Post Medical Job

Do you have a permanent (full-time or part-time) opening for a high-quality medical specialist? Click Here to post More »

Post Your Resume Here

Are you a healthcare professional working long 12 -14 hour days, too many weekends and holidays, or traveling too far from home? Are you not home for dinner usually or not able to spend enough quality time with your family More »

About US

NSI Healthcare Recruiters is one of the most trusted and reliable recruitment and placement services available to medical professionals in the USA. NSI has been in business for over 29 years and has assisted many healthcare providers in locating and hiring qualified medical professionals. More »

Contact Us

Candidates: Because our posted healthcare jobs are filled quickly we ask that you contact us for the latest updates. Employers: Please post your job here for affordable placement service. More »

Health-Care-Recruiter.com

We at Health-Care-Recruiter.com pride ourselves on the highest quality, personalized-service that medical facilities and medical job applicants alike have come to expect from us. pride ourselves on the highest quality, personalized-service that medical facilities and medical job applicants alike have come to expect from us. More »

 

Monthly Archives: November 2015

Number Of People Shopping For Health Plans On Spanish-Language Version Of Healthcare.gov Lags Behind Hopes

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Patients Want To Price-Shop For Care, But Online Tools Unreliable

Kate and Scott Savett were trying to be responsible when they needed some medical care. They live about an hour north of Philadelphia with their dog, Frankie. Scott, 43, is a chemist and designs software for labs Kate, 37, works in life insurance.

They buy their health insurance through Scott’s work, and, to keep their monthly costs affordable, they chose a plan with a high out-of-pocket maximum. They understood from the beginning that this would mean shopping carefully when they needed care, because costs can vary a lot among doctors and hospitals.

For years the couple didn’t use their insurance much — but that all changed this year.

This story is part of a partnership that includes WHYY, NPR and Kaiser Health News. It can be republished for free. (details)logo npr

Kate was diagnosed with multiple sclerosis in January. Doctors did a lot of tests and then follow-up tests. On top of that, Scott needed some imaging tests for a spinal issue.

Under their insurance plan, the two have to pay in full for the first $3,000 of their combined care. After that, they still have to pay 20 percent of the cost, until they reach a total of $8,000 in out-of-pocket expenses.

That knowledge made them want to find the best care for the best deal. But how?

They investigated, using an online cost estimator offered through their insurance company.

Kate and Scott Savett, of Allentown, PA, at an event of the Greater Delaware Valley chapter of the National MS Society, in Philadelphia, PA. (Photo by Bastiaan Slabbers for NPR)

Kate and Scott Savett, of Allentown, PA, at an event of the Greater Delaware Valley chapter of the National MS Society, in Philadelphia, PA. (Photo by Bastiaan Slabbers for NPR)

Scott logs in to use the tool, and searches for the typical cost of MRI scans in his region. The online calculator tells him the average cost is $1,270; the lowest is 躠 and the “above average” is $1,790.

The tool then produced a list of different providers and an estimate of how much they will specifically charge under the plan the Savetts have.

At first, this kind of information seemed great to the couple. But it quickly proved to be a headache.

A few days before Kate was scheduled to have her first MRI, she and Scott got a call from the radiology office, saying that the scan would cost them $2,400. They were shocked — the online calculator had told them it would only be about $500.

What’s the source of the discrepancy?

A hospital had bought the imaging center and raised the price.

There were misquotes on other procedures, too. The Savetts received some bills from health providers that were as much as a thousand dollars higher than the price the online calculator had led them to expect. Another time, they couldn’t find any listings at all for a procedure one of them needed.

The two quickly plowed through their $3,000 deductible. Financial planning became increasingly difficult. They delayed buying a new water heater for their house.

“It’s hard for us to pull the trigger on that, knowing that another [medical] bill could be coming around the corner,” Kate says.

It’s unclear how common these inaccuracies with online estimators are, but the tools are becoming more popular, as patients shoulder a bigger share of the cost of their medical care. Outside companies are developing the online calculators, and most insurers offer them.

“Each one of them — whether it’s Aetna, United, Cigna — they all have something,” says Francois de Brantes, the director of the Health Care Incentives Improvement Institute, a nonprofit based in Connecticut. De Brantes has been paying close attention to price-transparency tools.

“There’s lots and lots of variability in the information that’s provided to consumers,” he says.

Some of the estimators reflect an aggregate range of possible costs; others are based on historic pricing, or claims data from varying sources. Many, he says, are limited in the type of procedures they include.

As for United Healthare’s cost estimator — the one the Savetts used — Craig Hankins of UHC gives it an 8 out of 10 in terms of accuracy.

