Tag Archives: health insurance companies

Exigent Med Group, LLC to Launch SelfPayMD in September

Miami, FL (PRWEB) July 26, 2014

Exigent Med Group, LLC announced the scheduled September launch of SelfPayMD (SPMD), the first of five medical offices in Miami-Dade dedicated to providing deeply-discounted, “direct-access” to board certified Primary Care Physicians (PCP) to self-pay patients. Absolutely no health insurance will be accepted.

Even the best health insurance companies pay MDs only 20% to 25% of billed amount, while the latter shoulders rising overhead and labor-intensive collection efforts.“We do not accept any type of health insurance,” said Dr. Arroyave, MD, CEO. “Credit/debit card payments eliminate paperwork, billing and collection staff, and the huge savings allow $ 75 visits for the uninsured.”

As a direct result of diminishing reimbursements and rising overhead costs (long before the Affordable Care Act, aka: ObamaCare), some PCPs refused government or private insurance, opting for a 100% direct- access practice model. Currently in the US, direct-access accounts for 4%-6% of primary care medical practices – and growing. Even in England, with decades of socialized medicine, direct-pay is growing at 5% per year.

“Understanding our market of self-pay patients, we don’t stop there; we also navigate them (as needed) to a network of independent medical and surgical specialists, labs, imaging centers and even SurgiCenters offering deep discounts to direct-access patients – a free service to our patients. Patients are seen by appointments and walk-ins. “Membership is optional, at only $ 250 per year for individuals,” said Arroyave. “We will also offer special membership pricing to families and employers with less than 50 employees.”

Although ObamaCare provides health insurance for the poor, many in the middle-middle class who don’t qualify for subsidies will be unable to afford health insurance. Then there are those who will game the system, providing false information to get subsidies, and some young people who will opt for the small penalty rather than pay high premiums. Further, those with mandatory high deductibles of $ 5K – $ 9K may shop around for low, “out-of-pocket” prices. The government estimates that about 4 million people, or 1.2% of the population, will wind up paying the penalty tax rather than purchase health insurance. Healthcare experts believe that number is way underestimated, as there will be millions flying under the radar – without insurance.

Increased insurance rolls, a shortage of physicians, and more government control of healthcare access will result in long wait-times to be seen by a PCP. ObamaCare will add 32 million patients to the insurance rolls, and, by the government’s own admission, they expect a shortage of 52,000 PCPs by 2020. Even with the full implementation, they also predict that over 30 million people will remain uninsured (you read correctly)! This will lead to congestion.

Today in Massachusetts, with its mini-ObamaCare, the wait time to see a PCP is about two months; and, if patient care at VA Hospitals is an indication of things to come from more government involvement in health care, long appointment wait-times will be the norm. “Thus, many insured patients who want to be seen quickly will come to SPMD, even if they have to pay a small out-of-pocket fee,” said Chris Merlano, a senior executive with SPMD.

Corporate America is taking notice of direct-pay primary care models. “People will always need PCPs, regardless of recession or inflation. This is an opportunity for serious investors,” said Larry Chilson, a senior executive with DevelopMED since 2006.

For more information please contact:

Exigent Med Group, LLC

Marketing |Public Affairs | Communications

444 Brickell Avenue, Suite 51-121 | Miami, FL 33131| O 305.252.7921

contact(at)selfpaymd(dot)com | http://www.SelfPayMD.com

Nice Obamacare Problem photos

Check out these obamacare problem images:

obamacare problem
Image by SS&SS

Don’t believe the media. Obamacare is already adding to the unemployment rolls.


Commenting on the mainstream media of his day, Thomas Jefferson famously observed that "The man who reads nothing at all is better educated than the man who reads nothing but newspapers." Coming from the Sage of Monticello, whose credentials as an advocate of the free press were pretty darned solid, this is an arresting statement. And it is evident that the news business has changed little during the two centuries that have come and gone since he penned that uncivil passage. Even if one ignores the "reporting" perpetrated by the New York Times and other leading lights of journalism in the wake of the Tucson shooting, the continuing relevance of Jefferson’s comment can be verified by perusing the stories appearing in most prominent publications about the GOP effort to repeal Obamacare .

