March 2019 Volume 21 Issue 3
Providing Current Information on

Health Insurance Industry Issues and Legislation

Direct Primary Care The Future of Employee Healthcare?
Direct primary care (DCP) is a fee-based model giving people unlimited access to
a primary care physician for a set monthly fee, with no bill to the person's insurer.
The fee covers most of a patient's basic needs including treatment, consultations,
tests and prescription drugs, at lower cost to individual than they would pay
through their insurance. Employers offering DCP as a benefit are reporting better
outcomes, greater patient satisfaction and significant savings in total cost of care.
Direct Primary Care Won't End Out-of-Network Claims
While direct primary care may mean lower costs and better outcomes for basic
service, it will not stop people from having to go to the hospital or utilizing out-
of-network providers. When they do, H.H.C. is there to help minimize the cost of
these, many times, expensive claims. Our bulldog attorney negotiators are experts
at getting providers to sign agreements accepting an appropriate amount, usually
much lower than the billed amount, as payment in full eliminating potentially
costly balance bills.
Courts Weigh In On Balance Billing
As balance billing becomes ever more common, courts around the country are
stepping in to determine just how much people have to pay. Some legal scholars
argue patients should already be protected under the contract law concept of
"mutual consent". Courts in New York and Colorado have recently agreed. They have
mediated cases involving large out-of-network balance bills, ordering hospitals to
accept amounts near what they take for in-network private insurers or Medicare.
However, last year the Virginia Supreme Court found in favor a hospital, saying the
admission paperwork the patient signed was a valid contract.
Healthcare Cost Increases Who's to Blame?
Increasing prescription drug prices are driving up the cost of healthcare, but hospitals
are major contributors, too. Prices for hospital-based procedures increased 43% over
a 7 year period. In contrast, physician prices grew by only 18% over the same period.
Similarly outpatient services prices increased 25% while prices for outpatient physician
services rose only 6%. Many experts believe consolidation in the hospital segment is
a major driver of the increases and that hospital mergers and acquisitions need to be
better controlled.
Three Star Preferred Provider Program Additions
The Psychiatry Group
Spokane, WA 99207

Bassam Odatalia, M.D.
Fairfield, NY 07004

Marc Roth LMHC
Goshen, IN46536

Complete Bio Solutions, Inc.
Hialeah, FL 33010

Avanti Laboratories
Longs, SC 29568

Ascent Emergency Medical Center
Houston, TX 77030

Hearing Screening Associates of Utah
West Jordan, UT 84088

Southwest Georgia Heath Care Inc.
Richland, GA 31825

Broad Ripple Eye Care LTD
Indianapolis, IN 46220

Heritage Valley Beaver
Beaver, PA 15009