Monday, November 25th, 2013
There is a litany of national news service articles this week, covering the full political spectrum, highlighted concerns expressed by physicians in New York State regarding unfair treatment by health insurance companies offering coverage in New York’s Health Insurance Exchange.
Articles appeared in:
· US News & World Report and
· Kaiser Health News highlighting the challenges patients may face in New York’s Health Insurance
Exchange as a result of a number of concerns identified through the preliminary results ofMSSNY
survey gauging physician experiences with health insurance companies offering coverage through
New York’s Health Insurance Exchange.
The problems with health insurers identified in the MSSNY survey include failure to communicate whether a physician is part of an Exchange plan, failure to provide information regarding reimbursement for providing needed patient care and, in many cases, offering fees that, generally speaking, are significantly below existing commercial coverage. MSSNY continues to regularly communicate with top staff at the New York Exchange to convey these concerns. Last week’s MSSNY’s Advocacy Matters program featured top staff of the New York Health Insurance Exchange describing the roll-out of the Exchange in New York, including responding to many physicians’ questions. To watch a recording of this webinar, click here.
We also continue to urge physicians to complete the survey so that it is more representative of physician experiences statewide. If you have not already done so, we urge you to please complete the survey here.
We Need to Hear from You
MSSNY has contacted the NYS Department of Health regarding complaints of some physicians that they are listed as a participating physician in a health plan exchange network, but were not provided any written notice by the health plan that gave prior notification of such participation requirement, or the terms and conditions of such participation, including but not limited to, the fee schedule applicable to the exchange product. The NYS Department of Health has asked MSSNY to provide specific examples of physicians who believe that the health plan failed to provide prior written notice of participation in the exchange product. If a physician is interested in having the DOH investigate the specifics, the doctor should send an email to Regina McNally, VP of Socio-Medical Economics at firstname.lastname@example.org The email should identify the plan name and identify whether or not they have any contract with the specific insurer.
Sam L. Unterricht, MD
* * *
Friday, August 16th, 2013
The Affordable Care Act (ACA) and New York State Law require that starting January 1, 2014, all health insurance plans include a core set of health services (known as essential health benefits) and more cost-sharing choices. While EmblemHealth’s plans already offer many of these benefits, we will be replacing our current products with new, fully ACA-compliant plans.
On December 31, 2013, all of EmblemHealth’s current small group, sole proprietor and individual plans will be discontinued. As of January 1, 2014, EmblemHealth will offer new small group and individual plans that will meet the ACA requirements.
Notifying Small Groups and Subscribers
We are mailing letters announcing the discontinuance to affected small groups, small group subscribers, and sole proprietors about 90 days before the effective date. This will provide ample time for your clients to consider their options in the marketplace.
Under the ACA, when a business is owned only by an individual or an individual and his or her spouse, these individuals are not considered “employees” and the benefit plan is not considered a group health plan. As of January 1, 2014, these individuals will no longer be able to purchase group coverage and will need to purchase individual coverage.
If you have questions about the plan discontinuance, please contact your EmblemHealth representative.
Next month, we will be sending you more details about the discontinuance and news about our ACA- compliant products.
Tuesday, September 14th, 2010
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Nassau Academy of Medicine
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