Health Insurance ClaimLinx

ClaimLinx Glossary: Common Health Insurance Terms

ClaimLinx specializes in many health insurance services, including traditional group health insurance, employer-paid benefits, employer benefits consulting, supplemental insurance, and individual plan consulting. We’re a full-service insurance agency. Our team works to lower your health insurance costs while giving employees their ideal health insurance plan. In today’s blog, ClaimLinx explains common terms you might encounter as you are reviewing our services for health insurance plans.

Premium

A premium is the amount an individual pays for health insurance every month. Some employer-paid benefits come at no cost to employees, while others have employees pay premiums at a lower cost. For example, an employer could pay $100 a month for a worker’s health insurance while the employee pays $75 per month for the rest. ClaimLinx finds the right balance between premiums and out-of-pocket expenses for health care when it comes to employees.

Deductible

A deductible represents the amount someone pays for health care services, such as a doctor’s office visit or a trip to urgent care before the health insurance plan pays for part of the rest. For example, an employee’s deductible could be $500. After the person pays $500 for services, insurance may pay all or part of the rest of the health care services, thereby lowering someone’s overall healthcare costs the rest of the year. Our ClaimLinx Solution is a strategy that lowers the employer costs as well as the out-of-pocket costs of workers, saving everyone money.

Copayment (Co-Pay)

A copayment (commonly known as co-pay) is the fixed amount that someone pays for health services after the person pays the deductible in full. A visit to the doctor’s office may come to $100, but the copayment made by someone with health insurance lowers the cost to just $20 paid out-of-pocket. ClaimLinx determines optimal copayments for employees with respect to their deductibles.

Claim

When you file a claim, you request payment for healthcare services covered by a health insurance plan. As a third-party administrator, ClaimLinx offers easy ways for employees to file claims for processing so they can receive their benefits in a timely manner.

Marketplace

One service offered by ClaimLinx is the ability to let individual employees shop for their own personalized health insurance plan. This happens on a marketplace, sometimes called an exchange or health insurance marketplace, run by the state or federal government. A marketplace allows someone to put in their information through an online portal, and then the marketplace shows them the plans they are eligible for. 

ClaimLinx Experts Help You and Your Employees

Our expert health insurance consultants can help you and your employees wade through the jargon, options, and health insurance companies to find the best possible health coverage for everyone. Contact ClaimLinx or call our office at (800) 858-1772 to find out how we can save you between 20 and 40 percent on employer-paid benefits for your loyal workers.

Clogged emergency departments highlight need for alternative fees

Emergency departments were never meant for routine visits for people with chronic conditions, but in the absence of coordinated care, confused patients have turned to them when they don’t know where else to go.

Now, people with six common chronic conditions make up about 60 percent of all emergency room visits, according to a report released this year by Premier. Of those visits, about one third of them were likely preventable and accounted for $8.3 billion in additional costs for the industry.

This information came as no surprise to industry experts but highlights the need for the healthcare industry to rethink its service environment as a way of managing costs. Currently, about 90 percent of providers use a fee-for-service payment structure, which means that most people, especially those with chronic conditions, receive health services from a variety of providers with no single party coordinating care.

This style of care is not only confusing for patients but can also be dangerous and expensive. Fragmented care is associated with communication gaps, more hospital admissions, poorer outcomes and higher costs.

The problem only becomes worse for people with more than one chronic condition. Patients with one to two chronic conditions and highly fragmented care were 13 percent more likely to visit an emergency room and 14 percent more likely to require a hospital admission.

Fixing the issue would require a shift to a value-based model, in which a chronically ill patient receives care in a coordinate way that helps manage disease progress and promotes wellness. That way patients are guided through the management and/or treatment process rather than having to guess or piece together a picture of how ideal care would look.

“More and more providers are convinced that the future is going to be value-based payment, said Joe Damore, senior vice president of population health consulting at Premier, who produced the report.

The study looked at data from 24 million emergency department visits at 747 hospitals within Premier’s database.

Until the model changes, however, it’s important patients be their own advocates and consider the cost of an emergency room visits before going. Remember that managing a chronic condition is a learning process. There is no shame in asking questions.

We recommend to our members to ask their physicians as much as they can about what to do when a complication or issue arises. Try to remember that the emergency room was never meant to be a go-to first step in receiving care. They are set up for urgent visits when treatment is needed immediately. That can sometimes mean being proactive and aware of a provider’s regular hours.

Trump administration tackles drug advertising

Coming this summer: another addition to the “fine print” on all those drug commercials. Under a new rule announced this month by the Trump administration, pharmaceutical companies will have to reveal how much their drug costs during TV commercials.

