Employer health insurance

What do you mean my doctor is not accepted in your network? I asked if they accept my insurance before I went!

I read a post in the NAHU agents blog today that said “..Always add the caveat that the client needs to confirm with the doctor/hospital that their insurance is in fact accepted, ideally in an e-mail.”  (NAHU (nahu.org) is the National Association of Health Underwriters and is the professional organization for people like me who work in health insurance and employee benefits.)

OK back to the subject. Yes it is important to ask if your physician “accepts” your  insurance but it is even more important to ask  “Are you a contracted provider?”

The majority of medical providers will say yes if you ask if they accept your insurance. (unless it it Medicare and they may say they do not accept Medicare patients.) This does not mean they will be “in network” and thus be subject to the contracts that limit what the physician may charge you.

Here are some terms you need be aware of:

Contracted Provider: A medical provider who has agreed to a contract to provide services for a medical plan that you are a currently covered by.

Balance billing: If you use a “non contracted” provider they may accept what your insurance pays and then bill you for the “balance” which is whatever they feel remains of the bill.

Out of Network: This refers to a provider that is not contracted with the network of medical providers you have an agreement with. They may tell you they “accept” your insurance but they do not have to accept any limits from your insurance nor PPO network.

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For more information, contact Bill Weaver, Focus Benefits Group, 602-381-9900.

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That wellness and outreach health insurance stuff is a lot of touchy feely baloney!

How many times have I been told that one? Who is counting?… is a frequent response.

Wellness programs have become an industry of their own and I would tend to agree that many of them are over designed or just ineffective, but as a concept it is sound practice and employers who ignore this tool are making a mistake.

Let’s look at a story from AHIP today: “Chronic hypertension may increase risk of pregnancy complications” . There is the obvious human response that nobody wants to risk damage to somebody’s child. But many business owners might respond that they provide a quality medical plan and it is the mothers responsibility to be healthy for her child’s sake.

So let’s look at this from a less emotional perspective. What impact might hypertension and child birth have on an employer?

1. The hypertension may lead to a premature birth. The march of dimes reports that an  average preemie might cost $49,000 in year one versus $4.551 for a standard full term healthy baby.

2. Neonatal ICU costs average $3,000 per day, again that goes to the bottom line on the medical plan.

3. Parents incur a host of non covered costs (eg. hospital parking, co-insurance costs, child care for the children at home) which translate to stress on the employee and time off work.

4. If the mother is the employee she will be making a disability claim and if the child is premature she will be looking at FMLA. Each of these cause a loss of productivity not just for the mother but her concerned associates.

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For more information, contact Bill Weaver, 602-381-9900, Focus Benefits Group

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Alert: Human Resource Directors of Companies with Over the Road Truck Drivers.

HR directors of Companies with Over the Road Truck Drivers and probably any truck driver affected by DOT regulation, need to be paying attention to a deadline of May 21, 2014.

I know, “What another deadline I wasn’t aware of?”

Actually if you are the HR director for a company with these DOT regulated drivers you probably knew that the rules are changing for DOT medical examiners and physicals. But in the event that you had missed that somewhere along the line it is a big deadline on May 21. 2014.

Here is a small section of the wording from a very big document:  “National Registry of Certified Medical Examiners DATES: Effective on May 21, 2012. Compliance required beginning on May 21, 2014″

SUMMARY: FMCSA establishes a National Registry of Certified Medical Examiners (National Registry) with requirements that all medical examiners who conduct physical examinations for interstate commercial motor vehicle (CMV) drivers meet the following criteria: complete certain training concerning FMCSA’s physical qualification standards, pass a test to verify an understanding of those standards, and maintain and demonstrate competence through periodic training and testing. Following establishment of the National Registry and a transition period, FMCSA will require that motor carriers and drivers use only those medical examiners on the Agency’s National Registry and will only accept as valid medical examiner’s certificates issued by medical examiners listed on the National Registry.”

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For more information, contact Bill Weaver, Focus Benefits Group, 602-381-9900!

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