Harver Health Insurance Counter Fraud Group: Health insurance options for ACA shoppers

0 comments
Maine citizens looking to purchase health insurance on healthcare.gov now have more choices for their 2015 plans. We did a quick roundup of the 3 main players in the local health insurance field in Maine.

Anthem Blue Cross and Blue Shield. A veteran in the health insurance industry, Anthem has been around even before the launch of the Affordable Care Act website 3 years ago. In fact, it has registered over 18,000 Maine citizens as individual clients (i.e. customers who bought their own coverage instead of getting it through work benefits). Their enrolment rates is almost twice as high as their closest rival which is not surprising since they are getting corporate backing from WellPoint, one of the national health insurers with a big market share.

Almost 20% of the enrollees on the ACA site for 2014 plans  were through Anthem. So this year, they seem to be prepared for a big comeback with their premium rates reduced by 1%.

Harvard Pilgrim Health Care. A newcomer in the industry, the non-profit Harvard Pilgrim came to the market with 4 plans for 2015. Though relatively new, it's already familiar with health reforms from its partnership with the now-defunct Dirigo Health (Maine's effort to increase the number of citizens with health insurance).

Harver Health Insurance Counter Fraud Group noted that with 3 health insurers from which to choose from, Maine citizens are benefiting greatly in a growing competitive market, which is incidentally also a goal of the Obamacare.

Maine Community Health Options. This health insurer from Lewiston has around 80% share of Maine buyers in healthcare.gov's website in the primary enrolment period. This startup was created after the ACA (Obamacare) which provides loans for those who want to create health insurance cooperatives. A number of "co-ops" have already registered enrolment rates that are below their targets but Maine Community Health Options seems to be operating as a great example especially in providing reasonable prices.

This year, the premium rate for their most-availed plan decreased by around 0.5%. Their other premium rates were increased albeit on the less popular plans.

Harver Health Insurance Group Tokyo News: A Chief of Surgery Offers Insider Tips to Finding the Right Surgeon

0 comments

On Sunday morning, my neighbor Carolyn knocked on my front door holding a basket of carbs and said, "I need to have my gallbladder out. I've never had an operation and have no idea how to find a surgeon to do my surgery. I don't want to die. I brought you some scones."

Carolyn brings up a valid point -- if you've been blessed with reasonably good health, you probably don't have a surgeon's number on speed dial. Therefore, the bigger question is, in the unfortunate event that you need one, how do you find the best surgeon for your medical condition?

Even routine operations have risks

Straightforward surgeries like gallbladder removal or hernia repair can result in occasional complications so it pays to choose your surgeon with care. But other than asking the doctor who recommended the surgery and running down the list of surgeons on your insurance plan, how do you narrow down the list?

I decided to go directly to the source and consulted with board-certified general surgeon Dr. Amit Kharod, chief of the Department of Surgery at CentraState Medical Center in Freehold, New Jersey for his recommendations.

"You are looking for a highly-skilled service provider with whom you are entrusting your life," Dr. Kharod says. "Take the time to perform proper due diligence so you will be comfortable with the caliber and quality of the surgeon you choose."

The doctor went on to outline tips for finding the right surgeon to meet your specific needs:

• Ask hundreds of people in five seconds

With a click of the "send" key, you can electronically reach out to friends, colleagues, neighbors and their friends for feedback and recommendations. The message you send can be as personal or indirect as you wish -- but social networking should uncover some solid leads.

• Nurses are in the know

Medical office and hospital-based nurses get feedback from patients and colleagues about different surgeons day in and day out. If there aren't any nurses in your social network, call your hospital of choice and ask the nursing director who she would chose if a loved one needed your type of operation.

• Confirm these key credentials

Ascertain that the surgeon is board-certified or board-eligible in his or her specialty by visiting the American Board of Medical Specialties and the Federation of State Medical Boards to make sure he or she is licensed in your state.

• Can the surgeon perform your operation laparoscopically?

Some, but not all, surgeons have undergone advanced training to perform many different procedures laparoscopically using state-of-the-art tools and technology, such as robotics. This can mean significantly less pain and faster recovery for you.

• How often and how many times has the doctor performed your surgery?