The new House majority incurred the wrath of the media by refusing to change the name of the repeal bill and ignoring their calls to "wait a bit longer" before bringing it up for a vote. In fact, the Republicans had the temerity to give the "Repealing the Job-Killing Health Care Law Act" pride of place in their vote schedule. This affront has inspired a spate of "news" stories claiming that the GOP has misled the public concerning Obamacare’s effect on unemployment. The Republicans have, according to these articles, misrepresented a CBO report that suggests the new law will eliminate 650,000 jobs. A typical example is an AP "fact check" piece that includes this priceless quote from economist Paul Fronstin: "CBO isn’t saying that there is job loss as much as they are saying that fewer people will be working."

The irony of such verbal contortions is that they would be unconvincing even if they were not self-refuting. It isn’t necessary to invoke the CBO to demonstrate that Obamacare is a job killer. The ink was hardly dry on the new law when the layoffs began at the small insurance companies. Last year, HealthMarkets announced its plan to eliminate 250 jobs pursuant to "national healthcare reform." Likewise, Principal Financial Group said it would get out of the health insurance business and lay off 1,500 workers due to "the shadow of a lot of regulatory matters." The darkest of these regulatory shadows is Obamacare ‘s requirement that health carriers spend 80% of premiums on medical care. This mandate will drive many other carriers out of the market as well, and kill the jobs of anyone working in their health divisions.

The job losses have by no means been limited to health insurance companies. The actual providers of health care, including community hospitals, are beginning to eliminate jobs. Memorial Hospital in South Bend, Indiana, has had to cut nearly 50 jobs because Obamacare "has already started to cut reimbursement rates to hospitals across the region and the country and we expect that reality to get worse moving forward." Another small hospital, in Leominster, Massachusetts, will eliminate about 50 positions. The spokesman for that institution said the cuts were made necessary by "health care reform, with its reductions in Medicare and Medicaid reimbursements." Yakima Valley Memorial, in the state of Washington, will also cut 70 to 100 jobs because "Under federal health care reform, Memorial must reduce its expenses."

In addition to the jobs it will destroy in the insurance and hospital industries, Obamacare ‘s new taxes will kill countless jobs in the medical device industry. The Massachusetts Medical Device Industry Council estimates that about 90 percent of member firms will be forced to "cut back on operational costs — and jobs — after [Obamacare ‘s] 2.3 percent tax on their products is implemented in 2013." And, lest you fall into the error of thinking that "reform" will bring enough new customers to offset the increased tax burden, 42 percent of the affected firms have indicated that Obamacare will not increase their business. The others are no doubt hoping that at least one of the promises made on behalf of Obamacare will actually be fulfilled. Inevitably, however, this addition to their cost of doing business will add to the unemployment rolls.

If you believe that all this carnage will somehow render health care more "efficient," as many progressive policy wonks have claimed, remember that reform-induced job losses will not be limited to the health care industry. As health care economist John Goodman points out, the various mandates imposed by Obamacare will effectively raise the cost of labor across the economy. He estimates that they will add ".28 an hour for full time workers (individual coverage) and .89 an hour (family coverage) for fulltime employees." Many businesses simply cannot absorb such increases without cutting labor costs. This is why we have heard so many cris de coeur from low-margin employers like White Castle, which says the financial hit "will make it hard for the company to maintain its 421 restaurants, let alone create new jobs."

And the government cannot simply "waiver" this problem away. Thus far, the Obama administration has issued get-out-of-jail-free cards to well over 200 employers and unions that screamed bloody murder when they realized how much devastation Obamacare will wreak on their operations. These waivers don’t cure the disease. They merely treat its symptoms. Even worse, they will eventually draw U.S. health care into an increasingly corrupt, Chicago-style political spoils system. Because these waivers are issued at the pleasure of the HHS Secretary, it is inevitable that the companies and unions with the most political power (i.e. those which have made the largest cash donations to the Democrats) will be given special dispensations. Less affluent employers will be forced to save money by cutting their labor costs.

