Fortune Well’s Post

Key points from Discovery Health CEO Ron Whelan on President Ramaphosa’s signing of the NHI Bill - President Ramaphosa to sign National Health Insurance (NHI) Bill. - Discovery Health CEO Ron Whelan expresses disappointment due to flaws in the bill. - Discovery Health supports universal health coverage but deems current NHI Bill unconstitutional and unfeasible. - No immediate impact on medical schemes expected; status quo remains for now. - Implementation of NHI projected to take several years, possibly decades. - Funding remains a critical barrier to NHI's viability. - Discovery Health advocates for private sector collaboration in healthcare. - Flaws in the NHI Bill and legislative processes may lead to legal challenges and delays. - Discovery Health pledges to engage constructively while defending rights of medical scheme members. - Commitment to supporting healthcare partners, investing in both public and private healthcare systems.

🏥 New study from American Medical Association on insurer consolidation finds that insurance markets are HIGHLY concentrated and that insurers can use their monopoly status to raise premiums for patients and lower payments to providers. Quote: "In sum, we find that the vast majority of health insurance markets in the United States are highly concentrated. Coupled with external evidence on their anticompetitive behavior, this strongly suggests that health insurers are exercising market power in many parts of the country and, in turn, causing competitive harm to consumers and providers of care." https://bit.ly/490IvrF You can read what the Federation of American Hospitals has said about the impact of insurer consolidation here: https://bit.ly/4hUy3WB

Legal Update: Proposed Rule Would Expand ACA's Contraceptive Coverage Mandate On Oct. 21, 2024, the Departments of Labor, Health and Human Services, and the Treasury released a proposed rule that, if finalized, would expand access to contraceptive coverage without cost sharing under the Affordable Care Act’s(ACA) preventive care mandate. Notably, the proposed rule would require most health plans and health insurance issuers to cover over-the-counter (OTC)contraceptives without imposing cost sharing (e.g., deductibles, copayments or coinsurance) or requiring a prescription. For more Info, Click the Link below! https://lnkd.in/g8j7eceN

🎯🏥Congress takes aim at Brazilian health insurers Lawmakers from both the left and right called this week for a select committee to investigate Brazilian private health insurers, following reports that companies have unilaterally revoked thousands of insurance contracts with patients suffering from chronic conditions. Congresswoman Maria Rosas of the Republicans party — dominated by evangelical preachers — criticized federal private health regulator ANS during a House public hearing on Tuesday. She argued that the ANS has “clearly not done enough” and added that insurers have become too comfortable publicly admitting they canceled plans for financial reasons, which is illegal. Current legislation allows insurers to revoke individual contracts only in cases of fraud or default, and collective contracts can only be revoked by the employer or under a previously agreed notice period. 🔗Read more in our full article by Cedê Silva here 👇 https://lnkd.in/dKzTxttB #Congress #Health #Brazil #Insurance

The Healthcare Justice Coalition, an organization which collaborates with providers to ensure fair payment from insurers, filed a lawsuit in Ohio state court on January 30th, 2024 against Aetna to pursue payment for services owed to ED physicians. Aetna attempted to remove the case based on three arguments: the No Surprises Act, ERISA, and diversity jurisdiction. However, the judge rejected all of Aetna's arguments and remanded the case back to Ohio state court. Key points from this case: • The court rejected Aetna's NSA interpretation, stating the NSA lays out an optional IDR process that defers to state law for payment disputes. (this decision is highly remarkable; while this was a position the plaintiff had maintained from the beginning, we have not seen any decisions with this level of clarity directly on point. • ERISA preemption was dismissed as irrelevant since claims were for payments to providers, not patients. • Aetna’s argument that Meritain, the health plan administrator, wasn’t an insurer was rejected, with the court concluding Meritain had obligations for the services provided. This allowed HJC to defeat diversity jurisdiction. This ruling is a battle won for emergency physicians in the war to hold big health insurance accountable. It is a reminder that deference to state law is achievable when pursuing this type of litigation. #HealthcareLitigation Allia Group

Agents, you've probably gathered this already, but it's interesting to put data to it: when asked, 28% of consumers and 47% of physicians blame #healthcare costs on #healthinsurance companies. Only 10% and 9% blame the hospitals themselves, respectively. But, according to the same study, its flat out untrue. The Health Affairs Scholar Report found that hospitals actually have a higher profit margin than health insurance companies. and the price increases in hospitals have risen more than those in health insurance. And, if you have read our other posts, they came to a similar conclusion as other studies: areas with more hospital mergers and consolidation have higher prices.

New Law Prohibits AI Use in Denying Healthcare Coverage California has enacted the Physicians Make Decisions Act (SB 1120), authored by Senator Josh Becker (D-Menlo Park). This law prohibits health insurance companies from using AI to deny healthcare coverage, ensuring that medical treatment decisions are made by licensed healthcare providers. Key points: - AI will no longer be used to deny, delay, or modify healthcare coverage. - Licensed physicians must review any care denial based on medical necessity. - This legislation aims to prevent errors in AI-driven denials and safeguard patient access to quality care. - California sets a precedent for responsible AI regulation in healthcare. #Healthcare #AI #medicalinsurance #insuranceindustry Benefits for Expats Inc | Insurance Consulting and Digital Marketing

The cost of living crisis is a real concern, and in healthcare we need to work together to find solutions. I recently re-read a report by the AMA, which provides their insights on this issue, however given it is strangely their report card on private health insurance I can't help but notice that the AMA hasn't attempted or considered a report to address the broad range of fees charged by surgeons and specialists. As someone who has worked in both public and private healthcare both as a clinician and manager, I find this finger-pointing disheartening. While insurers need to do better, we do at least publish what it costs to run our business and our premium figures very publicly. Can the same be said for medical professionals? Shouldn't consumers know the costs upfront before booking an appointment and be able to assess the value when choosing a specialist? Let's all work together to strengthen our healthcare system and focus on our own backyard before pointing fingers. We are in this together for the right reasons.

The Deadline for Submitting Gag Clause Attestation Is Dec. 31, 2024 Effective in 2020, the Consolidated Appropriations Act, 2021 (CAA) prohibits health plans and health insurance issuers from entering into contracts with health care providers, third-party administrators (TPAs) or other service providers that contain gag clauses (i.e., clauses restricting the plan or issuer from providing, accessing or sharing certain information about provider price and quality and de-identified claims). Plans and issuers must annually submit an attestation of compliance with the CAA’s gag clause prohibition to the Departments of Labor, Health and Human Services, and the Treasury (Departments). The first attestation was due on Dec. 31, 2023. The next attestation is due Dec. 31, 2024, covering the period since the last attestation. Click the Link for more Info! https://lnkd.in/gB37PvNQ

What Are the ICD-10-CM Official Guidelines for Coding and Reporting? The ICD-10-CM Official Guidelines for Coding and Reporting are a set of rules to supplement the official conventions and instructions provided within the ICD-10-CM. Conventions and instructions of the classification take precedence over the guidelines. The United States published the ICD-10-CM, a morbidity classification, for classifying diagnoses and the reason for visits in all healthcare settings. It is based on the World Health Organization’s (WHO’s) ICD-10, the statistical classification of disease. The ICD-10-CM guidelines are based on the coding and sequencing instructions in the Tabular List and Alphabetic Index of ICD-10-CM but provide additional instruction. The Health Insurance Portability and Accountability Act (HIPAA) requires that these guidelines be followed for all healthcare settings.