Healthcare Services

People are being charged for preventive health care, health care that should be at no cost to them. That’s the headline from an article in the US News & World Report by Robert Preidt, HealthDay Reporter.

The article stated, “Out-of-pocket charges for preventive care that should be free under the Affordable Care Act can discourage patients from receiving recommended care…”. While a majority of patients are receiving preventive care for free, those who were charged only paid about $20 or less.

Unexpected charges were also common for routine screenings for cancer, diabetes, cholesterol, depression, obesity, and sexually transmitted infections, as well as pregnancy-related services.

The primary conclusion of the study was these charges were discouraging future health care screenings.

Employee Benefit Advisors provides, employee benefits, Healthcare Consumption Audits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

The No Surprises Act, a ban on surprise medical bills, will take effect beginning in 2022.

Surprise Medical Bills

Surprise medical bills occur when patients unexpectedly receive care from out-of-network health care providers. – A patient goes to an in-network hospital for surgery or emergency care, and an out-of-network doctor is involved in the patient’s care. Patients are not able to determine the network status of providers, such as emergency room doctors or anesthesiologists. The patient is simply not involved in the choice of provider.

No Surprises Act

The Act applies to surprise bills from doctors, hospitals, and air ambulances. It prohibits these providers from billing patients who have health coverage for unpaid balances. Providers will have to work with the health insurance issuer carrier to determine the appropriate amount to be paid by the plan.

(The No Surprise Act was included in the stimulus bill signed by President Trump on Dec 27, 2020.)

EBA will continue to keep you updated as information becomes available on the details of the law.

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

Employee Benefit Advisors recommends communicating the following to you employees. Odds are your company has either employees on Medicare, family members on Medicare, or both.

Copays for the Coronavirus test have been waived, but not the cost of the doctor visit needed to get the test or the treatment.

Telehealth – CMS announced that it will expand telehealth services for Medicare beneficiaries and cut back on HIPAA enforcement. Email and texts to docs will be possible! Read the CMS details here

Cost of testing – Medicare Part B (Medical Insurance) covers a test to see if you have coronavirus (officially called 2019-novel coronavirus or COVID-19). https://www.medicare.gov/coverage/coronavirus-test

3 Day Hospitalization Waived for Skilled Nursing Facilities – The waiver of the requirement for a 3-day prior hospitalization for coverage of a SNF stay provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who are evacuated, transferred, or otherwise dislocated as a result of the effect of disaster or emergency. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period (Blanket waiver for all impacted facilities). Click here to download the full CMS memo.

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Symptoms people may experience:
1. runny nose (Not to be confused with allergies)
2. sore throat
3. cough (develop the habit of coughing into your sleeve or handkerchief – never your hand!)
4. fever
5. tightening of chest / difficulty breathing (severe cases)

What can you do?
• Emergency Room – very expensive
• Urgent Care – less expensive than ER but more cost-effective options exist
• Primary Care Physician – generally a low flat copy; at most the contracted rate between the physician and insurance company
Because COVID-19 is highly contagious to prevent contaminating health care service workers, it is not recommended you go directly to the              ER, UC or PCP.
• Telemedicine – no cost! – If you need emergency care or any additional care the doctor will advise you.
(According to the Centers for Medicare & Medicaid Services (CMS), Essential Health Benefits (EHB) coverage generally includes coverage for the diagnosis and treatment of COVID-19.)

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Group health insurance premium are expected to rise 15-18% in 2019 and Telemedicine can be an important cost containment tool, for both employer and employee.

In a study of 17,000 telemedicine participants, hospital admissions dropped by 30% and doctor visits were reduced by 60%, for a savings of 45% in unnecessary doctor and emergency room visits. The American Medical Association states that 70% of doctor visits can be handled over the phone, and 50% of the emergency room visits are non-emergencies. Telemedicine’s savings in claim costs range from $300 for a single employee to more than $1,000 per year for a family of 4.

Telemedicine provides 24/7 medical access to employees as part of their benefit package. Advances in communication technologies make accessing professional medical opinions easier. This is particularly important if the network is strictly local, employees live in rural areas, or employees are worried about access to doctors while traveling.

In addition to the obvious convenience – patients/employees do not have to take time away from work for a medical appointment, sitting in the doctor’s waiting room, eliminating travel time – patients/employees have increased access to medical experts in many fields. Telemedicine puts the employee in touch with US Board Certified physicians in their state to treat common ailments; cold/flu, sinus infections, allergies, pink eye, etc.

What can employers do? – Employee Benefit Advisors recommends companies build a communication program to educate employees. In addition to informing employees the services that can be accessed via telemedicine be sure to include instructions on downloading your health insurance carrier’s app and login.

Interestingly, a bill submitted in New York proposes creating a task force to study how telehealth and telemedicine might help employees in workers comp. The task force would examine how connected health technology could improve outcomes for workers on worker’s comp, increase access to care providers and enable those providers to improve compliance with worker’s comp guidelines. The committee would also explore how telehealth and telemedicine could help employers and reduce fraud.

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.