None of the "reporters" peddling the CBO meme have shown any interest in the job losses already caused by Obamacare . They prefer to focus on the wickedness of the Republicans. As Paul Krugman phrases it, "The key to understanding the G.O.P. analysis of health reform is that the party’s leaders are not, in fact, opposed to reform because they believe… it will be ‘job-killing’ (which it won’t be). They’re against reform because it would cover the uninsured — and that’s something they just don’t want to do." This is the sort of dishonesty that prompted Jefferson to augment the above-quoted criticism of the Fourth Estate with the following: "Advertisements contain the only truths to be relied on in a newspaper." Were he with us today, he would no doubt include broadcast media and many Internet outlets in this indictment.


Getting Health Coverage through Obamacare – Workshop #1

Getting Health Coverage through Obamacare – Workshop #1
Event on 2014-02-08 10:00:00

This is the first of three, free public workshops organized by 100 Black Men of Syracuse Inc. to allow attendees the opportunity to hear local representatives from the health insurance companies participating in NY State of Health, the state's health benefit exchange, explain the details and costs for the plans they are offering. Attendees will also be able to question Navigators, the non-profit organizations certified to help the uninsured obtain affordable coverage, and take home other information about the subsidies, tax credits and premium discounts available through the federal Affordable Care Act, as well as Medicaid expansion.

Admission is free, and advance registration is not required. Two other free, public workshops are scheduled.

— 2) Saturday, Feb. 15, 2014, 2 p.m. to 4 p.m., Hopps Memorial CME Church, 1110 S State St, Syracuse, NY 13202
3) Friday, Feb. 21, 2014, 3 p.m. to 5 p.m., Onondaga Community College, Whitney Applied Technology Center, Room 101, 4585 W. Seneca Turnpike, Syracuse, NY 13215

at Bethany Baptist Church
149 Beattie Street
Syracuse, United States

Health Exchange CT Scrambles to Address Errors, Federal Changes

Health Exchange CTAs has been well-publicized in the media, the debut of the health insurance exchanges as mandated by the Affordable Care Act has been rocky to say the least. In response to the many problems experienced by Americans attempting to sign up for health insurance through the exchanges, the unexpected cancellation of millions of noncompliant policies and the numerous reporting errors received by health insurance companies, the federal government made several changes to deadlines and the law itself.

These changes and delays caused state exchanges, including Health Exchange CT, to scramble to address these problems and meet the new federal guidelines. Fortunately, Connecticut has consistently been recognized as a leader in the implementation of the ACA and has been able to handle the unexpected delays and changes with relative ease.

Health Exchange CT Catastrophic Coverage Availability Expanded

When millions of Americans began receiving letters from their insurance companies in November telling them their current policies would be cancelled due to noncompliance, the federal government knew it had to find a solution to get these residents covered without making them pay premiums that could be much higher than their 2013 premiums. First, the government allowed states and insurance companies to grant one-year extensions for these policies, thereby giving consumers an extra year before they would be dropped.

Most states and insurance companies, however, elected not to extend their noncompliant policies because they didn’t have rates in place, nor were they prepared to administer these plans for an additional year. As a result, the federal government, through the Center for Medicare and Medicaid Services (CMS), announced that individuals whose policies were cancelled for noncompliance reasons would now be eligible to purchase catastrophic plans. Previously, these plans were only available to young adults between the ages of 18 and 29.

Health Exchange CT honored the change by the CMS and opened enrollment into catastrophic plans to anyone who had his or her plan cancelled by insurance companies due to noncompliance with the ACA. The catastrophic plans offered through the CT health insurance exchange will offer comparable coverage to many of the cancelled plans, which often had high deductibles.

Residents who want to enroll in catastrophic coverage will have to apply for a “hardship” exemption through Health Exchange CT and provide proof of a cancelled plan. If an exemption is granted, residents will then have 60 days to change their current coverage to a catastrophic plan. This exemption must be granted by the end of the open enrollment period on March 31.

