Thursday, October 29, 2009

GP Health Insurance Coming to Small Business in Asheville

I have been querying the Asheville Chamber of Commerce about the possibilities of health insurance for the myriad small business in Asheville. Carol Hensley, associated w/ that organization, directed me to the Chamber of Commerce website re: this matter and I followed it to the bill which was signed by Governor Easley in August, 2009.

Here is what is at the Asheville Chamber of Commerce:

Asheville Area Chamber's Health Insurance Pilot Program Passes NC House and Senate
Contact: Carol HensleyAssistant Vice President Small Business and Entrepreneurship (828) 258-6116

The Health Insurance Pilot Program or H.B. 212 passed the North Carolina General Assembly on August 6, 2009 and was delivered to Governor Perdue on Friday, August 7, 2009 where it awaits her signature of approval.

The Health Insurance Pilot Program aims to allow the pooling of small and large businesses with hopes to demonstrate an affordable employer based health insurance plan for businesses. The pilot program could help to insure as many as 25,000 workers in the Asheville area.

The Asheville Area Chamber of Commerce and the Business Healthcare Roundtable have been working on a plan to provide affordable health insurance for local employees and employers for the past six years. The process has involved discussion with and input from large and small business in Buncombe County, physician groups, Blue Cross and Blue Shield, and United Healthcare. “Asheville is comprised of many great small businesses. We have long recognized the rising cost of health insurance and the inability of many of our small businesses to afford insurance for their employees. We are excited that Asheville can lead in the attempt to help bring affordable health insurance to North Carolina,” said Richard J. Lutovsky the President & CEO of the Asheville Area Chamber of Commerce.

Chamber employees and leaders from Western North Carolina are now working diligently to put the pilot program into practice. Many of Buncombe County’s largest employers will be participating in the final design of the product. H.B. 212 received unanimous support of all the members of the Western North Carolina delegation. The bill’s primary sponsors are Representatives Bruce Goforth, Susan Fisher, Ray Rapp and Jane Whilden. “This is a great opportunity for Western North Carolina to be the first pilot program in the state that allows employers to work together to reduce health insurance costs and make it easier for our companies to provide the insurance that so many residents need today,” said Representative Bruce Goforth. Senator Martin Nesbitt led the efforts in the North Carolina Senate.

Here is some info re: the law signed:
H 1
Short Title: Health Insurance Pool Pilot Program. (Public)
Sponsors: Representatives Goforth, Fisher, Rapp, Whilden (Primary Sponsors);
K. Alexander, Bell, Bryant, England, Faison, Hurley, Insko, Lucas, McElraft,
Tarleton, Wainwright, R. Warren, and Wray.
Referred to: Insurance, if favorable, Commerce, Small Business, and Entrepreneurship.
February 18, 2009
5 The General Assembly of North Carolina enacts:
6 SECTION 1. Notwithstanding any other provision of law to the contrary, health
7 insurance demonstration projects ("Demonstration Projects") for large and small employees
8 may be established by eligible sponsors ("Eligible Demonstration Project Sponsors"). Specific
9 Demonstration Projects, the goal of which is to reduce the number of uninsured North
10 Carolinians and to reduce the cost of health insurance for all purchasers of health insurance in
11 the Demonstration Project areas, may begin not later than April 1, 2010, and may continue
12 through December 31, 2014. Entities which are eligible under subdivisions (b)(1) and (b)(1a)
13 of G.S. 58-51-80 to have issued a policy of group health insurance are Eligible Demonstration
14 Project Sponsors. A Demonstration Project must comply with the following:
15 (1) The products for any pooling of groups are fully insured by an insurer
16 authorized to issue coverage in North Carolina.
17 (2) The insurance is issued through a group master contract with a bona fide
18 association as defined in G.S. 58-68-25 or a trust or other legal entity that,
19 pursuant to G.S. 58-51-80, is capable of entering into a group master
20 contract.
21 (3) The pooling arrangement requires that all small employers desiring to join
22 be accepted and that all eligible employees of each employer who elect
23 coverage through the participating employers be included in the pool.
24 (4) Each employer participating in the pooling arrangement and its employees
25 are offered the same benefit plan.

MEDICARE:CIGNA Government Services Does not List the 80% Hlth & Behavior Codes But They Do Pay Them

Just a heads up to people: CIGNA Government services, carrier for medicare in NC; TN; ID does not list on its CD that they send you in the mail, the Health & Behavior codes which pay at the 80% medical rate. However, they pay me for it. Even Humana pays me for the H & B codes tho there is no forthcoming information that they will honor these. Caveat: w/ Humana, send all your notes in w/ your CMS 1500 forms or they will balk at paying you.

I was just looking thru the '2009 North Carolina Medicare Clinical Psychologist Fee' and the H & B codes are not there there and that means that psychologists will not be alerted to use it. Interestingly, 90801 is not subject, according to this memo, to 62.5% mental health rate.

These CPT codes also are not subject to 62.5% mental health rate according to that CIGNA bulletin:

90802 96101 96102 96103 96105 96110 96111 96116 96118 96119 96120 96125

Saturday, October 17, 2009

Haywood Reg Med Cntr opens Service Member's Counseling & Support Center

Some Mental Health Services Cut While Others Put Into Place
by Marsha V. Hammond, PhD Licensed Psychologist, NC
828 772 1127, cell phone
e mail:

On October 16, 2009, in Asheville, Mountain Area Health Education Center made available training for mental health providers who desire to work with veterans and their families. In striking contrast to the cutting of mental health care services, particularly for NC state funded/ IPRS (non-insured; no Medicare, no Medicaid) consumers, monies have been allocated for the mental health care of veterans and their families.

On October 1, 2009, the 'grand opening' of Service Member's Counseling and Support Center took place at Haywood Regional Medical Center Urgent Care Center. Haywood county has more residents in the National Guard than any other county in NC. Additionally, the rates of National Guard veterans reporting mental health problems is 49% according to CSSP (Community Service Systems Providers).

In western NC, veterans can receive health care at the VA in Asheville but there is only one satellite clinic in western NC, specifically, Franklin. Providers can utilize TRICARE as insurance associated with veterans. Health Net Federal Services manages TRICARE for NC.

Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) not uncommonly are experienced by veterans when in Iraq or Afghanistan. The sequelae of PTSD include temper control problems, social isolation, boredom, and contributes significantly to marital and relationship difficulties. TBI can be subtle and is reflected in problems with speaking, hearing, seeing, or organizing one's thoughts, as well as headaches and impulsive behavior.

This support center's available information indicates a strategy of 'no one turned away' and can be contacted at 452 8354. This is a very welcome addition to mental health care services in mostly rural western NC.