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Tips to cash in on medical expense tax credits of the Harver Group - Your Health Insurance Counter Fraud Services Tokyo

Tips to cash in on medical expense tax credits of the Harver Group - Your Health Insurance Counter Fraud Services Tokyo | Harver Health Insurance Counter Fraud Group | Scoop.it
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If you are looking for a way to save tax for 2013, try the medical expense tax credit. This can save you tax dollars, but the calculations are often tedious. Start working on your claim well before April 30.

How much tax can you save? For example, suppose you have a net income of $50,000. What amount of medical expenses would you need to make a worthwhile claim? You'd need at least $1,500 in medical expenses to reach your three per cent threshold before any tax credits can be claimed at all.

Generally, for every $100 of medical expenses in excess of three per cent of your net income you can save $26 (using Saskatchewan rates) for 2013. Assume your medical expenses were $2,500 in total for 2013. Having $1,000 of expenses that exceed your $1,500 threshold means you'd save $260 tax.

If you only have $1,550 of medical expenses, with only $50 over the threshold, you'd save $13, which may not make the effort worthwhile, especially if you are paying an accountant by the hour.

Definitions what qualifies as a medical expense? Do an online search for "CRA medical expenses." You will find a web page listing 116 headings, ranging from attendant care to wheelchairs.

Eyeglasses count. Dental work counts, but not teeth whitening. Claim prescription drugs, but don't claim vitamins or supplements. Rehabilitative therapy is eligible. Fitness club fees are not eligible.

Did you pay for private health insurance coverage in 2013? That includes health insurance for out-of-country travel. Claim your premiums as a medical expense. Did your employer provide group health insurance such as a dental plan? When your employer provides such non-taxable benefits you cannot claim the premiums as a medical expense. Employees can only claim employee paid premiums. Check Box 85 of your T4 slip.

Similarly, retirees should check box 135 of their T4A slips for health insurance premiums deducted from employer pension payments.

Review your dental and health insurance claim forms. For each medical service listed, deduct the amount of reimbursement from the total cost. Claim only the unreimbursed portion as a medical expense on your tax return.

Medical travel costs Do you reside in a rural area, with no medical practitioners located within 40 kilometres of home? You can claim the cost of travelling to obtain treatment. Click on the "travel expenses" link on the CRA webpage. Use the simplified method to claim 45.5 cents per kilometre for trips starting in Saskatchewan.

To support your claim, list the dates of your trips and treatment locations. Describe the service (dental or physiotherapy, for example). State the medical practitioner's name. State the distance for each round trip. Claim $17 per meal and parking receipts if you had to travel at least 80 kilometres (each way) from your home.

Did you obtain treatment outside of Canada? Keep receipts for the medical service, travel and hotel costs. Convert receipt amounts to Canadian dollars.

Did you move into an assisted living retirement home because you had difficulty with daily living activities? If you are eligible for the disability tax credit, then limited amount of attendant care costs, such as food preparation, housecleaning and laundry services can be claimed as a medical expense. Your retirement home should provide a receipt breaking down rent into eligible and non-eligible services.

What if your employment income was so low in 2013 that you don't need to claim any medical expenses to eliminate tax owing? For example, suppose you had $10,000 of wages and paid $5,000 for dental work. Claim those medical expenses. You can receive a $1,142 tax refund because of the Refundable Medical Expense Supplement.

Terry McBride, a member of Advocis, works with Raymond James Ltd. (RJL). The views of the author do not necessarily reflect those of Raymond James Ltd. (RJL). Information is from sources believed reliable but cannot be guaranteed. This is provided for information only.

Securities offered through Raymond James Ltd., member of the Canadian Investor Protection Fund. Insurance services offered through Raymond James Financial Planning Ltd., not a member of the Canadian Investor Protection Fund.

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Harver Health Insurance Counter Fraud Group: Cyberattack Targets Health Insurer Records

Harver Health Insurance Counter Fraud Group: Cyberattack Targets Health Insurer Records | Harver Health Insurance Counter Fraud Group | Scoop.it
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One of the US' largest health insurers, Anthem, has announced last week that millions of their employee and client records have been illegally accessed through a sophisticated cyberattack.

 

While Anthem is still cooperating with ongoing investigations regarding the attack, the initial information given was that around 80 million customer and employee records in a database were compromised. The data apparently include addresses, birthdates, names, employment and income information.

 

However, they claim that credit card data were not included in the breach and stated that medical records and doctor information were likely not compromised.

 

This could be one of the largest breaches in client data to date and the largest in the healthcare sector, noted Harver Health Insurance Counter Fraud Group - http://hhicfg.com as Anthem owns a number of brands like Anthem Blue Shield, Anthem Blue Cross, Empire Blue Cross and Blue Cross of Georgia.

 

According to the health insurer, they learned of the breach by the end of January and have notified the FBI promptly. Cybersecurity firm Mandiant was also called in to secure Anthem's computer systems.

 

Anthem Chief Executive Joseph Swedish, whose personal data was involved as well, apologized through a letter and emphasized that they are working continuously to ensure their clients' and staff's data.

 

Security breach threats are particularly concerning in the financial and healthcare sectors that usually collect sensitive information about clients. Even without credit card information, combinations of names, birthdates and Social Security numbers would be more than enough to gain a lot of money in the black market. In fact, the FBI has already ranked cybercrime as a top law enforcement activity.

 

Technology experts from Harver Health Insurance Counter Fraud Group and other law enforcement officials are saying that getting hacked is inevitable and it's only a matter of when. They admitted that it is a challenge to keep up with the cyber criminals especially since most of them are based abroad.

 

Anthem promised that it will give free credit monitoring and identity repair services for affected clients.

 

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Harver Health Insurance Group Tokyo News: A Chief of Surgery Offers Insider Tips to Finding the Right Surgeon

Harver Health Insurance Group Tokyo News: A Chief of Surgery Offers Insider Tips to Finding the Right Surgeon | Harver Health Insurance Counter Fraud Group | Scoop.it

On Sunday morning, my neighbor Carolyn knocked on my front door holding a basket of carbs and said, "I need to have my gallbladder out. I've never had an operation and have no idea how to find a surgeon to do my surgery. I don't want to die. I brought you some scones."

 

Carolyn brings up a valid point -- if you've been blessed with reasonably good health, you probably don't have a surgeon's number on speed dial. Therefore, the bigger question is, in the unfortunate event that you need one, how do you find the best surgeon for your medical condition?

 

Even routine operations have risks

 

Straightforward surgeries like gallbladder removal or hernia repair can result in occasional complications so it pays to choose your surgeon with care. But other than asking the doctor who recommended the surgery and running down the list of surgeons on your insurance plan, how do you narrow down the list?

 

I decided to go directly to the source and consulted with board-certified general surgeon Dr. Amit Kharod, chief of the Department of Surgery at CentraState Medical Center in Freehold, New Jersey for his recommendations.

 

"You are looking for a highly-skilled service provider with whom you are entrusting your life," Dr. Kharod says. "Take the time to perform proper due diligence so you will be comfortable with the caliber and quality of the surgeon you choose."

 

The doctor went on to outline tips for finding the right surgeon to meet your specific needs:

 

• Ask hundreds of people in five seconds

 

With a click of the "send" key, you can electronically reach out to friends, colleagues, neighbors and their friends for feedback and recommendations. The message you send can be as personal or indirect as you wish -- but social networking should uncover some solid leads.

 

• Nurses are in the know

 

Medical office and hospital-based nurses get feedback from patients and colleagues about different surgeons day in and day out. If there aren't any nurses in your social network, call your hospital of choice and ask the nursing director who she would chose if a loved one needed your type of operation.

 

• Confirm these key credentials

 

Ascertain that the surgeon is board-certified or board-eligible in his or her specialty by visiting the American Board of Medical Specialties and the Federation of State Medical Boards to make sure he or she is licensed in your state.

 

• Can the surgeon perform your operation laparoscopically?

 

Some, but not all, surgeons have undergone advanced training to perform many different procedures laparoscopically using state-of-the-art tools and technology, such as robotics. This can mean significantly less pain and faster recovery for you.

 

• How often and how many times has the doctor performed your surgery?

 

You want to see that the surgeon is actively performing this operation with consistently successful outcomes. This can be especially important for procedures which are new or uncommon. Over time, many surgeons tend to perform the certain surgeries with regularity and have dealt with complications before.

