Health Education and Tips December 29, 2015

Health education is the process by which we learn about our health and
more specially, how to improve our body. Different types of people
provide education related to healthcare and there are several ways by
which health education is delivered and it is based on a variety of
behavioral change models. fitness education is significantly important
in improving the physical condition of the people.

We get awareness, skills, and positive attitudes about strength from
these health related articles. Such articles describe about physical,
mental, emotional and social physical condition. They inspire us to
improve and maintain our body; prevent diseases, and moderate risky
behaviors.

Health related articles support learning in many
other subjects. A study showed that reading and mathematics scores of
third and fourth class students who acknowledged comprehensive wellbeing
education were considerably higher than those students who did not.
Generally, hale and hearty students learn better than unhealthy
students. Many studies have exposed that healthier students incline to
do better in school or anywhere. They have higher presence, have better
marks, and perform better in examinations.

Depiction about Education and Health

According to Cutler and Lleras-Muney, there are three extensive
clarifications for the connection between body fitness and education.
Though, they recognize that these do not represent a comprehensive list.
The first one is that students with poor body remain in lower levels in
school because unhealthy childhood is attached with poor shape in
adulthood. On the other hand, it is implausible that the relationship
between child strength and adult health fully elucidates the association
between adult physical condition and accomplished education. Since few
children in the United State fail to be present at school only because
of their illness. One would be hopeful of the relationship between
education and health to weaken over time. Though, this relationship has
toughened telling that poor health only cannot make clear the
relationship between education and health.

The second probable
clarification is that additional factors. For example, family conditions
or individual dissimilarities both boost schooling and get better
health. Many researchers advocate that the relationship between
education and health can be clarified by unnoticed factors and skills as
the capability to delay satisfaction, that make better educated person
healthier. Though, Cutler and Lleras-Muney state that proof related to
this explanation has been mixed properly.

The third probable
clarification for the link between education and health is that
amplified education directly gets better health. Semi-natural
experiments have shown causal influences of several changes in the
educational plans. On the other hand, such natural experiments have not
considered as the quality of schooling. Moreover, experiments tend to
use study participants whose attributes differ from those of the rest of
the people, making it difficult to generalize the discoveries beyond
the research samples. Authors conclude that one should apply carefulness
while considering this explanation as the full explanation for the
relationship between health and education.

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Tags: United State

Categories: Health

Small Business Health Insurance – An Employer’s Guide to Getting Small Business Health Insurance December 13, 2015

Saving on your small business health insurance can be a
challenge. But there are ways to overcome the financial obstacles and
get the coverage necessary for your business. There are two major
benefits of employer-based coverage. First these plans, although
expensive, usually carry the best all around protection for you and your
employees. Second, providing benefits plays a key role in attracting
and retaining quality employees.

Why is coverage for small businesses so much more than for large corporations?

Health
insurance for small businesses cost so much because of the high quality
coverage concentrated among a small group of people. Every individual
within the group represents a different level of financial risk to an
insurance company, and this risk is added up and spread out among the
group. Large corporations pay considerably less because the risk is
spread to such a large group, where small business owners can see
unreasonably high increases in premiums due to one or two members. Small
businesses also have to insure their employees under state mandates,
which can require the policies to cover some specific health conditions
and treatments. Large corporations’ policies are under federal law,
usually self-insured, and with fewer mandated benefits. The Erisa Act of
1974 officially exempted self-funded insurance policies from state
mandates, lessening the financial burdens of larger firms.

Isn’t the Health Care Reform Bill going to fix this?

This
remains to be seen. There will be benefits for small business owners in
the form of insurance exchanges, pools, tax credits, subsidies etc. But
you can’t rely on a bill that is still in the works, and you can’t wait
for a bill where the policies set forth won’t take effect until about
2013. Additionally, the bill will help you with costs, but still won’t
prevent those costs from continually rising. You, as a business owner,
will need to be fully aware of what you can do to maintain your bottom
line.

What can I do?

First you need to understand the plan options out there. So here they are.

PPO

A
preferred provider option (PPO) is a plan where your insurance provider
uses a network of doctors and specialists. Whoever provides your care
will file the claim with your insurance provider, and you pay the
co-pay.

Who am I allowed to visit?

Your provider will cover
any visit to a doctor or specialist within their network. Any care you
seek outside the network will not be covered. Unlike an HMO, you don’t
have to get your chosen doctor registered or approved by your PPO
provider. To find out which doctors are in your network, simply ask your
doctor’s office or visit your insurance company’s website.

Where Can I Get it?

Most
providers offer it as an option in your plan. Your employees will have
the option to get it when they sign their employment paperwork. They
generally decide on their elections during the open enrollment period,
because altering the plan after this time period won’t be easy.

And Finally, What Does It Cover?

Any
basic office visit, within the network that is, will be covered under
the PPO insurance. There will be the standard co-pay, and dependent upon
your particular plan, other types of care may be covered. The
reimbursement for emergency room visits generally range from sixty to
seventy percent of the total costs. And if it is necessary for you to be
hospitalized, there could be a change in the reimbursement. Visits to
specialists will be covered, but you will need a referral from your
doctor, and the specialist must be within the network.

A PPO is an
expensive, yet flexible option for your small business health
insurance. It provides great coverage though, and you should inquire
with your provider to find out how you can reduce the costs.

HMO (Health Maintenance Organization)

Health
Maintenance Organizations (HMOs) are the most popular small business
health insurance plans. Under an HMO plan you will have to register your
primary care physician, as well as any referred specialists and
physicians. Plan participants are free to choose specialists and medical
groups as long as they are covered under the plan. And because HMOs are
geographically driven, the options may be limited outside of a specific
area.

Health maintenance organizations help to contain employer’s
costs by using a wide variety of prevention methods like wellness
programs, nurse hotlines, physicals, and baby-care to name a few.
Placing a heavy emphasis on prevention cuts costs by stopping
unnecessary visits and medical procedures.

When someone does fall
ill, however, the insurance provider manages care by working with health
care providers to figure out what procedures are necessary. Usually a
patient will be required to have pre-certification for surgical
procedures that aren’t considered essential, or that may be harmful.

HMOs
are less expensive than PPOs, and this preventative approach to health
care theoretically does keep costs down. The downside, however, is that
employees may not pursue help when it is needed for fear of denial. That
aside, it is a popular and affordable plan for your small business
health insurance.

POS (Point of Service)

A
Point of Service plan is a managed care insurance similar to both an HMO
and a PPO. POS plans require members to pick a primary health care
provider. In order to get reimbursed for out-of-network visits, you will
need to have a referral from the primary provider. If you don’t,
however, your reimbursement for the visit could be substantially less.
Out-of-network visits will also require you to handle the paperwork,
meaning submit the claim to the insurance provider.

POSs provide
more freedom and flexibility than HMOs. But this increased freedom
results in higher premiums. Also, this type of plan can put a strain on
employee finances when non-network visits start to pile up. Assess your
needs and weigh all your options before making a decision.

EPO

An
Exclusive Provider Organization Plan is another network-based managed
care plan. Members of this plan must choose from a health care provider
within the network, but exceptions can be made due to medical
emergencies. Like HMOs, EPOs focus on preventative care and healthy
living. And price wise, they fall between HMOs and PPOs.

The
differences between an EPO and the other two organization plans are
small, but important. While certain HMO and PPO plans offer
reimbursement for out-of-network usage, an EPO does not allow its
members to file a claim for doctor visits out its network. EPO plans are
more restrictive in this respect, but are also able to negotiate lower
fees by guaranteeing health care providers that it’s members will use
in-network doctors. These plans are also negotiated on a
fee-for-services basis, whereas HMOs are on a per-person basis.

