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What do members need to know about these plans that they probably don't?
1. Carry your membership card everywhere.
Make copies. It'll save huge amounts of hassle if you have an unexpected doctor or hospital visit.
2. Understand your plan's doctor and hospital network.
Insurance companies negotiate participation and payment rates with a network of providers to control costs.
"A lot of these exchange plans, in order to stay affordable, have much smaller networks than people are used to," saysNancy Metcalf, a senior editor for Consumer Reports. For many new members, "just because their friend has a plan and can go to a particular hospital doesn't mean that they necessarily can."
You can check a plan's directory - either online or often part of the documents you receive when you enroll - to find out if specific physicians are part of your network. You can call doctors' offices to confirm, too.
3. Stay in the network.
The health law says that, once you join a qualified plan, you won't pay more out of pocket per year than $6,350 for an individual and $12,700 for a family. But this applies only to in-network care. Whether you're in an HMO that pays almost no out-of-network benefits or a PPO that covers some, the pocketbook protections don't apply if you use a non-network doc or hospital.
Non-network providers also frequently bill you far more than what they charge patients in their networks for the same procedure.
4. Try to stay in-network even if it's for emergency care.
Insurance plans do have to pay for non-network emergency visits under the health law. If you're in a car crash far from home, you can't be picky about which hospital saves your life.
But non-network hospitals often "balance-bill" the difference between what your plan pays and what they charge, which is often much more.
5. Avoid all emergency rooms unless it's really an emergency.
Traditionally, health plans came with a modest copayment for an emergency visit - maybe $150.
But many policies sold under the health law, even those in the more expensive "gold" category, not only have ER copays of several hundred dollars but also subject ER charges to the overall deductible. (Copays are flat fees for specific services. Deductibles are what you pay out of pocket before the insurance kicks in.)
That means you could be billed for the full cost of an emergency visit - up to the out-of-pocket limit.
"This is a huge difference and will really hurt the unsuspecting person," says John Jaggi, an Illinois insurance broker. "We're putting a lot more people into that exposure here."
Broken leg? Head to the hospital. Sprained ankle? Maybe wait until the urgent care center or doctor's office opens.
6. Pay monthly premiums on time and accurately.
"Do not mess around. Pay your premium," admonishes Karen Pollitz, a consumer specialist at theKaiser Family Foundation. (KHN is an editorially independent project of the foundation.) "Otherwise that will be the end of you and you won't get to sign up again until the next open season."
(Open enrollment for 2014 coverage ends March 31. Open enrollment for 2015 begins Nov. 15.)
Even underpaying the premium by a few cents could give the insurance company grounds to kick you off, she said. Insurers allow a brief grace period if you get behind - somewhat longer if you're receiving premium subsidies - but they will terminate coverage for nonpayment.
7. Register online with your new insurance company.
Insurance sites are good for tracking claims. Increasingly they also let you shop around for the best deals on non-emergency treatment.
"Your health plan might pay one imaging center half what it pays another imaging center," Metcalf said. "That's really important if you've got a big deductible."
8. Save paperwork. Make sure you really owe what doctors and hospitals bill you for.
"Now is a good time to become a pack rat," says Pollitz. "If you've got any concern, it really is worth it to make a call and get them to explain what they did."
9. If you don't get satisfaction from providers or insurers, try regulators.
Check the insurer's explanation of benefits detailing your claims. It may show a phone number for a consumer assistance program in your state to help deal with medical coverage.
This list has contact information for state insurance departments and other regulators.
10. Do read the plan's summary of benefits and coverage.
"Get it and print it out, because that has the details of your plan," says Metcalf. "What do you have to pay in order to go to a primary care doctor? Is it before or after the deductible? How big is your deductible? How much does it cost to go to the emergency room?"
It's not like reading John Grisham. But the subjects - your health and your money - are really important.
It'd be great to do this.
NEW YORK — A whistle-blower will be paid $63.9 million for providing tips that led to JPMorgan Chase & Co's agreement to pay $614 million and tighten oversight to resolve charges that it defrauded the government into insuring flawed home loans.
The payment to the whistle-blower, Keith Edwards, was disclosed on Friday in a filing with the U.S. district court in Manhattan that formally ended the case.
In the Feb. 4 settlement, JPMorgan admitted that for more than a decade it submitted thousands of mortgages for insurance by the Federal Housing Administration or the Department of Veterans Affairs that did not qualify for government guarantees.
JPMorgan said it had failed to tell the agencies that its own internal reviews had turned up problems.
The government said it ultimately had to cover millions of dollars of losses when some of the bank's loans went sour, resulting in evictions and foreclosures nationwide.
“There were a lot of bad loans made during the financial boom, and the United States taxpayer was left holding the bag through the VA and FHA loan programs,” said Edwards' lawyer, David Wasinger. “Hopefully the settlement sends a message to Wall Street that this conduct is not allowed, and that in the future it will be held accountable.”
Edwards could not immediately be reached for comment.
About $56.5 million of Edwards' award concerns the FHA portion of the case, and $7.4 million concerns the VA portion. Wasinger declined to discuss his legal fees.
Edwards, a Louisiana resident, had worked for JPMorgan or its predecessors from 2003 to 2008, and had been an assistant vice president supervising a government insuring unit.
He originally sued in January 2013 under the federal False Claims Act, which lets individuals sue government contractors and suppliers for allegedly defrauding taxpayers. The Department of Justice later joined as a plaintiff.
Whistle-blowers can recover portions of False Claims Act settlements, which often grow if the government gets involved.
The purpose of the CCSD is to:
Establish and maintain a common standard of procedure codes and narratives that reflect current medical practice within the independent healthcare sector by publishing the CCSD Schedule
Establish and maintain industry standard codes for diagnostic tests (ISCs) which were launched in September 2013 to drive further standardisation of coding
Make this standard available to all those working in the sector at a minimal, equitable charge that does not limit adoption or usage
Update the standard in-line with new technologies and changes in medical practice
Two workstreams are responsible for CCSD work:
The CCSD Board acts as a steering committee, providing overall direction and strategy and ensures that the CCSD delivers against its strategic objectives
The CCSD Working Group is responsible for ongoing maintenance of the CCSD Schedule. The Working Group discusses and decides the outcomes of any new procedure amendment requests and other changes to the Schedule
I am teaching robotc coding. Your program showing all the logical connections (do/while, if then else, while, etc) is wonderful for helping students (and the teacher) see the relationships between the parts of the code. I would love to be able to print the code with all the colors and the connecting lines so I can insert it into a document for each exercise. For long code (over 60 lines or so), it would help to be able to insert a page break.
Considering there really no big "killer" features in ST3, I'd like to propose one, which might me a big extension to ST.
Virtual File Systems API should implement file I/O based on plugins. The end developer API could be taken from existing projects, e.g. FUSE.
VFS would allow deep integration with different off-site (not local) file editing without sacrificing any time for I/O waits. While there are lots of file system wrappers (e.g. FUSE), the implementation inside ST would benefit from higher integration with text edition and navigation tasks.
There is also a number of companies which use ST in corporate environments with high security requirements (e.g. no source code should be saved to local storage). VFS capability would allow to use ST in such environments.
End users would benefit from plugins for FTP, SFTP integration with file browser.
Virtual representations would also be possible. Consider a VFS based on class hierarchy with method definitions as leaves.
All this requires minor modifications to UI, but deep modifications to I/O core.
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