Insurers

health

MDSAVE ECOMMERCE TOOL HELPS INSURERS MEET NEW FEDERAL “TRANSPARENCY IN COVERAGE” REGULATIONS

The October 29, 2020 Federal Rule requires that insurers offer patients a tool to research their financial responsibility and both in-network and out-of-network negotiated rates. The MDsave tool, available now, enables 24/7, consumer-friendly price research and allows patients to purchase their care upfront without fear of surprise bills.

BRENTWOOD, Tenn., Oct. 30, 2020 (GLOBE NEWSWIRE) — MDsave, the leading health technology company in transparent, shoppable medical care, announces its ecommerce solution to help insurers meet new transparency requirements issued in an October 29th Final Rule. The Rule, issued jointly by the Departments of Health and Human Services, Labor, and the Treasury, mandates the creation of “an internet-based, self-service tool” that provides “personalized out-of-pocket cost information, and the underlying negotiated rates, for all covered health care items and services,” according to the Transparency in Coverage Final Rule Fact Sheet.

The MDsave transparency tool provides a user-friendly, ecommerce interface that allows patients to instantly purchase a procedure of their choice directly from the website, in addition to enabling personalized cost searches for the required 500 shoppable services and hosting machine-readable files containing all negotiated charges. 

Because each procedure on the MDsave platform includes the most commonly related services and their fees, patients can pay for the entire episode of care upfront without fear of surprise bills.

“Our ecommerce transparency platform is already being implemented for hospitals meeting the January 1, 2021 transparency deadline, so the technology is ready for insurers who want to provide a great patient experience but don’t want to build a tool from the ground up,” explains Greg Born, MDsave President and COO. “We have the platform, the searchability and the transaction capability. All insurers need to provide is the data.”

Insurers must launch their online self-service transparency tools for plan years starting January 1, 2023 for the federally specified 500 shoppable services and plan years starting January 1, 2024 for any remaining services or items.

To learn more, visit MDsave.com/price-transparency. 

About MDsave

Co-located in Brentwood, Tenn. and San Francisco, Calif., MDsave is the world’s first online healthcare marketplace, bringing together patients seeking affordable, reliable care with providers offering high-quality services at fair prices. Using cutting-edge technology, MDsave simplifies the healthcare billing process for patients and providers alike through negotiated rates, bundled pricing and upfront payment. The MDsave marketplace also helps employers and payers offer more value to employees and policyholders with out-of-pocket deductible costs. For more information, visit http://www.mdsave.com.

CONTACT: Kate Steurer MDsave 615-814-6260 [email protected]

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health

White House to Require Insurers to Post Negotiated Prices for Medical Care

Private insurers must publish the prices they have negotiated with providers under a Trump administration rule aimed at lowering health-care spending by giving consumers more information about their out-of-pocket charges.

The rule completed Thursday calls for gradually increasing the requirements. Private insurers will have to post the negotiated prices for 500 “shoppable” services in 2023, with the mandate extended to all services by 2024.

The action comes in the final days of President Trump’s re-election campaign and after Democratic challenger Joe Biden has criticized him for backing a lawsuit to invalidate the Affordable Care Act, which could result in about 20 million Americans losing health coverage.

With health care among the top issues for voters, the president has made price transparency a key part of his message on the subject. His administration also issued a rule Wednesday to ensure seniors on Medicare get any possible coronavirus vaccine administered at no cost.

Insurers and hospitals have criticized the White House initiatives as too expensive and burdensome and of little use to consumers they say are unlikely to shop around based on negotiated rates. A federal judge in June ruled against hospitals that had sued to block a similar rule compelling them to negotiate their rates with insurers. The case is now with the U.S. Court of Appeals for the District of Columbia.

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health

When are Medicare secondary payers? Insurers, claims, rules, and more

Medicare beneficiaries do not have to rely exclusively on Medicare for their healthcare coverage. People can use other insurance plans to allow them access to more services and lower their healthcare spending.

If someone has two different forms of coverage, the primary payer covers most costs, and the secondary payer then steps in to cover some or all remaining expenses.

With Medicare, secondary payers contribute to copayments and coinsurance. Usually, Medicare is the primary payer, although sometimes it can act as the secondary payer.

This article looks at Medicare as a secondary payer and how it works with other insurers. It also discusses the benefits of having two insurers and who pays first. It then looks at how the claims process works with both primary and secondary payers.

We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:

  • Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
  • Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
  • Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.

A person can choose to have more than one insurance plan to cover their healthcare costs and Medicare works with other insurance providers to give people comprehensive coverage.

Each insurance pays their share of the healthcare service or products that someone receives.

Medicare secondary payer (MSP) means that another insurer pays for healthcare services first, making them the primary payer.

The secondary payer covers some or all of the remaining costs that the primary payer leaves unpaid.

When someone has two insurers, they benefit from broader healthcare coverage. Each insurer could cover services that the other does not, such as dental care, eye examinations, or alternative health therapies.

As an example, a primary insurer may offer prescription drug coverage, meaning that a person with original Medicare would not need a separate Medicare Part D plan or a Medicare Advantage plan that includes prescription drug coverage. This could lower a person’s overall healthcare costs.

If someone needs to stay in a hospital or a nursing facility for a long time, they may find it beneficial to have two insurers. For example, an individual’s primary insurer would pay up to their limits, and Medicare Part A benefits would kick in much later, extending the coverage period.

Having two insurance plans could mean a person has two monthly premiums. For most Medicare beneficiaries, this means they have the standard Part B premium, plus the premium for the primary insurer.

Careful consideration of the overall costs could mean a person’s expenses increase or decrease with a secondary insurance plan, but since a secondary payer could cover most out-of-pocket expenses, a person may find they save money despite paying two premiums.

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