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On Spotting Medical Billing Errors – For Patients

Are you over-paying?

By Aetna

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Why Health Insurance Companies Fail To Generate Significant Reach with Their App Portfolio

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The “Health Insurance App Benchmarking Report for 2015”

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AN ME-P SPECIAL REPORT

By Ralf Gordon Jahns

rgj@research2guidance.com

The majority of health insurance companies can be described as hesitant in their app publishing activities, even those that have a larger app portfolio fail to have a significant impact. A new report from research2guidance analyses global app publishing activities of the leading health insurance companies.

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Some of the reasons are that health insurance companies are not leveraging their assets, their apps are not compliant with state-of-the-art app publishing rules and missing cross promotion.

The vast majority of health insurance companies have failed to generate a significant reach with their app portfolio, with 67% of health insurance companies having achieved less than 100,000 downloads. The majority of apps in the portfolio of healthcare payers belong to the long-tail:

  • 70% of health insurance companies can be described as hesitant publishing only 1 or 2 apps. However, if health insurance companies were to publish more apps they wouldn’t necessarily generate higher download numbers.
  • 77% of health insurance companies belong to the low impact category having published less than average apps with less than average download numbers. Only 9% of health insurance app publishers could be described as active with above average impact.

AETNA

Aetna is the one health insurance company that stands out. Having published 28 apps across both iOS and Android Aetna have achieved more than 14million downloads, significantly more than any other health insurance company. That being said 85% of those download come from just on app within their app portfolio, iTriage. This is not uncommon amongst those health insurance companies that have generated a large number of downloads.

For example, 7 of the top 10 biggest health insurance companiesapp portfolios generate more than 50% of downloads from the top performing app. What are the reasons for the little impact the traditional payers of the healthcare systems have in the app economy?

RESULTS

These are some findings from research2guidance’s latest report “Health Insurance App Benchmarking 2015”. The report provides information on app categories health insurance companies concentrate on, the number of apps they have published, target user groups and the organization of their app business model.

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cell

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The study results indicate that:

  • Most health insurance companies fail to produce ‘state of the art’ apps – Apps in most cases do not incorporate the 6 key elements of best practice: Tracking and coaching, automated input, remote consultation, secure use of mHealth data, integrating their solutions into the current IT healthcare infrastructure and beautiful design and usability.
  • Companies fail to realize the potential of app integrated incentive schemes – Health insurance companies are best positioned to link financial rewards via incentive schemes to healthy and cost saving behavior of their members. However, currently there are only a few companies that link healthy behavior to financial rewards with the help of an app.
  • Health insurance companies fail to successfully cross-promote their app portfolio– Companies do not successfully leverage their app portfolio through cross-promotion. Best practice mHealth app publishers manage to have almost equally successful apps in their portfolio by cross promotion using for example, “more apps” screens, pop-ups and push notifications. This is not being done at all by health insurance companies.

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How I Lost my Battle Against the NPI

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Refusing a National Provider Identifier Number

By Darrell K. Pruitt DDS

pruittI can no longer refuse to apply for a National Provider Identifier (NPI). I lost that long battle. Anyone rejoicing?

I’m spent. My leverage has vanished. Telling insurers “I have no NPI” held much more inherent power than “I have an NPI but I won’t share it with you on principle.” Far too many words. My profession has become dominated by unresponsive, unaccountable 3rd parties that dental leaders in the ADA welcome as policy. Working together, they promote and commandeer the technology dentists purchase and clueless patients pay for in increased fees. I have painfully learned that principles are only for dentists who can still afford them, and it’s a bad economy for luxuries.

Non-HIPAA Entity

Since I am not a HIPAA-covered entity and therefore not required by law to adopt an NPI, my capitulation to extortion disappoints me as an American citizen. I still find it hard to believe that an anti-consumer HIPAA rule enthusiastically enforced by the dental benefits industry could force me to “volunteer” for a PERMANENT identifier. As I and 96% of dentists become jerked around by our NPIs, I hope dental historians note that I am the ONLY dentist who publicly asked “Why?” instead of “Why not?” After 6 years, I’m still awaiting an answer to that question from leaders who continue to promote the NPI to dentists while ignoring their questions.

Dental Benefits Providers

I was able to hold out up until Aetna, Delta Dental and other dental benefits providers deprived my office of access to details of patients’ dental benefits unless I have an NPI. I’m waiting for someone – anyone – to tell me how the identifier can possibly improve the dental care of those who pay Aetna and Delta Dental premiums, especially if their benefits are intentionally kept secret from their dentists. I am certain that if the nation’s employers who purchase dental benefits were aware of the transparent nonsense, they would never purchase such products. Where’s the US Chamber of Commerce? Where’s the FTC? How about the US Constitution?

This is exactly why there needs to be more openness in our profession, Doc. The cockroaches who were invited to quietly overrun dentistry cannot withstand transparency, yet I don’t know how much longer I can fight for it without further risking the health of my practice.

As anyone can understand – and as anticipated by corporate executives in the insurance industry as well as by those with vested interests in the ADA Department of Dental Informatics – to have to explain to new patients why I cannot estimate how much they will owe for treatment would destroy my practice. Outside the US, other societies deem it unethical to deny patients informed consent to treatment for any reason. The NPI is such an egregious blunder that I never expect those who promoted to accept ownership.

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NPI

Assessment

If I lost the battle, who won? Do EDR enthusiasts in the ADA call this a glorious victory and a likely source of ADA pride for decades to come? Or is it much more shameful? Since I lost freedom, I want to know who won?

