How Oversight of Insurance Companies can prevent Surprise Medical Bills

3 Sep 2017 Lifestyle, Medical

How Oversight of Insurance Companies can prevent Surprise Medical Bills

Surprise medical bills are one of the biggest problems that both patients and the physicians agree on. It is frustrating when you get an unexpected medical bill that will cost you up to thousands of dollars, yet you have health insurance. The surprise medical bills are usually a product of the doings of insurance companies. It is part of the business strategy insurance companies providing health insurance use to make them look more valuable.

A patient will purchase a health insurance package with the hope that it will help them pay for their medical care. But for insurance companies, it is a business. So what they do is that they create a sufficiently and irresistibly attractive plan, enroll policyholders then work around to ensure that the biggest chunk of the cash they receive stays with them instead of going to health care for the patients. Additionally, they will advertise and recommend specific physicians and medical facilities just to save more money. The end result is that the insurance companies end up benefiting while the patients are left having to bear the costs of their medical bills.

To get the burden of such bills off the back of patients, Bellaire ER advocates for the idea of oversight of insurance companies. This will help regulate the policies and actions of health insurance service providers to the benefit the patients. Most of the states, including Texas, have laws that require insurers to cater for the costs of non-contracted emergency health care and at the normal rates. The problem comes when you look at the guidelines. The guidelines that govern this law are not uniform, providing room to the insurance companies to determine their own rates. That is why you will find a good number of insurance companies having a payments percentage that is way lower than what the law stipulates. The result is the burden of surprise medical bills being created as the patients end up not receiving the full benefits they ought to receive from their health insurance provider.

Freestanding emergency rooms have been a popular target for health insurance companies. The model of freestanding emergency rooms is quite an innovative one and provides better access to emergency care for patients more effectively and efficiently. But they have been accused of misleading patients and lacking transparency; as per the narrative that insurance companies have. They use this as their basis for processing freestanding emergency center claims. As per the law in Texas, FECs are recognized as essential and are supposed to be processed at the same level as in-network benefit or the normal customary level. However, insurance providers use their “lack of transparency” excuse and the lack of clear guidelines in the law to charge out-of-network rates for freestanding emergency center claims. They end up denying the patient’s coverage access yet they are paying their insurance rates. The result is higher patient responsibility in the form of the surprise bills.

In a move deemed as a step towards the right direction for Texas, the Texas Association of Freestanding Emergency Centers passed a resolution that calls for the Texas Department of Insurance and the Texas Legislative arm to increase and improve data collection with regards to health insurance payment. With this data, it will be much easier for both the patients and the insurance providers to be certain as to what constitutes the customary reimbursement for Texas emergency room procedures. This is part of the efforts that are being made to improve the oversight and the transparency of health insurance companies and the health insurance industry in general.

Data from the Texas Department of Insurance clearly shows that there has been systematic attempts by a good number of insurance companies to slash the payments slated for freestanding emergency centers and have the costs channeled to their patients instead. In fact, some of these insurance companies go as far as keeping the freestanding emergency centers in the out-of-network category intentionally just to ensure that they pay the least amount possible in healthcare claims. This is a chronic practice that can only be stopped with increased oversight of these health insurance service providers to ensure that they are fair to their customers.

This behavior is becoming increasingly rampant and more people are not realizing the benefits of having a health insurance cover. To turn the tables in favor of the patients and against the “greedy” profit approach that insurance companies are employing, the legislative arm of the Texas Government should make it a priority to establish the appropriate laws and clear guidelines to regulate health insurance companies. They should come up with clear standards that are easily enforceable for reimbursements rates that can hold health plans accountable. The main goal is ensuring that all citizens get easy, affordable and reliable access to quality health care. A clear oversight of insurance companies will go a long way in ensuring the realization of this goal.

What is The Texas Association of Freestanding Emergency Centers (TAFEC)?

What is The Texas Association of Freestanding Emergency Centers (TAFEC)?

