The Health Insurance Blog of Attorney Adam V. Russo
Welcome to Passion for Subro! The purpose of this site is to share my passion for the health insurance industry with the rest of you fanatics. I hope this site will be your destination for the latest in health care as well as self insured news across the country. While I envision that this site will serve as a great educational resource, it will also keep you entertained with the funny, difficult, confusing and just plain weird world of self insurance.
Thanks for visiting!
Posted By cmonfils on January 27, 2012
WASHINGTON (AP) — One of the most popular provisions of President Barack Obama’s health care overhaul — consumer-friendly summaries of what your insurance plan covers — suddenly seems to be at risk.
Consumer groups say it’s not Republican opposition they’re worried about, but a White House that doesn’t want to be seen, in an election year, of churning out costly new regulations.
Posted By cmonfils on January 27, 2012
BOSTON—Massachusetts residents who do not have health insurance will face a higher financial penalty in 2012 under newly finalized rules.
Posted By cmonfils on January 27, 2012
Among other things, 2012 will be the year of the Department of Health and Human Services (“HHS”) Office of Civil Rights (“OCR”) pilot audit program to assess compliance with the Health Insurance Portability and Accountability Act (“HIPAA”) Privacy and Security Rules and Breach Notification standards. The American Recovery and Reinvestment Act of 2009, in Section 13411 of the HITECH Act, required that HHS conduct periodic audits to monitor and ensure compliance with HIPAA. OCR will implement this requirement through a pilot program of 150 audits from November 2011 through December 2012, including an initial wave of 20 audits that will inform how the remaining audits will be conducted. OCR has established a HIPAA Audit Program website.
Posted By cmonfils on January 27, 2012
Fri Jan 13, 2012 5:00am EST (Reuters) What could pediatrician appointments possibly have to do with Joe Merrick’s business as an online precious metals dealer? When it comes to health insurance, the answer is everything. The 13 full-time employees of Merrick’s Dallas-based Provident Metals have 30 children, all under the age of 15, with four babies born in 2011 alone. That means potentially high medical bills for everything from childbirth to vaccinations, which Merrick had to factor into his health-insurance decisions.
Posted By cmonfils on January 25, 2012
The Department of Health and Human Services (HHS) issued interim final regulations addressing standards for electronic funds transfers (EFTs) applicable to health care claims payments transmitted by health plans to health care providers.
Posted By cmonfils on January 25, 2012
January 17, 2011 (PLANSPONSOR.com) – California Attorney General Kamala D. Harris has filed a friend-of-the-court brief in the U.S. Supreme Court supporting the constitutionality of federal health care reform and urging the high court to uphold the law.
Harris, joined by 12 other attorneys general, argued in the brief that the Constitution gives Congress broad powers to regulate interstate commerce, including individual conduct that substantially affects interstate commerce.
Posted By cmonfils on January 25, 2012
People without health insurance are more likely to smoke and generally have less healthy habits than people with coverage, Gallup reports show.
People with health insurance are less likely to smoke and more likely to exercise regularly and eat a healthy diet than those without insurance, according to Gallup Poll data released in December 2011.
Posted By cmonfils on January 25, 2012
DOVER — “If you do something to encourage a healthy lifestyle, it will make folks happier, they’ll have more energy and be more productive,” says Pat Sliva at the Tuscarawas County Board of Developmental Disabilities.
Sliva is human resources coordinator at the Board and credits these positive outcomes to the organization’s five-year involvement with Union Hospital’s Workplace Wellness program.
Posted By cmonfils on January 25, 2012
The 2011 Society for Human Resource Management (SHRM) Health Care Benchmarking Survey examined health care costs for U.S. employees and found that costs vary widely, depending on the industry. One way to try to streamline health care costs is to opt for a self-funded health plan.
Some of the industries that the survey found “spent the most on health care per covered employee during plan year 2010″ were: Utilities; Insurance; Real Estate; Government; and Manufacturing. The industries that spent the least were: Telecommunications; Publishing; Broadcasting and other Media; Accommodation and Food Services; Arts, Entertainment and Recreation; and Business Support Services.
Posted By cmonfils on January 25, 2012
The Eleventh Circuit Court of Appeals recently held in a case of first impression in this circuit that the Family and Medical Leave Act (FMLA) “protects a pre-eligibility request for post-eligibility leave.” That is, the FMLA protects an employee who gives notice, before she is eligible for leave, of intent to take FMLA leave for a qualifying reason once she becomes eligible. Pereda v. Brookdale Senior Living Communities, Inc., D.C. Docket No. 0:10-cv-60773-FAM, Eleventh Circuit Court of Appeals (January 10, 2012).
Posted By cmonfils on January 25, 2012
This study examined the consequences of adding a fitness-membership benefit on the self-reported health status of enrollees in Medicare Advantage plans. Using a quasi-experimental design, we found that persons enrolling in plans after the addition of a fitness-membership benefit reported significantly better general health, fewer limitations in moderate activities, less difficulty walking, and higher PCS scores than did persons who enrolled in the same plan before the fitness benefit was added and in matched control plans that never offered a fitness benefit. These patterns persisted in the analyses of 2-year follow-up responses for all measures except self-reported general health. Our findings suggest that there is an association between the adoption of fitness-membership benefits in Medicare Advantage plans and the enrollment of healthier Medicare beneficiaries.
Posted By cmonfils on January 25, 2012
Insurance coverage can be a confusing thing. Coverage for employee benefit plan fiduciaries sometimes adds a wrinkle to the process that can be overlooked. Depending on the type of claim asserted, there are a variety of “coverage” options that may apply. I think the new fee disclosure rules are likely to increase claims for breach of fiduciary duty in the future, but even without that development, it makes sense to at least know whether you have coverage and what your options are. So let’s take a look at some of the options.
Posted By cmonfils on January 24, 2012
WASHINGTON — The Obama administration said Thursday that rate increases sought by a health insurance company were unreasonable, and it ordered the insurer to rescind them or justify its refusal to do so.
Kathleen Sebelius, the secretary of health and human services, issued the finding against the carrier, Trustmark Life Insurance Company, a unit of Trustmark Mutual Holding Company.
Posted By cmonfils on January 24, 2012
In a cavernous room just east of San Francisco, an army of phone operators fields calls from their customers. A large computer screen blinks the number of people on hold: two, and the average wait time: one minute, 12 seconds.
These phone operators working in a non-descript office park in Alameda are employed by a large health insurance plan, and they’re willing to go the extra mile for their customers. They’ll schedule a doctor to come to your home, a pharmacist to drop off a prescription, and they’ll even help you fill out an application for food stamps.
Posted By cmonfils on January 24, 2012
Under the Patient Protection and Affordable Care Act (ACA) passed by Congress, most Americans will be required to be covered by health insurance or pay a penalty—the so-called individual mandate. The legality of this feature is being debated in the courts.
These Urban Institute authors estimate the effects of the ACA and the individual mandate, as well as various levels of exchange participation, using a model that simulates decisions of individuals and businesses in response to policy changes. Exchange enrollment is viewed as necessary to reduce adverse selection, or the likelihood of only the sickest choosing to be insured.