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Direct Reimbursement [DR] and RiskManagers.Us

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Transparent Dental Benefits versus Confusion

[By Darrell K. Pruitt; DDS]

pruitt

“If you are not a part of the solution, there is good money to be made prolonging the problem.” 

Company slogan- www.riskmanagers.us

Meet Mr. William Rusteberg

Today, I met William Rusteberg on the PennWell forum when he replied to the thread, “Why the long NPI, BCBS-TX?” which I copied below, along with my response which includes a plug for Direct Reimbursement [DR].

http://community.pennwelldentalgroup.com/forum/topics/why-the-long-npi-bcbstx?page=1&commentId=2013420%3AComment%3A26976&x=1#2013420Comment26976

Mr. Rusteberg represents a company called RiskManagers.Us, whose specialty involves the benefits market, yet it is not exactly an insurance company – just like there is no such thing as true dental insurance.  RiskManagers.us is a firm that works directly with businesses to identify and develop cost-effective benefits packages – emphasizing transparency and fairness.  Now that is refreshing, friends! 

Defining RiskManagers.Us 

Here is how RiskManagers.us describes itself: 

“We do not work for an insurance company, we work for you. As an independent brokerage, and consulting firm we can represent any licensed insurance company in Texas, Colorado, Mississippi, Louisiana, Alabama, Illinois & Florida.”

If one visits the Web site’s “Reference Library,” here are some of the topics offered:

·         Self Funding – Need a second opinion?

·         Texas leads in transparency issues

·         Can’t get claim information? HB 2015 May Solve Your Problem

·         Medical Stop Loss Through a Captive

·         PPO Discounts – Games People Play

·         PPO Networks – Shell Game

·         Can Hospitals waive Deductibles in Texas?

“What is a NPI number?” 

Mr. Rusteberg’s initial question on the PennWell forum simply asked, “What is a NPI number?”  Following my explanation, he wrote: 

 “It seems that many of those in your profession would do well in accepting cash only, or directly working with employer groups who sponsor dental/medical plans on a direct pay basis. We have had good success in doing this for our clients – we have one employer in San Antonio who pays medical care providers directly and quickly – providers like it and the plan pays a fair and reasonable rate, not relying on a PPO network to “re-price” claims. We have done the same on dental plans, eliminating the insurance company, PPO network and paying dental care providers submitted charges directly and quickly. We see little or no trend increases on dental charges using this method. In my view, insurance companies interfere in patient – provider relationships in a financially detrimental way.”

Thanks for your reply.

My Response:

I like you, William; 

What you describe sounds like my all-time, personal favorite dental benefits plan. It is called Direct Reimbursement {DR}, and it not only gives the employer the unlimited capability to design a plan which reflects the level of commitment desired by the company, but most importantly, it naturally preserves quality of care by allowing employees unlimited freedom of choice in dentists.  And that’s as good as the market gets. 

http://www.directreimbursement.com/

In addition, since there are no NPI requirements for DR, employees are also permitted see dentists who decline NPI numbers for ethical reasons. That increases employees’ choice by 50% over BCBS-TX clients, according to recent information provided by the Healthcare IT Transition Group.

http://www.npidentify.com/stats.htm#states

Little Management Needed

Just like the benefits plans you mention, with DR, very little money is spent on management because such policies are so simple and transparent that there is no room for profit-enhancing (wasteful) confusion used by unethical companies like BCBSTX, Aetna, Cigna, UnitedHealth, Delta Dental, United Concordia, and so many other members of the National Association of Dental Plans (NADP).

Assessment

Without transparency and the invisible hand of freedom-of-choice, free-market competition for healthcare dollars disappears as fast as executive bonuses rise. We’ll see where it goes from here. It would sure be swell if a Direct Reimbursement representative takes interest in the conversation; anyone home? 

Conclusion

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UnitedHealth Group Shenanigans

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Ingenix’s Lack of Independence Cited

[By Dr. David Edward Marcinko; MBA]

dem2

According to Melissa Dahl, Jeff Rossen and Robert Powell of msnbc.com on Jan. 13th, 2009, UnitedHealth Group agreed to pay $50 million in a settlement after being accused of over charging millions of Americans for health care.

The Investigation

An investigation was launched after receiving hundreds of complaints about Oxford Insurance and its parent company, which claims to rely on “independent research from across the health care industry” to determine reimbursement rates.

Faux Independence

In actuality though, it relies on the well known firm, Ingenix, a research arm owned by UnitedHealth Group. The allegations are that Ingenix has been manipulating the numbers so insurance companies pay less.

Other Insurers under Investigation

Although UnitedHealth Group and Oxford Insurance were the only entities investigated, other major insurers use Ingenix, including Aetna, CIGNA and WellPoint/Empire BlueCross BlueShield.

CEO Bill McGuire

The $50 million UnitedHealth Group will pay as the settlement will be used to create a nonprofit organization that will determine reimbursement rates for patients. William W. McGuire MD was the CEO of United from 1992 until his ignominious resignation in 2006, because of his involvement in an employee stock options scandal. Hence, rise of the insider moniker; “Useless Healthcare.”

Assessment

According to blogger Robert Laszewski,

“The big losers here are the docs. The result is going to be about the same and their medical societies will now have less reason to challenge the customary and reasonable system than they did before.”

As a medical practitioner, I eschewed contracts with this company a decade ago. Relative to peers, I was never so happy! Some companies just can’t seem to learn, or change their culture. But, the more important question to ask: is this indicative of an isolated rogue company, or the entire health insurance industry?

Conclusion

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