Ted Doolittle

Healthcare Advocate for the State of CT. Former senior Medicare official & federal prosecutor. Healthcare policy, law & consumer protection.

[Ted Doolittle @TedDoolittle2]

Free, expert health coverage assistance & representation for anyone who lives in CT or works for a CT company.

Commercial insurance, Medicare, HUSKY or any other health coverage.

Help with denials, appeals, & any other insurance issue is available:

https://t.co/RgKPIDczDS

[Ted Doolittle @TedDoolittle2]

@WeHartford @Cigna Ronni, sorry you are dealing with this. CT residents facing medical denials or other health coverage issues can get free, expert advice & representation from the state Ofc. of the Healthcare Advocate, https://t.co/kW1txekMtv or 866-466-4446

[theshallowstate.bsky.social🌹 @wildcorrective]

seems basic but you gotta give him an atta boy

[Ted Doolittle @TedDoolittle2]

@bjdickmayhew *Multiple Employer WELFARE Arrangements, sorry.

[Ted Doolittle @TedDoolittle2]

@bjdickmayhew Good question, pretty sure that self-insured MEWAs (Multiple Employer Benefit Arrangements) are generally regulated by the states, whereas fully-insured MEWAs (e f., Association Health Plans) are generally regulated by the feds -- the opposite of regular health insurance.

[Ted Doolittle @TedDoolittle2]

@bjdickmayhew So, Association Health Plans or other MEWA, if self-funded, maximum state regulatory authority. Still must be "consistent with ERISA," though. But my guess is DOL doesn't monitor these or get involved in oversight in the normal unless there's a complaint from someone.

[Ted Doolittle @TedDoolittle2]

@bjdickmayhew Re self-funded MEWA, state rules that regulate "insurance may apply to the extent it is not inconsistent with ERISA.
In the case of a fully-insured MEWA, a state could only enforce those state laws that provide standards [re] re levels of reserves ...."

https://t.co/mQ4gjmgUFi

[Ted Doolittle @TedDoolittle2]

@xpostfactoid @GeBaiDC @GovNedLamont Hospitals remain super-powerful - they exist in every statehouse district & not shy about galvanizing employees to complain & lobby state reps, sometimes w/ less than accurate info.

Pleasantly surprised we're even having this discussion, w/ significant bills cleared committee.

[Ted Doolittle @TedDoolittle2]

@xpostfactoid @GeBaiDC @GovNedLamont Personally, I think the fact the two large CT systems continue to build & open dozens if not hundreds of new system-branded medical buildings, two or three on every state rep's commute in to Hartford, visually demonstrating great wealth & power, has changed the political climate.

[Ted Doolittle @TedDoolittle2]

@xpostfactoid @GeBaiDC @GovNedLamont Idea is an OON cap would have knock-on effect on in-network prices ... Similar to MA plans paying very close to Medicare rates for INN even though that is not required. Why? B/c they can't reimburse hospitals more than 100% of Medicare for OON care.

[Ted Doolittle @TedDoolittle2]

@xpostfactoid @GeBaiDC @GovNedLamont Amended language that made it out of committee currently 150 percent of Medicare.

Establishing the principle as important as the particular number. Even large insurers completely unable to negotiate w/ the large systems & need bolstering from the entire community (i.e., states)

[Ted Doolittle @TedDoolittle2]

@GeBaiDC @xpostfactoid @GovNedLamont *piece

[Ted Doolittle @TedDoolittle2]

@GeBaiDC @xpostfactoid Using this pi in CT state legislative debates to bolster @GovNedLamont 's first-ever (for CT) policy agenda w/ actual solutions directed at underlying hospital & pharma prices.

Notable: ban anti-competitive hospital contract clauses & OON price cap.

https://t.co/g6JmYfl1HH

[Ted Doolittle @TedDoolittle2]

@mirandayaver @bjdickmayhew @charles_gaba This builds on CMS's anti-fraud program integrity pivot starting in 2010 to focus not on individual claims, but on monitoring provider's overall practice patterns. Once outliers are identified, investigate, educate, and if still needed, suspend, terminate, and/or prosecute.

[Ted Doolittle @TedDoolittle2]

Welcome to my client's world, where far-away insurance doctors deny complex claims inside of 10 minutes w/o reading the appeal letters & supporting medical records my staff creates.

Savage bullying of sick families that can be made better.
https://t.co/uYSQdFRK3Z

[Ted Doolittle @TedDoolittle2]

@ESilvermanMD @pop_popculture https://t.co/3bSD2G5rdL

[Ted Doolittle @TedDoolittle2]

Welcome to my client's world, where far-away insurance doctors deny complex claims inside of 10 minutes w/o reading the appeal letters & supporting medical records my staff creates.

Savage bullying of sick families that can be made better.
https://t.co/uYSQdFRK3Z

[Ted Doolittle @TedDoolittle2]

@bjdickmayhew @mirandayaver @charles_gaba Your position hinges on dubious proposition that insurance companies are adopting new best practices faster than other doctors.

Remember, you don't go to work for an insurance company b/c you love the practice of medicine... You go cuz you're trying to get away from it.

[Ted Doolittle @TedDoolittle2]

@bjdickmayhew @mirandayaver @charles_gaba And, remember, insurance company docs by definition are rusty & non-practicing. Also super-common for carriers to flout rules requiring a doc from same specialty to review claim.

Individual cases may vary, but generally speaking treating docs knows more than the insurance doc.

[Ted Doolittle @TedDoolittle2]

@bjdickmayhew @mirandayaver @charles_gaba But why keep the patient in the middle of this fight b/t medically sophisticated parties?

Don't deny hundreds of claims from bad/outdated doctors ... Educate them & if they don't shape up, kick them out of network.

Make in-network status mean something, in terms of quality.