HSA (Health Savings Account)

An
HSA is a tax-advantaged account used to pay existing and future medical
expenses. HSAs are used in conjunction with high-deductible health
plans (HDHP), which will make some with pre-existing conditions
ineligible. Also, HSAs must be funded with cash. Communicating the terms
of this account to your employees is important, as a large number of
HSAs are underfunded or improperly funded. The health savings accounts
were signed into the law by George Bush in 2003, and have become an
affordable alternative to a group health plan.

When inquiring
about an HSA, there will be a few things you will want to clarify. While
HSAs generally cover routine medical expenses and copays, some can
provide dental and vision care as well. And since HSAs can be combined
with certain compatible plans, it is important to understand how money
from the account will be allocated. And finally, you will want to know
about cashing out your HSA balance. The amount is taxable and could be
subject to a ten percent excise tax.

HRA (Health Reimbursement Arrangement)

An
HRA is exactly what it sounds like. The employer reimburses the
employee for health care. As an employer, you will usually have the
option to contribute to a reimbursement fund, or to pay fees as they are
incurred. These reimbursements can be deducted from your taxes, and are
tax-free for your employees, saving you both money.

Some
providers empower employers by giving them more options. HRAs, unlike
HSAs, don’t have to be funded with cash money, placing a book keeping
entry on your balance sheet is enough. You can usually control aspects
of your arrangement such as reimbursement limits, whether you or your
employee pays first, and if the previous year’s funds roll over.

HRAs
are becoming a more popular option because of the control it has given
small businesses. Combined with a high deductible health plan (HDHP), an
HRA could be the most cost-effective solution to your small business
health insurance problems. It’s always best to compare these plans to
PPOs, HMOs, and EPOs to know what works best.

Fee for Service (FFS) or Traditional Indemnity

A
fee for service plan is the most flexible small business health
insurance option. You choose your doctor, and your hospital. You can see
a specialist without a referral. This flexibility, however, comes with
more out-of-pocket expenses and higher insurance premiums.

The
typical FFS plan has a deductible ranging anywhere from five to fifteen
hundred dollars. After this amount is reached, the provider will pick up
eighty percent of your medical bills, and require you to pay the
remaining twenty percent. Because of the rising costs of health care,
and the potential for a small number of doctor’s visits to cost
thousands, these plans can become incredibly expensive.

Flexible Spending Account (FSA)

A
flexible spending account is a savings account to be used for medical
expenses, and is funded by pre-tax dollars. Using pre-tax dollars means
that your employees will actually show that they have less income, and
will therefore have less taxes withheld. As an employer, you set the
limit on contributions to the account per year. In addition to the
employee contribution, you can also credit the account, or fund it
completely from your general assets.

An FSA, especially if combined with an HDHP, can significantly reduce the costs of small business health insurance.

You
should be forewarned, money from FSA accounts cannot be rolled over.
They are, however, available to use for two years and two and half
months after the benefit year. A terminated employee won’t be able to
use leftover funds, unless there is a positive remaining balance and
COBRA is elected.

Small business health insurance providers have
made significant improvements in their services to simplify the
administration of your plan. With HRAs, FSAs, and HSAs, your employees
can use debit cards for medical transactions. Be sure to research this
thoroughly. You will want to be sure your debit card plan is IRS
compliant, and that you can use a large number of pharmacies. You should
also pick a plan that can verify eligibility on the spot. Talk with
your agent about linking transit, parking fees, and prescriptions to the
same card. When picking the debit card options, please be sure to
clarify the details of the substantion process. This is IMPORTANT! With
other plans, the provider may assign someone to manage your plan. Or you
may have to hire someone. Still, you should be able to login to your
account and print insurance cards, important papers etc.

The next
thing you can do is thoroughly assess your needs. Being that every
member of your small business plays a key role in its success, it is
vital that their needs are met. And understanding these needs is crucial
to finding the right plan. Find out about chronic illnesses, and
additional information related to past health issues. Know what your
employees think about health insurance, and get them involved in the
process.

Hiring an agent or a broker

Finding
and understanding small business health insurance can be a daunting
task. While some choose to go it alone, others need some professional
assistance. You need to understand the difference between an agent and a
broker, and how you can get the most from either of them.

A broker

Brokers
function independently and usually work for several different
companies. Since they have a variety of resources, they can usually
provide more options and a better overall view of the marketplace.
Brokers will assist you by evaluating the costs and designs of plans
from your local major carriers. The cost isn’t everything, you want to
get the coverage that you need.

Ask the broker how he or she is
getting paid for their services. They should readily divulge that
information. Some brokers may charge you a flat free. Some receive a fee
from an employer, while others receive a commission from the insurance
provider. Any commissions could be reflected in your premiums, but not
to the point that you should worry.

An agent

Agents
typically provide services for one company. They have a closer
relationship to the insurance company than a broker would, giving them
more leverage to make alterations to your plan. In some cases they can
offer a particular plan for less than a broker, and may have access to
additional services like worker’s compensation. To find out what
different providers have to offer, talk to more than one agent. It may
be time-consuming, but it could bring you closer to the most
cost-effective solution for your small business health insurance.

One
of the common options presented by agents is the employee-elect option.
This is an arrangement where employees pick the plan they prefer. Those
who don’t need as much coverage won’t be forced to pay so much, and
those who do need it can get it without increasing the financial burden
of the company as a whole.

How to Save On Your Small Business Health Insurance Plan

What’s
important to remember is that there really is no inexpensive solution
to health care. Even if your initial premiums are reasonably low, they
could rise significantly at your next renewal. So saving money on small
business health insurance is about doing a combination of things
simultaneously to get good rates, and to then maintain those rates.. And
it will require a consistent effort from you, your employees, and your
insurance provider.

First, you can save yourself money by reading the fine print.
You need to know exactly what your plan does and DOESN’T cover. There
are also state mandated coverages. For example, in states like Illinois,
your insurance must cover mammograms. Also, understanding the ins and
outs of your plan will give you and your employees a better idea of how
to deal with your insurance.

Next, you should shave unnecessary benefits.
After reading all about your plan, you will find coverage for things
you may not need. Eliminating these benefits can significantly drop
monthly small business health insurance premiums. For example,
eliminating coverage for brand name medications can reduce costs by more
than 25 percent.

Wellness program have worked wonders for small businesses.
A wellness program is any program designed to promote healthy living
within the organization. Weight loss competitions benefit every
participant. Add a financial incentive for further motivation. Stock the
work fridge with water, and leave literature about healthy living lying
around. Search the internet for calorie counting charts. Raising
awareness entice workers to make positive changes. Active, exercising,
diet-conscious employees have stronger immune systems, more vitality,
and more productive workplaces. They also don’t deal with as many health
issues. Fewer doctor visits and hospitilizations will help maintain
lower annual premiums, because it will prove to your insurance provider
that your business is a low financial risk.

Increasing your co-pay and deductible can go a long way towards cutting costs.
For instance, raising co-pays by just ten dollars has saved companies
as much as thirteen percent on their premiums. A higher deductible will
significantly reduce your monthly premium. To lessen the financial
burden of high-deductible health plans (HDHPs), combine them with an
HSA. Combinations like these have saved both business owners and
employees bundles of cash.

Check into getting a nurse hotline.
A nurse hotline is a toll free, 24-hour-a-day, seven-day-a-week
service. Employees can get medical advice from qualified, registered
nurses. This method has deterred a large number of people from emergency
visits, and it can also be used for preventative care as well. Insurers
like Nationwide have them, or you may have to purchase from a
third-party provider.

