Clean Hands


A friend of mine, an attorney, had a couple of quick questions about Medicare.  He will be turning 65 soon and needed to confirm that he didn’t have to sign up for Medicare Part B since he plans to stay on his wife’s group health policy.  I verified that his wife works for a company with over 20 employees.  So yes, he doesn’t need Medicare Part B.  But, I asked, is the group plan a High Deductible Health Savings Account (HSA) Qualified Policy and do you contribute to the HSA?  He confirmed that Yes and Yes.  In that’s case, he must renounce Medicare Part A, too.  You can not contribute to a Health Savings Account if you have Medicare.  In fact, there is a six month look-back.  He didn’t know.  And if an attorney could have accidentally screwed this up, what are the chances that your average office worker or machinist couldn’t make the same mistake?

Capitol Conference, the annual opportunity for members of the National Association of Health Underwriters to hear from members of the administration and meet with our elected officials, was the last week of February.  Fourteen of us from Northeast Ohio were part of the audience of over 700 that heard from Seema Verma the Administrator of the Center of Medicare and Medicaid Services (CMS).  House members Lauren Underwood (D-IL), Joe Courtney (D-CT), Greg Walden (R-OR), Kurt Schrader (D-OR), Adrian Smith (R-NE) as well as Senator Todd Young (R-IN) shared their views on pending legislation.  The speeches were interesting, the graphs (!) colorful, but the most important part of our annual trip to Washington are our scheduled appointments with our Congressman and Senators.

For many of us, our favorite appointment each year is with Abby Duggan, Senator Sherrod Brown’s legislative aide.  We appreciate that she is well prepared and that Senator Brown has shown a real interest in some of our issues.  Ms. Duggan has acknowledged that we come with “Clean Hands”.  Our issues – Surprise Billing, Employer Reporting, and the big Medicare concerns dealing with the Observation Trap, COBRA as Medicare compliant, and HSA’s – have nothing to do with our incomes.  We are here to solve problems, to represent our clients.

Senator Brown is the sponsor of S. 753 which would allow observation stays to be counted toward the three day mandatory inpatient stay for Medicare coverage of a skilled nursing facility.  This happens to be one of our priorities.

We talked about the Medicare COBRA and HSA issues in Senator Brown’s office three days before my friend asked his questions.  H.R. 2564 and H.R. 3796 address these problems.  Our members discussed these bills with every Congressman and legislative aide we met.

Our #1 issue was Surprise Billing / Balance Billing.  As Congressman Walden noted, 1 in 5 emergency room visits and 1 in 6 hospital admissions produce a Surprise Bill.  We’ve discussed and defined Surprise Billing in previous posts.  Our goal is to take the unsuspecting client out of the equation and to focus on reimbursement being tied to the median in-network amount determined by reasonable, contracted amounts paid by private health plans to similar providers in a geographic area.  Obviously, we don’t want our clients forced into arbitration.

Our friends and clients count on us for good advice and to be alert to their needs.  Our periodic trips to Washington and our state capitols allow us to work with our elected officials to make health insurance, the way most Americans access and pay for health care, better.  We carry with us two messages wherever we go.  All health care is local.  And, we are all on the same team.


Pictures – Looking For Something To Read At The Library Of Congress – David L Cunix

And – A Plane Washington – David L Cunix



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