Outpatient Surgery vs Inpatient Surgery

UnitedHealthcare’s policy will limit outpatient surgery payments to hospitals Kelly Gooch    UnitedHealthcare has expanded prior authorization requirements and site of service medical necessity reviews for certain surgeries in an effort to shift surgical procedures to less expensive locations, according to Modern Healthcare. The outpatient surgery policy will limit the circumstances under which UnitedHealthcare will pay for certain surgeries in a hospital outpatient setting. Taking effect in November for fully insured groups in most states, UnitedHealthcare will only pay for a surgical procedure performed in an outpatient hospital setting if the insurer determines the site of service for the procedure is medically necessary, UnitedHealthcare told Becker’s Hospital Review. “Medical necessity reviews for… Read More

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Are you 65 and over before December 31st 2019?

It’s Your Last Chance.. The Medicare Access and CHIP Reauthorization Act of 2015 eliminates all Medigap Plans that cover the Medicare Part B deductible. A deductible is an amount of money you must pay out of pocket before your plan will begin covering services. The Part B deductible in 2019 was $185 and is projected to be $197. Medicare Part B covers most of your outpatient services. Things such as Doctor visits, labs and tests, durable medical equipment, and some medications. That means, unless a preventative care visit, you would have to pay out of pocket $197 before your plan would cover you. Why would Congress decide to pass a… Read More

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Think You’re Covered With Original Medicare?

Medicare in 2020   Everyone has heard of Medicare and over the years, here at Total Benefit Solutions have posted numerous articles explaining how Medicare works. We even wrote out a post about the history of Medicare a little over a year ago (That post can be found here ). However, nothing in the Insurance World stays still and every so often we like to revisit this sector of the Insurance Market and explain how Medicare works with some updates. This way, whether you’re new to Medicare, or you’ve been on it for a while, you are up-to-date on how your Insurance Plan works! Original Medicare (Part A and Part… Read More

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Proposed Rules Clarify Individual Coverage HRAs

IRS explains application of employer mandate to individual coverage HRAs Federal authorities announced in June that beginning in 2020 employers could offer employees an HRA designed to reimburse individual market medical insurance policies in lieu of group medical insurance. But one piece of the puzzle was missing: How would an employer satisfy the Affordable Care Act’s employer mandate by only offering such an HRA? The IRS has now proposed rules explaining precisely how an employer can satisfy the ACA employer mandate and avoid penalties simply by offering an individual coverage HRA (ICHRA).  Background ICHRAs differ significantly from the familiar and traditional HRAs. The key difference is that a traditional HRA… Read More

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The Ultimate Internet Safety Guide for Seniors

Written By: ERIC C. POSTED: DECEMBER 16, 2018 Every year, seniors are scammed out of tens of billions of dollars, money they’ve spent their entire lives saving only to have it stolen. The elderly have always been a prime target for Internet scams because of a perceived vulnerability, and now because Internet use among seniors is on the rise. A Pew Research Center survey showed that 67% of seniors are now regular Internet users. Internet security is something everyone should prioritize, regardless of age, so it’s important to be aware of current threats and how to deal with them. With so many people online, the magnitude of scams is increasing. Protect Your Computer Hackers are always on… Read More

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New Employer Tool

    Health coverage is a key benefit employers offer workers in order to attract and retain the best and the brightest. Yet employers face numerous complex regulatory rules and administrative burdens in providing health coverage to their employees. Most big employers have entire departments devoted to understanding the rules and administering health coverage. But, many smaller business owners don’t have that luxury. They alone must take on the task of navigating how to provide health coverage to their employees.  This year, the Trump Administration took a big step forward in doing just that by issuing new rules expanding Health Reimbursement Arrangements (HRAs). HRAs are employer-funded accounts that workers can… Read More

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Medical Price Transparency Update 08-19-19

Proposed Law Can Help Lower Your Medical Costs By Allowing You to Shop Around! On July 29, 2019, the Centers for Medicare & Medicaid Services (CMS) proposed policies that follow directives in President Trump’s Executive Order, entitled “Improving Price and Quality Transparency in American Healthcare to Put Patients First,” that lay the foundation for a patient-driven healthcare system by making prices for items and services provided by all hospitals in the United States more transparent for patients so that they can be more informed about what they might pay for hospital items and services. Included in this proposal is also a redefinition of what “Preventative Care” means. Why is this… Read More

