Health Insurance For Consultants

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Health Insurance For Consultants – This analysis is part of the USC-Schaeffer Initiative on Health Policy, a collaboration between Economic Research and the Schaeffer Center for Health Policy and Economics at the University of Southern California. The initiative aims to inform the national health debate with rigorous and evidence-based analysis that leads to actionable recommendations, leveraging the strengths of USC’s collaboration and USC.

Health insurance is a product regulated by state and federal agencies. However, there are various flaws in today’s market that allow unregulated products to flourish, which can cause many consumers to purchase insufficient coverage and increase costs for people who rely on traditional comprehensive coverage. traditional. A dangerous example is fixed indemnity coverage, a benefit that is not regulated by law but is often disguised as a standard health insurance product. Fixed indemnity products are offered in a cumbersome and non-transparent manner in individual health insurance markets and by employers offering insurance coverage to their employees. However, Congress, federal and state regulators all have options to strengthen oversight of these products and prevent them from harming consumers and the health insurance market.

Health Insurance For Consultants

Christen Linke Young Assistant Vice President for Health and Veterans Affairs – Former Fellow at the House Policy Council on Health and Veterans Affairs – USC – Schaeffer Initiative on Health Policy

Medical Insurance: In Pursuit Of Health?

Traditional health insurance premiums are registered monthly in exchange for paying for some or all of the health care services a person receives. Fixed cost coverage (also called hospital indemnity) is structured differently with “time-based” payments. Instead of paying health care providers for specific services, fixed indemnity coverage pays for days (or months, or other periods) that a person is hospitalized or sick.

Historically, this allowance has been considered an income replacement. That is, these policies are not intended to directly pay for medical care, but to provide an alternative source of income at a time when expenses may increase and the ability to work may be limited. Because it is considered a different purpose than traditional health insurance, fixed-term insurance coverage has been defined as an “excluded benefit” that is exempt from most federal health insurance laws since the mid- 1990. In particular, the Affordable Care Act (ACA) health insurance standards do not apply to excluded benefits, so fixed reimbursement coverage based on pre-existing conditions may discriminate, deny coverage of the ACA’s essential health benefits, and lower annual premiums. there is no need to limit the rights. out-of-pocket expenses.

In its historical form—the $100-a-day benefit payment for a daily illness—fixed-compensation coverage is no substitute for health insurance. This covers the risk of income fluctuations in times of inflation, but not in private medical expenses. Of course, households may find it worthwhile to purchase this product, especially as a supplement to their regular health insurance.

However, some of the modern equipment designs are very different. We do not know systematic data on fixed income coverage in the individual or group market, but the planning tools available to potential customers provide an overview of the benefits. Instead of paying a fixed daily amount for illness or hospitalization, many existing fixed benefit plans vary the payment based on the specific health services received. That is, they pay $100 for a pediatrician visit (or in some plans, a “daily” pediatrician visit), $30 for an amoxicillin prescription. , and $1,000 for a tonsillectomy. Plans may have more complex benefit structures that mimic traditional insurance, requiring enrollment to meet deductibles before payments begin. Additionally, some modern reimbursement products pay these amounts directly to health care providers rather than to enrollees and have a network of providers with whom they negotiate discounted rates. those who register. In other words, these fixed-indemnity plans can start out in the same format as traditional health plans, adding “per diem” or “per-service” to the reimbursement schedule, and exempts himself from the rules.

The Staggering Costs Of Health Insurance “sludge”

A shining example is application-based products available in eleven states [1] with 170,000 different reimbursement amounts for specific services. To take just a few examples, the plan pays $3 for a blood draw, $153 to see an OBGYN, $119 for a 30-day course of Xifaxan antibiotics, $7,198 for hospitalization for a skin infection, and $10. , 903 were taken to hospital with collapsed lungs. Figures 1 and 2 show excerpts from the plan’s website with thousands of different payment amounts for this “system” compensation product. Although the plan is not transparent about how these payment amounts are derived, the reimbursement arrangements for hospitals and outpatient services use the Diagnostic Service definition. Related Group (DRG) and the Healthcare Common Procedure Coding System (HPCCS). separate payment amounts for each DRG and HCPCS code – the same basic structure as standard health insurance products.

Although this product is the most extreme example we came across in our research, all the premium products we came across have different payment amounts along with the severity of the care received. Payments for outpatient care often vary widely, but payments for hospital services are often less. For example, a plan pays for hospitalization at a variable amount depending on whether the admission is for illness or injury, but outpatient services are paid at the amount Medicare can provide for ‘the care that is available. A large national carrier (with a large online presence in many states) offers a multi-level reimbursement formula for surgery: benefits are paid on a four-tiered schedule that reflects complexity surgery, as well as anesthesiologists, assistant surgeons, and outpatient fees. In this product, payment for hospital admissions does not vary by specific diagnosis, but reflects the nature of the care required, such as in the intensive care unit, where the provider treats the patient. on a day, and if it is due to illness or injury. Another carrier offers a daily rate for “hospital stays,” but includes short hospital stays, emergency room visits, newborn care, “intensive” hospital screening services, and more. Many also offer different payment plans that allow customers to choose the level of reimbursement they want to receive, from $ 100 to $ 3,000 per day for the hospital, for example – where the former logically represents the income replacement product and the latter is profit. This is considered payment for medical expenses. Figure 3 shows part of these design tools.

The organization of the carrier network can also be complex and reminiscent of traditional insurance, as shown in Figure 4. One fixed reimbursement plan has a large network of nearly 5,000 hospitals and one million doctors worldwide. the country. Those who enroll in the plan receive a discount lower than the provider’s rate for self-pay patients, although the size of the discount is unclear. The fixed reimbursement carrier will pay the specified amount to the provider, and the provider will bill the patient for the remainder. (If the plan’s payment amount is greater than the provider’s bill, the additional amount will be billed directly to the customer.)  Some carriers offer an ID card designed to be used like a regular health insurance card together. to the provider paying for the plan. through standard electronic transactions. Another carrier offers a payment card that is linked to the enrollee’s plan and used by the participant for care at participating providers. When a payment card is used, the plan pays its share and the enrollee’s credit or debit card is automatically charged for the balance. Such arrangements indicate that fixed reimbursement products are clearly intended to be the primary source of funding for health care. Products designed to provide general reimbursement or to help families pay for various expenses do not require complex systems to manage direct payments to providers; and products sold to consumers as an alternative to traditional health insurance have clear reasons to rely on these arrangements.

Fixed indemnity benefits masquerading as traditional health insurance are dangerous for consumers in the individual and employer markets.

Fixed Indemnity Health Coverage Is A Problematic Form Of “junk Insurance”

First, consumers can purchase this product as an alternative to health insurance, although it has limitations compared to full health insurance. Consumers often look for products that shift the financial risk of a health plan, but fixed indemnity products—almost by definition—do not. They set a payment amount related to the service or type of service received and are responsible for the difference between the customers

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