Texas pays out $28 billion a year to some 4.8 million people, according to Kaiser.

The state picks up one-fourth of the tab, and the feds pay the rest.  The FBI estimates that 10% of Medicaid claims are fraudulent, which comes out to $2.8 billion a year in Texas alone.

On Monday, Austin company 21CT launches a new computer system called “Torch” to help the state bring scammers to justice.

Torch will collate state data around the clock. The system will monitor frequency of claims, the size of claims and any funny patterns or anomalies.

21CT has grown to over 100 employees, most of them devoted to the crackdown. Company officials say what they are finding is eye opening.

“You know it’s there,” said Kyle Flaherty, Vice President of Marketing for 21CT. “What’s so surprising is how complex and entrepreneurial the fraudsters can be. This is a business for them and we need to disrupt the business they are creating.”

Torch will eyeball providers: businesses, medical supply companies, doctors, therapists, dentists, ambulance firms, hospitals and more. The system will make it easier to sort out.

“In my old job as a healthcare fraud investigator for the state I would have eighteen browser windows open with tabs in them,” Ross Worden, 21CT Director of Data Science said. “I had no idea what was going on. Now, it’s all in one place. I can click through and see who is connected to what… what they are doing… what they are going to do potentially. It’s a fantastic tool.”

Cheats use patterns to pull off their scams, but they can be spotted if you know what to look for. However, Torch isn’t talking.

“The reason I won’t tell you what they are is they may be listening,” Flaherty said. “The last thing I want a fraudster to know is the techniques we can pick up on.”

Those could include suspicious associations, peculiar transaction accounts and unsavory networks.

A little modest bill padding, or honest mistakes are to be expected in Medicaid. Torch looks for the big boys.

“There’s always something where you say no, you knew it,” Worden said. “It was bad and you tried to hide it. Those are the things that really interest us. We want the bad people.”

When the red flags fly, they are passed along to state investigators to pick up the trail.

If you are busted, it could mean a fine, paying restitution or even jail time.

Connecticut learns less is more with state health insurance website

Tuesday, November 12, statistics put out by Connecticut demonstrate that its website is the only one to sign up more folks for private insurance than for Medicaid.

Angel Medina, 21, went to talk to an Affordable Health Care act navigator in Hartford. Medina was dropped from his mother's health insurance two years ago.

"I have really bad eyes. I like to get them checked often, but since I don't have health insurance, no doctor's going to really want to take a look at me," he said.

He found out that he may qualify for Medicaid, which was long-drawn-out under Obamacare.

So far, 9,123 have enrolled over Connecticut's ultimate goal is to sign up 275,000 people.

Kevin Counihan, chief executive officer of Connecticut's health exchange, says he's not discouraged by the number of people signing up for private health insurance.

"Buying health insurance is expensive and it's expensive and it's confusing and it's complicated. So no, I am not disappointed by it. However, we clearly have a strong goal to meet by March," he said.

Counihan look forward to have 100,000 people enrolled by the end of March.  He credits the state's computer system with the smooth even out.

"Number one is, less is more. Do fewer things well than try to do more things inconsistently. Two is test the heck out of the system and make sure that before you go live, you are pretty darn confident that you know what is going to happen. And three is hire the best people that you can," he said.

Counihan was implicated with Massachusetts' health insurance rollout in 2006.  He says that taught him people don't buy insurance like they do a book or car.  They usually consider the options an average of 18n times before making up their minds.

He foresees a sprint of people signing up between Thanksgiving and Dec. 15, which in case is the deadline for coverage beginning on Jan. 1.

http://www.westhillinsuranceconsulting.com/blog/westhill-consulting-insurance-connecticut-learns-less-is-more-with-state-health-insurance-website/

How to Find AffordableFamily Health Insurance

Take advantage of free quotes:

Who doesn’t like free, it a great price!  There are many health insurance websites where you can find lot of sites with free family insurance quotes.  You must take advantage of these.  Not every policy is going to fit for everyone because every family is different.  To know the best one for you and your family, use these quoting tools to gather prices and service offerings.  And do not think about it as a waste of time, after all it is a free look into the company.  It is free yet well worth the time it takes to fill out the questionnaire or quoting application.

