According to local media reports, more than one-quarter of claims in Malawi paid by health insurance firms are fraudulent Keep on reading.
The Society of Claims Professionals in the UK has released a set of guidelines to help claims professionals better identify fraudulent practices.
Findings from multiple organisations found that fraud, waste and exploitation contribute to a high percentage of erroneous medical claims in the region.
The Board of Health Care Funders of South Africa found that 40 per cent of medical aid schemes' claims in the region are forged; while reports from Medical Aid Society of Malawi and Horizon Health Malawi - both major health insurance providers in the country - also confirmed this, with 25 per cent and 40 per cent of their claims, respectively, being fraudulent, costing them around MWK6 billion a year.
In response to this worrying figure, health insurance funding bodies have come together to tackle medical insurance fraud.
Hfam Interim President Elsie Munthali, who is also CEO for Horizon Health Malawi, said the most common fraud involves schemes' members conniving with service providers to pay them cash, which in turn the service providers claim as if they provided the service.
"That is the most serious fraud we are currently facing as an industry. On our part as Horizon, we calculate that between 40 and 50 per cent of our claims are fraudulent in nature because fraudsters have now become more sophisticated. So, that's why we have come up with this association to start talking and acting with one voice," she said.
Read the full story at International Travel & Health Insurance Journal
Medical insurance was one of the main topics discussed by sugarcane farmers during the consultations in Ba and Lautoka yesterday.
Sugar Cane Growers Fund CEO Raj Sharma says the majority of cane farmers have been requesting medical cover, especially from their family.
Sharma says they've made a proposition for farmers to pay $200 for medical cover per year to which the majority of cane growers have agreed to.
"A farmer would be able to get a medical treatment from any General Practitioner for unlimited number of times to a total of 4 members in a family which means husband, wife, and children below the age of 18 years and if they are university students up to 23 years old they can get that premium at $200 so this sort of things the farmers were requesting and we are able to hold this out for this year."
Other concerns such as cane cutting issues, mill problems, cane harvesting seasons and shortage of labor were raised in the consultation.
Present during the meeting with the farmers was the FSC Chief Executive Graham Clarke, Minister for Lands Ashneel Shudakar and Assistant Minister for Sugar George Vegnathan.
Read the full story at FBC News
What's the name of your plan? Know your insurance company.
Then take a note of the type of plan, such as Health Maintenance Organization or Preferred Provider Organization.
What are the tiers of providers? Health insurance companies control cost by encouraging you to see providers who have signed special contracts to charge the insurance plan a discounted rate for medical services.
The providers benefit through the opportunity to serve you and millions of members covered under the plan.
Insurance plans usually divide them into three tiers - preferred; in-network; and out-of-network - in order of low to high cost.
You can search by specialty to get a list of preferred and in-network providers on the insurance company's website.
What services are covered? The Affordable Care Act requires that all health insurance plans cover routine wellness and preventive care, such as a limited number of visits to the primary care doctor, immunizations and cancer screenings.
Read the full story at The State Journal-Register
Kamal Nath government on Saturday decided to bring 12.55 lakh state employees, pensioners and their families under medical insurance cover.
The decision was taken at the cabinet meeting headed by the chief minister at the state secretariat on Saturday afternoon.
Minister for health Tulsi Silawat said, "Mukhya Mantri Samohik Swasth Bima Yojana effective from April 1 will make every government employee and his or her family eligible for free medical treatment up to Rs 5 lakh per annum. For some critical diseases, eligibility may be increased to Rs 10 lakh per annum. OPD treatment in hospitals will be free up to Rs 10,000 per annum." Claiming it as a historic decision taken by the state government, Tulsi Silawat said that retired state government employees under previous regimes received free medication worth Rs 288 per annum.
While all employees will be eligible for Rs 5 lakh medical treatment, permission will be necessary from a state-level medical board for approval to increase the insurance cover to Rs 10 lakh for specific critical diseases.
