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Not long after she signed up for health insurance under the Affordable Care Act, Judy Shoemaker received a phone call that puzzled her. The caller said she was welcoming new members to the insurance network and then asked Ms. Shoemaker to take a survey about health care issues, so information could be provided to her physician. Ms. Shoemaker declined, saying she didn't understand why her insurer would be seeking medical information to give to her doctor. "I thought it was strange," said Ms. Shoemaker, a consultant to nonprofits in Indiana. "I can talk to my doctor myself." James Tuck, who runs a dog care business in Chicago, got a similar call after signing up for insurance through the Affordable Care Act in March. The caller said he was contacting Mr. Tuck on behalf of his new insurer, Blue Cross Blue Shield of Illinois, to go over his benefits and ask him some questions. Mr. Tuck hadn't yet received his insurance card and was hesitant to answer questions, especially after he consulted a private health advocate, who had helped him evaluate insurance options. She advised him not to answer the queries. "She said their goal is to find a reason to get you booted off your insurance." Insurers say they are doing nothing of the sort. Lauren Perlstein, a spokeswoman for the Health Care Service Corporation, parent of Blue Cross Blue Shield of Illinois and plans in four other states, said in an email that the company contacted new policy holders to help "new members get the proper coverage and medical assistance they need, by helping guide them through the health care system." The company's "experts" contact new members to explain benefits and answer any questions, she said, as well as to "identify members who can benefit from our personalized medical management program so they can best manage their health."

Practical Saver: Tips for saving money on healthcare By KARA ROZENDAAL Courier Columnist Changes in the health insurance arena have many consumers scrambling for affordable options. Don't despair; there are still ways to save significant money on healthcare. Below are a few medical resources that Prescott has to offer, as well as tips on how to pay less at the doctor's office, and an alternative to health insurance. To save money on premiums, many families opt for higher-deductible health insurance policies. High deductibles generally equate to lower monthly insurance premiums. However, in exchange, the majority of the medical expenses are paid out of pocket. In the case where doctor's visits and medical treatment are paid out-of-pocket, you can save money by asking the medical office if there is a cash pay discount. When a patient pays cash and the business doesn't need to submit the claim to the insurance company, it saves the office time.

Charging you for help getting new insurance Someone contacts you, offering to help you navigate the Health Insurance Marketplace for a fee - or saying that you need a new insurance card now or you'll have to pay a penalty. Regardless of the set-up, their goal is to get your bank account or credit card number. Don't give your information. The people who offer legitimate help with the Health Insurance Marketplace - sometimes called Navigators or Assisters - are not allowed to charge you. In fact, you can't pay them. What's more, you don't need to buy a special insurance card, or pay any penalties for not buying one, either. Bottom line: Never give your money or your information to anyone who contacts you. Medicare cards Someone gets in touch, saying you need a new Medicare card because of "Obamacare." They tell you that you'll lose Medicare coverage if you don't pay a fee for a new card or give them your Social Security number and bank account or credit card number. Not true. The Affordable Care Act doesn't say you need a new Medicare card, or another health insurance card. Nor does the law say you'll lose Medicare coverage. Don't give your personal or financial information to anyone who contacts you. When in doubt, call 1-800-MEDICARE, before you give anyone your money or information. Medical discount plans Someone contacts you, offering discounts on health services and products. They might say the discount plan will save you money and that it meets the minimum coverage required under "Obamacare" so you won't have to pay a penalty or look at other plans. Medical discount plans are not health insurance. Sometimes, medical discount plans illegally pretend to be insurance. The only way to know is to ask specific questions and not pay until you read the terms. Most medical discount plans are a membership in a "club" that claims to offer reduced prices from certain doctors, certain pharmacies, and on some procedures.

Millions of Americans gained health insurance coverage under the Patient Protection and Affordable Care Act this year, but the influx apparently has not yet translated into patients packing doctors' offices. That may reflect a lack of understanding about how and where to seek care-and a lack of outreach by their new plans and providers. "If coverage expansion is allowing patients to establish new relationships with physicians, we would expect to see physicians devote a greater share of their calendars and work effort to caring for new patients," wrote the authors of a report released this week by the Robert Wood Johnson Foundation and Athenahealth, a company that sells cloud-based health information and practice management technology. But that is not what they found. Though it may seem counterintuitive, the organizations discovered that during the first five months of 2014, all specialties-with the exception of pediatrics-experienced lower rates of new-patient visits than they had in the year-ago period. This was based on data taken from more than 14,000 providers across specialties. For example, the proportion of visits from new patients to primary-care physicians in the sample from January to May 2014 was 18.8% compared with 19.3% during that same five-month period in 2013. The study did not analyze what caused this decline, but the authors suggest that one reason is that the newly insured are continuing to go to emergency departments instead of physician offices. That explanation seems consistent with studies that showed increased emergency department use after pre-ACA expansions of health insurance in Massachusetts and Medicaid in Oregon.

