January 2023 - My Blog

January 25, 2023

Affordable Health Insurance in Massachusetts

Massachusetts is a unique state when it comes to health care coverage. Massachusetts has become the model for health care reform for the nation. Of all states, affordable health insurance in Massachusetts is the most possible. There are cost-efficient public options subsidized by the state as well as many private and employer-sponsored plans from which to choose.

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Affordable Health Insurance in Massachusetts: Statistics

The average annual premium for an employee-sponsored health plan in Massachusetts after employee contribution was $1,110 in 2009. The average cost of one day in a Massachusetts hospital that would come out of your pocket if you do not have health insurance is over $2,100 per day. Massachusetts is in the top 3 in the U.S. when it comes to physicians, obesity, immunization, infant mortality and occupational fatalities, which makes the Massachusetts one of the healthiest states in the U.S.

Affordable Health Insurance in Massachusetts: The Health Connector

Massachusetts is the most insured state in the nation. Over 97 percent of residents have some form of health care coverage. Enacted into law in April of 2006, Massachusetts health reform has pursued the goal of near-universal health care in the state and has achieved it for the most part. The law requires adults who can obtain affordable health insurance in Massachusetts to do so. The Health Connector is a state agency of Massachusetts that aides residents of the state find affordable health care insurance and avoid tax penalties. Because health care coverage is mandatory, with some exceptions, tax penalties may be enforced if you fail to gain coverage. The Health Connector provides information concerning the public plans available, the cost of those plans, and qualification information for subsidized plans and the health care insurance exemption.

January 25, 2023

Plans For California Health Insurance Exchange Take Shape

California officials are working to make health insurance for California more affordable and value-based with plans for an Internet-based exchange. The plan is expected to not only help individual consumers, but to also help business owners struggling with escalating California health insurance rates.

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In California, health insurance premium increases have outpaced the rate of inflation by more than four fold. While the state’s overall inflation rate has increased 23.1 percent since 2002, California health insurance premiums increased by 117.5 percent.

In the legislature, attempts to bring rate increases under regulatory control were defeated by insurance companies in 2008, 2009 and 2010. Determined to gain authority similar to that already in existence in some other states where regulators can prevent unwarranted rate hikes, California legislators have proposed a like-minded bill in the current session.

California Health Insurance Exchange Is Based On Working Model

In Southern California, the country’s oldest and most successful California health insurance exchange already serves more than 150,000 members and almost 12,000 employers. CaliforniaChoice has been in operation for 15 years and provides a successful working model for the future exchange.

Growing out of the Affordable Care Act that became law in 2010, the new California health insurance exchange is meant to give consumers greater choice in health plans. Something similar to an Internet-based shopping mall is being designed to expand access for individuals and employers to see how health plans stack up to each other in side-by-side comparisons.

Health Insurance For California Will Provide A Standard Set Of Benefits

To protect consumers from the “small print” that can conceal exclusions and limits to significantly reduce coverage consumers may think they are buying, the California health insurance exchange will have a standard set of benefits. Health care services will cover specific benefits while offering different levels of cost sharing, such as co-pays and co-insurance.

The Affordable Care Act not only has provisions to make health coverage more transparent, but it also includes government subsidies to share access to health care with U.S. citizens who can’t afford the cost of California health insurance premiums. Financial help will be based on family

January 25, 2023

Why You May NOT Want to Use Your Health Insurance for Counseling

Why not use your health insurance for counseling? Isn’t that what it is for?

Perhaps.

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But using health insurance for mental health services is a little different than other medical issues. Sometimes mental health issues are not covered by your health insurance. Once you use your health insurance for mental health, you will have a mental health diagnosis on file – a mental health disorder/mental health illness must be on the insurance claim in order for insurance to pay for treatment. This will be in your permanent medical record.

Of course you want to consider using your health insurance for counseling, but there are some good reasons for you to consider why you may not want to use your insurance for counseling services.

Why doesn’t my counselor accept my health insurance?

Many counselors choose not to accept health insurance for very good reasons. They want to focus 100% of their time in treating you. If they accept health insurance, there is a lot of extra work involved in accepting insurance, in addition to agreeing to work for a discounted fee. The counselor may spend hours on the phone getting benefit information, authorizations, or following up on claims payments. The counselor has to wait a month for payment from the insurance company. The counselor has to file progress reports with the insurance company. The counselor is required to submit treatment reports and other details about your medical history with the insurance company.

It’s not that counselors don’t like insurance companies, or don’t want you to use your insurance (we have health insurance too!), but many counselors prefer to focus 100% of their time and energy in helping clients, rather than doing paperwork for insurance companies.

But this isn’t the only reason counselors may not be in network with your health insurance company.

The other reasons are more compelling, and you need to consider them BEFORE you decide to use your health insurance.

