Mira Edorra

If you have Medicare Part A and Part B, you may have the option to enroll in a Medicare Advantage plan. Medicare Advantage (Medicare Part C) is an alternate way to receive your Medicare Part A and Part B coverage. It does not replace your Medicare Part A and Part B coverage. There are several different kinds of blue cross Medicare Advantage plans. These plans are available from private Medicare-approved insurance companies, and they are allowed to offer extra benefits beyond Part A and Part B. Plans might include routine for dental and vision care and other health-related services not covered by Original Medicare (Part A and Part B).

For most seniors, enrolment in Medicare Part A is easy, because often times, it is automatic. Some seniors also meet the qualifications to enrol in Part B automatically, but many aren’t. It is important to learn how to enroll in Medicare Part B because it protects yourself from high, unprotected out-of-pocket costs of doctor visits. Part B covers your doctor visits, check-ups, and any other service that Medicare would consider as an “outpatient” service. Medicare providers in pennsylvania can help you for getting many health benefits of Medicare part B.

The assignment is an agreement between you (a person with Medicare), doctors, other health care suppliers or providers, and Medicare. You “assign” Medicare to your physician, supplier or provider to pay directly for care. In some cases, doctors, other health care suppliers, and providers must accept the assignment. For example, assignments must be accepted upon receipt of the services of a Medicare-covered physician assistant. Doctors, other health care suppliers, and medicare providers in pennsylvania  are required to submit your claim directly to Medicare, and you cannot be charged for a claim.

The human and economic statistics surrounding the opioid epidemic are staggering. According to the U.S. Department of Health and Human Services, 11.4 million people have misused prescription opioids, and more than 130 people die daily from opioid-related drug overdoses.

Moreover, the Society of Actuaries found that the total economic burden of the opioid crisis in the United States from 2015 to 2018 was at least $631 billion. The organization attributed nearly one-third of that cost to extra healthcare spending for individuals with opioid use disorder (OUD) and those around them.

The New York Times reported that the addiction treatment industry brings in $35 billion dollars a year. That finding presents substantial opportunities for companies — startups in particular — to develop innovative solutions and disruptive technologies to help people with OUD.

Here are some four examples of ground-breaking opioid addiction prevention tools in the digital health space:

1. A Data-Based Smart Medication Dispensing System

One major area of focus is on digital solutions that help ensure patients take their medication by tracking data consistently and enabling clinicians to see how well a treatment program is working so that it can be adjusted to the patient’s needs. Think of such a system as working as a high-tech pill box for high-risk medications like Suboxone  — the only opioid substitute approved by the U.S. Food and Drug Administration (FDA) for office-based treatment of OUD.

New York City-based MedicaSafe, Inc. has designed a system with secure pre-packaged cartridges of buprenorphine/naloxone (Suboxone) that provide the correct dose at the right time courtesy of a SmartKey device. Certified pharmacies program the SmartKey according to the patient’s treatment plan.

The use of tamper-resistant and tamper-evident packaging prevents patients from taking the medication too often or too early. Each dose is taken, or the lack thereof gets recorded and collated into treatment reports, equipping clinicians to track how or if patients stick to their prescribed regimens. Plus, getting more insights into patient behaviors through the data collected by the MedicaSafe system could allow proactive dose adjustments if concerning trends appear.

The National Institute of Health (NIH) awarded MedicaSafe with a $1 million Small Business Innovation Research (SBIR) grant to support a clinical trial. The goal is to examine the effect of MedicaSafe’s drug-device combination system versus the standard of care in the treatment management of OUD.  

MedicaSafe also recently announced a partnership with Amneal Pharmaceuticals, Inc. The pairing will provide Amneal’s generic version of Suboxone for MedicaSafe’s data-generating medication system.

2. E-Prescription Platforms and Blockchain Technology

Many people with substance abuse engage in a practice informally known as “doctor shopping.” They present to multiple physicians in an area with complaints that typically get treated with narcotics. However, the introduction of prescription monitoring programs (PMP) stifles that tactic. A PMP platform shows all the prescriptions associated with a single patient. Pharmacists in many states must check PMP systems before filling opioid prescriptions.

