Surprises In Healthcare Coverage For 2016

This past Sunday’s Parade article, 12 Tips to Get Your Best Healthcare in 2016, provided surprising news about where and how to get the best healthcare.  The suggestions consisted of employers encouraging you to go overseas for surgery, going to a corporate hospital or paying yourself.

For example, if you work for Lowe’s or Wal-Mart, then the corporation may have relations with particular hospitals where procedures can be covered, or discounted.

Some employers may incentivize you to engage in what is called “medical tourism,” where Americans travel to developing countries for procedures, stay in luxury hotels and end up paying a fraction of what they would have for just the procedure in the U.S.

Lastly, in the event you are priced out by the changes in plans and premiums and coverage (because the health insurance companies retained that power and are unrelated by State Commissioners), you may have to take a self-insured or Health Savings Account route to cover your care in the U.S.

For those residing in Washington state, here are two resources to use in comparing healthcare insurance options:

  1. Washington Health Plan Finder
  2. Washington Health Benefits Exchange

Copyright 2015 The Filutowski Law Firm, PLLC. Disclaimer: This page is intended for general information purposes only and should not be construed as legal advice or legal opinions on any specific facts or circumstances. An attorney-client relationship is not created or continued.

How Much Will ObamaCare Cost?

obamacareThis is the question on many people’s minds.  It is a good question that is difficult to answer with certainty.  MSN Money today posted an article that lists 5 things you need to know about ObamaCare:

1. Competition  

The Affordable Care Act (also known as “ACA” or ObamaCare) mandates that each state create an insurance exchange.  The exchange must offer a variety of Qualified Health Plans (“QHPs”).  The state must ensure that the insurance companies placed on the exchange comply with ACA guidelines for premium limits and scope of offerings within the plan.

As with most marketplaces, the larger the state, likely the more competitive the options.  Therefore, Vermont may see less options than residents will in California. [Read more…]

How Will Obama Care Affect Health Insurance Premiums?

With Obama winning another four years in the President’s office, his self-named “Obama Care” health care plan is coming under renewed scrutiny.

In June this year, the U.S. Supreme Court upheld the constitutionality of Congress requiring every U.S. resident to buy health insurance.   The opinion did not comment on how the law would be applied by the States, nor did it require each of the States to expand Medicaid.  However, for those States that agree to expand Medicaid to beyond those at or under the poverty level, the federal government would pay the full cost for the first three years, starting in 2014, and gradually decrease its share to 90 percent in 2020 and beyond.

The New York Times today raises the following questions about ObamaCare:

Mr. Obama faces crucial choices about strategy that could determine the success of the health care overhaul: Will the administration, for example, try to address the concerns of insurers, employers and some consumer groups who worry that the law’s requirements could increase premiums? Or will it insist on the stringent standards favored by liberal policy advocates inside and outside the government?

Answers will come in the following year as each State decides how to interpret and apply the federal law locally to its residents.

The Department of Health & Human Services (DSHS) will be promulgating rules on how to carry out Obama Care later this year.  Part of these rules will be the calculation of premiums.  Will there be a flat premium across the board for all insureds, or staggered premiums based on income, age, or health condition?  Only time will tell.

Copyright 2012 The Filutowski Law Firm, PLLCDisclaimer: This page is intended for general information purposes only and should not be construed as legal advice or legal opinions on any specific facts or circumstances. An attorney-client relationship is not created or continued.



Electronic Medical Records Pose Risk of Tampering

Yesterday The Baltimore Sun reported on privacy issues with digitalizing patients’ medical records. The article raises valid concerns about the risks associated with digitizing patients’ medical records. While paperless increases the efficiencies in transferring, updating and sharing a patient’s information, it also provides opportunities for insurance companies to alter records to avoid responsibility for coverage and payment.

As efforts to implement electronic medical records escalate, so do the debate about patient privacy and the potential for commercial exploitation of the technology.

Computerized files are seen as a way to improve care and save tens of billions of dollars in health costs, but doctors and advocacy groups have raised concerns about the risks of exposing detailed personal health information. In particular, doctors worry that insurance and drug companies could manipulate the records to affect decisions on patient treatment.

MedChi, which represents more than 22,000 Maryland physicians, recently announced that it was the first medical society in the nation to pass a resolution calling for state-level legislation to ensure that doctors retain responsibility for treatment decisions and that medical records are made available on a neutral platform that does not advance any commercial interests.

“As we implement the system, we want to make sure the data remains the patient’s data and is private,” said Gene Ransom, MedChi’s chief executive officer.

The establishment of electronic medical records is a major part of national health care reform. The Obama administration set aside nearly $19 billion in stimulus money to establish electronic records for all Americans by 2014. The records would include a patient’s history as well as guidelines and the latest medical research and treatments for diseases.

[Read more…]

Tanning Bed Addiction, Possible Need For FDA Regulation

The American Association for Justice (AAJ) reported today:

The Los Angeles Times (4/20, Roan) reports that, according to a study published in the April issue of the Archives of Dermatology, “as many as a third of young people who use tanning beds may be addicted to the behavior.” While “it’s unclear how or why tanning can become compulsive…exposure to UV light triggers production of brain chemicals called endorphins that boost mood. One study, published in 2006 in the Journal of the American Academy of Dermatology, found that frequent tanners experience some withdrawal symptoms when given naltrexone, a drug that blocks endorphins.”

