UHC Says Maybe Not

The Obamacare exchanges are (allegedly) less than a year away and one of the largest health insurance carrier in the country may not be ready to walk down the aisle and get hitched.

**UnitedHealth Group Inc. CEO Stephen Hemsley told analysts the insurer's involvement in online exchanges that are expected to help millions buy coverage will depend on whether it's financially viable for the company.

"We will only participate in exchanges that we assess to be fair, commercially sustainable and provide a reasonable return on the capital they will require," he said.**

Star Tribune

Well this should be fun.

Proponents of the overhaul say the exchanges will help restrain premium hikes because insurers will be competing against each other as customers compare several policies side by side to find the best match.

Obviously written by someone who has no clue and has only listened to sound bites from politicians.

This reminds me of the chant from the 60's:

"Suppose they gave a war and nobody came."

More ObamaTaxes

And in case you were wondering about your W-2: no, it's not just your withholding that'll be affecting your take-home, it's the ObamaTax at work, as well:

"Beginning for the 2012 calendar year, certain employers are required to report in Box 12 of the IRS Form W-2 provided to their employees, the aggregate cost of employer-provided health care coverages."

That's just one of a litany of new tax-related rules that took affect 3 weeks ago. Courtesy of Assurant Health, an easy-to-follow recap of the new W-2 rules and regs is available for download here.

Get 'em while they're hot (or not).

Shecantbeserious hits bottom, keeps digging

[UPDATE: Looks like Nate has scooped me!]

Words fail:

"When patients pay for medical care out of pocket, they should be able to keep doctors and hospitals from telling their health insurers about the care."

This advice is just part of a new, 560+ page compendium of final rules and regs just released by Madame Secretary and her minions. Masochistic readers may peruse them at their leisure here. Oh, and in case you're wondering, the initial projected cost of implementing these new rules is up to $225 million, and up to $43 million annually after that. I think that's low-balling it.

Among the many wonderful new rules are more onerous compliance requirements on private health info, while at the same time expanding school vaccination programs and the sending of a deceased's health information (he's dead, Jim) to survivors.

But the most egregious part is this little gem:

"[A]nother provision restricts "disclosures to health plan concerning treatment for which  the individual has paid out of pocket in full"

The problem is that this hinders insurance carriers from accurately pricing the risk, and it's going to be a major problem for in-network providers, whose contracts generally include this kind of disclosure. Not to mention, how does the doc (or his office staff) know which info to pass along, and which not?

As usual, the rocket surgeons now running our health care system leave a lot to be desired.

ADDENDUM: Our resident Medical Office Manager, Kelley B, noticed something, um, odd:

This is the dumbest thing I have read today:

"Commenters also asked what providers should do when patients said they would pay for sensitive care out of pocket but failed to pay for it"

Uh, if the patient presents at checkout and states he will pay for the service, he does not want it billed, then the money is collected right there, there is no billing the patient, as there is no electronic billing.  If he says, "oh I didn't know you would want my money now," then we tell the patient, too bad, so sad, but now we will bill insurance.

HHS Codifies Insurance Fraud

I would love to see a list of which other industrialized nations with healthcare spending half ours has laws like this;

http://www.lifehealthpro.com/2010/07/08/hhs-doctors-can-help-patients-hide-care-from-plans

"If, for example, a patient received care for asthma and for diabetes from the same physicians and paid for the diabetes-related care out of pocket, the patient could keep the physicians from telling the health plan about the diabetes, officials say.

The health care provider or other covered entity could still contact the health plan if the patient did not really pay the full out-of-pocket costs for the care. If, for example, a patient's check bounced, a provider could contact the health plan for payment, officials say."

So hiding information from your healthplan who is being told to better manage health and cost is going to be law, sounds counter productive.

Plans have filing limits, if the doctor waits until the patient doesn't pay they might miss the time they have to file for reimbursement under the plan, or will plans now also be required to extend the time to file claims based on employees wanting to hide information form them. Not to mention the mess that makes of reinsurance contracts.

My advice to clients, this is reason 328 to go back to reimbursement plans. Dump the PPO and assignment of benefits and let members submit claims and be reimbursed at plan allowable. Solve not only this issue but excessive provider cost as well.

An after thought, employee suffers some condition related to smoking which they lie and tell their healthplan they do not do in order to get the lower premium. In order to continue paying the lower premium they hide any claims related to smoking. Until they get major claim at which time they let the plan pay. 

On Medicare and The ObamaTax

A friend of mine just posted this on his FaceSpace page:

"Participating in one of my favorite annual activities (not)........trying to determine why Medicare cannot accurately, efficiently bill me for my premium! Starting my second year on Medicare, and premium for February is different than January. Same thing happened last year. Last year it took three months for Medicare rep's to give an explanation of why my premium changed during my first quarter on Medicare. Good thing I have a sense of humor."

And folks think that these same bureauweenies can run the rest of our health care system any better?

Finally: Some good news from the Much Vaunted National Health System©

It appears that a significant number of providers have had enough with treating illegal immigrants:

"While [MVNHS©] hospitals are allowed to charge foreign patients for treatment if they do not come from a country with a reciprocal arrangement, GPs are forced to take on people without charging."

What to do, what to do?

Ah:

"A survey of GPs has found that the majority think this is too generous and the rules should be changed."

The docs claim that the rules themselves are quite confusing, and reimbursement levels for illegals is significantly reduced. They even manage to work in medical tourism as a potential culprit. In an eerily prescient statement, Dr Paul Roblin, who chairs the Berkshire, Buckinghamshire and Oxfordshire Local Medical Committee, notes:

"GPs are expected to practice with limited healthcare funding and if we are using that money for treating visitors, the taxpayer loses out."

On this side of The Pond, we call that The ObamaTax.

Cavalcade of Risk #175: Call for submissions

Julie Ferguson hosts next week's Cav. Entries are due by Monday (the 21st).

To submit your risk-related post, just click here to email it.

You'll need to provide:

■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like). And please only submit if you are willing to link back to the carnival if your submission is accepted.