I wanted to know how hard it would be to be "in compliance" with reporting to HHS for the Insurance companies. Remember, there's a $1 per person, per day fee for Insurance companies that are out of compliance on their "report procedures." (See my blog on Health Care and the Insurance Companies.) So, I thought I'd take a look at just how the Senate health care bill says to report.
According to the part on penalties:
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(as determined under subparagraph (B)) against a health plan that has failed to meet the requirements under subsection (h) with respect to certification and documentation of compliance with--
`(i) the standards and associated operating rules described under paragraph (1) of such subsection; and
`(ii) a standard (as described under subsection (a)(1)(B)) and associated operating rules (as described under subsection (i)(5)) for any other financial and administrative transactions.
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OK, lets look up subparagraph (B)....(h)...(1)... that would say this:
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`(h) Compliance-
`(1) HEALTH PLAN CERTIFICATION-
`(A) ELIGIBILITY FOR A HEALTH PLAN, HEALTH CLAIM STATUS, ELECTRONIC FUNDS TRANSFERS, HEALTH CARE PAYMENT AND REMITTANCE ADVICE- Not later than December 31, 2013, a health plan shall file a statement with the Secretary, in such form as the Secretary may require, certifying that the data and information systems for such plan are in compliance with any applicable standards (as described under paragraph (7) of section 1171) and associated operating rules (as described under paragraph (9) of such section) for electronic funds transfers, eligibility for a health plan, health claim status, and health care payment and remittance advice, respectively.
`(B) HEALTH CLAIMS OR EQUIVALENT ENCOUNTER INFORMATION, ENROLLMENT AND DISENROLLMENT IN A HEALTH PLAN, HEALTH PLAN PREMIUM PAYMENTS, HEALTH CLAIMS ATTACHMENTS, REFERRAL CERTIFICATION AND AUTHORIZATION- Not later than December 31, 2015, a health plan shall file a statement with the Secretary, in such form as the Secretary may require, certifying that the data and information systems for such plan are in compliance with any applicable standards and associated operating rules for health claims or equivalent encounter information, enrollment and disenrollment in a health plan, health plan premium payments, health claims attachments, and referral certification and authorization, respectively. A health plan shall provide the same level of documentation to certify compliance with such transactions as is required to certify compliance with the transactions specified in subparagraph (A).
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and for (i)....(5)...
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`(5) OPERATING RULES FOR OTHER STANDARDS ADOPTED BY THE SECRETARY- The Secretary shall adopt a single set of operating rules (pursuant to the process described under subsection (g)) for any transaction for which a standard had been adopted pursuant to subsection (a)(1)(B).
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Soooo, what I get from that, is all insurance premiums WILL be electronically transferred....that would be whether you like it or not. Where does it say I have a choice in this matter? Where does it say, the consumer can choose to have funds electronically transferred, or write a check, or put it on Discover? It says electronically transferred. Period. And if they aren't, the insurance companies will be fined $1 per day, per person covered. Do you think they will drop you like a hot potato if you don't get your transaction electronically transferred? Do you think that will be your only option? And who do you think will have all that information? Tim Geithner. I don't want Tim Geithner having my electronic funds transfer information. China is hacking into our computers and the government is saying, don't look at China, they're not a threat.....
I can't even find section 1171, so how can I be in compliance with it? On the outside chance that it must mean section 1171 of the Social Security Act, I looked that up. Here is what section 7 of section 1171 of the Social Security Act says:
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(7) Standard.—The term “standard”, when used with reference to a data element of health information or a transaction referred to in section 1173(a)(1), means any such data element or transaction that meets each of the standards and implementation specifications adopted or established by the Secretary with respect to the data element or transaction under sections 1172 through 1174.
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So, now I have to look up sections 1172, through 1174? OK, to summarize, 1172 says that there has to be a standard for all electronic information transmitted. And when the government is involved, you can't use a standard already in place, because you didn't consult the government first before using it. We had a saying when I was in the Navy: If it makes sense, the government probably didn't do it.
1173 talks about safeguards. Reasonable safeguards. Have you seen the people they hire in the records departments of some of these places? Do I trust them with not only my personal medical history but now my financial records? I think not. And they want to set up procedures to sign stuff electronically. I signed a mortgage paper electronically....with the click of a mouse. Anyone could have done it. I called my husband, got his permission and signed his name...anyone could have done it without his permission. Scary thought. How could he have proven that I didn't have his permission?
1174 is a timetable. So 1171, 1172, 1173 will be carried out 18 months after the health insurance portability bill of 1996. They'll use that to change it to state health care bill instead of insurance portability, I imagine. Then they could say, you didn't raise a fit then why do it now?
So, in summary, I don't like the HHS telling me I HAVE to pay with an electronic transfer. I don't like the government telling any business how to submit a form. I worked for the government. I know how inefficient government forms are. Have you ever been to a government office to file for claims? It's going to be just like standing in line at the Welfare office, and I'm sure they are going to make everyone feel like a Welfare recipient. It's like I feel when I go to the department of motor vehicles. They know you have to go there, you have no choice, and most of them aren't very nice. They treat you like crap because you can't go anywhere else to get your business done. And they get paid high wages to treat you like crap. We the peons who are underpaid with our hands out looking for free money. "Please, Mr. Government, may I have some more?"
Not this skinny white chick. If they bump me from Tricare Prime, into Standard, or try to put me into anything else, they can pump sand. I'll refuse insurance all together and they can put me in jail. My parents will watch my children until I get out of jail.
Lori Ann Smith
I fight for Freedom, until the knock me down and I can fight no more.
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