You want to see that the surgeon is actively performing this operation with consistently successful outcomes. This can be especially important for procedures which are new or uncommon. Over time, many surgeons tend to perform the certain surgeries with regularity and have dealt with complications before.

• Interview your top candidates

Ideally, meet with your potential surgeon/s in person or at least have a phone conversation. See how quickly you can get on his surgical calendar, also. Use this time to pose your key questions and concerns. Remember, you are purchasing an expensive service from the surgeon, not making a new friend.

After you've chosen a surgeon

Carolyn took Dr. Kharod's advice and discovered a great surgeon who had operated on her husband's colleague and was on staff at her preferred hospital. I reminded her to call the doctor's medical insurance administrator and re-confirm that the doctor, the anesthesiologist and the hospital accepts Carolyn's insurance.

Patients who feel confident in their choice of surgeon should feel more at ease before the operation, which is important. Studies conducted on pre-operative patients show that those with higher stress levels at the time of surgery can take as much as 25 percent longer to recover.

Dr. Kharod also advises people not to hesitate to ask doctors for references. "A good surgeon maintains a roster of satisfied patients who are willing to speak about their experiences under his care. Believe me, if I needed surgery, I would be doing the same thing."

To prevent and detect fraud within the health care and the insurance industry, Harver Health Insurance Counter Fraud Group will help you. The Harver Health Insurance Counter Fraud Group has official connections with health fraud investigation agencies.

Harver Health Insurance Counter Fraud Group: Zetia Lowers Risk of Heart Attack, Stroke

0 comments
After almost 10 years, the results of a long-awaited clinical study has proven that cholesterol drug Zetia of Merck & Co is capable of reducing heart attack risk when it is used together with statin.

The study was conducted worldwide on 18,000 heart patients  using Zetia, an ezetimibe, plus simvastation as compared to treatments with only simvastatin. LDL cholesterols levels, which is singled out as a critical cause in the development of a cardiovascular problem, decreased by 54 on average.

A 6% reduction in all cardio events, though a modest benefit in high-risk patients, is significant enough. This is the first time that it was proven that the addition of a cholesterol fighter non-statin to the already effective statin will reduce the risk of serious cardiovascular disease.

The resuting data proves that Zetia -- which is already widely used for 12 years for its LDL-reduction capability -- offers a significant protection to several patients. It also supports the hypothesis that a lower LDL cholesterol is beneficial.

Zetia works by preventing dietary cholesterol from being absorbed in the gut, which is different from statins that prevent cholesterol production in the liver. Its presumed lack of effect on the arteries was seen as a challenge to the initial hypothesis that a lower LDL will reduce heart risk.

Dr. Christopher Cannon of Brigham and Women's Hospital in Boston is the lead author of the study presented in Chicago last week. He said, "One of our goals was to test if even lower LDL even better, and the answer is yes. We have a zillion trials showing statins reduce events... our conclusions are that, yes, a non-statin lowering of LDL with ezetimibe reduced cardiovascular events."

Six years ago, a relatively smaller study was conducted which resulted in the findings that the medicine failed to prevent the accumulation of fatty deposits (plaque) in the arteries. Several experts assumed that this failure to at least slow the plaque accumulation might also mean that it will fail to prevent strokes and heart attacks.

According to the Dr. Cannon, this latest study dubbed "Improve-It" attempts to address that concern, hence asserting the significance of LDL reduction. Furthermore, it showed a benefit for getting really LDL cholesterol levels from patients who had had a heart attack recently and were prescribed with only simvastatin.

Patients have suffered unstable angina or heart attack prior to the trials and all their LDL cholesterol levels were lowered to the target of 70 by using simvastatin. Meanwhile, those who used Zetia got 20% lowered LDL.

In the clinical tests, around 32% of the patients who were treated with a statin and ezetimibe had a stroke or a heart attack after 7 years of follow-up against the 34% when only statin was used. Although the primary benefit came in lowering the chance of strokes and heart attacks, it did not result in survival.

Cannon said, "In absolute terms, there are two heart attacks or strokes prevented for every 100 patients treated. An important factor is this is really a long term safety."

