Common Health Insurance Terms

Common Health Insurance Terms

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Common Health Insurance Terms

We understand that navigating the insurance maze can be daunting. Insurance companies use terms like, “Copay” and “Out of Pocket” and sometimes their terms can seem like a foreign language. Here are some of the most common terms you may hear and what they mean.

 

Insurance Premium– This is the cost of your plan, the monthly bill you, or your employer, pays for insurance coverage.

 

Deductible-This is the amount you pay BEFORE your insurance plan kicks and pays for certain services.

 

Copay– This is the upfront fee you pay to your doctor for services and office visits. This also applies to some medications.

 

Coinsurance– This is the amount you pay for services after your deductible has been met.

 

Total Member Responsibility-The amount that you owe for services AFTER your insurance plan has paid their portion. This can include deductibles, copays and coinsurance.

 

Out of Pocket Maximum– This the MOST you will be required to pay towards your deductible, copays and coinsurance. When you meet the Out of Pocket Maximum, all eligible charges for medical services are covered at 100% for the rest of the year.

 

Have questions? Give us a call!

Tips for Keeping New Year’s Resolutions

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Many of us make a list of resolutions in the beginning of a new year, fresh starts, new beginnings and all, right? Often, keeping those resolutions or goals can be difficult, as we settle into our old habits and patterns. Here are a few ideas to help keep you motivated.

  1. Keep them realistic. If you make a goal to lose 50 pounds this year, you may be setting yourself up for failure. Start with a more attainable goal that you can achieve in a relatively short amount of time.
  2. Start with one goal, and write it down. Having a visible reminder can help you stick to it.
  3. Make new goals, don’t repeat the same one you failed at in the past. Change it up, change your approach and keep in mind that change is a process.
  4. Don’t wait until the end of the year, or the last minute. Plan a head and keep moving forward.
  5. Celebrate all small victories towards your goal. This will help keep you motivated and when results are achieved, no matter how small, you will feel like you are accomplishing something and you will eventually conquer it.

Lastly, don’t be hard on yourself or let setbacks get you down. Use your family and friends for support, try using those relapses as learning opportunities towards growth and ultimately, change.

Amazon Partners with Blue Cross, Medical Supplies Now Available for Purchase

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Great news for Amazon shoppers and Regence Blue Cross members.

Retail medical supplies and equipment can now be purchased through an Amazon Local Associates shopping page. Blue Cross members can shop, buy and file a claim through the Regence website at:

https://www.regence.com/web/regence_producer/

“Once members have accessed this page:

1)     Members will be prompted to sign an authorization agreement opting them into the program

2)     They will be given a unique, one-time 10% off discount code that they can apply in the discount coupon field on the Amazon checkout page for applicable equipment and supplies

3)     The member is then redirected to the Amazon Local Associates shopping page where they can shop for and purchase medical equipment and supplies

o   Please remember to apply your unique discount code upon checkout to receive the 10%            discount.

o   This program will be in place until the end of September, with the potential to extend further based on member engagement.”

 

 

Source: https://www.regence.com/web/regence_producer/

 

 

 

Recent Study Looks At Health Care Pricing

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According to a recently published healthcare economics paper, different insurers pay varied prices for the same services and procedures at the same hospital, indicating that bargaining leverage really does impact healthcare prices.

 

Authors took actual data from claims for three national insurers. Studies showed that dominate hospitals can dictate how much they are going to get paid for specific services and procedures. For hospitals that hold an monopoly in their area, that number was 12.5% higher than those who had nearby competitors. For more concentrated markets, providers can shift more risk to insurers, which affects the ability to keep prices at a set standard.

 

“The two main types of contracts use prospectively set prices that pay a fixed dollar amount based on the DRG classification code, or a model that sets payments as a percentage of hospital charges.
Hospitals are likely to prefer the latter because they get paid for every service they provide, and thus bear less risk. This drives prices up and also places less pressure on the hospital to reduce costs.”

 

In simply terms, it’s about negotiation. The hospital may charge $50,000 for a hip replacement, but the negotiated price may be more like $22,000, Medicare reimbursements would be even less.

 

“Researchers also found that prices increased by more than 6% when merging hospitals were less than 5 miles apart. They didn’t find significant price impact when the hospitals were separated by at least 25 miles.”

