Alliance of Claims Assistance Professionals

ACAP Position on Health Insurance Reform, October 2009

21 Steps to Better Health Insurance -- A Proposal for Health Insurance Reform

The Alliance of Claims Assistance Professionals (ACAP) is a national organization of professionals who assist patients and families with problematic medical billing issues. We advocate on behalf of patients with their insurance companies and healthcare providers. This makes the Alliance uniquely positioned to understand the flaws in the current health insurance system.

Our members see patients and their families struggle with confusing paperwork, exorbitant bills, denials, misapplication of benefits, network and coverage confusion, and poor customer service. Providers are dropping out of Medicare and insurance company networks at an alarming rate, leaving patients struggling to find new doctors. Low-income patients with Medicaid find it difficult to locate participating providers. Patients with pre-existing conditions are unable to obtain coverage or have unaffordable premiums.

Our perspective enables us to identify systemic improvements that would benefit all major groups affected by health insurance legislation, patients, doctors and health insurance companies. The Alliance of Claims Assistance Professionals believes that meaningful health insurance reform must have the following goals:

Elimination of all underwriting restrictions and rescissions.
Elimination of insurance annual and lifetime maximum benefits.
Universal coverage with affordable premiums based on patient income.
Fair payment rates for providers to ensure access to quality care for all patients.
Elimination of in network and out of network distinctions in coverage.
A standardized way for providers to submit claims.
A mandated percentage of premiums to be spent on healthcare services.
Limits on patients' annual out-of-pocket medical expenses.
Elimination of discrepancies in individual state mandated benefits and administrative policies.

To accomplish the above goals, the Alliance recommends the following changes to the current health insurance system.

Insurance Coverage

Establishment of a basic package of services that all plans must cover, including group health plans and Medicare.
Guaranteed acceptance, with no underwriting or rescission permitted.
Creation of a national public option, to include all state and federal government employees, current Medicaid recipients and people not insured elsewhere.
Mandated enrollment, with individuals enrolled automatically in the public option if a plan isn't chosen.
Elimination of dual coverage for two-earner households.
Elimination of prescription deductibles in plans with medical deductibles.

Insurance Regulation

Administrative fee caps to ensure premium dollars are being spent on healthcare and not on administrative bureaucracy.
Published annual performance audits of claims turnaround, customer service and provider relations, with financial penalties for poor performance.

Administrative Efficiencies

Standardized billing requirements across plans.
Establishment of fair, published, regional reimbursement schedules that apply to all plans (reimbursement rates will not be negotiated by insurance companies).
Elimination of prior authorizations and other paperwork requirements that create burdens on providers and patients.
Elimination of medication formularies, pharmacy prior authorizations, step therapy and quantity limit requirements.
Establishment of a national patient identifier to simplify identification and claims processing throughout the country.
Establishment of a federal Patients? Bill of Rights to give all patients codified recourse against providers, billing services and insurance companies.

Medicare Reform

Elimination of the "donut hole" for Medicare Part D recipients.
Elimination of regional carrier and intermediary local medical review policies, so that coverage and benefits are consistently applied on a national level.
Increase in income levels eligible for Part B and Part D premium and coinsurance subsidies.
Elimination of subsidies for Medicare Advantage plans and to corporations retaining retiree drug coverage.
Reinstatement of monthly Medicare Summary Notices to patients.

Provider Reforms

Require that all providers submit claims and accept the standard reimbursement for covered services.
Development of a standardized patient statement including all the information submitted to the insurance company, including coding.