Networks participation is extraordinarily plastic. Providers can leave networks at will, and entry can be anywhere from signing a new contract to being invited in to being wined, dined and sixty-nined until the provider agrees to participate. In the past year for Mayhew Insurance, providers have left our primary commercial (non-Exchange) network for the following reasons: …
Changing plans — not just for the Exchanges
Plan designs change all the time. That is why the whole brouhaha over the “If you like your plan, you can keep it” was so amazingly stupid but effective. As I was digging for articles for a post that I want to write on narrow networks, I saw this interesting piece from northwestern Pennsylvania: It’s …
Changing plans — not just for the ExchangesPost + Comments (39)
Snipping Costs
I got snipped today. I was also a minor contributor to high healthcare costs due to insurance benefit design. Vasectomies are very straightforward, generic procedures with few complications. It is a fairly low skill operation. It could be done almost anywhere. However I elected to have it done at a regional academic medical center. This …
Virtually Speaking tonight
I’m scheduled to talk about health care and PPACA implementation with Jay Ackroyd tonight at 9:00pm EST. Virtually Speaking is here: My big concern is a combination of tech problems on my end and the fact that I have a voice best suited for blogging. Update: That was a lot of fun. We …
Getting old is expensive
Getting old sucks and it is expensive. Covering kids and young adults had been an easy fall-back option for Democrats and some Republicans prior to the passage of PPACA because it is an easy thing to do. SCHIP expansion was one of the first bills that passed the 2009 Congress with only two Democrats in the …
Carve-outs are common
In the post yesterday concerning the Iowa Medicaid waiver, a commenter asked what the state meant by a “capitated commercial dental plan carve-out”. This is a common arrangement for Medicaid, Medicare or most private health insurance companies and plans. There are four chunks of information in that phrase. The first is capitated which means a fixed fee per …
Good News Everybody
Most of Iowa’s Medicaid expansion waiver has been approved according to the Washington Post: the Department of Health and Human Services has just notified Iowa that it is prepared to grant the state a waiver to pursue much of what it has asked for in response to its request for HHS approval to expand Medicaid-funded coverage to …