Ohio Benefits Group

“How do I prove that I’m a Veteran?” It’s a question often asked by those who once served in the military. Many businesses offer discounts to Veterans for restaurants, hotels, stores, recreational activities and even home improvement, among other perks. Former service members will want to take advantage of those opportunities.
First, you’ll want to apply for VA’s Veteran ID Card (VIC), which is a digital photo ID you can use to get those discounts. Since September 2022, all new Veteran ID cards have been digital. A Veteran with a physical ID card can continue using it to get discounts. The VIC is separate from the VA health care ID, which a Veteran receives when enrolling in VA health care.
If you have any questions or need help, email VA’s VIC program at vetidcard@va.gov.
Click here to apply online and login using your existing Login.gov, ID.me, DS Logon or MyHealtheVet account. A Veteran without any of these accounts can create a free Login.gov or ID.me account. If you are unable to submit your VIC application through VA.gov, please use Access VA. 
When applying, make sure to have your social security number; a digital copy of your DD214, DD256, DD257 or NGB22 that you can upload; and a copy of a current and valid government-issued ID, such as a driver’s license, passport or state-issued identification card.
You’ll also need a digital color photo of yourself from the shoulders up. The photo should follow all of these standards:

• Show a full, front view of your face and neck with no hat, head covering or headphones covering or casting shadows on your hairline or face.
• Be cropped from your shoulders up much like a passport photo.
• Show you with your eyes open and in a neutral expression.
• Be taken in clothing you’d wear for a driver’s license photo.
• Be a square size and have a white or plain-color background with no scenery or other people in the photo.
• Show what you look like now, meaning a photo that is no older than 10 years old; it should be uploaded as a .jpeg, .png, .bmp or .tiff file.

A Veteran must meet certain criteria to be eligible for a VIC, including both of these requirements:

• Service on active duty, in the Reserve or in the National Guard, including the Coast Guard.
• Receipt of an honorable or general discharge under honorable conditions.

If the Veteran received an other-than honorable, bad conduct or dishonorable character of discharge, that person is not eligible for a Veteran ID card. If a Veteran has an uncharacterized or unknown discharge status, VA must verify that person’s eligibility before approving an application. The Veteran must provide a copy of his/her discharge papers when applying for a VIC to prove their character of discharge.
After a Veteran applies for a VIC, VA will check that person’s eligibility and verify that the character of discharge meets eligibility requirements, the ID submitted is valid and the image chosen to appear on the card meets photo requirements.
VA will then send an email letting the Veteran know the status of the application. If the Veteran has an unknown or uncharacterized discharge status, the application will take more time to process. VA may need to request your records from the National Personnel Records Center, part of the National Archives and Records Administration.
If a Veteran receives an email from VA asking for additional information or evidence to process the application, that person must sign in to AccessVA and update the application.
VA will send an email with the digital card attached if a Veteran is eligible for a Veteran ID Card.
For more information, email VA at vetidcard@va.gov. You can also click here.

​https://news.va.gov/117828/va-id-card-proof-discounts/?utm_id=19APR2023

Patients are getting blindsided by ‘facility fees,’ and states are taking actionAbout half of all patients are getting hit with facility fees, which are billed for doctor visits at hospital-owned clinics, as three in four physicians are now employed by hospitals, health systems or other corporate entities.By Markian Hawryluk | April 07, 2023


When Brittany Tesso’s then-3-year-old son, Roman, needed an evaluation for speech therapy in 2021, his pediatrician referred him to Children’s Hospital Colorado in Aurora. With in-person visits on hold due to the COVID-19 pandemic, the Tessos met with a panel of specialists via video chat.
The specialists, some of whom appeared to be calling from their homes, observed Roman speaking, playing with toys, and eating chicken nuggets. They asked about his diet.
Tesso thought the $676.86 bill she received for the one-hour session was pretty steep. When she got a second bill for $847.35, she assumed it was a mistake. Then she learned the second bill was for the costs of being seen in a hospital — the equipment, the medical records, and the support staff.
“I didn’t come to your facility,” she argued when disputing the charges with a hospital billing representative. “They didn’t use any equipment.”
This is the facility fee, the hospital employee told her, and every patient gets charged this.
“Even for a telehealth consultation?” Tesso laughed in disbelief, which soon turned into anger.
Millions of Americans are similarly blindsided by hospital bills for doctor appointments that didn’t require setting foot inside a hospital. Hospitals argue that facility fees are needed to pay for staff and overhead expenses, particularly when hospitals don’t employ their own physicians. But consumer advocates say there’s no reason hospitals should charge more than independent clinics for the same services.