“Right now, I would say if we look at our tool, relative to others that are offered, I would say ours is average — if not above average — in terms of breadth of services as well as accuracy,” Hankins says.

UHC’s cost calculator is based on current information, he says, adding that it is in the insurer’s interest to have the online tool work. If members get care at an acceptable cost, that saves everyone money.

But, he says, the tool has limits — it’s hard to predict what a particular doctor will actually do during an exam, treatment, or office visit, and how he or she will bill for it.

That gets at a deeper challenge with these online estimators, says David Newman, director of the nonprofit Health Care Cost Institute, in Washington, D.C. The way billing and reimbursement works in health care is extremely complicated, he says.

“There are 8,000 procedure codes, tens of thousands of diagnostic codes, a million different providers, and hundreds of insurance companies,” says Newman. Calculators are often based on one specific procedure, so they may not reflect all that happens and is billed for during a visit. In that way, he says, “this is probably going to be as good as it gets.”

But de Brantes thinks much more improvement is possible.

“It’s not that difficult. It really — technologically — is not that difficult at all,” he says.

The information people like the Savetts are seeking exists in the health care system, de Brantes says, even if in some cases it is hidden behind contract agreements. The bigger problem, he says, is that there is no internal pressure to make the online calculator work as well as it could. Health care has thrived in an opaque environment where costs are hard to find.

But the needle is starting to move. Employers are demanding these tools for their employees. And several states mandate public reporting of price information.

As for Scott and Kate Savett, the current climate has turned each of them into a new breed of health care consumer: a savvy one.

Scott says he knows they are approaching their Ű,000 out-of- pocket cap for the year, which means insurance will soon cover the entire cost of their care. But he doesn’t want to give in. He wants to see improvements.

“I would rather crawl to that $8,000 cap than sprint to it,” he says. “I know we’re going to get there this year, unfortunately, but to blow it all on an MRI that’s excessively priced rubs me the wrong way.”

A few weeks after we first talked, Savett received a bill for his MRI. Turns out, it’s pretty close to what the estimator predicted it would be — $1,100. He says he will keep using the tool; but he sees it as an imperfect clue rather than a price tag.

This story is part of a reporting partnership that includes WHYY’s The Pulse, NPR and Kaiser Health News.

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

First Edition: November 30, 2015

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

A Tale Of Two Obamacare Co-op Insurers: One Standing, One Falling

Thousands of Americans are again searching for health insurance after losing it for 2016. That’s because health cooperatives — large, low-cost insurers set up as part of Obamacare — are folding in a dozen states.

The failure of Colorado’s co-op has hit Rick and Letha Heitman hard. They are currently customers of the Colorado HealthOP, which is closing up shop at the end of the year. The couple, who own a contracting business, say the co-op proved to be a life-saver when Rick was diagnosed with aggressive prostate cancer last spring.

“I owe them for taking care of me. They helped me at a time when I needed it a lot,” he says.

This story is part of a partnership that includes Colorado Public Radio, WNPR, NPR and Kaiser Health News. It can be republished for free. (details)logo npr

About 80,000 people are in the same boat as the Heitmans, on the hunt for new insurance plans on Colorado’s exchange. HealthOP’s CEO Julia Hutchins says the co-op got walloped by the equivalent of a fast-moving tornado after the federal government said it wouldn’t be paying co-ops millions in subsidies they had expected.

“We were really blindsided by that,” she says. “We felt like we’d done our part in helping serve individuals who really need insurance and now we’re the one left holding the bag.”

And, she insists the co-op was on track to be profitable. Colorado HealthOp is one ofಗ nationally in 22 states that opened after Obamacare was enacted. The startups were supposed to shake up the traditional marketplace by being member-owned and nonprofit, but it was tough to figure out how much to charge. They needed to estimate how much medical care their customers would use, and they had to do that without data from previous years and without the cushion of a reserve fund. Established insurers can use reserves and experience to recover if they underestimate premium prices in a given year.

Rick and Letha Heitman are on the hunt for a new insurance plan on Colorado's exchange. Their current insurance through the Colorado HealthOP will end when the co-op shutters at the end of the year. (John Daley/Colorado Public Radio)

Rick and Letha Heitman are on the hunt for a new insurance plan on Colorado’s exchange. Their current insurance through the Colorado HealthOP will end when the co-op shutters at the end of the year. (Photo by John Daley/Colorado Public Radio)

Many co-op plans were priced low, and customers poured in. But these new customers had high health costs, so the co-ops had to start paying a lot of bills. The math didn’t add up. On top of that, they were counting on a variety of funding streams from the federal government, and not all of them materialized.