 

Know your priorities:

You should know and you must be well aware of all your priorities regarding your health care.  Are you satisfied with your current doctor or are you open to find new ones?  If you are unsure, sit down and take some time listing of your top five most important things when looking for a new policy or health insurance company.  This will help you narrow down exactly what you only need and what your looking for.

Ask for help if you need it:

It is all known to us that understanding the ins and outs of health insurance policies and coverage could sometimes be very frustrating.  This is more common to those who are just new to it.  Do not hesitate to ask questions if you need to ask questions, ask your questions to the health insurance company representatives.  You can even ask your husband, your wife, your dad, your mom, or even your friends.  But if you feel that you are not satisfied with the answers you got, don’t be frightened to enlist the help of an insurance broker.  They can help you find the best rates available, can explain the inner workings of the policy, and know what places are reputable and which ones are not.

 

Know your budget: 

It’s time to sit down and take a close look at your budget if you don’t know what you can spend.  Be tough on numbers and better be sure that you not only know what you can spend, but what you are willing to spend.  Be sure that you nail this down and know your budget as well as possible because what you can spend and what you’re willing to spend might be two different figures.  This will assist when you are shopping because you can contract the super high quotes that you get back from companies, and right away put the quotes that are in your price range into a spread sheet and begin comparing the positives and negatives.

 

When it comes time to compare health insurance, consider your family and what you want and need for them.

Make sure that a policy that works through the natural changes of a growing and changing family is very important because these young families are often growing and changing and you don’t want have to go out and find new healthcare every time something happens with them.  With the help of these tips, you should be able to compile the best rates quickly and easily, giving you the tools you need to make a well-informed decision.

Tips for navigating Obamacare

http://www.westhillinsuranceconsulting.com/blog/westhill-consulting-tips-for-navigating-obamacare/

Think hard before your drop insurance entirely

Tambe said that might not make good business sense despite some companies might be tempted to abolish insurance benefits completely and let employees go to marketplaces to get coverage.

The problem is insurance purchased on the marketplace will be more expensive for individuals.  Then the company will risk talent leaving the company for a competitor who offers them the less expensive option if the company isn’t willing to compensate by raising their salary.

“It may work to keep costs down but you’ll have a hard time keeping talented folks,” he said.

Other federal programs could help you

For households making under 400 percent of the Federal Poverty Level, the ACA grants subsidies available on the public marketplace under certain circumstances.

Additionally there are current efforts for Ohio to spread out the Medicaid program to households making less than 138 percent of the poverty level.  This in turn if acted out would make more people eligible for those programs.

Not all individuals will qualify for subsidy even though most Americans will be eligible to obtain coverage through the exchange.  Employer-sponsored coverage may affect an employee’s ability to meet the criteria for the subsidy.

If there are many employees qualify for federal assistance, it will be reasonable to let them use those plans, particularly since employees being offered insurance by an employer aren’t allowed onto the marketplace if their employer is offering insurance deemed affordable, or 9.5 percent of their wage rate based on 130 hours per month for single coverage.

“A lot of folks qualify for these things, and there’s no penalty to employers,” Tambe said.

Know the paperwork

There are a number of new requirements employers need to be aware of in order to remain in compliance under the ACA. For instance, all employers are required to provide notices to new hires and current employees about the health insurance exchanges before Oct. 1.

Tambe said the fines for failure to comply can be steep. For example, if an employer fails to provide employees with an SBC, the potential penalty to the employer is $1,000 per employee per day.  There are also requirements that employers provide Summaries of Benefit and Coverage (SBC) to each employee 30 days prior to their renewal and 60 days in advance of any material changes to their plan outside of their renewal.

