As deductible and co-pay amounts continue to grow in employer-sponsored health care plans, employees are taking greater advantage of the so-called account-based plans that help them pay for deductibles and co-pays with dollars that are set aside in a tax preferred account. Health Reimbursement Arrangements (HRAs) and Flexible Spending Accounts (FSAs) are helping millions of Americans save money on their out-of-pocket health care expenses.

However, the IRS requires that dollars claimed from these types of plans be approved, or “substantiated” by a third party administrator (TPA) who insures that they meet the requirements of a qualified medical expanse. In most instances, the TPA will require the employee to submit a receipt so the claimed expense can be verified.

The increased use of debit cards associated with these types of accounts has eliminated the need for some of this paperwork, but has created its own set of substantiation challenges. While the cards are able to “auto substantiate” many of the transactions that occur at drug stores and physician offices, some purchases still need to be verified manually by the TPA and this requires the employee to submit a receipt for money that has already been disbursed from the plan.

That happens if the employee no longer has a receipt, or if the purchase does not qualify as a medical expense? In most cases the employer must find a way to collect the non-substantiated amount from the employee, or add the amount as taxable income onto the employee’s W2 at the end of the year. Both of these alternatives create additional paperwork for the employer, and a potentially negative experience for the employee.
Now there is a better way to deal with these unsubstantiated debit card claims. Acclaris, a platform and business service provider leader that enables its clients to transform the way they offer and administer consumer-driven health and reimbursement accounts, has introduced an industry leading claims offset feature that allows the consumer to use yet unclaimed dollars to offset the amounts that were previously claimed, but for which the consumer does not have a valid receipt.

With this new feature, which is available online and on mobile devices, Acclaris enables its client’s consumers to make their own decisions about how to seek reimbursement for eligible expenses. Additional paperwork and potential embarrassment is eliminated as consumers can simply choose to scan and upload images of previously unclaimed paper receipts / EOBs, or use the portal to designate currently unclaimed carrier claims to offset previously unsubstantiated transactions.

About Acclaris, Inc: Through our clients we serve more than 1.8 million active account holders. Acclaris enables our clients to transform the way they offer and administer consumer-driven health and reimbursement accounts, maximizing their revenue and profit opportunity. Our integrated end-to-end operations, consumer focus and true private label approach help our clients increase revenue and lower costs, while delivering market leading CDH products and services under their own brand.
To learn more visit the Acclaris website at http://www.acclaris.com.

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PITTSBURGH (June 21, 2012) — Highmark Inc. announced today that it will open a Highmark Direct retail health insurance store in Erie, Pa. The store will be the ninth location in Pennsylvania.

“Across other parts of the state, the Highmark Direct stores have helped customers better understand health insurance and make more informed decisions about their health,” said Matt Fidler, Highmark vice president of consumerism and retail marketing. “With the addition of the Erie store, we’ll be able to reach even more Pennsylvanians who need health insurance support.”

Highmark opened its first two Highmark Direct stores in March 2009, added four stores in 2010 and two additional stores in 2011. Since inception, the stores have seen more than 144,000 visitors and provided health insurance to thousands of individuals and their families.

The Highmark Direct Erie store is scheduled to open in August and will be located at 5753 Peach Street in Kingswood Plaza. Eight additional employees will be hired as staff for the new store location.

Highmark Direct offers consumers in Highmark’s service area the opportunity to meet one-on-one with a health insurance specialist to discuss their health insurance options and their benefits as a Highmark member. The stores sell health insurance plans to individuals, seniors and small businesses, as well as ancillary products such as dental insurance, critical illness and accident insurance as well as a personalized genetic health program.

About Highmark
Highmark Inc., based in Pittsburgh, is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Highmark serves 4.9 million members in Pennsylvania, West Virginia and Delaware through the company’s health care benefits business and is one of the largest Blue plans in the nation. Highmark has 20,000 employees across the country and provides a broad range of health and wellness related services through subsidiary and affiliate companies. For more information, visit www.highmark.com.

 

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HARTFORD, Conn., June 19, 2012 — Aetna’s (NYSE: AET) work life platform Aetna Resources For Living has been combined with the Consult A Doctor™ 24/7 telemedicine service to provide employees with easier access to resources that help improve overall health, work/life balance and workplace productivity. Consult A Doctor Plus™ is a unique, on-demand solution that also allows employers to better manage health care costs by providing members with the help and support they need – where, when and how they need it.