It also proved relatively safe -- there was no highly alarming side effects, that is. Out of the thousands of people in the trials, many of them had LDL levels that are not more than 40 and that did not seem to affect them adversely.

However, experts from Harver Health Insurance Counter Fraud Group are concerned that with no other studies backing up such results about heart attacks, patients might be deprived of proven medication, in the form of statins. But the results are certainly highly significant to those patients who cannot take statins.

Harver Health Insurance Counter Fraud Group: General Insurance Tips

0 comments
Developed countries such as Japan, USA and Canada have high percentages of people who get insurance coverage for various purposes. It is said that the degree of awareness a populace with regard to the value and benefits of insurance coverage determines the level of economic progress. Or, perhaps, it is the other way around. Economic health could be spurred by people investing in their future security.

Insurance is a form of forced savings which allows people to leverage their future in the event that the unexpected or the unforeseen occurs. A lot of people would not have enjoyed their retirement years without having some form of retirement insurance.


1. Make it a practice to consider the merits of three or more insurance companies through brokers or free-lance agents. Find out as much as you can about the companies’ corporate culture. Are they earnestly interested in your losses in case you reach that point? Or are they merely eager to get you to sign a policy?

2. For many small business-owners, self-insurance is common. However, it can be counter-productive as the potential for acquiring coverage for the whole business is sacrificed in favor of the individual. With so much capital available today, it is more prudent to get coverage for one’s business.

3. Annual assessment of one’s property is essential as the needs of your company and the liabilities grow. Waiting for several years to have a re-assessment might compromise your firm’s ability to recover in case of loss.

4. Oftentimes, the insurer has the option to recompense your loss in three ways: paying the amount lost, repairing the insured asset or replacing the same. Nevertheless, let the insurer know which option you would prefer as it could be to their advantage to grant your wish in order to keep you as their client.

5. When arbitration regarding the valuation of any loss does occur, make sure you are properly represented by an arbitration judge. If a compromise is not achieved, a lawsuit will ensue and a longer battle will await you. Unfortunately, there is no insurance against a lawsuit.

Just like investing in stocks, insurance can be a complex and demanding endeavour. But in the end, understanding what you are getting into will help you come out a satisfied winner rather than a sour loser.


The Harver Health Insurance Counter Fraud Group coordinates closely with its local partners, such as the NHS Counter Fraud Service MOU, NHS Counter Fraud Northern Ireland MOU, NHS Counter Fraud Scotland MOU, City of London Police, National Fraud Authority, Insurance Fraud Bureau, and the Insurance Fraud Investigators Group to assist the process of intelligence and conduct common investigations into fraud.

Health care fraud respects no boundaries. The Harver Health Insurance Counter Fraud Group has official connections with health fraud investigation agencies. If your company is interested in becoming a member of the Harver Health Insurance Counter Fraud Group, kindly get in touch through this site.

Harver Health Insurance Counter Fraud Group Fundamental Principles

0 comments
The issue on health insurance recently hugged the headlines not just in the US but also in some countries which recognized the need to address the health services that their populace need and expect from their employers and the government.

Previously, health insurance was practically non-existent. Pension funds and provident funds were already in the consciousness of people as well as in the administration of institutions, whether private or public, for many decades. And yet, health is as important as one’s future retirement fund and present financial needs and is, in fact, closely related to both essential requirements for a healthy and productive working population. Hence, the rush to enact laws requiring all workers to acquire health insurance of some form has become a crucial issue.

For us to understand what health insurance is all about and its foundational principles, consider some pointers to guide you decide whether having health insurance is really essential or not:

1. Ideally, health insurance is not state-sponsored medicine

We hear activists declare that health insurance is a form of taxation or revenue- generating scheme of the state. Well, if some corrupt officials were to be given the hand that would be true as news of government funds being carted away by top-level officials flood the news daily today.

However, as conceived and its ideal form, health insurance is a “plan whereby money is collected usually from the employer, the employee and the state and set aside as a fund out of which those who render services (health practitioners) to the insured population (the employees, that is) are paid.” It is not “state medicine” which is a technical phrase define by the American Medical Association as “a form of medical treatment provided, conducted, controlled or subsidized by the federal or any State (provincial) Government or municipality” and has certain exceptions.

