Discover and read the best of Twitter Threads about #healthplan

Most recents (5)

1/ Important #NSA update as @CMSGov has posted "a checklist of reqs. for group health plans" after rec'g @ACEPNow @EDPMA letters & examples detailing numerous instances of #healthplan non-compliance w/ regs; 2/ The agency details several of most impactful non-compliance issues...
2/ health plans requiring that physicians/hospitals proceed through hosted website by the carrier to initiate the req. 30 day open negotiation period + lack of QPA info. + lack of health plan name, address AND email for sending the open negotiation notice 3/CMS states clearly....
3/ that the initial payment should be an amount the health plan "reasonably intends to be payment in full) (p. 2); 4/ CMS makes clear that the "clock" for the 30 day open negotiation period notice begins to run upon sending the notice, not per an "acceptance process or website".
Read 7 tweets
1/ Lookie here: CMS blocks 3 UnitedHealthcare Medicare Advantage plans from 6 states--for failing to meet their mandated "medical loss ratios" (MLRs) where they're supposed to spend 85% of the premium dollar on health care between '18-'20 yet @UHC says..…
2/ "COVID-19" was the reason that they didn't make their MLR requirements--really? How was COVID-19 a factor in '18 & '19? Folks didn't defer care then for COVID-19 w/ first reported US cases in December--so what's your new excuse--give us one that we believe--chickens coming ..
Read 4 tweets
Health insurance provides people with a much needed financial backup at times of medical emergencies.

It’s important to have health insurance as a safety net. If you unexpectedly get sick or injured, health insurance is there to help cover costs that you likely can’t afford to pay on your own.
Health care can be very expensive. It can be an enormous financial burden. Surgery, emergency care, prescription drugs, lab work, scans and examinations – these sorts of costs can add up very quickly.
Read 8 tweets
1/ In what has 2 be described as a stunning “admission against interest” (lawyer term for someone who speaks against their own interest & is deemed to be highly probative of the truth in evidence), the #TX @AHIPCoverage speaker presented a slide of ED pro fee charges & payments..
2/ slide shows that for 5 levels of ED pro fee claims the initial payments average was $142–database of >76K IDR disputes—& the adjudicator’s average award (all 5 ED levels averaged) was $985, that’s 6.94X of the health plan’s initial payment—improved from first 10 months—so …..
3/ what does this say about IDR as the method to resolve $ disputes? 1. Health plans ridiculously low ball initial payments; 2. Physicians are winning more now 16 months in vs. the first 10 months; 3. The average award has increased to nearly 7X from 4.5X initially; 4. Booyah TX!
Read 5 tweets

36% of current 32,600 Health Plan participants
•2,900 Plan 2 Participants
•650 Age & Service Participants
•8,200 Senior Performers
•11,750 Total Participants will lose their SAGaftra Health Care
May not hit you personally; it affects your coworkers.
These draconian changes affect all performers: day players, stunts, singers, stand-ins, background actors, dancers, recording artists, voice-over artists, broadcasters, and most importantly, the seniors who built our Union.

For #SAGAFTRA Members over 65 taking their pensions, residuals no longer will count as earnings.
BUT! These same members will have contributions made into the Plan on those earnings. These same members will continue to pay dues and taxes on them.
Read 29 tweets

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