E-prescribing solutions complement PMP platforms. Several states mandate using them when writing or filling opioid prescriptions. Such a setup electronically sends a prescription directly from a provider to a pharmacist. This digital system also reduces manual work for providers and eliminates issues where a pharmacist may have trouble reading handwriting and need to call the provider for clarification.

A medical startup in Tennessee called EirSystems hopes to capitalize on e-prescribing with help from blockchain technology. The blockchain is an immutable digital ledger system, which makes it potentially well-suited for opioid addiction prevention tools. This company, launched by two brothers, will provide a time-stamped prescription history that gives indisputable evidence.

Moreover, the system can give alert notifications when a doctor historically prescribes opioids with unusual frequency, or a patient has risk factors that make them prone to addiction. E-prescriptions are not new, and all 50 states accept them. However, bringing these prescriptions to the blockchain could give an even higher degree of transparency.

3. Solutions to Improve and Expand Opioid Addiction Treatments

Besides the opioid addiction prevention tools that curb inappropriate Suboxone dosages and prescription misuse, several companies are working to change how patients can treat their addictions. As an example of some non-digital progress, US WorldMeds, LLC offers a medication called Lucemyra. It stands out for being the first FDA-approved treatment to mitigate opioid withdrawal symptoms that don’t contain opioids.

Then, Workit Health is a company working to increase access to addiction treatment by offering it through a telemedicine platform. People can get access to the conventional medicines that ease withdrawals, plus talk to clinicians via a secure video or voice chat feature. Another option is for participants to attend support groups on their smartphones.

A team at Yale University came up with another smartphone-based solution. That one, an app known as BUP Home Induction, walks people through the first few days of taking buprenorphine for relief of withdrawal symptoms. For example, when patients input data into the app to say they have at least five withdrawal symptoms, BUP Home Induction instructs them to take the first dose. The app includes medication information and a place to record dosages, too.

One of the downsides of people going through treatment for opioid addiction while at home while under the guidance of clinicians is that numerous factors and triggers could increase the likelihood that they become compelled to use again. A digital product called reSET-O depends on cognitive-behavioral therapy to boost the retention rates of patients participating in programs to overcome OUD.

The reSET-O platform provides 12 weeks of digital content that teaches people about the main components of cognitive-behavioral therapy and give them opportunities to build their skills. The lessons are text or audio-based and sometimes have elements like animations or videos to help solidify the concepts learned.

4. An App to Provide Instant Access to Helpful Information

When a person with opioid addiction decides to get help, or their loved ones want to attempt interventions, it’s crucial to have access to reliable information about which resources exist. An app from Delaware called Help Near and Now (HeNN) involved philanthropic contributions from some tech companies in the state.

The HeNN app has prevention-based content, plus health resources and lists of places where people can go for treatment or support groups. Finding a treatment facility is simple due to features that show users how to get to locations, plus read or leave reviews. Moreover, users can receive automatic notifications when they’re within a certain distance of the desired service.

The app only has content for places in Delaware now, but plans are in the works to roll it out nationwide. Future versions may include a database that lets people see which treatment centers near them have open beds or are accepting patients. Only healthcare providers currently have access to such information, and it’s through other platforms outside of this app.

The HeNN app and others like it could remove the friction addicted patients and their loved ones encounter while seeking treatment. As a result, they could find it’s easier to get the required help without delays.

Opioid Addiction Prevention Tools for the Digital Age

There’s no straightforward way to conquer opioid addiction. But, some of the companies and tools here are well-positioned to lead the fight.

The opioid epidemic continues to devastate American communities. Health insurance providers are tackling the crisis with improved prevention, early diagnosis, and treatment of opioid use disorders.

As part of prevention efforts under the AHIP STOP Initiative, insurance providers help patients avoid or minimize opioid use. Low back pain is the number one reason patients are prescribed opioids, and therefore addressing back pain is a priority for insurance providers.

