Category Archives: Healthcare Reform

Beware higher charges if you go to an out-of-network ER

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Sign for an emergency room.By Michelle Andrews
KHN

When you need emergency care, chances are you aren’t going to pause to figure out whether the nearest hospital is in your health insurer’s network. Nor should you.

That’s why the health law prohibits insurers from charging higher copayments or coinsurance for out-of-network emergency care.

Beware, you could be left on the hook for substantially higher charges than you might expect.

The law also prohibits plans from requiring pre-approval to visit an emergency department that is out of your provider network.  (Plans that are grandfathered under the law don’t have to abide by these provisions.)

That’s all well and good. But there are some potential trouble spots that could leave you on the hook for substantially higher charges than you might expect. Continue reading

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State exchange doubles the number health plan options to be offered this fall

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From the Washington Healthplanfinder

Washington MapThe Washington Health Benefit Exchange Board today certified 10 health insurance carriers at to offer 82 Qualified Health Plans (QHPs) for individuals and families through the state’s health insurance exchange, the Washington Healthplanfinder.

Last year, eight health insurers were approved to sell 46 plans through Washington Healthplanfinder.i

The small business market, Washington Healthplanfinder Business, will be available statewide for the first time this year with 23 different health plans.

Additionally, five insurance carriers will offer six pediatric Qualified Dental Plans (QDPs).

The open enrollment period, which runs from Nov. 15, 2014 to Feb. 15, 2015, will provider coverage starting Jan. 1, 2015.

“We’re thrilled to see the number of available health plan options has doubled in one short year,” said Richard Onizuka, Chief Executive Officer for Washington Healthplanfinder.

“Not only will these additional coverage options increase consumer choice, they will also foster competition among our participating health insurance companies,” Onizuka said. Continue reading

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Turning 65? Know your Medicare options – Guest column

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Center for Medicare & Medicaid ServicesMedicare tips from Oraida Roman, president of Senior Products for Humana’s Intermountain Region

Approximately 11,000 adults become eligible for Medicare every day, reflecting a dramatically increasing senior population, and that number is only going to grow.

The U.S. Census Bureau predicts there will be nearly 47 million seniors age 65 and up in 2015 and about 72.1 million seniors – nearly 20 percent of the population – by 2030.,

Here in Washington, the 65 and older population is expected to increase from 13.9 percent of the overall population in 2015 to 18.1 percent of the overall population by 2030.

Health concerns are a major issue for seniors, with nine of 10 older adults living with at least one chronic condition, such as diabetes, arthritis, hypertension or lung disease, according to the National Council on Aging.

Making matters worse, these conditions place a significant financial burden on seniors and, sometimes, their caregivers. As a result, there’s a clear need for access to affordable health care that meets the needs of individuals as they age.

As Seattle residents approach their 65th birthday, it is important for them to know their Medicare options, including when they can enroll and the types of health plans available. Continue reading

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Special exchange enrollment period for those with signup or billing problems begins today

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Coverage is hereA temporary special enrollment period begins today for those consumers who have experienced difficulties with enrollment in health plans on the Washington Healthplanfinder.

Insurance Commissioner Mike Kreidler authorized the special enrollment period this week as another option to those who feel they might need more help.

This voluntary special enrollment period starts Aug. 27 and runs through Nov. 14, 2014.

Only people who attest to having enrollment, billing, or payment issues with an Exchange plan may change plans during this time.

If you’re considering this option, you should be aware of all of the details involved, including the fact that you could lose a current premium subsidy.

Special enrollment may not be the best choice for everyone. But as the commissioner notes, “Hopefully, it will bring relief to some.”

 A list of answers to questions about this temporary special enrollment is available on the exchange’s website

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90 health plans OK’d for next year’s Exchange; Rates to rise a record low of 1.9%

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ACA health reform logoThe Washington State Office of the Insurance Commissioner (OIC) has approved 10 health insurers to sell 90 individual health plans inside Washington’s Exchange, Washington Healthplanfinder next year.

The overall approved average rate change is just 1.9 percent, significantly lower than the Exchange insurers’ original request of 8.6 percent, the OIC said.

