Tag Archives: ombusdman

A Three-fer for you!

Section 1002 – Finally!

This section is entitled” Health Insurance Consumer Information.”  Here the Federal Government wants to help the states create programs to help the consumers of health care insurance (us!) navigate the sometimes difficult process. It offers grants to create both assistance programs, and ombudsman (I love that word. Om-buds-man. There are so many things you could do with that.) for dealing insurance.

To get the grant, you have to create these offices, which will help people file appeals, track what problems people are having with insurance, educate consumers, assist them in enrolling in group health insurance, and resolve tax credit problems. They also have to track this data, and submit it to the Secretary of Labor. There was $30,000,000 available in the first year, and then it has to be reauthorized every year after that.

And that, my friends, is IT for section 1002.

Section 1003 – Ensuring that Consumers Get Value for their Dollar

This section also amends the Public Health Service Act (remember that from the first day!). This section allows the Department of Health and Human Services to review premiums to ensure that they are not rising too quickly. Health plans that are found to have unreasonable increases must justify their increases. This premium review process will continue, with Federal government support, to identify patterns of increases. It also addresses how this premium review process will affect the Health Insurance Exchanges that are part of the overall larger mandates for health insurance. That comes in around section 1300 – so we’ll get to it. There are funds appropriated for this process, and states can apply for grants to get them of between $1,000,000 and $5,000,000 a year. Given that they allocated $250,000,000 for the whole process, they have enough money for every state to get the maximum.

This section also creates something called a Medical Reimbursement Data Center. These will help to develop geographically accurate fee schedules, update these using the best statistical tools, and make the information public, about both the fees and the methodologies. This attempts to address the issue of transparency in the fees – which directly impacts the doctors that are receiving reimbursements. However, the insurance companies are not required to give data to these centers. So how accurate they might be is debatable.

Section 1003 – done!

Section 1004 just lists the effective dates of the sections preceding, with 1002 and 1003 immediately, and the rest six months later. So they have been in effect for a while. Has everyone been enjoying their ombudsman?


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