they don't define WHAT proactive means? Could this be a part of your diabetes too? I heard many programs going into affect because untreated or taken care of diabetes has such severe health consequences. I'm not certain about severe consequences of MRI's. More I read it will be more difficult to get MRI's.
I think you need to find out what proactive means. It might be an excersize program, quitting smoking, get weight within range stuff like that.

From the new law...

Coverage Levels:

page 113

(d) LEVELS OF COVERAGE.
(1) LEVELS OF COVERAGE DEFINED.The levels
of coverage described in this subsection are as
follows:
(A) BRONZE LEVEL.A plan in the bronze
level shall provide a level of coverage that is designed
to provide benefits that are actuarially
equivalent to 60 percent of the full actuarial
value of the benefits provided under the plan.
(B) SILVER LEVEL.A plan in the silver
level shall provide a level of coverage that is designed
to provide benefits that are actuarially
equivalent to 70 percent of the full actuarial
value of the benefits provided under the plan.
(C) GOLD LEVEL.A plan in the gold level
shall provide a level of coverage that is designed
to provide benefits that are actuarially equiva


O:BAIBAI09M01.xml [file 1 of 9] S.L.C.


113


lent to 80 percent of the full actuarial value of
the benefits provided under the plan.

(D) PLATINUM LEVEL.A plan in the
platinum level shall provide a level of coverage
that is designed to provide benefits that are actuarially
equivalent to 90 percent of the full actuarial
value of the benefits provided under the
plan.


&

and here--insurance companies get increased reimbursement for

g) REWARDING QUALITY THROUGH MARKET
- BASED INCENTIVES. -
(1) STRATEGY DESCRIBED. -A strategy described
in this paragraph is a payment structure
that provides increased reimbursement or other incentives
for -
(A) improving health outcomes through the
implementation of activities that shall include



Page 147


quality reporting, effective case management,
care coordination, chronic disease management,
medication and care compliance initiatives, including
through the use of the medical home
model, for treatment or services under the plan
or coverage;

(B) the implementation of activities to prevent
hospital readmissions through a comprehensive
program for hospital discharge that
includes patient - centered education and counseling,
comprehensive discharge planning, and
post discharge reinforcement by an appropriate
health care professional;
(C) the implementation of activities to improve
patient safety and reduce medical errors
through the appropriate use of best clinical
practices, evidence based medicine, and health
information technology under the plan or coverage;
and
(D) the implementation of wellness and
health promotion activities.

Hey

Just a suggestion before you make any decision, well a question and then a suggestion. Did this come form your insurance company or your HR department?

If it came from the HR department, it should have had a list of things that would qualify that the insurance company would supply to them. If it came from the insurance company, there should be, at the very least, a number you can call to request help and or information in understanding what "proactive" means.

But either way, try to check in to it all before you make any decision. As there always has been, there will be pros and cons to each policy, or level or type of policy, and you may do better with one or the other than you thought. One of the people who works in the billing department at the medical center that I go to told me, and of course there is still alot of confusion, butt what she is starting to see is that MRIs that are questionable are being targeted, in other words, they want to get to the point where only those that are really warranted are being done, and that there will be coverage for those, but just as a "Let's get an MRi" kind of thing, they are trying to make that go away. Less waste. So that might be a question to ask, if it makes a difference how many or for what reason you are having one.

Good Luck, I hope your coverage doesn't change too much and helps you to maintain your health.

Due to the health care reform those that are on Medicare which I am one of them, many doctors are not taking new patients on the government insurance (Medicare Advantage Plans or Medicare). I was trying to find a new primary care doctor as insurance changed. I called 5 and was turned down. I finally find one. I ask the nurse why and did it have to do with heath care reform. She stated it did and it started March 1st 2010. I can understand your frustration.

The staste you live in tirednbunny doeas not provide enough funding for physician traing--hence ther is not enough competition for physicians---I think tired bunny that will change, unfortunately not right away,. The state that behave responsibly toward their citizens are not having the issue you describe---its the state that do not act like their greatest resource is the people in their state that are having the issue you complain about tiredbunny....I gaurentee you its not everywhere.
In western states docs will be reimgbursed for medicare/medicaid better also. that wil help too. IN the past a strange formula reimbursesd docs different in different geographically. That loophole has finally been corrected too.

xaviarmom74--it sounds like your insurance company will lose money if you don't participate and they just sent you notice that if they lose money your gonna pay too---its alays a matter of following the money. Healthcare funds, lobbying money, highway funds. Its the money.

:) the state I live in provides funding to medical colleges and stem cells were discovered at the main one, along with other advances, with the assistance of state tax dollars. We don't have an issue with docs not accepting medicare/medicaid. Our people are treated like they are a great natural resource of the state and they rise to the expectation made for them. :)