“If there is no change in patient care, then the fees seem artificial at best,” said Aditi Sen, a Johns Hopkins University health economist.
At least eight states agree such charges are questionable. They have implemented limits on facility fees or are moving to clamp down on the charges. Among them are Connecticut, which already limits facility fees, and Colorado, where lawmakers are considering a similar measure. Together, the initiatives could signal a wave of restrictions similar to the movement that led to a federal law to ban surprise bills, which took effect last year.
“Facility fees are simply another way that hospital CEOs are lining their pockets at the expense of patients,” said Rep. Emily Sirota, the Denver Democrat who sponsored the Colorado bill.
Generally, patients at independent physician clinics receive a single bill that covers the physician’s fee as well as overhead costs. But when the clinic is owned by a hospital, the patient generally receives separate bills for the physician’s fee and the facility fee. In some cases, the hospital sends a single bill covering both fees. Medicare reduces the physician’s payment when a facility fee is charged. But private health plans and hospitals don’t disclose how physician and facility fees are set.
Children’s Hospital Colorado officials declined to comment on the specifics of Tesso’s experience but said that facility fees cover other costs of running the hospital.
“Those payments for outpatient care are how we pay our nurses, our child life specialists, or social workers,” Zach Zaslow, senior director of government affairs for Children’s Hospital said in a February call with reporters. “It’s how we buy and maintain our imaging equipment, our labs, our diagnostic tests, really all of the care that you expect when you come to a hospital for kids.”
Research suggests that when hospitals acquire physician practices and hire those doctors, the physicians’ professional fees go up and, with the addition of facility fees, the total cost of care to the patient increases, as well. Other factors are in play, too. For instance, health plans pay the rates negotiated with the hospital, and hospitals have more market power than independent clinics to demand higher rates.

Those economic forces have driven consolidation, as hospital systems gobble up physician clinics. According to the Physicians Advocacy Institute, 3 in 4 physicians are now employed by hospitals, health systems, or other corporate entities. And less competition usually leads to higher prices.
One study found that prices for the services provided by physicians increase by an average of 14% after a hospital acquisition. Another found that billing for laboratory tests and imaging, such as MRIs or CT scans, rise sharply after a practice is acquired.
Patients who get their labs drawn in a hospital outpatient department are charged up to three times what they would pay in an office, Sen said. “It’s very hard to argue that the hospital outpatient department is doing that differently with better outcomes,” she said.
Hospital officials say they acquire physician practices to maintain care options for patients. “Many of those physician practices are not viable and they were having trouble making ends meet, which is why they wanted to be bought,” said Julie Lonborg, a senior vice president for the Colorado Hospital Association.
States are considering limits on facility feesAlong with Colorado and Connecticut, other states that have implemented or are considering limits on facility fees are Indiana, Minnesota, New Hampshire, Ohio, Texas, and Washington. Those measures include collecting data on what facility fees hospitals charge, prohibiting add-on fees for telehealth, and requiring site-neutral payments for certain Medicaid services. A federal bill introduced in 2022 would require off-campus hospital outpatient departments to bill as physician providers, eliminating the possibility of charging facility fees.
Connecticut has gone the furthest, banning facility fees for basic doctor visits off-campus, and for telehealth appointments through June 2024. But the law’s application still has limitations, and with rising health care costs, the amount of facility fees in Connecticut continues to increase.
