Category Archives: Health Insurance

‘Pastoral counselors’ help fill mental health gap in rural states

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Mental health therapists most often leave issues of faith outside their office doors, even for patients who are religious. But one class of counselors believes a nonsectarian model doesn’t serve everyone equally well.

“On a feeling level, people want a safe, respectful place, to ponder the tons of questions that come begging in hard times,” said Glenn Williams, a pastoral counselor in Kentucky and chair of the Kentucky Association of Pastoral Counselors. “Where is God?  Why did this happen?  Is it karma, sowing-reaping, happenstance?  What purpose does this suffering serve?”

Six states allow these counselors – who include faith and spirituality in their work – to be licensed mental health counselors, which can make it easier for them to get health insurance reimbursements.

Williams, who works at the St. Matthews Pastoral Counseling Center outside Louisville, said many of his patients are quite “intentional” about their preference for pastoral counselors over other mental health professionals.

Kentucky recently became the sixth state (joining Arkansas, Maine, New Hampshire, North Carolina and Tennessee) to allow pastoral counselors to become licensed mental health counselors. Continue reading

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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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Hospitals rethink charity care for those declining coverage

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This KHN story also ran in wapo.

As more Americans gain insurance under the federal health law, hospitals are rethinking their charity programs, with some scaling back help for those who could have signed up for coverage but didn’t.

The move is prompted by concerns that offering free or discounted care to low-income uninsured patients might dissuade them from getting government-subsidized coverage.

“Applicants who refuse to purchase federally-mandated health insurance when they are eligible to do so will not be awarded charitable care.”

If a patient is eligible to purchase subsidized coverage through the law’s online marketplaces  but doesn’t sign up, should hospitals “provide charity care on the same level of generosity as they were previously?” asks Peter Cunningham, a health policy expert at Virginia Commonwealth University.

Most hospitals are still wrestling with that question, but a few have gone ahead and changed their programs, Cunningham says. Continue reading

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Hospitals seek to help patients with Obamacare premiums

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This KHN story also ran on .

Low-income consumers struggling to pay their premiums may soon be able to get help from their local hospital or United Way.

Some hospitals in New York, Florida and Wisconsin are exploring ways to help individuals and families pay their share of the costs of government-subsidized policies purchased though the health law’s marketplaces – at least partly to guarantee the hospitals get paid when the consumers seek care.

But the hospitals’ efforts have set up a conflict with insurers, who worry that premium assistance programs will skew their enrollee pools by expanding the number of sicker people who need more services.

“Entities acting in their [own] financial interest” could drive up costs for everyone and discourage healthier people from buying coverage, insurers wrote recently to the Obama administration. Continue reading

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Variation in hospital charges for blood tests called ‘irrational’

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RedBloodCellsBy Roni Caryn Rabin
KHN

One California hospital charged $10 for a blood cholesterol test, while another hospital that ran the same test charged $10,169 — over 1,000 times more.

For another common blood test called a basic metabolic panel, the average hospital charge was $371, but prices ranged from a low of $35 to a high of $7,303, more than 200 times more.

The wide disparity in hospitals’ listed charges for routine blood tests at California hospitals was revealed in a study published in the August issue of BMJ Open. The study examined the listed charges for routine blood tests performed in 2011. Continue reading

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More employers limit health plan networks but seek to preserve quality, says adviser

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Dr. Robert Galvin is chief executive officer of Equity Healthcare, where he works with executives of nearly 50 companies that purchase health coverage for 300,000 people.

Question Q&AGalvin says the 2010 Affordable Care Act has made employers more engaged in health benefits while encouraging their workers to be savvier health care consumers.

“I think what the ACA has done more than anything is it has made every employer examine their strategy and in every case it’s bringing the CFO and the CEO” into decisions about the company’s health care, which often didn’t use to happen, he said.

Galvin also sees the move to offer workers plans with limited numbers of doctors, hospitals and other providers as increasing, but says most companies are eager to make sure those networks offer adequate quality assurances and that employees are given the option of using other providers if they want to pay more for their care.