 

• Interview your top candidates

 

Ideally, meet with your potential surgeon/s in person or at least have a phone conversation. See how quickly you can get on his surgical calendar, also. Use this time to pose your key questions and concerns. Remember, you are purchasing an expensive service from the surgeon, not making a new friend.

 

After you've chosen a surgeon

 

Carolyn took Dr. Kharod's advice and discovered a great surgeon who had operated on her husband's colleague and was on staff at her preferred hospital. I reminded her to call the doctor's medical insurance administrator and re-confirm that the doctor, the anesthesiologist and the hospital accepts Carolyn's insurance.

 

Patients who feel confident in their choice of surgeon should feel more at ease before the operation, which is important. Studies conducted on pre-operative patients show that those with higher stress levels at the time of surgery can take as much as 25 percent longer to recover.

 

Dr. Kharod also advises people not to hesitate to ask doctors for references. "A good surgeon maintains a roster of satisfied patients who are willing to speak about their experiences under his care. Believe me, if I needed surgery, I would be doing the same thing."

 

To prevent and detect fraud within the health care and the insurance industry, Harver Health Insurance Counter Fraud Group ( http://hhicfg.com ) will help you. The Harver Health Insurance Counter Fraud Group ( http://hhicfg.com/blog ) has official connections with health fraud investigation agencies.

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Harver Health Insurance Counter Fraud Group: General Insurance Tips | Harver Health Insurance Counter Fraud Group

Harver Health Insurance Counter Fraud Group: General Insurance Tips | Harver Health Insurance Counter Fraud Group | Harver Health Insurance Counter Fraud Group | Scoop.it

Developed countries such as Japan, USA and Canada have high percentages of people who get insurance coverage for various purposes. It is said that the degree of awareness a populace with regard to the value and benefits of insurance coverage determines the level of economic progress. Or, perhaps, it is the other way around. Economic health could be spurred by people investing in their future security.

 

Insurance is a form of forced savings which allows people to leverage their future in the event that the unexpected or the unforeseen occurs. A lot of people would not have enjoyed their retirement years without having some form of retirement insurance.

 

Here are some valuable tips about insurance for business-owners which will help them appreciate what insurance can do for them and what they can do with having one:

 

1. Make it a practice to consider the merits of three or more insurance companies through brokers or free-lance agents. Find out as much as you can about the companies’ corporate culture. Are they earnestly interested in your losses in case you reach that point? Or are they merely eager to get you to sign a policy?

 

2. For many small business-owners, self-insurance is common. However, it can be counter-productive as the potential for acquiring coverage for the whole business is sacrificed in favor of the individual. With so much capital available today, it is more prudent to get coverage for one’s business.

 

3. Annual assessment of one’s property is essential as the needs of your company and the liabilities grow. Waiting for several years to have a re-assessment might compromise your firm’s ability to recover in case of loss.

 

4. Oftentimes, the insurer has the option to recompense your loss in three ways: paying the amount lost, repairing the insured asset or replacing the same. Nevertheless, let the insurer know which option you would prefer as it could be to their advantage to grant your wish in order to keep you as their client.

 

5. When arbitration regarding the valuation of any loss does occur, make sure you are properly represented by an arbitration judge. If a compromise is not achieved, a lawsuit will ensue and a longer battle will await you. Unfortunately, there is no insurance against a lawsuit.

 

Just like investing in stocks, insurance can be a complex and demanding endeavour. But in the end, understanding what you are getting into will help you come out a satisfied winner rather than a sour loser.

 

About Us

 

The Harver Health Insurance Counter Fraud Group coordinates closely with its local partners, such as the NHS Counter Fraud Service MOU, NHS Counter Fraud Northern Ireland MOU, NHS Counter Fraud Scotland MOU, City of London Police, National Fraud Authority, Insurance Fraud Bureau, and the Insurance Fraud Investigators Group to assist the process of intelligence and conduct common investigations into fraud.

 

Health care fraud respects no boundaries. The Harver Health Insurance Counter Fraud Group has official connections with health fraud investigation agencies. If your company is interested in becoming a member of the Harver Health Insurance Counter Fraud Group, kindly get in touch through this site.

 

http://hhicfg.com/blog/harver-health-insurance-counter-fraud-group-general-insurance-tips/

 

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Harver Health Insurance Counter Fraud Group Tokyo on Financial Planner Tips

Harver Health Insurance Counter Fraud Group Tokyo on Financial Planner Tips | Harver Health Insurance Counter Fraud Group | Scoop.it
You have insurance on your home, your car, your health.
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“People have homeowners insurance to protect against fires and floods,” notes independent financial planner Stephen Ng, founder and president of Stephen Ng Financial Group, (www.stephenngfg.com). “They buy insurance to replace their car if it gets wrecked and they buy health insurance to protect themselves from medical costs.

 

“But for many people, their biggest material asset is their retirement portfolio. When I look at a new client’s portfolio and ask, ‘Where’s your insurance?’ they look at me like I’m crazy!”

 

Insure your retirement fund by taking steps to safeguard at least a portion of it, Ng says. As you get closer to retiring, the amount you safeguard will be what you need to rely on for your retirement income.

 

“Your retirement income should be derived from guaranteed sources, such as Social Security benefits and your pension plan,” says Ng, a licensed 3(21) fiduciary advisor, certified to advise companies about their 401(k) and other retirement plans. “It’s the amount you need to pay the bills and do the other things you hope to do in retirement, so your retirement income needs to be a guaranteed source of income.

 

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The Obamacare Transition: Tips for Buying Health Insurance

The Obamacare Transition: Tips for Buying Health Insurance | Harver Health Insurance Counter Fraud Group | Scoop.it
Now that the Obamacare transition has come into effect, it is important to understand some of the differences that are now at work. Understanding some of t
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Harver Health Insurance Counter Fraud Group Tokyo

 

Now that the Obamacare transition has come into effect, it is important to understand some of the differences that are now at work. Understanding some of the changes can make it easier to get the greatest benefit from new policy changes that might affect you most. This can also help you to avoid potential negatives. For example, missing the important March 31 deadline can result in a fine of $95 or 1% of your total income (whichever number is greater).

 

“For those that do not qualify for Medicaid, you will be required to pay your monthly premium fee to your selected insurance company in order to receive coverage,” said Jim Holm of EnhanceInsurance.com . “In some cases, customers will need to pay for their deductibles along with a set copay fee for doctor visits or a portion of the cost for the medical service.” This latter scenario is referred to as co-insurance, and customers will generally need to complete these payments before the insurance company can actually cover your medical costs. For most information on this, you can visit the federal government’s website at HealthCare.gov , a federal government website, and learn more about your options for each insurance plan. To find this information, located the section entitled “See plans before I apply.”

 

Plan Choices

 

Many industry experts recommend that you narrow down your potential choices to five comparable plans, and then go to the insurer’s official website in order to educate yourself about the various benefits available in each program. It is important to look for the types of things that might not be covered — for example, acupuncture or hearing aids. This can help you to avoid plans that are probably not best-suited for your expected needs. It is also a good idea to pay attention to the company’s cited coverage examples. These will help explain exactly what the patient will be expected to pay and which costs will be covered by your plan. Note the ways that co-pays, co-insurance and deductibles are explained, as these elements help form the basis for what your plan has to offer.

 

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Harver Health Insurance Counter Fraud Group: Have You Contributed to a Health Scam?

Harver Health Insurance Counter Fraud Group: Have You Contributed to a Health Scam? | Harver Health Insurance Counter Fraud Group | Scoop.it

If it works, the GoBe will be life-changing. But it’s a big if.

 

The GoBe is a bracelet that looks like a small microplane has been affixed to a black watchband—the top of the microplane is a display, and its underside is a sensor. Through its “patented flow technology,” the GoBe promises to measure the wearer’s heart rate, calories burned, sleep, and stress levels. That’s all conceivable, given what the FitBit and other body trackers already measure. But the GoBe also promises something a little more sensational: Automatically tracking the calories of everything the wearer eats, through his or her skin.

 

“We live in an age where people struggle with their diets and need simple ways to take control of their health,” Artem Shipitsyn, the CEO of GoBe’s parent company, HealBe, says in a video on the device’s Indiegogo campaign page. He says the technology would help “people like me live a healthy life with less effort.”

 

The automatic calorie-tracking, which GoBe claims to do by reading glucose levels in cells, would revolutionize dieting—even the best calorie-counting apps today rely on manual food logging.

 

“Tell it nothing. Know everything,” the soothing video narrator’s voice says over b-roll of people skiing and clicking on their smartphones.