How to Find Affordable Family Health Insurance http://www.westhillinsuranceconsulting.com/blog/how-to-find-affordable-family-health-insurance/ Take advantage of free quotes: Who doesn't like free, it a great price! There are many health insurance websites where you can find lot of sites with free family insurance quotes. You must take advantage of these. Not every policy is going to fit for everyone because every family is different. To know the best one for you and your family, use these quoting tools to gather prices and service offerings. And do not think about it as a waste of time, after all it is a free look into the company. It is free yet well worth the time it takes to fill out the questionnaire or quoting application. Know your priorities: You should know and you must be well aware of all your priorities regarding your health care. Are you satisfied with your current doctor or are you open to find new ones? If you are unsure, sit down and take some time listing of your top five most important things when looking for a new policy or health insurance company. This will help you narrow down exactly what you only need and what your looking for. Ask for help if you need it: It is all known to us that understanding the ins and outs of health insurance policies and coverage could sometimes be very frustrating. This is more common to those who are just new to it. Do not hesitate to ask questions if you need to ask questions, ask your questions to the health insurance company representatives. You can even ask your husband, your wife, your dad, your mom, or even your friends. But if you feel that you are not satisfied with the answers you got, don't be frightened to enlist the help of an insurance broker. They can help you find the best rates available, can explain the inner workings of the policy, and know what places are reputab

The needs of elderly parents can surprise even those who are prepared, but you don't have to support your family alone Adult children of older parents should prepare financially for the costs of care and travel. Photograph: Alamy We all want to age like the late Pete Seeger, who celebrated his 90th birthday performing onstage in front of thousands of adoring fans of all ages at Madison Square Garden, and went on to entertain the Newport Jazz Festival audiences a few months later. In our pragmatic moments, we know that the odds of living that long and in such good health aren't in our favor. We know we need to plan not only to live longer but perhaps to spend more time in costly nursing homes or care facilities. It's not just ourselves we have to worry about. Failing to develop a plan to help our parents in their final years could deliver a similar kind of blow to our emotional and financial wellbeing. In the last few months, I've watched three friends, ranging in age from their 40s to the early 60s, scramble to resolve non-medical problems for their parents. In all cases, that meant forking out on costly airfares to be there in person; in one case, it required money to hire a new accountant. "I've always been aware that at some point, there would be an emergency, but I had assumed it would be a stroke or something, not this," one told me, ruefully. A recent US Trust survey revealed that while about half of all Americans have planned for their own long-term care needs, on

Tips for navigating Obamacare http://www.westhillinsuranceconsulting.com/blog/westhill-consulting-tips-for-navigating-obamacare/ Think hard before your drop insurance entirely Tambe said that might not make good business sense despite some companies might be tempted to abolish insurance benefits completely and let employees go to marketplaces to get coverage. The problem is insurance purchased on the marketplace will be more expensive for individuals. Then the company will risk talent leaving the company for a competitor who offers them the less expensive option if the company isn't willing to compensate by raising their salary. "It may work to keep costs down but you'll have a hard time keeping talented folks," he said. Other federal programs could help you For households making under 400 percent of the Federal Poverty Level, the ACA grants subsidies available on the public marketplace under certain circumstances. Additionally there are current efforts for Ohio to spread out the Medicaid program to households making less than 138 percent of the poverty level. This in turn if acted out would make more people eligible for those programs. Not all individuals will qualify for subsidy even though most Americans will be eligible to obtain coverage through the exchange. Employer-sponsored coverage may affect an employee's ability to meet the criteria for the subsidy. If there are many employees qualify for federal assistance, it will be reasonable to let them use those plans, particularly since employees being offered insurance by an employer aren't allowed onto the marketplace if their employer is offering insurance deemed affordable, or 9.5 percent of their wage rate based on 130 hours per month for single coverage. "A lot of folks qualify for these things, and there's no penalty to employers," Tambe said. Know the paperwor