Increase the size of your group to reduce your monthly small business health insurance premiums.
In a survey by America’s Health Insurance Plans, small businesses who
employed ten people or less paid forty three more dollars on average
than businesses with twenty six to fifty employees. Check around with
other businesses owners, or fellow members of business organizations.
Some states also have small business groups and pools for this purpose.
Check with your state Chamber of Commerce and Department of Insurance.

Beware of heavily discounted plans.
First, there are numerous scammers trying to get your money. They
promise low rates, and usually cover little to nothing at all. The
internet is notorious for swindlers trying to hustle you out of a buck.
If you are going with a company you aren’t familiar with, please do your
research. On another note, even reputable companies present problems.
In an attempt to gain market share, Blue Cross offered small businesses
discounted rates in 2008. For 2009, some of these same businesses were
set to see increases of as much as 47% in their premiums. As the costs
of medical care increases, the costs are shifted from the insurer to the
insured, and discount plans become overpriced plans quickly.

Shop around.
As mentioned before, talking to different agents will expose you to the
best that insurance providers have to offer. Ask other small business
owners about their providers. You can use trusted online resources like
Netquote and Ehealthinsurance to shop around instantly. These services
also let you compare plans side by side, and allow you to purchase your
plan online. Even after you get your initial plan, it’s good to annually
reevaluate your coverage. This will keep you on the up-and-up about
what the market is offering. Keeping costs down is an ongoing effort,
especially with rates and plans changing all the time from company to
company.

Share some of the costs with your employees.
Raising employee contributions isn’t a popular option, but it may be
one of the only ways to absorb costs and maintain small business health
insurance coverage. Communicate with your employees about how to keep
costs down, and remind them that their increase is your increase as
well.

The sad truth is that, no matter how many cost-cutting
methods you apply, your insurance premiums are expected to continually
rise. In addition to this, you can’t prevent every health problem with
exercise and higher co-pays.

The Health Care Reform Bill won’t
kick in until about 2013, so waiting on its benefits won’t do you any
good. There is definitely a need for change, because the current system
discourages competition and growth. With smaller businesses functioning
as the backbone of this ailing economy, company medical insurance must BE affordable, and STAY affordable.

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Tags: EPO, HMO, HSA, PPO

Categories: Health

How You Can Save Up To 47 Percent On Your Health Insurance Right Now December 11, 2015

Do Not Read This Unless You are Making a lot of Money!:

If
you would like to know how you can save up to 47% on your current Health
Insurance Coverage read on… this is going to be one of the most
informative messages you will ever read. After reading this message you
will never going to have words; expensive and health insurance in the
same sentence.

As you already know health insurance costs are at
highest they have ever been and there is no sign of them slowing down.
More and more Americans are forced to cancel their coverage simply just
because they cannot afford it.

Who are the uninsured?

o Approximately 46 million Americans,
or 15.7 percent of the population, were without health insurance in 2004
(the latest government data available).

o The number of uninsured rose 800,000 between 2003 and 2004 and has increased by 6 million since 2000.

o
The increase in the number of uninsured in 2004 was focused among
working age adults. The percentage of working adults (18 to 64) who had
no health coverage climbed from 18.6 percent in 2003 to 19.0 percent in
2004. An increase of over 750,000 in 2004.

o Nearly 82 million
people – about one-third of the population below the age of 65 spent a
portion of either 2002 or 2003 without health coverage.

o The number of uninsured children in 2004 was 8.3 million – or 11.2 percent of all children in the U.S. (1).

You might say that I have great coverage that I am happy with… that’s totally fine.

For
past sever years average rate increase for health insurance was 16.2%
and what if it keeps on going? If you are right now paying $500 per
month for your health insurance in three years from now you would expect
to pay over $780 for the same plan. Wait… we all know that insurance
companies consistently decrease their benefits and increase co-pays and
deductible. Therefore you will pay more for less coverage. By the way
if you keep same plan for over five years you will pay over $1000 a
month just for your medical coverage. What if you use your Health
Insurance?… Chances are if it is not for a regular doctor visits or a
check ups it would be considered pre-existing condition. That means your
chances of changing to a more affordable coverage in the future will be
nearly impossible. That is one of the main reasons people cancel their
health insurance because they were diagnosed with something or taking a
prescription medication and the insurance company kept raising their
rate until they could not qualify for any other coverage and could not
afford the one they had.

Now you are saying I do not need coverage my spouse works for a company and I have group coverage… Great.

What
would happen if your spouse left that job or the company stopped
providing benefits? Probably the most obvious things that you can see
how much that group coverage is really costing you. Next time check how
much is deducted out of the paycheck for health coverage, especially for
dependents. Group plans do cost more money because by law they are what
are called “guaranteed issue”. That means you can have serious medical
conditions and still get coverage. Insurance companies have to follow
the law and they know they have to accept everyone who works for a large
company, therefore they do charge more money for coverage. The biggest
problem is not the cost of group health insurance it is what happens if
some one, while on the group plan, is diagnosed with a condition or
starts to take prescriptions medications. We get back to same issues as
mentioned before, unable to qualify for health insurance in the future.
There are people that want to leave their job but they cannot because
they are going through treatment and cannot to pay for it on their own.

There
is another solution… Some might save, so what is the point of even
having health insurance. Once you diagnosed with something and insurance
company is going to keep raising rates to the point where I am going to
have to cancel it anyway. Especially if something does happen and I
have to use my coverage I might not be working and I might not have
income. Is my insurance company is still going to keep raising my rates?
YES.

Before you think about canceling your coverage consider this. Here are some statistics

o
A recent study by Harvard University researchers found that the average
out-of-pocket medical debt for those who filed for bankruptcy was
$12,000. In addition, the study found that 50 percent of all bankruptcy
filings were partly the result of medical expenses. Every 30 seconds in
the United States someone files for bankruptcy in the aftermath of a
serious health problem.

o Illness and medical bills caused half of the
1,458,000 personal bankruptcies in 2001, according to a study published
by the journal Health Affairs.

o Average day in the hospital is $7500 per day.

How
can you save up to 47% on your health insurance? Simple… You probably
already heard of Health Saving Accounts. They are becoming more and
more popular everyday. With the way health insurance prices are moving
today Health Saving Accounts are the only way to keep your coverage,
save hundreds per month on your health insurance and still have a peace
of mind.

To this day I was not able to hear a good definition that
everyone can understand. I will do everything I can to make it simple
to understand. The easiest way to understand Health Saving Accounts is
to think of them as Roth IRA or your Company’s 401k plan. Instead of
giving your money away to insurance company you get to keep it more of
it for yourself. The way HSA plans work is there health insurance
combined with savings account which works in a similar way to your
retirement account. There tremendous benefits to have HSA qualified
health plan. First all the money that you put in to your HSA account is
100% tax deductible and it is your money that rolls over year after
year. At the age of 65 and up if you have not used up all of your HSA
money you can roll it over in to your retirement account. Second your
health insurance costs are going to be cut almost in half. For example
if you had Health Insurance plan with $2500 deductible now and it is
costing you $300 per month the same plans with HSA qualified plan, now
will cost you only about $160 per month. The reason you save so much
money with HSA qualified health plan is because HSA qualified plans do
not cover anything until the deductible is met. There are exceptions
depending on the Health Insurance Company. Some insurance companies
will pay for your once a year physical before you meet your deductible.