Inaccurate Information on Shopping Screens

Although Health Exchange CT’s website ran much more smoothly than the federal government’s exchange website, it was not without its share of problems. In some cases, people who attempted to enroll in coverage through the website in October may have been shown inaccurate plan information when they compared policies.

The exchange became aware of these inaccuracies on September 26 and proceeded to place a warning on these pages, advising consumers to look at the plan summaries, all of which included the correct information. In addition, the exchange called every person who enrolled in a plan in October to advise them of the errors on the shopping screens. Written communication also told these individuals they could choose another plan if the inaccuracies were sufficient enough to warrant such a change.

Moreover, the health exchange did not submit any information received in October to health insurance companies to give consumers time to make any changes. Only after consumers were notified of the inaccuracies did Health Exchange CT pass the data from October enrollments to the insurers.

The shopping pages were corrected by October 30, so anyone who purchased a plan in November was not affected. Health Exchange CT has been proactive in correcting any problem with the website or enrollment process that has been identified by users or technicians. Currently, there are more than 13,000 visitors to the site every day, with more than 1,400 of those visitors completing the enrollment process.

All website improvements are documented on the exchange’s calendar and are addressed regularly at public forums including exchange board meetings. Although problems with such a complex website roll-out were expected, Health Exchange CT has been successful at promptly responding to technical issues and getting them fixed within a reasonable time-frame.

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Obamacare Mental Health Coverage Gets Funding Boost from HHS

obamacare mental healthIn an effort to support the new Obamacare mental health mandates requiring all insurance companies to cover mental healthcare and substance use disorders, the U.S. Department of Health and Human Services recently announced plans to provide $ 50 million in funding to assist Community Health Centers either establish or expand services for people who struggle with mental illness and/or drug and alcohol abuse issues.

These funds will be used to expand programs in about 200 health centers across the country and will go to cover the costs of hiring more mental health and substance use disorder professionals and to increase the number of services they can offer to people with mental health and substance abuse conditions. Currently, many people have mental health and substance use disorders that respond to treatment but they are not able to access care.

ObamaCare Mental Health Parity

One of the major goals of the Affordable Care Act is to reduce the barriers that can prevent people from getting treatment for mental health issues. Obamacare mental health coverage provisions require insurance companies to cover mental health and substance use disorders in the same way they cover other medical conditions. This is known as parity and the protections afforded to consumers fall under the Mental Health Parity and Addiction Equity Act.

Under the Parity Act, which includes details about how Obamacare and mental health conditions relate, people who need services for mental health conditions or substance use disorders will:

  • Pay the same copay and coinsurance as they would for physical health services.
  • Have the same limits on mental health-related inpatient or outpatient visits as are placed on physical health-related inpatient or outpatient visits.
  • Have the same rules for care management of mental health or substance use disorders as they have for physical health conditions.

The main point of the Parity Act is to ensure insurance companies do not place more stringent rules on mental health care conditions than on other medical issues not related to mental health. This was often the case before the Obamcare mental health provisions were passed, making it more expensive and difficult to access mental healthcare benefits. In addition, health insurance companies are now required to disclose how mental health conditions are covered so consumers can compare those benefits with their physical healthcare benefits to make informed decisions.

Approximately 60 million Americans will benefit from this law, with 30.4 million Americans who currently have some mental healthcare benefits getting expanded coverage and 32.1 million Americans who will gain coverage for the first time. It is possible the numbers might be even higher once more people begin to seek treatment for illnesses that have not previously been diagnosed. Moreover, since health insurance companies are no longer able to deny coverage to people with pre-existing conditions, consumers will be able to access health care for mental health and substance use disorders that have already been diagnosed but may have not been treated until now.

It is important to note that the Parity Act does not force insurance companies to cover mental health or substance use disorder benefits. Those requirements fall under the Obamacare mental health provisions in the Affordable Care Act. The Parity Act only outlines the coverage requirements if a plan does cover mental health and substance use disorder benefits. Most health insurance plans, though, will cover these benefits beginning in 2014.

