John Kelly
Owner at J Kelly & Associates LLC
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🔷➡️Here's the deal.🔷Health insurance is a contract between the insured/beneficiary and the insurance company or ERISA plan. Like any contract, there are terms.➡️The attached Commonwealth Fund report shows that a very significant number of consumers/members/beneficiaries are being denied coverage for which they 'thought' they had coverage. 🔷However, a large number of persons never challenge the denial, but a significant portion who challenge the denial ultimately prevail (either the coverage is granted or the balance is written off).🔷✅💪🏼Point: There is certainly enough 'failure' to go around -- complex language in the contracts as written by carriers, failure to read and get educated by beneficiaries, poor documentation or failure to get approvals by providers -- all this adds up to a messy situation with both financial implications, time wasted and potentially limitations on access to care.
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John Kelly
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Urgent Care or ER? With ‘One-Stop Shop,’ Hospitals Offer Both Under Same Roof - KFF Health News https://kffhealthnews.org🔷How will the patient know if their health insurance coverage determines the visit to be covered as “emergent” and “in-network” if the determination of urgent or emergent is determined “after the fact”?🔷✅The patient/member becomes “the pickle in the middle” between the insurer and the provider.
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John Kelly
Owner at J Kelly & Associates LLC
FTC's Non-Compete Ban: Anticipated Impacts on Health Care phillipslytle.comhttps://lnkd.in/gea8NeQM recent FTC ban seems to be holding despite at least two temporary judicial injunctions.
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John Kelly
Owner at J Kelly & Associates LLC
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Medicare Advantage's geographic disparities axios.com🔷Where you live can highly influence your healthcare access and also health outcomes.🔷➡️The point of the attached article is to demonstrate that the availability of high quality Medicare Advantage plans varies by geography.🔷In our health insurance practice we saw this clearly in evidence when assisting a client in rural Wisconsin seek a Medicare Advantage plan with access to specialty care providers to keep continuity of care for highly complex chronic condition. The county in SW Wisconsin had a very limited number of MA plans and all the plans had limited networks. In comparison, the more populated (and wealthier) regions closer to Madison and Milwaukee had 10 times the number of MA plans and the overall plan quality was higher and networks broader.🔷Note: Medicare Advantage plans are bid/contracted on a county by county basis...so the county of your permanent residence matters when you're looking for access to MA plans and, through the plans, access to providers.
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John Kelly
Owner at J Kelly & Associates LLC
A protein called Reelin keeps popping up in brains that resist aging and Alzheimer’s npr.org- Report this post
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John Kelly
Owner at J Kelly & Associates LLC
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POLITICO Pro: ‘Nobody’s immune’: States move to limit health data breach liability subscriber.politicopro.com🔷❓Does immunity from class action lawsuit improve cyber-security?✅Not likely.Sounds more like an admission of defeat.
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John Kelly
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Online portals deliver scary health news before doctors can weigh in washingtonpost.com✅Issue resolved…time to move on. A patient has the right to full access and timely disclosure.
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John Kelly
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Health Plan Hygiene Part 2:ERISA Fiduciaries – That May Mean You! | Benefits Law Advisor https://www.benefitslawadvisor.com🔷😀A nice and easy-to-read explanation of the difference between fiduciary role and settlor role.
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John Kelly
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Spillover of highly pathogenic avian influenza H5N1 virus to dairy cattle - Nature nature.com🔷”Spillover” is just a big fancy word that means Avian bird flu is easily transferred from one mammal species to another — more easily then originally thought.p.s. Humans are mammals. 😳
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John Kelly
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CVS Caremark defines future of pharmacy benefit management cvshealth.com🔷The CVS/Caremark pledge to greater transparency and cost savings comes on the same day as the State of Illinois prevailed in a $45 Million settlement agains the PBM for failure to hand over drug rebates.🔷❓Poor timing?🔷❓A chance for redemption?➡️➡️See link to Settlement Agreement -->https://lnkd.in/gj5BqKzxhttps://lnkd.in/gymiibpb#pharmacyrebates #CVS #PBM
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