Tag: health

  • Hospitals cry foul over latest Anthem fare…definitions change and definitely cause harm

    June 15, 2018

    Tags: , , , , , , , , , , ,

    Anthem has changed their policy regarding imaging performed in hospitals on an outpatient basis and will expand this into fourteen states.  Hospitals are not happy, nor amused and have filed suit.  Anthem stakes its claim on the idea of medical necessity, and hospitals are saying that doctors have the right to show necessity, not carriers.  And so the battle continues as carriers continue to try to dictate care but those who are responsible for care are not responsible for the payment.  No winners here…

    And as if that were not enough, Anthem has also begun pushing back on patients who visit the emergency room for ailments the carrier deems minor – called the “avoidable ER program” (as in avoiding payment).  While Anthem has lightened up on their procedures somewhat, they are refusing to pay some ER visits as non emergency (after the fact) which is not making patients and doctors particularly happy.  Stay tuned.

  • Independents may not be so depending on the interdependence of employment status

    June 11, 2018

    Tags: , , , , , , , , , , ,

    The California State Supreme Court, in the case of a suit against Dynamex Operations West, said simply that “when a worker has not independently decided to engage in an independently established business but instead is simply designated an independent contractor – there is a substantial risk that the hiring business is attempt to evade the demands of an applicable wage order through misclassification.” In short, to be independent they must be, you know, independent.  Businesses must show that the worker is free from the control and direction of the employer, perform work that is outside the hirer’s core business and customarily engage in an independently established trade, occupation or business

    On April 30, 2018 the California Supreme Court determined that California employers must always start with the presumption that a worker is a common law employee.  They may classify them as independent ONLY IF ALL of these criteria are being met:

    Worker is free from control and direction in connection with the performance of the work

    The worker performs work that is outside the usual course of the hiring entity’s business

    Worker customarily engaged in independently established trade, occupation or business

    This gives common sense to what the Department of Labor has long used as their “twenty questions” to determine the independence of an independent contractor.  The only question remaining now is that, if the DOL finds an employer responsible for an “employee” who may have previously been misclassified, if all rights and benefits that apply will be made retroactively

  • Always ask the real price before you pay…prescription drugs need a prescription for action

    June 6, 2018

    Tags: , , , , , , , , , , ,

    This should be apparent, but apparently it isn’t.  Sometimes prescription drugs, so often dispensed as generics, have a lower price than the copayment stated on the benefit card.  A new study, however, shows that consumers aren’t asking, thus not only paying a higher amount than necessary, but this amount is then “clawed back” by the Pharmacy Benefit Manager (no, the pharmacy does not keep the difference, nor does the insurance carrier) which acts as a middleman between the carrier and the consumer.  During a study period comprising the first half of 2013, a USC study found that overpayments totaled $135 million.  A good example – hydrocodone acetaminophen (that would normally be called “Vicodin”) was prescribed 120,000 times and there was an average overcharge of $6.94.  It is not just generics, moreover.  The brand name drugs of longer standing also often fall under the brand name co payment (Ambien was cited as the most egregious example)  So next time, don’t just reach for the card…

  • Opioids in America | CA Benefit Brokers

    June 5, 2018

    Tags: , , , , , , , , , , , , ,

    Lately, there’s been a big focus on America’s opioid addiction in the news. Whether it’s news on the abuse of the drug or it’s information sharing on how the drug works, Americans are talking about this subject regularly. We want to help educate you on this hot topic.

    Opioids are made from the opium poppy plant.  Opium has been around since 3,400 BC and it was first referenced as being cultivated in Southwest Asia. The drug traveled the Silk Road from the Mediterranean to Asia to China. Since then, the drug has gained popularity for pain relief but it also has gained notoriety as an abused drug. Morphine, Codeine, and Heroin are all derived from the opium poppy and are all highly addictive drugs that are abused all around the world. As the demand for these drugs has increased, so has the production.  From 2016 to 2017, the area under opium poppy cultivation in Afghanistan increased by 63 percent. In 2016, it killed some 64,000 Americans, more than double the number in 2005.

