Note-This post is about 99.9% etched in stone with concern to my thoughts and ideas.
WHAT IS UNIVERSAL PRIMARY PAYER HEALTH CARE?
-Universal Primary Payer Health Care or "UPP CARE" is a government health care plan that functions differently from other proposed health care plans.
-UPP Care closely resembles the proposed government controlled Single Payer health plans BUT it goes several big steps further by allowing those participants covered under the plan the option to have ALTERNATE INSURANCE (such as private insurance). A tax voucher is possible at the end of the year IF the individual's alternate insurance qualifies.(See post on Vouchers).
-UPP Care is intentionally designed NOT to compete with private insurers but to actually work in harmony with them. It does this by providing options for it's active participants to choose from so that their ALTERNATE INSURANCE can pay for medical procedures performed using the SAME negotiated discounted rates that the UPP Care plan uses. This is PROVIDED that the procedure or benefits are IDENTICAL to the UPP Care plan.
The term alternate insurance includes private insurance, group insurance, self insurance, non-profit insurance, charity medical funds and alike.
One way to make identical coverage easier to verify is to require ALTERNATE INSURANCE to adopt UPP Care's legal policy language so that an identical match between benefits and procedures is without question identical.
-UPP CARE would AUTOMATICALLY BY LAW become the PRIMARY PAYEE (first payee) for ONLY those medical procedures that are included in the plan and for those participants that decide to remain ACTIVE PARTICIPANTS in the plan.
An active participant is one that is eligible for coverage under the UPP Care plan and does not reject being included into the plan by officially notifying the UPP Care Administrator by filing and singing an UPP CARE PARTICIPATION REJECTION form.
-Under the UPP Care plan any COVERED medical procedure or benefit that is performed on a participant of the plan would be paid by the government's UPP Care plan FIRST, UNLESS the government's UPP Care Administrator is told in writing by the participant that the individual has chosen an ALTERNATE INSURER to be the ALTERNATE PRIMARY PAYEE (Plan A or B) or the FINAL PAYEE.
ALTERNATE PRIMARY PAYEE-
-An ACTIVE PARTICIPANT in the UPP Care plan can TEMPORARILY release UPP Care from the obligation of paying or controlling the individual's medical bills as PRIMARY PAYEE. This is done to allow the active participant's alternate insurance to pay the medical bills DIRECTLY with or with out the option of paying using UPP Care's discounted rates.(See Plan A & Plan B options below). This selected option is TEMPORARY and can be changed.
This plan option DOES allow the alternate insurer to pay the medical bills using UPP Care's negotiated discounted rates. However, there is a fee charged to the ACTIVE PARTICIPANT'S account for the permitted use of the UPP Care's rates by the ALTERNATE INSURER. This charged fee will reduce a tax voucher to some degree at the end of the year if the individual's alternate insurance qualifies.(See post on Vouchers).
This plan option DOES NOT allow the alternate insurance to pay the medical bills using UPP Care's negotiated discounted rates. This could allow for a full tax voucher at the end of the year if the individual's alternate insurance qualifies.(See post on Vouchers).
This option would require UPP Care to pay FIRST but then the ALTERNATE INSURER would simply be sent a copy of the bills to permit reimbursement to UPP Care. If full reimbursement of costs are made to UPP Care by the end of the year then a higher tax voucher could be possible if the individual's alternate insurance qualified.(See post on Vouchers).
-If no ALTERNATE PRIMARY PAYEE or FINAL PAYEE is selected then the government option remains the PRIMARY PAYEE (first payee) and also the FINAL PAYEE as well.
-One advantage of the ALTERNATIVE PRIMARY PAYEE option is that it permits an active participant with alternate insurance to re-route the payment of a claim to the alternate insurer. By re-routing the claim to an alternate insurer the active participant reduces or eliminates claim costs charged to the UPP Care plan and could possibly receive a higher tax voucher if his alternate insurance qualifies at the end of the year.(See post on Vouchers).
-Another advantage of ALTERNATIVE PRIMARY PAYEE option is that an individual that is an ACTIVE PARTICIPANT in the UPP Care plan can use the plan as a BACK-UP plan should his alternate insurance be lost during the same time period or for some reason not pay the medical bill. This could be done with little if any cost to the individual if the individual's alternate insurance qualifies for a full tax voucher at the end of the year. The size of the tax voucher would depend on the outcome of who pays the medical bills in the end.(See post on Vouchers).
-MINIMUM REQUIREMENTS TO PAY USING UPP CARE"S NEGOTIATED DISCOUNTED RATES-
For a alternate insurer to be able to pay the subscribers medical bills using the governments discounted rates, one of the following requirements must be meet and maintained:
A) INDIVIDUAL PARTICIPATION OPTION-
In this option, the individual must remain an ACTIVE PARTICIPANT in the government's UPP Care plan and pay taxes into the plan to permit his chosen alternate insurer the option of reimbursing the medical bills using UPP Care's negotiated reduce rates. When an individual's alternate insurance uses UPP Care's discounted rates their is a charge to the individual's account for the use them. This will then reduce any possible tax voucher to the active participant at the end of the year should he apply and qualify for one.(See post on Vouchers).
B) PRIVATE INSURER GROUP PARTICIPATION OPTION-
This option could be available to private insurers permitting them to use UPP Care's negotiated discounted rates for identical benefits for an annual fee to UPP Care. This would permit a private insurer to pay any identically covered medical procedures or benefits using UPP Care's negotiated discounted rates even if the individual that received the treatment WAS NOT an ACTIVE PARTICIPANT in the government's UPP Care plan. This permits those that may be in-eligible to receive UPP Care the benefit of paying medical bills at UPP Care's discounted rates indirectly.
If the private insurer's treated individual subscriber IS NOT a participant of the UPP Care plan but the private insurer has paid a fee to UPP Care for the use of the negotiated discounted rates then the private insurer would be permitted and responsible to DIRECTLY pay the individual's medical bills using the government's negotiated discounted rates. Their would be no reason for the UPP Care plan to be involved with the payment process beyond providing necessary information and proof to the parties involved that the private insurer is permitted to pay using the UPP Care's negotiated rates. By law, payments paid at UPP Care's negotiated discounted rates would have to be accepted under this option.
If however, the private insurer's treated individual subscriber IS also an ACTIVE PARTICIPANT in the government UPP Care program then should it be necessary, the government could still be requested to pay the medical bills in the end the same way as if the individual selected an ALTERNATE INSURANCE option as previously mentioned.
-WHAT UPP CARE IS NOT.
-UPP Care is not a co-op. The government has full control over the plan and the negotiation of the rates and benefits.
WHAT IS THE MAIN MOTIVATION TO EXPANSION OF UPP CARE COVERAGE?-
Private insurers and self insurers will only benefit from discounted rates where their coverage is identical to the government's coverage. The more medical procedures covered by the government's plan the more private insurers and self insures will also benefit from the discounted rates in identical areas. If you scratch my back, I'll scratch yours!
More to come.
-to be continued.