2014 Fiscal Year Budget Provisions

With the passage of the 2014 Fiscal Year Budget, Obamacare mental health coverage is affected in several ways:

  • Funds necessary for the timely implementation of the Affordable Care Act, which includes the mandatory coverage of mental health and substance use disorders.
  • Finalized regulations that guarantee mental health conditions will be covered the same as any other illness.
  • A $ 130 million initiative that is aimed at helping teachers identify signs of mental illness in students so they can refer them to Obamacare mental health services. This initiative will also support efforts to improve mental health outcomes for young people and provide funds to train 5,000 additional mental health professionals that will specialize in treating students and young adults.
  • $ 3.8 billion in funds to develop or expand mental health services offered through community-based health centers.
  • Increase incentives for mental health professionals to provide services in communities that are most in need. Obamacare mental health funds have tripled the size of the National Health Service Corps, which offers scholarships and loans to health care professionals who make a commitment to practice in communities that have high incidents of mental health and substance abuse disorders.

To assist consumers with mental health-related issues, the federal government has also launched a new user-friendly website to provide information about mental health conditions and their symptoms, how to get help and how to discuss mental health issues with others. This website is www.mentalhealth.gov and is available now.

The post Obamacare Mental Health Coverage Gets Funding Boost from HHS appeared first on ObamaCare Insurance.

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Obamacare Benefits: Insurance Companies Are Forced To Drop Substandard Coverage

obamacare benefitsRecently, there has been much criticism in the media surrounding insurance companies dropping consumers from healthcare coverage due to the Affordable Care Act. Unfortunately, this criticism is misleading because no one is losing their insurance because of Obamacare. The plans that are being cancelled by health insurance companies provide substandard coverage under the requirements of the ACA. They have to replace these junk plans with newer ones which provide better coverage..

The cancellation notices have only been mailed to some of the five percent of individuals who currently have substandard policies on the individual health insurance market. More than 75 percent of Americans currently get their insurance through their employer, the Veterans Administration, Medicare, or Medicaid and are not affected by these cancellations.

Obamacare Benefits: Health Plans Should Have Minimum Standards

All people who have received cancellation notices from their health insurance companies are gaining health insurance under new plans that meet the minimum standards of the Affordable Care Act. New Obamcare benefits that must be included in each qualified health plan include maternity coverage, mental healthcare, prescription medication coverage, and preventive care. In addition, Affordable Care Act health plans cannot drop you if you get sick and they cannot deny you coverage if you already have a medical issue.

People who have been covered under a substandard health insurance policy can choose to continue with their current health insurance company by enrolling in a more generous plan. They can also shop for affordable coverage on their state’s health insurance marketplace, where they may be eligible to receive federal premium subsidies to lower their monthly costs. The majority of Americans who are in this position will pay less for policies that cover the Obamacare benefits than they were paying for a less comprehensive plan.

Some People May Pay More

Although the federal premiums will be available to help many Americans who are losing their current substandard plans purchase better plans through their states’ health insurance marketplace, Americans who are in the higher income brackets may see their rates increase. This is because federal subsidies are only available to people who earn under a specific income as defined by the Affordable Care Act. Health plans offered on the exchange will generally be more expensive than substandard plans before subsidies because of the additional Obamacare benefits that have to be covered.

This is part of the individual responsibility President Obama mentioned in his speech that further clarified his earlier statements that Americans would be able to keep their current plans if they wanted to. People who are able to afford health insurance should receive less government assistance than people with lower incomes.

The president also said that if Americans had substandard plans that they wanted to keep prior to the Affordable Care Act becoming law, those plans could be grandfathered in. However, if an insurance company sold a substandard plan after the ACA became law, they would have to replace those plans with a qualified plan beginning in 2014. This is why some Americans are getting notices of cancellation, but in the end, the more comprehensive benefits under Obamacare benefit everyone. In general, people will be paying less for better healthcare, which meets one of the goals of the Affordable Care Act.

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