Archive for February 11th, 2013

TPA’s To Pay For Birth Control

Monday, February 11th, 2013

Apparently I am going to be spending a fortune on birth control, sadly I don’t expect I will have time to use any of it.

“The preamble to the proposed rule suggests several ways in which this could be done, but the basic idea is that the TPA would take responsibility for providing coverage, and in turn contract with an insurer in the individual market to provide the coverage.  The insurer would in turn pass the cost of the coverage (which now will be a real cost since the insurer has no responsibility for covering maternity or any other health care costs) on to a federally facilitated exchange (FFE), which would offset the cost through a reduction in user fees — in other words, the insurer would receive a reduction in the user fee it otherwise owes to the FFE to cover both its costs and any administrative costs incurred by the TPA.”

That’s just the summary. Where to begin….
I have never seen a contraception-only policy before; are they even legal to sell?
I need to find a carrier, send them eligibility on a regular basis, and not got paid for any of it?
I am going to be really pissed if some carrier has a data breach and exposes PHI or Red Flag Data and I have to deal with the cost for services I didn’t get paid for; I haven’t seen any mention of immunity.
Will MLR apply to these policies? I foresee a lot of work to provide a small dollar benefit. In fact, I could see the administrative cost being higher then the cost of the drugs.
And who gets the rebates?

“Insurers providing contraceptive coverage would be responsible for notifying plan participants and beneficiaries of the availability of the coverage using language found in the proposed regulation.  The notice would be provided separately from any other plan information, generally on an annual basis.”

There starts the excessive administrative fee.  Apparently single males would also need to be offered this policy and notice?
Fraud potential in this is huge: I don’t see where anyone is asking the TPA to verify who these policies are being purchased for.

Source: Insureblog

Draft Dodging

Monday, February 11th, 2013

As Bob noted last week, some of the 58 states have begun to take a serious look at how their Exchanges (if any) will be run. A key issue is the role of agents/advisors, and how they’re to be qualified and compensated.
Now comes word that HHS Secretary Shecantbeserious is planning to “start registering agents and brokers around July 1.”
Okay, when you’re through laughing, we can continue.
Have you noticed the little countdown timer in our sidebar? That’s the countdown to the day the Exchanges are to go “live.” The date? October 1st. Now, keeping this in mind, wrap your head around this:
The federal exchange managers want to promote the agents by publishing lists of individual exchange producers starting in August and lists of the producers registered to sell Small Business Health Options Program (SHOP) exchange coverage starting in September.” [emphasis added]
Now, given the institutional efficiency for which the HHS is so widely admired, what are the odds of this actually working out?
Yeah, that’s what I think, too.
Anther question we might be asking ourselves is whether or not any sane insurance agent wants to participate. After all, under a state-regulated system, worst case scenario is generally a fine and/or loss of license. But these are (presumably) going to be subject to Federal laws, so the down-side must surely be more serious, no?
Which is not to say that it won’t happen (I’m still on the fence, for example), but it does give one pause. And since that clock is clicking down at a pretty good clip, this may end up being a rather high-stakes game of chicken with Ms Kathy.
Editor’s Note: Source: Insureblog – great blog!

What Does A Hip Replacement Cost?

Monday, February 11th, 2013

“If one hospital can put in a hip for $12,000, then every hospital should be able to do it. When there’s 100 percent variation in sticker price, then there is no real price. It’s about profit.”