Let
take an example of how HSA qualified plan could benefit you. Let take
some actual numbers from actual health insurance company. In this
example I am going to use HSA plans from company called Assurant Health.
Assurant Health is leader in Health Saving Accounts and they one of the
first companies to implement them. The main reason is that Assurant
Health is part of the world’s largest financial company that sets up
retirement accounts. In this example I am going to use a family of four,
husband 46, wife 42, kids are 12 and 16. On a regular family plan with
$2500 deductible, maximum out of pocket of $5500, co-insurance of 80%
and doctor visits covered with $35 co-pay, they are going to pay
$676.40. Something to keep in mind that all of the regular PPO plans
that are available on the market today have family deductible which is
double of individual deductible. That means that if you have a plan with
$2500 deductible and $5500 maximum out of pocket that means that your
family deductible is $5000 and your family maximum out of pocket is
$11,000. When we are comparing HSA qualified health plans there is only
one deductible, once you meet it you are covered at 100% on the most
plans. There are some companies and plans that you still might be
responsible for the percent age of the bill until you reach your maximum
out of pocket. Most HSA plans do not have maximum out of pocket that
meant once you met your deductible you are covered at 100%, it’s that
simple. The same plan with $5700 deductible for the entire family with
HSA qualified health plans will only be $491.64 per month. For the total
monthly savings of 184.76 per month. Also your maximum out of pocket
will decrease from $11,000 on a regular plan to $5700 with HSA health
plan. That’s yearly savings of $2,217.12 and additional savings of $5300
on the maximum out of pocket. (that’s if you have had to use the plan
for emergencies) The main reason for starting HSA health insurance is
for Saving Account and being able to put money in to account, at your
discretion, tax free. You can put money in to HSA qualified account up
to your deductible and you do not have to put any money in to that
account if you do not want to. Health Saving Accounts are as flexible as
you would want them to be. TO get more information on HSA accounts and
get quotes for HSA qualified health coverage see my bio.

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Tags: Assurant Health, Health Insurance Company, Health Saving Accounts, HSA

Categories: Health

Health Insurance Money Saving Strategies – How Combining Health Insurance Saves Money December 5, 2015

How does anyone get the best value with health insurance? Answer:
Combine Health Insurance Plans. To explore the principles at work, many
people should understand how combining health insurance is a sound
solution to a serious problem. It may appear obvious that combining
insurance improves coverage, but few people truly understand how
combining plans leads to thousands of dollars in potential savings over
time. With so many health insurance plans available and over 1 million
insurance agents actively licensed today, it leads one to question why
no one knows how combining plans saves money.

Today, too many
people are learning the hard way that they are under-insured when it
comes to health insurance. This happens because competitive health
insurance agents bid lower and lower amounts in an inflated market,
leading to more gaps in coverage that less experienced agents often fail
to comprehend well enough to explain. There is a simple truth to
understand about the rising costs of health care.

Health Care Costs Will Continue to Rise When No Regulation is in Place

Hospitalvictims.org
conducted research on hospital charges nationwide. These charges were
compared to those of Johns Hopkins Hospitals, one of the most respected
health care institutions in the nation. What were the results?

The
vast majority of hospital charges average between 300% and 400% above
the institutions’ costs for treatment. Johns Hopkins Hospital’s average
charges are 117% above its costs. For every $1 charged, Johns Hopkins
pays $0.85, or earns a profit of $0.25 for every dollar charged.

The
average U.S. hospital pays $0.27 for every dollar it charges. The
average hospital is paying $25 Million in costs while charging $95
Million to patients. The average profit margin is around $70 Million
annually. The greatest of these charges are credited to surgical
supplies and the administration of anesthesia.

In an
ever-inflating health care industry, a solution does exist. While
politicians continue making promises to solve the health care crisis,
individuals and families continue to expect more than the insurance
market can bear. But many self-employed individuals and families can
find comfort in knowing they can do something to secure assets by simply
doing the legwork and becoming informed about health insurance.

The solution is based on a very simple principle of insurance. Insurance is an Agreement to Share the Financial Risk of Loss Between Individuals and Companies

This
basic concept is more important for individuals to understand now than
ever. Health insurance companies, like individuals, cannot afford the
rising costs of health care on their own today. Many health insurance
companies have developed their focus to specific areas where they can
offer more competitive coverage at very affordable prices. This is where
people can save significant amounts of money by adjusting to this
trend. It is no longer the case that a single health plan can offer
full, comprehensive coverage at a competitive price because health care
costs are out of control.

Today it takes multiple health plans from multiple
health insurance companies to have the best coverage at the lowest
price. This follows the trends associated with investing in the economy.
One creates greater risk for their financial performance in the market
by investing all funds in one stock or trade. The safest, most secure
investment is a diversified portfolio. Health insurance is no different
today.

Why You Do Not Know

Is it surprising to learn
that many insurance professionals have no idea how to give individuals
and families the best coverage and the greatest savings on health
insurance? The majority of health insurance agents today are captive to
one company. This means that most insurance agents are only trained to
present the products of the health insurance company they represent.

Independent
agents are less restricted to one plan, but a large number of these
professionals still have limited access to the competitive plans
available to individuals and families. While this explanation is
complicated, the simple answer is that most agencies earn the majority
of their profits from the volume of product sales per company, not the
volume of sales overall. Some general agency contracts offer higher
incentives to the agency, which can influence what products agencies
offer.

So, it comes down to the individual shopping for health
insurance to find the policies that create the greatest coverage and
savings.

A Well-Structured Health Insurance Portfolio is the Key to Having the Best Coverage for the Lowest Price

Combining
health insurance plans is the best way to improve coverage save money
on health insurance long term. Health Insurance Money Saving Strategies
is a 10-week campaign to spread the word to self-employed individuals
and their families looking for private health insurance. A
well-structured Health Insurance Portfolio is the best way for people to
protect their assets and be comfortable knowing their insurance
adequately protects them from the worst medical situations. The benefit
is knowing that this type of approach to health insurance saves people
money.

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Tags: Johns Hopkins Hospitals

Categories: Health

Healthcare Reform – What About Us November 17, 2015

In recent times, there have been extraordinary events that put a
pause on routine and threw our country into animated conversation but
they have mostly been about bad news – 9/11, the invasion of Iraq and
most recently the Wall Street bailout. The election was neither bad news
nor a distraction like a celebrity meltdown, it actually mattered. And
as a result of this incredible election season, America’s children have a
chance to grow up unaware that there’s anything unusual about an
African-American President or a woman running for the White House.

2008 Legislative Success

Now, it’s over – the excitement, the soaring and in some cases
snoring oration, the primaries and the debates – the Presidential
campaigns are over. It was my great good fortune to attend the
Democratic National Convention and to have affirmed in speeches and by
actions that our community has indeed made progress. We had Senator
Kennedy’s bittersweet appearance and his steadfast commitment that was
so critical to the passage of parity; Michelle Obama’s unexpected
reference to mental health when she talked about universal healthcare;
Bill Clinton’s description of a mom struggling with her sons’ autism;
the first ever “recovery room” at a convention; and a luncheon honoring
the Campaign for Mental Health Reform that included A list celebrities
as well as national and state political leaders all vocal in their
support of accessible, affordable mental health and addiction
treatments.

The rhetoric of the convention was matched by an
extremely successful legislative year: the delay of damaging Medicaid
rules on rehabilitative services and targeted case management and the
introduction of the Medicaid Services Restoration Act; the passage of
Medicare parity; veterans legislation that extends mental health and
addictions services beyond the VA out to communities; improved
collaboration between criminal justice and mental health; expansion of
the disability definition in the ADA making it easier for people with
disabilities to obtain protection against disability-based
discrimination; and the passage of parity ending health insurance
discrimination.