    We can see that the danger from this drug is growing rapidly. What can we do to recognize potential abuse problems and to get help? Here are some facts about opioid addiction:

    • How do they work? Opioids attach to pain receptors in your brain, spinal cord, and other areas that recognize pain signals. As they attach to the receptors, it reduces the sending of pain messages to the brain and therefore reduces the feelings of pain in your body.
    • Short-acting opiates are typically prescribed for injuries and only for a few days. They take 15-30 minutes for pain relief to begin and this relief lasts for 3-4 hours. Long-acting opiates are prescribed for moderate to severe pain and are used over a long period of time. Relief typically lasts for 8-12 hours and can be used alongside a short-acting drug for breakthrough pain.
    • Dependence is common with long-term use of an opiate. This means that the patient needs to take more of and higher doses of the medicine to get the same pain relieving effect. This does not necessarily mean the patient is addicted. Addiction is the abuse of the drug by taking it in an unprescribed way—like crushing tablets or using intravenously.
    • Americans account for less than 5% of the world’s population, but take 80% of the world’s opioid About 5% of the people who take opiates become addicted to the drug.
    • Help is available through many channels from private recovery centers to insurance providers. The Substance Abuse and Mental Health Services Administration helpline is 1-800-662-HELP. This line is confidential, free, and available 24-hours a day and 7 days a week. Family and friends may also call this number for resources for help. Additional resources can be found at drugabuse.com.

    Make sure you are educated about the dangers of opioid abuse. But, don’t be discouraged and think that the abuse is incurable! There are many resources that can be used to break the addiction cycle and can make real change in the lives of its victims. Ask for help and offer help.

     

  • Are retirees given any guarantees? The issue keeps going back and forth

    June 4, 2018

    Tags: , , , , , , , , , , ,

    The Supreme Court has once again found that retiree benefits are not vested.  So the employer can promise but…     Actually, the Court simply clarified the need for clarity.  In the absence of specific language that vests retiree health benefits, the retirees may no longer assume that silence or ambiguity allows a lifetime contract.  Instead, the contract itself must state the case.  Seems simple, but this has been kicking around, even though the Supreme Court said the same thing in 2015.  Now it will show the unions that what they want needs to be negotiated and then put in writing (we will call this the “common sense” doctrine)

  • The new normal – see our White Paper – everyone is buying everyone – can we buy their act?

    May 31, 2018

    Tags: , , , , , , , , , , ,

    Walmart is in preliminary talks to buy and partner with Humana

    CIGNA is buying Express Scripts

    CVS bought Aetna

    And the list goes on…

  • Don’t worry…we’re going to fix it now

    April 20, 2018

    Tags: , , , , , , , , , , , , , ,

    Well, now the concerns are over.  Jamie Dimon JP Morgan, Jeff Bezos from Amazon and Warren Buffet from Berkshire Hathaway have all teamed up to solve our nation’s health care problems.  There are no details at this point, of course, but they say they plan to hold down costs by bringing “their scale and complementary expertise to this long term effort”  They will create an independent company “free from profit making incentives and constraints” to focus on technology solutions”  This is great, except for the fact that technology is only one part of the problem (but definitely worth fixing) and that the scale these companies bring will really only benefit a narrow slice of consumers – their companies.  By the way, Steve Case of AOL tried this years ago and failed miserably, but who remembers Steve Case any more?

  • Learn all about Medical Savings Accounts! | CA Benefit Brokers

    March 23, 2018

    Tags: , , , , , , , , , , , , , ,

    Take control of your health care expenses and save money in 2018!

     

  • 6 Ways to Keep the Flu from Sidelining Your Workplace | CA Employee Benefit Brokers

    March 2, 2018

    Tags: , , , , , , , , , , , , , ,

    This year’s flu season is a rough one. Although the predominant strains of this year’s influenza viruses were represented in the vaccine, they mutated, which decreased the effectiveness of the immunization. The flu then spread widely and quickly, and in addition, the symptoms were severe and deadly. The U.S. Centers for Disease Control and Prevention (CDC) reported that the 2017 – 2018 flu season established new records for the percentage of outpatient visits related to flu symptoms and number of flu hospitalizations.

    Younger, healthy adults were hit harder than is typical, which had impacts on the workplace. In fact, Challenger, Gray & Christmas, Inc. recently revised its estimates on the impact of this flu season on employers, raising the cost of lost productivity to over $21 billion, with roughly 25 million workers falling ill.

    Fortunately, the CDC is reporting that it looks like this season is starting to peak, and while rates of infection are still high in most of the country, they are no longer rising and should start to drop. What can you do as an employer to keep your business running smoothly for the rest of this flu season and throughout the next one?

