Due date for 1095 forms moved to March

Tax filing deadlines are coming up so some of you may have employees asking questions about their 1095 health coverage information forms. Please be advised at the end of last year the Internal Revenue Service (IRS) extended the deadline for issuing these forms to March 2, 2018.

This means insurance carriers and other insurance providers have until this date to provide Forms 1095-B or 1095-C to members. This 30-day extension is automatic and does not require any paperwork to request it.

However, this does not mean that employees are required to wait to receive this information to file their individual income tax return. The IRS states these forms can be used to assist in preparing a return but are not required to file.

As a reminder, these forms are issued from the primary insurance carrier on your plan, not by ClaimLinx. If employees have not received this form after this deadline, they can request it from the insurance carrier directly.

If you have received any additional instructions from your primary insurance carrier regarding these forms, such as if your carrier is National General, please follow their instructions for filing as soon as possible.

 

Billing errors cost members and employers on services

As many as 80% of medical bills in the United States contain errors, according to Derek Fitteron, CEO of Medical Cost Advocate, a partner of ClaimLinx. And those errors can lead to an unnecessary increase in a bill’s overall cost. In fact the credit agency Equifax reported that for bills totaling $10,000 or more, there is an average error of $1,300.

A big reason these errors occur is the way healthcare providers classify diagnosis, symptoms and procedures. They use a coding system called the ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification). The system is incredibly complex with mistakes leading to patients potentially being charged for procedures or testing they did not receive or more expensive versions of their care.

Errors can occur on any medical bill, but tend to be found on bills for complex medical procedures, inpatient care, care from a medical specialist or when patients receive care at a facility outside their insurance carrier’s network.

To prevent this issue for all ClaimLinx clients with a Medical Expense Reimbursement Plan, any high dollar medical claims are automatically sent to Medical Cost Advocate for review and negotiation. But employees can also help to combat this issue by being sure to check any medical bills for procedures or testing they do not recognize, especially bills totaling over $1,000.

Members should contact their provider first with questions about any bill. Then if a change must be made to a previously processed claim, they can contact the Claims Department at help@claimlinx.com.

Some of this information was taken from an article which featured our partner, Medical Cost Advocate, published in Employer Benefit News. Read the article.

 

State of the Union spotlights pharmaceutical problem in America

Pharmaceutical companies’ stocks took a hit just after the State of the Union address, when President Trump listed drug pricing as one of his “greatest priorities” this year.  Medication prices across the board have been rising sharply, occasionally with consequences from Washington.

For example, Turing Pharmaceuticals former CEO Martin Shkreli was called to appear before Congress when he raised the price of the AIDs medication Daraprim from $13.50 per pill to $750 per pill in 2016.

There have not yet been any policy initiatives to force drug prices down, and until there are, prices are likely to continue to rise — with insurance companies finding more ways to pass this burden onto you, the consumer.

One of biggest changes I’ve seen among my own clients is many medications have changed tiers, resulting in a much higher cost share for members.  So a drug that was once in Tier 2 and covered with a $50 copay may now have switched to Tier 3 with a $150 copay — for the same drug at the same insurance carrier. That’s a pretty shocking price hike in a matter of just a few months.

I’ve also seen many insurance carriers adopt a Mandatory Generic Substitution for a growing number of medications. This requires members only receive the generic version of a drug, or pay the difference for the brand name version.

Then some drugs have fallen off of insurance carriers’ formularies altogether, meaning they are no longer covered at all.  Most often this happens when a drug has become so expensive even insurance carriers are having trouble paying for them. So imagine how the average consumer feels.

All in all, this is not a problem exclusive to 2018 alone, but it is a problem that will only get worse until sweeping changes are made to how drugs are priced. So please, Mr. President, make the drug industry great again.

 

 

An insurance shakeup? Three American corporations join forces to tackle healthcare

Amazon CEO Jeff Bezos, Berkshire Hathaway CEO Warren Buffett and JP Morgan CEO Jamie Dimon are joining forces to launch their own healthcare company, according to a press release today on Business Wire.

The goal of their new joint venture “is to create solutions that benefit our U.S. employees, their families and, potentially, all Americans,” said Bezos.

But what does that mean for everyone else in the health insurance industry?

Right now — nothing. Aside from a quick, and might I add pretty painful, hit to stock prices of insurance carriers like Cigna, Aetna and UnitedHealth, there won’t be any immediate repercussions.

What can be speculated though is that these three enormous companies will make potentially huge waves as they pull employees off current major carriers’ services. Depleting members reduces the pool of money that insurance carriers will have for their own claims and administration. If the majority of those leaving are young, healthy people, some Americans could see an increase in costs for their insurance plan — on top of already rising prices in the industry overall.

On a more positive note, new enthusiasm and innovation might just be what the industry needs. Having new blood in an incredibly old, often entrenched system might spur creative strategies to encourage savings. Major carriers across the country will have to do something to shore up for the changes this new company could bring.

Ultimately employees of the three companies will benefit first as the new healthcare company will be staged to take care of just them as a starting point. If Bezos statement rings true after this initial step, it may benefit “potentially, all Americans” by providing healthy competition into an ever-shrinking market.

Senators To Vote On Republican Healthcare Bill

This week Republican Senators Lindsey Graham, of South Carolina, and Bill Cassidy, of Louisiana, introduced a new healthcare bill aimed at repealing and replacing the Affordable Care Act known as Obamacare.

The Senate is expected to vote on the bill next week, as any repeal and replace bill must be completed and voted on by September 30 in order for it to pass with only a simple majority of 51 votes. 

This bill would mean a radical change to the current healthcare system. Here are some of the biggest changes in the bill:

  • Repeals the individual mandate requiring all individuals have health insurance.
  • Repeals the employer mandate requiring all businesses with more than 50 employees to provide an affordable health plan.
  • Allows insurance companies to reinstate lifetime benefit maximums.
  • Allows insurance companies to charge people with preexisting conditions more money for a plan.
  • Requires insurance companies still provide coverage to people with preexisting conditions.
  • Removes the optional Medicaid expansion for each state.
  • Dissolves the federal insurance marketplace known as healthcare.gov.
  • Gets rid of the federal subsidies to help pay insurance premiums for those that cannot afford them.
  • Combines the funds for the Medicaid expansion and insurance subsidies into large block grants given to each state to spend freely to improve healthcare in the state. 

Funding in the form of federal block grants to states would continue until the year 2026, when funding would be cut off. Most harmed by this bill are those states that chose to implement the Medicaid expansion through the ACA. States that did not do this would see a large influx of cash through the federal block grants in the bill. 

Because of the short time frame to vote on the bill the Congressional Budget Office will not be able to provide a full analysis of how this will affect coverage for Americans, though the CBO did say it would release a limited analysis early next week. 

You can see how your state’s funding will be affected in this analysis by the Kaiser Family Foundation.