 

The premise was so lofty, in fact, that it didn’t take long for tech reporters, led by PandoDaily’s James Robinson, to attack.

 

Let’s say GoBe does measure glucose levels without piercing the skin, as it claims to do. That would be a godsend to diabetics, who, as it stands, must regularly prick their fingers to test blood sugar. The less-invasive technology is probably coming soon, Michelle MacDonald, a clinical dietician at the National Jewish Health hospital in Denver, told PandoDaily, “but when it does it will be the size of a shoebox ... It will come from a big lab, will be huge news[See: http://hhicfg.com ] and make a lot of money.”

 

But on top of that, blood glucose is only a rough measure of total energy intake. Eat a tablespoon of olive oil, and you’ve consumed 119 calories, but your blood sugar would barely rise. A very thin slice of white bread, meanwhile, would send blood sugar soaring and only yields 40 calories.

 

From its launch in March, the GoBe campaign steadily raked in Indiegogo donations—it’s now at 1,081 percent of its original $100,000 goal. Robinson stayed on the warpath, citing more and more experts who denounced the GoBe technology and publishing several more articles[Visit: http://hhicfg.com/blog ] about what he considers to be a complete scam.

 

HealBe began commenting negatively on Robinson’s articles, then deleting the comments. GoBe backers started demanding refunds. Delivery of the finished device was pushed back to August.

 

“I’ve been seeing some disturbing articles regarding this project,” one commenter wrote on the HealBe Indiegogo campaign page. “Various articles stating that the things that the GoBe promises cannot be done ... Can anyone offer a rebuttal? Worried about all of the delays and negative statements. Thanks!” [See more: http://www.theatlantic.com/health/archive/2014/06/can-you-spot-the-fake-health-gadget/372788 ]

 

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Harver Health Insurance Counter Fraud Group: Lawmakers Join All-Out Push to Combat Medicare Fraud

Harver Health Insurance Counter Fraud Group: Lawmakers Join All-Out Push to Combat Medicare Fraud | Harver Health Insurance Counter Fraud Group | Scoop.it

WASHINGTON, DC - As law enforcement announced a nationwide sting against Medicare fraudsters today, a bipartisan group of lawmakers in Washington was putting the finishing touches on legislation aimed at making a significant dent in the problem.

 

Federal law enforcement officials in Miami today announced the details of a multi-agency strike force operation that resulted in the arrest of 90 people nationwide for defrauding Medicare out of some $260 million.

 

U.S. Senate Special Committee on Aging Chairman Bill Nelson (D-FL) and Ranking Member Susan Collins (R-ME), who have spent a great deal of time examining the problem of Medicare fraud( http://hhicfg.com/ ) and ways to curtail it, commended the actions announced today by federal officials while also saying that the crackdown illustrates the need to do more to stop Medicare fraud.

 

Nelson and Collins, along with Sens. Tom Carper (D-DE) and Chuck Grassley(R-IA), have authored legislation to strengthen the government's hand in stopping Medicare fraud. The lawmakers plan to formally file the legislation on Thursday.

 

"This is exactly why we're doing the legislation," said U.S. Sen. Bill Nelson (D-FL) who chairs the Senate Special Committee on Aging. "We've got to get the problem under control."

 

Senator Collins added, "For decades, the GAO has identified Medicare as being at high risk for improper payments. This is unacceptable. The loss of these funds not only compromises the financial integrity of the Medicare program, but it also undermines our ability to provide needed health care services to the more than 54 million older and disabled American workers who depend on this vial program. Our legislation emphasizes a strategy to prevent fraud from happening in the first place."

 

"Medicare provides lifesaving care to some of our nation's most vulnerable citizens," said Sen. Carper. "Unfortunately, too many unscrupulous individuals take advantage of this vital program and end up costing taxpayers millions and shortchanging beneficiaries. It is critical that we do all that we can to curb fraud while protecting beneficiaries and ensuring effective care. This legislation is an important step in combating Medicare fraud and preserving this essential program for the future generations. I commend Sens. Nelson and Collins for their leadership in this effort."

 

"Our bill will build on the Physician Payments Sunshine Act that I co-authored," Grassley said. "It requires HHS to use available data, including data from the Sunshine Act, to verify doctors' reported information about ownership interests in organizations that bill Medicare. This will help flush out any doctors who commit fraud from their own facilities."

 

Specifically, the legislation will require Medicare to verify that those wishing to enroll in the program have not owned a company that previously defrauded the government. Currently, Medicare relies on self-reported information. As a consequence, a provider who previously had an ownership interest in an organization that defrauded Medicare could potentially get back into the program by using a different name and failing to disclose their interest in the previous organization.

 

The bill will also allow private insurers to share information about potentially fraudulent providers with Medicare, and requires new medical coding systems to be tested before they're deployed to ensure Medicare's fraud prevention systems work properly. Additionally, the Medicare Payment Advisory Commission will be allowed to make recommendations regarding fraud prevention and Medicare will be required to develop a strategy to reliably estimate just how many taxpayer dollars are lost each year to fraud.

 

According to a recent estimate, fraud in the country's Medicare system takes some $60 billion to $90 billion annually out of the system and puts it into the pockets of crooks.

 

The lawmakers' legislation already has the support of the National Health Care Anti-Fraud Association, the Coalition Against Insurance Fraud, the National Insurance Crime Bureau, America's Health Insurance Plans( http://hhicfg.com/blog/ ), Humana and theBlue Cross Blue Shield Association. Continue reading: http://insurancenewsnet.com/oarticle/2014/06/16/lawmakers-join-all-out-push-to-combat-medicare-fraud-a-518362.html

 

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The Harver Group - Most state health insurers seek rate boost: Proposals compared

The Harver Group - Most state health insurers seek rate boost: Proposals compared | Harver Health Insurance Counter Fraud Group | Scoop.it

Proposed rate changes for 2015 individual health plans are all over the map, but most companies are keeping up with tradition by requesting increases in premiums.


If approved, rate increases for 2015 individual health plans proposed by 12 insurance companies may affect most policyholders, whether they bought their plans through Washington Healthplanfinder’s online marketplace or in the outside market.

 

Washington is one of the first states to see proposed rate changes for 2015 individual health-insurance plans.

 

The proposed rate changes ( http://hhicfg.blogspot.com/2014/05/the-harver-group-most-state-health.html ) range from a decrease of 6.8 percent — from Molina Healthcare of Washington — to an increase of 26 percent from Time Insurance, a national company with relatively few Washington policyholders.

 

Most rate-change requests, particularly from larger insurers, were in the middle ground, with most asking for increases from about 2 to about 11 percent.


To anyone who has had individual insurance, premium increases are not surprising: Records show that, on average, insurers have proposed rate increases for individual plans from about 9 percent to more than 18 percent every year from 2007 to 2013. After review by the Office of the Insurance Commissioner, the average rate increases imposed were lower — in most cases, only slightly lower. But in one year, rate-increase requests were cut by more than 3.5 percentage points.

 

With the exception of relatively few grandfathered plans, all individual plans were new in 2014 to comply with provisions of the Affordable Care Act (ACA), which set certain standards for coverage and barred insurers from excluding people with pre-existing conditions.

 

Some insurers offer plans only inside the Healthplanfinder exchange; some offer plans only in the outside market. Five are proposing plans both inside and outside the exchange. Any rate- change proposals for those insurers would affect both inside and outside plans.

 

The rates do not become final until they pass review.


Spokeswoman Stephanie Marquis said it likely would be a tough review this year because insurers have only a few months’ worth of actual claims data, so they must use other data sources to justify rate increases.


There didn’t appear to be differences between proposed rates for plans sold only inside the Healthplanfinder exchange market and those sold only outside.


BridgeSpan Health, whose exchange plans picked up a relatively small portion of the market this year, asked for a 1.7 percent increase; its affiliate, Regence BlueShield, which offers only outside-the-exchange plans, asked for 5.1 percent.

 

Coordinated Care Corp., with exchange-only plans, asked for 11.2 percent, as did Group Health Cooperative, which has plans both inside and outside the exchange. Group Health Options, with plans offered only outside the exchange, asked for 14.2 percent.


Premera Blue Cross, offered both inside and outside the exchange, and Community Health Plan of Washington, with only exchange plans, asked for 8.1 and 8.4 percent, respectively.


