Network dispute leads to $14 million in balance bills

Posted by Alex Tolbert on Wed, Apr 25, 2018 @ 10:04

Patients could see balance bills soon

Are you covered under BlueCross BlueShield of Tennessee Network S? You may not have known that prior to this year, BlueCross had an agreement with HCA TriStar hospitals to provide emergency care at in-network rates, even though HCA TriStar hospitals are not a part of Network S. 

That agreement ended as of January, and the result is a $14 million headache that may soon affect patients’ pocketbooks. HCA has announced it will soon begin balance billing BlueCross members for out-of-network care received at TriStar facilities. 

What does all this mean?

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Tags: healthcare, aca, The Tennessean, healthcare costs, amazon, apple

Tech companies tackling healthcare

Posted by Alex Tolbert on Wed, Apr 11, 2018 @ 09:04

Is tech disruption coming?

Tech companies like Amazon, Apple, and Google have revolutionized our lives. Many of us hail rides on our smartphones, run our homes with virtual assistants, and can have almost any item we need delivered directly to us.

But there’s one corner of the American economy that has, so far, held tech disruption at bay—healthcare.  Perhaps more than any other industry, healthcare has resisted the trends that have radically changed the ways we shop, bank, travel and more.

We still use paper forms at the doctor’s office, you still have to call to make appointments, competition has dwindled, and prices have skyrocketed. Sounds like an industry ready for disruption, right?

The above companies seem to think so. So far this year, several big tech companies have announced plans to tackle healthcare. While no single company could solve all of the healthcare industry’s issues, the companies are proposing solutions to different pieces of the puzzle.

Here are plans from Amazon, Apple, Uber, Lyft and Google to bring healthcare into the 21st century.

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Tags: healthcare, aca, The Tennessean, healthcare costs, amazon, apple

Health insurance market may soon split according to healthy, sick

Posted by Alex Tolbert on Mon, Apr 02, 2018 @ 07:04

Individual mandate changes to affect individual market


For most consumers, 2019 feels pretty far away. But in the insurance world, it’s practically right around the corner. In just a few short months, carriers will have to decide if they intend to sell individual insurance next year.

These decisions will be influenced by recent proposals by President Trump’s administration that would allow carriers to offer plans that don’t meet current Affordable Care Act standards. This could result in more coverage options outside of the ACA, but it could also lead to fewer options and premium increases for ACA plans.

In other words, these health policy changes could create two separate insurance markets, one for healthy consumers, and one for sicker consumers.

To see how this could happen, let’s look into the health care crystal ball and see how these health care policy changes might play out in Tennessee and elsewhere.

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Tags: healthcare, aca, rising healthcare costs, The Tennessean, healthcare costs, pricing

Three ways Congress could reduce health care costs in the U.S.

Posted by Alex Tolbert on Mon, Mar 12, 2018 @ 09:03

Employers teaming up to address healthcare

America’s legislators have been debating health policy for years, but very few proposals have addressed the one issue consumers say they are most concerned about — the high cost of receiving health care in the U.S. 

Americans pay more for health care than anyone else in the world, even for the exact same services and prescriptions. For example, consumers in the U.S. pay $2,669 for a 28-day supply of the rheumatoid arthritis drug Humira, while the Swiss pay just $822 — less than a third of the U.S. price.

The reasons are numerous and complicated, but pricing issues have largely been ignored by Congress in the past decade.

Here are three policy ideas that would affect healthcare pricing. While these proposals would represent a shift, they could lead to more affordable health care in the U.S. 

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Tags: healthcare, aca, rising healthcare costs, The Tennessean, healthcare costs, pricing

Nashville’s healthcare tapeworm

Posted by Alex Tolbert on Fri, Mar 02, 2018 @ 09:03

Employers teaming up to address healthcare

Any consumer who has experienced a major medical event has probably been unpleasantly surprised at America’s high healthcare costs. It can be truly shocking to see the sticker price for surgeries, hospital stays, and prescriptions.

Even one of the richest men in the country, Warren Buffett, can relate. In January, Buffett called healthcare costs “a hungry tapeworm” on the American economy.