Those who will be covered under the insurance scheme include 5,73,752 state government employees of various departments, another 1,79,470 government school teachers and 4,91,666 retired state personnel.
Implementation of the scheme will incur a financial burden of Rs 756.54 crore on the exchequer.
Portion of the premium will be deducted from employees' salaries and the amount will be determined through the salary grades.
Read the full story at The Times of India
The Democratic-controlled U.S. House of Representatives and 20 Democratic-led states asked the Supreme Court on Friday to declare that the landmark Obamacare healthcare law does not violate the U.S. Constitution as lower courts have found in a lawsuit brought by Republican-led states.
The House and the states, including New York and California, want the Supreme Court to hear their appeals of a Dec. 18 ruling by the New Orleans-based 5th U.S. Circuit Court of Appeals that deemed the 2010 law's "Individual mandate" that required people to obtain health insurance unconstitutional.
The petitions asked the Supreme Court, which has a 5-4 conservative majority, to hear the case quickly and issue a definitive ruling on the law, formally called the Affordable Care Act, by the end of June.
A district court judge in Texas in 2018 found the entire law unconstitutional.
In 2012, the Supreme Court narrowly upheld most Obamacare provisions including the individual mandate, which required people to obtain insurance or pay a financial penalty.
The court defined this penalty as a tax and thus found the law permissible under the Constitution's provision empowering Congress to levy taxes.
In striking down the individual mandate, the 5th Circuit avoided answering the key question of whether the rest of the law can remain in place or must be struck down, instead sending the case back to a district court judge for further analysis.
Read the full story at KFGO
As a cost-cutting measure, effective January 1, the Ontario government eliminated the Out of Country Travellers Program from the Ontario Health Insurance Plan, which is the government-operated health insurance system for Ontario residents.
The only service that Ontario residents will continue to receive OHIP coverage for while out of Canada is kidney dialysis.
This is not the first-time health insurance services for Ontario residents traveling outside the province have been cut.
The Ministry of Health is recommending that Ontario residents who spend time outside of Canada get private insurance to cover their medical expenses.
The Canadian Snowbird Association, which represents Canadians who spend the winter months outside the country, is challenging the Ontario government's decision in court on the grounds that it violates the Canada Health Act, the federal law that states how provinces are to administer the public health insurance system.
Most Canadians who spend considerable lengths of time outside the country usually get additional health insurance.
The elimination of out-of-country OHIP coverage by the Ontario government highlights several things about Canadian health care.
Read the full story at North Country Public Radio
The new year brings sweeping change to several state health coverage laws, from a health insurance mandate to new coverage opportunities for undocumented young adults.
According to a new tax mandate by California, residents without health insurance this year will pay a penalty on 2021 tax returns.
The penalty fine for not having health insurance for a full year is whichever is higher: either $695 per adult and $347.50 per child, per household, or, if higher, 2.5% of the annual household income above the state tax filing threshold.
A new change to coverage also means that mothers who are diagnosed with a maternal mental health disorder and whose providers leave their insurance network are still able to visit the provider and remain fully covered for up to 12 months.
A separate budget change has extended Medi-Cal coverage to mothers with mental health disorders from 60 days to one year.
A study from the U.S. National Library of Medicine National Institutes of Health in 2011 showed that worldwide, approximately 60% of women with enduring mental health issues have dependent children.
Read the full story at Enterprise-Record
Getting medical care is expensive in the United States.
About 71% of all medical expenses are mitigated via private and public health insurance.
There is a lot of money flowing between the medical industry and patients.
According to a new medical study, about $1 out of every $4 is wasted on bureaucracy, processing inefficiencies, and unnecessary procedures.
Another $240 billion is wasted on unnecessarily high prescription medication costs and medical services.
Over $282 billion in waste is created in inefficient outpatient services and in-hospital medical mistakes.
According to Dr. Shrank, recognizing and streamlining established medical bureaucracy inefficiencies now is the best way to eliminate systematic waste.