In the small group market, insurers on average proposed smaller rate increases, with at least four insurers asking to decrease rates. That may be because insurers expect to pick up younger members now insured by association plans that have been discontinued because they did not meet the requirements of the ACA, Marquis said.

 

Four new companies have submitted proposals for individual plans to be sold inside Washington’s Healthplanfinder exchange. Because the plans are new, there are no rate changes proposed. Those companies are Columbia United Providers, Health Alliance Northwest Health Plan, UnitedHealthcare of Washington, and Moda Health Plan. Moda currently has individual plans in the outside market but plans to replace all existing plans.

 

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The Harver Group - Your Health Insurance Counter Fraud Services Tokyo

The Harver Group - Your Health Insurance Counter Fraud Services Tokyo | Harver Health Insurance Counter Fraud Group | Scoop.it

More Insured, but the Choices Are Narrowing
http://www.nytimes.com/2014/05/13/business/more-insured-but-the-choices-are-narrowing.html

In the midst of all the turmoil in health care these days, one thing is becoming clear: No matter what kind of health plan consumers choose, they will find fewer doctors and hospitals in their network — or pay much more for the privilege of going to any provider they want.

These so-called narrow networks, featuring limited groups of providers, have made a big entrance on the newly created state insurance exchanges, where they are a common feature in many of the plans. While the sizes of the networks vary considerably, many plans now exclude at least some large hospitals or doctors’ groups. Smaller networks are also becoming more common in health care coverage offered by employers and in private Medicare Advantage plans.

Insurers, ranging from national behemoths like WellPoint, UnitedHealth and Aetna to much smaller local carriers, are fully embracing the idea, saying narrower networks are essential to controlling costs and managing care. Major players contend they can avoid the uproar that crippled a similar push in the 1990s.

The Times would like to hear from Americans who have signed up for health care under the Affordable Care Act.

“We have to break people away from the choice habit that everyone has,” said Marcus Merz, the chief executive of PreferredOne, an insurer in Golden Valley, Minn., that is owned by two health systems and a physician group. “We’re all trying to break away from this fixation on open access and broad networks.”

But while there is evidence that consumers are willing to sacrifice some choice in favor of lower prices, many critics, including political opponents of the new health care law, remain wary about narrowing networks. A concern is that insurers will limit access to specialists ( http://hhicfg.com/blog/ ) or certain hospitals. “Too often, Obamacare cancels the policy you wanted to keep and tells you what policy to buy,” Senator Lamar Alexander, a Tennessee Republican, said in a speech in April.

Dr. Monica Wehby, a pediatric neurosurgeon, is using the potential reaction to narrower networks as momentum for her campaign for Senate in Oregon. A Republican promising to repeal the Affordable Care Act, her slogan is “Keep your doctor. Change your senator.”

Other complaints involve confusion over which providers are participating in which plans.

“The thing you’re buying is access to the provider network,” said Lynn Quincy, a policy expert at Consumers Union. “Right now it feels like you’re forced to guess.”

In response, state and federal regulators say they are more closely monitoring the plans being offered in the coming year to be sure they are clear and that consumers have sufficient access to hospitals and doctors. In some cases, they are already insisting on changes.

Nonetheless, for people who are directly picking plans in the open markets, insurers say price is turning out to be critical. People “are weighing affordability and breadth of network,” said Karen Ignagni, the chief executive of America’s Health Insurance Plans, an industry trade group. “What we’re finding is individuals are experiencing a preference for affordability,” she said.

Minnesota would seem to be a case in point.

On the state exchange, PreferredOne offered an inexpensive plan with a network of 13 hospitals, but those low premiums helped the insurer grab 60 percent of the individual insurance market.

While many insurers are including only those hospitals and doctors willing to charge lower prices, experts say the makeup of the networks is likely to evolve over time, focusing less directly on price and more on the ability of providers to deliver coordinated and high-quality care.

Although a similar attempt to restrict choice failed in the early ‘90s, after opposition to H.M.O.s and managed care, insurers insist these efforts will not run into the same resistance because they are now working more closely with providers, and customers are more concerned about costs. “It’s a new era,” said Dr. Sam Ho, the chief medical officer for United Healthcare.

Others agree. “You’re going to see this as a dominant strategy,” said Jeff Hoffman, who works closely with hospitals for Kurt Salmon, a consulting firm.

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Millions More People Are Getting Health Insurance Because Of Obamacare, Survey Finds

Millions More People Are Getting Health Insurance Because Of Obamacare, Survey Finds | Harver Health Insurance Counter Fraud Group | Scoop.it

The Harver Group - Your Health Insurance Counter Fraud Services Tokyo

Andrew Holt's insight:

More Info: http://hhicfg.com/

 

Nearly one week after White House enrollment numbers showed Obamacare surpassing the seven-million mark, an economist-driven survey is projecting more good news for the Affordable Care Act.

 

RAND Corporation released its findings Tuesday, showing that the health care law is poised to spur a net gain of 9.3 million more insured Americans. The survey results were collected through March 28, 2014, and respondents will be part of a follow-up later in April, once new data is available.

 

The survey adds that thanks to shifts caused by circumstances like job and marital status changes, the study cannot pinpoint which shifts were specifically driven by Obamacare's arrival. But limited conclusions can be drawn, including an estimate that the share of uninsured Americans will drop from 20.5 percent to 15.8 percent.

 

RAND Corporation's numbers arrive one day after Sen. Mike Lee (R-Utah) and Nebraska Senate candidate Ben Sasse (R) penned an op-ed in the Washington Examiner, warning Republicans that there is urgency to create alternatives to Obamacare.

 

"The good news is that the final chapter on the president’s disastrous health insurance takeover has not been written," they wrote. "Conservatives are making a strong comeback with concrete proposals that, if enacted, would create real progress toward better healthcare outcomes for all Americans."

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Tips to consider on getting a health plan

Tips to consider on getting a health plan | Harver Health Insurance Counter Fraud Group | Scoop.it

Harver Health Insurance Counter Fraud Group - Harver Health Insurance Counter Fraud Group UK aims to prevent and detect fraud within the health care and the insurance industry.

Andrew Holt's insight:

Choosing health benefits is one of the most significant decisions you make every year, Harver Health Insurance Counter Fraud Group provided below some basic points you need to consider in choosing the plan that is best for you and your family.

 

1. Understand the meaning of terms

 

Basically, you need to comprehend the meaning of various health benefits-related terms such as deductible, co-insurance, premium, in-network and health savings account. You can check different glossaries online related to healthcare.

 

2. Give consideration to other people

 

If other people are going to be covered under your benefits plan, don’t just think of yourself. As you are reassessing your benefits for the upcoming year, take this tip into consideration.

 

3. Create a list

 

Make a summary of your recent and expected future health care needs. This list may include any planned surgeries, health care procedures or prescription medications for the upcoming year.

 

4. Ask your doctor

 

In addition to your list, ask your doctor or one of the doctor’s associate’s questions about your consultations, tests medications and other health care services you might need over the coming year.

 

5. Decide which is the best benefit plan

 

You should identify on which benefit plan have worked best for you in the past because it may still work for you. But you need to reconsider your health benefit needs if you had a major change in life like getting married, having a baby or retiring.

 

6. Read the fine print

 

Think of the problems you had with your previous benefits plans. The open enrollment period is a good time to try to learn more about coverage you wish you had in the past. Also, be sure to read well the ‘fine print’ – number of clauses within a health insurance policy. It consists of important definitions and explanations.

 

7. Review your plan

 

Review thoroughly the open enrollment material supplied by your employer, or information from your insurer about plans for the next year. Especially, make an effort to make note of how the benefits plans are going to change from this year to next, and whether your selected doctors and hospitals are in the plan’s network.

 

8. Understand the deadline

 

You must know the deadline for making your decision. Make specific note regarding the timeline for enrollment and give yourself enough time to decide on your benefits before the deadline. Start ahead of time because you do not wish to be rushing answers with the deadline approaching.

 

9. Ask questions

 

You must understand what you’re buying. You can pose a question to your employer or your broker, marketplace or insurance company if you don’t understand the details of the plan offered if you’re buying coverage yourself. Many employers also provide open enrollment meetings as well as other resources that will help you better understand your choices.

 

10. Keep in mind the cost of your plan

 

While there are probably several factors in your health benefits decision, cost is practically one of the primary factors. Be sure you understand all the costs associated with your plan, and not simply the plan premium.