Buffett’s company, Berkshire Hathaway, is teaming up with Amazon and JP Morgan to tackle healthcare costs for their employees and, potentially, all Americans.

In other words, three of the country’s biggest employers are teaming up to take on the tapeworm, and Nashville is paying close attention.

Why? Healthcare is Nashville’s biggest industry, and any disruption to healthcare costs will affect the many healthcare companies that call Music City home.

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Tags: healthcare, aca, The Tennessean, Medical Loss Ratio, individual mandate

Three health care myths affecting consumers in 2018

Posted by Alex Tolbert on Wed, Feb 14, 2018 @ 09:02

Policy changes lead to confusion

When it comes to health care, things are as confusing as ever. Possible changes to the Affordable Care Act made plenty of headlines in 2017, but actual changes were few and far between. 

This disconnect has created a lot of misinformation. Polls show a third of Americans incorrectly believe President Trump has repealed the Affordable Care Act, and many other myths have cropped up around healthcare, especially regarding insurance and costs.

Here are three healthcare myths that could be costly for consumers in 2018.

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Tags: healthcare, aca, The Tennessean, individual mandate

Is Obamacare repeal over?

Posted by Emily Kubis on Mon, Feb 12, 2018 @ 07:02

Repeal train slows, but what’s next?

Is the GOP giving up on Obamacare? Healthcare stakeholders and political news entities are suggesting as much. Forbes reports “insurer profits rise as Trump waves white flag on Obamacare,” noting the President mentioned Obamacare only once during his State of the Union address.

Politico reported there were no discussions of repeal and replace at a recent House and Senate joint retreat, and BenefitsPro said Republican leaders in the House and the Senate see a lot of risk and little reward in trying repeal again.

While hardly anything is certain when it comes to U.S. healthcare policy, if the GOP does move on to new priorities in 2018, where does that leave brokers and employers?

Here are three things employers should consider.

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Tags: Affordable Care Act, obamacare, aca, employers, health insurance small employers, employer digest, employee benefit adviser, repeal and replace

Three open enrollment takeaways for Nashville

Posted by Alex Tolbert on Tue, Jan 30, 2018 @ 08:01

Trying to beat the tax time rush?

The most recent open enrollment period for the Affordable Care Act marketplaces was unique. It was the first administered under anyone other than former President Obama, it was half as long as previous periods, and it was the last open enrollment for which the individual mandate applies.

These different circumstances may be signals of what’s to come for the ACA.

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Tags: healthcare, aca, HSA taxes, taxes, The Tennessean, individual mandate

Three healthcare tips for tax time

Posted by Alex Tolbert on Mon, Jan 15, 2018 @ 07:01

Trying to beat the tax time rush?

Mid-January marks the start of tax season, and health care items throughout the past year can impact how you file your taxes. 

This time of year typically creates a lot of consumer confusion, and getting all the facts straight can be tricky. With the repeal of the Affordable Care Act’s individual mandate recently in the news, this topic is certain to cause particular issues this year. 

Aside from the individual mandate, other health care expenses can also affect your tax return, including Health Savings Accounts and high-cost medical expenses. 

If you’re trying to beat the tax time rush, here are a few tips on what you should know about these items.

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Tags: healthcare, aca, HSA taxes, taxes, The Tennessean, individual mandate

With the individual mandate repealed, three things to expect

Posted by Alex Tolbert on Fri, Jan 12, 2018 @ 10:01

When is the repeal effective? 

Republicans successfully repealed the Affordable Care Act’s individual mandate through their tax reform legislation, which has created many questions for consumers.

How will this decision affect insurance markets and consumers’ ability to get coverage? Without additional legislative action, there are three things we can expect.

With the individual mandate repealed, many healthy people will drop their coverage. This will likely lead insurers to expect to lose money, and they will either exit the individual market or raise premiums. As a result, there will be increased pressure on Congress to come up with a solution before consumers’ access to coverage is reduced.

Let’s go through each of these predictions, but first, a little more on repeal.

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Tags: healthcare, aca, The Tennessean, individual mandate

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