Read the full story at RealDaily
Insurance will compensate the victims of a vehicular accident at the Lucky Plaza mall in Singapore, which led to two fatalities and injured four others.
According to reports by the Straits Times, the accident occurred on the late afternoon of December 29, 2019, when a car crashed into several pedestrians and through a guard rail, landing several metres below on the mall's carpark exit ramp.
The accident, which occurred on the workers' day off, will be covered by the mandatory insurance paid for by their employers.
By law, the employers must purchase personal accident insurance and medical insurance for their domestic workers.
The personal accident cover has a minimum sum insured of SG$60,000, the report said, while medical insurance is worth at least SG$15,000.
There is a separate insurance scheme for them.
Centre for Domestic Employees chairman Yeo Guat Kwang said that the agency will provide assistance to the victims and their families in filing claims under their personal accident insurance policies.
Read the full story at Insurance Business Asia
Mike Kreidler, the Washington state insurance commissioner, has imposed fines on two health insurance market players in the past two weeks.
Kreidler announced today that Health Plan Intermediaries Holdings LLC, an arm of Health Insurance Innovations Inc., has agreed to pay a $1.5 million fine to resolve allegations concerning its appointments with two insurers, its affiliations with 434 insurance producers, the registration of a "Doing business" as name, and the authorization status of some of the products it sold in Washington state.
Kreidler announced Dec. 30 that he has ordered another organization, Trinity Healthshare Inc., to pay a $150,000 fine, and blocking the organization from operating in Washington state after 2020, in connection with the allegation that Trinity has marketed itself as a health care cost sharing ministry without meeting Washington state's legal definition of a health care cost sharing ministry.
The ACA provides exemptions from the usual ACA rules for short-term health insurance and for health care cost sharing ministries.
The administration of President Donald Trump recently gave issuers of short-term health insurance a boost by letting short-term health insurance policies stay in effect for up to 364 days, if a state allows that, and to let consumers use renewals to keep short-term coverage in place for up to three years, if a state and the coverage issuer allow that.
Issuers of ACA-compliant coverage, and many health policy specialists and state insurance regulators, have argued that letting health care payers outside of the ACA-compliant coverage market grow could destabilize the ACA-compliant issuers, by pulling many of the younger, healthier people out of the ACA-compliant coverage market.
Washington state is not the only state action taking action on the health care costing sharing ministry issue.
Read the full story at ThinkAdvisor
Negotiations have failed between UnitedHealthcare and Houston Methodist, meaning patients with that medical insurance could receive a very large bill for care from Houston Methodist doctors or hospitals.
"If you're insured under United and you seek treatment in a Methodist hospital after January 1, 2020, they will not pay for you except at out-of-network rates, which means you could get a very large balance bill," Seth Chandler, a professor with the University of Houston Law Center, told ABC13 in October.
Houston Methodist claimed UnitedHealthcare reduced previously negotiated rates for how much they charge for care.
Houston Methodist had a contract in place with United for 21 years before they abruptly gave notice of termination a few months ago, creating confusion among our 100,000 patients insured by United.
Although Houston Methodist negotiated in earnest, an agreement was not reached by the Jan. 1, 2020 deadline and now those Medicare Advantage and commercial patients must search for new doctors and new facilities.
"Care at Houston Methodist Hospital is significantly more expensive than care at other top-ranked hospitals in Texas as well as some of the most prestigious hospitals in the entire country. Every time we attempted to reach a compromise during the negotiations, Methodist responded with proposals showing that it is intent on maintaining its position as one of the most expensive health systems in the country."
Read the full story at ABC Eyewitness News
CAA South Central Ontario is reminding travellers that changes to out-of-country medical coverage in Ontario.
Are now in effect, prompting the need to review travel insurance coverage.
"Travel insurance protects from unexpected and costly emergencies and it's important to evaluate available coverage, based on personal needs, to determine how to best safeguard you and your family. This is even more important now that there is no coverage through OHIP.".