Freestanding Emergency Centers are a relatively new concept in Texas, having been established in 2009. This form of healthcare differs from other healthcare providers due the type and quality of healthcare offered. There are many freestanding emergency centers spread all over Texas. To maintain high quality standards and present a unified voice, the freestanding emergency centers formed the Texas Association of Freestanding Emergency Centers (TAFEC). Bellaire ER explores the formation and functions of TAFEC.

Formation

The freestanding emergency care industry was established in 2009 under House Bill 1357. However, there were few freestanding ERs in Texas that operated individually before the bill was passed. Each of these ERs set their own regulations about operating times and the quality of care.
After the recognition of the freestanding ERs by law, there was a need to standardize their practices. It is due to this need that TAFEC was formed. The association became the first statewide representation for FECs in the United States.

Aim

TAFEC looks to provide a unified voice from the freestanding emergency centers. This way, the industry can present its views clearly and have a central point of representation. This unification helps the industry pay an important role during the creation of laws and regulations affecting the freestanding emergency centers.

TAFEC is also involved in creating awareness on freestanding emergency centers all over Texas. Through their awareness mandate, TAFEC aims to inform residents about the benefits of FECs and how to use them.

TAFEC also helps to maintain high quality standards for all its members. This includes high quality service to patients in minimum wait times.

Advocacy

TAFEC has been involved in many advocacy roles to create fair regulation for the FEC industry.
Health insurance transparency is one of the items under TAFEC’s legislative agenda. TAFEC is pushing for legislation that will require insurance companies to be transparent about how they calculate the rates paid to out-of-network healthcare providers.

The problem of surprise medical costs has plagued consumers who visit FECs. People are often presented with huge medical bills especially when they visit out-of-network FECs. This is because some insurance companies only cover a small portion of the bill and thus the patient is left to cater for the rest out-of-pocket.

With a transparent calculation mechanism, the insurers will have to be consistent in their payments to healthcare providers and the law can institute penalties for any insurance company that underpays.

Keeping in its role to provide fair regulation in the industry, TAFEC is looking to eliminate surprise medical bills through legislation. They hope to create a law that standardizes the reimbursement rates from the insurance providers. This way, patients will not be presented with surprise medical bills as they’ll already know how much their insurance covers.

Apart from the transparency of insurance companies, TAFEC also aims to promote the transparency of FECs. FECs in Texas were plagued with the problem of people confusing them with urgent care centers. This led to the passage of the Senate Bill 425 that mandated FECs to provide clear signage and information on the difference in cost and quality of care between them and urgent care centers.

The bill requires the FECs to post notices that inform patients that the facility is a freestanding emergency center and that billing is similar to a hospital based emergency center. The notices also inform the patients that their medical insurer might not cover their costs and that the physician attending to them might bill separately from the hospital.

These notices have to be placed in areas where they are clearly visible such as the entrances, treatment rooms, payment locations, and on the FECs website.

The bill helped to reduce complaints by patients who were met with surprise bills to the Texas Department of State Health Services.

In keeping with the need for transparency, TAFEC also has a section on its website that informs patients on which healthcare facility can serve them best. The section primarily aims to distinguish between urgent care and emergency centers. Illnesses and injuries such as flu symptoms, sprains, cuts, and allergies are best treated at an urgent care. Emergency rooms should be accessed for true emergencies such as heart attacks, stroke, chest pain, and severe burns.

TAFEC also has a lot of materials on other subjects such as FEC billing and Texas medical statutes. All this information is meant to help patients make the right decision when visiting a healthcare center. It also helps them access quality healthcare in times of an emergency since they know that that the insurers are supposed to pay for the emergency services at in-network rates.

Membership

TAFEC has 30 members who run 220 FECs across Texas. The FECs are located in more than 100 communities all over Texas. All the facilities operated by each member have to join if the parent company decides to join the association. These facilities also have to pay separate dues.

