LTC MetLife Hiring Independent Caregiver

LTC MetLife Hiring Independent Caregiver


As people age—or due to a life-changing event such as a stroke—the ability to live inde- pendently may change. Over 44 million Americans spend time caring for family members or friends who can no longer live on their own without assis- tance.1 Often a family member or friend steps in to help the person with the activities of daily living such as bathing and dressing, everyday chores, or preparing meals.

Over time, the need for assis- tance often increases, which in turn increases the time commitment from family

and friends. Individuals often desire to remain in their own home, even though they need more help to stay there. It is frequently at this point that caregivers must begin to look at sources beyond the family to assist with care.

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Out of Control Out of Network Charges

Out of Control Out of Network Charges


Out of Control Out of Network Charges

Few healthcare changes have been more impacted than the out of  control out of network charges billed to patients.  The health care reform  bill known as PPACA has for the most part been insignificant in the Northeast, in particular, as many  state laws  have already addressed issues such as pre-existing conditions, contraception, coverage rescissions and maximum loss ratios (MLR).

Instead, the market forces are reshaping the medical field  into significant insurance & provider consolidation, larger hospital groups and flattening provider reimbursements.  The  problem is pointed out in  Out of Network Medical Costs Affecting NY State Across  investigation report commissioned by Governor Cuomo recognizing the unexpected out-of-network claim problem.  Officials say that this is now  “an overwhelming amount of consumer complaints.”   Some examples cited in the report An Unwelcome Surprise – “a neurosurgeon charged $159,000 for an emergency procedure for which Medicare would have paid only $8,493.”  Another example: ” a consumer went to an in-network hospital for gallbladder surgery with a participating surgeon. The consumer was not informed that a non-participating anesthesiologist would be used, and was stuck with a $1,800 bill. Providers are not currently required to disclose before they provide services whether they are in-network.” The average out-of-network radiology bill was 33 times what Medicare pays, officials say.

To make matters worse, Health Insurers have reduced their out of network recognized charges from private industry index UCR (usual customary and reasonable) to the Medicare Index known as RBRVS Resource Based Relative Value Scale ).  Insurers moved away from UCR after then-NYS D.A. Mario Cuomo in 2009 forced Unitedhelatcare Group (owners of Inginex) to settle $50 Million in a conflict of interest allegation.  D.A. Cuomo future hopes for UCR were to that it be overseen by a non-profit entity.  So much for best laid plans.

Today, 90% of SMB members have in network only benefits but the few remaining consumers are paying for eroding out of network benefits with little transparencies and necessary protection from new out of network billing practices.  The NY Dept of Financial services  is calling for providers in non-emergency situations to disclose whether or not all services are in-network, what out-of-network charges will be and how much insurers will cover.

Insurers such as Aetna are taking action – with lawsuits throughout the country such as Aetna sues 9 N.J. doctors for “unconscionable” fees.  Another Aetna lawsuit is discussed extensively in a law blog: In New Lawsuit, Health Insurers Allege Fraud and Kickbacks Against Out-of-Network Providers Who Forgive Patients’ Financial Responsibility.

In an ominous statement” “Failure to recognize this historical out-of-network avalanche will result in shocking financial disasters, as experienced by so many hospitals in 2003″

2012 Medicare B Deduction for Self-employed

2012 Medicare B Deduction for Self-employed

Some good news for small businesses owners on Medicare Part B.  The IRS is permitting for the 1st time self-employed people to deduct their Medicare Part B healthcare premiums.

What is Part B? Part B helps cover medically-necessary services like doctors’ services, outpatient care, durable medical equipment, home health services, and other medical services. Part B also covers some preventive services. The costs for Medicare part B have substantially risen form a modest $54 to a $99.90 minimum and now indexed for income.

Table 1: Part B Monthly Premium


 Beneficiaries who file anindividual tax return with income

  Beneficiaries who file a joint tax return with income

Your 2012 Part B Monthly Premium Is

If Your Yearly Income Is


 $85,000 or less

$170,000 or less











 Above $214,000

Above $428,000


Prior to the 2010 tax year, the IRS did not permit the deduction to seniors who paid Medicare Part B health insurance premiums, according to a Bloomberg report.  Strangely the IRS did not release of this announcement but the deduction is on line 29 of the new 1040 tax form and applies to people who do not claim a tax deduction.

Anyone who is self-employed, regardless of age, may deduct the premiums paid for health insurance, under certain conditions such as insurance established under the business or in the name of the person who runs the business.

This posting is not necessarily tax advise and it is recommend to  check with you accounting professional before filing 2011Tax returns.

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U.S. Budget Deal’s Effect on Private Insurance

U.S. Budget Deal’s Effect on Private Insurance

After balancing the budget and announcing  $2.4 trillion in government spending cuts over ten years, politicians and media pundit are insisting that it is only the beginning of the attack on health care, pensions and other social programs.

So why is balancing the budget and cutting medicare so bad for the Privately Insured? After all, the Democrats have made sure the automatic cuts leave Medicare benefits untouched, and the Republicans have blocked any new taxes.

Everyone is content right? Or so it seems. But the truth is that cutting payments to Medicare providers will mean some Americans are going to pay more. It may not be called a tax, but if you’re covered by private health insurance, money will be coming out of your pocket nonetheless.

Here’s how cuts in Medicare affects the rest: If a hospital provides a service that costs $1,000,000, and the government elects to pay just $980,000, the $20,000 gap doesn’t disappear. The hospital has to cover it somehow. It will likely do so by shifting the costs to commercial insurers, which eventually means higher premiums. This cost shifting is nothing new-it’s been happening for years-but more cuts will just make it worse.

NY Hospitals in particular have felt Federal Funding cuts for teaching hospitals over the last decade.  This has been a contributing factor to St. Vincents declaring bankruptcy last January.  Many surviving hospitals however have the size to negotiate effectively with private insurers to make up that funding short fall.

So guess who makes up that difference?  The fact remains, if you don’t deal with underlying costs, you’re not fixing the problem, you’re just covering it up.