Also, Kaiser Health Plan of the Northwest (Kaiser) and Moda Health Plan, Inc. (Moda) have been approved to sell 23 health plans inside the Washington Healthplanfinder Business, formerly known as SHOP.

Kaiser enrollees will receive an average rate decrease of 3.7 percent and Moda is new to the market and will be available statewide. Kaiser is available only in Clark and Cowlitz counties.

The Washington’s Health Benefit Exchange Board is scheduled to certify the approved insurers and their plans at its Aug. 28 board meeting. Continue reading

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Federal officials order Medicaid to cover autism services

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Jigsaw puzzle with one piece to add

Photo: Willi Heidelbach

When Yuri Maldonado’s 6-year-old son was diagnosed with autism four years ago, she learned that getting him the therapy he needed from California’s Medicaid plan for low-income children was going to be tough.

Medi-Cal, as California’s plan is called, does provide coverage of autism services for some children who are severely disabled by the disorder, in contrast to many states which offer no autism coverage.

But Maldonado’s son was approved for 30 hours a week of applied behavioral analysis (ABA), a type of behavior modification therapy that has been shown to be effective with autistic children, and she was worried that wasn’t enough.

So she and her husband, neither of whose jobs offered health insurance, bought an individual private policy for their son, with a $900 monthly price tag, to get him more of the comprehensive therapy.

“I don’t know any family that can really afford that,” says Maldonado. “We made some sacrifices.”

That should be changing soon. In July, the Centers for Medicare & Medicaid Services announced that comprehensive autism services must be covered for children under all state Medicaid and Children’s Health Insurance Program plans, another federal-state program that provide health coverage to lower-income children. Continue reading

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Special enrollment period for those having trouble signing up or with billing on health insurance exchange

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MKreidlerPhotoFrom the Office of the Insurance Commissioner

OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler announced a limited special enrollment period – effective Aug. 27 – for people who have experienced difficulty enrolling in health coverage through Washington’s Exchange, Washington Healthplanfinder, or who have had billing or payment issues.

The special enrollment period starts Aug. 27 and is scheduled to run through Nov. 14, 2014.

Anyone who has been unable to get or keep coverage in a plan through the Exchange because of an error in their enrollment, bill, or premium payment is eligible.

Only people who attest to having enrollment, billing, or payment issues with an Exchange plan may change plans during this time.

General open enrollment for 2015 individual and family coverage starts Nov. 15, 2014 and ends Feb. 15, 2015. Continue reading

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New birth control rules appear to track Supreme Court suggestion

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Top row (left to right): Associate Justice Sonia Sotomayor, Associate Justice Stephen G. Breyer, Associate Justice Samuel A. Alito, and Associate Justice Elena Kagan. Bottom row (left to right): Associate Justice Clarence Thomas, Associate Justice Antonin Scalia, Chief Justice John G. Roberts, Associate Justice Anthony Kennedy, and Associate Justice Ruth Bader Ginsburg.

Those who favor women being guaranteed no-cost birth control coverage under their health insurance say the new rules for nonprofit religious organizations issued by the Obama administration simply put into force what the Supreme Court suggested last month.

“We interpret what  [the administration] did to be putting into effect that order,” said Judy Waxman, vice president for health and reproductive rights at the National Women’s Law Center. She’s referring to the controversial Supreme Court order in a lower court case involving Wheaton College, a Christian school in Illinois.

The unsigned order agreed to by six of the nine justices said Wheaton College need not fill out and send to its insurance company a form opting out of offering the coverage. Instead, it could merely inform the government of its objections.

The new rules unveiled Friday require those with religious objections to providing some or all FDA-approved contraceptives to do exactly that – notify the government rather than their insurance carriers that they cannot provide the coverage. Continue reading

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Obamacare still ‘red meat’ for GOP candidates but focus of attacks shift

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JUPITER, Fla. – Beverly Hires, a former nurse running for Congress here in one of the nation’s rare competitive House races, ticks off her problems with the federal health care law: higher premiums, cancelled policies and employers cutting full-time jobs.

