come. However, there are ways to save on your insurance premiums if you take the time to do the research and make changes as necessary. Here are some simple ways you may be able to cut costs on your health insurance premiums.

1. Shop around – if you haven’t evaluated other insurance options in a while, it’s time to do so. Even if you have employer provided healthcare, there may be more than one option available. If so, be certain to check it out before you simply sign up for the same plan year after year. And, don’t assume that the coverage options offered by your employer are the best or the least expensive. You might be surprised.

2. Talk to the company that provides your homeowner’s insurance, car insurance, or both. Many large companies that provide auto and homeowner’s insurance offer open enrollment healthcare coverage. If they can give you a discount based on the fact that you carry other insurance with them, you may be able to save money.

3. Investigate insurance available through groups you belong to – Your union or other professional group may offer group discounts to members or people in the same field. For senior citizens, AARP offers good and affordable healthcare coverage. It’s not just designed to be a supplement to Medicare – it’s great for those over age 50 who don’t have access to Medicare yet.

4. Review your coverage – It’s important to review your healthcare coverage periodically to ensure that you’re not paying for coverage you don’t need.

5. Switch to a high deductible plan – The higher your yearly deductible, the lower your monthly premiums. By choosing a higher deductible on your health insurance, just like your car insurance, you may be able to save a lot of money on premiums.

6. Add catastrophic coverage – Adding catastrophic coverage may allow you to reduce your other coverage, saving you money overall. Because your catastrophic kicks in on a major medical event, you may need less coverage on your primary policy, which is where most of your premium costs go.

7. Get healthy now – Make no mistake that down the road we’ll be paying more in health insurance premiums if we are higher risk. In fact, it’s already happening in some places. So, if you need to lose weight or if you smoke, take care of those issues immediately. It will lead to reduced premiums (and better health) in the long run.

Healthcare insurance is a hot topic in the US right now. While much of what we hear on the subject is simply rhetoric, we can hope that, over the long haul, we’ll all gain better health insurance at lower cost to us. In the meantime, do your homework and make sure you’re getting the best health insurance deal for your family right now.

Mary Ward is a freelance writer and likes writing about medical education topics, such as how to research and choose among online X-ray tech schools, how to apply for online college grants, and more. I thank her for this post today.

There was one major surprise that came from the health care bill being sponsored by Senator Max Baucus of Montana, and it’s the one thing that could scuttle the entire bill. It wasn’t the price tag of $856 billion either.

It was the provision that stated if people didn’t buy into it, they would be fined. Individuals would be fined $950, families would be fined $3,000.

What the heck? I know anyone who read this had to feel blindsided. This isn’t what anyone was expecting to come out of a health care plan that was intended to take care of people who couldn’t afford it. Oh yeah, if you can prove you can’t afford it, you won’t have to pay the fine, but in a backdoor way, you just hit the middle class, who were the major group that didn’t have any health care, the folks the bill was really for in the first place. In essence, they’d be paying for health care, whether it’s $3,000 or some other figure, which I’ve been unable to find, whether they wanted it or not.

And that’s not all. I don’t really have much of a problem hitting up insurance companies with surcharges, although we all know they’d just pass it on to the rest of us. I do mind that the bill would also hit up hospitals, which in many states are non-profits and are already paying out money to the states through a series of surcharges (since non-profits aren’t supposed to be taxed, they came up with “surcharge” to get around it), while at the same time still planning on reducing reimbursements of both Medicare and Medicaid.

Nope, I hate this bill, and from what I’m reading, a lot of Democratic senators also hate this bill. What could this guy be thinking, putting out a bill that, for lack of a better word, penalizes people in this fashion? This may be one time where many Democrats and Republicans will join in agreement in the Senate, at least the first time I can think of since President Obama has been in office.

How would you like your health care? Not like this.