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How much time and money does it take for a new startup (50 employees) to fill out the paperwork to become a group for the purpose of negotiating for health insurance for their founders and employees?
I'm not sure if this is a purely exploratory question or if you're inferring that you're planning on navigating the group health insurance market without the assistance of a broker. If the latter, I'd caution against it for several reasons (which I'll omit for now for the sake of brevity).To get a group quote, generally all that's needed is an employee census. Some states apply a modifier to the rate depending on the overall health of the group members (for a very accurate quote, employees may need to fill out general health statements).Obtaining rates themselves can take a few minutes (for states like CA which don't have a significant health modifier) to several days.I suspect your cor question is the time/effort required once you've determined the most appropriate plan design for your company. This is variable depending on how cohesive your employee base is.Best case scenario - if all employees are in one location and available at the same time, I could bring an enrollment team and get all the paperwork done in the course of 1-3 hours depending on the size of your group. In the vast majority of cases, the employer's paperwork is typically around 6 pages of information, and the employee applications about 4-8 pages. Individually none of them take more than several minutes to complete.Feel free to contact me directly if you have specific questions or concerns.
Do the HIPAA laws prohibit Health Insurance companies from allowing members to fill out and submit medical claim forms on line?
No, nothing in HIPAA precludes collecting the claim information online.However, the information needs to be protected at rest as well as in-flight. This is typically done by encrypting the connection (HTTPS) as well the storage media
What are some reasons that a health insurance company would ask for a pre-authorization form to be filled out by a Dr. before filling a prescription?
One common reason would be that there is a cheaper, therapeutically equivalent drug that they would like you to try first before they approve a claim for the prescribed drug. Another reason is that they want to make sure the prescribed drug is medically necessary.Remember that nothing is stopping you from filling the prescribed drug. It just won't be covered by insurance until the pre-authorization process is complete.
If US military members were promised free health care as part of their enlistment then how does the current administration justify them having to pay now?
Ah!  Well, it's complicated on the one hand, and very, very easy on the other.Let's start with the easy part:  The military is part of the government and the government gets to follow its own rules, no matter what the rules are for everyone  else.  So, it turns out a lot of people are thinking, gee, our military sure is costly, wish we could figure out a way to trim that budget down some- and that's when you start hearing mutterings about "entitlements".  Now, entitlements means something a person is owed, is entitled to have, which certainly encompasses the pay and benefits a member of our military, who has fulfilled his or her contractual obligations, is owed.  Problem is, these entitlements are becoming, in some folks' eyes, too costly.According to the US Comptroller report, the US military's pay and allowances- which includes health care costs which have grown 40% since the early 2000s- take 1/3 of the budget. That's a pretty sizeable chunk.  In fact, something has got to give- but where and what?Well, let's return to the days of yesteryear, back even before a time when our military went from a conscription force to an All-Volunteer Force to find out how a near-same problem was solved then.After WWII, it was discovered the military simply did not have the facilities to fulfill their contractual obligation to vets- to whit: To prhealthcare at no-cost to active-duty members and their families, and vets and their families.  There weren't enough doctors and clinics to do the job.  So, the military decided to contract out to civilian medical facilities for family-member health care using these two acts: The Dependents Medical Care Act of 1956 and the Military Medical Benefits Amendments of 1966, these, in turn, morphed into Champus, or Civilian Health and Medical Program of the Uniformed Services.  Now, Champus was in play when I first became a military dependent (---now considered a bad word), but I didn't have to use it until I had a few kids who needed health care, and the hospital at Offut AFB, Nebraska, couldn't prit.  So, Champus kicked in.  As I recall, while I did not pay any premiums, I did have to pay a co-pay, and find a doctor who accepted Champus or pay any cost over Champus' allowable.  I remember it turned out a doctor's office visit allowable cost, in the late 70s, was $25.00  I marveled that anyone could think a doctor would see a person for that little bit of money.  If we used Champus, we always paid out of pocket.  Still, military medical costs continued to mount.  There had to be a better way, a more cost-efficient way, to prthe care that was contractually promised (for a given definition of 'contractual') and control these costs.  Which is where Tricare comes in.In the 80s, the military forced members with families to enroll in a new HMO-type service called TriCare (Champus).  We had to start paying premiums, and we had to pay co-pays.  