News & Info Related To 2017 Open Enrollment

Jan 26, 2016

  1. AllenChicago
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    January 26, 2016

    Health and Human Services (HHS) started preparing for 2017 before 2015 ended. Here's a plain English summary of the "Benefit and Payment Parameters 2017 (proposed) Rule".

    High Level Summary: Proposed Benefits And Payment Rule Includes Standardized Plans, New Network Adequacy Standards

    More Detailed Summary: The 2017 Benefit and Payment Parameters Proposed Rule: Drilling Down

    Full Rule is Here: https://www.federalregister.gov/art...ce-of-benefit-and-payment-parameters-for-2017

    -ac
     
  2. Yagents
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    https://aishealth.com/archive/nhex0...Magnet&utm_medium=Email&utm_campaign=89027609

    CMS Wants to Classify Provider Networks

    Beginning in 2017, CMS proposes classifying QHP provider networks into one of three tiers. Information about a network’s relative breadth would be made available to health plan shoppers, according to the letter. Each network would be compared to networks used by other QHPs in the same geographic area, CMS explained. It also would compare the number of providers in a network to the number of providers included in all QHP networks in a county. This “Provider Participation Rate” (PPR) would then be used as a baseline. Health plans that have larger networks will be labeled as “Broad,” while those that are unusually narrow will be classified as “Basic.” Networks that are within one standard deviation of the mean PPR would be classified as “Standard.”

    CMS outlined its intention to review network adequacy in its BPP in November, but only hinted that it might eventually rate provider networks. Industry observers say they are surprised at the level of detail included in December’s letter.

    CMS also proposed maximum travel times and distance standards for a variety of provider types (see table, p. 3). For each specialty and standard listed, the issuer would need to provide access to at least one provider for at least 90% of enrollees. CMS expects that insurers will be able to meet the standards at least 90% of the time and will not need to submit justifications more than 10% of the time.
     
    Yagents, Jan 28, 2016
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  3. RayNY
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    I wonder if CMS will classify the network based on what it actually is, or what the insurance company reports in their directory.

    Because, let me tell you, the provider directories are a whole new level of messed up this year. More than half the calls coming in right now are people who can't get a doctor to see them. Docs say they won't take new patients (even if you use the "accepting new patients only" criteria). They say they're not in the network, never signed a contract, or that the carrier terminated their contract. Many are listed 4-10 times as duplicates. Even getting the carrier on a 3-way call with the provider leads to nothing.

    I had one client looking for a Gastro within 10 miles, it gave 80 results. turned out, it was only 17 doctors listed multiple times, and not a single one would take her.
     
    RayNY, Jan 28, 2016
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  4. Tkruger
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    I recently ran into a similar issue with Humana and a client in Land O Lakes. Not one Primary taking new clients in a 20 mile radius of his zipcode. In turn I had to switch him to a different carrier.
     
    Tkruger, Jan 28, 2016
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  5. sman
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    I received a call from a client while she was at the doctors office. Doctor is in Humana network, but stating they will not accept on-exchange plans. Problem is, the Humana National POS network is the same whether on or off exchange.

    Obamacare has created a whole new class of haves and have-nots.
     
    sman, Jan 28, 2016
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  6. Yagents
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    Please keep topics related to 2017.

    I don't want Allen getting his forum thread organization system messed up.

    He'll blame me. :twitchy:
     
    Yagents, Jan 28, 2016
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  7. RayNY
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    There's no way for them to check or verify, I coach my clients to never say it's "obamacare" or "on exchange" and to just say "It's a Humana plan with the POS network".

    The solution really is that simple. Outside of that, I have to call in, confirm they participate in the network, and directly ask why they won't accept my client with a plan using that network when they are contractually obligated to do so.

    The usually just take the client at that point. If they don't I just insist they have to or they'll have their contracting with the carrier terminated for-cause.

    (Doesn't matter if it's true, all that matters is they get off their high horse and service the patients they're supposed to.)
     
    RayNY, Jan 28, 2016
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  8. bluediamond
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    I also coach my clients to say it's not obamacare, we have the exact same network for on or off.
     
  9. FLM2
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    Am I glad to be walking away from this garbage, instead of fixing the issues they will focus on making things even more complicated.
     
    FLM2, Jan 28, 2016
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  10. AllenChicago
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    WHY would health insurance companies who lost +$100,000,000 (over a hundred million) in 2015, and expect 2016 to be as bad, or worse, come back to the Exchanges in 2017???

    SEP people only accounted for 30%-40% of the losses. The majority of medical claims came from people who signed up during open enrollment. If health insurers signed up no one at all outside of open-enrollment, they still would have lost a ton of money.

    Could it be that their losses are being offset "under the table" by our government? I really have a hard time believing that FOR PROFIT companies would voluntarily hurt themselves and their shareholders, by locking in a 3rd consecutive year of losses.
     
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