 

Get more information: http://hhicfg.com/blog/

 

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Harver Health Insurance Group Tokyo News: Fidelis Care Offers Tips for Selecting Coverage

Harver Health Insurance Group Tokyo News: Fidelis Care Offers Tips for Selecting Coverage | Harver Health Insurance Counter Fraud Group | Scoop.it

As NY State of Health Extends Enrollment Deadline, Fidelis Care Offers Tips for Selecting Coverage

 

By a News Reporter-Staff News Editor at Managed Care Weekly Digest -- If you need health insurance coverage on January 1, 2015 and have yet to enroll through NY State of Health: The Official Health Plan Marketplace, time is running out. This Saturday, December 20, is the deadline to enroll for coverage that takes effect when the new year begins (see also Medical, Healthcare).

 

Choosing coverage is an important decision, but it doesn't have to be overwhelming. Fidelis Care Chief Marketing Officer Pamela Hassen offers the following tips to help you pick the coverage that's right for you.

 

Compare the coverage options:

 

The NY State of Health products are organized by metal level (platinum, gold, silver, and bronze), all offering the same coverage but with different monthly premiums and cost sharing. Hassen recommends taking a look at your health care needs to determine which metal level will be the most economical, balancing the premium with your expected out-of-pocket costs. While there are child-only products, you likely have the option of enrolling your child in quality, affordable coverage through the State-sponsored Child Health Plus program.

 

Determine the cost of coverage:

 

"Everyone wants to know how much their coverage will cost, but it's not always as simple as looking at the premium rate that's listed. Many individuals and families qualify for subsidies or tax credits that can lower their premiums and cost sharing," Hassen explained.

 

It's easy to get an estimate of your costs in about 60 seconds, using the Fidelis Affordable Care Advisor. Found on the homepage of Fidelis Care's website, fideliscare.org, the Affordable Care Advisor only needs basic information to calculate an estimated monthly premium, including federal subsidies and tax credits. It will also let you know if you may qualify for Medicaid.

 

Check the providers and the formulary:

 

If you prefer to see specific doctors or regularly take certain prescription drugs, be sure to do your homework. Hassen advises you check the health plan's provider network to see if your specific doctor is included. Also, drug formularies vary from health plan to health plan. It's important to consider how much you will pay for specific prescription drugs.

 

Keep an eye on the calendar:

 

While you must enroll by December 20 in order for your coverage to be effective on January 1, 2015, NY State of Health open enrollment runs through February 15, 2015. After that time, it is difficult to select or change health insurance coverage. Most New York State residents are required to have health insurance coverage in 2015 or face a tax penalty.

 

To make the enrollment process as easy as possible, Hassen recommends turning to an expert for assistance.

 

"Our trained representatives will meet you at our office, a community location, or even at your home. They are experts and can make sure you enroll correctly and sign up for federal assistance if you are eligible," she said.

 

To prevent and detect fraud within the health care and the insurance industry, Harver Health Insurance Counter Fraud Group ( http://hhicfg.com ) will help you. The Harver Health Insurance Counter Fraud Group ( http://hhicfg.com/blog ) has official connections with health fraud investigation agencies.

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Harver Health Insurance Counter Fraud Group: Zetia Lowers Risk of Heart Attack, Stroke

Harver Health Insurance Counter Fraud Group: Zetia Lowers Risk of Heart Attack, Stroke | Harver Health Insurance Counter Fraud Group | Scoop.it

After almost 10 years, the results of a long-awaited clinical study has proven that cholesterol drug Zetia of Merck & Co is capable of reducing heart attack risk when it is used together with statin.

 

The study was conducted worldwide on 18,000 heart patients  using Zetia, an ezetimibe, plus simvastation as compared to treatments with only simvastatin. LDL cholesterols levels, which is singled out as a critical cause in the development of a cardiovascular problem, decreased by 54 on average.

 

A 6% reduction in all cardio events, though a modest benefit in high-risk patients, is significant enough. This is the first time that it was proven that the addition of a cholesterol fighter non-statin to the already effective statin will reduce the risk of serious cardiovascular disease.

 

The resuting data proves that Zetia -- which is already widely used for 12 years for its LDL-reduction capability -- offers a significant protection to several patients. It also supports the hypothesis that a lower LDL cholesterol is beneficial.

 

Zetia works by preventing dietary cholesterol from being absorbed in the gut, which is different from statins that prevent cholesterol production in the liver. Its presumed lack of effect on the arteries was seen as a challenge to the initial hypothesis that a lower LDL will reduce heart risk.

 

Dr. Christopher Cannon of Brigham and Women's Hospital in Boston is the lead author of the study presented in Chicago last week. He said, "One of our goals was to test if even lower LDL even better, and the answer is yes. We have a zillion trials showing statins reduce events... our conclusions are that, yes, a non-statin lowering of LDL with ezetimibe reduced cardiovascular events."

 

Six years ago, a relatively smaller study was conducted which resulted in the findings that the medicine failed to prevent the accumulation of fatty deposits (plaque) in the arteries. Several experts assumed that this failure to at least slow the plaque accumulation might also mean that it will fail to prevent strokes and heart attacks.

 

According to the Dr. Cannon, this latest study dubbed "Improve-It" attempts to address that concern, hence asserting the significance of LDL reduction. Furthermore, it showed a benefit for getting really LDL cholesterol levels from patients who had had a heart attack recently and were prescribed with only simvastatin.

 

Patients have suffered unstable angina or heart attack prior to the trials and all their LDL cholesterol levels were lowered to the target of 70 by using simvastatin. Meanwhile, those who used Zetia got 20% lowered LDL.

 

In the clinical tests, around 32% of the patients who were treated with a statin and ezetimibe had a stroke or a heart attack after 7 years of follow-up against the 34% when only statin was used. Although the primary benefit came in lowering the chance of strokes and heart attacks, it did not result in survival.

 

Cannon said, "In absolute terms, there are two heart attacks or strokes prevented for every 100 patients treated. An important factor is this is really a long term safety."

 

It also proved relatively safe -- there was no highly alarming side effects, that is. Out of the thousands of people in the trials, many of them had LDL levels that are not more than 40 and that did not seem to affect them adversely.

 

However, experts from Harver Health Insurance Counter Fraud Group( http://hhicfg.com/ ) are concerned that with no other studies backing up such results about heart attacks, patients might be deprived of proven medication, in the form of statins. But the results are certainly highly significant to those patients who cannot take statins.

 

 

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Harver Health Insurance Counter Fraud Group Fundamental Principles

Harver Health Insurance Counter Fraud Group Fundamental Principles | Harver Health Insurance Counter Fraud Group | Scoop.it
Andrew Holt's insight:

The issue on health insurance recently hugged the headlines not just in the US but also in some countries which recognized the need to address the health services that their populace need and expect from their employers and the government.

 

Previously, health insurance was practically non-existent. Pension funds and provident funds were already in the consciousness of people as well as in the administration of institutions, whether private or public, for many decades. And yet, health is as important as one’s future retirement fund and present financial needs and is, in fact, closely related to both essential requirements for a healthy and productive working population. Hence, the rush to enact laws requiring all workers to acquire health insurance of some form has become a crucial issue.

 

For us to understand what health insurance is all about and its foundational principles, consider some pointers to guide you decide whether having health insurance is really essential or not:

 

1. Ideally, health insurance is not state-sponsored medicine

 

We hear activists declare that health insurance is a form of taxation or revenue- generating scheme of the state. Well, if some corrupt officials were to be given the hand that would be true as news of government funds being carted away by top-level officials flood the news daily today.

 

However, as conceived and its ideal form, health insurance is a “plan whereby money is collected usually from the employer, the employee and the state and set aside as a fund out of which those who render services (health practitioners) to the insured population (the employees, that is) are paid.” It is not “state medicine” which is a technical phrase define by the American Medical Association as “a form of medical treatment provided, conducted, controlled or subsidized by the federal or any State (provincial) Government or municipality” and has certain exceptions.

 

2. The end beneficiary of health insurance is the insured

 

Again, this is the ideal case. At any time an employee or member of the fund requires medical attention, the fund is obligated to answer the immediate need without the insured having to pay anything above the premium already being collected. Of course, we hear of cases where hospitals or doctors turn away patients who could not put up a deposit or, perhaps, certain technical requirements such as a missing ID or other reasons; but these are exceptional cases. In general, the fund is meant to serve the beneficiary for the state sees the fund as a means to promote health.

 

3. The other beneficiary of the health insurance is the medical practitioner.

 

The health insurance may appear as if it puts the health service providers as the masters and not as the public servants that they are. We all have those people in every place – those who look at their work not as a way of alleviating suffering but aggravating it among those who sustain their livelihood. Yet, it is through the health insurance fund that health practice is enlivened and made more accessible to more people with the proper implementation of the program.

 

4. No monetary benefits.

 

The only benefit the insured gets from the fund is medical service, not cash benefits. In some cases, the insured may receive free medicine, diagnosis or medical surgery for free, depending on the coverage and the type of services that a particular state provides for it populace. However, in general, only medical service is given to the insured and not cash as it is often done in other insurance policies.

 

5. Preventive and curative medicine are given equal attention in health insurance.

 

This is one of the ideal principles in the program; but it is one that is easily forgotten or abused by practitioners and even by politicians who manage or control how the funds coming from the State should be used.

 

We know that medical practice has become a big moneymaking venture, especially among those who support the industry with pharmaceutical drugs, equipment and assorted medical supplies. The end-user in terms of medical care has to be knowledgeable enough to know what he or she needs for any particular health issue in order not to be taken advantage of by unlawful medical-service providers.

 

With these basic facts about health insurance, you can determine what you can expect to derive from having a health insurance. Ultimately, sustaining an active and healthy life will not depend on having the protection of a health insurance but having a healthful and wholesome lifestyle. Doctors and the medicine they use to cure people, ultimately, do not heal us. The body has the built-in immune system to do that. Medicines and other therapies and methods only enhance the immune system’s ability to bring back the body to its optimum condition.

 

Hence, a health insurance is more a temporary fall-back position than a real solution to having a reasonably healthful and fulfilling life. Leading a consciously active and healthful way of life is much better than depending on a supposedly a fail-safe crutch while living a carelessly unhealthful lifestyle.

 

Source:

http://hhicfg.com/blog/harver-health-insurance-counter-fraud-group-fundamental-principles

 

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Harver Health Insurance Counter Fraud Group Tokyo: Where is the Health Care Poverty Gap?

Andrew Holt's insight:

The Affordable Care Act is already cutting health care costs, especially at hospitals that in the past provided charity care for uninsured, low-income patients. The reduction in charity care in states that have expanded their Medicaid programs with federal funds means the costs for this care are no longer being shifted to insured and self-paying patients, which makes health insurance more profitable for hospitals and insurers without increasing consumer costs.

 

But this drop in costs is happening only in the states in about half of the nation that have expanded their Medicaid programs. The other states — mostly in the South and the Plains — have been involved in political struggles that have blocked expansion of health insurance for their poor residents.

 

Expanding state-run Medicaid assistance programs has been called critical for the success of the new federal health care law. In states that haven’t expanded Medicaid, it is currently available to those who have incomes at or below the federal poverty line, which in 2014 is $11,670 for a single person and $27,910 for a family of four. In the states that have expanded their Medicaid programs, the eligibility level is 138%, or $16,104 for an unmarried person and $37,375 for a family of four.

 

The federal health law was written with this expansion in mind, and it offers most people with incomes ranging from 138% to 400% of the federal poverty level the opportunity to be eligible for federal subsidies as they purchase health care policies through the new health insurance exchanges.

 

These subsidies were to be paid for by decreases in Medicare reimbursements to hospitals and doctors. The U.S. Supreme Court decided that the federal government could not force states to expand their Medicaid programs, but the cuts in Medicare reimbursements did not change.

 

Read related content:
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http://hhicfg.com/blog/

 

 

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Harver Health Insurance Counter Fraud Group: Health Insurers may have Fleeced Taxpayers

Harver Health Insurance Counter Fraud Group: Health Insurers may have Fleeced Taxpayers | Harver Health Insurance Counter Fraud Group | Scoop.it

Report Says Probe Indicates Health Insures may have Fleeced Taxpayers out of $70 Billion

 

(NATIONAL) -- A year-long investigation by the Center for Public Integrity has revealed that health insurers( http://hhicfg.com/ ) may have fleeced taxpayers out of $70 billion in just five years.

 

The report is posted on the Center's website by reporter Wendall Potter who says taxpayers should not assume their elected lawmakers in Washington will be outraged or even launching a federal probe about this.

 

Potter:

 

"You would think members of Congress in both parties would be so outraged they’d be launching their own investigation and railing against the “fraud and abuse”( http://hhicfg.com/blog/ ) they decry on the campaign trail.

 

But I’m not holding out much hope. That’s because I know just how powerful and influential the health insurance industry is and how its lobbyists almost always get what they want out of Congress and the White House, regardless of who is sitting in the Oval Office."

 

The Center’s investigation called the "Medicare Advantage Money Grab" found here discovered that:

 

- Federal officials made nearly $70 billion in “improper” payments to Medicare Advantage plans from 2008 to 2013, mostly over-billings, by manipulating or misusing a Medicare payment tool called a “risk score.”

 

- From 2007 through 2011, Medicare Advantage risk scores rose more than twice as fast as the average for people in standard Medicare in more than 500 counties nationwide.

 

- Federal health officials have long kept key financial records of Medicare Advantage plans in a “black box,” inaccessible to the public and press.

 

- Medicare Advantage health plans collect billions of dollars from controversial “house calls” that industry officials say help improve care but which critics argue inflate costs needlessly.

 

Reporter Potter says the findings didn't come as a shock to him because during his two decades in the industry, at both Humana and Cigna, "I came to understand just how much of a cash cow the Medicare Advantage program has become to insurers participating in the program. Wall Street financial analysts devote considerable attention to determining how much insurers’ Medicare Advantage business contributes to their bottom lines and how much of the money they take in from the government is actually paid out in medical claims. The less they spend on medical care, the better, from Wall Street’s perspective."

 

Potter adds this is a huge business and one that is growing rapidly and because the business is so profitable, insurers spend millions of dollars on lobbying, advertising, PR and “grassroots” political activities to keep the money flowing unimpeded.

 

Article source: http://www.skyvalleychronicle.com/BREAKING-NEWS/REPORT-SAYS-PROBE-INDICATES-HEALTH-INSURERS-MAY-HAVE-FLEECED-TAXPAYERS-OUT-OF-70-BILLION-1766176

 

 

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Harver Health Insurance Counter Fraud Group: Advance directives clarify choices

Harver Health Insurance Counter Fraud Group: Advance directives clarify choices | Harver Health Insurance Counter Fraud Group | Scoop.it

Advance directives clarify choices, guide family

 

Pulmonologist Dr. Rick Blevins often sees patients and families grappling with a decision he says should have been made long before.

 

Blevins treats many patients in the intensive care unit who won't survive. If they do not have advance directives, their families are left to make hard decisions that they may not have answers to.

 

"It's a subject that comes up and (in the ICU) is the worst possible time for conversations to be initiated," Blevins said.

 

Many times, the ICU patient is unable to make decisions for himself, so it falls on the family, Blevins said.

 

The role of the family in that situation is to make the decision the patient would make, Blevins explained. But families don't always know or don't agree.

 

Advance directives, such as living wills, provide instruction to families and especially health care providers on how the patient wants to be treated in the event of incapacity. Besides the living will, other common forms people complete are powers of attorney for health care that gives another person the authority to make health care decisions in the event of incapacity of the patient, and a form called Five Wishes, which provides not only instructions on medical care but also emotional care.

 

Blevins said it can be difficult not only for families to have discussions about advance directives, but these conversations may not be happening in the doctor's office either.

 

Doctors are encouraged to talk to their patients about their health care wishes, but time constraints might prevent that, he said.

 

Many advance directives are legal documents, so lawyers can help people draw them up. But many are also available on the Internet, and Benefis has a link to the Five Wishes form on its website( http://hhicfg.com/ ).

 

The POLST form, which stands for Provider Orders for Life-Sustaining Treatment, is available for patients who have a serious illness and provides instructions on how they want to be treated in an emergency situation. It can be filled out by a provider only in consult with the patient.

 

Sue Rose, the State Health Insurance Assistance Program( http://hhicfg.com/blog/ ), or SHIP, coordinator for Area VIII Agency on Aging in Cascade County, said she can assist seniors who want to fill out advance directives.

 

All the services provided are free.

 

Rose explained that SHIP can provide assistance with Medicare and other health insurance, possible Medicare fraud and long-term care assistance, including advance directives.

 

While Rose can't offer legal advice, she is able to explain to seniors the purpose of the forms and help them fill the forms out. Work on advance directives is done one-on-one, but Rose gives group presentations periodically. Continue reading: http://www.greatfallstribune.com/story/life/health-and-fitness/2014/06/16/advance-directives-clarify-choices-guide-family/10652171/

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Son watched father die, writes book on health care system

Son watched father die, writes book on health care system | Harver Health Insurance Counter Fraud Group | Scoop.it

David Goldhill’s father died from an infection he contracted in a well-regarded New York hospital.

 

That began a quest to investigate America’s health care system. In his book “Catastrophic Care: How American Health Care Killed My Father and How We can Fix It,” Goldhill reports that nearly 100,000 Americans die every year from hospital-borne infections.

 

That’s more than double the number of Americans killed in car crashes and five times the number of those murdered.

 

How did American hospitals miss the quality control revolution that affected the rest of the American economy?

 

Goldhill contends that our current system drives “excess treatment, cost inflation and medical errors.” And he says the Affordable Care Act only worsens the perverse incentives and would raise the cost of care.

 

He worries that the exchanges will reduce competition among insurers, the subsidies will make consumers less price-conscious and mandates will cause healthy people to drop insurance.

 

The result may be less coverage at higher costs than the authors of the Affordable Care Act intended. He describes the health care system as “the Beast” that tolerates excess and careless medicine.

 

“Bad health care is crowding out needed care,” he writes.

 

His solution is to combine the liberal desire for universal health care with a conservative desire for market-oriented approaches.

 

He calls for a national insurance safety ( http://hhicfg.com/blog/ ;) net that covers health crises that are “major, rare and unpredictable.”

 

“Insuring everyone isn’t the same as insuring everything,” he writes.

 

That means using insurance as it was meant to be used, for rare catastrophic events.

 

What the health care system does disastrously is provide quality care at affordable prices. In 2009, Medicare had $54 billion in proper payments.

 

Goldhill’s plan involves health savings accounts, health loans and catastrophic insurance.

 

- Increase money we put into health care and save the difference.

 

- Reduce the use of unnecessary health care to some people so others may build savings.

 

- Cut spending in ways that don’t hurt quality and transfer that into savings.

 

Money currently put into the health system would accumulate in a tax-free account. That money would be used to pay premiums for cradle-to-grave health insurance.

 

If you run out of money, you can borrow against your future contributions. While it doesn’t sound practical in today’s political system, the ideas are based on an interesting set of principles. His plan is basically along the same lines as Singapore’s national system.

 

“We’re stuck in a vicious cycle in health care. The more we try to protect ourselves from the realities of care, the more complex and unconnected from us the system becomes,” he wrote. It’s far too complicated for the average person.

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The Harver Group: How Will 2015 Health Insurance Premiums Compare to 2014?

The Harver Group: How Will 2015 Health Insurance Premiums Compare to 2014? | Harver Health Insurance Counter Fraud Group | Scoop.it

The Affordable Care Act’s (ACA) 2014 open enrollment period for the individual health insurance market has only just ended, and actuaries for health insurers already are developing premium rates for the 2015 plan year. Much of the uncertainty regarding the health spending by plan enrollees that existed when insurers submitted their 2014 rates remains for 2015.  Although insurers have information on enrollee demographics, only limited information will be available on enrollee health status and health spending when premium submissions are due this spring.

 

Key drivers of 2015 premium changes ( http://healthaffairs.org/blog/2014/05/13/how-will-2015-health-insurance-premiums-compare-to-2014/ ;) include how the composition of the risk pools in 2014 compares to what was expected, the reduction of funds available through the temporary reinsurance program, and the underlying growth in health costs. How enrollment differs from projected will vary by insurer and by state, with larger premium increases possible in states that adopted the transition policy allowing non-ACA-compliant plans to be renewed.

 

The composition of the risk pool and how it compares to what was projected

 

When calculating 2014 premiums, insurers had to make assumptions regarding which individuals would purchase coverage and what their medical spending would be. There was much uncertainty regarding these assumptions because insurers had only limited experience data on individuals who would be newly insured.

 

Insurers face a similar uncertainty for 2015. Although they have information regarding the age and gender of their 2014 enrollees, they have only limited information on enrollee health status, due to the reporting lag between when health care services ( health care services ) are provided and when claims are processed. Practitioners are observing that while some insurers are seeing 2014 enrollee demographics fairly similar to what they projected, others are seeing an older-than-expected enrollee population. Any available medical claims data will need to be adjusted to reflect any expectations that individuals enrolling later during the open enrollment period are healthier.

 

The composition of the risk pool and the impact on premiums will vary by state. Many states opted for the transitional policy that allowed non-ACA-compliant plans to be renewed. In these states, the risk profile of 2014 ACA-compliant plans might be worse than insurers projected if lower-cost individuals retained their prior coverage and higher-cost people moved to new coverage. The transitional policy was instituted after 2014 premiums were finalized, meaning insurers weren’t able to incorporate this policy into their premiums. For most states, the transitional policy for 2015 is known in advance and can be incorporated into assumptions regarding the composition of the 2015 risk pool. The impact on premiums could be greatest in states that had large, heavily-underwritten individual markets in place prior to 2014.

 

Differences by state in enrollment outreach efforts or technical problems with the marketplaces could also have affected the composition of the 2014 risk pool. Insurers will incorporate that experience into their 2015 premium assumptions to the extent they expect such trends to continue.

 

Importantly, if actual experience regarding the risk profile of 2014 enrollees differs from assumptions and losses occur in 2014, insurers cannot recoup past losses through higher future premiums. Instead, assumptions for 2015 will be reset incorporating available 2014 experience.

 

Reduction of reinsurance program funds

 

The ACA transitional reinsurance program compensates plans in the individual market when they have enrollees with especially high claims. Reinsurance payments reduce net claims, allowing insurers to offer premiums lower than they otherwise would be.

 

For the 2014 plan year, $10 billion will be used to reimburse plans for a portion of the spending for high-cost individuals. These payments generally have reduced projected 2014 net claims by about 10 to 14 percent. For the 2015 plan year, the amount collected for the reinsurance program will decline to $6 billion, and will likely reduce net claims by about 6 to 8 percent. This lower reduction in claims translates to about a 4 to 7 percent increase in projected claims for 2015 relative to 2014, due solely to the reduction in the reinsurance program and not factoring in any other factors such as medical trend. This increase could be offset to the extent that insurers expect a healthier risk pool profile in 2015, arising for instance from lower-cost individuals delaying enrollment until 2015 rather than enrolling in 2014.

 

Underlying growth in health care costs

 

The increase in costs of medical services, referred to as medical trend, reflects not only the increase in per-unit costs of services, but also increases in health care utilization and intensity. In recent years, health spending growth has been low relative to historical levels. Premiums for 2015 will reflect assumptions regarding the extent to which the recent slowdown will persist.

 

Other drivers of 2015 premium changes

 

Other factors potentially contributing to rate changes include any modifications to provider networks; provider reimbursement structures; benefit packages; risk margins; administrative costs; or geographic region definitions. The increase in the health insurance fee imposed by the ACA could put upward pressure on premiums if it is not offset by a commensurate increase in enrollment. Insurers will also incorporate market considerations when determining 2015 premiums.

 

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The Harver Group - Your Health Insurance Counter Fraud Services Tokyo: ACA Marketplace Enrollment Solutions

The Harver Group - Your Health Insurance Counter Fraud Services Tokyo: ACA Marketplace Enrollment Solutions | Harver Health Insurance Counter Fraud Group | Scoop.it

 

ACA Marketplace Enrollment Solutions Provides Tips on How the Affordable Care Act Protects Americans Who Recently Lost Their Job-Based Health Insurance Coverage

Andrew Holt's insight:

Main site: http://hhicfg.com/

 

"It is extremely unfortunate when any American loses their job and along with it their job-based health insurance coverage," began Bill Hallberg, Chief Enrollment Officer, ACA Marketplace Enrollment Solutions (ACAMES). "The good news is that with the Affordable Care Act, consumers now have two laws that protect them by providing health insurance coverage options and potentially saving them money on their health insurance premiums. Additionally, for the first time, consumers have an affordable choice beyond the traditional extended job-based health insurance coverage, COBRA."

 

Educate Yourself On The Facts Surrounding Loss of Job-Based Health Insurance:

 

   • Now there are two laws that protect consumers who are losing their job-based health insurance coverage: COBRA continuation coverage and the Affordable Care Act.

 

   • Loss of job-based coverage is considered a qualifying event, which allows the potential insured to purchase a plan through the new Health Insurance Marketplace.

 

   • Under the traditional and often costly COBRA option, individuals are responsible for paying 100% of premium of the job-based plan plus 2% for administrative costs.

 

   • Through the Affordable Care Act, individuals can choose from a variety of plans available to them in both the Health Insurance Marketplace and in the traditional marketplace.

 

   • In the Health Insurance Marketplace, many individuals will be eligible for subsidies, which can cover a substantial portion of their premium (up to 100% of premium in some cases). These individuals will have the ability to choose from one of the many insurance carriers, plans, and benefits available to them and can select one that will best meet their needs. Also, they may find that the cost of a Marketplace plan is significantly lower than the COBRA option offered by their job-based plan. "It's a fact that many consumers choose COBRA coverage due to lack of information about their other health insurance options. They may not be aware of the new laws that protect them as a result of the Affordable Care Act," remarked Hallberg. "Additionally, many individuals do not realize that they have a 60-day window under the special enrollment provision to consider their options and decide on whether to enroll for quality and affordable insurance in the Health Insurance Marketplace, or elect the Cobra continuation of coverage option" Hallberg concluded. Many people shy away from the Marketplace option because they do not know where to turn for Health Insurance Marketplace enrollment assistance. This is where ACAMES' team of licensed and CMS certified health insurance professionals could assist consumers. Who is ACA Marketplace Enrollment Solutions?

 

   • ACAMES is a licensed, certified and multi-lingual national enrollment firm that specializes in the Health Insurance Marketplace and Senior Products.

 

   • ACAMES is not affiliated with any governmental agency. As a Health Insurance Marketplace enrollment provider, we are here to assist individuals and families secure health insurance. ACAMES is compensated by the insurance carrier and there is no cost to the potential customer or enrollee.

 

   • ACAMES agents certified on the Marketplace Exchange possess extensive knowledge on the enrollment process. These certified agents will also help calculate subsidies and explain how deductibles, out-of-pocket maximums and copayments work under The Affordable Care Act.

 

   • ACAMES represents national and regional health insurance carriers across the country that offers products both on and off the Health Insurance Marketplace. Visit our website at http://www.acaenroll.com or call us at (800) 342-0631 to get more information.

 

What Value Does ACA Marketplace Enrollment Solutions Provide Consumers?

 

1. Help you shop and compare. ACAMES' licensed and certified insurance professionals can first educate the consumer regarding the new health insurance laws. Second, they can compare the health insurance plans, benefits, and premiums offered through the Health Insurance Marketplace.

 

2. Determine if you qualify for a government offered health insurance subsidy. Through the Marketplace you'll also learn if you qualify for free or low-cost coverage from various plans offered on the Marketplace.

 

3. Explain the rules that apply when entering the Health Insurance Marketplace following the open enrollment period. The team at ACAMES can thoroughly explain the rules and closing dates that apply. Loss of job-based health insurance is considered a "qualifying event" under the Affordable Care Act. There is only a 60 day window; based on the date the job-based health insurance is discontinued, to be eligible for coverage through the marketplace.

 

4. Accessible to their customers. Staffed Monday through Friday 8 a.m. thru 8 p.m. and Saturday 9 a.m. through 3 p.m. CST, enrollment agents stand ready to assist clients with their health insurance needs. Visit our website at http://www.acaenroll.com or call us at (800) 342-0631 to get more information.

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The Harver Group - Your Health Insurance Counter Fraud Services Tokyo: Handling Detailed Interrogation

The Harver Group - Your Health Insurance Counter Fraud Services Tokyo: Handling Detailed Interrogation | Harver Health Insurance Counter Fraud Group | Scoop.it

Here's a guide to navigating the difficult questions that you are asked while buying insurance.

Andrew Holt's insight:

While buying insurance online, the toughest part for most customers is answering the medical-and lifestyle-related queries in the proposal form. Some questions are general, but some are specific and relate to medical condition, profession and hobbies of the buyer.

 

Sample these questions. Has your weight altered by more than five kg in the last two years? Have you been incapable of working for more than five days in a week in the past two years? How many cigarettes do you smoke in a day and/or how many pegs of alcohol do you consume in a week?

 

Why would the insurer like to know how many cigarettes you smoke or how much liquor you consume? Do the answers to these questions have a bearing on your insurance premium?

 

The answer is yes. Hence, it is important that you answer all questions correctly.

 

"Present and past medical conditions, insurance history, personal and family health, lifestyle habits, etc., have an important bearing on risk and, therefore, product pricing," says Mayank Bathwal, deputy CEO, Birla Sunlife Life Insurance.

 

However, answering these questions can be tricky, especially for a person who is buying the policy on his/her own. We assess these questions and how they can impact the underwriting process.

 

DIFFICULTY LEVEL

 

The questions asked in a life or health insurance application form can be generic or very specific. The difficulty level may vary accordingly. The answers are mostly in yes or no. If the answer to each question is no, the process is hassle-free if the declarations are true.

 

However, if the answers are yes, the company seeks further explanations and in some cases even documents so that it can decide the premium or whether to accept your application.

 

"The purpose of asking about the person's health is to ascertain his well-being. If any risk is noted, further tests may be sought on the basis of sum assured and the person's age," says Bathwal of Birla Sunlife Life.

 

So, if your answer to the question whether you are a smoker is yes, you will be asked what you smoke (cigarette, beedi or cigar), how many do you smoke in a day and for how many years have you been smoking. If you say you have stopped smoking, you will be asked when and why.

 

Explanations and documents may not always be difficult to furnish. However, at times, understanding questions, especially the ones related to health, could give you a hard time.

 

Take, for instance, this question. "Have you undergone/have you been recommended to undergo any of the following: angioplasty, heart bypass surgery, brain surgery, heart valve surgery, aorta surgery or organ transplant or any other major surgery or treatment?"

 

The use of medical terms, which most people may not be aware of, makes things difficult for the buyer. For instance, you need to be a biology student or a medical practitioner to know which diseases are considered congenital.

 

Further, it is possible that you have not undergone any of the above mentioned surgeries but some other surgery. Should you mention this in the column 'other major surgery or treatment' category?

 

Then there are questions that are sure to put you in a fix. So, if the insurer asks if you have experienced any health problem or medical condition within the past three months for which you have not consulted a doctor, what should be your answer? Even if the answer is yes, you will probably not know the name of the condition from which you suffered.

 

As a result of these issues, insurance companies, which were aggressively promoting online sales, have witnessed very low conversion of online enquiries into sales. The companies are trying to address the issue by starting online assistance, 24X7 call centres etc. Some are even selling online policies through agents.

 

"To help customers during purchase, we have set up a 24/7 customer helpline. Customers can connect with our telesales advisors through our toll-free number at their convenience. We also call customers who leave their details on our website and assist them through the buying process," says Sevantika Bhandari, director, marketing, Max Bupa Health Insurance.

 

"Some questions are very technical in nature and so customers may find them difficult to understand. We have tried to translate such questions into a simpler language," says Anuj Gulati, CEO, and Religare Health.

 

IMPACT ON UNDERWRITING

 

Based on these declarations, the insurance company assesses the risk involved in insuring the applicant and accordingly fixes the premium. In some cases, it will ask the buyer to undergo medical tests before issuing him the policy.

 

So, who is a bigger risk for a life or health insurance company-a person who smokes or one who consumes alcohol?

 

"In term insurance procedures smokers get impacted directly as there are separate slabs for smokers and non-smokers. There is nothing like this for drinkers," says Yashish Dahiya, CEO and cofounder, Policybazaar.com.

 

This means if you are a smoker, you will pay a higher premium than a non-smoker for a life or a health insurance policy.

If you are in a 'hazardous' occupation or love adventure sports, then also you fall in the higher risk category. The insurer may even reject your request for insurance in such a case.

 

"If an applicant is involved in adventure sports or lives in a life threatening environment, the insurer can accept the application, reject the application, accept it with exclusions or accept it after premium loading," says Sevantika Bhandari.

 

Even in case a 'healthy' person's family has a history of diseases such as cancer, diabetes or heart problems, he is usually asked to undergo a test to determine if he/she is susceptible to genetic diseases.

 

"Based on the results of these tests, the policy can be rejected, passed or passed with restrictions or loading. There is no set rule for such scenarios. It's a subjective call taken by the underwriting team," says Dahiya of Policybazaar.com.

 

In chronic conditions, where repeat hospitalisation is all but sure, the decision to issue a policy is taken on the basis of medical tests.

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