Provider Solutions

Change in Insurance Standards

The PPACA includes regulations that set standards for insurance companies, employers, and providers. Some are specified in the law, others are subsequently established by the Secretary of Health and Human Services. Among these new standards are a ban on the ability to drop policyholders if they become sick, a ban on price discrimination on the basis of pre-existing conditions or gender through a partial community rating, require providers to ensure the quality of care and reduction of errors through preventative care, as well as allowing children and dependents to remain on their parents' insurance plan until their 26th birthday.

Provider Resources

Obesity

Obesity is now considered a disease the CDC has related these conditions to obesity include:

• Heart disease
• Type 2 diabetes
• Cancers of the endometrium, breast and colon
• High cholesterol
• High blood pressure
• Stroke
• Liver and gallbladder disease
• Sleep apnea
• Osteoarthritis
• Gynecological issues such as abnormal menses and infertility

Obesity is a disease that currently plagues 69.7% of the total population of the United States of America. In the corporate environment known as “Corporate America”, Obesity is crippling 85% of the total population.
Research shows it costs about $1,400 more a year to treat an unhealthy individual as compared with a person at a healthy weight and composition. With all of the “new” changes in healthcare it is imperative to know and understand what is exactly included in your coverage and how to get the best help possible for achieving your wellness, health, and fitness goals today.

Under the Act

The bad news is, under the Act, companies are allowed to increase the surcharges to employees with medical conditions to 30 percent of their health insurance premiums for an average charge of about $1,620 per year.

In effect this allows companies to punish their employees for pre-existing conditions. Large increases in insurance premiums of up to $5,000 for a family of four which also results in un-insurance or switches to cheap but stingy high deductible insurance plans (with very high up-front payments of up to $12,000 before medical care is covered).

The good news is under the new health care law, employers offer a variety of different options to patients, from working with registered dietitians and health coaches to group sessions with a professional teaching lifestyle changes, to a hotline with a Professional Health Counselor who answers questions.

Plans vary widely in what they will do. Some insurers are offering telephone counseling, others cover visits with a health coach, and some cover group sessions that offer lifestyle advice. Under the health care law, plans can have doctors do the weight-loss counseling or "use medically appropriate" alternatives to meet the requirement. Insurance companies are also paying for memberships or offering discounts or reimbursements. Among those who are already obese, offer respectful long-term behavioral programs that reduce a few realistic pounds at a time, rather than fining those who fail to achieve what are nearly impossible goals.

Raising Standards in Care

365|Health offers all health and medical practitioners the opportunity to provide efficient on-site, in-home, and on-line health solutions for each patient. These evidence based programs improve patient safety and errors, improve patient health outcomes, prioritize reduced risk of critical diseases, and reduce the likelihood of hospital re-admissions.

Currently compliant to industry standard ICD-10 coding, 365|Health's integrated Solutions deliver all of the tools necessary to be effective within each required component of comprehensive healthcare. This enables health providers the ability to bridge the gap in care for any patient in demand of access to true health care.