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It is time for the 34th annual SIIA National Educational Conference and Expo. As in years past, Complete Health Systems will be exhibiting at the show, which will be held on October 5 - 7, 2014 in Phoenix, AZ.

Be sure to stop by booth #500, so we can show you how CHS can help improve how you manage self-insured programs.


By: Nicola Heredia, CHS Marketing Coordinator

When the Affordable Care Act was first presented to the public, one of the key components was that Americans would no longer be denied health insurance coverage due to preexisting conditions. Insurance companies would no longer be able to treat those with chronic illnesses and expensive diseases different than others.

“Health plans now guarantee coverage for individuals and families regardless of health status,” said Clare Krusing, a spokesperson for American’s Health Insurance Plans.

Although the law has worked to make insurance more accessible and affordable for individuals, there are still tactics insurance companies are using to try to deter potentially expensive customers from signing up for coverage.

Insurance plans will have a smaller network to limit what doctors and specialists can be seen under the plan. Companies have also excluded prestigious hospitals that specialize in cancer treatment, for example, to discourage cancer patients from signing up for the plan.

“It’s the same insurance companies that are up to the same strategies,” said Jerry Flanagan, an attorney with Consumer Watchdog, in a Desert News article. “Take in as much premium as possible and pay out as little as possible.

While insurance plans may not be legally allowed to deny coverage, providers can still deny medical claims submitted. Although the insurance plan member is covered, it does not guarantee that all medical visits and procedures will be covered under the terms of their plan agreement.

“If a patient’s got insurance and their claim has been denied, they shouldn’t take that as the final decision, especially now under the Affordable Health Care Act,” said Mark Rukavina, principal at Community Health Advisors LLC in a Dallas News article.

The same law that requires insurance plans to be offered to everyone also allows participants to appeal the decision of the insurance company on whether the medical bill will be covered. In fact, when the insurance company denies the claim, they must provide a reason and instructions on how to submit an appeal along with a deadline.

According to an AP Business article, experts say that patients have a 50 percent chance or higher that the insurance company’s decision will be reversed when evidence is supplied to nullify the claim rejection. Be sure to research and seek outside help, if needed, to make sure the appeal is detailed and includes accurate information.

“Try, if at all possible, to avoid the denial,” said Martin Rosen, co-founder of Health Advocate. “There are plenty of things that consumers can do to avoid a denial, starting out with understanding and following the directions and the descriptions of the health plans.”

An article on highlighted five reasons why insurance companies deny claims. Identifying these reasons can help patients avoid denials in the future, in addition to appealing the rejections.

Here are the most common reasons why insurance companies reject medical claims according to that article.

  • Non-coverage charges, which are outlined in the clinical policy guidelines
  • Lack of referral from the primary doctor
  • Out-of-network care for physicians
  • Errors in birthday, social security, etc.
  • Wrong insurance company has been billed

Claim denials can be avoided by being aware of what exactly the insurance plan covers.  Examining the coverage should be done prior to selecting a health insurance plan to ensure the plan will be suitable to each individual’s needs. This is certainly a case where reading the fine print is a requirement.


By: Nicola Heredia, CHS Marketing Coordinator

Paying a visit to the doctor can involve long distances and even more time spent in the waiting room then with the doctor. The process of going to the doctor can sometimes deter patients from receiving medical care. The introduction of telemedicine has created a new avenue to communicate with physicians.

According to the American Telemedicine Organization, telemedicine allows medical information to be exchanged from one site to another through electronic means. Communication methods can include two-way video, email, smart phone applications and other technologies.

“The premise is that if you can put monitoring equipment in a patients’ homes and it gives them information on their disease, they’ll be more likely to know when their having problems and ward off returns to hospital,” said Carolyn Goodall, Home Care Director at Franciscan St. Margaret and St. Margaret Mercy hospitals’ in a NWI Times article.

The “virtual house call”, as it has come to be known, allow patients to remain in the comfort of their home, while still being able to follow-up with their doctor. There are various technologies and approaches that each physician uses, but overall the visits try to accomplish the same as an in-person appointment.

For patients with chronic diseases, virtual appointments have been helpful at managing their symptoms and illness. Communicating electronically has allowed people to have more access to their doctor. In addition, those who may live far from specialists will no longer have to face a long commute for a routine follow-up appointment.

“Knowing that they’re going to check in with me every month helps my patients stay motivated,” said Dr. Amy Fogelman, a Beacon Hill physician, in a CommonHealth article. “Having your doctor there with you as a team is really helpful.”

Not all doctors are set-up to provide telemedicine as an option to their patients, but the idea of this type of treatment is growing in popularity. Although more physicians are accepting virtual appointments, they are still required to provide the same standard of care as with any in-person appointment.

“For patients who may be isolated or suffering from something that requires human contact, then the online follow-ups aren’t necessarily the best thing,” said Dr. Dixon, Medical Director at Beacon Health clinic. “We don’t say that you shouldn’t see a doctor or nurse anymore. We’re just saying that some visits can be replaced or avoided by using virtual visits instead.”

Although it will take some time, telemedicine is starting to become a more acceptable method of treatment within the medical industry. There are, however, a few obstacles facing physicians. In order to virtually treat a patient, the doctor is required to be licensed in the state the patient is in. Additionally, some states will not allow prescriptions to be written unless the patient is seen in person.

While those are a few of the challenges facing virtual visits, both patients and doctors are continuing to see the benefits this service can provide in the future. Doctors will have better means to track patients’ progress on their treatment, while patients can have more accessibility to their physicians. Additionally, individuals will no longer have to deal with long commutes and waiting room time to visit their doctor. 

“Through telehealth, we can reach more people by keeping up with their healthcare without us being there,” said Goodall. “Through the information we receive remotely, we can monitor the patient and immediately report to the doctor when something’s going on.”

This valuable method of treating patients will have beneficial results for both physicians and patients. 



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