Equity Healthcare is a wholly owned subsidiary of Blackstone, a global investment and advisory firm.

Galvin spoke recently with KHN’s Mary Agnes Carey to discuss the Affordable Care Act and how it is changing the way companies of all sizes purchase health insurance.  What follows is an edited transcript of that conversation. Continue reading

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Deadline looms to provide proof of citizenship for health insurance

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Alert Icon with Exclamation Point!If you have received a letter from the federal health insurance exchange asking for proof of citizenship, you have until September 5th to reply or you will lose your health insurance coverage by the end of the month, the government warns:

Here are the details from HealthCare.gov

Continue reading

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One in seven employers to offer low-benefit ‘skinny’ plans

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Nearly one company in six in a new survey from a major employer group plans to offer health coverage that doesn’t meet the Affordable Care Act’s requirements for value and affordability.

Many thought such low-benefit “skinny plans” would be history once the health law was fully implemented this year.

Instead, 16 percent of large employers in a survey released Wednesday by the National Business Group on Health said they will offer in 2015 lower-benefit coverage along with at least one health plan that does qualify under ACA standards.

The results weren’t unexpected by benefits pros, who realized last year that ACA regulations would allow skinny plans and even make them attractive for some employers.

But the new survey gives one of the first looks at how many companies will follow through and offer them. Continue reading

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Must a divorced dad cover adult kids? Will Medicare pay for infusion therapy?

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This week, I answered questions from readers about the obligation of ex-spouses to provide children with health insurance once they’re adults, Medicare coverage of home infusion therapy and how to calculate eligibility for subsidies on the state marketplaces.

Q. My ex-husband has been responsible for providing health insurance for our kids until the age of majority. My sons are now 21 and almost 18.

My ex has family coverage for himself and his new wife, but he wants me to put the kids on my insurance now that they have reached the age of majority.

Covering the kids doesn’t cost him anything extra, but for me to switch from a single plan to a family plan is an extra $175 a month and I can’t afford it.

Since the age of majority for health insurance is now 26, is it possible he still is required to keep them on his insurance? Continue reading

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Health Care For $4: Are You Ready For Walmart To Be Your Doctor?

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Walmart logoAfter years of “Will they or won’t they?” discussion, Walmart is making its long-awaited move into delivering primary care: The retailer has quietly opened a half-dozen primary care clinics across South Carolina and Texas, and plans to launch six more before January.

via Health Care For $4: Are You Ready For Walmart To Be Your Doctor?.

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If you have a stroke, better it should be in Paris

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Frank Browning (Photo by Christophe Sevault)

Frank Browning. (Photo by Christophe Sevault)

Frank Browning writes from Paris
KHN

I had a stroke last month, oh boy.

It’s just that I didn’t know it. Here’s what happened:

Only after three days of flashing, floating visual squiggles — commonly known as ocular migraines that usually last 20 minutes — do I email my old friend Dr. John Krakauer, who helps run stroke recovery at Johns Hopkins Hospital in Baltimore.

After a few questions he told me to get an MRI scan as soon as possible.

In the U.S. that could involve the emergency room (with its hours-long wait) or a complicated process of getting the referral — and then finding a radiologist who would take my coverage.

Here in France, it is so much simpler. Continue reading

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Health Law calls for some workers to be automatically enrolled in coverage

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Newly hired employees who don’t sign up for health insurance on the job could have it done for them under a health law provision that may take effect as early as next year.

But the controversial provision is raising questions: Does automatic enrollment help employees help themselves, or does it force them into coverage they don’t want and may not need?

A group of employers, many of them retail and hospitality businesses ,want the provisions repealed, but some experts say the practice has advantages and is consistent with the aims of the health law. Continue reading

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When health care prices stop being hidden, and start getting real – Vox

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Twenty-dollar bill in a pill bottleOver the past two years the Blue Cross and Blue Shield health plans have been running a quiet experiment, to see what would happen if prices became available in some cities but not others. And they found that just the act of making prices available can have a really dramatic impact on what they had to spend to get patients a very basic procedure.

via When health care prices stop being hidden, and start getting real – Vox.

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