Consult A Doctor Plus (CADR+) enables consumers to contact physicians, either by phone or email, for specific questions they may have. This product provides members with a variety of benefits, including:

  • Confidential 24/7 telephonic consultation and prescription-writing.
  • Access to Aetna Resources for Living work life resources and support.
  • Patient advocacy bill review/mediation, provided by The Karis Group.
  • Access to online wellness tools and health records.
  • Legal and financial consulting.

“We are pleased to work with Providence Financial Group to provide those in need with support and services in all areas of physical, emotional, psychological and social well-being,” said Louise Murphy, head of Aetna Behavioral Health. “Aetna Resources For Living is a suite of offerings designed to engage people in addressing lifestyle issues and workplace stresses by providing a comfortable and safe environment for our members. This platform together with Consult A Doctor creates a concrete combination of medical and work life services.”

Powered by TeleCare 3.0, Consult A Doctor provides customized versions of its telemedicine platform to meet the needs of all the major constituents in healthcare, including practices, hospitals, clinics, health plans and employers.

“With Consult A Doctor Plus, we are able to work hand-in-hand with Aetna to reach beyond traditional, primary care settings and explore new opportunities within the telemedicine spectrum of health care,” said Wolf Shlagman, founder and CEO, Consult A Doctor. “We are excited to provide employers with a faster, more convenient and affordable resource that gives members access to such services anytime and anywhere.”

About Providence Financial Group

Providence Financial Group (PFG) is a sales and marketing organization of industry-leading financial products and services, marketed primarily through contracted agents and brokers.
PFG is an authorized representative of both Aetna Behavioral Health and Consult A Doctor, and Reseller/Administrator of the Consult A Doctor Plus program. For more information please visitwww.pfgef.com or contact us at www.pfgef.com/contact.

About Consult A Doctor
Consult A Doctor is the leading innovator of cloud-based telemedicine services and technology platform solutions empowering organizations to lower healthcare costs, provide revolutionary access and improve outcomes. With years of experience delivering direct-to-employer and consumer telemedicine services that offer convenient 24/7 access to doctor consultations by phone, email and video, Consult a Doctor has saved employers millions of dollars in unnecessary healthcare costs, and added millions of dollars of productivity to the bottom line by helping keep employees at work and healthy. Its telemedicine network of U.S. board certified physicians in all 50 states has made it possible to give on-demand care, anytime, anywhere with access to care in the lowest cost setting. Consult A Doctor is further transforming the economic equation of care by partnering with payers, providers and other organizations to deploy its telemedicine platform solution that grants its members and patients unmatched access to quality care, offers a new revenue source for providers, and lowers costs for health plans, employers and groups. For more information about Consult A Doctor, please visit www.consultadr.com, emailtelecare@consultadr.com or call 888-688-DOCT (3628).

About Aetna
Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 36.1 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services and health information technology services. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.

 

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CHICAGO, June 13, 2012 /PRNewswire via COMTEX/ — Consumers enrolled in Consumer Driven Health Plans (CDHPs) are more likely to make sustainable, positive behavior change leading to significant health plan spend reductions year over year, according to data studied by Health Care Service Corporation (HCSC), operator of the Blue Cross and Blue Shield Plans in Illinois, Texas, Oklahoma and New Mexico. Members who migrated to CDHP plans – those that have a higher deductible, prompting consumers to be more directly involved with the selection and usage of health care services – reduced their health care spending significantly.

This study is unique because of its focus on tracking individual members who migrated from traditional health plan coverage to CDHP coverage in order to analyze their health care behavior and their health care spending habits both before and after the switch. The data also showed that changes in behavior, including increases in preventive care and use of generic prescriptions, helped contribute to a reduction in health care spending for both employers and members.

The CDHP program, BlueEdge(TM), is offered through the four Blue Cross and Blue Shield Plans, and includes Health Savings Account (HSA) and Health Reimbursement Account (HRA) options. BlueEdge enrollment surpassed 1.5 million members earlier this year, after experiencing double-digit percentage increases for six straight years.

Key results from the study indicate that, following migration from a traditional non-CDHP plan to a CDHP, on average, the CDHP members studied:

  • were four percent more likely to take advantage of preventive services.
  • reduced health care utilization by an aggregate of more than 12 percent.
  • were 10 percent more likely to fill their prescriptions with generics.
  • spent 24 percent less on inpatient hospital services and eight percent less on outpatient services.
  • had a 12 percent decrease in emergency room visits.
  • reduced combined medical and pharmacy spend by an aggregate of 11 percent

In addition, data showed that employers who offered only a CDHP saw even greater spend reductions – up to an aggregate of 14.4% over the three years following migration from a traditional plan to a CDHP.

