Kevin Knauss: Health, History, Travel, Insurance
Posts related to coverage, prescription medications, benefits and providers under health insurance plans.
By the time I had all the fun in the urologist’s office, the prostate pain had virtually disappeared. My PCP and I had theorized before the PSA test that the new mountain bike I bought, with the knife-like seat, may have traumatized the pudendal nerve, a common problem among cyclists. I had stopped riding my new bike and the pain gradually subsided. The next PSA test result was a 4, confirming that I needed to buy a new bike seat.
The single payer proposals I have read deal mainly with the consumer side regarding access to care and reduced patient costs. What seems to be missing is recognition that medical groups and hospital have built their budgets around the existing health insurance plan reimbursement rates. There is no mechanism in the single payer proposals to limit the costs such as the cost of labor (nurses) which is a significant financial element for hospitals. Until we get a handle on the cost of health care, health insurance rates will continue to rise and a viable single payer proposal, where you have more than one or two hospitals participating, will only be a dream.
The goals of Prop 8 sound good: better patient care and lower costs. Basic economic theory suggests that artificially regulating prices lower leads to shortages. We cannot force the current dialysis clinics to become nonprofit organizations. Just like large retailers close under-performing brick and mortar stores, I would expect no less from the CEO of a dialysis company to close those locations whose primary insurance payer were on the lower end of the reimbursement scale such as Medi-Cal or Medicare.
By paying for prescription drugs out-of-pocket, and not having them accumulate toward the maximum out-of-pocket amount for the health plan member helps the insurance company, not the consumer. Not having the drug costs go through the health plan could cost the consumer thousands of extra dollars in health care expenses because they did not meet their maximum out-of-pocket amount for the year.
The big change for the Gold plan was an increase in the MOOP from $6,000 in 2018 to $7,200 in 2018. That is a 16% increase. Before 2018, the Gold plans did not make a lot of financial sense considering they were so much more expensive than Silver plans. In 2018 the Gold plan MOOP was reduced to $6,000 and the Silver plans offered through Covered California were artificially inflated by approximately 10%. This meant for consumers receiving very little monthly tax credit subsidy, they were better off enrolling in a Gold plan because for some carriers the rate was less than the Silver plan.
For eligible members, there is no additional cost to participate in this program or for services provided by Landmark. Covered services provided by non-Landmark providers through a referral from Landmark may be subject to cost-sharing based on members’ health plan benefits and coverage.
Health Net is bringing primary, preventive and urgent care right to our members — literally. Starting May 1, 2018, your PPO clients — individuals and all group sizes — will have a new way to connect to care with a Heal doctor who can make house calls.
Tuesday evening I took a shower and this rash had blossomed around my waist and butt. The most uncomfortable outbreak was around my couch and between my legs, not to mention it just looked awful. I was the perfect candidate to have a flare up of the herpes zoster virus also known as Shingles when it manifests itself as a rash. I was over 50, had chicken pox as a child, and had not had the Zostavax vaccine to prevent Shingles.
If you own a small business or receive income for a service you provide, and most likely file a schedule C with your tax return, you should consider having your estimated taxable income reviewed by your tax planner. The IRS has noted that as they develop guidance for all of the changes to the tax regulations for 2018 they will be posting them on their website.
In the case of this specialty genetic laboratory test, the lab billed $8,000 for the test. The health plan determined that the Allowable Amount was $3,000 for the test. The health plan paid 50% of the allowable amount in the form of a check to the plan member. Oddly, the Evidence of Billing indicated that none of the $8,000 claim was covered, even though they sent a check to the plan member for 50% cost-sharing for the test. Regardless, the plan member is still responsible for full $8,000 to the lab for the test.
