Coordinated Care

International Health Fund

JOURNAL: ISSUE 3 - 2015

For participants covered by the International Health Fund (IHF) as well as most other plans, understanding the concept of coordinated care is important to getting the greatest value from your healthcare benefits and limiting financial risk.

When you or a family member become ill, there are often other things on your mind than whether the provider you have been referred to by your physician is in your medical plan’s network. But it’s essential to pay attention to because costs for an out-of-network provider can be significantly higher than an in-network provider. Some plans don’t cover out-of-network coverage at all. Says IHF Executive Director Robin Donovick, “It’s really important to know where you can find out about your plan’s network. IHF participants can find in-network providers at www.myuhc.com.”

The Case for In-Network Providers

When selecting a physician, it may be beneficial to see a multispecialty group practice where doctors are employees of the organization, which then contracts directly with hospitals to coordinate care in an optimal matter. Sometimes the physicians are not employees but have integrated services with health plans or hospitals. These are known as Accountable Care Organizations (ACOs), which were created as a result of the Affordable Care Act (ACA). ACOs are designed to improve patient care, reduce costs, and provide incentives for providers to be engaged in the patient’s health.

Again, if treatment is not urgent, says Donovick, “It’s best to schedule tests or procedures at a hospital or outpatient facility in your network. Many providers such as anesthesiologists and radiologists, known sometimes as ancillary providers, don’t sign network contracts. But if that provider treats you in a network facility, plans typically cover all providers in the facility as in-network, thus reducing cost-sharing and financial risk of the patient.”

In an emergency, go to the nearest facility. Don’t worry about whether the facility is a network provider. Plans typically cover emergency admissions as in-network regardless of whether the facility is in the network.

King v. Burwell

The Supreme Court ruled on June 28th that the Affordable Care Act (ACA), also known as Obamacare, is constitutional, a decision that will protect the most significant health care reform law in a generation and keep millions of Americans protected. The ruling does not immediately impact multiemployer Taft-Hartley plans such IHF and BAC health care plans, although BAC President James Boland commented, “The ACA has accomplished a great deal – millions more have coverage, pre-existing conditions are a thing of the past, and young adults can stay on a parent’s plan through age 26. But the fact remains that in the U.S. we’re still spending twice what other developed nations are on healthcare. We can and must find better ways to address rising costs.”

If you or your family member does not have coverage under a CBA, you may be eligible to receive tax subsidies if you enroll in an Exchange. Log onto Working America at http://workingamericahealthcare.org/ for information. 
 

Members Get the 4-1-1 on IHF Private Health Exchange 

In rolling out the IHF Private Health Exchange program (see Issue 2, 2015 Journal, p.21), the IHF held web seminars at member meetings in Alabama, Texas and Oklahoma in early July at which IHF staff answered questions from members and their spouses about the new plan options now available to members of Locals 8 SE and 5 OK/AR/TX (options that other IHF Locals are considering instituting).