Many of 21,000-plus members of Chinese Community Health Plan (CCHP) will experience low back pain at some point in their lives, whether an isolated ache, an injury, sciatica, or a variety of other reasons. The San Francisco-based insurance provider offers access to a variety of care options, such as Traditional Chinese Medicine. Interventions include acupuncture, cupping, moxibustion, and massage. CCHP members have used Tai Chi and Qi Gong therapy as part of a mind-body approach to relieving low back pain.

Traditional Chinese Medicine for Pain Management

In Traditional Chinese Medicine, the treatment depends on the cause of pain – and pain is a result of blockages or deficiencies that prevent the Qi and Blood from nourishing an area of the body and keeping it healthy.

Qi is a Fundamental Substance that translates to “life force,” which flows through different parts of the body. When the flow of Qi becomes obstructed, the body cannot function properly, resulting in illness or pain.

Xue, or Blood, is the liquid life force of the body and is a subset of Qi. When Blood supplies are appropriate, the body is healthy; when there is undersupply, parts of the body may experience challenges.

CCHP maintains a provider directory listing specialists who can treat back pain, including those who practice Traditional Chinese Medicine. The directory lists provider education, including degrees and certifications from institutions such as the American College of Traditional Chinese Medicine and Five Branches University, where traditional, holistic methods like acupuncture are taught to students.

The widespread use of acupuncture is a testament to its potential as a treatment for those suffering with pain. And with the ongoing opioid crisis, patients are encouraged to consider non-opioid treatment options to help manage their pain – this increasingly includes mind-body therapies, stress management, exercise, and other non-pharmacological therapies.

What is a health reimbursement arrangement (HRA)?

A health reimbursement arrangement (HRA), sometimes called a health reimbursement account, is an IRS-approved, employer-funded, tax-advantaged health benefit used to reimburse employees for out-of-pocket medical expenses and personal health insurance premiums.

An HRA is not health insurance. Instead, employers offer employees a monthly allowance of tax-free money. Employees then buy the health care services they want, potentially including health insurance, and the employer reimburses them up to their allowance amount.

An HRA plan is an excellent way to provide health insurance benefits and allow employees to pay for a wide range of medical expenses not covered by insurance. It’s an especially good option for small businesses that can’t afford to offer group health insurance, as the business can choose the amount of the allowance to offer its employees.

How does an HRA work?

Health reimbursement arrangements are notional arrangements; no funds are expensed until reimbursements are paid. Through HRAs, employers reimburse employees directly only after the employees incur approved medical expenses. This feature is especially helpful for businesses that want to retain control over their cash flow.

Although each HRA is different, all HRAs follow the same five-step structure:

The business sets the allowance amount. Businesses decide how much tax-free money they want to offer employees every month. This represents the maximum the business will reimburse each employee for health care.

Employees make purchases. Employees then choose the health care products and services that fit their personal needs, potentially including personal health insurance.

Employees submit proof of expenses incurred. To be reimbursed, employees must submit documentation that shows they incurred an HRA-qualified expense. This documentation is usually given in the form of receipts, but could also be provided by something like an explanation of benefits.

The business reviews employee documentation. The business reviews employees’ documentation for three things: the service or product, the date of the service or sale, and the amount incurred. If it includes these three items and the service or product is HRA-qualified, the business approves the expense.

The business reimburses employees. After approving the expense, the business reimburses employees from their allowance amount. After the allowance amount has been reached, the business won’t make further payments until the next month.

There are a couple other things to keep in mind. First, because HRAs are notional arrangements, businesses don’t need to pre-fund the HRA.

Second, HRAs allow some rollover. Depending on which HRA plan an employer chooses, health reimbursement arrangement balances may roll forward from month to month or from year to year. QSEHRAs may roll forward from month to month only, for example; annual rollover must still abide by the QSEHRA’s annual allowance caps.

Under one-person stand-alone HRAs or group coverage HRAs, however, employers can allow balances to accrue from one year to the next. They may also design the program not to allow annual rollover.

Employers may also allow employees to have access to their health reimbursement arrangement accounts after retirement.

What can be reimbursed with an HRA?