Despite the fact that “indoor tanning can cause skin cancer, premature skin aging, and eye damage, according to the US Food and Drug Administration,” Bloomberg News (4/20, Randall) explains that “about one-third of college students who tried indoor tanning facilities were addicted to the artificial rays, and the addicts drank more alcohol and smoked more marijuana than other students, researchers found,” according to a study in today’s medical journal, Archives of Dermatology.

[Read more…]

Uninsured Children Have 60% Increased Chance of Dying

A recent John Hopkins study confirms that children who are uninsured are more likely to die in the hospital. This is not a matter of the child not receiving adequate care or priority treatment at the hospital, but rather an issue of adequate, routine care leading up to the hospital visit.

Uninsured children do not regularly see a pediatrician for routine check-ups. It is not until the children’s health conditions reach an emergency situation that their parents take them to the hospital, when often it is then too late.

Sources that also covered this issue: Newsweek, US News Health Blog, BusinessWeek

Battle of Insurance Coverage: Workers’ Compensation v. Health Insurance

Another debate regarding which insurer should pay for the medical bills makes headlines. On April 12 nad 14, 2009, Pasadena hospital nurse, Amelia Mendoza, suffered traumatic brain injury when a patient repeatedly violently struck her in the head. A week following the attacks, Amelia (52 years old) collapsed with a stroke.Amelia’s private insurer, BlueCross is denying coverage, stating that it was an on-the-job-injury. Amelia’s employer, Huntington Memorial Hospital, is also denying coverage, stating that the stroke, which occurred on April 20, was not due to the patient’s attacks.

As Amelia remains in a vegetative state and her husband cares for her through feeding tubes, hopefully the courts will get involved quickly enough to help interpret the California workers’ compensation statute.

Similar coverage principles apply in Washington State.� If one is injured on the job, treatment for those injuries must be paid by workers’ compensation.� If not an on-the-job injury, then health insurance should cover the treatment for the injury.

Coverage issues are common in automobile cases, specifically where the health insurance carrier paid out benefits before learning that the injuries were caused by a car accident and that there was an alternative form of primary insurance available, e.g., personal injury protection (PIP). In these situations, the PIP carrier reimburses the health insurer and everyone is satisfied. No courts. No delays. No issues.

Until the law changes, insurance carriers will continue to deny coverage unless a court orders otherwise.

To prevent an impasse with your insurance carrier, you should be careful with paperwork. Most paperwork you complete at a doctor’s office and any records the office completes on your behalf are sent to your insurance company for consideration of paying for your visit (claim). You probably recall in-take sheets asking you if the injuries are due to a car accident, on-the-job injury, or other. If you are unsure, before checking the box, have an open conversation with your health care provider about the issue. Only once you feel comfortable with the origin of your injury, report it on the intake form with the health care provider’s office. This can save major future financial headaches.

Selecting or Renewing Your Health Insurance Policy?

While the debate on health care reform continues, the annual renewal period for health insurance policies is quickly upon us. Whether you have an individual, private plan or are covered by your employer’s insurer, this post applies to you.

This weekend the NY Times published an excellent article outlining the considerations insureds must make when renewing or purchasing a new health insurance policy. In addition to the article’s points, you should also:

1. Closely read the terms of the policy. Just like with any contract you sign, you should always read the fine print and terms and conditions (no matter how burdensome) before signing.

2. Ask questions. If you do not understand a term or condition or policy’s exclusion (e.g. pre-existing condition exclusion), don’t hesitate to say so and to ask for a layperson’s explanation from the insurance company. Some health insurance policies are written so vaguely that even lawyers struggle to interpret them and therefore leave it up to the courts to do so!

3. Consider your finances and your current health. If you have some health issues, can you afford a higher monthly premium with a lower deductible? If you are young and generally in good health, perhaps a high deductible is OK.

4. “Preferred provider” network? If you are switching insurance companies, look to see if your general practitioner (GP) and other doctors are in the “preferred provider” network of the new insurer. Unfortunately many insureds overlook this issue, and then must find a new general practitioner or pay more out-of-pocket simply to see their current GP.

5. Comparison shopping. Use an online comparison agent, like, to assist in your selection by comparing coverages, premiums and deductibles.

Insurance Bad Faith – recover $$ from your insurer for dropping you

An insurance company owes its insured a duty of acting in good faith and fair dealing. In other words, the insurer must act reasonably in processing and paying your insurance claims. This contractual relation is why you pay your insurer steep monthly insurance premiums – to be covered in times of need.

In South Carolina, an insurance company dropped a young man from its policy when it learned that he was HIV positive. The young man sued, and the South Carolina Supreme Court found in favor of the young man, awarding both compensatory and punitive damages (something we don’t have in Washington State).

In Washington State, if your insurance company is stalling and denying reasonable claims for payment under your insurance policy – your first stop for recourse is the Office of the Insurance Commissioner. You should also talk with us about about your additional options.