Archive for November, 2007

Colorado New Workers’ Comp Law and PPOs

Friday, November 30th, 2007

Letters are now going out from PPOs to their payor clients requesting their help to comply with the new workers’ compensation Colorado law (Senate Bill 79). In these letters work comp PPOs are requesting the following information from their payor clients: (1) where should doctors send the bills (2) where to call for inquiries. The real difficulty in the law is that the injured worker has to present the above information to the medical provider at the first visit.

It is somewhat easy for the PPO to comply with these requirements for direct clients. Yet, it is much more difficult when a reseller such as a medical bill review company is the client of the PPO. For PPOs to follow this law, it is going to take the help of the medical bill review companies and their clients.

This state law, as in so many, once again shows the limited understanding legislatures have of the various layers of workers’ compensation cost containment.

Socialism and Healthcare

Thursday, November 22nd, 2007

I recently began reading The Reagan Diaries (everyone that knows me well understands my admiration for Ronald Reagan). In reading a passage from his diaries regarding America’s grain embargo in the 1980s with the Soviets, Reagan said the following about the Soviets:

“Their socialism is an ec. failure. Wouldn’t we be doing more for their people if we let their system fail instead of constantly bailing it out?”

Reagan was a true conservative and what he knew well was that socialism is simply a failure. Unfortunately, many in our country now want socialized medicine. Some want complete socialization and other just want to play around with a little of it. Either way, it’s really bad for our country.

People define socialism, especially in regards to medicine, in many different ways. Yet, for me, socialized medicine is simply where the government redistributes wealth from the masses to pay for healthcare for some or all Americans.What would Reagan say about socialized medicine? Well, no doubt he would be completely against the current movement for government intervention in our healthcare system, especially those that want a Canadian or UK type system.

In my mind socialism is simply bad for our country and frankly immoral. Look at Reagan’s quote again, as he had it right. We should let socialism die on the world political stage just as communism did. For the better of us all, America should not go down this path in healthcare.

Is Healthcare a Right?

Thursday, November 15th, 2007

I think the core philosophical issue regarding healthcare today is if total universal healthcare is a right to all Americans or instead something else. See the quote below from Women4hope blog.

“Just the other day on my Women 4 Hope blog…I had a young man comment about being told he had sleep apnea, and that he needed a special devise to help him breath at night or he could die. Oddly, his insurance company won’t cover the cost of this piece of equipment. How can that be? This young man has resourcefully started a blog in hopes to find a used machine, or raise enough money to purchase a new one.So, how is it…That we are the richest country in the world, but we can’t afford to make sure our own citizens have quality affordable health insurance? This is actually a question I intend to pose to the presidential candidates at the10 Questions project, later this weekend (I’ll post the video here in comments, once I have it ready).”

I understand the issue this guy is facing. He needs to find a way to pay for a healthcare item that his insurance company does not cover in its policy. He obviously is complaining that the insurance carrier should be paying and not him. So, is it his right to have someone pay for this device?

I don’t think so. I wish him the best, and hope he gets what he needs. In fact, he has taken a very American approach to solving his problem. He is blogging to see if others can help him.

The point here is this, an individual that has a need should not be dependent on the government for healthcare. If healthcare is a right, then where do we stop with the thought pattern? Do we as a society provide clothing to everyone? What about food? That must be a greater need than healthcare. The logic just does not work for me. Healthcare is something we have to pay to receive. Americans simply have their priorities wrong. We would rather have the latest iPod or cell phone than save for our healthcare expenses. Insurance should take care of catastrophic problems; we should be paying for everything else, not expecting the government to take care of us cradle to grave!

Healthcare Blogs And Their Liberal Point of View

Saturday, November 10th, 2007

I have been reading a lot of blogs today regarding the overall healthcare debate. Most of what I read on the Internet tends to be from a Liberal point of view. I think all views should be heard, but it is interesting that Liberals are so very angry over this topic, and seem to post in a disproportionate volume compared to Conservative views. Granted, that is just my anecdotal observation, but it does seem one sided. Also, these sites can’t seem to help themselves in throwing in comments about their anti Iraq war feelings on a healthcare post. I still have not figured that one out.

All of this reading has me thinking about my own employees and their various situations. Our employees pay a net of $31 a month for individual healthcare insurance from a major carrier. Every employer can afford the same type of insurance we offer if they choose to. Obviously some of them simply choose to not offer the benefit. In other cases, we have employees that just decide they don’t want healthcare insurance. That is their choice (at least for now). Either way, it really makes me wonder why the whole issue of the uninsured has to be so complicated.

I would like to see everyone have to buy insurance coverage. I just think it makes sense for the greater good of us all. By itself, that one factor would help control costs for all Americans. If any American can afford a cell phone and cable bill combined, they can buy health insurance. If they can’t afford both, then get rid of the cell phone and cable, the health insurance is more important. Also, I don’t have a problem with Employers being mandated to offer insurance to its employees, with help to small businesses from the government. Yet, I would prefer that employers pay into a pool based on employee size and all American’s purchase insurance on their own, just like they do car insurance.

I guess my bottom line here from reading all the post today is this. Too many people want the government to run healthcare. That is one major mistake if we go down that road. The people that tend to want this who post on the blogs believe incorrectly that all the problems in healthcare go away with government intervention. If only they had a larger thought capability and realized it would make things much much worse. So, keep the government out of my life as much as possible, but a proper role for government would be to help make sure that all Americans have access or help in purchasing private insurance.

My individual employees pay $31 net for great coverage. Can someone please fill me in on how an employer or employee can’t afford this?

National Work Comp Conference Summary

Friday, November 9th, 2007

I just got back earlier this week from the National Work Comp Conference in Chicago. It was a productive conference, although I liked the setting of Las Vegas better last year.

The big difference at the conference was the buzz over Coventry. With all of the mergers and deals this year, it was clear Coventry was going to be the main topic for everyone, which held to be true. An irony of the conference was that Coventry seemed to be very quiet themselves. There was not a big splash from Coventry promoting their new “super network”. Instead, there was just a lot of talk from Resellers as to if they were going to be termed by Coventry or see their rates go up (or both).

I also heard a lot of buzz regarding Fair Pay and other “fair and reasonable” business model companies. It seems the time has come for this major form of cost containment.

Otherwise, it was a quiet conference.

Coventry Work Comp PPO Strategy

Saturday, November 3rd, 2007

As stated in other posts, it continues to amaze me the changes in 2007 for the workers’ compensation PPO market. This week brought more changes.

From my discussions with many different people, it seems that Coventry has now entered a new strategy. What I am hearing is that they are now going to offer a “Super Network” (not a very creative name) consisting of Focus, Aetna, and Coventry. For this “Super Network” the payor will get all 3 networks but at a much increased price. We shall see if this ends up holding true, but it seems to be the understanding of a lot of industry people. I imagine we will all know much more after the National Work Comp Conference held next week in Chicago. Also, it sounds like the plan from my sources is for Coventry to cancel all of the reseller agreements they have in place to drive everyone to them as a total solution (thus cutting out all of the resellers including software companies and bill review companies). If this is the strategy, it will only work if they term all of the resellers.

PPO percentage of savings have just gone to low, so the market is about to adjust itself with Coventry’s plan if it holds true. In a sense, I think this is a good thing as PPOs can’t continue to offer full coverage at increadibly low prices. Payors always underestimate what it really cost to run a PPO.

Whatever the strategy ends up being, the payors just needs to understand that options exist like Prime Health Services. No one has to be cornered by Coventry or any other company. The free market always wins in the end. New companies will emerge and existing ones will rise to the top to take on the “super network”