Posted By cmonfils on January 17, 2012
BEWARE STATISTICAL DISTORTIONS: SPBA is often asked “How many TPAs are there?”. The answer is multi-facetted and (not by design) may sound like double-talk. It is best if you read it once, open-minded, purely for the insight. Then re-read for specific reference to your situation. I have to start with a big disclaimer. I always warn that every number or statistic about TPAs, health care & costs, employee benefits, etc. have a built-in 1,000% distortion factor. It is not that anyone is lying. It is merely that even the most simple vocabulary terms have vastly different meanings & usage in the employee benefits, insurance and medical communities in which TPAs operate. For example, one “life” can refer to one individual in a plan….or it might be an employee + spouse + 10 children. Even highly-respected sources of statistics get distorted results. Let me demonstrate by anecdote. A few years ago, I was asked to serve as a judge of a federal government panel of experts. It was about 20 of the top statistical research agencies of government, such as GAO, CMS, Bureau of Labor Statistics, Congressional Research Service, White House Office of Economic Advisors, etc. My role was purely ceremonial. About 25 of the same questions had been planted in studies of these research organizations. These were all very basic questions (including number of self-funded plans & size of TPA market). Each group came before me and was very proud of their methodology & credentials. However, their findings for the same items were tens of millions of people different and tens of billions of dollars different. So, the moral of the story is even if you find some very official & impressive-seeming sources for a statistic…..variations of 1,000% will be found.
Category: Third Party Administrators |
No Comments »
Tags:
Posted By cmonfils on January 17, 2012
H-E-B is sharing with the public what it’s learned about its own employees’ wellness and on Friday will launch “Healthy at H-E-B” at the store at 2950 Southmost Blvd.
The company describes the effort as a “comprehensive commitment to improve the health of Texans.” As part of the initiative, H-E-B will showcase chef-inspired recipes at in-store cooking demonstrations designed to show customers how to make healthy, inexpensive meals
Category: Texas, Wellness |
No Comments »
Tags:
Posted By cmonfils on January 17, 2012
Breast-feeding avengers may be coming to a workplace near you.
Women want to be able to breast feed their babies when and where they want to. Witness the “nurse-ins” at Target stores on the West Coast last week that were prompted by a shopper who was mocked for breast feeding by employees at one Target. Moms, however, also want to be able to breast feed when they’re on the clock.
Category: Health Care Legislation, PPACA |
No Comments »
Tags:
Posted By cmonfils on January 17, 2012
With little fanfare and little attention from the media, the Obama Administration recently issued proposed rules to crackdown on health insurance scams that use ERISA to avoid state law enforcement and regulatory actions.
Since the 1974 enactment of ERISA — the federal law governing employee pension and health benefit plans — crooks have used it to promote health insurance scams. There have been bipartisan Congressional attempts to address this problem, e.g., the passage of the 1982 amendments to clarify state authority and the 1996 HIPAA amendments to increase penalties for health fraud. But until the passage of the Patient Protection and Affordable Care Act (ACA), the federal government has had limited administrative authority to fight health insurance scams.
Category: DOL, ERISA, Health Care Legislation, Health Insurance, PPACA |
No Comments »
Tags:
Posted By cmonfils on 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.
Category: HHS, HIPAA, Plan Sponsor |
No Comments »
Tags:
Posted By cmonfils on 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.
Category: Health Care Legislation, Supreme Court |
No Comments »
Tags:
Posted By cmonfils on 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.
Category: Health Insurance |
No Comments »
Tags:
Posted By cmonfils on 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.
Category: Fiduciary |
No Comments »
Tags:
Posted By cmonfils on 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…)
Category: California, Claims Procedures, Plan Language |
No Comments »
Tags:
Posted By cmonfils on 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.
Category: Health Care Legislation, Health Insurance, Supreme Court |
No Comments »
Tags:
Posted By cmonfils on 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.
Category: Health Care Legislation, Medicaid, Medicare |
No Comments »
Tags:
Posted By cmonfils on 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.
Category: Health Care Legislation, Health Insurance |
No Comments »
Tags:
Posted By cmonfils on January 13, 2012
FRANKFORT, Ky.—Kentucky licensed 18 new captive insurance companies in 2011, bringing the total number of active captives in the state to 137 at year’s end.
http://www.businessinsurance.com/article/20120113/NEWS06/120119936?tags=58|73|60
Category: Kentucky |
No Comments »
Tags:
Posted By cmonfils on January 13, 2012
Blue Cross and/or Blue Shield (BCBS) organizations along with their affiliates enrolled 94.4 million people as of September 30, 2011, more than 30% of the population in the United States and more than 50% of those commercially insured. Linked together through the Blue Cross and Blue Shield Association (BCBSA), the Blues are a national federation of 38 independent Blue Cross and Blue Shield companies. Most Blues organizations operate individually and in a single local market. However, that may shift as plans come to terms with changes brought about by health care reform. In this report Mark Farrah Associates examines membership changes that occurred at BCBS entities from September 2010 to September 2011 and looks at financial data as of December 2010.
Category: Health Care Legislation, Health Insurance |
No Comments »
Tags:
Posted By cmonfils on January 13, 2012
Top brass may have the last word when it comes to adverse actions. But even comments made by lower-level managers — including those in human resources — may be used to support the kind of discrimination claim that often follows in the highly emotional climate following a layoff.
A recent appeals court ruling in a Family and Medical Leave Act (FMLA) case illustrates the consequences for a company when HR doesn’t fully support the decision.
Category: 7th, FMLA |
No Comments »
Tags:
