Harver Health Insurance Counter Fraud Group

Harver Health Insurance Counter Fraud Group

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  • Because 2015 is the first year Californians will have to provide information about their health insurance on their tax returns, the U.S. Department of Health and Human Services released a fact sheet detailing what they'll need to know, officials announced.

    In the coming weeks, the administration will continue to provide added resources to help consumers prepare for tax filing season, including online tools to help individuals connect with local tax preparation services and determine if they are eligible for an exemption, officials said.

    More than three quarters of tax filers will just need to check a box on their tax return indicating they had health coverage for all of 2014, but there will be added steps for those who bought coverage through the Health Insurance Marketplaces, or decided not to enroll in coverage. Those who had basic health insurance in 2014 meeting the Minimum Essential Coverage requirement for the Affordable Care Act won't receive any new forms in the mail and won't have to fill out new forms when they file their 2014 income tax returns.

    What consumers need to know:

    When you file your tax return, you'll need to check a box indicating you and your family had health insurance for all of 2014. Types of coverage that meets the Affordable Care Act's standards include: Most job-based plans, including retiree plans and COBRA coverage; Medicare Part A or Part C; Medicaid; the Children's Health Insurance Program (CHIP); most individual health plans you bought ou...

  • Maine citizens looking to purchase health insurance on healthcare.gov now have more choices for their 2015 plans. We did a quick roundup of the 3 main players in the local health insurance field in Maine.

    Anthem Blue Cross and Blue Shield. A veteran in the health insurance industry, Anthem has been around even before the launch of the Affordable Care Act website 3 years ago. In fact, it has registered over 18,000 Maine citizens as individual clients (i.e. customers who bought their own coverage instead of getting it through work benefits). Their enrolment rates is almost twice as high as their closest rival which is not surprising since they are getting corporate backing from WellPoint, one of the national health insurers with a big market share.

    Almost 20% of the enrollees on the ACA site for 2014 plans were through Anthem. So this year, they seem to be prepared for a big comeback with their premium rates reduced by 1%.

    Harvard Pilgrim Health Care. A newcomer in the industry, the non-profit Harvard Pilgrim came to the market with 4 plans for 2015. Though relatively new, it's already familiar with health reforms from its partnership with the now-defunct Dirigo Health (Maine's effort to increase the number of citizens with health insurance).

    Harver Health Insurance Counter Fraud Group noted that with 3 health insurers from which to choose from, Maine citizens are benefiting greatly in a growing competitive market, which is incidentally also a goal of the Obamacare.

    Main...

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    On Sunday morning, my neighbor Carolyn knocked on my front door holding a basket of carbs and said, "I need to have my gallbladder out. I've never had an operation and have no idea how to find a surgeon to do my surgery. I don't want to die. I brought you some scones."

    Carolyn brings up a valid point -- if you've been blessed with reasonably good health, you probably don't have a surgeon's number on speed dial. Therefore, the bigger question is, in the unfortunate event that you need one, how do you find the best surgeon for your medical condition?

    Even routine operations have risks

    Straightforward surgeries like gallbladder removal or hernia repair can result in occasional complications so it pays to choose your surgeon with care. But other than asking the doctor who recommended the surgery and running down the list of surgeons on your insurance plan, how do you narrow down the list?

    I decided to go directly to the source and consulted with board-certified general surgeon Dr. Amit Kharod, chief of the Department of Surgery at CentraState Medical Center in Freehold, New Jersey for his recommendations.

    "You are looking for a highly-skilled service provider with whom you are entrusting your life," Dr. Kharod says. "Take the time to perform proper due diligence so you will be comfortable with the caliber and quality of the surgeon you choose."

    The doctor went on to outline tips for finding the right surgeon to meet your specific needs:

    • Ask ...

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    After almost 10 years, the results of a long-awaited clinical study has proven that cholesterol drug Zetia of Merck & Co is capable of reducing heart attack risk when it is used together with statin.

    The study was conducted worldwide on 18,000 heart patients using Zetia, an ezetimibe, plus simvastation as compared to treatments with only simvastatin. LDL cholesterols levels, which is singled out as a critical cause in the development of a cardiovascular problem, decreased by 54 on average.

    A 6% reduction in all cardio events, though a modest benefit in high-risk patients, is significant enough. This is the first time that it was proven that the addition of a cholesterol fighter non-statin to the already effective statin will reduce the risk of serious cardiovascular disease.

    The resuting data proves that Zetia -- which is already widely used for 12 years for its LDL-reduction capability -- offers a significant protection to several patients. It also supports the hypothesis that a lower LDL cholesterol is beneficial.

    Zetia works by preventing dietary cholesterol from being absorbed in the gut, which is different from statins that prevent cholesterol production in the liver. Its presumed lack of effect on the arteries was seen as a challenge to the initial hypothesis that a lower LDL will reduce heart risk.

    Dr. Christopher Cannon of Brigham and Women's Hospital in Boston is the lead author of the study presented in Chicago last week. He said, "One of our goals...

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    The issue on health insurance recently hugged the headlines not just in the US but also in some countries which recognized the need to address the health services that their populace need and expect from their employers and the government.

    Previously, health insurance was practically non-existent. Pension funds and provident funds were already in the consciousness of people as well as in the administration of institutions, whether private or public, for many decades. And yet, health is as important as one’s future retirement fund and present financial needs and is, in fact, closely related to both essential requirements for a healthy and productive working population. Hence, the rush to enact laws requiring all workers to acquire health insurance of some form has become a crucial issue.

    For us to understand what health insurance is all about and its foundational principles, consider some pointers to guide you decide whether having health insurance is really essential or not:

    • Ideally, health insurance is not state-sponsored medicine

    We hear activists declare that health insurance is a form of taxation or revenue- generating scheme of the state. Well, if some corrupt officials were to be given the hand that would be true as news of government funds being carted away by top-level officials flood the news daily today.

    However, as conceived and its ideal form, health insurance is a “plan whereby money is collected usually from the employer, the employee and the state and ...

  • The Affordable Care Act is already cutting health care costs, especially at hospitals that in the past provided charity care for uninsured, low-income patients. The reduction in charity care in states that have expanded their Medicaid programs with federal funds means the costs for this care are no longer being shifted to insured and self-paying patients, which makes health insurance more profitable for hospitals and insurers without increasing consumer costs.

    But this drop in costs is happening only in the states in about half of the nation that have expanded their Medicaid programs. The other states — mostly in the South and the Plains — have been involved in political struggles that have blocked expansion of health insurance for their poor residents.

    Expanding state-run Medicaid assistance programs has been called critical for the success of the new federal health care law. In states that haven’t expanded Medicaid, it is currently available to those who have incomes at or below the federal poverty line, which in 2014 is $11,670 for a single person and $27,910 for a family of four. In the states that have expanded their Medicaid programs, the eligibility level is 138%, or $16,104 for an unmarried person and $37,375 for a family of four.

    The federal health law was written with this expansion in mind, and it offers most people with incomes ranging from 138% to 400% of the federal poverty level the opportunity to be eligible for federal subsidies as they purchase heal...

  • Harver Health Insurance Counter Fraud Group Tokyo

    Now that the Obamacare transition has come into effect, it is important to understand some of the differences that are now at work. Understanding some of the changes can make it easier to get the greatest benefit from new policy changes that might affect you most. This can also help you to avoid potential negatives. For example, missing the important March 31 deadline can result in a fine of $95 or 1% of your total income (whichever number is greater).

    “For those that do not qualify for Medicaid, you will be required to pay your monthly premium fee to your selected insurance company in order to receive coverage,” said Jim Holm of EnhanceInsurance.com . “In some cases, customers will need to pay for their deductibles along with a set copay fee for doctor visits or a portion of the cost for the medical service.” This latter scenario is referred to as co-insurance, and customers will generally need to complete these payments before the insurance company can actually cover your medical costs. For most information on this, you can visit the federal government’s website at HealthCare.gov , a federal government website, and learn more about your options for each insurance plan. To find this information, located the section entitled “See plans before I apply.”

