“ACA Discount Is Better Than PPO Discount” to Phantom Coverage. Any coverage without access or freedom of choice is a phantom coverage.
Hanover Park, IL (PRWEB) July 01, 2012
After the Supreme Court upheld the Patient Protection and Affordable Care Act (PPACA, or ACA) on June 28, 2012, ERISAclaim.com announced an “ACA Discount Is Better Than PPO Discount” Program to improve access and affordability to out-of-network healthcare, as HMO or PPO Discount fails to reduce medical bankruptcies and phantom coverage. Even with 95% of HMO or PPO discount for decades, about 77% of insured Americans who paid for out-of-network coverage were only able to file less than 5% healthcare claims. According to the AMA and Kaiser’s Health Security Reports in June 2012, "Even among people who make $90,000 or more per year, nearly 40% skipped or delayed care because of cost.” Any in & out-of-network coverage without real accessibility or true freedom of choice of providers due to the high deductible and/or co-insurance is considered a “Phantom Coverage”.
Under ACA, patients are constitutionally entitled to all ACA protections, discount and savings. On June 28, 2012, the Supreme Court upheld the constitutionality of Patient Protection and Affordable Care Act (ACA). ACA is also known as Patient's Bill of Rights, a new federal health reform law went into effect on March 23, 2010. ACA now authorizes health providers, as patients’ Authorized Representatives, to appeal all improperly denied or delayed healthcare claims by their health plans, and protects their constitutional rights to ACA Accessibility and Affordability Discount and Savings, which were not available to patients before.
“ACA Discount Is Better Than PPO Discount” Program is the latest one of the ERISAclaim.com’s PPACA compliance programs since PPACA was signed into law on March 23, 2010, says Dr. Jin Zhou, President of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.
ERISAclaim.com’s Affordable Care Act Discount (ACA Discount) compliance program educates providers on new patient protections for the accessibility and affordability of the already paid out-of-network coverage for actual healthcare under the Provider’s Corporate Compliance Policy to anyone who qualifies, on a case by case basis. Patients only pay what they can afford or are willing to pay for their deductible and co-insurance, as outlined in their plan cost-sharing obligations, only based on their medical need, in relation to their income at the time of the service. Most people may qualify and their satisfaction of the freedom of choice of providers shall be guaranteed by their plans and out-of-network Premiums under PPACA.
According to a New York Times report on January 26, 2012: “Health Insurance Deductibles Doubled in 7 Years, Study Finds - If you’ve seen your health insurance premiums increase along with your deductible, you’re not alone.” (http://bucks.blogs.nytimes.com/2012/01/26/family-health-insurance-costs-doubled-in-7-years-study-finds/)
After paying for the high premiums, even with HMO or PPO discount, but still unable to pay for the high deductibles and/or co-insurance again, most people just simply skipped or delayed the timely sensitive treatment until the disastrous events strike, then the healthcare costs really go skyrocketing.
As reported by an American Medical Association news report on June 26, 2012, according to Kaiser’s Health Security Report in June 2012: “Insured, High-Income Patients Delay Medical Care, Too: Even among people who make $90,000 or more per year, nearly 40% skipped or delayed care because of cost.”
According to CNN in 2009, “Medical bills prompt more than 60 percent of U.S. bankruptcies”.
From Businessweek: “Harvard researchers say 62% of all personal bankruptcies in the U.S. in 2007 were caused by health problems—and 78% of those filers had insurance” http://www.businessweek.com/bwdaily/dnflash/content/jun2009/db2009064_666715.htm
According to U.S. Bureau of Labor Statistics in August 2011, about 77% of insured Americans purchased out-of-network coverage under private industry benefit plans (DOL, BLS, NBS 2010, page 11 of 167) http://stats.bls.gov/ncs/ebs/detailedprovisions/2010/ebbl0047.pdf
While economic challenges facing the country continue, the Supreme Court has decided the fate of the Affordable Care Act (ACA). Many provisions of the ACA are designed to improve access and affordability to health care and health insurance. ERISAclaim.com acted quickly on the Supreme Court ACA decision to develop its PPACA Discount solutions under HHS and OIG Guidance (http://archive.hhs.gov/news/press/2004pres/20040219.html), and CMS FAQ for Medicare and non-Medicare patients(http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/downloads/FAQ_Uninsured.pdf).
ACA Discount protects patients from medical bankruptcies. Patients and their loved ones no longer have to skip or delay timely sensitive healthcare. “ACA Discount Is Similar to, But Much Better Than PPO Discount,” says Dr. Zhou.
To find out more about PPACA Claims and Appeals Compliance Services from ERISAclaim.com:
Located in a Chicago suburb in Illinois, for over 12 years, ERISAclaim.com is the only ERISA & PPACA consulting, publishing and website resource for healthcare providers in the country. ERISAclaim.com offers free webinars, basic and advanced educational seminars and on-site claims specialist certification programs for doctors, hospitals and commercial companies, as well as numerous pending national ERISA class action litigation support. Dr. Jin Zhou is regarded as the industry “Godfather of ERISA claims” for healthcare providers. Dr. Zhou were frequently consulted by and advised numerous providers and healthcare attorneys in ERISA claim appeals and health care provider ERISA class actions in the past 12 years.
For any questions, please contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.