 

 

 

 

Sources: The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured Zack Cooper (Yale University) Stuart V. Craig (University of Pennsylvania) Martin Gaynor (Carnegie Mellon University and NBER) John Van Reenen (Massachusetts Institute of Technology, CEP, and NBER)

Modernhealthcare.com

Health Care Cost Institute

 

 

Safe Opioid Disposal

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Did you know that eighty percent of people addicted to heroin started with a legal prescription of an opioid?

Opioids are a common medication given to treat pain. Often, a patient prescribed these medications does not need the entire prescribed amount, leaving extra pills unused. Opioids can also be very addictive, thus a safe way to dispose of any unused amounts is important.

Some common opioids include:

  • Hydrocodone (Norco, Lortab, Vicodin, Zohydro)
  • Oxycodone (OxyContin, Percocet, Percodan, Roxicodone)
  • Morphine (MSIR, MS Contin)
  • Codeine (Tylenol #3, Phenergan with codeine)
  • Fentanyl  (Duragesic, Actiq)
  • Hydromorphone (Dilaudid)
  • Oxymorphone (Opana)
  • Meperidine (Demerol)
  • Tramadol (Ultram, ConZip)
  • Buprenorphine (Subutex, Suboxone, Butrans, Zubsolv)
  • Methadone (Dolophine, Methadose)

Intermountain Community Pharmacies provide collection sites for free.

For more information on safe disposal visit  http://useonlyasdirected.org/

 

 

 

Source: Use Only As Directed 

 

Opticare of Utah offers Discount of Lasik

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Opticare of Utah has very rich discounts at Standard Optical for LASIK, Normally it is $250 discount per eye compared to the 15% discount with most other carriers, this is a definite advantage and a great benefit, offer ends 3/31/2018!

 

Visit https://www.facebook.com/StandardOptical/

Source: Opticare of Utah 

Medicaid Waiver Amendments Passed in Utah Senate

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Recently, the Utah Senate voted in favor of SB  0172, authorizing some changes and waivers to Medicaid requirements.

These changes would allow the Utah Department of Health to:

Ask for federal funds or block grants for Medicaid recipients without certain restrictions on how they use the money.

Second, if the block grant is denied, the bill would allow the health department to do three things:

  1. Require able-bodied Medicaid enrollees to have a job or be working toward a job
  2. Create an HSA option for Medicaid enrollees
  3. Enable Medicaid enrollees flexibility in paying for health care

The goal is allow able-bodied people on Medicaid to live more dignified and and give them the tools to to assist them in no longer needing to rely on the program.

 

Source: Sutherland Institute

 

 

Small Business Owners, Including Ark’s Rebecca Yates, attend Goldman Sachs Summit

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‘More than 110 of Utah’s small business owners attended the Goldman Sachs 10,000 Small Business Summit in Washington DC.  As graduates of the small business-training program, run by Salt Lake Community College, business leaders heard from the ‘who’s who’ of entrepreneurism and government leadership such as Tyler Perry, Senator Marco Rubio and former New York City Mayor Michael Bloomberg.

The summit, titled The Big Power of Small Business, showcased speakers like Richard Branson of Virgin Group who said ‘in order to be a good leader, you have to be a good listener.’ Sara Blakely, Founder and CEO of Spanx, a billion dollar brand, told her story of starting her business with grit and determination. Warren Buffett received a standing ovation as he spoke about the remarkable things small business leaders do and how they impact the economy and lives in every community.’

PC: SLCC

Goldman Sachs 10KSB graduates and Utah Sen. Mike Lee (center) photo courtesy of SLCC

 

 

Read full article https://saltlakecommunitycollege.blogspot.com/2018/02/goldman-sachs-10k-small-business-alums.html

Payment Deadlines Extended

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Due to the growth in their plans and high call volumes,  the University of Utah Health Plans and SelectHealth are extending their payment deadline to January 12  ( U of U) and January 15 for individuals with a January 1 effective date. 

Select HealthU of U Health Plans

Select Health to enforce CMS Guidelines

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Select Health will be enforcing the CMS guidelines for the Special Enrollment Periods (SEP) for marriages as of September 1, 2017. The CMS guidelines states that at least one of the applicants has had one day of coverage in the past 60 days, at a minimum. Proof of both the marriage and prior coverage is required to process a SEP application.

Changes to Preventive Lab Services also in effect as of January 1, 2017.

The following lab procedures are covered under the adult medical benefit when billed with a covered diagnosis codes:

  • Basic Metabolic Panel
  • Comprehensive Metabolic Panel
  • General Health Panel
  • Thyroid
  • Urinalysis

 

Questions? Please give us a call.

Doctor in black tie with stethoscope studio shot