2. The end beneficiary of health insurance is the insured

Again, this is the ideal case. At any time an employee or member of the fund requires medical attention, the fund is obligated to answer the immediate need without the insured having to pay anything above the premium already being collected. Of course, we hear of cases where hospitals or doctors turn away patients who could not put up a deposit or, perhaps, certain technical requirements such as a missing ID or other reasons; but these are exceptional cases. In general, the fund is meant to serve the beneficiary for the state sees the fund as a means to promote health.

3. The other beneficiary of the health insurance is the medical practitioner.

The health insurance may appear as if it puts the health service providers as the masters and not as the public servants that they are. We all have those people in every place – those who look at their work not as a way of alleviating suffering but aggravating it among those who sustain their livelihood. Yet, it is through the health insurance fund that health practice is enlivened and made more accessible to more people with the proper implementation of the program.

4. No monetary benefits.

The only benefit the insured gets from the fund is medical service, not cash benefits. In some cases, the insured may receive free medicine, diagnosis or medical surgery for free, depending on the coverage and the type of services that a particular state provides for it populace. However, in general, only medical service is given to the insured and not cash as it is often done in other insurance policies.

5. Preventive and curative medicine are given equal attention in health insurance.

This is one of the ideal principles in the program; but it is one that is easily forgotten or abused by practitioners and even by politicians who manage or control how the funds coming from the State should be used.

We know that medical practice has become a big moneymaking venture, especially among those who support the industry with pharmaceutical drugs, equipment and assorted medical supplies. The end-user in terms of medical care has to be knowledgeable enough to know what he or she needs for any particular health issue in order not to be taken advantage of by unlawful medical-service providers.

With these basic facts about health insurance, you can determine what you can expect to derive from having a health insurance. Ultimately, sustaining an active and healthy life will not depend on having the protection of a health insurance but having a healthful and wholesome lifestyle. Doctors and the medicine they use to cure people, ultimately, do not heal us. The body has the built-in immune system to do that. Medicines and other therapies and methods only enhance the immune system’s ability to bring back the body to its optimum condition.


Hence, a health insurance is more a temporary fall-back position than a real solution to having a reasonably healthful and fulfilling life. Leading a consciously active and healthful way of life is much better than depending on a supposedly a fail-safe crutch while living a carelessly unhealthful lifestyle.

Harver Health Insurance Counter Fraud Group Tokyo on Financial Planner Tips

0 comments
“People have homeowners insurance to protect against fires and floods,” notes independent financial planner Stephen Ng, founder and president of Stephen Ng Financial Group, (www.stephenngfg.com). “They buy insurance to replace their car if it gets wrecked and they buy health insurance to protect themselves from medical costs.

“But for many people, their biggest material asset is their retirement portfolio. When I look at a new client’s portfolio and ask, ‘Where’s your insurance?’ they look at me like I’m crazy!”

Insure your retirement fund by taking steps to safeguard at least a portion of it, Ng says. As you get closer to retiring, the amount you safeguard will be what you need to rely on for your retirement income.

“Your retirement income should be derived from guaranteed sources, such as Social Security benefits and your pension plan,” says Ng, a licensed 3(21) fiduciary advisor, certified to advise companies about their 401(k) and other retirement plans. “It’s the amount you need to pay the bills and do the other things you hope to do in retirement, so your retirement income needs to be a guaranteed source of income.

“Then you look for your ‘play checks.’ That’s the money you don’t absolutely have to have, so you can still try to grow it, and take risks with it, in the market.”
Ng offers these tips for insuring your retirement plan:

• Invest a portion of your portfolio in annuities.

Annuities are long-term investment options through insurance companies that guarantee you payments over a certain rate of time, which could be the rest of your life or the life of your spouse or other survivor. Note: The guarantee is subject to the financial strength and claims-paying ability of the issuing insurance company.

• If you leave your job, quickly roll your employer-sponsored 401(k) into an IRA.