Some of the key things to consider when it comes to buying travel insurance are how many trips you are taking a year; if you want comprehensive coverage or medical-only insurance; and whether or not the insurance provider offers additional assistance such as interpreters, hospital recommendations and other coordination services.
It's important to remember that the intent of travel medical insurance is to treat emergency conditions, and return you to your home province for ongoing treatment once your medical condition is stabilized.
Emergency travel medical insurance may require completion of a medical health questionnaire depending on age.
Medical questionnaires determine premium, NOT coverage.
Read the full story at Bezinga
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The scope of the report includes a detailed study of global and regional markets Global Medical Billing Outsourcing Market with the reasons given for variations in the growth of the industry in certain regions.
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Read the full story at MarketWatch
Ontario residents have lost the majority of their out-of-country coverage through the Ontario Health Insurance Plan, leading some in the travel industry to worry private insurers will raise the cost of their travel plans.
As of Jan. 1, 2020, Ontario has scrapped all out-of-country insurance for medical emergencies, with an exception for dialysis services.
Last summer, Ontario's health minister said the old system was an "Irresponsible use of taxpayer money."
Health Minister Christine Elliott said the funding did "Little in the way of providing meaningful travel coverage," since it only covered a daily maximum of $400 for inpatient treatments, with an additional $50 per day for emergency outpatient services.
Court challenge ahead. The decision to end out-of-country coverage is now being challenged in court, with the Canadian Snowbird Association filing an application for judicial review, arguing the province is violating both the Canada Health Act and Ontario Health Insurance Act.
Shop around, says CAA. The changes to out-of-country coverage may actually help raise awareness about the importance of private health insurance, according to Caitlin Charter, manager of the CAA's Travel Store in Orléans.
Charter said Ontario residents planning to travel abroad should check to see if they have existing travel insurance whether through private insurance plans or their credit cards.
Read the full story at CBC News
China's new national medical insurance catalog came into effect Wednesday, including 70 new drugs with their prices slashed by 60.7 percent on average.
Eight domestically-produced drugs that are seen as "Major innovations" and have just hit the market in recent years are among the new additions, according to the National Healthcare Security Administration.
Some 22 anti-cancer drugs, seven drugs for rare diseases, 14 for chronic diseases and four for children will be included in the catalog, and the prices of three new drugs for hepatitis C will be reduced by an average of 85 percent, said the NHSA. Most of the additions are new drugs of high clinical value that can be used to treat multiple diseases including cancer, diabetes and tuberculosis, and the prices of most imported drugs will be set at the lowest in the world.
After the price reduction and medical insurance reimbursements, the financial burden on patients will be eased by over 80 percent.
The additions are part of the first adjustments to the catalog since the NHSA was established in 2018.
The 2019 catalog has a total of 2,709 drugs, compared with 2,645 in 2017.
Read the full story at XinhuaNet
Federation of Uganda Football Associations has confirmed starting next year, players plying their trade in the Uganda Premier League will get medical insurance cover.
He revealed Fufa have entered into a one-year partnership with AAR Insurance Company with an option of renewal.
"Starting 2020, Fufa will offer medical insurance to all the players in Uganda Premier League by AAR Insurance Company," Magogo is quoted by the Fufa website.
"This will cater for injuries to players and compensation for permanent disabilities as a result of injuries. We have observed over the years some players have sustained career-threatening injuries and clubs failed to help them recover fully. In this arrangement, 400 players will be catered for and the registration is almost done."
Uganda Premier League chairman, Arinaitwe Rugyendo who was also part of the press briefing lauded Fufa for the initiative and believes this is a great stripe in helping players.
I laud Fufa for extending medical insurance to our players and this will help a lot.
It should be noted Fufa also offers medical insurance to delegates, Fufa staff, Uganda Cranes' players and players featuring in the Fufa Juniors League.
Read the full story at Goal