When the Bergen County couple filing for unemployment certified they were "able and looking for work," they did so the same way thousands of others do from home every week - by logging into the state Department of Labor website. The online world, however, is not quite as anonymous as many believe. Every computer carries a unique electronic address so it can be found on the internet, and what alerted state investigators to this particular claim was the location of the network being used. It was not in New Jersey. It was registered to Royal Caribbean Cruises in Miami, and no one was under any illusion that the couple was looking for work at sea. Unemployment fraud is a multimillion-dollar business in New Jersey, say officials, with 1,600 to 2,000 attempts to bilk the system each week - from the couple on vacation certifying they were able to work while cruising to the Bahamas, to hackers from all over the world trying to game the system, to people still trying to collect unemployment benefits even after finding new jobs. "No one likes to be ripped off, but the volume of money we put out is staggering," said Harold Wirths, the commissioner of the Department of Labor and Workforce Development. New Jersey's Unemployment Trust Fund went broke in 2009, not only under the strain of the severe recession that led to high unemployment levels, but from years of fraud that went on through decades of neglect. Wirths said the fund is now solvent again, due in part to anti-fraud measures being put into play that he said have saved the state $448.7 million the past three years. "We're fighting fraud on every front," the commissioner said. It is a national issue, according to Douglas Holmes, president of UWC Strategic Services, a Washington, D.C., group that represents businesses on unemployment issues.

WEDNESDAY, May 7, 2014 (Health Day News) - there will be almost twice as many elderly Americans in 2050 as there are now, posing serious issues for the nation's health care system, according to two U.S. Census Bureau reports released Tuesday. "The United States is projected to age significantly over this period, with 20 percent of its population age 65 and over by 2030," Jennifer Ortman, chief of the Population Projections Branch at the census bureau, said in an agency news release. The number of people aged 65 and older is projected to reach 83.7 million by 2050, compared with 43.1 million in 2012, the bureau reported. This sharp rise is due to aging baby boomers, which were born between 1946 and 1964 and began turning 65 in 2011. An aging population "will have implications for health care services and providers, national and local policymakers," Ortman added. She said businesses will also have to adapt to meet new demands as a rising number of elderly influences both the "family structure and the American landscape." Baby boomer-influenced growth in health-care related industries began a few years ago, the agency said. According to the census bureau, there were about 819,000 health and social assistance-related facilities and businesses in 2011 - a 20 percent jump from 2007.

Here's some cheerful news: States and the federal government are doing little to stop a costly form of Medicaid fraud, according to a government report released last week. Medicaid, the federal-state health insurance program for poor Americans, now covers more than half its members through what's known as Medicaid managed care. States pay private companies a fixed rate to insure Medicaid patients. It has become more popular in recent years than the traditional "fee for service" arrangement, in which Medicaid programs reimburse doctors and hospitals directly for each service they provide. Despite the growth of managed care in recent decades, officials responsible for policing Medicaid "did not closely examine Medicaid managed-care payments, but instead primarily focused their program integrity efforts on [fee-for-service] claims," according to the Government Accountability Office, the investigative arm of Congress. The managed-care programs made up about 27 percent of federal spending on Medicaid, according to the GAO. The nonpartisan investigators interviewed authorities in California, Florida, Maryland, New Jersey, New York, Ohio, and Texas over the past 12 months. STORY: No Background Checks Needed for Home Health Workers in 10 States Funded jointly by the federal government and the states, Medicaid provided health insurance to about 72 million low-income Americans at a cost of $431 billion last year, according to the report. By the Medicaid agency's own reckoning, $14.4 billion of federal spending on Medicaid constituted "improper payments," which include both overpayments and underpayments. That's 5.8 percent of what the federal government spends on the program. The $14 billion figure doesn't tally what states lose to bad payments. The fraud risk for managed care is twofold. Doctors or other health-care providers could be bilking the managed-care companies, which pass on those fraudulent costs to the government.

