This is being sent out to you my clients for the reason of keeping you informed on current Healthcare issues.
Uniform Medical Plan and Regence Blue Shield Change the Rules: Are You Impacted?
Click here for a link to the Fall 2010 Washington Massage Journal article on Uniform Medical Plan and Regence Blue Shields Networks. We are sending this out prior to the mailing of the Journal because we realize that this is a time-sensitive issue that may affect many of our members.
If you have questions or concerns, the following contact information may be helpful:
Uniform Medical Plan Provider Services:
Toll-free 1-800-464-0967
Local (425) 686-1246
Fax (425) 670-3199
Regence Blue Shield
Phone: 1 (800) 322-1737
Fax: (253) 573-3318
Fax: 1 (877) 367-6551
The Office if the Insurance Commissioner
http://www.insurance.wa.gov/
1-800-562-6900
Washington State Health Care Authority
http://www.hca.wa.gov/contact.html
Initiative 1082 and Workers Compensation: How it may affect you
By: John C. Peick, JD
http://www.peickconniff.com/
Initiative 1082 will completely alter the worker compensation program as we currently know it. As healthcare providers, or as potential injured worker, if this initiative passes, you will be subject to the tender mercies, not of L&I claims managers, but of insurance company adjusters. Of course, this statement presupposes you will not be excluded altogether from the new system. Read on and please pass this information to your patients, friends and colleagues. We are only 7 weeks from the election so we need action NOW!!
What is really in I-1082? Not what you might think......
· Private workers’ comp insurers are given authorization to set their own rates without approval by the Insurance Commissioner. This is unlike every other line of insurance in Washington. (section 2, subsection 4)
· Allows group business plans to set up medical networks to receive premium returns governed only by the insurance company, not safety standards or effective claims management. (section 2, subsection 7)
· Sets up standards for communication between insurers and workers under new private insurance:
- It requires insurers to notify workers within 30 days of procedures approved. It does not require insurers
- to ever make a decision or to notify workers if they deny coverage.
- Workers do not have the right to compel a decision, as they do in other lines of insurance.
- There is no requirement for insurers to communicate with employers or medical providers on any matter.
- I-1082 changes the way workers are notified of their right to appeal a decision. Insurers can show they mailed a notice but don’t have to prove you ever got it. If you moved or never received notice, it does not matter, the insured loses their rights. (section 4)
· Eliminates the employee share of the insurance premium. (section 9)
· Leaves the Board of Appeals as the only way to resolve complaints, leading to a large increase in the number of cases before the Board. And the cost, estimated at more than $40 million, will come from tax revenues, impacting funding for schools and health care. (section 11)
· Grants the insurer full discretion to decide if workers are not cooperative and to cut off benefits or deny vocational rehabilitation training without any input from authorities. (section 11)
· The new tax structure would take effect 30 days following the election. However, the new private insurance cannot be sold for at least 18 months. During this period of time employers will have to cover the entire employee share of the insurance premium. This will mean a 25% tax increase hitting small businesses while the economy is still recovering. (section 15)
· Gives insurers special rights which include the right to talk to the injured worker’s doctor all the way through the claims process and right up to the end of the appeals process. (section 10)
· Appoints a business and insurance-oriented legislative task force that requires future legislatures to accept the Task Force’s interpretations of the measure. Under I-1082, this task force is given the power to change the law to benefit insurers without the elected legislature having the authority to change it. (section 13)
There are also many consumer protections which apply to other lines of insurance intentionally excluded from I-1082:
· Under I-1082, workers’ compensation insurance would not be under the safety net of the Insurance Guaranty Act which protects workers and employers in the case of fraud or bankruptcy by an insurer.
· Similarly, the new workers’ comp insurers treatment of injured workers are exempted from all consumer protection laws and the voter approved Insurance Fair Conduct Act – even though these laws apply to auto, home, health and every other type of insurance. They are also exempt from protections for injured workers that the State or self insured employers are subject to.
· Unlike in other insurance fields, this initiative does not require insurers to have an in-state adjuster, or any in-state training to handle Washington claims. They don’t even have to maintain toll-free numbers.
· There is no way under 1082 to recapture the funding for vital workplace safety programs and vocational retraining that are currently paid for by premiums. These costs will fall exclusively on taxpayers.
All told, according to independent budget experts, I-1082 would add a total of at least $275 million in direct new taxes-- over $200 million in new workers’ comp premiums for small businesses, $30 million in increased workers’ comp premiums for governments, and at least $40 million in taxes to pay for cost shift to taxpayers for Board of Industrial Insurance Appeals.
Cultural Competency in Health Services and Care
The Washington State Department of Health (DOH) is pleased to announce a new resource to help health care providers serving diverse populations of patients. A law passed in 2006 requiring all health care providers licensed by the department to receive multicultural health awareness education and training. The Cultural Competency i Health Services and Care – A Guide for Health Care Providers is a tool in that effort.
This guide is intended to increase the knowledge, understanding, and skills of those who provide health care in cross-cultural situations. The guide is available on the DOH Web page. We hope it will broaden your awareness of health disparities, provide a better understanding of why cultural competency is important, and illustrate some of the resources available to you. There are several online resources that offer continuing education credits. There are also resources with important information and statistics on the populations you serve.
For questions about this project, please contact Kris Reichl at Kristin.reichl@doh.wa.gov or (360) 236-4985.
