Friday, November 16, 2018

Health Care Sharing Ministries in the crosshairs

This just in:

"Nebraska published a consumer alert about health care sharing ministries - consumers should be aware of the significant limitations (like no-legal-responsibility-to-pay-claims-level limitations)"

Why this is just now being treated as "breaking news" is beyond me: we've been pointing out these very real problems for years:

"My claim from October had still not been paid. Yesterday I received a notice dated April 19, 2017 that since I was no longer a paying member my medical claims are no longer eligible for payment!"

Of course, these plans have their good sides, as well: ACA-compliant, relatively inexpensive, often include decent benefits (and omit unnecessary ones that tend to drive up rates). But as I point out to my own clients, they aren't insurance, so there's really no recourse if they decline a claim or simply fold up shop. And, as the report points out, there are often significant limitations in what's covered (and for how much).

Still, they remain a viable ObamaPlan alternative, as long as one joins up with eyes wide open.

[Hat Tip: Rachel Schwab]

Thursday, November 15, 2018

Fall Health Wonk Review

Well, we got our first major ice-storm of the season last night (and continuing this morning), so it seems that Fall is, indeed, making itself known. And Lisa Lines is making her presence known, too, as she makes her Health Wonk Review hosting debut over at The Medical Care Blog.

And a right nice job she does of it: with posts ranging from Open Enrollment to Big Pharma Phunnelling Funds, you're sure to find *something* to pique your interest!

A Deadly Conundrum

Here's the (gruesome) headline:

"California dad charged with insurance fraud after he drove off cliff, killing autistic sons"

Now, we've discussed before the fact that one may not profit from a crime:

"In this story ... we learn about Joaquin Shadow Rams, who seems to have a habit of buying, and then collecting on, life insurance policies for his intended victims, including (allegedly) his mother and his girlfriend."

And of course there have been others. In all of the related posts I can find, though, all save one have been about straightforward and underwritten (term, whole or universal life) plans. But this one's different, and I'd like to talk about that difference.

"Regular" (aka "ordinary") life plans like term and whole life are generally underwritten (although there are guaranteed issue versions which impose waiting periods). But "accidental death" plans pay out only if the death is due to an non-purposeful injury (well, almost always). And the key to these plans is that they are generally not underwritten.

[ed: As an aside, one wonders if there was a cultural motive involved here in addition to the financial one]

In the case at hand, the facts seem pretty straightforward as to what happened. What's interesting to me is why the father chose an Accident Only plan instead of a term or even "Jumping Juvenile" one. And it seems to me that the answer is fairly obvious: the lack of underwriting makes it an easier "buy," and the fact that it's Accident only makes it a lot cheaper.

It's also worth noting this little tidbit:

"[T]wo years and 12 days earlier, Elmezayen bought the last of his insurance policies, which were purchased to cover his family in the event any of them accidentally died."

One presumes that this was to avoid triggering the "Contestability Clause," but I'm not seeing where that would apply to an Accident Only plan. After all, that clause is to protect the carrier from misstatements of health, age or sex; I'm not aware of any app that asks "Are you planning to murder your spouse/children any time soon?"

This is obviously a very sad case, but also a very strange one.

Wednesday, November 14, 2018

Cost transparency: I'll drink to that!


"Health care is a service like any other. We ought to expect price transparency for medical goods and services to make informed choices that maximize value."

I, too, have been chasing this wild goose for many, many years. And I still believe that it's a noble goal.

But as long as government and insurance - in other words, 3rd party payers - are in the mix, it's not a viable one.


And why would any physician agree to this? And perhaps more critically, how would they?

Which brings me back to my first point (above): so long as the government (through Medicare and Medicaid reimbursement levels) and insurance (trough multiple provider contracts) distort the price (that is, that which the consumer/patient/insured pays), then there's no practical way for this to occur.

Which of course brings to mind Direct Care (whether Primary or other): when one pays the piper oneself, then it's reasonable (and viable) to pre-determine the cost of various services beforehand [ed: up to a point - what if the knee surgery uncovers something more serious?]. Of course, there's still an affordability challenge (and, often, an accessibility one), which means we still have a long way go.

Which is still another reason I'd love to see true cat plans re-legalized.

Tuesday, November 13, 2018

Tuesday Potpourri

So this past August we posted on the most recent "shiny new thing," Association Health Plans, which allows otherwise disparate groups of folks (employers and individuals) to band together to create larger insurance "pools." Our friends at HAFA (Health Agents for America), tip us that some carriers are beginning to roll out actual plans:

"Land O'Lakes, several Nevada chambers of commerce, and the National Restaurant Association have formed association plans this year ... the Land O'Lakes association plan “will offer another really good choice for individuals who either don't receive a subsidy and cannot afford coverage on the exchange or for some reason prefer not to purchase that coverage.”

Interesting. And we're seeing a lot of activity lately in the group self-funded space. So perhaps the market itself is killing ObamaCare with 1,000 cuts?

We'll see.

Thanks to FoIB Dabz, we're treated to this very interesting piece on creative (and viable) ways to deal with the (over-hyped) pre-existing conditions issue. For example:

"... the option of buying coverage at some point in the future—insurance against developing a health condition that makes one uninsurable."

This is not new; a decade ago we noted that (now-defunct) American Community Mutual rolled out "Community Flex," it starts out as an accident policy (major claims are only paid for injury, not illness), with some coverage for doc visits, preventive care, and a drug discount card ...  if you want more coverage, such is available through a "Gold Plan" buy-up."

And of course, "Dave's Plan" takes a similar approach:

"The capper, though, is that the plan has a rider that allows the insured, at their discretion (and with with no additional underwriting) to convert it to a major medical plan."

Which is to say, Chris Jacobs at The Federalist is spot on.

As we've long noted (most recently here), The VA is a hot mess. And if you still harbor any doubts, well:

Wonderful Veteran's Day.

Monday, November 12, 2018

Dutch Doc in Dutch

We've written before about Holland's fascination with euthanasia:

"The number of Dutch people killed by medical euthanasia has more than doubled in the 10 years since legislation was changed to permit it, rising 13 per cent last year to 4,188."

And that was a little over 5 years ago. In the meantime, seems that the situation has deteriorated even further:

Thing is, it's not really clear to me why this doc has been singled out: it's not as if the underlying culture of enforced expiration is new, or somehow a secret.

Perhaps it's because, according to the linked article, this particular case was "assisted suicide" in much the same way as The Soprano family offered free swimming lessons. So the *true* message is ... a more subtle, refined ... approach.

It will be interesting to see how the case is ultimately resolved. Perhaps it, too, will (not so quietly) "go away."

Friday, November 09, 2018

Stupid, Self-Defeating Carrier Tricks

So, have a (long-time) client that needs a short term medical plan. Decided on one from United Healthcare (don't judge). After choosing deductible and co-insurance options, we started the "Broker Assisted Application" process (which basically means that I fill in his name and date of birth, etc, and checking account info). Once that's done, I press a button that sends him a link, he completes that link with his last name and date of birth, then hits continue to send it back to me for finalization.

Well, that's the way it's supposed to work, anyway.

What happened this morning - repeatedly - was that he would get the link, enter the info, press the magic button, and be told:

"Application not found."

Really, then how the $@()*^ did you know to send him the link in the first place, dummies?

After repeating this another time, with different browsers and same results, I called the ever-helpful people at Home Office. They advised me that he needs to complete this process from Google Chrome. I responded, well then, maybe we'll just use the "via text" option, and was assured that this process will not work for the application portion.

Then why offer it, you dolts??

This person wants to give you money and you're making it difficult for him to to do so?

Wow, just wow.

From the P&C Files: Ooops!

Thursday, November 08, 2018

Rx and Profits: A Contrary Perspective

There's no question that the cost of prescription medication is a significant driver of health insurance costs. And there's decent enough evidence that "Big Pharma" plays by ... ummm ... perhaps different rules than most industries, racking up fairly decent profits (NTTAWWT). And we hear from the "health care press" on a daily basis how bad this is for consumers and patients.

But maybe there's a good reason for this: after all, in a (nominally) free enterprise system, greater risk should justify greater return.

Okay, Henry, what the heck are you babbling on about?

Well, this:

Keep in mind that it may cost millions of dollars and decades of research to come up with even one new med, which then has to undergo the (presumably) stringent FDA approval process. And, of course, some non-trivial number of these new efforts fail to pay off.

Maybe there's some room for debate here, after all.