Avoid community ratings

Effective at renewal in 2014, one of the more substantial changes for employers with less than 50 employees is the new rating structure, Community Rating.  Community rating will need health insurance companies to give out health insurance policies to all people in an area, at the same price and without medical underwriting, in spite of of their health status.

Under this new structure, most groups will see a substantial increase in rates by as much as 30 percent to 50 percent, he said.  A strategy that Tambe is implementing for some of his clients is to renew their current group plan Dec. 1, 2013, which will allow them to maintain their current rating structure rather than immediately moving to community rates.

Consider how you want to grow long-term

Industries, if not all, some, like food service industries, retail, and those with large unskilled workforces have traditionally employed large numbers of part-time employees.  These industries may have to adjust workforce toward larger numbers of part time workers in order to avoid the requirement of providing insurance to full time workers, Mullins said.

“Maybe you’ll have to consider hiring a few extra part-timers to get your people under 30 hours,” he said.

Tambe also said the rules are different for companies with under 50 employees compared with those employing more than 50, which should also factor into business growth plans.

Controlled groups beware

A controlled group must provide the same benefits to all of the employees in all of the companies.  This companies are defined by the Internal Revenue Service as multiple corporations connected to a single parent corporation through stock ownership.

Failure to do so could be considered discrimination, and land those companies an IRS audit, Tambe said.

Take a look at self insurance

More companies, particularly smaller companies, have been looking into self insurance, and some providers are now offering self-insured options for as few as 15 lives, Tambe said.

Here is how it goes, in a self-insured product, the employer pays all employees’ minor health costs out of pocket, and buys coverage only for major expenses only, “major” expenses defined in the range of more than $50,000 for an individual, or more than $500,000 for the whole company, although there’s a wide range of policies companies can buy.

Tambe said it can be a risk, but if employees are generally healthy, chances are companies will save money.

Build a team of experts

Ultimately, Tambe said there is no single strategy for navigating the ACA. It will affect companies differently depending on their industry, size, and workforces.

Tambe said it’s important for employers work with a knowledgeable and trusted advisor to come up with a long-term plan for their companies.

For that reason, he said professional employer organizations, or PEOs, have been a popular option for employers to outsource the responsibility for ACA compliance, as have using temps.

“For any one employer trying to do this, it’s going to be a whole lot of work for HR,” Tambe said.

Jl Jendral Sudirman Kav 3-4
Jakarta
San Francisco, CA 10220(221) 573-5843

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I understand that insurance is a major buget consideration for any person, family or business, and our mission is to serve the needs of the residents of Denham Springs, Walker, Livingston, Central and Baton Rouge area as well as other areas of the state of Louisiana by offering Auto Insurance, Home Insurance, Life Insurance, Business Insurance, & Health Insurance at competitive prices with exceptional customer service.

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IMPORTANT TIPS FROM A HEALTH INSURANCE SPECIALIST

Never take medical health insurance advice from someone that is absolutely unqualified to give you with these tips!!

Don’t take medical health insurance advice from someone unqualified to provide these tips. Seek any adverse health insurance specialist, they’ve analyzed and therefore are licensed to provide these tips and they are liberated to you. Rely On Them!!

All of us have our own opinion of what health plan we want.  And not because someone is your relative, someone you know or someone he knows are associated with some section of healthcare totally not connected to insurance, does not necessarily mean they are completely knowledgeable of the solutions for your individual needs and questions.  And even before problems show up, insurance specialists are always readily available.  Most insurance specialists get compensated through insurance service providers, so their professional services can you. Rely On Them!!

Determine your actual needs.

Consider your actual needs. Request yourself questions so guess what happens your particular health plan needs are, that method for you to make certain you choose an agenda that fits them. In the end, if you do not understand what you really need inside a plan, how would you determine if you’ve encounter the best fit?

