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Stephanie Cohen, Scott Golden, Jack Cohen

MAY NEWS FROM GOLDEN & COHEN

Highlights from The Atlantic Magazine's April 20 Health Care Reform Summit in Washington, DC

By Scott Golden, CFO
Scott@Golden-Cohen.com

On behalf of Golden & Cohen, I was invited to attend a recent invitation-only Health Care Reform Summit hosted by The Atlantic magazine. Featured speakers included Congressman Henry Waxman, Henry Aaron of the Brookings Institution, Christopher Dawes of the National Association of Children's Hospitals, Henry Fineberg of the Institute of Health, and Ambassador Nancy Brinker, founder and CEO of the Susan G. Komen for the Cure.

The event was broken into three panel discussions, which included conversations about "the system," "the patient," and finally Congressman Waxman (pictured below) was interviewed by The Atlantic's senior editor Joshua Green about health care reform.

While I found all of the discussions interesting and insightful, the conversation about the monetary ramifications intrigued me most. Here's why.

Without exception, each panelist embraced the new bill. Many stated that this bill was long overdue; the emphasis seemed to be on access, which makes sense as this is what the bill does best.

One of the biggest concerns was about cost. There was recognition that there would be a great burden in terms of rolling out this bill, especially on the state level as it pertains to Medicaid. No one on the panel was confident about controlling the costs in the short or long-term. All agreed that the bill needs to be funded, but were unsure as to whether the bill addresses that issue fully.

I was also fascinated by Congressman Waxman's description of the process involved in arriving at the bill. He equated the process to "sausage making." That is, lots of stuff went into creating the bill – some of the ingredients you want to know about, and some you don't.

The bottom line

In a nutshell, Waxman said the health care reform bill represents many compromises, and he was confident that the bill would not be repealed as there are lots of things that people will like in it. "It would be equivalent to taking a new toy away from a baby," he said. "No one wants to do that once the baby has that toy."

In fact, each of the speakers said they believe that the players are taking a wait-and-see approach. It is clear that no one – from legislators to health care administrators – is sure what the bill's ultimate impact will be, and there are still plenty of elements that are unknown because roll out for the bill is extended over a number of years.

From everyone at Golden & Cohen, we hope the legislators make this bill the best sausage it possibly can be. Here's to your good health!

Stephanie Cohen, CEO, stephanie@golden-cohen.com
Scott Golden, CFO, scott@golden-cohen.com
Jack Cohen, COO, jack@golden-cohen.com

HEALTH CARE REFORM UPDATE: Dependent Care Coverage Policy Market

By Jack Cohen

The "Patient Protection and Affordable Care Act of 2010," as amended by the "Health Care and Education Reconciliation Act of 2010" (together referred to as the health care reform law), includes provisions to extend health care coverage on parents' policies to adult children.

Specifically, this provision extends coverage to adult children up to age 26 on their parents' policies, for plan benefit years beginning September 23, 2010.

Recognizing that many young people may lose their coverage because of their age, student status, including graduation from school, or other factors, CareFirst has joined with 38 other independent Blue Cross and Blue Shield plans to accelerate the extension of dependent coverage to June 1, 2010. This extension of coverage applies to all CareFirst members insured under our individual, direct-to-consumer plans, as well as members who receive CareFirst coverage through their employer's fully insured plan.

After June 1st, qualified dependents may enroll for coverage under their parents' policies, beginning on the first of the month following their enrollment. (i.e., dependents who re-enroll on June 5, 2010, will be covered beginning July 1, 2010). There will be no opportunity for retroactive enrollment for these dependents.

As of June 1st, eligible dependents may enroll and secure coverage under their parents' policies. A dependent qualifies if he/she:

  • Is under the age of 26; and is not eligible for coverage under an employer-sponsored health plan (applies only to group plans).
  • A married dependent does qualify, but his/her spouse and children do not.
  • Fully insured groups and/or their agents/brokers will be responsible for ensuring that they perform any validity checks with regards to dependent eligibility. In addition, employers are also required to notify their employees of the details of this provision.

Have questions? We're here to help clarify this information. Send an email to Jack@golden-cohen.com.


NEWS YOU CAN USE FROM GOLDEN & COHEN

Take Control of Your Healthcare: Talking To Your Doctor When & Where You Need To

Imagine picking up the phone and calling your doctor and having her/him answer. Most of us think that this is from days long past or that we'd need to spend thousands of dollars a year out-of-pocket for this type of access.