A health reimbursement arrangement can reimburse any expense considered to be a qualified medical expense under IRS Section 213(d) of the Internal Revenue Code (also listed in IRS Publication 502), including premiums for personal health insurance policies. Because an HRA can reimburse medical expenses as well as premiums, it’s a very valuable benefit for employees in many insurance situations.

HRA-eligible expenses include items such as:

Individual health insurance premiums

Individual dental or vision premiums

Amounts paid toward a policy’s deductible

Copays

Office visits

Prescription drugs

Nonprescription drugs (with a doctor’s note)

Mileage for travel to/from eligible health care

For a total list of reimbursable items, check out our HRA eligible expenses tool.

Different HRAs may restrict certain items from reimbursement. Additionally, the business offering the HRA can choose to eliminate items from eligibility. Many businesses choose to offer a premium-only HRA, for example.

Which HRAs are available in 2020?

HRAs have undergone a lot of regulatory change since their introduction in the 1970s. Today, businesses can choose between six different HRAs:

1. The qualified small employer HRA (QSEHRA)

The QSEHRA is by far the most popular HRA currently available. Created in 2016, the QSEHRA is available exclusively to small businesses with fewer than 50 employees. With the QSEHRA, small businesses can offer different allowance amounts to employees based on family size.

In 2020, employers can offer up to $5,250 ($437.50 per month) per self-only employee and $10,600 ($883.83 per month) per employee with a family in 2019. These amounts roll over month to month and can roll over year to year as well, but total QSEHRA reimbursements should not exceed the annual limits for the year. The QSEHRA is automatically available to all full-time W-2 employees, and businesses can choose to offer it to part-time employees as well (as long as part-time employees receive the same allowance amounts). Businesses cannot offer a QSEHRA at the same time as a group policy.

2. The individual coverage HRA (ICHRA)

The individual coverage HRA works much like the QSEHRA, though with fewer restrictions. It would be available to businesses of all sizes, come with no contribution limits, and allow businesses to offer different allowance amounts based on certain employee classes. However, the individual coverage HRA would only be available to employees enrolled in individual insurance; employees covered by a family member’s group policy or an alternative like Medi-Share couldn’t participate.

The excepted benefit HRA is similar to a group coverage HRA. It would be available to businesses with a group health insurance policy and allow the company to reimburse employees for out-of-pocket medical expenses like a dental visit or a short-term health insurance policy. The excepted benefit HRA would be capped at $1,800 per year per employee and couldn’t be offered with any other HRA.

3. The group coverage HRA.

As its name suggests, the group coverage HRA is available to businesses who also offer a group health insurance policy. With the group coverage HRA, businesses can offer monthly allowances to cover items not eligible under the group policy, such as the deductible. Businesses of all sizes can offer the group coverage HRA, there are no allowance caps, and businesses can offer different allowance amounts to different employees.

4. The Excepted Benefit HRA

Much like the group coverage HRA, an Excepted Benefit HRA is used to reimburse medical care expenses in addition to other excepted benefits. While the group coverage HRA is typically used to reimburse employees for out-of-pocket expenses, the excepted benefit HRA can also used to reimburse employees for excepted benefits.

5. The retiree HRA.

The retiree HRA is available solely to a business’s retired employees. It works much like the one-person stand-alone HRA: businesses of all sizes can offer it, it has no allowance caps or group health insurance requirements, and annual rollover is permitted.

6. Dental/vision HRA

Employers who also want to provide dental and vision benefits to employees can utilized a dental/vision HRA to make reimbursements exclusively for these expenses.

Is an HRA the right choice for my business?

An HRA can be a great choice, particularly for small businesses.

To determine whether an HRA is a good fit for your business, first ensure you meet the HRA’s eligibility guidelines. To offer a QSEHRA, for example, you must be a qualified small employer with fewer than 50 employees and without any group insurance policy.

Next, determine what you can afford to spend on health benefits. If you can afford a group health insurance policy with a low deductible, you may not want to offer an HRA. If you can only afford a high-deductible health policy, you may choose a group coverage HRA to complement it. Finally, if you can’t afford group health insurance at all, a QSEHRA is a good choice.