It is a hopeful time for people with disabilities.
Our string of legislative and policy successes reflects tremendous
progress. And substance use and mental health advocates – united by the
Presidential campaign – can share a path forward into a new era.

The Economy and Service Capacity

But times are tough in communities across the country – and the
world, people losing their jobs, their homes and their retirement
savings. Many of us at the National Council have spent these last few
months traveling from state to state and community to community. And we
return from these trips filled with anxiety.

As states attempt to
manage their budgets in a very fragile economy, increased demand for
mental health services could be on a collision course with impending
cuts to publicly funded services. Our already tattered mental health and
addictions safety net is in grave danger of collapsing as unemployment
rates soar, anxiety over the future grows and demand for services is at
an all time high.

We urge states to resist cutting essential
mental health and addictions services and we’re lobbying for federal
stimulus packages that include Medicaid relief and financial supports so
that communities can meet treatment demand in the difficult months and
perhaps years ahead. At the same time, our industry -the behavioral
healthcare industry – has to be ready to work with the greatest
efficiencies and be accountable for every taxpayer dollar. And the
National Council’s proud of the initiatives – our Access and Retention,
Six Sigma and Process Benchmarking projects -that we’ve introduced to
support member efforts to streamline access, creating more treatment
capacity and more effectively engaging consumers and communities in the
recovery process.

Our Role in a Progressive Era

Now the question being asked is what’s our role in a new
administration, in a new era? One of President elect Obama’s challenges
will be to harness the extraordinary idealism that he inspired in his
campaign to a larger, national cause. We appear to be leaving behind the
conservative agenda and entering a progressive era. A progressive era
being shaped by the millenniums with their internet culture and by a new
breed of the very rich that are using their wealth to support
progressive causes and demanding accountability in return for
philanthropy.

But even in a new era, the reality, pace or shape of
healthcare reform – is uncertain. Washington is already abuzz with
health care groups lobbying their points of view and potential
candidates for healthcare posts in the new administration polishing
their resumes. But economics, politics, and history suggest that any
major overhaul of our healthcare delivery system will be a difficult
process at best. Healthcare is now bigger than the “military-industrial
complex” about which we were warned in 1950s, 1960s and 1970s; and
there’s no sector of the economy with more politically powerful special
interests.

To date behavioral healthcare’s progress has received
little mainstream attention. And our community has a good story to tell.
While healthcare costs have skyrocketed, our services, historically
underfunded, have seen little increases. Richard Frank, Harvard
economist and co-author of Better But Not Well, uses data from the
National Co-morbidity Survey to make the case that more money is being
spent on mental health but mental healthcare’s share of GDP is constant
and its share of health spending is declining while access, quality, and
supports for people with mental illnesses have increased. We have data
that tells a compelling story; and science that supports return on
investment. So what about us?

It’s almost a sure bet that the next
administration will include treatments for mental illnesses and
addictions in any expansion of health coverage. We’ll be included in
movement towards universal coverage, whether incrementally like the
re-authorization of SCHIP or as part of more comprehensive reform like
the plan offered by Ezekiel Emanuel (Dr. Emanuel, who is invited to
speak at the National Council’s conference in San Antonio, is the
brother of Obama’s new chief of staff Rahm Emanuel) in Health Care
Guaranteed. But will inclusion in universal coverage strategies or
general reform solve the fundamental problems we face? At best, reform
will enable us to begin to solve our own problems.

Mental
healthcare shares the problems of the larger healthcare system; and like
health care suffers unintended policy consequences. We threw medicine
out with the medical model, now we’re talking as if we’ve just
discovered that mental health is fundamental to health and the result is
people with serious mental illnesses are dying far too young. We
brought Medicaid into every possible service, promoted decentralization
and the marketplace, and now we’re faced with the same consequence –
fragmentation.

Over the years, risk and responsibility have been
downloaded from states to community organizations without the resources
needed to keep pace with mental health, addiction and co-occurring
treatment advances; without the resources to create organizational
infrastructure that supports planned change; and without the resources
needed to coordinate and ensure good general medical care for people
with serious mental illnesses. Instead of investing in quality services,
states have introduced intermediaries to manage what they still call
their “system” – the result is a deskilled workforce and business as
usual.

And in some cases, providers have lost the trust of their
communities. As they’ve been increasingly relegated to and paid for only
the treatment of people with the most serious mental illnesses, their
communities have been left adrift. Mental health prevention and early
intervention were very much part of the original concept of community
based mental health care. We justified eliminating the funding for those
services by labeling them as dollars wasted on the “worried well”.

Serving
your community means running a receptive and responsive organization:
flexible hours that fit the schedules of people who work; emergency
availability; and a presence in all aspects of the community where help
is needed – schools, jails, senior centers, foster homes, and on and on.
It also means offering one stop shopping, sending people to multiple
sites of service doesn’t work very well and doesn’t work at all when
there is little to no coordination.

Can we transform ourselves into organizations that
will be propelled by a progressive agenda and supported by new
coalitions? I think the question is answered by another question. Can we
offer a vision of communities increasingly free from addictions and
mentally fit; a vision of communities where those with histories of
addiction and mental disorders are included not excluded from mainstream
life; and can we be accountable for the quality of services we provide -
with national standards and practices? Can we do as education has done,
combine vision with accountability? If the answer is yes, then perhaps
the new entrepreneurial philanthropy will be by our side and perhaps one
day President-elect Obama will write about the staff in behavioral
health as he writes about teachers in The Audacity of Hope, “There’s no
reason why an experienced, highly qualified, and effective teacher
shouldn’t earn $100,000 … teachers in such critical fields as math and
science – as well as those willing to teach in the toughest urban
schools – should be paid even more.”

An Actionable Agenda

But even as we think big thoughts about health care reform, the
National Council remains practical and ready to move an actionable
agenda.

We need to be accountable for continuity of care for
people with serious mental illnesses and addictions. The National
Council’s Health care Collaborative Project successfully brings together
behavioral health and primary care organizations offering a
bi-directional approach for care, addressing the integration of primary
care services in behavioral health settings as well as the need for
behavioral health services in primary care. But far too often when the
patient walks out the door, our responsibility ends – from hospital to
community, from mental health to addiction treatment center to primary
care, from the streets to the jails – we’ve created an array of
disconnected even if well intentioned services. People with chronic
illnesses and chronic problems need a home; and science has taught us
that mental and addiction disorders are often chronic conditions. The
patient-centered medical home – that provides care management; shifts
the focus from episodic acute care to managing the health of those
living with chronic health conditions; and emphasizes self-care that
resonates with our recovery and resilience orientation – is a model we
can embrace. And at the community level the idea of behavioral health
care organizations providing a “health care home” for people with
serious mental illnesses and addictions makes a lot of sense.

We
need cost based plus financing that supports clinical excellence –
skilled staff delivering nationally recognized practices within
organizations that live by the rule, if you don’t measure it you can’t
improve it. People want and deserve high quality services but services
depend on the staff skill, and skilled staff must be adequately
compensated. Low salaries have created-and are perpetuating-a
recruitment and retention as well as a quality crisis for behavioral
health care. We need organizations and staff that can provide state of
the science behavioral health interventions, can treat and triage
general health disorders and can lead site of service performance
improvements. The public increasingly accepts that mental illnesses and
addictions are treatable disorders and that recovery is possible. Now we
must be sure that there are effective organizations and skilled
practitioners.