    1. Help sick employees stay home. Consider that sick employees worried about their pay, unfinished projects and deadlines, or compliance with the company attendance policy may feel they need to come to work even if they are sick. Do what you can to be compassionate and encourage them to stay home so they can get better as well as protect their co-workers from infection. In addition, make sure your sick leave policies are compliant with all local and state laws, and communicate them to your employees. Be clear with the expectation that sick employees not to report to work. For employees who feel well enough to work but may still be contagious, encourage them to work remotely if their job duties will allow. Be consistent in your application of your attendance and remote work rules.
    2. Know the law. Although the flu is generally not serious enough to require leaves of absence beyond what sick leave or PTO allow for, in a severe season, employees may need additional time off. Consider how the federal Family and Medical Leave Act (FMLA), state leave laws, and the Americans with Disabilities Act (ADA) may come into play for employees who have severe cases of the flu, complications, or family members who need care.
    3. Be flexible. During acute flu outbreaks, schools or daycare facilities may close, leaving parents without childcare. Employees may also need to be away from the workplace to provide care to sick children, partners, or parents. Examine your policies to see where you can provide flexibility. Look for opportunities to cross-train employees on each other’s essential duties so their work can continue while they are out.
    4. Keep it clean. Direct cleaning crews to thoroughly disinfect high-touch areas such as doorknobs, kitchen areas, and bathrooms nightly. Provide hand sanitizer in common areas and encourage frequent handwashing. Keep disinfecting wipes handy for staff to clean their personal work areas with.
    5. Limit exposure. Avoid non-essential in-person meetings and travel that can expose employees to the flu virus. Rely on technology such as video conferencing, Slack, Skype, or other platforms to bring people together virtually. Consider staggering work shifts if possible to limit the number of people in the workplace at one time.
    6. Focus on wellness. Offer free or low-cost flu shots in the workplace. If your company provides snacks or meals for employees, offer healthier options packed with nutrients.

    Get it all

    AGENCY RESOURCES: Get the latest weekly flu stats from the CDC. Learn more about how the FMLA and ADA may be used during pandemic flu from the U.S. Department of Labor.

    By Rachel Sobel

    Originally posted by www.ThinkHR.com

  • Hospitals cry foul over latest Anthem fare…definitions change and definitely cause harm

    June 15, 2018

    Tags: , , , , , , , , , , ,

    Anthem has changed their policy regarding imaging performed in hospitals on an outpatient basis and will expand this into fourteen states.  Hospitals are not happy, nor amused and have filed suit.  Anthem stakes its claim on the idea of medical necessity, and hospitals are saying that doctors have the right to show necessity, not carriers.  And so the battle continues as carriers continue to try to dictate care but those who are responsible for care are not responsible for the payment.  No winners here…

    And as if that were not enough, Anthem has also begun pushing back on patients who visit the emergency room for ailments the carrier deems minor – called the “avoidable ER program” (as in avoiding payment).  While Anthem has lightened up on their procedures somewhat, they are refusing to pay some ER visits as non emergency (after the fact) which is not making patients and doctors particularly happy.  Stay tuned.

  • Independents may not be so depending on the interdependence of employment status

    June 11, 2018

    Tags: , , , , , , , , , , ,

    The California State Supreme Court, in the case of a suit against Dynamex Operations West, said simply that “when a worker has not independently decided to engage in an independently established business but instead is simply designated an independent contractor – there is a substantial risk that the hiring business is attempt to evade the demands of an applicable wage order through misclassification.” In short, to be independent they must be, you know, independent.  Businesses must show that the worker is free from the control and direction of the employer, perform work that is outside the hirer’s core business and customarily engage in an independently established trade, occupation or business

    On April 30, 2018 the California Supreme Court determined that California employers must always start with the presumption that a worker is a common law employee.  They may classify them as independent ONLY IF ALL of these criteria are being met:

    Worker is free from control and direction in connection with the performance of the work

    The worker performs work that is outside the usual course of the hiring entity’s business

    Worker customarily engaged in independently established trade, occupation or business

    This gives common sense to what the Department of Labor has long used as their “twenty questions” to determine the independence of an independent contractor.  The only question remaining now is that, if the DOL finds an employer responsible for an “employee” who may have previously been misclassified, if all rights and benefits that apply will be made retroactively

  • Always ask the real price before you pay…prescription drugs need a prescription for action

