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Insurance Industry "Concerned" About Mandatory Adoption of Health Policy Summary Form Print E-mail
Written by Bernd Wollschlaeger, MD   
Wednesday, 31 August 2011 17:16

IN MY OPINION


A recent article in WSJ reports that, as part of the health-care overhaul law, federal regulators will unveil the proposed health insurance policy summary form.  This will lay out the details of each policy, from deductibles to how much it might cost to have a baby. The requirement is supposed to take effect next March.  Currently, states mandate certain disclosures from health insurers, but they vary by state. The information often comes as part of a document known as the certificate of coverage or evidence of coverage, which can run to dozens of densely written pages and is often supplied ONLY AFTER a consumer has signed up for a policy. Employers offering coverage typically provide materials to their workers, but these also don't follow any common national format. 

The proposed new summary is expected to closely follow a draft version from a committee convened by the National Association of Insurance Commissioners, people with knowledge of the matter said.  Health and Human Services is expected to finalize the form after a public comment period. Insurers said they were concerned about the potential cost and administrative burden of the new requirement, particularly if they have to create different iterations of the form for every possible plan design a consumer could explore and for every single employer.
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"Insurance companies will make every effort to maintain the status quo, which disenfranchises the consumer." 

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Of course they are concerned because for the first time the policies will be readable, comparable and can form the basis of rational decision making in a complex market place.  Who does understand his/her current health care policy? I don't!  I still struggle to understand how much my insurance will cover for a colonoscopy and how much I have to budget for this procedure.  If we want a free market place then we should allow for measures that create accountability and transparency.  Currently, insurance companies will make every effort to maintain the status quo, which disenfranchises the consumer.  We should support this new federal regulation and express our opinions during the public comment period.  Let's not miss this opportunity.  
 
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Last Updated on Wednesday, 07 September 2011 16:51
 
READER RESPONSE (late August 2011) Print E-mail
Written by Various Readers   
Wednesday, 24 August 2011 18:25

RE:  Entitlement Reform

In a recent CNNMoney.com article about the Eurozone, the author stated "The high government debt loads threaten to trap countries in a vicious cycle: The debt weighs on economic growth -- and austerity measures aimed at attacking the debt only put a further drag on their economies."  This is the reality for the US as well.  Remember too that the government will choose cuts to providers as more politically practical than cuts to beneficiaries.  Although in the end both will suffer a lot.

Healthcare Consultant, N. Miami


RE:  Pay Per Call Arrangements

I would point you to FL Statute 817.505 which prohibits pay-per-call arrangements in Florida.  There is an exception for "referral" services under section (3)(i) of this statute, but even this exception prohibits linking a fee to substantive lead, as this could clearly be interpreted as "...based on the potential value of a patient or patients..." (Which is prohibited under Section (3)(i) 4. of the statute.

Healthcare Banker, Broward County

Click HERE  to submit your comments to Reader Response

Last Updated on Wednesday, 24 August 2011 18:37
 
READER RESPONSE (early August 2011) Print E-mail
Written by Various Readers   
Wednesday, 10 August 2011 10:27

Regarding Examining the Demographic Bulge and the Dynamics of Capitalism:  Why the Pundits are too Gloomy

Well said. I also remain confident. There is no movement without friction. Every generation has had its obligation to overcome immense obstacles at long odds.  America may get a downgrade from S&P and Moodys, but I remain bullish. I think most of us are positive even with the bad news. It's part of our American DNA.  -IDTF Owner, Miami


Regarding ASK BEN

Thank you for publishing Mr. Frosch's columns.  His advice and insights are invaluable. -Practice Administrator, Orlando
Last Updated on Wednesday, 24 August 2011 18:36
 
Examining the Demographic Bulge and the Dynamics of Capitalism: Why the Pundits are too Gloomy Print E-mail
Written by Jeffrey Herschler   
Wednesday, 03 August 2011 13:15

LEARNING TO CRAWL     

It's pretty depressing reading the newspapers these days.  I speak metaphorically when I say "reading the newspapers".  Clearly online reading is replacing traditional print media at an exponential rate.  But more on that later.  According to the experts, we are heading to Hell in a Handbasket because of unfunded entitlement programs, a demographic bulge and anemic growth.   Add to that runaway inflation caused by an historic increase in money supply (see hilarious and cynical video on The Quantitative Easing).  Admittedly the Great Recession and chronic budget deficits have left us with a full plate of challenges.  But it's not as bad as the prophets of doom have made it out to be.  Here's why.  READ MORE.
Last Updated on Wednesday, 03 August 2011 13:40
 
Federal Budget Cuts Threaten Graduate Medical Education Print E-mail
Written by Bernd Wollschlaeger, MD   
Wednesday, 27 July 2011 17:03

In their efforts to reduce the federal deficit the partisan negotiators seem to agree on one issue only: drastic cuts of the Medicare subsidy for postgraduate medical education and funding reduction for advanced equipment that teaching hospitals require to train young doctors.

