Health Insurance - Good News About Claim Denials

According to an AP article more consumers are successfully appealing denied health insurance claims. According to Nancy Davenport-Ennis of Patient Advocate many people pay bills they do not owe that have been coded incorrectly. At the Gelker and Rohrer Insurance Agency located in Costa Mesa we urge all our health insurance clients to register at the carrier website so that they may review all claims for accuracy. A quick call to Anthem, UHC, or Aetna Claims department can save you hundreds of dollars.

Small employer wellness grants

Section 10408 of the Patient Protection and Affordable Care Act (or health care reform law) allocates $200 million in funding over a five-year period to help small employers promote better health. From Anthem Health plans:

Starting in 2011, small employers (those with fewer than 100 employees who work 25 or more hours a week) may apply for grants that help pay for wellness programs that meet specific requirements. HHS is expected to release detailed criteria about programs that are eligible for grant funding in 2011. Only wellness programs started after the health care reform law was enacted (March 23, 2010) will be eligible for grant funding.

Our agency, located in Costa Mesa, Ca will be looking for the guidelines of the benefit, once HHS releases the regulations and application.

Individual Health Insurance for the Young

Health Care Reform has had a chilling effect on the individual health insurance market. Anthem,

Healthnet and Aetna no longer offer individual health insurance policies for children under the age of 18 years. Individual policies for children can be purchased only when they are listed as a dependent on a policy of an individual over 19 years of age. Our agency , located on Costa Mesa, California is also concerned that all the insurance companies offering individual health plans have reduced their plans offered by 50 %. We think market based solutions, not federal mandated are the way to get affordable health insurance to consumers.

Saving on health insurance premiums

Many plans offered at significant premium savings have one thing in common. Generic prescriptions only or no drug card included on the plan. Our agency has noticed that one of the great drivers of the increasing cost of health insurance premiums is prescription drug cost. While no one can argue with the efficacy of brand drugs, most consumers have been slow to adopt more cost effective generic drug alternatives. Target pharmacy located on Harbor Blvd in Costa Mesa, CA. has a list of hundreds of generic drugs at $4.00/30 day supply. Less expensive than many co-pays on group insurance plans.

Common sense procedures

An article in Risk and Insurance Magazine, An Infectious Condition talks about Health Care organizations risk management strategies to avoid lawsuits over care. One of the areas discussed is the liability resulting from MRSA bacterial infections sustained by patients in post operative care. 85% of all MRSA infections have been attributed to invasive procedures in hospitals. Our Agency is involved in providing benefits for many businesses in Costa Mesa, CA and was surprised to learn form the article that the number one MRSA prevention instituted by hospitals was hand washing. So if you are hospitalized at Hoag Hospital, St Josephs or Fountain Valley make sure you insist that all care givers wash their hands when they enter your room.

California Insurance exchange

The legislature has approved two bills that would establish a statewide health insurance exchange to comply with the federal health care reform law. One bill would set up the state's insurance exchange to help consumers compare information about insurers before choosing a health plan. Insurance carriers are concerned that provisions may have serious impacts on consumer choice. Our agency is concerned that federal mandates will limit choice and force some insurance companies out of the health insurance marketplace in Costa Mesa, California and Newport beach, California

Tax Credit for Group Insurance premiums

Small business owners may be eligible for tax credit on group insurance premiums for their employees. According the IRS website the following eligibility rules apply:

Eligibility Rules

Provide 50% of the cost of the single rate for employees
Must have 25 or fewer employees
Average wage must be below $50,000

Amount of Credit

Up to 35% of premium cost

Orange County businesses can contact our Agency located in Costa Mesa, California for more details about this tax credit.

Anthem Blue Cross has published a free booklet with more information on managing health care costs.