This angered many vets and members who had entered the service under a "free-for-life" contract, and the colloquial story I remember is a bunch of vets went to Washington with posters from WWII and Korea, printed by Uncle Sam, himself, with fine print that clearly stated members and their families would enjoy free health care for life if the member met certain conditions.  These vets sued and won, and so a second class of vets was formed, who received free care at military bases and, tellingly, through the VA system. This is one reason VA costs are so high-  because the military tried to control costs by shifting some of those costs onto members, then lost in Court and had to prcare somehow, so shifted that care and costs to the VA, well,  VA costs, beauracracy and wait times went up as their own budget went down.Now, a quarter century later, we have active-duty members who must enroll in and pay TriCare premiums as soon as they have a family member, a huge, complex systems adminstrated by the lowest bidder health insurance company willing to take on the job (usually United Health-  it now takes me over 2 weeks to get an authorization for an x-ray-  that's how costs are being "controlled") all because the military decided it didn't want to play by its own rules, and found a way around those rules by enacting new rules.  Which is what the talk is now, too.  Instead of keeping its promises to retired veterans and active members, the military is considering making TriCare premiums "comparative" to those of civilians-  it's the only way, they say, to control costs.  I admit, DH and I pay a miniscule premium monthly, and a small co-pay, and we can still get scripts filled for free at the Post clinic, but, our beef is the hypocrisy of it all.  Consider:  What would the military have done had DH said, "Yanno,  I may have signed up to catch bullets, but this is just getting too rough, and I want to change the rules.  I quit, and you can't do anything about it!  Nothing-  no black mark on my records, no charges, no penalties- AND you still owe me all my benefits every month!"Wouldn't get very far, would it?But that's what the military has done and is considering doing again: They make their own rules, and we who are a part of that service simply follow the rules.And bitch.  We still get to bitch.
How do I choose the best health insurance plan for my family?
I have answered this question many times and will again answer this:Factors that you can consider:a. What would be the family size?b. What kind of cover are you looking for? There are policies where in there is no capping on treatment charges, no capping on room rent on the one hand and there are policies where in there is restriction on treatment costs and room rent. These have impact on premium.c. Are you residing in a metro city - Delhi, Mumbai, Kolkata, Bengaluru, Chennai, Ahmedabad or Hyderabad? Or in any other city? There are policies where the premium can be different if you decide that you will take treatment, in the unlikely event of hospitalization, in a Tier II city rather than a metro.d. All Health Insurance policies cover major expenses associated with Hospitialization expenses such as Room Expenses, Surgery, Nurse, Anesthesia, Operation Theatre charges, IUC charges and like.e. And then Insurers, to differentiate themselves, give add ons - such as yearly Medical check up to a check up every 4 years, 2nd opinion for major surgeries / critical illnesses through their Hosptial Network and like.f. You need to decide whether you want a family floater policy or a individual sum insured for each family members. Both have advantages and disadvantages.g. Where there are big time age differences between seniors in the family and the rest the floater policy can work out to be expensive. This is because, in a floater policy, the eldest person’s age is considered to arrive at the premium and can impact the premium for the family as a whole. Hence policy for seniors should be separate.h. Advantage is that a single policy covers everyone with a single sum insured and can attract a relatively lower premium. Demerit is that one might end up selecting a low sum insured.i. On the other hand, there are policies that, in a single policy, cover each family member with Individual sum insured. Advantage of this policy is that for relatively higher premium the family is covered for a much larger sum insured but with the advantage of a single policy.j. Every policy has a Waiting period of 3 types:First 30 days hospitalization on account of disease / illness will not be covered.Specific medical conditions will not be covered for the 1st 2 years. Pre Existing illnesses will not be covered for the first 2 to 4 years (period depends on Insurers)k. Upto the age of 65 Insurers cannot say No to people for Health Insurance. However, they can impose conditions on the policy by loading the premium or by having a copay.Hope, I have given you a broad overview of what factors you should consider.If you think, I can be of help, please write to me at: natarajan.riskmgt@gmail.com.Thanks.
My dental insurance ran out today for fillings for the year. Can they just charge more teeth to my family members who are on my policy?
It would be fraud.They have to submit x-rays of your teeth with the claim. It is easy to differentiate your teeth from those of other family members. That’s why teeth can be used to identify dead bodies.Do you think your dentist wants to toss out the equivalent of a medical school education to help you get filings? Hopefully, the worse teeth were done this year.Your spouse may have coverage through a job. You could change your job and get new insurance through a new employer (be sure they don’t use the same carrier). Other than that, pay out of pocket or wait until January. Or use a Health Savings Account to pay.
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