The recommendations made by the National Commission on Fiscal Responsibility and Reform, currently under consideration, would cut about $5.8 billion in graduate medical education funding from the nation's teaching hospitals. This represents a 53% cut compared to the current $10.9 billion in payments!! The Simpson Bowles Commission, which advised President Obama on debt and deficit reduction, called in December 2010 for reducing "excess" payments to hospitals for medical education. The commission said the payments could be brought in line with the costs of medical education by limiting the direct subsidy to 120 % of the national average salary paid to residents. A second, indirect subsidy, which pays for intensive services and advanced equipment, should also be reduced.  

The proposed draconian cuts will jeopardize the sorely needed expansion of graduate medical education in the U.S. and exacerbate the looming physicians’ shortage. Who will care for the baby boomers seeking medical services? Who will provide primary care physicians once millions of Americans gain access to healthcare coverage in 2014?

The proposed measures are based on penny wise and pound foolish approaches to cover our federal deficit and ignore the long-term investments needed to protect our crumbling healthcare service infrastructure in the U.S. The suggestions were developed by politicians with a limited political life cycle.

I suggest a review of thoughtful proposals such as the Nineteenth Report by the Council on Graduate Medical Education (COGME) entitled "Enhancing Flexibility in Graduate Medical Education" before throwing out the baby with the bath water.

The future of our healthcare is at stake and politicians must step aside to let experts take charge.    Comment on this Story

Last Updated on Wednesday, 03 August 2011 13:15
 
READER RESPONSE July 2011 Print E-mail
Written by Various Readers   
Thursday, 14 July 2011 09:07

When Ideology Trumps Common Sense and Compassionclick headline to view post in its entirety

In the past week, Florida lawmakers turned down a $2.1 million federal grant that would pave the way for the state to receive $35 million in federal funding that would move elderly and disabled patients from nursing homes to their own homes during the next five years. With the help of this federal funding elderly people could be moved out of nursing homes to independent-living facilities or to support care at home with their families resulting in less money to be spent on nursing-home care. Republican legislators defended their refusal of the latest federal grant, known as the Money Follows the Person funding...Is there any hope that rational thought will prevail in Tallahassee? -Bernd Wollschlaeger, MD

RE:  Medicare Reform 

According to a CNNMoney.com article posted on July 8... "Democrats have spent a lot of time lambasting Republicans for supporting a Medicare reform plan from House Budget Chairman Paul Ryan. They excoriate it as 'destroying Medicare as we know it.'"  When will the Progressives realize that Medicare as we know it is unsustainable and must be destroyed?  Over utilized and plagued with fraud, the Medicare Program's time has come and that's a good thing for young and old, for conservatives and liberals!  -Healthcare Professional, Ft. Lauderdale   

Re:  Doctor Accountability vs. Patient Justice

Medical liability reforms such as HB-479 are bad for everyone except those hospitals and doctors who make mistakes that hurt patients.

Is it fair to limit the recovery of a patient who is the victim of a wrong leg surgery...by a doctor who had performed ANOTHER wrong leg surgery just a year before?

I represented a client in just that situation.

Some claim that the new legislation promotes a friendlier place to practice medicine.

Is "friendly" really what the citizens of Florida deserve or need?

How about safe and accountable?

What do you think?

 -John Leighton, Leighton Law  | www.LeightonLaw.com

888.395.0001 | DearJohn@LeightonLaw.com

Re: Understanding HB 155:  Is this a Joke?

It's not a joke and FAFP has joined in a lawsuit with other medical physician organizations to try and declare the law unconstitutional. These are nasty times.

 -Tad Fisher, Executive VP, Florida Academy of Family Physicians

New Jersey license has a statement on their license renewal to waive your  rights.

 -New Jersey Physician

Re:  Unfunded Entitlements

The Greek debacle is a cautionary tale.  We must face down the budget crisis now to avoid the chaos recently seen in Athens.  Greece has become a nation of corrupt and entrenched bureaucrats, idle rich and a disillusioned workforce that has largely forgotten how to hustle and innovate.  If our leaders don't lead, the US is headed down that same path.  The nation that perfected democracy has to avoid the Hell being endured in the country that invented it.  -Healthcare Executive, Miami

Last Updated on Saturday, 23 July 2011 18:43
 
Playing The Odds: Hedge Funds Finance Medical Malpractice Claims Print E-mail
Written by Jeff Segal, MD, JD, FACS, Michael Sacopulos, JD and Wayne Oliver   
Thursday, 07 July 2011 09:36

IN OUR OPINION

Investors are always looking to earn an easy profit, particularly from well-managed companies. But when the profit is from a hedge fund that finances medical malpractice lawsuits aimed at driving doctors out of the profession, Wall Street may have gone too far.

An entirely new industry has cropped in recent years as trial lawyers set their sights on making money off physicians, corporations and other targets--particularly financing malpractice suits through hedge funds. In 2010, hedge funds invested $1 billion in these types of suits, much of it for medical malpractice cases.

Frivolous lawsuits are helping drive physicians out of the profession and pushing up the cost of health care. A Gallup-Jackson health care survey released last year found that $1 in every $4 spent in health care is for unnecessary tests and procedures that doctors order to prevent from being sued.

Click here to read more.                                   

Forbes.com Commentary - June 23, 2011

 
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