Consider your budget, designs of physician and hospital visits, and prescription medication usage when identifying your requirements.  Reflect on these questions: How often would you go to your physician? Do you opt for examinations only or do you opt for sick visits? The number of occasions are you currently within the hospital previously 24 months? Would you take regular medications? What exactly are they? Generic or Brands? This really is another area where the majority of my clients neglect.

In the majority of those areas in roughly any affordable way, it is not easy to have maximum coverage because maximum coverage for that physician and hospital plus medications leaves a dent or dimple within the budget.  Though, almost every medical health insurance plans offer several version of the identical plan.

Resist the need to in excess of-insure!!

Resist the need to in excess of-insure! Healthcare Reform has transformed the number of plans work and you’ll have the ability to receive ample or superlative coverage without over-covering. And more importantly, with no hefty rates!

Some thinks that if the have maximum coverage for doctors, hospitals, and medications; they have “good” insurance.  But in reality it is simple, many people who definitely are approved for individual medical health insurance will not need all of this coverage.  What you need to understand is: Healthcare Reform and prevent-Loss. First, Healthcare Reform enables for maintenance services to become covered at 100%. For instance, should you only get examinations, why sign up for the program with 100% doctor’s visit coverage? Sign up for the program having a lower premium and pays $10 copay for the sick visit.
Then, choose your plan after following the above tips.

Westhill Consulting Insurance - Important Tips From a Health Insurance

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Aetna will stop selling individual health plans in California

SACRAMENTO, California — Aetna Inc. discontinue selling individual health insurance policies in California, just weeks after opting out of the exchange that is being established as part of the national health care reforms, a state regulator said last month.

California Insurance Commissioner Dave Jones said he was disappointed in Aetna's decision because consumers need more choices. The decision does not affect people who have Aetna insurance through their employer.

"This is not good news for California consumers," Jones said in a statement. "A competitive market with more choices for consumers is important, as we implement the Affordable Care Act and health insurance coverage is a requirement."

In California's individual health insurance market, Aetna is a quite small player. According to 2011 figures compiled by the California HealthCare Foundation, Aetna has about 5 percent of the state's individual health market. By comparison, Anthem Blue Cross, Blue Shield and Kaiser share 87 percent.

Aetna says it has about 58,000 individual enrollees in the state and expects to have about 49,000 by the end of the year. It plans to withdraw from the state at the end of the year but will continue to offer small and large group plans, as well as Medicare, dental and life insurance products.

Those in search of to buying their own health insurance will be directed to Covered California, the state's new health insurance exchange starting Oct. 1. Aetna was not among 13 insurance carriers that will sell individual coverage to millions of Californians through the exchange.

According to Jones' office Under state law, Aetna will not be allowed to sell individual policies in California for five years once it leaves that market.

Forms of term life insurance coverage:

ART or Annual renewable term life - The policy holder can renew the policy yearly for a set period of time, can be for as long as 30 years. Premiums are adjusted higher with each annual renewal and such policies are based on the age of the policy holder.

A Guaranteed level premium term life is an insurance that allows the policy holders to lock in an assured premium for a set period of 5, 10, 15, 20 years or more. The guaranteed level serves as a protection of the policy holders from increases due to inflation or from higher premiums - that might otherwise result from changes in the policy holder's health.

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http://www.westhillinsuranceconsulting.com/blog/westhill-consulting-retire-overseas-8-top-spots-for-quality-health-care/

Retiring overseas may seem like a fabulous idea, but the quality of health care often has post 50s thinking twice before making a move abroad. But they needn't worry.Live and Invest Overseas, an online publication devoted to helping those interested in living abroad, has a list of the eight best places to retire for quality health care. (They also published a list of the 21 best places to retire in 2013 earlier this year.)

Live and Invest Overseas' Retirement Index took into account the availability of care that most foreigners would find acceptable; insurance coverage options; cost (both of care and of local insurance); and the quality and number of hospitals and clinics.