Believe it or not, this type of access is available now, and at a price that costs less each month than ordering a pizza to be delivered. It's available through DocTalker Family Medicine (www.doctalker.com), a primary care medical practice that's gone back to the roots of medicine. When any patient calls the practice, a practitioner will pick up the phone and talk directly to the caller, including nights and weekends.

DocTalker is a patient-driven practice that consults with its patients by same-day office visits, phone, email, videoconferencing and house calls. About 60% of all consultations for existing patients are done by telemedicine, which treats patients as quickly as possible and saves patients time and money. Click here to learn more.

For all Carefirst Clients / Changes to Monthly Small Group Eligibility Audits

Starting April 23, 2010, for all groups renewing in July, 2010, Carefirst will mail letters of non-renewal to groups who did not provide a response or who did not pass the eligibility audit. Going forward, these letters will be sent at least 65 days prior to the group's scheduled renewal date for Virginia and 45 days prior for Maryland and DC. This is a change to the current process.

The group must provide this information prior to receiving the non-renewal letter. No documents will be accepted after the letter of non-renewal has been sent and no exceptions will be allowed.

How to Avoid Identity Theft

One of the fastest growing crimes in America is identity theft. The perpetrators of these crimes are getting more clever with each passing day.

The FTC reports that 1.2 million complaints of identity fraud were registered in 2008. In 2007, the number of complaints was 800,000 – and the number of incidences is rising at an alarming rate.

Unfortunately, the information/computer age is aiding this crime spree as each industry converts to computer-based communication and recordkeeping. Our information is out there and we need to protect ourselves, our companies, and our employees.

The most common mistake an individual makes in determining the plan to protect themselves is thinking that there is only one area to watch, when in fact there are five: Financial, Driver's License, Character / Criminal, Social Security Number, and Medical.

The good news is that there is an Identity Theft Shield and Life Events Legal Plan, which is offered only through Pre-Paid Legal Services, Inc. Read more here. Or call Carol McCarty (301-503-7397) or Toni Whaley (443-802-3842).



 

YOU GOTTA LAUGH:
My Life in the Trenches of the Health Insurance Business

By Stephanie Cohen and Scott Golden
www.golden-cohen.com

Stephanie Cohen, Scott Golden, Jack Cohen

This month's insurance nightmare: Your employer enrolled you in the company plan, but you did not receive the cards for two months and are not listed on the bill.

The situation: An employer named J.J. hired Bill on October 16. The waiting period established by J.J.‘s plan begins the first of the month following the hiring date of the employee. Therefore, the effective date of Bill's family's coverage is November 1. However, Bill did not get an insurance card, and J.J.'s bill for November does not reflect the fact that Bill has been added onto the plan. Understandably, J.J. is upset because he does not want to pay for the month of November since Bill cannot use the company health insurance plan that month, as his coverage was not reflected on the November bill.

The solution: There is always a time lag between the date that an application is submitted to the time a card is sent to the employee and the bill is adjusted. Employers should estimate that the process takes two months. And cards can take up to three weeks to be received by the new employee.

To avoid confusion and frustration, employers need to explain to newly hired employees that they have coverage on the effective date, but they will probably not have a card in their hand for several weeks.

A phone call to the insurance company can confirm that the employee's application is being processed. Also, keep copies of all correspondence, emails and faxes to prove when the application was sent and received by the insurance company.

If we were the Health Insurance Ambassadors: We would rid the world of those pesky insurance cards. Instead, there could be a website that the provider could access showing the application was received, and being processed. This would be a much more efficient and less costly strategy for the insurance company – and a stress-free solution for the consumer.

The painful truth: The reality is that there is a time lag for insurance companies to process an application, regardless of whether it is online or paper. Bills are often not correct, and it would be better to retroactively charge employers for more than one month of premiums to make up for the time lag.

Employers: Be prepared for incorrect bills and a delay in receiving insurance cards. However, if the waiting period is met after the date of hire, the employee is covered and thus the premiums MUST be paid regardless of the lack of card or bill. If not, the insurance company is liable and on the hook for any expenditures incurred.

What's your insurance nightmare? We encourage you to send your stories to our newsletter editor, hope@inkandescentpr.com.

Newsletter by Inkandescent Public Relations
By Hope Katz Gibbs, president & founder, The Inkandescent Group; Design by Michael Gibbs; Programming by Max Kukoy

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