Linda Gorman, with the Independence Institute, a conservative-leaning Colorado think tank, says the new co-ops were in over their heads.

“You shouldn’t go into business counting on federal subsidies,” she says. “The notion that you should beat up on for-profit entities and then form these nonprofits and everything will be magically OK is unfortunate to begin with. We’ve wasted a lot of taxpayer money on that.”

But the HealthOP’s senior IT manager Helen Hadji, a Republican, blames conservatives in Congress for not authorizing the money needed to keep the cooperatives afloat.

“This is a federal failure,” she says. “This is all a political battle to dismantle Obamacare.”

Colorado’s co-op captured Ȉ percent of the individual market on the state’s exchange. Now as customers, like the Heitmans, hunt for new insurance, they are finding higher prices: They paid about $500 a month last year. Next year, it could be double or triple that.

“You know, that’s a big ‘owee!’” says Letha Heitman.

But it’s the price they’ll pay to keep Rick with the doctors who are treating his cancer.

In Connecticut, the opposite story is playing out. If Colorado saw an early surge in membership because of low prices, Connecticut’s co-op nearly priced itself out of the market in its first year. With rates much higher than its competitors, HealthyCT only got 3 percent of the state’s business under the Affordable Care Act.

“In that first year, the reason we had such low market share was that consumers — new to the industry, new to insurance — most of those individuals bought on price,” says Ken Lalime, who runs the co-op.

And, he says, starting it was hard.

“Nobody’s built a new insurance company in the state of Connecticut in 30 years,” he says. “There’s no book that you pull off the shelf and say, ‘Let’s go do this.’”

Lalime faced the same problem as insurers across the country: He didn’t know who his customers would be, he didn’t know whether they’d be sick or healthy, and he didn’t know how much to charge. It turns out he ended up charging too much.

But even though that meant relatively few signups in year one, the slow ramp-up actually helped. He didn’t have a huge number of claims to pay right out of the gate, and the ones he did pay didn’t break the bank.

“Hindsight, yes, that didn’t hurt us. To be able to take it slowly,” he says.

In year two, he had more competitive average premiums — and his company went from 3 percent market share to 18 percent. For 2016, HealthyCT and the state — after some back and forth — settled on a 7 percent premium hike for customers.

Paul Lombardo is an actuary for the state. He says that bouncing around is an indicator that setting premiums under the Affordable Care Act is still a bit of a gamble. That’s in part because there’s still no good data. So few people signed up with HealthyCT in the beginning that they didn’t have enough information to help set 2016 premiums.

“There wasn’t a lot of data to say, OK, we can use 2014 experience to project forward,” Lombardo says.

For now, at least, Lombardo says HealthyCT is holding its own.

“They’re in good standing,” he says. “The premium we think that we’re setting for 2016 — albeit a little bit higher than they wanted it to be on the revision — is appropriate.”

Enrollment for health insurance in the co-ops runs through Jan. 31 with just 11 of the original 23 co-ops still in business.

This story is part of a reporting partnership with NPR, Colorado Public Radio, WNPR and Kaiser Health News.

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

As HMOs Dominate, Alternatives Become More Expensive

Consumers seeking health policies with the most freedom in choosing doctors and hospitals are finding far fewer of those plans offered on the insurance marketplaces next year. And the premiums are rising faster than for other types of coverage.

The plans, usually known as preferred provider organizations or PPOs, pay for a portion of the costs of out-of-network hospitals and physicians. They are the most common type offered by employers, and some consumers in the individual marketplaces find them more appealing than health maintenance organizations and other policies that pay only for medical facilities and doctors with whom they have contracts.

This KHN story also ran on NPR. It can be republished for free (details). logo npr

In Kelly Filson’s Indiana hometown of Plymouth, all but two of the 75 insurance policies available on the health marketplace are the restrictive type. Only one of those would provide substantial coverage to the two hospitals her family wants access to next year, a local community facility and a children’s hospital where her 12-year-old will need special surgery. But at $1,1ǩ a month, the policy is twice as costly as the cheapest plans in the area.

“I’m just trying to figure out what we can feasibly afford. That’s the bottom line, said Filson, a music teacher.

A Kaiser Health News analysis of costs in the three-dozen states selling policies through the federal  healthcare.gov website found a sharp difference in premium prices between plans that offer out-of-network care and those that do not. The analysis compared the monthly premiums for the least expensive silver-level plans — the category that are the most popular purchases — for a 40-year-old in each county.

While the average premium for the least expensive closed network  silver plan—principally HMOs—rose from $274 to $299, a 9 percent increase, the average premium for the least expensive PPO or other silver-level open access plan grew from $291 to $339, an 17 percent jump, KHN found. The cost variations hold true for any age.