    Plan Choices

    Many industry experts recommend that you narrow down your potential choices to five comparable plans, and then go to the insurer’s official websit...

  • Report Says Probe Indicates Health Insurers may have Fleeced Taxpayers out of $70 Billion

    (NATIONAL) -- A year-long investigation by the Center for Public Integrity has revealed that health insurers may have fleeced taxpayers out of $70 billion in just five years.

    The report is posted on the Center's website by reporter Wendall Potter who says taxpayers should not assume their elected lawmakers in Washington will be outraged or even launching a federal probe about this.

    Potter:

    *"You would think members of Congress in both parties would be so outraged they’d be launching their own investigation and railing against the “fraud and abuse” they decry on the campaign trail.

    But I’m not holding out much hope. That’s because I know just how powerful and influential the health insurance industry is and how its lobbyists almost always get what they want out of Congress and the White House, regardless of who is sitting in the Oval Office."*

    The Center’s investigation called the "Medicare Advantage Money Grab" found here discovered that:

    • Federal officials made nearly $70 billion in “improper” payments to Medicare Advantage plans from 2008 to 2013, mostly over-billings, by manipulating or misusing a Medicare payment tool called a “risk score.”

    • From 2007 through 2011, Medicare Advantage risk scores rose more than twice as fast as the average for people in standard Medicare in more than 500 counties nationwide.

    • Federal health officials have ...

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    If it works, the GoBe will be life-changing. But it’s a big if.

    The GoBe is a bracelet that looks like a small microplane has been affixed to a black watchband—the top of the microplane is a display, and its underside is a sensor. Through its “patented flow technology,” the GoBe promises to measure the wearer’s heart rate, calories burned, sleep, and stress levels. That’s all conceivable, given what the FitBit and other body trackers already measure. But the GoBe also promises something a little more sensational: Automatically tracking the calories of everything the wearer eats, through his or her skin.

    “We live in an age where people struggle with their diets and need simple ways to take control of their health,” Artem Shipitsyn, the CEO of GoBe’s parent company, HealBe, says in a video on the device’s Indiegogo campaign page. He says the technology would help “people like me live a healthy life with less effort.”

    The automatic calorie-tracking, which GoBe claims to do by reading glucose levels in cells, would revolutionize dieting—even the best calorie-counting apps today rely on manual food logging.

    “Tell it nothing. Know everything,” the soothing video narrator’s voice says over b-roll of people skiing and clicking on their smartphones.

    The premise was so lofty, in fact, that it didn’t take long for tech reporters, led by PandoDaily’s James Robinson, to attack.

    Let’s say GoBe does measure glucose levels without piercing the skin,...

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    Advance directives clarify choices, guide family

    Pulmonologist Dr. Rick Blevins often sees patients and families grappling with a decision he says should have been made long before.

    Blevins treats many patients in the intensive care unit who won't survive. If they do not have advance directives, their families are left to make hard decisions that they may not have answers to.

    "It's a subject that comes up and (in the ICU) is the worst possible time for conversations to be initiated," Blevins said.

    Many times, the ICU patient is unable to make decisions for himself, so it falls on the family, Blevins said.

    The role of the family in that situation is to make the decision the patient would make, Blevins explained. But families don't always know or don't agree.

    Advance directives, such as living wills, provide instruction to families and especially health care providers on how the patient wants to be treated in the event of incapacity. Besides the living will, other common forms people complete are powers of attorney for health care that gives another person the authority to make health care decisions in the event of incapacity of the patient, and a form called Five Wishes, which provides not only instructions on medical care but also emotional care.

    Blevins said it can be difficult not only for families to have discussions about advance directives, but these conversations may not be happening in the doctor's office either.

    Doctors are encouraged to talk to thei...

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