    June 6, 2018

    Tags: , , , , , , , , , , ,

    This should be apparent, but apparently it isn’t.  Sometimes prescription drugs, so often dispensed as generics, have a lower price than the copayment stated on the benefit card.  A new study, however, shows that consumers aren’t asking, thus not only paying a higher amount than necessary, but this amount is then “clawed back” by the Pharmacy Benefit Manager (no, the pharmacy does not keep the difference, nor does the insurance carrier) which acts as a middleman between the carrier and the consumer.  During a study period comprising the first half of 2013, a USC study found that overpayments totaled $135 million.  A good example – hydrocodone acetaminophen (that would normally be called “Vicodin”) was prescribed 120,000 times and there was an average overcharge of $6.94.  It is not just generics, moreover.  The brand name drugs of longer standing also often fall under the brand name co payment (Ambien was cited as the most egregious example)  So next time, don’t just reach for the card…

  • Opioids in America | CA Benefit Brokers

    June 5, 2018

    Tags: , , , , , , , , , , , , ,

    Lately, there’s been a big focus on America’s opioid addiction in the news. Whether it’s news on the abuse of the drug or it’s information sharing on how the drug works, Americans are talking about this subject regularly. We want to help educate you on this hot topic.

    Opioids are made from the opium poppy plant.  Opium has been around since 3,400 BC and it was first referenced as being cultivated in Southwest Asia. The drug traveled the Silk Road from the Mediterranean to Asia to China. Since then, the drug has gained popularity for pain relief but it also has gained notoriety as an abused drug. Morphine, Codeine, and Heroin are all derived from the opium poppy and are all highly addictive drugs that are abused all around the world. As the demand for these drugs has increased, so has the production.  From 2016 to 2017, the area under opium poppy cultivation in Afghanistan increased by 63 percent. In 2016, it killed some 64,000 Americans, more than double the number in 2005.

    We can see that the danger from this drug is growing rapidly. What can we do to recognize potential abuse problems and to get help? Here are some facts about opioid addiction:

    • How do they work? Opioids attach to pain receptors in your brain, spinal cord, and other areas that recognize pain signals. As they attach to the receptors, it reduces the sending of pain messages to the brain and therefore reduces the feelings of pain in your body.
    • Short-acting opiates are typically prescribed for injuries and only for a few days. They take 15-30 minutes for pain relief to begin and this relief lasts for 3-4 hours. Long-acting opiates are prescribed for moderate to severe pain and are used over a long period of time. Relief typically lasts for 8-12 hours and can be used alongside a short-acting drug for breakthrough pain.
    • Dependence is common with long-term use of an opiate. This means that the patient needs to take more of and higher doses of the medicine to get the same pain relieving effect. This does not necessarily mean the patient is addicted. Addiction is the abuse of the drug by taking it in an unprescribed way—like crushing tablets or using intravenously.
    • Americans account for less than 5% of the world’s population, but take 80% of the world’s opioid About 5% of the people who take opiates become addicted to the drug.
    • Help is available through many channels from private recovery centers to insurance providers. The Substance Abuse and Mental Health Services Administration helpline is 1-800-662-HELP. This line is confidential, free, and available 24-hours a day and 7 days a week. Family and friends may also call this number for resources for help. Additional resources can be found at drugabuse.com.

    Make sure you are educated about the dangers of opioid abuse. But, don’t be discouraged and think that the abuse is incurable! There are many resources that can be used to break the addiction cycle and can make real change in the lives of its victims. Ask for help and offer help.

     

  • Are retirees given any guarantees? The issue keeps going back and forth

    June 4, 2018

    Tags: , , , , , , , , , , ,

    The Supreme Court has once again found that retiree benefits are not vested.  So the employer can promise but…     Actually, the Court simply clarified the need for clarity.  In the absence of specific language that vests retiree health benefits, the retirees may no longer assume that silence or ambiguity allows a lifetime contract.  Instead, the contract itself must state the case.  Seems simple, but this has been kicking around, even though the Supreme Court said the same thing in 2015.  Now it will show the unions that what they want needs to be negotiated and then put in writing (we will call this the “common sense” doctrine)

  • The new normal – see our White Paper – everyone is buying everyone – can we buy their act?