Finally, consider whether the HRA would suit your employees. If your small business has a lot of employees on a family member’s policy or who live out of state, for example, the QSEHRA is a great solution.

Generally, the more diverse your employees and the more budget-conscious your business, the better fit an HRA can be.

Should I use an HRA administrator?

Businesses offering an HRA should always use an HRA administrator. Without one, it’s easy to run into compliance trouble and HIPAA privacy violations.

HRA administration reporting features make real-time monitoring of HRA liabilities, reimbursements, and utilization easy. Employers can change plan benefits at any time or cancel the entire plan at any time, provided those offering QSEHRAs supply employees with the required notice.

In fact, HRA administrators like PeopleKeep allow small businesses to spend 10 minutes a month or less administering the benefit.

Any act of giving and kindness, no matter how small or large, creates a ripple of goodness and spreads generosity around our planet. Planting trees, opening a door for someone with their hands full of groceries, deciding to offer a warm smile to a stranger looking stressed, or visiting a local senior center to join in conversation and listen to an elder’s stories are all examples of small acts of kindness and generosity that can ripple out to many lives in wide rings of goodness we may never fully see with our own eyes. But we can feel the warmth, happiness, and uplifting joy in our own hearts.

This act of giving and creating goodness is at the heart of GivingTuesday, with the ultimate goal of creating a more just and generous world. And this is the heart of why we at California Health Advocates are again participating in this year’s #GivingTuesday on December 3, 2019.

#GivingTuesday is held annually on the Tuesday after Thanksgiving (in the U.S.), Black Friday and Cyber Monday. It’s also way to kick-off the holiday giving season and inspire people to collaborate and to give back in impactful ways to the organizations and causes they support.

Last year, millions of people in over 160 countries participated in #GivingTuesday, and now in its 8th year, nearly every country on earth is participating. We invite you to join the movement and give to California Health Advocates this December 3. Your gift supports our work ensuring our older adults in California and younger people on Medicare with a disability are informed and empowered in understanding, navigating and accessing their health care benefits and rights, and that our Medicare program stays strong!

Make your tax-deductible donation today! And, we have a matching grant! So, with our matching grant, your gift will have twice the impact, and is one that will keep on giving to the over 5.6 million Medicare beneficiaries and their families in our state.

There are various health insurance companies in pa, which provides group health insurance plans for you and if you want to know more then please drop your comments.

With the average cost of health benefits topping $12,000 per employee per year, employers are looking for ways to bend the cost curve without compromising employee health. Bundled payments offer one solution.

Also known as episode-based payments, these payments are part of reimbursement models that compensate providers for the value of the care they provide, not the volume. Properly executed, not only do they control costs for employers and workers, but they can also enhance care quality, improve clinical outcomes and create a more coordinated health care delivery system.

How Do Bundled Payments Work?

It may be helpful to think of a bundled payment as a prix fixe for health care vs. ordering a la carte.

Instead of being charged piecemeal for each individual service, payers pay a lump sum for the entire episode of care. That payment “bundles” everything together, from the initial consultation to all the procedures provided at the hospital or doctor’s office — even tests and lab work — to follow-up care such as rehab, physical therapy or skilled nursing facilities. The payment is based on the disease or medical issue itself, not on how the disease is treated, and it generally has to meet specific quality and patient satisfaction goals. The aim is simple: Align financial incentives with high-quality clinical outcomes.

This approach is designed to discourage wasteful care. If the episode’s spending on services is below budget, the providers can share in the savings — but if costs exceed the budget, providers may face a financial penalty. They can also face penalties for failing to meet quality and patient satisfaction goals. This encourages health care professionals to pay attention to costs (something they often haven’t been asked to do) and to work with other providers to ensure patients receive uninterrupted, high-quality care. This adds another layer of cost reduction: Working together across the continuum of care, providers can identify opportunities for savings, as well as for quality improvement and care coordination.