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NEW HRA RULES FOR 2020

New Rules for 2020 to Pay Attention To Many Employers offer things such as HRAs, FSAs or HSAs to help Employees offset the out-of-pocket costs and gaps in their Health Benefits. I’ll give a quick summary of each: -A Health Reimbursement Arrangement (HRA) is an employer-funded account that helps employees pay for qualified medical expenses not covered by their health plans. HRAs are compatible with all types of health insurance plans and since they are solely funded by the employer, they also own it. -A health savings account (HSA) is a tax-advantaged medical savings account available to people  enrolled in a high-deductible health plan (HDHP). The funds contributed to an account are not… Read More

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2020 ACA Plans PLUS A New Insurer Enters the Five County Area

Important Update! 2020 ACA Plans Offer Consumers More Choice, Modest Requested Increases Harrisburg, PA – Insurance Commissioner Jessica Altman today released the 2020 requested rate filings for health insurance plans under the Affordable Care Act, highlighting that consumers in all Pennsylvania counties will now have more options, markets will have greater competition, and average rate increase requests are modest in comparison to some previous years. “As filed, all 67 counties will maintain the insurers currently offering coverage in 2019 for the 2020 coverage year,” Altman said. “Pennsylvania’s market has seen great increases in competition and choices for consumers in recent years, and the trend will continue into 2020. Based on their… Read More

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New Executive Order Addresses Healthcare Issues

On June 24, 2019, President Trump issued an Executive Order (“EO”) directing the relevant federal agencies to issue regulations or other guidance to make available more meaningful information related to the price and quality of healthcare. This summary highlights aspects of the EO that may be relevant to employer-sponsored group health plans and their covered participants.   • By October 22, 2019, the Treasury shall issue guidance to expand the ability of patients to select a qualified high deductible health plan (“QHDHP”) that can be used alongside a health savings account (“HSA”), and that cover low-cost preventive care, before the deductible, for medical care that helps maintain health status for… Read More

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The Exact Types of Insurance You Need In Your 20s, 30s, and 40s..

Insurance isn’t the most thrilling to think about, but it’s necessary for protecting yourself, your family, and your wealth. Accidents, illness, and disasters happen all the time. At worst, events like these can plunge you into deep financial ruin if you don’t have insurance to fall back on. Some insurance policies are unavoidable (think: car insurance in most US states), while others are simply a smart financial decision (think: life insurance). Insurance is largely personal, though, and the type of policy or amount of coverage that’s right for you and your financial situation usually won’t match your friend’s or relative’s. Plus, as your life changes (say, you get a new job or have… Read More

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Full Self-Service Compliance Center At No Additional Charge to You!

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Medicare Won’t Cover This Key Expense…

Dental costs can take a huge bite out of seniors’ finances, even if they have Medicare. And many Seniors have to tap into their Retirement Funds to cover treatment.

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The Future of Employee Benefit Offerings: Student Debt Repayment Assistance

When looking for a job, the benefits offered to an Employee are definitely a big factor in consideration of accepting an offer of employment. Most people are willing to choose a company with a slight pay decrease if the benefit package compensates for the lost wages. With unemployment the lowest it has been since 2000 in the United States, attracting new talent isn’t as easy as it used to be and Employers are looking for ways to snatch up qualified applicants. When you think of benefit packages, you usually think of the basics: Health Insurance (with possibly an HSA, HRA, or FSA included), Dental and Vision coverage. “Good” benefit packages… Read More

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IBC to Reach Agreement with Providers in Our Area!

We are pleased to share that Mercy Health System, St. Mary Medical Center, Saint Francis Healthcare and Independence Blue Cross (Blue Cross) anticipate coming to an agreement on a new, long-term contract this week, meaning there should be no interruption to your care or coverage at the following facilities: Mercy Fitzgerald Hospital Mercy Philadelphia Hospital Nazareth Hospital St. Mary Medical Center Saint Francis Healthcare in Delaware We thank you for your continued support and patience throughout this process, and apologize for any anxiety or inconvenience this negotiation may have caused you or your family – that was never our intention. We look forward to continuing to provide you the care… Read More

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