They Call It Healthcare Reform

They call it healthcare reform, but under the new law some Medicare beneficiaries and providers will cover more of the costs. So, it's not really cost reform; it's cost reallocation? Well maybe it's a little of both.

Medicare has been around since 1965, about 46 years, providing access to healthcare for seniors age 65 and older. If you thought the program had been around longer-it hasn't. It's a fairly modern answer to one of society's big challenges, how to provide quality healthcare for everyone. And the U.S. is a little late coming to the table when it comes to establishing broad health benefits for its citizens.

Today, Medicare covers about 47 million Americans, making it the nation's largest health insurance program. So, the way Medicare operates has a significant impact on the country's healthcare. And on our pocketbooks. In fact, according to the Center for Medicare and Medicaid Services, one in every five dollars spent on health services in 2008 were spent through Medicare.

Since its enactment, spending on Medicare has grown to be a larger and larger share of the U.S. federal budget and gross domestic product (GDP). And a larger share of consumer spending. The trend is expected to continue as prices for health services continue to rise, the number and complexity of services increases, and the number of enrollees goes way up as the population ages.

That's why there's a big push for continuing retirement healthcare reform. The Patient Protection and Affordable Care Act (ACA) implemented in 2010 is expected to reduce overall spending on Medicare. But where will those savings come from and who will pay?

Under the new law, Medicare savings are expected to come from reduced annual fee-for-service payments to providers, changes to payments for Medicare Advantage plans, reduced payments for preventable hospital readmissions and home health services.

Beginning in 2015, there will be a 15-member Independent Payment Advisory Board (IPAB) charged with recommending Medicare program changes if spending growth exceeds specific limits. To give that group some clout, a supermajority vote will be required by Congress to override the Board's recommendations. We know-there is a lot of concern about this panel setting policy without public input. But as it stands, this group could very well find ways to reduce Medicare spending by continuing to push more costs to enrollees and providers.

And under the new law there will be more enrollees who fit the high-earner income levels requiring them to pay higher premiums for Medicare Part B (physician service). That's because the law temporarily eliminates the annual inflation adjustment for income levels, freezing them at 2010 levels until 2019. So, the income thresholds for higher Part B and Part D premiums are now fixed at $85,000 for an individual and $170,000 for couples through 2019.

Then there are incentive plans intended to improve the quality and coordination of care, produce efficiencies and, ultimately, program savings. And if you've been to a hospital lately, you know firsthand the need for improvement. What we wouldn't do for better communication among providers, and between providers and patients. And whether you were the patient or a visitor, you can't help but long for better quality care. Let's face it, if you end up in the hospital today, you had better have an advocate to help oversee your stay, or it's very possible you will end up with an infection, won't make a full recovery or could even become a statistic.

When it comes to possible efficiencies, just think about the hospital billing process. After a hospital stay, you get separate bills for doctor and hospital services. You may even get bills from doctors you didn't even know treated you or what they treated you for. That bill may arrive months later. And there is really no way to verify that you received the service. Nor is there a way to challenge the amounts you're being charged. Come on! Is it really $10 for an aspirin? Really? Can you say "simple fraud prevention?" Clearly, reforms are needed. The reality of a hospital stay doesn't look anything like what you see on TV. And every business can find ways to implement best practices and become more efficient. It's just a question of what should be changed and how it will be paid for until the associated savings are realized. Implementing efficiencies is one of the few areas where true cost savings are possible. But watch out for the tendency to cut costs by simply shifting them to the patient, doctor or back to Medicare.

There are also provisions in the law that will increase Medicare spending, offsetting some of the planned program savings. For instance, the law phases in coverage that closes the Part D prescription drug gap ("doughnut hole") by 2020. And there is an annual wellness visit and other improvements in coverage for preventative services. Providing those additional services may be important and may provide cost relief for recipients, but the coverage will certainly add costs to the Medicare program. So, here again the costs haven't been eliminated; they've merely been shifted.

The law even includes provisions that produce revenue for Medicare, including an increase in the Medicare payroll tax for high earners, those with incomes of $200,000 for an individual and $250,000 for a couple. And, there are new fees directed at drug and equipment manufacturers. Here again, no real cost elimination. The revenue inflow to Medicare will come from some beneficiaries, or vendors. It is certainly possible that both targets of cost increases can well afford to pay. But, more than likely when it comes to vendors, they'll simply increase the prices they charge, and the costs will end up right back with Medicare. Lots of energy expended to end up right back in the same place.

In addition to monthly premiums, Medicare enrollees contribute to the cost of care through deductibles and coinsurance. And, some healthcare services like vision, dental, hearing and long-term care aren't covered by Medicare, so you must either purchase separate insurance, pay for the services yourself or forego having that test or procedure. Here again, beneficiaries continue to shoulder the costs.

So, while overall the new law should save the Medicare program money, the impact on beneficiaries and vendors will vary. Those who use fewer health services will carry less of the financial burden. And, those with higher incomes will pay a bigger share for their benefits and a bigger share of their own and others' expenses.

Because Medicare is such a large part of the federal budget, the program will undoubtedly be central to the deficit reduction conversation. And that may mean more change is coming.

Some proposals for additional reforms expand caps on Medicare spending growth, increase beneficiary contributions even further, delay the age of Medicare eligibility and expand the scope of the advisory Board. We can either, bite the bullet and pay more, find new sources of revenue to fund the program or overhaul these benefits completely. It's a challenge with wide-reaching implications for the government, providers and beneficiaries.

Stocks Surge Due To Health Care Ruling And How This Might Affect You

On June 28th, 2012, the Supreme Court decided to pursue with the 2010 health care overhaul bill. The decision resulted in a 5 to 4 split decision with the majority favoring the passing of the bill. The bill itself requires almost every person to have health insurance. By this bill passing, more people will be in the hospital while having the insurance companies covering the cost.

President Barack Obama signed the Patient Protection and Affordable Care Act in March 2010. The act has sparked much controversy because of its nature, which essentially is to protect and serve consumers from being bullied by corporate giants. For instance, any child under the age of 19 years of age with preexisting health conditions would now be eligible to get insurance. The Food and Drug Administration (FDA) would be authorized to approve of more generic drugs. By doing so, more consumers would be able to take advantage of the lower cost attributed to the cost of generic drugs.

As soon as the act was officially on its way, the stocks of hospitals have made an improvement. One of the hospital institutions has had their stock rise by an about 14000% increase. The reason for this increase is because of the mandates that are soon to come. In 2014, the mandates will be in full effect and every American would have to carry insurance or face a penalty, which is 1% of the person's income or $95 a year (whichever is greater).

With the huge influx of patients, there will come a profuse amount of patient confidential information. Consequently, the need for data privacy and protection will need to be increased as well. An effective method for the healthcare industry would be to carry out a 2 factor authentication security system while using 1 time passwords in a more secure network such as an out-of-band method. This type of data security is a more cost-effective way to manage the change to come.

An example where this is a more financially beneficial to hospital institutions is this, nurses or other healthcare professionals that are accessing patient information can use 2 factor authentication to safeguard themselves from hackers. The 2 factors that can be used in a cost-effective manner that will consist of a personal login and password along side with a one time password (OTP) delivered to a health professionals' mobile device. With all the data breaches occurring on all different industries, the hospital institutions will need to ensure the safety of their patients' confidential information. Health records should not be taken lightly and should be highly regulated and enforced.

Problems in Getting Health Insurances Claim

Health is the bigger issue in today's life and people have to be very much cautious to know about their health and related issues. The changed life style, wrong eating habits, excessive junk food and late night working has become the prominent cause of health issues. The major problems like obesity, heart disease, cancer etc silently penetrate into individual's life without giving any early warning signal. It becomes more complicated when these diseases crosses the limit and individual have no other option just to surrender, so it becomes essential to constantly monitor the health and right insurance policy give the big way to meet with such challenges of the life which comes before us, in the form of health problems.

What is a health insurance policy?

Health insurance is the insurance by an individual for the risk of incoming medical expenses. Overall health expenses risk is estimated and calculated among target groups, and individual insurer get a routine financial structure like monthly premium where money is available in certain insurance agreements for the health care benefits payments. This benefit is monitored and administered by the reputed organizations like some government agencies, nonprofit groups and private businesses. A health insurance policy is agreement between insurance company and an individual or the family which is applicable for the citizens of the country for covering health care costs for all the diseases or some major diseases. An individual needs to know certain points which are involved in the health care policies. These are:

Premium: The amount to be paid by the policy holder for getting the health coverage.

Deductible: This includes the amount which policy holder have to pay for the doctor visits and prescriptions before the insurance company pays its share.

Co-payment: this is the amount which is paid by the insured person to get the doctor service for every visit which is solely born by the individual.

Co-insurance: This is the fixed percentage of amount which individual have to pay. This is the percentage of the total cost which is shared by the insured person.

Exclusion: This refers to indicate that insurance policy will cover for which services and insurer have to pay for services which are not covered in the policy.

Coverage limits: This would reveal that the health care policy would cover the health care up to maximum limits, remaining expenditure will be born be the individual policy holder.

Capitation: This is the amount paid by the insurer to the health care provider for the treatment of all the members of the insurer.

prior authorizations: This is the authorization or certification necessary for getting the payment for medical services utilized by the insurer.

Explanation of benefits: this is the document which reveals the medical services covered by the insurance policy provider and payment terms and conditions.

Problems in getting heath insurance claims

It is quite complicated to deal with the problems to potential health insurance claims. It is as tedious as maintaining good care of your body. It is utmost essential to thoroughly read the major prospect of the policy and it is quite necessary to know that what all services are covered in by your policy and what not? At that same time the medical service provider must also know that does your policy covers the given medical treatment services. If it doesn't covers the same then it is not possible to get medical insurance claims It is important for the insurer to procure medical service and the policy papers for getting the quick claims. Some of the private investigations on the matter of the medical problems bring out the facts that the insurer gets huge trouble in getting their medical claims. There are few vital point if they are properly followed then surely an individual will have not much problem in getting the medical insurance claims.

First of all you should know what type of coverage is in your policy.

Get the confirmation from the customer service department for your plan in the writing.

Document your contacts.

If your problem is not resolved or getting delayed then you can take up expedite grievance process.

If your problem is not resolved and the condition is not danger to your health then write letter explaining your concern. This is called filing a grievance. This letter will project your problem and initiated steps you took to solve the problem. It should have the copies of any supporting documentation from doctor or the medical representative.

In addition to filing a grievance with your plan, you can also file a complaint with the Insurance Commissioner's office.

Conclusion

At any point in the dispute of getting the claim, it becomes necessary to select an expert medical insurance claim attorney. He must be able to contact the insurance company before commencing a law suit against them preceding a law suit is a costly and stressful affair and will not result in solving the problem.

I am Chandraprakash Babu, a private investigators in Salem. I spent 15 valuable years of my life in the field of private investigation, corporate investigations, insurance investigations, skip tracing, verification services and business investigation. I worked with corporate risk protection management groups in Salem to provide various investigation services in the above mentioned fields. I started my career as a ground investigator, but later on my dedication and consistent hard work made me to get the prestigious position of Managing Director of a multinational group of corporate risk protection companies.