ACE USA Expands Coverage to Address Growing Trend of Hospital and Physician Integration

ACE USA Medical Risk Group introduce a wide range of physician professional liability insurance products and coverage solutions in support of hospitals and healthcare facilities for their employed physicians, and their owned or affiliated medical groups. Product offerings include companion primary physician professional liability policies, fronting capabilities for primary physician professional liability policies, reinsurance of physician professional liability policies issued by healthcare facility captives, and uniquely structured integrated hospital and physician insurance program designs that may include separate or shared retentions and policy limits.

The physician professional liability insurance coverages are available for hospitals, healthcare facilities and Accountable Care Organizations (ACO) providing insurance or alternative risk financing solutions to their employed physicians, or owned or affiliated medical groups.

Product Highlights of the companion Primary Physicians Professional Liability policy* include:

• Separate limits of liability each physician and corporate entity
• Defense expense in addition to policy limits
• First dollar coverage (no deductible) or deductible options
• Individual tail coverage or group rolling tail coverage for departed physicians
• Consent to settle provision
• Professional Legal & Audit Defense Coverage
• Full claims capabilities to support companion primary physician primary policies

Benefits of an integrated or coordinated hospital / physician insurance program include:

• Common insurance or reinsurance partner for both the healthcare system and their employed, owned or affiliated physician groups
• Joint or coordinated defense provides greater control and cost containment of joint claims
• Coordinated risk management support services
• Integrating physician insurance into an integrated self-insurance or alternative risk financing mechanism may offer lower cost compared to traditional insurance
• Backed by the ACE Group’s financial strength and excellent reputation

*This coverage is currently not available for stand-alone medical groups that are not owned by or affiliated with an ACE insured hospital or healthcare system.

Baby Stuck in Hospital Because of Insurance Company

A 3-month old baby boy in Nebraska was separated from his parents for 100 days because their insurance company refuses to pay for their baby to be moved.

The baby is in Presbyterian St. Luke’s Hospital in Denver, while his parents live in Lincoln, Nebraska, and have been forced to commute to see their son every other weekend.

Julius James Frack was born on December 30, 2012 weighing one pound, six ounces and was only 12 inches long.

Jennifer and David Frack weren't expecting the baby to arrive soon but had complication with her pregnancy while visiting family in Sydney, Nebraska, after Christmas.

Doctocs in Sydney said that the mom needed needed specialized care and arranged for her to be flown to Presbyterian St. Luke’s Hospital in Denver. Because Julius was so small, he was rushed to the hospital’s NICU.   

The mom healed in a few weeks and was allowed to go home but the baby was too fragile for long drive. Howerver, the parents need to go back to work. And since December, the parents has been spending too much money to drive back and forth from Lincoln to Denver every other weekend.

Fracks asked to have Julius moved since the commute is too much. Doctors told the parents that the baby needs to be transferred by helicopter and doctors at Presbyterian St. Luke’s Hospital helped them fill out paperwork but their insurance company denied the request.

The Fracks’ insurance company, Blue Cross and Blue Shield of Nebraska, released a statement that said, “In general, when our nurses and physician reviewers look at cases such as this, the decision to cover a service is based on whether a ‘medical necessity’ exists,” said Dr. David Filipi, Chief Medical Director, Blue Cross and Blue Shield of Nebrask

source: http://kdvr.com/2013/04/14/parents-separated-from-baby-for-100-days-over-insurance-decision/#ooid=9kOHB5YTqKX8XQn55UgtnqXYpYBIbLXu

Small Businesses would rather pay Penalty than offer Health Insurance

The Wall Street Journal reports that a number of companies would rather pay government's penalty to break the law and it will be cheaper for them than following it.

Under the Obamacare provision that goes into effect next year, employers with 50 or more full-time workers will be required to provide coverage for employees who work an average of 30 or more hours a week in a given month. An alternative to that mandate is for business owners to pay a $2,000 penalty for each full-time worker over a 30-employee threshold.

Rick Levi owns Consolidated Management based in Des Moines, Iowa that runs cafeterias at schools, offices and jails in 10 states. The law would require him to offer insurance to all of his 102 full-time employees starting in January. Assuming all of them take the coverage, Mr. Levi says the cost of premiums could exceed $500,000 per year if every employee takes the insurance plan. The penalty will cost him around $144,000.

"I've never made a profit in any year of the company that has surpassed that amount," says Mr. Levi, 62 years old. "I don't make enough money."

He says it makes more sense to drop insurance entirely and pay a penalty of about $144,000.

Using Medicaid Dollars for Private Insurance

The Obama administration and Republican officials in several states are exploring ways to redirect federal money intended to expand Medicaid, the main public insurance program for the poor, and use it instead to buy private health insurance for Medicaid recipients. The approach could have important benefits for beneficiaries and for the future of health care reform. But the idea also carries big risks. Federal officials will need to enforce strict conditions before agreeing to any redirection of Medicaid dollars that were originally intended to enlarge the Medicaid rolls.

The Supreme Court ruled last year that the states could decide whether they want to expand their Medicaid programs to cover more of the uninsured; they can’t be required to do so, as the health reform law intended.