We need a federal mental health funding stream
dedicated to mental health and integrated treatment services for the
uninsured. The uninsured have exceptionally high rates of untreated
mental illnesses with co-occurring addiction disorders and there is no
safety net. State general fund mental health dollars were reallocated to
the Medicaid match. And now state plans to cover the uninsured are
floundering. We have large numbers of individuals with treatable mental
illnesses in our overburdened emergency rooms, in jails and on the
streets …and without access to the services that can engage them,
treat them and return them to work. We’re denying our economy productive
taxpayers. We’re wasting human lives.

We need a pool of funds to
support investments by behavioral health care organizations in
information technology. We talk about information technology and service
transparency yet organizations that move forward to automate their
clinical systems find little available support, funding, or technical
assistance. A September 2006 National Council poll of community
behavioral health care providers across the country indicated that 8
percent had implemented an EHR system with clinical components fully
functioning. Technology offers critical support to the service
improvement process; promotes the application of protocols and
guidelines; helps maintain contact with individuals who move through
complex systems; and holds the promise to reduce the enormous financial
burden of paperwork and reporting duplication-all efficiencies that
improve service quality. The time has come to walk the technology talk.

We
must have increased emphasis on and greater funding for research-based
education and prevention practices. We have prevention and education
programs that work. Research-based prevention programs that reduce the
risk of childhood serious emotional disturbance by treating maternal
depression; and the Nurse-Partnership Program that has an array of
consistent positive effects across multiple trials. We have
research-based education programs that increase mental health literacy
like Mental Health First Aid. The National Academies Institute of
Medicine report to be issued later in 2008 is expected to underscore the
importance of greater emphasis on prevention and health-promotion
practices that can impede the onset or reduce the severity of mental
health and substance-use disorders in children, youth and young adults.
This report presents an excellent opportunity to place prevention
practices on the new Administration’s table.

The “Key Contact” Club

We can provide healthcare homes for people with serious mental and
addictive disorders; we can ensure a skilled workforce, effective
organizations and quality care; we can help those that are mentally ill
and uninsured become productive members of their communities; we can
employ the promise of technology; and we can bring research-based
prevention and education to our communities. But we know from our ’08
successes that we cannot do any of these things without the leadership
of our members – members that have real impact, tackling what can appear
to be intractable problems. We have a vision, we have an agenda, and we
have a “key contact” strategy.

Under the direction of Chuck
Ingoglia, our VP, Public Policy, our strategy is to establish and track a
key contact system – a network of members, their boards, consumers and
families who have good, and soon to be better, relationships with
members of Congress. Key contacts must be committed to meeting with the
elected officials and to keeping us updated on these contacts. Our plan
is to have a key contact in every congressional district. We’re taking
what has been an ad hoc arrangement of our members reaching out to
Congress and nurturing what we hope will be a formidable rolodex.

When
change is being debated in Congress, we will be there. We’ll leave
behind references to a system in shambles; we’ll lead with data; with
our history as good managers of public dollars; and with an actionable
agenda. But we need you at our side, as John F. Kennedy said so very
long ago, “Political action is the highest responsibility of a citizen.”

I look forward to hearing from you and to your involvement in the “key contact” club.

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Tags: Ezekiel Emanuel Dr, National Co-morbidity Survey, National Council, Richard Frank

Categories: Health

Women Health Center in Los Angeles Recommends Routine Check-up October 10, 2015

Made up your mind to visit a gynecologist – this means that you have
started taking care of your body. It is not that you will have to go to a
gynecologist only after you face any health issue relating to your
reproductive system. For a routine check-up and to remain healthy, it is
mandatory that you inculcate a habit of visiting the gynecologist’s
place. As per the publication published by the Women Health Center in
Los Angeles, many women make the mistake of rushing to a gynecologist’s
clinic after the situation has slipped from their hands. They wait for
the eleventh hour with a hope that the problem will be sorted out
automatically, but this is not a reality.

So, why should you see
a gynecologist and go through the Gynecology Care in West Hills? Do you
have any idea? A gynecologist will help you in understanding your body.
She will tell you the procedures to be followed to take appropriate
care of it. A physician will explain you the normal conditions, so that
you can trace out the changes easily, such as vaginal infection signs.
If any, the problems will be detected at an early stage, thereby
preventing it from getting out of control.

What are the situations when you will actually feel the necessity of
visiting a gynecologist? According to the Women Health Center in Los
Angeles, a teenage girl (of age group 13-15) should start visiting a
physician’s clinic. This way you can build a strong relation with your
gynecologist and can learn more about your body changes. Suppose, you
miss to visit a doctor at that age, then you should without failure
visit a gynecologist in the occurrence of certain circumstances like if
three months have passed and you have not got your periods again, if you
have severe stomach pain, when yellow, green or grey fluid is coming
out from the vagina and the fluid has strong bad odor. These are the
symptoms of PID. Some other circumstances are like you are suffering
from an intolerable pain during your menstrual and you are bleeding
heavily and for a longer period of time, then in such cases, you should
visit a gynecologist and discuss your problems with her.

A
gynecologist will ask you some questions regarding you & your family
for learning that whether the illness is hereditary or not. Tell her
everything clearly, so that issue can be cured quickly. Once you visit a
professional, she will handle the case efficiently.

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Tags: Los Angeles, PID, Women Health Center

Categories: Health

What Penis Health Cremes Can do and What They Cannot September 16, 2015

Men are naturally preoccupied with the condition of their penis; and
any sign of a problem, no matter how large or how small, can become a
source of intense concern. For this reason, a large number of products
is available claiming to help issues ranging from minor skin problems to
erectile dysfunction to concerns about size. Understanding what penis
health cremes can really do, as well as keeping expectations reasonable,
can help men to make an informed decision about the money they invest
in a penis care products and to avoid preparations that are based more
on wishful thinking than on any realistic benefits.

What penis health cremes can really do?

Research in cosmetics and skin care has revealed that certain nutrients
have significant benefits when it comes to the skin. Vitamin A, for
instance, is a frequent ingredient in cosmetic cremes, as it works to
smooth away blemishes and minor scars. In fact, vitamin A has long been
used by dermatologists in treating wrinkles, acne and other unsightly
skin issues.

Vitamin C, on the other hand, works at a deeper
level, boosting the skin’s natural elasticity and supporting the
underlying collagen that gives it its shape and supple texture. In
addition, vitamin E works to seal in needed moisture to prevent drying,
as well as soothing skin that is irritated or prone to peeling and
roughness.

All of these ingredients are frequently found together in facial cremes
for women, and men are just beginning to learn that these same benefits
apply to the penis, as well. Men who use a vitamin-rich formula on
their penile skin may find that their skin is smoother, softer and
suppler. Those who have lost some degree of sensation due to toughening
of the outer layers of skin (a natural result of daily wear and tear, as
well as the friction caused by masturbation and sex) often find that a
quality creme can actually improve sensitivity in the area.

What creams and ointments cannot do?

While quality penile cremes can have some real benefits, there are some things that they cannot do:

Choosing and using the right product

Deciding which product to buy depends, of course, on each man’s individual needs, but here are some rules of thumb:

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Categories: Health

Health Coaches in Canada! September 15, 2015

With the change in eating trends rises the need of clean and healthy
eating. Excessive junk food has not only increased heart diseases but
increased the obesity among people. For that matter, people have turned
to health coaches in Canada. To eat healthy and to stick to fitness
goals, you need a coach who is trained in both categories i.e. health
and fitness. Health coaches of Canada cannot work alone; they need to
join hands with body coaches as well.