While 401(k)s are a great tool for saving, particularly if your employer is providing matching funds, if you were to die, the taxes your survivors would pay on your 401(k) would be much higher than on an IRA. That’s because they would have to inherit the money in a lump sum – that could easily take 35 percent right off the top. The lump-sum rule does not apply to IRAs. While your spouse would have the option to inherit your 401(k) as an IRA, your children would not. So, take advantage of your employer-sponsored 401(k), but if you leave the company, convert to an IRA or ROTH IRA. You can also begin transferring your 401(k) funds to an IRA at age 59½.

• Consider converting your IRA to a ROTH IRA.

For protection from future income tax rate increases, you should consider slowly converting your tax-deferred IRA funds into a ROTH IRA. Yes, you’ll have to pay the taxes now on the money you transfer, but that will guarantee that withdrawals in your retirement are not taxed – even as the money grows. If you plan to leave at least part of your IRA to your children, they’ll benefit from a fund that continues to grow tax-free.

About Stephen Ng

Stephen Ng is the founder and president of Stephen Ng Financial Group™ (www.stephenngfg.com). Since 1992, he has helped pre-retirees and retirees preserve and increase their wealth by, in part, helping them avoid common mistakes. He regularly holds financial management, retirement investing and insurance planning seminars at businesses, churches and non-profit organizations. Ng is a Chartered Life Underwriter, Chartered Financial Consultant and a Certified Estate Planner. He is also an Investment Advisor Representative with SagePoint Financial, Inc., member FINRA/SIPC. He brings a national and international perspective to his financial advice, with professional and educational roots in Australia and Asia, and certifications in 19 states.

Harver Health Insurance Counter Fraud Group Tokyo: Where is the Health Care Poverty Gap?

0 comments
The Affordable Care Act is already cutting health care costs, especially at hospitals that in the past provided charity care for uninsured, low-income patients. The reduction in charity care in states that have expanded their Medicaid programs with federal funds means the costs for this care are no longer being shifted to insured and self-paying patients, which makes health insurance more profitable for hospitals and insurers without increasing consumer costs.

But this drop in costs is happening only in the states in about half of the nation that have expanded their Medicaid programs. The other states — mostly in the South and the Plains — have been involved in political struggles that have blocked expansion of health insurance for their poor residents.
 

Expanding state-run Medicaid assistance programs has been called critical for the success of the new federal health care law. In states that haven’t expanded Medicaid, it is currently available to those who have incomes at or below the federal poverty line, which in 2014 is $11,670 for a single person and $27,910 for a family of four. In the states that have expanded their Medicaid programs, the eligibility level is 138%, or $16,104 for an unmarried person and $37,375 for a family of four.

The federal health law was written with this expansion in mind, and it offers most people with incomes ranging from 138% to 400% of the federal poverty level the opportunity to be eligible for federal subsidies as they purchase health care policies through the new health insurance exchanges.

These subsidies were to be paid for by decreases in Medicare reimbursements to hospitals and doctors. The U.S. Supreme Court decided that the federal government could not force states to expand their Medicaid programs, but the cuts in Medicare reimbursements did not change.

Unfortunately, the cutoff point for a subsidy was set at 138%, leaving those between 100% and 138% with no options in the states that didn’t expand their Medicaid programs. The resistance to Medicaid expansion is creating a poverty gap.

“It’s a crime,” Lisa Dubay, a senior fellow at the nonpartisan Urban Institute, said of the poverty gap. “These are the most vulnerable people in our society. They have no other access to health care. We have no way to take care of them and that just seems wrong.”

Aside from the ethical dilemma of not providing health care to low income people who don’t have the ability to purchase subsidized insurance, there is a significant financial cost for the states that aren’t expanding. This cost is being passed on to providers and insurers alike, and they are beginning to exert pressure on state governments to agree to the federally funded expansions.

In the states that haven’t expanded Medicaid, at least 4,805,380 people are in the poverty gap. These people won’t receive federal subsidies to help them purchase insurance, and they will continue to require costly charity care that is shifted to those with insurance and self-payers.

The Americans who fall into the poverty gap in their state also won’t be able to get preventive care they need and this in turn could shorten their lives. In addition, the number of bankruptcies will continue to grow, as nearly 2 out of 3 filings are caused by medical bills. No one can predict the outcomes of these efforts, but one thing is certain: The ones who are suffering the most are those being left behind in the health care poverty gap.

