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Insurance: What’s a CPT Code Got to Do With It?

| April 5, 2013

Chances are, when you’re at the doctor’s office you aren’t thinking about CPT Codes. In fact most of us don’t even know what a CPT code is. Until recently, patients didn’t really have any involvement with these codes unless they contacted their insurance company or doctor’s office.

It stands for Current Procedural Terminology and every time you receive a medical service such as a flu shot, physical exam, stitches or more, your physician assigns a corresponding five-digit CPT code. Even so much as a brief five-minute telephone consultation with your doctor has a corresponding CPT code.

These codes are developed and maintained by the American Medical Association (AMA) and are used by insurers to determine the amount that a practitioner should be reimbursed by the insurance company. As the practice of health care undergoes reform, the AMA develops new codes for new services and current or old codes may be revised or discarded if unused.  There are already thousands of CPT codes in use and these are updated yearly. Although everyone in the industry uses the same codes to ensure uniformity, it does not necessarily mean that each practitioner receives equal reimbursement for the same procedure.

As patients, we can learn a thing or two from CPT codes. When you receive a medical bill, a CPT code can prove handy in deciphering health costs. They reveal information about our medical issues, how they are being treated and how they determine medical billing. Your doctor’s office should be able to discuss any questions regarding CPT codes with you.

 

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Health Insurance Subsidies May Result in Higher Costs Later

| April 3, 2013

Under the Affordable Care Act, individuals who purchase private health insurance through an exchange after January 1, 2014 are eligible for subsidies on insurance premiums and cost-sharing as long as your income is less than 400 percent of the federal poverty level.

The two forms of subsidies offered by the government are premium assistance tax credits meant to lower individual or family premiums and cost-sharing assistance, which limits an individual’s maximum out-of-pocket costs.

As millions of consumers take advantage of these subsidies hoping to save money, they could actually get hit by surprise tax bills if they incorrectly project their income. Typically, the lower your income, the higher subsidy you should receive.

That’s all well and good, but the there’s no definitive way for you or the government to know how much money you will actually be bringing in next year. The government must rely on the 2012 tax return you filed this spring. Say you are granted with a subsidy and in 2014 your total income rises due to a raise or other factors. You could end up with a larger subsidy than originally intended.

What many don’t realize is that you will be required to pay back part of that money when you file a tax return in spring 2015, resulting in surprise tax bills or smaller refunds. This oversight highlights a bigger issue among Americans, that not many of us completely understand the new health care law.

Health insurers, advocates of the health law and tax experts are planning public awareness campaigns to familiarize consumers with the health care law and its implications. Without this education, millions of middle-income taxpayers could get stung with penalties and end up owing money.

 

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Group Doctor Appointments – A Thing of the Future?

| April 2, 2013

Would you rather wait six weeks to see your doctor or share a group appointment and get in almost immediately? This is a decision a growing number of consumers are being confronted with today.

The group doctor visit trend has slowly gained popularity due to a number of factors, including the growing medical needs of our large senior population as well as an imbalanced number of primary care physicians available to meet the country’s health care needs post reform.  A survey conducted last year by the American Academy of Family Physicians found that 8.4 percent of doctors offered shared appointments in 2010, up from 5.7 percent in 2005.

The idea behind this approach is that doctors can provide care more efficiently and patients will have more time with their doctors. Ideally, patients with related conditions such as diabetes could share an appointment and discuss their issues together. There, doctors and nursing assistants can examine everyone and answer questions in a collaborative group forum. An added advantage is that patients can have more time with their doctor, up to two hours.

Insurance should work similarly for shared appointments as it does for individual appointments. There will be no change in co-pay amount. What do you think- would you feel comfortable sharing a doctor with up to a dozen other people or would you rather stick with an individual appointment?

 

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States to See Big Disparities in Health Costs

| March 29, 2013

Research continues on the rising cost of health insurance premiums, and while some say the talk of rates is merely speculation, studies are showing differently.

A study sponsored by the Society of Actuaries (SOA) projects that medical claims costs, the biggest drivers of health insurance premiums, are to increase by huge percentages. The nation’s leading group of financial risk analysts predicts a jump of 32 percent, to be exact.

While some states will actually see a decrease in medical claims costs per person, a large majority of states will be experiencing double-digit increase in the individual health insurance markets. Some of the estimates by 2017, according to the SOA report are as follows:

  • 62 percent increase in California
  • 80 percent increase in Ohio
  • 20 percent increase in Florida
  • 67 percent increase in Maryland

What’s responsible for the jump in costs, you ask? The study claims costs will rise as more unhealthy and sick individuals join the insurance pool. Under the Affordable Care Act (ACA), insurers face new rules for sex or age-based rates, so while younger individuals typically paid less in the past, they will now be required to pay more while older people may pay less. Women who historically paid more for insurance will now pay less and as the disparity evens out, men may pay more.