“It hasn’t changed much, partly because there’s so much money involved,” said Ted Doolittle, who heads the state’s Office of the Healthcare Advocate. “They can’t just painlessly take that needle out of their arm. They’re addicted to it.”
Bill would prohibit fees for primary careThe Colorado bill would prohibit facility fees for primary care visits, preventive care services that are exempted from cost sharing, and telehealth appointments. Hospitals would also be required to notify patients if a facility fee would apply. The ban would not apply to rural hospitals. The bill was scaled back from a much broader proposal after criticism from hospitals about its potential consequences.
Rural hospital executives, like Kevin Stansbury, CEO of Lincoln Health, a small community hospital in the eastern Colorado town of Hugo, had been particularly worried about the impact of a fee ban. The state hospital association estimated his hospital would lose as much as $13 million a year if facility fees were banned. The 37-bed hospital’s netted $22 million in patient revenue last year, resulting in a loss. It stays open only through local taxes, Stansbury said.
“This will still harm access to care — and especially essential primary and preventive care that is helping Coloradans stay healthier and out of the hospital,” Lonborg said of the revised approach. “It will also have a detrimental impact on access to specialty care through telehealth, which many Coloradans, especially in rural parts of the state, have come to depend on.”
The Colorado bill presents particular challenges for health systems such as UC Health and Children’s Hospital, which rely on the University of Colorado School of Medicine for staffing. For outpatient appointments, the medical school bills for the doctor’s fee, while the hospital bills a facility fee.
“The professional fee goes solely to the provider, and, very frequently, they’re not employed by us,” said Dan Weaver, vice president of communications for UC Health. “None of that supports the clinic or the staff members.”
Without a facility fee, the hospital would not receive any payment for outpatient services covered by the ban. Weaver said the combination of the clinicians’ and facility fees is often higher than fees charged in independent clinics because hospitals provide extra services that independent physician clinics cannot afford.
“Prohibiting facility fees for primary care services and for telehealth would still cause significant problems for patients throughout our state, forcing some clinics to close, and causing patients to lose access to the care they need,” he said.
Backers of the Colorado bill disagree.
“The data on their costs and their revenue paints a little different picture of their financial health,” said Isabel Cruz, policy manager for the Colorado Consumer Health Initiative, which backs the bill.
From 2019 through 2022, UC Health had a net income of $2.8 billion, including investment gains and losses.
The Colorado market is dominated by large health systems that can dictate higher rates to health plans. Plans pass on those costs through higher premiums or out-of-pocket costs.
“Unless the employers and patients that are incurring the prices are raising the alarm, there really isn’t a strong incentive for health plans to push against this,” said Christopher Whaley, a health care economist with the nonprofit think tank Rand Corp.
Consumer complaints helped pave the way for the federal No Surprises Act, which protects against unanticipated out-of-network bills. But far more people get hit with facility fees — about half of patients compared with 1 in 4 hospital patients who receive surprise bills, Whaley said.
Dr. Mark Fendrick, a University of Michigan health policy professor, said facility fees are also generally surprises but don’t fall under the definition of the No Surprises Act. And with the rise of high-deductible plans, patients are more likely to have to pay those fees out-of-pocket.
“It falls on the patient,” Fendrick said. “It’s a tax on the sick.”
Tesso held off paying the facility fee for her son’s visit as long as possible. And when her pediatrician again referred them to Children’s Hospital, she called to inquire what the facility fee would be. The hospital quoted a price of $994, on top of the doctor’s fee. She took her son to an independent doctor instead and paid a $50 copay.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

