OOA Third Party Bulletin September 2013

The Affordable Care Act (ACA)

The ACA requires all employers to notify their employees of the opening of the Marketplaces/Exchanges by October 1. The OOA sent an email September 18 about this. Click here for the correct link to the Dinsmore article.

The ACA continues to be confusing and “evolving”. There are several issues that this committee is attempting to clarify. In the near future, Mr. Cornett will have a meeting with key executive for insurers in Ohio. The purpose of this meeting is to lay the groundwork for the OOA to become a friendly advisor to these companies on eye and vision issues. This is a new approach. This is a huge step forward in terms of trying to obtain some consistency in the interpretation of the ACA and other issues. We are working hard on getting clarification but we don’t always control the agenda. Look for more on this in future bulletins.

*OOA Executive Director Rick Cornett and Consultant Mark Ridenour will give a one-hour presentation “An Update on the Affordable Care Act” Saturday, October 5 at 7:00 a.m. at EastWest Eye Conference. Register online at http://www.eastwesteye.org

Small Business Employer Update/ACA

The ACA defines small business as having 50 or fewer full time equivalent (FTE) employees and provides THE OPTION to purchase group insurance via the “Exchange” or “Marketplace”. IF you have fewer than 25 employees and if you choose to cover at least 50% of their health insurance premium AND average salaries are less than $50,000, you can receive a business credit. There is a sliding scale. More information can be found in the latest issue of Perspectives, online by clicking here or contact your insurance agent/broker.

HIPAA

AOA website has information about new HIPAA requirements including a manual to download at no charge. Click here for more information.

*Dr. Chuck Brownlow will present a one-hour HIPAA Update Friday, October 4 at 2:00 at EastWest Eye Conference. Register online at http://www.eastwesteye.org.

Laws Concerning Forces Discounts on Uncovered Services

Many of you are aware that some state legislatures are considering laws that present insurers from forcing providers to give additional discounts on non-covered items. There is a bill in the Ohio legislative process that clarifies this for Ohio providers. The OOA is monitoring this legislation.

OOA Supports Ohio Department of Aging Falls Prevention Campaign

The OOA is listed as a supporter on the Ohio Falls Prevention Resources Page. Click here to view the page.

Essential Health Benefit for Children

Dr. Brownlow shared the following question from an Ohio doctor:

A mother of two children presented with Medical Mutual for medical insurance and VSP Access plan. The doctor is running a kid’s special for school and had her pay a discount price. Someone from Toledo, OH area told her that with Obamacare all kids under 21 get free eye exams. My understanding is the free eye exam starts January 1, 2014. Can you clarify?

Dr. Brownlow’s response:

First, it’s not a “free” eye examination. The law states that ever medical insurance plan must include a benefit covering children’s eye examinations and glasses if needed. It’s just like all other insurance…it may be free or less expensive for the patient or the patient’s family because insurance is paying all or part of it, but it is not free. The provider will be paid by the insurer with any deductibles or co-pays paid by the patient or patient’s family. Also, the benefit does not go into effect until October 1, 2013 at the earliest and reimbursements to providers will be a matter for negotiation and contract, just like reimbursements for all other services.

OOA Third Party Committee: Dr. Rod Snow, Chair; Dr. Nathan Bjork; Dr. Rob Engel; Dr. Lee Favede; Dr. Heath Gilbert; Dr. Larry Gill; Dr. Steve Hansen; Dr. Jay Henry; Dr. Mark Horvath; Dr. Jason Miller; Dr. Pete Mogyordy; Dr. Michael Ringel; Dr. Bill Rudy; Dr. Dave Shilling; Dr. Steve Shroder; Dr. Ted Smiley; Dr. Brent Swartz

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