The payer reimburses the providers involved collectively using a negotiated set price based on various factors, including historical data. Each payer calculates the budget differently, but generally, here’s how it works:

Begin with the fee-for-service payments for all services being bundled.

Remove any deemed unnecessary.

Add to the budget to deal with potential complications.

Take that final amount and discount it about 3 to 5 percent.

A bundled payment isn’t appropriate for every condition; it makes the most sense for conditions with clearly defined treatment guidelines. Among the more common ones are heart attack, labor and delivery, joint replacement, urinary tract infection, congestive heart failure and stroke.

How Does Everyone Benefit?

Bundled payments show tremendous promise. They’re expected to account for 17 percent of payments by 2021, and that figure is only set to increase. By removing the incentive for providers to earn more money by performing more services, bundling payment encourages better coordination of care — replacing a fragmented approach with a comprehensive, collaborative one.

That’s important, because despite improvements in recent years, the health care system remains segmented. This lack of care coordination drives up costs and leads to poor health outcomes. By breaking down the silos and encouraging providers to coordinate patient care throughout an entire episode, bundled payments reduce division and compartmentalization.

It’s still early, but the evidence points to increased efficiency and improved outcomes. One study found that joint replacement surgery payment bundles for 3,942 Medicare patients saved roughly 21 percent per joint replacement care episode. Similarly, private payers have reduced unnecessary utilization and costs while still improving outcomes.

Medicare got the ball rolling with bundled payments. Today, it’s also becoming increasingly common among private payers, including Anthem. More small businesses have begun to offer at least one small business health insurance options , and some large employers, recognizing the value of bundling, are directly negotiating bundle pricing, either individually or through multi-employer collaborations.

For employers, it’s all about bending the cost curve. For providers, bundling means increased efficiency and the potential to share in the savings. For patients, it means an enhanced experience, lower costs and better health outcomes. And that benefits everyone.

Statistically, it’s likely that you have employees living with chronic conditions. In fact, 6 in 10 Americans has one.

When your employees have heightened care needs, they don’t care about the number of tests the lab technician ran — they just want to feel confident that they’re going to feel better.

Value-based care reflects this by paying providers for the quality — not quantity — of the services they offer.

By focusing on outcomes through holistic, patient-centered care, a value-based care system can help improve the health of your employees living with chronic conditions. Here are three reasons why.

Care Coordination

The financial incentives that come with paying providers for the number of services they provide over the outcome of those services can fragment patient care. In contrast, value-based care establishes incentives for doctors to work together to share information and coordinate the care they deliver for the best possible outcome. Coordination — through data sharing among providers and encouraging patients to become more involved in their care — can help doctors pool their resources to identify and treat health concerns that might otherwise go unnoticed. The primary care physician may seek guidance from a specialist through an electronic consultation (or e-consult), potentially expediting care, though the patient may still follow up with a separate visit, since specialists may take the lead for some chronic medical conditions as their role evolves with specialty-specific bundled payments.

Coordinating care can help most patients, but those with chronic diseases like diabetes could see the greatest benefit. Unlike with many other chronic health conditions, patients with diabetes often manage their own care for decades. Care coordinators can provide education on living with diabetes and managing symptoms to maintain their quality of life. In the “Glucose to Goal” study, which evaluated the impact of diabetes educators in a value-based care model, 80 percent of participating patients improved their blood sugar levels.

Health Information Technology

According to the Centers for Disease Control and Prevention, someone has a heart attack every 40 seconds in the United States. Heart disease is the leading cause of death in both men and women across most racial and ethnic groups, so almost any of your employees could be at risk for this chronic condition. High blood pressure, which increases the risk of heart disease, can be managed — but only by actively involving the patient in solutions that work with their lifestyle.

When patients take part in a value-based care system, research says they adhere better to medication and condition-management plans. This is doubly true when they’re given the tools to play a leading role in their own health. Telemedicine, apps and wearable devices all offer patients the opportunity to comply with treatment without disrupting their lives. When providers make it easy for their patients to be proactive about their health, they will be.

Preventive Screenings

There are more than 100 types of cancer. The earlier it’s caught, the easier it generally is to treat — and vaccines for some conditions, including HPV and Hepatitis B, can help to reduce the risk for certain kinds of cancer. Value-based care’s emphasis on supporting well-being through prevention could be why patients within a value-based care model receive 10 percent more cancer screenings. A focus on prevention — in tandem with greater patient engagement and education on health options — can help your employees make informed decisions about their care and determine the treatment they’d prefer to receive.

Under the fee-for-service care model, providers sometimes overutilize tests and treatments for patients with cancer. The shift in focus toward quality of life and outcomes may help reduce unnecessary ER visits and tests while increasing the use of palliative and hospice care. All of these individual pieces are the building blocks of a better patient experience — when patients are active participants in their care, they can more easily follow a care plan and reach their unique health goals, whether they want to manage a condition or alleviate pain.

Your business depends on a present and productive workforce. Without proper treatment and strong health plan options, chronic conditions can lead to a rise in workplace absenteeism, decreased quality of life and higher health care costs for both you and your employees. The value-based care and fee-for-service models both developed to support better health and they can live fearless.

They just have different ways of making it happen — and different levels of success. Value-based care takes an informed and patient-centric approach to care so patients can decide what high-quality care means to them and work with doctors to achieve it. When chronic conditions set up residence in the workplace, value-based care rewards providers for keeping employees healthy.

The Texas Department of Insurance is alerting consumers about a phone calling scam being perpetrated by a group claiming to be the Consumer Insurance Association.

The calls offer to lower the recipient’s auto insurance costs and ask about current coverage. It’s a scam, TDI says.

The caller may mention the names of well-known insurance companies, and the phone number may originate from any state. According to TDI, Consumer Insurance Association is not a licensed insurance company or agency in Texas.

“This could be an attempt to get you to reveal personal information for identity theft,” Chris Davis, head of TDI’s Fraud Unit, said in a media release. “It’s always good to be cautious of anyone who calls when you haven’t asked for information.”

TDI recommends consumers getting a call offering to lower their insurance costs to ask for the agent’s Texas insurance license number. Recipients of such calls should not provide personal information such as your address, birth date, Social Security number, or bank account numbers, TDI said.

Monday: The Sutter system could be liable for more than $2 billion under state law. Also: A deadline for wildfire damage claims, and the Eve Babitz revival.

Sutter Health, a sprawling system of 24 hospitals and 5,500 affiliated doctors, faces trial in San Francisco today over accusations that it used its dominance in Northern California to stifle competition and force patients to pay higher medical bills.

Our colleague Reed Abelson, who covers the business of health care, explains the significance of the case.

You can expect the courtroom to be standing room only for the Sutter antitrust trial. The case is being brought by the state’s attorney general, Xavier Becerra, along with employers and unions that say they have been harmed by Sutter’s actions.

Because Sutter is able to force health plans to include all of its hospitals and doctors in their networks, patients can’t go elsewhere for care that is cheaper or better quality, Mr. Becerra said. He describes Sutter as showing signs of being a “bully.”

Sutter’s critics say this leads to much higher prices in Northern California for medical care than in the southern part of the state. Hospital care for a heart attack costs around $25,000 in San Francisco, according to research by the Petris Center at the University of California at Berkeley. It’s closer to $15,000 in parts of Los Angeles.

Sutter says that its big system benefits patients and that it does not engage in any behavior that would hurt competition in the market. It says the big insurance companies support the case because they want to limit patients’ choice and increase their own profits.

There’s a lot at stake: Sutter could be liable for more than $2 billion under state law, which can treble the amount of damages awarded.

But other big systems, many of which employ similar tactics to prevent insurers from steering patients to other places, are also paying attention to what happens in court. The wave of mergers and acquisitions of physician practices across the country has left many markets with a dominant hospital.

If the case doesn’t go in Sutter’s favor, you can expect other big systems to start worrying about their own behavior in making sure insurers don’t send patients outside their hospitals and medical groups. As Leemore Dafny, a former antitrust official and Harvard business professor, said: “It could have a chilling effect on these practices nationwide.”