Not all of you like training in gym. People who think
that they are over-weight are shy to show up. They need work out
coaches at home to maintain their privacy and seek individual attention.
They need help in

What is the cost of hiring a personal health and fitness coach in Canada?

Personal trainers can charge anywhere from $25 to $200 an hour in
Canada. Your personal trainer is limited to your gym or fitness club and
you cannot access him around the clock. The fee is un-affordable for so
many people who want to unlock their health and fitness issues.
Additionally, weather changes and holiday season can hurdle your fitness
and health results too! With prices starting at $649, home gym seems
impossible! So, what do you think?

Should you give up on your dream to get fit and healthy from your home?

Certainly not! You can opt for free Beachbody coach whenever you make a
purchase of Beachbody in-home based workouts. Beachbody workout
programs are created to satisfy the needs of people with diversified
health and fitness needs. You can consult any team Beachbody coach to
assist you in choosing the right workout for you. A Challenge Pack is
combination of health, fitness and support to give you success in your
fitness journey with countless satisfied customers.

30-day free
Shakeology and nutrition guide secures your health. Easy to play-n-pause
DVDs teaches you workout moves and workout calendar serves to do the
guess work. Your personal Beachbody coaches guides you, motivates you
and keep you accountable to your workout to complete your fitness
journey.

Become a Beachbody Coach!

Join
hands with Beachbody coaches to eliminate the trend of obesity from
nation. Become a coach and earn up to 6-figure income with Beachbody
coaching opportunity. You can start it as a part-time job initially. It
is unlike any MLM company, your status with Beachbody will be
Independent Team Beachbody Coach where you are the CEO of your fitness
business.

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Tags: Canada, CEO, MLM

Categories: Health

Health Care Fraud – The Perfect Storm September 5, 2015

Today, health care fraud is all over the news. There undoubtedly
is fraud in health care. The same is true for every business or endeavor
touched by human hands, e.g. banking, credit, insurance, politics, etc.
There is no question that health care providers who abuse their
position and our trust to steal are a problem. So are those from other
professions who do the same.

Why does health care fraud appear to
get the ‘lions-share’ of attention? Could it be that it is the perfect
vehicle to drive agendas for divergent groups where taxpayers, health
care consumers and health care providers are dupes in a health care
fraud shell-game operated with ‘sleight-of-hand’ precision?

Take a
closer look and one finds this is no game-of-chance. Taxpayers,
consumers and providers always lose because the problem with health care
fraud is not just the fraud, but it is that our government and insurers
use the fraud problem to further agendas while at the same time fail to
be accountable and take responsibility for a fraud problem they
facilitate and allow to flourish.

1. Astronomical Cost Estimates

What better way to report on fraud then to tout fraud cost estimates, e.g.

-
“Fraud perpetrated against both public and private health plans costs
between $72 and $220 billion annually, increasing the cost of medical
care and health insurance and undermining public trust in our health
care system… It is no longer a secret that fraud represents one of the
fastest growing and most costly forms of crime in America today… We
pay these costs as taxpayers and through higher health insurance
premiums… We must be proactive in combating health care fraud and
abuse… We must also ensure that law enforcement has the tools that it
needs to deter, detect, and punish health care fraud.” [Senator Ted
Kaufman (D-DE), 10/28/09 press release]

- The General Accounting
Office (GAO) estimates that fraud in healthcare ranges from $60 billion
to $600 billion per year – or anywhere between 3% and 10% of the $2
trillion health care budget. [Health Care Finance News reports, 10/2/09]
The GAO is the investigative arm of Congress.

- The National
Health Care Anti-Fraud Association (NHCAA) reports over $54 billion is
stolen every year in scams designed to stick us and our insurance
companies with fraudulent and illegal medical charges. [NHCAA, web-site]
NHCAA was created and is funded by health insurance companies.

Unfortunately,
the reliability of the purported estimates is dubious at best.
Insurers, state and federal agencies, and others may gather fraud data
related to their own missions, where the kind, quality and volume of
data compiled varies widely. David Hyman, professor of Law, University
of Maryland, tells us that the widely-disseminated estimates of the
incidence of health care fraud and abuse (assumed to be 10% of total
spending) lacks any empirical foundation at all, the little we do know
about health care fraud and abuse is dwarfed by what we don’t know and
what we know that is not so. [The Cato Journal, 3/22/02]

2. Health Care Standards

The
laws & rules governing health care – vary from state to state and
from payor to payor – are extensive and very confusing for providers and
others to understand as they are written in legalese and not plain
speak.

Providers use specific codes to report conditions treated
(ICD-9) and services rendered (CPT-4 and HCPCS). These codes are used
when seeking compensation from payors for services rendered to patients.
Although created to universally apply to facilitate accurate reporting
to reflect providers’ services, many insurers instruct providers to
report codes based on what the insurer’s computer editing programs
recognize – not on what the provider rendered. Further, practice
building consultants instruct providers on what codes to report to get
paid – in some cases codes that do not accurately reflect the provider’s
service.

Consumers know what services they receive from their
doctor or other provider but may not have a clue as to what those
billing codes or service descriptors mean on explanation of benefits
received from insurers. This lack of understanding may result in
consumers moving on without gaining clarification of what the codes
mean, or may result in some believing they were improperly billed. The
multitude of insurance plans available today, with varying levels of
coverage, ad a wild card to the equation when services are denied for
non-coverage – especially if it is Medicare that denotes non-covered
services as not medically necessary.

3. Proactively addressing the health care fraud problem

The
government and insurers do very little to proactively address the
problem with tangible activities that will result in detecting
inappropriate claims before they are paid. Indeed, payors of health care
claims proclaim to operate a payment system based on trust that
providers bill accurately for services rendered, as they can not review
every claim before payment is made because the reimbursement system
would shut down.

They claim to use sophisticated computer programs
to look for errors and patterns in claims, have increased pre- and
post-payment audits of selected providers to detect fraud, and have
created consortiums and task forces consisting of law enforcers and
insurance investigators to study the problem and share fraud
information. However, this activity, for the most part, is dealing with
activity after the claim is paid and has little bearing on the proactive
detection of fraud.

4. Exorcise health care fraud with the creation of new laws

The
government’s reports on the fraud problem are published in earnest in
conjunction with efforts to reform our health care system, and our
experience shows us that it ultimately results in the government
introducing and enacting new laws – presuming new laws will result in
more fraud detected, investigated and prosecuted – without establishing
how new laws will accomplish this more effectively than existing laws
that were not used to their full potential.

With such efforts in
1996, we got the Health Insurance Portability and Accountability Act
(HIPAA). It was enacted by Congress to address insurance portability and
accountability for patient privacy and health care fraud and abuse.
HIPAA purportedly was to equip federal law enforcers and prosecutors
with the tools to attack fraud, and resulted in the creation of a number
of new health care fraud statutes, including: Health Care Fraud, Theft
or Embezzlement in Health Care, Obstructing Criminal Investigation of
Health Care, and False Statements Relating to Health Care Fraud Matters.

In
2009, the Health Care Fraud Enforcement Act appeared on the scene. This
act has recently been introduced by Congress with promises that it will
build on fraud prevention efforts and strengthen the governments’
capacity to investigate and prosecute waste, fraud and abuse in both
government and private health insurance by sentencing increases;
redefining health care fraud offense; improving whistleblower claims;
creating common-sense mental state requirement for health care fraud
offenses; and increasing funding in federal antifraud spending.

Undoubtedly,
law enforcers and prosecutors MUST have the tools to effectively do
their jobs. However, these actions alone, without inclusion of some
tangible and significant before-the-claim-is-paid actions, will have
little impact on reducing the occurrence of the problem.

What’s
one person’s fraud (insurer alleging medically unnecessary services) is
another person’s savior (provider administering tests to defend against
potential lawsuits from legal sharks). Is tort reform a possibility from
those pushing for health care reform? Unfortunately, it is not! Support
for legislation placing new and onerous requirements on providers in
the name of fighting fraud, however, does not appear to be a problem.

If Congress really wants to use its legislative powers
to make a difference on the fraud problem they must think
outside-the-box of what has already been done in some form or fashion.
Focus on some front-end activity that deals with addressing the fraud
before it happens. The following are illustrative of steps that could be
taken in an effort to stem-the-tide on fraud and abuse:

- DEMAND
all payors and providers, suppliers and others only use approved coding
systems, where the codes are clearly defined for ALL to know and
understand what the specific code means. Prohibit anyone from deviating
from the defined meaning when reporting services rendered (providers,
suppliers) and adjudicating claims for payment (payors and others). Make
violations a strict liability issue.

- REQUIRE that all submitted
claims to public and private insurers be signed or annotated in some
fashion by the patient (or appropriate representative) affirming they
received the reported and billed services. If such affirmation is not
present claim isn’t paid. If the claim is later determined to be
problematic investigators have the ability to talk with both the
provider and the patient…

- REQUIRE that all claims-handlers
(especially if they have authority to pay claims), consultants retained
by insurers to assist on adjudicating claims, and fraud investigators be
certified by a national accrediting company under the purview of the
government to exhibit that they have the requisite understanding for
recognizing health care fraud, and the knowledge to detect and
investigate the fraud in health care claims. If such accreditation is
not obtained, then neither the employee nor the consultant would be
permitted to touch a health care claim or investigate suspected health
care fraud.

- PROHIBIT public and private payors from asserting
fraud on claims previously paid where it is established that the payor
knew or should have known the claim was improper and should not have
been paid. And, in those cases where fraud is established in paid claims
any monies collected from providers and suppliers for overpayments be
deposited into a national account to fund various fraud and abuse
education programs for consumers, insurers, law enforcers, prosecutors,
legislators and others; fund front-line investigators for state health
care regulatory boards to investigate fraud in their respective
jurisdictions; as well as funding other health care related activity.

-
PROHIBIT insurers from raising premiums of policyholders based on
estimates of the occurrence of fraud. Require insurers to establish a
factual basis for purported losses attributed to fraud coupled with
showing tangible proof of their efforts to detect and investigate fraud,
as well as not paying fraudulent claims.

5. Insurers are victims of health care fraud

Insurers,
as a regular course of business, offer reports on fraud to present
themselves as victims of fraud by deviant providers and suppliers.

It
is disingenuous for insurers to proclaim victim-status when they have
the ability to review claims before they are paid, but choose not to
because it would impact the flow of the reimbursement system that is
under-staffed. Further, for years, insurers have operated within a
culture where fraudulent claims were just a part of the cost of doing
business. Then, because they were victims of the putative fraud, they
pass these losses on to policyholders in the form of higher premiums
(despite the duty and ability to review claims before they are paid). Do
your premiums continue to rise?

Insurers make a ton of money, and
under the cloak of fraud-fighting, are now keeping more of it by
alleging fraud in claims to avoid paying legitimate claims, as well as
going after monies paid on claims for services performed many years
prior from providers too petrified to fight-back. Additionally, many
insurers, believing a lack of responsiveness by law enforcers, file
civil suits against providers and entities alleging fraud.

6. Increased investigations and prosecutions of health care fraud

Purportedly,
the government (and insurers) have assigned more people to investigate
fraud, are conducting more investigations, and are prosecuting more
fraud offenders.

With the increase in the numbers of
investigators, it is not uncommon for law enforcers assigned to work
fraud cases to lack the knowledge and understanding for working these
types of cases. It is also not uncommon that law enforcers from multiple
agencies expend their investigative efforts and numerous man-hours by
working on the same fraud case.

Law enforcers, especially at the
federal level, may not actively investigate fraud cases unless they have
the tacit approval of a prosecutor. Some law enforcers who do not want
to work a case, no matter how good it may be, seek out a prosecutor for a
declination on cases presented in the most negative light.

Health
Care Regulatory Boards are often not seen as a viable member of the
investigative team. Boards regularly investigate complaints of
inappropriate conduct by licensees under their purview. The major
consistency of these boards are licensed providers, typically in active
practice, that have the pulse of what is going on in their state.

Insurers,
at the insistence of state insurance regulators, created special
investigative units to address suspicious claims to facilitate the
payment of legitimate claims. Many insurers have recruited ex-law
enforcers who have little or no experience on health care matters and/or
nurses with no investigative experience to comprise these units.

Reliance
is critical for establishing fraud, and often a major hindrance for law
enforcers and prosecutors on moving fraud cases forward. Reliance
refers to payors relying on information received from providers to be an
accurate representation of what was provided in their determination to
pay claims. Fraud issues arise when providers misrepresent material
facts in submitted claims, e.g. services not rendered, misrepresenting
the service provider, etc.

Increased fraud prosecutions and
financial recoveries? In the various (federal) prosecutorial
jurisdictions in the United States, there are differing loss- thresholds
that must be exceeded before the (illegal) activity will be considered
for prosecution, e.g. $200,000.00, $1 million. What does this tell
fraudsters – steal up to a certain amount, stop and change
jurisdictions?

In the end, the health care fraud shell-game is
perfect for fringe care-givers and deviant providers and suppliers who
jockey for unfettered-access to health care dollars from a payment
system incapable or unwilling to employ necessary mechanisms to
appropriately address fraud – on the front-end before the claims are
paid! These deviant providers and suppliers know that every claim is not
looked at before it is paid, and operate knowing that it is then
impossible to detect, investigate and prosecute everyone who is
committing fraud!

Lucky for us, there are countless experienced
and dedicated professionals working in the trenches to combat fraud that
persevere in the face of adversity, making a difference one claim/case
at a time! These professionals include, but are not limited to:
Providers of all disciplines; Regulatory Boards (Insurance and Health
Care); Insurance Company Claims Handlers and Special Investigators;
Local, State and Federal Law Enforcers; State and Federal Prosecutors;
and others.

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Tags: Care Regulatory Boards, David Hyman, Health Care Standards, Obstructing Criminal Investigation

Categories: Health

Get Information About Health & Wellness Coaches Online August 11, 2015

Health and wellness is an important aspect in human’s life. To maintain
one’s health, it is very essential to follow a proper diet plan and
also do physical exercises on a regular basis. There are a number of
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wellness coaches play a significant role in individuals life. These
professionals are those people who help each individual achieve physical
and mental well being in an effective manner. Therefore, it is quite
necessary for candidates to select the right coach.

With the availability of several fitness experts, selecting the best
one can be extremely difficult and daunting for anyone. The best health
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exercises along with effective diet programs. The prime job of these
coaches is to motivate the people for achieving physical and mental well
being. When it comes to finding the right fitness expert, it is better
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Nowadays, several online portals are available
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You can choose your category and start your search by simply clicking
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Health wellness coaching, business coaching or life coaching, they are
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help people get connected with expert coaches in an easy, safe and
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If you are seeking
for the best Wellness life coaching, then you have come to the perfect
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also provide you the opportunity to start your own coaching business. In
order to get the basic listings for coaches, you can sign-up with them
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Tags: ADHD, Life Personal

Categories: Health

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