The law provides hugely attractive financial incentives for states to add more people. The federal government will pay 100 percent of the cost of caring for newly eligible enrollees for the first three years, tapering to 90 percent in later years. Even so, some state officials, mostly Republicans, are proposing that the very generous federal financing for expansion be used instead to pay the premiums of poor people on new electronic health care exchanges, created by the reform law, where people can shop for subsidized private insurance.

Private insurance obtained on the exchanges could help poor beneficiaries in several ways. They would be less vulnerable to disruptions every time their incomes fluctuated above or below the boundary line that determines whether they are poor enough to qualify for Medicaid, where they would see one array of doctors, or slightly better off and eligible for subsidized insurance on the exchanges, where they might see a completely different group of doctors. Providers would be paid the same amount whether treating a Medicaid recipient or a privately insured patient, potentially creating a wider network of doctors for Medicaid patients. And some poor residents of states resistant to expansion, who would otherwise be frozen out by a glitch in the reform law, could gain coverage through the exchanges.

But the main benefit would be political in that it could engage Republicans in the whole health reform effort, make it easier to carry out the law and reduce the appetite among Congressional Republicans to gut the law.

There are at least two big caveats. The switch would be likely to increase costs for the federal government, and ultimately state governments, because private insurance is almost always more costly than Medicaid. That could force a cutback in the number of people covered because the money won’t go as far. There is also a risk that poor people will end up with fewer benefits and higher cost-sharing on the exchanges despite regulations that should prohibit that.

Federal officials must be vigilant in ensuring that recipients on the exchanges receive the same services and same cost-sharing limits that they would under an expanded Medicaid program. State officials who don’t want to play by those rules would be better off using the generous federal dollars as originally intended — to expand their Medicaid programs to cover many more of their uninsured residents.

nytimes.com

Board meets on Texas Wind Insurance Assoc. future

AUSTIN, TX (AP)- The board of the Texas Windstorm Insurance Association will have a meeting to determine the future of the agency that provides coverage to homeowners along the coast.

Better known as TWIA, the association has been in serious financial trouble for years. The board is considering putting TWIA into receivership at a meeting on Monday.

The association provides insurance to 266,000 homeowners and businesses who cannot find commercial insurance because of the risk of hurricanes or severe storms. TWIA relies on all of the insurance companies in Texas to help finance it.

But following major hurricanes and mismanagement, many question whether TWIA can provide coverage if another hurricane strikes. The Legislature overhauled the association in 2011, but the problems persist. The board has been searching for a way to become more solvent. 

Tennessee: Pit Bull Insurance Law Would Require Owners To Purchase Policies For Dangerous Dogs

In Tennessee, a proposed pit bull insurance law would require owners of the controversial dogs to purchase a $25,000 policy for liability against possible attacks.

The proposal has brought controversy among those who work with and own pit bulls. Wendy Jackson, founder of East Tennessee Pit Bull Rescue, said pit bulls are given an unfair reputation and don’t deserve to be targeted.

Much of the problem comes from the owners, Jackson said. Pit bulls tend to attract abusive owners drawn to the “thug mentality” and image, she said.

“Yes, this type of dog is a powerful dog and obviously if they were motivated to do harm they could,” Jackson told WBIR in Tennessee.  “The issue should be controlling people who control the dogs.”

The Tennessee legislature will discuss the pit bull insurance law next week. The bill is sponsored by Representative Brenda Gilmore of Nashville, who is seeking to define “vicious dog” as any animal with a history of causing injury or death to another person, or any dog that “belongs to a breed that is commonly known as a pit bull dog.”

Critics view the pit bull insurance law as a way to price poorer residents out of owning pit bulls.

“I don’t think you can legislate these types of issues. What we really focus on is responsible ownership, pet owners who have trained animals, and owners who restrain their animals appropriately,” said Jeff Ashin, CEO of the Young-Williams Animal Center in Knoxville. “Legislation often comes with unintended consequences.”

The proposal comes in the wake of some high-profile pit bull attacks in the past week. In New Orleans, three dogs attacked a 54-year-old woman in her home, leaving her in critical condition after losing both arms, an ear, an eye, and part of her scalp.

A second attack took place in the Bronx, where a pit bull mauled a young girl in an attack captured on surveillance video.

The pit bull insurance is not the only effort to legislate dangerous animals. In Indiana, fatal pit bull attack on a 7-year-old boy has prompted local officials to try to overturn a state law and allow pit bulls to be banned in the city.

inquisitr.com

Mortgage Life Insurance

Mortgage protection insurance or mortgage life insurance is a form of insurance specifically designed to protect a repayment mortgage. If the policyholder were to die while the mortgage life insurance was in force, the policy would pay out a capital sum that will be just sufficient to repay the outstanding mortgage.

Mortgage life insurance is supposed to protect the borrower's ability to repay the mortgage for the lifetime of the mortgage. This is in contrast to Private mortgage insurance, which is meant to protect the lender against the risk of default on the part of the borrower.

The beneficiary of this type of policy is almost always the mortgage company.

Mortgage life insurance disadvantages: The premium you pay is often lumped into the home loan, which means you are paying finance charges on the premium. A healthy nonsmoker can usually beat the price of mortgage life insurance by as much as 50%. Another disadvantage is the insurance stays with the house. In other words, it's not transferable the way regular life insurance is.