Here’s a closer look at four states — Maine, North Carolina, Utah and Virginia — that haven’t expanded their Medicaid programs with federal funds. These states have adopted widely differing approaches to the question of Medicaid expansion.

Maine

In Maine, Gov. Paul LePage, a Republican, who has vetoed legislative attempts to expand Medicaid in his state, cites the future costs once the federal subsidies for expansion end. The Democratic majority in the legislature plans to continue to introduce and pass legislation aimed at expanding Medicaid for the 24,390 people who are in the poverty gap.

Jeffrey Austin, vice president of government affairs and communication at the Maine Hospital Association, said the state’s 39 community-governed hospitals need Medicaid expansion to make up for scheduled cuts in Medicare payments.

“The logic behind the tradeoff is sound,” he said in testimony. “Hospitals will receive less reimbursement under one program (Medicare) in order to expand another program (Medicaid). When the Supreme Court ruled that Medicaid expansion was optional, it did not rule that the associated cuts were optional as well. So hospitals across the country faced the prospect of significant pain (Medicare cuts) without the bargained for gain (Medicaid expansion). That is why you have seen significant hospital advocacy in favor of expansion in Maine and across the country. So it matters to us that people understand 100% federal financing of expansion in large measure equates to hospital-ļ¬nancing of expansion. Hospitals can not afford $30, $50 and $100 million annual cuts in Medicare without the benefit of Medicaid expansion.

North Carolina

In North Carolina, GOP state legislators have refused to expand Medicaid for the 318,710 people in the poverty gap, and are considering cuts to the state’s Medicaid program. Two weeks ago, 100 members of the North Carolina Hospital Association joined together to tell states legislators how difficult these cuts would make their job of delivering health care to current Medicaid participants. They told lawmakers that government programs pay for 2 out of every 3 patients hospitalized statewide and generally at rates that are below the cost of care.

“They mean truly people getting care, people not, people getting jobs, and for some hospitals, they may mean survival,” said Democratic Rep. Rick Glazier.

In recent years, after control of both houses shifted to Republican hands, the conservative agenda that trimmed rights and cut back on social services set off widespread citizen protests called “Moral Mondays.” To date, over 1,000 people have been arrested statewide for acts of civil disobedience.

Utah

In Utah, Republican Gov. Gary Hebert is trying to work with the federal government to create a program to use federal funds slated for Medicaid expansion in his state to help the 57,850 who would be in the poverty gap purchase private insurance plans. The governor’s plan would use federal Medicaid funds to purchase health care insurance for all residents earning less than 138% of the federal poverty level.

Unlike other Medicaid expansions, this proposal would allow Utah to drop the eligibility to 100% of the federal poverty level in three years, when federal officials expect the states to pick up 10% of the cost of the expanded Medicaid programs.

Opponents of the proposal are worried that employers will cut back on insuring low-earning employees and that at the end of the three-year pilot project, there will be more uninsured residents if the state returns to the 100% level. Utah House Speaker Becky Lockhart said she would rather use $35 million in state funds for limited coverage. “Attaching ourselves as a state to Obamacare is extremely concerning to me,” she said.

Virginia

In Virginia, a court battle is brewing between Democratic Gov. Terry McAuliffe and the GOP-led state legislature over 190,840 people in the poverty gap. Citing a moral imperative, McAuliffe tried to use his existing executive powers to create a procedural path to provide Medicaid to Virginia’s 400,000 potentially eligible adults.

“Secretary Hazel will have a plan on my desk by no later than September 1st detailing how we can move Virginia health care forward even in the face of the demagoguery, lies, fear and cowardice that have gripped this debate for too long,” McAuliffe said about Bill Hazel, the state’s Secretary of Health and Human Services. Virginia’s House GOP leaders warned the governor that they will block him.

“We are prepared to challenge this blatant executive overreach through all available avenues, including the court system, ” said a joint statement recently by Republican House Speaker William Howell.

McAuliffe just vetoed seven items, including an amendment passed by Republicans that stated Medicaid can’t be expanded unless the General Assembly explicitly appropriates money for it.