The report however, made no estimates regarding employer-based health plans as the new health care law will primarily affect individuals who do not receive insurance coverage through their employer.

 

 

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How Large Businesses are Cutting Health Care Costs

| March 28, 2013

Working for a big company has its perks. They tend to have higher compensation packages, more funds and resources, and typically generous health benefits. While many employees of large businesses have been enjoying a range of health insurance benefits at low out-of-pocket costs, more and more companies are switching up their offerings.

In its annual “Employer Survey on Purchasing Value in Health Care” survey, Towers Watson and the National Business Group on Health identified trends in the health care benefit programs of some of the best performing companies. Specifically, it identified a recent trend among large companies to move employees toward high-deductible plans linked to a savings account for medical expenses, citing that 66 percent of companies with one-thousand employees or more offered at least one of the these plans this year.

The report helped show how health reform in the U.S. and rising costs have caused many employers to reconsider employee benefits, salary and other incentives while still fulfilling the need for competitive salary and health incentives. Employees are seeking to lower costs and avoid the Patient Protection and Affordable Care Act excise tax coming up in 2018 while still encouraging health and wellness among workers.

A shift to plans with higher deductibles and savings accounts is already an idea smaller firms are used to, as their insurance deductibles are typically higher than employees of a larger firm.

How It Works

The standards for such plans have been set by Federal law, under the IRS. In 2013, insurance plans containing health savings accounts must have a deductible of at least $1,250 for individual coverage and $2,500 for family coverage. The maximum out-of-pocket expense for an individual will be $6250 and $12,500 for families. Both workers and employers can contribute to the savings account, tax-free.

In an analysis on consumer-driven health plans done by The Robert Wood Johnson Foundation, plans with high deductibles linked to savings accounts reduced total health care spending on average from 5 to 14 percent. The shift of costs onto employees also causes them to make better health care choices.

 

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Open Enrollment Period for Individual Health Plans

| March 26, 2013

As established under the Affordable Care Act (ACA), the U.S. Department of Health and Human Services released final rules establishing the new insurance marketplaces beginning in 2014.

Under the new health law, individuals will be required to maintain a minimum level of insurance coverage starting on January 1, 2014 whether it’s through an employer, individual coverage, or a federal program such as Medicare and Medicaid. Individuals without insurance will be subject to a tax penalty.

The initial open enrollment period has been extended which begins on October 1, 2013 through March 31, 2014. It’s important that consumers who lack coverage obtain benefits during this open enrollment period so they do not get fined for not having health insurance.

Another policy under the ACA prevents insurance companies from discriminating or denying health coverage to consumers with pre-existing conditions. Come 2014, insurers cannot refuse or limit coverage, or charge higher premiums to anyone because of a pre-existing condition. These individuals will be able to apply for coverage when open enrollment begins.

What to Expect

During this open enrollment period, you will have the opportunity to shop for and compare affordable insurance policies sold from different carriers in a “one-stop shopping” marketplace. In effort to simplify the process, plans will be divided into four different categories based on the level of benefits: bronze, silver, gold and platinum. In addition to the four levels of plans, there will also be benefit options for young adults.

How to Prepare

There are some things that you can do to prepare:

  • Make a list of your questions beforehand so you know exactly what to look for when the time comes.
  • Determine your budget.
  • Start by gathering basic information about your household income to see if you are eligible for a health insurance subsidy.

This will help you narrow down your health plan options by cost. To find out if you may be eligible for a subsidy in 2014, visit http://www.gohealthinsurance.com/subsidy.

 

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What Texans Need to Know about Health Care Reform

| March 25, 2013

Unfortunately for many Americans, health care reform is confusing. Yet, there are many provisions that are specific to Texas and could benefit residents.

Six things that Texans should know about health care reform:

  1. Texas is not setting up a health insurance exchange. The federal government is solely responsible for providing residents with a public exchange. Texans will be able to get health insurance, subsidies for insurance coverage, and check eligibility for Medicaid on the federal exchange.
  2. Residents will have to get coverage or pay a fine starting January 1, 2014 due to the individual mandate. There will be open enrollment periods for individual coverage starting October 1, 2013 through March 31, 2014.
  3. Right now, Texas is opposing Medicaid expansion but that could change. Health care reform expands Medicaid eligibility to individuals making up to 133 percent of the federal poverty level (FPL). Currently, the Texas Medicaid income eligibility level is set at 25 percent of the FPL for parents. If Medicaid coverage is expanded in Texas, 58 percent of uninsured adults would be eligible for Medicaid and 22 percent of uninsured children would be eligible for Medicaid in the state.
  4. Over 1.5 million Texas consumers have received a health insurance rebate from reform due to the Medical Loss Ratio (MLR). In 2012, the rebates total $166,975,000.
  5. Texas Community Health Centers have received federal grants under reform. As of 2012, community centers have received more than $167,900,000 to expand and improve facilities, and to expand the services provided by the centers.
  6. Over 7,000 Texans with pre-existing conditions have participated in the Pre-Existing Condition Insurance Plan (PCIP). Residents who had been turned down for coverage, gone without coverage for six months and have pre-existing conditions were eligible for this program.

For more information on health insurance coverage in Texas and cities in Texas, visit here.

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Health Insurance Premium Speculation Continues in Congress

| March 21, 2013

The rivalry among Democrats and Republicans continues over the effects of the Affordable Care Act. The major questions at hand are whether premiums will be increasing and if so, how much?

This is a question that has remained at the center of the health care reform overhaul and both political parties have different responses. Most Republicans are confident that health insurance premiums are going to skyrocket, while Democrats predict that the new health care law will cause costs to slow. While both sides have data to support their claims, there is no concrete evidence until insurers actually announce the premiums for 2014, later this year.

New plans must be ready this fall in order to bid in the statewide insurance exchanges which open October 1st. Employer-based coverage also begins open enrollment around that time. Both parties met in a House panel last week to forecast their premium predictions and speak their case.

Republican witnesses cited new insurance regulations that could be responsible for the spike in premiums, including mandatory coverage for facilitative services, oral and vision care and limitations on cost-sharing.

 

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Self-Insuring: the New Loophole for Small Business?

| March 19, 2013

Many businesses, typically larger employers, make the choice to ‘self-insure’ in order to cut health care costs. A self-insured group health plan is one in which the employer directly assumes all costs of providing health care benefits to its employees. Instead of paying a fixed-premium amount to a carrier, employers will pay out of pocket claims as they arise.

Self-insuring can help large companies better predict medical costs, but for smaller businesses it can be a little riskier.  For a thousand-employee business, the costs and risk is spread thin, whereas for a small business of fifty or fewer employees, just one accident or surgery could push expenses through the roof.

A Threat to the Affordable Care Act

As premiums rise, many small businesses are considering the risk of self-insuring. But what does it mean for the statewide insurance exchanges set to take effect in 2014? Many officials see self-coverage as a threat to the Affordable Care Act- that small businesses are trying to get out of health reform requirements. With more small businesses self-insuring and avoiding ACA guidelines, others worry the small business marketplaces could break down and become too expensive.

The ‘community-rating’ feature of health exchanges, which spreads health care costs among both the healthy and the sick and encourages insurers to offer competitive pricing could be jeopardized if smaller, healthier workplaces choose to self-cover. If this is the case, small business insurance exchanges will be left with older, less healthy members which drives costs up.

Officials in some states are working to limit self-coverage by introducing legislation that will reduce or eliminate small firms’ ability to self-insure. However advocates argue that if self-insuring can be a viable solution for enormous companies, the option should also be on the table for small firms.

 

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Are Body Stats the Key to a Healthier You?

| March 15, 2013

How do you quantify yourself? This is the key health care question coming out of the South by Southwest Interactive Festival this year. As body-tracking gadgets like the Nike+ Fuelband or the Garmin Forerunner, become more popular the inevitable question arises: How can we use this data and what effect will this data have on my life in the long run? If you have your running blood pressure, your perspiration rate, and your body fat percentage will these numbers translate into a healthier you? Companies are pushing to answer this question with a “yes, definitely.”

One company that’s taking body biometrics to the next level is BodyMedia. Prior to 2009 the company focused on developing products for medical research but realized there was a unique opportunity to help consumers. Their armband collects 5,000 data points per minute (measuring heat flux, motion, skin temperature, and skin’s electrical conductivity); the data points are then translated into meaningful advice about calories burned, sleep quality and how well your body’s metabolism is working.

BodyMedia and other companies are hoping their products will soon be able to track for chronic diseases. So far, the main benefit body tracking devices have is communal. The devices allow you to post workout information and body stats on social media and online communities. Studies have shown people who receive support for specific goals and events are more likely to stick with them.

So will quantifying your fitness and resting stats keep you from developing a chronic illness and keep your health care costs down? We don’t know but the tech experts at South by Southwest will continue trying to give you every resource available.

 

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