Katherine Hempstead, who studies insurance offerings for the Robert Wood Johnson Foundation, said there are fewer PPOs because insurers found them more expensive to offer. That’s because out-of-network doctors generally charge more than the contracted rates insurers offer their in-network providers. And, even though insurers only pay a portion of an out-of-network bill, the costs add up.

“Out of network providers were causing carriers to lose a lot of money, and they really needed to put their thumbs down on that,” Hempstead said.

Hempstead found that there will be fewer or no silver-level PPOs in 22 states next year. Federal records show there will be none in Miami and most Florida counties, much of Texas, New Mexico, New York and many counties in Mississippi and South Carolina.

The price gap between PPOs and HMOs is growing in many places where both are offered. In Chicago, the least expensive silver PPO next year will cost $270 a month, ๛ more than the least expensive silver HMO, and 27 percent more than the cheapest silver plan costs now. Meanwhile, the price of the least expensive silver HMO in Chicago is dropping by 12 percent.

In Salt Lake City, the premium for the only silver PPO is growing by 30 percent, nearly four times the increase for the least expensive HMO. In Philadelphia, the cheapest silver PPO will be $389, $113 more than the cheapest HMO. This year, Philadelphians wanting a silver open access plan had to pay just $66 more. As in many places, insurers also are selling different bronze, gold and platinum PPOs (the metals indicate how the insurer and patient divide the cost of care), but the cheapest plan in each tier in Philadelphia is an HMO.

In Houston, the only plans available through the federal exchange have closed networks. Blue Cross Blue Shield of Texas, which offered a PPO plan in Houston for 20ǯ, cited rising costs as a reason it will not offer any open access plans next year. There is at least one PPO that consumers can purchase directly or through a broker, offered by the Memorial Hermann Health System, but it is not listed in the federal marketplace offerings so premium subsidies are not available.

“Everyone is up in arms,” said Jo Middleton, a Houston insurance broker. “I do not have a single client who is happy. They want PPOs and can’t get them. They want the flexibility.”

The biggest complaint, she said, is not that the HMOs don’t allow out-of-network coverage, but that their networks are too small.

“If you are someone who needs several doctors and several specialists, it’s difficult to find a network they are all in,” Middleton said. “In many cases, the doctors may be in a network, but only have admitting privileges at a non-network hospital. In the 11 years I’ve been in the business, this is unprecedented.”

None of the plans available through the federal exchange in Houston include the city’s well-known MD Anderson Cancer Center in their networks. “It’s a huge problem,” said insurance broker J. Casey Lowery. “If you’re a cancer patient, think about it. All of a sudden you have to switch doctors.  Or, if you want to stay with a doctor because he saved your life, and now you’re in an HMO, you have no coverage.”

Dan Fontaine, an administrator at MD Anderson, said some insurers did not invite the cancer center into their network. Others offered payment rates that he said “we don’t consider serious” because they were too low “and oftentimes less than what Medicare or Medicaid pay us.” He said the center was trying to make arrangements with insurers for patients who are in treatment now.

Plans with out-of-network benefits are not disappearing everywhere. Alaska, Arkansas and Wyoming are bucking the trend by only offering PPOs. Out-of-network costs even with PPOs can be prohibitively expensive since many PPOs will only cover a minority of costs, diminishing the difference from HMOs. Also, people who qualify for government premium subsidies can be insulated from the full cost of a PPO.

Allen Gjersvig, an executive at the Arizona Alliance for Community Health Centers, says one PPO in the state requires approval before seeing a specialist—a restriction often associated with HMOs—while there are HMOs that don’t mandate pre-approval of specialist visits. “The meaningfulness of HMO and PPO is starting to really blur,” he said.

Brokers say they are scrambling to help customers find new plans.

“I’m 31 and hardly go to the doctor,” said broker Michael Ledgerwood, president of the Houston Association of Health Underwriters. “If my doctor isn’t in the network, I don’t care. But my response would be quite different if I had more health care issues or saw more specialists.”

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Viewpoints: Prostate Cancer Screening; Another Abortion Review; Successful Ebola Vaccine

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

State Highlights: Insurers Fight Calif. Medicaid Managed Care Tax; Auditors Say Minn. Health Officials Handled Bids Properly

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Key Scientist At Coke Retires After Memos Show Ties To Anti-Obesity Group

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

ACLU, Abortion Providers File Lawsuit To Press MaineCare To Fund Abortions

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

CDC Updates Guidelines On Who Should Take HIV Prevention Drug Truvada

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS