Health Insurance Industry Issues and Legislation

The utilization of healthcare services is trending upward, especially among people who have been vaccinated. Based on a Strata report, inpatient admissions, observations, emergency room, and outpatient visits were all up in March versus the prior month. Most were up over 6%. As expected, admissions and visits increased most sharply for patients over 65 who have the highest levels of vaccinations, but the numbers increased significantly for younger patients, too.

"As people are getting vaccinated, things are returning to normal. They're going for routine screenings that are more invasive, and they're willing to go to the hospital if something is seriously wrong," said Steve Lefar, executive director of StrataDataScience. "That's a sign that confidence is returning and care is returning to normal."

Additionally, more and more people are starting to seek care that had previously been deferred. Much of this deferred care is lower acuity, from less emergent cases. However, emergent care may also continue to increase as restrictions are reduced and more people increase their activity levels.

Increased utilization will mean more claims and more costs that payers will need to manage and control.

As healthcare service utilization increases rapidly, so, too, will self-insureds need to make certain they are paying only the appropriate amount for the healthcare services their plan enrollees utilize. Multiple cost containment tools are available that smart self-insured commercial and government entities are using to control their healthcare spend.

Free pre-screens and no charge appeals support are two of the many reasons payers choose and stay with H.H.C. to reduce their healthcare spend. H.H.C. Group provides Line Item Medical Bill Reviews (LIR) of large dollar out-of-network and in-network (when allowed) facility claims.

H.H.C. Group initially earned accreditation from URAC for both Internal and External Reviews in 2004. Now in more than thirty states, we're among a handful of companies authorized by the states to provide these types of reviews.

At H.H.C. Group, we're often asked to make independent determinations of medical necessity for dependent care services (dcs). In one case a 23-year-old blind woman with multiple conditions living at home had requested the continuation of 168 hours of dcs a week. Due to changes in her situation, our Board Certified physician specialist determined that due to changes in her situation, only 84 hours of continued dcs were justified.