In the health care business these days, its all about the networks.

Spurred on by competition on the new Affordable Care Act exchanges, health insurers are moving to pare down their provider networks, promising participating hospitals and doctors more patients in exchange for lower payments.

Docs are busy selling out their practices to hospitals that can negotiate better rates for their services, giving up their independence to become salaried hospital employees.

And together, hospitals and large medical groups are joining accountable care networks in which, like insurers, they agree to provide all of a familys medical needs for a fixed annual fee.

Its one reason perhaps a big reason why medical costs have begun to level off in recent years. But its not without its trade-offs. Lower rates and higher volumes at hospitals and doctors offices often translate into inferior service for patients longer waits, rushed appointments, less help from the staff. And if you find yourself outside the network, its apt to be very expensive, whether you intended to go out of network or not.

There have been numerous stories in the news recently about people who carefully take the time and effort to arrange for an in-network surgeon to perform an operation at an in-network hospital only to find a bill in their mailbox a few weeks later for thousands of dollars from the out-of-network anesthesiologist, or pathologist, or assistant surgeon who were brought in on the operation without their knowledge and approval.

Or the people who, even in the ambulance, have the presence of mind to request to be taken to an in-network hospital, only to find out later that the entire emergency room operations has been contracted out to an out-of-network provider who bills at three, five, even 10 times the in-network reimbursement rate.

Theres no data on how often this happens, but as networks have tightened, industry experts say, its happening more and more. A recent study ordered up by the Texas legislature found that half of the hospitals that participated in the networks of that states three biggest health plans had no in-network emergency room doctors. And nationally, an estimated 65 percent of hospitals contract out some or all of their emergency room functions. Many of the largest ER contractors do not participate in any insurance networks.

Hospitals say they often have no choice but to rely on non-staff doctors because there are not enough willing to work on a hospital salary or to put it another way, some hospitals refuse to pay the market rate. Hospitals also argue that scheduling of surgery is often so fluid and last-minute that there is not enough time to inform patients in advance that they will be treated by out-of-network specialists.

Several states, including Maryland, California, Colorado and most recently New York, have passed laws restricting balance billing by non-network providers for genuinely emergency services. In most cases, those laws leave it up to the hospitals and the patients insurers to negotiate the payment. A similar restriction is contained Obamacare, although initially it only applies to newly established health plans.

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Tendon surgery sheds light on the lack of clarity in some out-of-network pricing

MONTEREY >> Construction is set to begin in the conversion of a once problem-riddled nightclub into 22 luxury apartments in downtown Monterey.

In 2013, the City Council approved the conversion of the second- and third-floors of the Paseo Del Alvarado Building at Alvarado Street and Del Monte Boulevard to 22 apartments.

The building, which houses Cibo Ristorante, Taco Bell, and other businesses on the ground floor, has been home to upper-story offices and nightclubs since it was built in the 1970s as part of the city's first urban renewal push.

The building's upper floors previously housed the Hippodrome nightclub, which was shut down by state alcohol control officials after fights and reports of public drunkenness.

The apartment conversion was embraced by police, downtown business groups and the public when the council approved the change.

The combination of retail and residential uses in the building fits with the city general plan encouraging such mixes. It also dovetails with city plans to revitalize downtown by encouraging more people to live in the city center, Chip Rerig, planning chief for Monterey, said at the time.

Cibo Ristorante issued a press release Thursday saying construction will span 10 months. Part of the makeover by Paseo de Alvarado Partners and San Jose Construction will include adding outdoor seating to the restaurant.

The new apartments will be soundproofed so the restaurant's music won't disturb tenants, the statement said.

Businesses will likely remain open throughout the construction, and Cibo's statement said there will be no construction noise during the restaurant's business hours of 4 p.m. to 1:30 a.m.

The statement said the renovations were a "multi-million dollar" project that includes a "full exterior face-lift."

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Construction starting on 22 new luxury apartments in Monterey

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Friday, October 10, 2014, 2:24 pm

Qualified Remodeler, a remodeling publication serving contractors who specialize in residential and light commercial remodeling, has selected Tri City Remodeling of Midland as one of the Top 500 remodelers of 2014.

Tri City Remodeling was honored for meeting a set of criteria including installed remodeling dollar volume, total years in business, industry association membership, industry certification, industry awards and community service.

Based on Qualified Remodelers analysis, the Top 500 firms tend to share several common attributes, including excellent business acumen, a commitment to customer service, insightful sales techniques and strong customer loyalty said Laurie Banyay, managing editor. Were positive these attributes helped put the firms on this list and contribute to their success.