“The Affordable Care Act is not making insurance more affordable,” she said in an interview, citing many of the same criticisms as her five GOP opponents in the Aug. 26 primary, who are vying for the chance to oust first-term Democrat Rep. Patrick Murphy.

Hires’ messaging on Obamacare in this South Florida district targeted by the GOP tracks a pattern around the country as Republican candidates follow a focus-group tested script recommended by pollsters.

“The messages that work best are succinct, clear statements about the effects of Obamacare on consumers directly,” by increasing costs, taxes and taking away jobs, said Whit Ayres, president of North Star Opinion Research, a Republican polling group that’s surveyed likely voters to determine the best way to attack Obamacare. Continue reading

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Californians favor tougher rules on health insurance rates, survey

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California voters are showing strong early support for a ballot initiative that would expand the state’s authority to regulate health insurance rates.

Nearly 7 of every 10 respondents indicated that they would vote in favor of Proposition 45, while 16 percent would vote against it, according to an independent poll released Wednesday by the Field Research Corp. in San Francisco.

Proposition 45 would give California’s insurance commissioner the power to veto health insurance rate increases.

Proposition 45 would give California’s insurance commissioner the power to veto health insurance rate increases. Continue reading

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Some insurers refuse to cover contraceptives, despite health law requirement

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nuvaring contraceptiveBy Michelle Andrews
KHN

How much leeway do employers and insurers have in deciding whether they’ll cover contraceptives without charge and in determining which methods make the cut?

Not much, as it turns out, but that hasn’t stopped some from trying.

Kaiser Health News readers still write in regularly describing battles they’re waging to get the birth control coverage they’re entitled to.

“We’ve seen this happen, plenty.”

In one of those messages recently, a woman said her insurer denied free coverage for the NuvaRing.

This small plastic device, which is inserted into the vagina, works for three weeks at a time by releasing hormones similar to those used by birth control pills. Continue reading

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Healthplanfinder: ‘Moderately effective,’ could improve | HealthCare Checkup | Seattle Times

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report-card-thumbHow does Washington’s online exchange marketplace compare with those in other states?

As part of an ongoing study, the nonprofit Urban Institute assessed how well state exchanges created  under the Affordable Care Act provide the sort of information consumers want to know about insurance plans they’re considering buying.

via Healthplanfinder: ‘Moderately effective,’ could improve | HealthCare Checkup | Seattle Times.

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HMO, PPO, or EPO – Which Health Plan Is Best?

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What’s in a name? When it comes to health plans sold on the individual market, these days it’s often less than people think.

The lines that distinguish HMOs, PPOs, EPOs and POS plans from one another have blurred, making it hard to know what you’re buying by name alone–assuming you’re one of the few people who know what an EPO is in the first place.

“Now, there’s a lot of gray out there,” says Sabrina Corlette, project director at Georgetown University’s Center on Health Insurance Reforms.

Ideally, plan type provides a shorthand way to determine what sort of access members have to providers outside a plan’s network, including cost-sharing for such treatment, among other things.

But since there are no industry-wide definitions of plan types and state standards vary, individual insurers often have leeway to market similar plans under different names.

In general: Continue reading

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Premera to include Children’s in its networks – PSBJ

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Seattle Children's Whale LogoSeattle Children’s Hospital will be included in the Premera Blue Cross health insurance networks through 2017 as a result of an agreement that ends a lengthy legal dispute.

via Legal wrangling pays off: Seattle Children’s, Premera make nice – Puget Sound Business Journal.

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Are nurse practitioners, physician assistants encroaching on specialists’ turf?

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One of the hopes embedded in the health law was to expand the role of nurse practitioners and physician assistants in addressing the nation’s shortage of primary care providers. But a new study questions whether that’s actually happening in doctors’ offices.

Mid-level providers – PAs and NPs – “are doing invasive procedures and surgery. I’m not sure they were trained to do that.”

Of the more than 4 million procedures office-based nurse practitioners and physician assistants independently billed more than 5,000 times in a year to Medicare – a list including radiological exams, setting casts and injecting anesthetic agents – more than half were for  dermatological surgeries. Continue reading

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