How to Not Go Nuts by Eating Nuts Cashews for Depression, Anxiety, and General Health

Want to know how not to go nuts by eating nuts? Pun intended… well then, you will need to eat lots and lots of cashew nuts. Yes! This sounds pretty weird but it is true. Cashew nuts are essential when it comes to maintaining good mental health and staying away from stress and anxiety. At a time when depression, anxiety and panic attacks are accounting for a very big percentage of the emergency room visits in America, the cashew nuts revelation comes as a very big reprieve to many. So, why are cashew nuts regarded as important foods for good mental and general health? We want to take a deeper look at the brief history of cashew nuts, where they come from and why they are very good for you mental health.

History of Cashew Nuts

Cashews are native to Brazil, like the Brazil nut. Cashews were given their botanical name because they are heart-shaped. Both the Spanish and the Italian name for cashews include the root for the heart. The cashew tree belongs to the same family as the pistachio and is as a fast-growing, evergreen perennial. It loves the tropics and in tropical heat can grow to heights of forty or fifty feet.

 The cashew fruit has two distinct parts: the fleshy pear-shaped stalk or stem known as the cashew-apple, two to four inches in length and the heart-shaped nut, the true fruit, about an inch in length that is attached to the lower end of the apple. The nut, like other nuts, contains the edible kernel. The “apple” is not only edible but also delicious and rich in Vitamin C, but it is practically unknown outside of regions where cashew trees grow, as are its products like cashew apple wine.

The nutritional value of Cashew nuts

Cashew nuts, besides helping people not go nuts, are very good for the body. Besides being deliciously creamy, it is very health and can substitute a number of foods from our daily diets and provide the body with the nourishment it offers. Cashew nuts can substitute foods such as eggs, butter cheese and even yogurt because of their high protein levels. Just like all nuts, they have essential fats, Vitamin B and magnesium which is helpful for the mental health as we will see later on. Here are some of the body parts which benefit from the nutrients coming from cashew nuts;

The Heart

Cashew nuts have fats but have no cholesterol. This makes them ideal for the heart and blood vessels. They have antioxidants as well which help with cleansing blood. The oleic acid contained in their sap is essential from the reduction of lipoprotein cholesterol in the body.

Weight Loss

Cashew nut are essential in weight loss as well and if you replace your love for junk with a craving for cashew nuts, you will be helping shed weight in your body. To be fair, cashew nuts just taste as good if not better than junk food. They are also high in protein and low in carbohydrates which helps manage your average weight.

Blood pressure

Cashews contain magnesium, which helps lower your blood pressure and prevent hypertension. They help with the reduction of systolic and diastolic blood pressure. This means that you will be safe from the diseases associated with blood pressure such as hypertension.

Gums and Teeth Cashews contain copper and magnesium which is essential for development and maintenance of skin, bones, connective tissue, and organs. Just like all the nuts, the minerals contained in cashew nuts are important for the proper development and growth of various body organs.

Disease Prevention Cashews are rich in antioxidants that fight off toxins and diseases like cancer. They help boost your body’s immunity and the riboflavin and niacin help cure some bacterial infections in the body.

So, now that we have seen the nutritional value of cashew nuts, let’s go back to our main point; depression, anxiety and general mental health. So what makes cashew nuts good for depression?

Why cashew nuts are good for depression?

Cashew nuts are good for mental health, because they have an abundance of the following elements;

1. Vitamin B
2. Magnesium
3. Tryptophan

Here is how these elements and vitamins are helpful in boosting one’s mental health and preventing depression;

Tryptophan

The amino acid tryptophan is critical in the uptake of serotonin in the brain. Serotonin is one of the precursors to the anti-depressant hormone. Low levels of serotonin in the bodies make you feel anxious, stressed and very moody.

Magnesium

Magnesium is critical in the proper development of organs in the bodies and the nervous system is one such beneficiary of the nourishing powers of Magnesium. It helps suppress anxiety and generally keeps one calm even during tough times.

Vitamin B6

Cashew nuts are rich in Vitamin B6 which increases the uptake of serotonin in the body. This helps keep your anxiety levels and depression down. Vitamin B6 also helps improve overall brain health.

So if you want to avoid going nuts, then eat as much cashew nuts as you can.

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