Posted in Business on Friday, October 10, 2014 2:24 pm.

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Annapolis, Maryland (PRWEB) October 11, 2014

October is the month to visit pumpkin patches and enjoy hot cider in front of a warm fire. While this is a autumn tradition at home, the River Dunes boating community celebrates the changing of the seasons by visiting the boating capital of Maryland, Annapolis. This weekend and next, it's estimated over 130,000 people from around the world will come to explore the latest in marine gear and boats.

Folks interested in Inner Banks waterfront property will be able to talk with the folks at River Dunes at the Annapolis shows. River Dunes is a two time winner of Real Estate Scorecard's Bliss Award for Best Boating Community of the Year and this is just one of many awards the community has achieved!

October 9-13, 2014 marks the dates for the United States Sailboat Show in Annapolis. This event is the oldest and most popular boat show around the globe, and folks from miles around are traveling here to discover whats new in the sailing world. River Dunes is the host of the annual sailing Leukemia Cup Regatta held within the community of Oriental North Carolina, nicknamed the "Sailing Capital of North America" where sailboats outnumber residents three to one. This past June, the event raised over $140,000 for charity. River Dunes is a coastal master-planned community with 124 deepwater boat slips, an 1,100 foot boating access channel and protected Grace Harbor Marina. Cottage homes come in a variety of styles and sizes. Some have wide white front porches, tall windows and attractive metal roofs featuring coastal designs by Historical Concepts, an award winning Georgia based architectural firm.

On October 16-19, 2014, folks who like more power behind the wheel can check out the United States Powerboat Show at the same location. Both the Sailboat and Powerboat events begin at 10 a.m. Friday and last until 5:00 p.m. on Sunday. Tickets for adults for one day are $18 and a three day VIP preview costs $35. Children can accompany their parents for free if they are 6 years old or under. Buyers searching for Inner Banks waterfront property will have plenty of time to see the 100+ water exhibits, meet the friendly folks of River Dunes and attend the Seminars on Sailing presented by Chesapeake Bay and the Annapolis School of Seamanship.

Whether folks are serene sailors or a propelled powerboaters, everyone has the opportunity to explore the newest makes, models, equipment and accessories at both 2014 Annapolis Boat Show weekends. Manufacturers and brokers will be available to answer questions, while exhibits will feature the latest and greatest products for people who want to sail in style. It is truly a boating extravaganza and a great chance to talk with the folks at River Dunes in Annapolis.

River Dunes has been capturing the attention of boaters for years. This 1,345 acre boating community is the ultimate in Inner Banks waterfront property. More than 35 homes have been built to date and a total of 650 are planned.

Check out River Dunes homes

328 acres are dedicated as an exclusive nature preserve and include scenic hiking trails and 14 miles of natural shoreline. The award winning River Dunes boating community is known for their love of the open water, but the residents also cherish amenities already built within their neighborhood.

RIVER DUNES AMENITIES

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Visit River Dunes at the October 2014 Annapolis Boat Shows in Maryland

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Al Phillips

Al Phillips isnt satisfied with the direction Maryland is moving and the decisions being made by current state lawmakers, so hes taking matters into his own hands.

The Gaithersburg Republican is running for a state delegate seat in District 39, which includes Clarksburg, Germantown, Montgomery Village and parts of Gaithersburg.

I have a laundry list of issues where I disagree with these people, Phillips said. I believe that sometimes you need to be the change you want to see or at least make an attempt to be it.

Since filing to run, Phillips, 49, said he has participated in several regional events, such as the Gaithersburg Labor Day Parade and Montgomery Village Fourth of July Parade, to meet voters. He plans to attend future community events, and host meet-and-greets to get to know voters better.

Ive been doing things here and there but I believe now Im in full campaign mode, Phillips said, adding that he also had flyers and yard signs created to give out to citizens.

Although there are many issues Phillips hopes to tackle in office, the largest one is changing various tax rates.

Lowering the corporate income tax rate to make it more competitive with Virginias is a major priority for Phillips. By having a higher corporate income tax rate than Virginia, Maryland is losing businesses to its southern neighbor, Phillips said.

Other necessary changes include reducing the tax rates on gasoline, alcohol and tobacco, Phillips said. Climbing tax rates on these items are pushing consumers to spend their money outside of the state where taxes are lower, he added.

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Gaithersburg plumber looks to take on taxes as delegate in District 39 -- Gazette.Net

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