"If health care is a priority (that is, if you have an existing, ongoing medical concern), then you probably want to stick close to a city," said Kathleen Peddicord, publisher of Live and Invest Overseas. "Medical care is cheaper most everywhere in the world than it is in the United States; of course, not everywhere in the world boasts international-standard medical care.

"However, you can find top-notch care in centers of population, from Cuenca, Ecuador to Panama City, and from Kuala Lumpur to Montevideo," she added. "And, in these places, this legitimately world-class care can be one-fourth the cost of comparable care in the United States or less."

http://www.westhillinsuranceconsulting.com/blog/westhill-consulting-nobel-prize-winner-sets-sights-on-fixing-u-s-healthcare/

Having heard Clay Christensen expound on disruptive innovation, it shouldn’t come as a surprise that change always comes from outside of incumbent players. While health orgs are dooming their innovation to failure or dither by not taking any meaningful action, it’s notable that a Nobel Peace Prize winner sees an opportunity to fix a critical portion of the U.S. healthcare system. As any good entrepreneur would do, Yunus identified an unmet need and so Grameen created an offering tailored to their target customers.

This article is a section of a longer paper on Direct Primary Care (DPC) that was introduced in an earlier piece – Health Plan Rorschach Test: Direct Primary Care. The following excerpt from that article briefly explains DPC if it’s a new concept. Click through the previous link for additional context.

Despite its inclusion in Obamacare, Direct Primary Care (DPC, aka Concierge Medicine for the Masses), it’s surprising how few health insurance executives know about DPC. DPC  is a model of paying for primary care outside of insurance. The individual or organization paying for healthcare pays a monthly fee (like a gym membership) for all primary care needs. Generally, DPC providers say they can address 80 or more of the top 100 most common diagnoses.

Grameen America Partners with DPC Provider to Low Income Patients

Nobel Peace Prize Winner, Muhammad Yunus, is famous for creating the concept of microfinance which has brought thousands out of poverty via the Grameen Bank. Grameen America is their U.S. affiliate which has already lent $93 million to over 17,400 women impacting 70,000 people (each borrower averages a family of four). Their microfinance repayment rate is 99.4% in the U.S. which is even more impressive than they have achieved internationally. Grameen has partnered with Iora Health to offer primary care services to their borrowers in New York. They believe addressing healthcare is a key facet of bringing people out of poverty.

Grameen’s plan is to initially offer Iora’s services only to Grameen borrowers. After that, Grameen will extend Iora’s services to their family members (including children) and eventually more broadly.  Like their microfinance program, it isn’t designed as charity. Rather, Grameen borrowers will pay $10 per week ($43/month) which they expect will be economically sustainable. The borrowers, many of whom are undocumented workers, fall outside of what Medicaid and Obamacare address so the rest of the healthcare system is quite happy to keep these individuals out of the ER or even Federally Qualified Health Centers. Grameen’s “competition” will be the ER and FQHC so they must demonstrate that higher level service and dealing with the same healthcare team provides distinct advantages over disjointed (though often free) care in the ER/FQHC.

This development will further debunk the myth that DPC isn’t applicable to the broad populous. Given the extremely high Net Promoter Scores Iora achieves (higher than Google GOOG +1.57% or Apple AAPL +1.56%), if there is a “two tier healthcare system” (a common criticism of retainer-based medicine) it is higher income people getting the short end of the primary care stick. Doctors call the flawed fee-for-service model “hamster wheel primary care” because it’s a nightmare for the doctor and delivers sub-optimal value for the consumer — i.e., rushed 7-minute appointments, insurance bureaucracy laden processes, and delays in getting to see a doctor, etc. Not unlike how mobile phone carriers have developed profitable offerings to serve low income immigrant populations, Grameen hopes to prove they can do the same in healthcare. It will be interesting to watch.

Nunivak