A pair of editorials last week took up the issue of Medicare and Medicaid fraud, waste and abuse, signifying these problems are becoming a greater focus of public attention and debate "Area ambulance companies are facing deserved scrutiny for their disproportionate share of the nation's outsize[d] healthcare costs," The Inquirer wrote. Ground ambulance providers around Philadelphia collected 64 percent more Medicare dollars than the national average in 2012, with 33 area companies raking in 10 times the norm, the article noted. "No wonder Medicare has stopped taking new company enrollments while it sorts out the fraud," the article stated. The Inquirer referenced charges against eight local ambulance providers since 2011, including one's five-year prison sentence for executing a $3.6 million scam involving kickbacks for unnecessary transport. "Medicare is still not as open [as] it should be," the editorial said. "It has spurned numerous attempts by The Inquirer to get additional information on the ambulance companies that are costing the government the most." The paper wants to know if aberrant providers still collect federal money and if Medicare demanded overpayment refunds. Meanwhile, a Farmington Daily Times editorial highlighted the case of Agave Health, Inc., an Arizona mental health services company that in six months received more than $172,000 from Medicaid. Half this money was disbursed before the completion of a state audit led to a funding freeze for 15 nonprofit healthcare providers. "The question is whether those payments suggest state officials prejudged the conclusion of the audit before it was completed," the editorial stated. That audit exposed $36 million in Medicaid overpayments, the Times reported, which led New Mexico to halt Medicaid funding to in-state providers and shift business to Arizona companies like Agave. But New Mexico paid Agave more than it paid in-state providers.

The typical cost of health care for a family of four with employer-based insurance this year is $23,215, according to a new report from the Milliman actuarial firm. The bad news first: That amount has more than doubled in the past 10 years. The goodish news: That cost grew just 5.4 percent between 2013 and 2014, the slowest growth rate since Milliman started keeping track in 2002. That $23,215 figure isn't what the employee pays, though. Employers pay about 60 percent of those costs ($13,520), while workers pay the rest through payroll deductions ($5,908) and out-of-pocket costs ($3,787). The employee share of the costs have been rising faster - increasing 73 percent since 2007 - than the employer contribution, which has grown 52 percent over the same period. The Milliman numbers are for family coverage under preferred provider plans, so it excludes the increasing prevalence of consumer-driven health plans, in which employees handle a higher share of the costs. Don't blame the four-year-old Affordable Care Act for these changes, though. Milliman says Obamacare has barely had any impact so far on these large employer plans, but that's about to change. The actuarial firm cites Obamacare's impending excise tax on "Cadillac" plans - valued at at least $27,500 for family coverage starting in 2018 - as a factor that will force employers to scale back health plans. Milliman points to other factors that will push down cost increases. Higher out-of-pocket costs are fueling efforts around health-care price transparency, and that's making consumers become better health-care shoppers. Conversely, an improving economy and an increase in expensive specialty drugs will pressure costs to rise.

Welcome to Wonkbook, Wonkblog's morning policy news primer by Puneet Kollipara (@pkollipara). To subscribe by e-mail, click here. Send comments, criticism or ideas to Wonkbook at Washpost dot com. To read more by the Wonkblog team, click here. Follow us on Twitter and Facebook. (Photo by Mike Segar/Reuters) Wonkbook's Number of the Day: 70 percent. That's the latest estimate of the mortality rate in the Ebola outbreak in West Africa, the World Health Organization announced. Wonkbook's Chart of the Day: Oil prices are falling, and fast. Wonkbook's Top 5 Stories: (1) Obamacare October surprises and a lower sales bar; (2) Ebola treatments for U.S. patients; (3) attorney general nomination update; (4) security threats of climate change; and (5) new help for long-term jobless. 1. Top story: With a month to go, why the Obama administration won't oversell Obamacare in year two Team Obama's year-two strategy: Underselling Obamacare. "The Obama administration vastly oversold how well Obamacare was going to work last year. It's not making the same mistake this year. Gone are the promises that enrolling will be as easy as buying a plane ticket on Orbitz. The new head of HHS is not on Capitol Hill to promise that HealthCare.gov is on track. And no one is embracing Congressional Budget Office projections of total sign-up numbers.Sobered - and burned - by last fall's meltdown of the federal website, the administration is setting expectations for the second Obamacare open enrollment period as low as possible. Officials say the site won't be perfect but will be improved." Jennifer Haberkorn in Politico. Explainer: 5 things we need to know about Obamacare before enrollment begins. Jason Millman in The Washington Post. Source: Westhill Healthcare Consulting Jakarta fraud prevention review</d