https://www.benefitspro.com/2023/04/07/patients-are-getting-blindsided-by-facility-fees-and-states-are-taking-action/?kw=Patients%20are%20getting%20blindsided%20by%20%27facility%20fees%2C%27%20and%20states%20are%20taking%20action&utm_source=email&utm_medium=enl&utm_campaign=bprodailynews&utm_content=20230410&utm_term=bpro&oly_enc_id=8686I4299356B7C

Texas judge strikes down ACA’s free preventive care requirementThe ruling, which applies nationwide and takes effect immediately, mandates that insurers and employers are not required to cover certain free preventive screenings for cancer, heart disease and other diseases under Obamacare.By Lynn Cavanaugh | March 30, 2023

The Earle Cabell Federal Bldg. houses the U.S. District Court for the Northern District of Texas.

Today, a federal judge in Texas struck down a key provision of the Affordable Care Act requirement that insurers and employers cover free preventive screenings for cancer, heart disease, HIV and other diseases. The decision, which applies nationwide and takes effect immediately, threatens access to over 100 million Americans who use these services, which include mammograms and STD testing.
Judge Reed C. O’Connor of the U.S. District Court for the Northern District of Texas –who previously struck down the entire ACA law before it was upheld by the Supreme Court – granted Braidwood Management Inc.’s request to block an ACA requirement for cost-sharing coverage of preventive services.
The ruling invalidates nationwide zero cost-sharing coverage requirements of preventive services recommended by the U.S. Preventive Services under the Affordable Care Act and finds that required coverage of PrEP for HIV violates the Religious Freedom Restoration Act. Cost sharing will likely deter patients from scheduling those procedures. The ruling won’t impact every preventive screening, as some recommendations predate the ACA, which was signed into law in 2010. More than 2,000 legal challenges have been filed in state and federal courts contesting parts for all of the Affordable Care Act (ACA) since it became law. Today’s case, Braidwood Management v. Becerra, involved the ACA’s requirement that most private insurance plans cover specific preventive care items and services — such as contraceptive care and supplies, as well as cancer screenings. The case could have long-term implications for millions of people who are covered by private insurance, according to Kaiser Family Foundation.
In Braidwood Management v. Becerra, two Christian-owned businesses and six individuals in Texas challenged the legality of the preventive care mandates on constitutional grounds. The plaintiffs also challenged the requirement to cover medication to prevent HIV, based on religious grounds.
In September 2022, Judge O’Connor ruled partly in favor of the plaintiffs and partly in favor of the Department of Health and Human Services (which defended the ACA).
While not surprised by Judge O’Connor’s decision, “It is imperative that these critical preventive services must continue for the health of our nation,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “We expect that the U.S. government will quickly act to stay this decision so that preventive services can continue nationwide, and appeal it. Preventive services are all critical and well-established medical services … While the appeals process moves forward, we call on health insurers to act on their own and continue to cover these preventive services without cost-sharing for the benefit of their enrollees.”
Related:  Texas court decision could change preventative medical services costsAs a result of the ruling, “the government may no longer be able to require insurance plans to cover certain preventive services and items at no cost to patients. Insurers and employers would once again have discretion over whether to cover preventive services, resulting in lower premiums in some cases but also a patchwork of coverage,” according to KFF. “Any rollback of the government’s ability to enforce these requirements could impact the millions of people covered by private insurance. The outcome of this case could also have broader ramifications for the authority of federal agencies to address a wide range of issues through regulation.”
It is likely that the Biden administration will appeal the ruling. KFF officials maintain that Braidwood Management v. Becerra has the potential to reach the U.S. Supreme Court.

https://www.benefitspro.com/2023/03/30/texas-judge-strikes-down-acas-free-preventive-care-requirement/

​As pharmacy benefit managers face scrutiny on Capitol Hill, a new Ohio lawsuit alleges Express Scripts and Prime Therapeutics used a Switzerland-based company to illegally drive up drug prices.By Alan Goforth | March 29, 2023

Public officials continue to turn up the heat on pharmacy benefit managers. Less than a week after a U.S. Senate committee approved PBM reform legislation, the Ohio Attorney General has sued Express Scripts and Prime Therapeutics, alleging that the companies conspired to illegally increase drug prices.
“PBMs are modern gangsters,” Attorney General David Yost said. “They were designed to protect and negotiate on behalf of employers and consumers after big pharma was criticized for overpricing medications, but instead they have absolutely destroyed transparency, scheming in the shadows to control drug prices on all sides of the market.”
The lawsuit alleges that Express Scripts, one of the country’s three largest PBMs, responded to criticism of its model by forming the group purchasing organization Ascent Health Services in 2019. It then granted Prime Therapeutics ownership in Ascent before moving its operations to Switzerland, which allowed it to further obfuscate its pricing models. The lawsuit also names Cigna Group, parent company of Express Scripts; Evernorth Health, another subsidiary of Cigna; Humana Pharmacy Solutions; Humana, parent company of Humana Pharmacy Solutions; and Ascent.
Express Scripts and Prime Therapeutics then used their shared stake in Ascent to share pricing, discount and rebate information with one another as well as with Humana Pharmacy Solutions, an Ascent customer, which drove up prices further, according to the lawsuit.
“Both drug buyers and sellers have little choice but to play the game by the PBMs’ rules, allowing PBMs to extract both monopoly profits from individuals and monopsony (a market situation where there is only one buyer) profits from the market,” Yost said.
Related: PBMs face scrutiny as House committee opens investigationThe suit alleges multiple violations of the Valentine Act, Ohio’s antitrust law, which prohibits price fixing, controlled sales and other agreements that restrain trade and hurt competition. The act is broader than its federal counterpart, the Sherman Act, in that the Ohio law prohibits market harms in addition to consumer harms. The lawsuit seeks seeks statutory fines and restitution of any illegals profits.
Yost has been a vocal critic of PBMs and the models they deploy to manage drug spending, particularly rebates and spread pricing. He has filed multiple lawsuits against different PBMs, making this week’s filing just the latest salvo in a lengthy war.
PBMs have been intensely scrutinized in the debate over who is at fault for rising drug costs, and pharmaceutical manufacturers typically blame PBMs for driving up expenses. In addition to congressional action, the Federal Trade Commission subpoenaed six of the largest PBMs – CVS Caremark; Express Scripts, OptumRx, Humana, Prime Therapeutics and MedImpact Healthcare Systems – last year.
https://www.benefitspro.com/2023/03/29/pbms-are-gangsters-ohio-ag-alleges-in-lawsuit-against-express-scripts-6-others/?printer-friendly