    May 31, 2018

    Tags: , , , , , , , , , , ,

    Walmart is in preliminary talks to buy and partner with Humana

    CIGNA is buying Express Scripts

    CVS bought Aetna

    And the list goes on…

  • Don’t worry…we’re going to fix it now

    April 20, 2018

    Tags: , , , , , , , , , , , , , ,

    Well, now the concerns are over.  Jamie Dimon JP Morgan, Jeff Bezos from Amazon and Warren Buffet from Berkshire Hathaway have all teamed up to solve our nation’s health care problems.  There are no details at this point, of course, but they say they plan to hold down costs by bringing “their scale and complementary expertise to this long term effort”  They will create an independent company “free from profit making incentives and constraints” to focus on technology solutions”  This is great, except for the fact that technology is only one part of the problem (but definitely worth fixing) and that the scale these companies bring will really only benefit a narrow slice of consumers – their companies.  By the way, Steve Case of AOL tried this years ago and failed miserably, but who remembers Steve Case any more?

  • Learn all about Medical Savings Accounts! | CA Benefit Brokers

    March 23, 2018

    Tags: , , , , , , , , , , , , , ,

    Take control of your health care expenses and save money in 2018!

     

  • 6 Ways to Keep the Flu from Sidelining Your Workplace | CA Employee Benefit Brokers

    March 2, 2018

    Tags: , , , , , , , , , , , , , ,

    This year’s flu season is a rough one. Although the predominant strains of this year’s influenza viruses were represented in the vaccine, they mutated, which decreased the effectiveness of the immunization. The flu then spread widely and quickly, and in addition, the symptoms were severe and deadly. The U.S. Centers for Disease Control and Prevention (CDC) reported that the 2017 – 2018 flu season established new records for the percentage of outpatient visits related to flu symptoms and number of flu hospitalizations.

    Younger, healthy adults were hit harder than is typical, which had impacts on the workplace. In fact, Challenger, Gray & Christmas, Inc. recently revised its estimates on the impact of this flu season on employers, raising the cost of lost productivity to over $21 billion, with roughly 25 million workers falling ill.

    Fortunately, the CDC is reporting that it looks like this season is starting to peak, and while rates of infection are still high in most of the country, they are no longer rising and should start to drop. What can you do as an employer to keep your business running smoothly for the rest of this flu season and throughout the next one?

    1. Help sick employees stay home. Consider that sick employees worried about their pay, unfinished projects and deadlines, or compliance with the company attendance policy may feel they need to come to work even if they are sick. Do what you can to be compassionate and encourage them to stay home so they can get better as well as protect their co-workers from infection. In addition, make sure your sick leave policies are compliant with all local and state laws, and communicate them to your employees. Be clear with the expectation that sick employees not to report to work. For employees who feel well enough to work but may still be contagious, encourage them to work remotely if their job duties will allow. Be consistent in your application of your attendance and remote work rules.
    2. Know the law. Although the flu is generally not serious enough to require leaves of absence beyond what sick leave or PTO allow for, in a severe season, employees may need additional time off. Consider how the federal Family and Medical Leave Act (FMLA), state leave laws, and the Americans with Disabilities Act (ADA) may come into play for employees who have severe cases of the flu, complications, or family members who need care.
    3. Be flexible. During acute flu outbreaks, schools or daycare facilities may close, leaving parents without childcare. Employees may also need to be away from the workplace to provide care to sick children, partners, or parents. Examine your policies to see where you can provide flexibility. Look for opportunities to cross-train employees on each other’s essential duties so their work can continue while they are out.
    4. Keep it clean. Direct cleaning crews to thoroughly disinfect high-touch areas such as doorknobs, kitchen areas, and bathrooms nightly. Provide hand sanitizer in common areas and encourage frequent handwashing. Keep disinfecting wipes handy for staff to clean their personal work areas with.
    5. Limit exposure. Avoid non-essential in-person meetings and travel that can expose employees to the flu virus. Rely on technology such as video conferencing, Slack, Skype, or other platforms to bring people together virtually. Consider staggering work shifts if possible to limit the number of people in the workplace at one time.
    6. Focus on wellness. Offer free or low-cost flu shots in the workplace. If your company provides snacks or meals for employees, offer healthier options packed with nutrients.

    Get it all

    AGENCY RESOURCES: Get the latest weekly flu stats from the CDC. Learn more about how the FMLA and ADA may be used during pandemic flu from the U.S. Department of Labor.

    By Rachel Sobel

    Originally posted by www.ThinkHR.com

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