“Our BlueEdge CDHP program gives consumers the flexibility and tools to help make positive decisions to reduce their healthcare spend, coupled with broad access to care, award-winning service, comprehensive incentives, wellness and care management programs, and a personalized, engaging health care experience,” said Thomas Meier, Vice President, product development, HCSC. “Our experience finds that CDHP members tend to be more engaged and informed in making better health care decisions.”

This is the second year that HCSC has done this analysis, this year studying more than five years of data for more than 265,000 members (with pharmacy data available on 121,000 of those members). HCSC continues to invest in more consumer focused approaches, adding more robust incentives and value-based insurance design products in 2013 to complement both traditional and CDHP plans.

“Our findings are significant because they indicate both real and potential health care spend reductions. Rather than comparing the utilization of different groups of consumers, we have focused on the utilization changes of members who migrated from traditional plans to CDHP. The fact that we are comparing the same members in both plans allows us to minimize inherent risk differentials,” said Guy McGinnis, Vice President, client analytics, HCSC.

About Health Care Service CorporationHealth Care Service Corporation, a Mutual Legal Reserve Company, is the country’s largest customer-owned health insurer and fourth largest health insurer overall, with more than 13 million members in its Blue Cross and Blue Shield plans in Illinois, New Mexico, Oklahoma and Texas. HCSC is an independent licensee of the Blue Cross and Blue Shield Association. For more information, please visit www.HCSC.com , visit our Facebook page or follow us at www.twitter.com/HCSC .

SOURCE Health Care Service Corporation

 

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New Program Helps Aetna Members Make Informed Decisions When Considering Surgery

June 11, 2012

HARTFORD, Conn., June 07, 2012 — Surgery often is the most extreme approach to care for most health conditions, and in many cases, alternative options for care are available. Aetna (NYSE: AET) recently made the Welvie Surgery Decision Support Program available to help Aetna members who are considering surgery work with their health care providers to make the [...]

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Consumers Are Ready to Adopt Mobile Health Faster than the Health Industry is Prepared to Adapt;

June 8, 2012

NEW YORK, June 7, 2012 /PRNewswire/ — Widespread adoption of mobile technology in healthcare, or mHealth, is now viewed as inevitable in both developed and emerging markets around the world, but the pace of adoption will likely be led by emerging markets and lag consumer demand, according to a new global study conducted for PwC Global Healthcare by [...]

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Wellmark and Genesis Health System enter into Accountable Care Organization

June 5, 2012

Today, Wellmark Blue Cross and Blue Shield of Iowa officially announced a collaboration with Genesis Health System in Davenport to create an Accountable Care Organization (ACO). The new ACO will focus on coordinating patient care to improve quality, provide greater value, and slow increases in health care costs. Genesis Health System President and CEO, Doug [...]

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Priority Health Launches MyGo Points Facebook App to Motivate Healthy Lifestyles, Encourage Tourism

June 1, 2012

GRAND RAPIDS, Mich.–(BUSINESS WIRE)–Priority Health has developed a Facebook app, called MyGo Points, in an effort topromote health and wellness among Michigan residents, as well as support local tourism. The app, which launched May 1, givespeople the opportunity to earn points to win prizes by participating in activity-based events and Facebook challenges. “Priority Health is [...]

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One year later, Capital BlueCross Accountable Care Arrangements proving successful

May 2, 2012

HARRISBURG, Pa., May 1, 2012 /PRNewswire/ – Today marks the one-year anniversary of Capital BlueCross’ launch of two Accountable Care Arrangements (ACA). Preliminary results demonstrate that this innovative care delivery model is improving care coordination, lowering the medical cost trend, and improving the member’s management of chronic conditions and overall satisfaction with care.  This initiative builds off of [...]

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TriZetto Founder Jeff Margolis Fusing Healthcare Population Management and Social Networking

January 10, 2012

DENVER, Jan. 9, 2012 /PRNewswire via COMTEX/ — Well known for founding healthcare payer software powerhouse, The TriZetto Group, and growing it to return $1.4 billion to shareholders in just 10 years, as well as authoring The Healthcare Cure, Jeff Margolis is now focusing on the opportunity to improve healthcare value through social networking technology. [...]

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