The rule is set to go into effect this summer and will require drug companies to include the price of a drug if it exceeds $35 for a 30-day supply, or the usual course of therapy.

The move is meant to increase transparency in the industry and ideally force pharmaceutical companies to lower its sticker prices on drugs for fear of appearing too expensive.

“Requiring the inclusion of drug list prices in TV ads is the single most significant step any administration has taken toward a simple commitment: American patients deserve to know the prices of the healthcare they receive,” said Alex Azar, Health and Human Services secretary.

As expected, drug companies pushed back on the new rule. Representatives said they fear including drug prices during commercials will discourage customers from asking their physicians about the drug because they believe they cannot afford it. The new rule stipulates listing the price before any discounts or health insurance coverage, which could lower the cost.

It is notable, however, that because of rising costs an increasing number of Americans are being forced onto high deductible health plans, which can often lack the comprehensive drug coverage required to significantly reduce the cost of prescriptions.

“If drug companies are ashamed of those prices—lower them,” President Donald Trump tweeted shortly after the rule was announced.

Industry experts do not necessarily oppose the new rule, but are skeptical it will result in substantial cost reductions, especially because enforcement of the law is left to the drug companies themselves.

If one drug company fails to include the pricing information in an ad, a competitor can file a lawsuit under the deceptive and unfair trade practice provisions of the Lanham Act. No additional oversight plan has been announced by the Trump administration.

The consensus among Americans appears to be that added transparency in the pharmaceutical industry may be helpful, but is no guarantee. According to a POLITICO/Harvard poll in the summer last year, 63 percent of Americans favored including price information in drug advertisements, but only 28 percent believed it would lower costs.

As for the ClaimLinx team, we don’t expect this to bring about big change in the industry. If it does, though, you can bet we will be ready to use it to our advantage to lower costs for members and clients.

ClaimLinx wants member feedback

We’re always looking for ways to improve our services for our members. To that end, we are asking our members to answer a few questions. The survey takes less than two minutes, but gives us a lot of insight about their priorities, how happy they are with their plan and allows us to plan for future improvements.

Anyone who completes the survey can be entered to win a $100 American Express gift card as well as ClaimLinx promotional items. So please fill it out as soon as possible.

Improve your health with Spring cleaning

Jumping into Spring with a good cleaning means participating in an age-old tradition rooted in biological, cultural and even practical traditions that goes back hundreds of years.

The change of season has long required a good scrubbing because of the byproducts of keeping a home warm. Think of the 1800s and earlier, when homes were coated with a noticeable layer of soot from the fires lit with coal and wood or the lamps burning oil and kerosene.

Spring also coincides with religious ceremonies associated with a tradition of cleaning the home or altar, including Passover, Easter and Nowruz, or Persian New Year.

Spring cleaning isn’t just practical or a tradition, though. Studies have found cleaning, as an activity, can help reduce stress, and the resulting lack of clutter and cleanliness curtails anxiety. It also helps improve health by improving the air quality and helping you remain active without thinking about it.

Here are 7 tips to get you started Spring cleaning:

  1. Set a schedule: It’s always better to have goals and structure when starting a big house project. Make a schedule that fits your availability, such as setting particular days or weeks to de-clutter, clean the kitchen, garage, living spaces, bathrooms, bedrooms and more.
  2. Top to bottom: Start your cleaning with the ceiling and work your way down. That way you avoid having to repeat dusting or vacuuming along the way.
  3. Tidy up: Clutter creates stress in your environment, so it’s important to start any Spring cleaning with a cleanse. Use some quick questions to ask yourself to help you decide if an item is worth keeping. “Have I used this in the last year? Does this item spark joy in my life?” Read Marie Kondo’s book The Life-Changing Magic of Tidying Up for more on how to get rid of old items and organize.
  4. Enlist help: You and your family helped make the mess together, it’s only right that you clean it together. Simple tasks can be allocated to young children and this is a good opportunity to teach older children how to do more thorough cleaning. They may not enjoy the process but they will certainly love a clean home.
  5. Deep Clean: Don’t forget all the items you don’t clean on a regular basis, such as curtains, ceiling fans, blinds, rugs, carpets and anything else. Cleaning these items even a few times per year will help them last longer and cut down on the allergens and germs in your house.
  6. Stay safe: Be careful with the chemicals you’re using to clean. Regular household cleaners can be dangerous when mixed together or if used without proper ventilation. So use green or natural chemicals when you can. They’re less harsh on the environment and on your belongings.

These are just a few tips to get you started. See more tips about cleaning individuals items by clicking here.

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