cmonfils | January 15, 2012
The Department of Health and Human Services plans to audit 150 plan sponsors and employers to make sure employee health and financial records are adequately protected. Creating appropriate policies and procedures, instituting a risk assessment and training employees are keys to compliance, experts say.
cmonfils | January 15, 2012
A small-business group fighting President Barack Obama’s health-care law asked the Supreme Court on Wednesday to add two plaintiffs to its lawsuit after possible problems arose with an initial plaintiff.
cmonfils | January 15, 2012
Millions of patients are enrolled in health insurance plans that don’t kick in until they’ve spent $1,000 or more out of pocket, and many don’t have tax-free accounts to help them meet their deductibles.
Enrollment in high-deductible plans rose from 14% of insured adults in 2010 to 16% in 2011, according to the Employee Benefits Research Institute, which surveyed 4,703 adults from age 21 to 64 who had employer-based insurance.
cmonfils | January 15, 2012
Not to be too flippant or cynical, but whenever, over the years, I have heard an economist base a nice, highly logical, elegantly structured analysis on the underlying base assumption that investors or business people or consumers are acting rationally – without accounting for the likelihood that they won’t actually do that – I understand anew why cynics call economics the dismal science (I often like to cross-examine economists by asking them about that reputation, if for no other reason than the sport of it). As a result, nothing about this article by Michael Lewis on the extensive literature in psychology – including Nobel Prize winning work –concerning the utterly non-rational behavior of individuals and the problems it exposes in economic theory really came as a surprise to me.
cmonfils | January 15, 2012
MyHealthGuide Source: Todd Leeuwenburgh, Editor, Employer Health Benefits, Thompson Publishing Group, 1/12/2012, www.Thompson.com
Case: Pacific Shores Hosp. v. United Behavioral Health, 2011 WL 6402435 (C.D. Calif., Dec. 19, 2011)
A benefit administrator’s adverse benefit determination was imperfect but sufficient to comply with claims procedure rules, the U.S. District Court for the Central California district concluded in the above case. Discrepancies by reviewing physicians and adjustments made in discharge criteria were not enough to support allegations of claims-procedure violations and overturn the denial, it held. (more…)
cmonfils | January 15, 2012
Industry files brief on issue of severability; Insurance market reforms and coverage requirement cannot be separated
AHIP and BCBSA today filed an amicus brief in the U.S. Supreme Court stating that certain insurance market reforms in the Affordable Care Act (ACA) are inextricably linked to the law’s personal coverage requirement and have to be severed from the ACA if the Court finds the coverage requirement unconstitutional.
cmonfils | January 15, 2012
2013 may be the most significant year in health care policy ever.
But we have to get through 2012 first.
Once the 2012 election results are in there will be the very real opportunity to address a long list of health care issues.
If Republicans win, the top of the list will include “repealing and replacing” the Affordable Care Act. If Obama is reelected, but Republicans capture both houses of Congress, we can still expect a serious effort to change the law. Then there is the granddaddy of all problems, the federal debt. The 2012 elections could well prepare the way for entitlement reform—particularly for Medicare and Medicaid. Even if Obama is reelected, the 2013 agenda will include a serious debate about Republican ideas to change Medicare into a premium support system and block grant Medicaid to the states.
cmonfils | January 15, 2012
Insurance companies spent millions of dollars trying to defeat the U.S. health-care overhaul, saying it would raise costs and disrupt coverage. Instead, profit margins at the companies widened to levels not seen since before the recession, a Bloomberg Government study shows.