Many counselors prefer not to work in network with health insurance companies so that they can better protect your confidentiality. Any information (claims, reports, or treatment plans) filed with health insurance leaves the protection of their office and their locked files and your personal, private, emotional information is outside of your counselor’s office. In order for any insurance company to reimburse or pay for counseling (both in network and out of network), you must be considered “ill”. You must be diagnosed with a mental health illness or disorder. If you are not ill enough to warrant a diagnosis, then insurance will not pay for counseling services. If you do qualify for a mental health diagnosis, your illness will be listed in your permanent medical record. Many counselors don’t like this “medical model” of declaring s

January 25, 2023

Health Care Reform Made Simple

My name is John Ross and I have spent my entire 40 + year career in health care. Specifically, my background and experience is in developing and managing evidence planning, reimbursement applications, and health economics strategies for a number of fortune 500 health care technology businesses. In short, my job was to help the companies that I worked for to understand the health care market place from three important perspectives. The first was to answer the question; “What can we expect to be paid for the medical technologies we are developing and planning to market? The second question; “will the results and/or lower costs associated with the use of these medical technologies justify the payment level we think they deserve? Finally, what product development, marketing and sales strategies do we need to employ to insure that our future medical technologies are quickly accepted by hospitals, physicians, payers and patients? Obviously with such a focus I had to deal with Medicare (health insurance for folks over age 65 and the disabled), Medicaid (state-run insurance programs for the less fortunate) and commercial health insurance companies (the companies that insure and administer employer-based health insurance plans). I also spent a lot of time assessing the needs of physicians, hospitals and large integrated health care delivery networks that purchase and use a wide array of medical technologies.

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From a funding standpoint I have seen America’s health care system go from almost “anything goes” to today’s increasing focus on cost and outcomes. Outcomes, is just another way of asking the question; “for the dollars we are spending nationally or on a particular patient’s disease or injury are we getting a good value in return? In other words, is the price of the drug, medical device, procedure, diagnostic or surgical intervention worth the cost in terms of better results and lower costs compared to how we would traditionally manage this patient’s condition?

This blog is a forum for talking “honestly” about:

1. Where health care in America is going?

2. Why it is going there?

3. What can we expect from tomorrow’s health care system compared to what we have become used to?

4. What we can do to the best of our ability to use less of it (think preventive health strategies)?

5. How we should think about and help those unfortunate individuals, young and old, who need more of it than we do?

6. How can we help to make sure those who need health care get access to good health care when they need it?

7. What can we do to increase the chances that state of the art health care will be there when we need it and at a price we can afford?

I will also provide education as to how the health care system works from the various perspectives of the stakeholders. It is vital that we understand these perspectives, what drives them and the many conflicts that exist. Areas to cover will be:

January 25, 2023

Telemedicine in the Affordable Health Care Act Explained

Telemedicine is a significant part of the hearty and innovation driven Reasonable Consideration Act framework (Obama care) and gives roads to lessening costs in the new medical care structure, since it offers choices in how to get to medical care administrations.

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The Reasonable Consideration Act is the most extensive upgrade of the country’s medical services framework in many years and it’s execution and recruits will be in every way handled through commercial center trades.

What is going on with Telemedicine?

Telemedicine is the utilization of media transmission and data innovation to give clinical medical services without a conventional up close and personal meeting. It wipes out distance obstructions and can further develop admittance to advantageous clinical benefits for individuals with:

Essential or No Protection
High Deductible (HDHP) Protection
Conventional Protection

Tele-wellbeing Versus Telemedicine

‘Tele-wellbeing’ is a more established, more extensive term for administrations like wellbeing schooling and isn’t restricted to clinical administrations, while ‘Telemedicine’ barely centers around the genuine corrective perspective between the patient and medical care proficient. Instances of Tele-wellbeing are wellbeing experts examining a case via phone or leading mechanical medical procedure between offices at various finishes of the world.

Tele-Wellbeing has a more extensive degree than telemedicine and is at times called e-wellbeing, e-medication, or telemedicine. Medical services proficient use instruments like messages, e-visits, e-recommending, night-time care, e-updates, wellbeing appraisals, self-administration apparatuses, wellbeing instructing and so forth.

The Condition of the Market

The Reasonable Consideration Act (Obama Care) Health care coverage Trade (HIX) opens on Oct first, 2013. what’s more, goes into procedure on Jan first, 2014. The Obama Care trades, are State, Government or joint-run web-based commercial centers for health care coverage. Americans can utilize their State’s “Reasonable” Protection Trade commercial center to get inclusion from contending private medical care suppliers.

Moves toward Pursue Medical services Plans

Members enter individual data into an online interface
Become familiar with their qualification for sponsorships in view of pay, state-decided standards or manager based choices.
Utilize a value mini-computer to shop, look at and pick a best advantage wellbeing plan.

A few significant wellbeing organizations have programs like TelaDoc in Aetna, KP-OnCall in Kaiser and so on, attempting to set up tractions in a market that is broadly expected to quickly develop. All members need to do is research for telemedicine benefits through their health care coverage plans or pursue free projects.

How Medical care Experts Direct Telemedicine

Specialists can treat most regular wellbeing needs by telephone or a booked video counsel. A concentrate by the American Clinical Affiliation shows that 4 out of 5 visits to an essential consideration specialist might have been treated via telephone all things considered. After every meeting, patients will get a clinical report which can be messaged to an essential consideration doctor.

January 24, 2023January 24, 2023