Wednesday, October 22, 2014

Can I Charge Interest?

One of my clients dropped their employer sponsored insurance plan effective May 1, 2014. This forced 21 of their employees (including the owners) to find individual coverage. We met and worked with all of them to secure coverage either off the exchange or through

In another month we will perform this exercise in patience once again. To really do a good job for our clients this process is frustrating, complex, and time consuming.

It's even more frustrating for me though when one of the insurance companies still hasn't paid my commissions yet.

For the last six months we have continued to help with service questions for the employees I enrolled with this particular insurer and have spend an inordinate amount of time trying to get paid. We knew there would be problems with this whole process and I understand that the initial issues could be a result of mistakes from all parties. However, those items were fixed a couple of months ago.

When will I get paid? Who knows. Its too bad I can't charge them interest though.

VaderCare? "Pray I don't alter it any further"

As the Halbig saga slogs on, the industry itself is moving forward:

"[I]nsurance companies offering plans on this year had a new clause inserted into their contracts ... that allows them to cancel plans if federal premium subsidies are eliminated."


Now why do you suppose that Ms Burntwell and her minions might agree to that?

It isn't very difficult to connect the dots.

Another Ebola Insurance update

Well, the more the merrier! This latest comes to us via email from Medical Mutual of Ohio:

"All fully insured and self-funded health plans administered by Medical Mutual Mutual and Mutual Health Services will cover treatment for Ebola as if it were any other illness, subject to terms and conditions of the member’s plan."

This is crucial language: it means that items like isolation and special travel arrangements are likely covered. On the other hand:

"[W]e do not have specific information about treatments considered “unproven,” experimental or investigational, such as plasma transfusions from recovered patients or the medication Zmapp."

They do go on to note, though, that they would "likely" be covered. I understand this: no one really knows what we're getting into here. And if this does in fact become pandemic, well, all bets are off.

Tuesday, October 21, 2014

Blue Cross Wrist Slap

Received this via email:

"The ruling confirms last year's judgment by a federal court in Detroit, which found that BCBSM collected millions of dollars in hidden fees over a nearly 20-year period from the  employee health plan for Hi-Lex Controls, Inc. and Hi-Lex America, Inc."

Over the years, we've blogged on the Blues' various legal travails more than once (most recently here). It's nice to see one that's actually "gone the distance," though.

The case at hand actually took 3 years to wend its way to SCOTUS, but it's apparently not the last:

"The Hi-Lex matter is the first of nearly fifty cases filed by Varnum [law firm] over the fraudulent fees."

It seems that BX was acting as the claims payor for self-insured plans, and reporting different amounts than were actually being charged. Even more egregiously, managers apparently knew of the practice, but discouraged employees from mentioning it, making them unwitting accomplices.

It appears that BX has since discontinued this practice, perhaps as a result of the litigation.

[Hat Tip: Tyler Lecceadone]

Monday, October 20, 2014

Have Faith (and Insurance)!

For the past 14 or so years, I've participated in a healing prayer group with some friends. We meet weekly and pray for the health of folks running the gamut from broken limbs to terminal illnesses. The one hard-and-fast rule we have is that the person for whom we're praying must know that we are praying for him (or her) and must have given us explicit permission to do so (there are exceptions, of course: someone in a coma is unlikely to meet those criteria for a while).

That rule is because we believe that the key to our efforts is that we are connected to and with the folks on the list. To that end, we also endeavor to get regular, timely updates from them on their progress (If any). We acknowledge that we don't know - can never "know" - whether or not our efforts have been successful, but we continue to meet week in and week out because we believe that we are making a difference in these people's lives.

Which may explain why my interest was immediately piqued by this item:

"I was parked in front of a patient’s home before my visit, running through my checklist. Patient’s diagnosis and prognosis. Any known family members or friends supporting the patient. Religious affiliation, if any. Patient’s name – you should always recheck the patient’s name. It’s good to know little about a patient’s medical concerns, but as chaplain, my concern is not what the patient’s illness is, but who the patient is. I want to address their spiritual needs and see how their spiritual health affects their overall health."

Turns out, the (anonymous) author works for an ACO (Accountable Care Organization - healthcare companies that are paid as a percentage of the money saved through their care management) called MissionPoint Health Partners. The folks in my healing prayer group were also intrigued,and urged me to connect with the firm to find out more.

So I reached out via their site's contact form, and even sent a LinkedIn invite to whom it appears is their media outreach person.

Days later: /crickets.

That's a shame, too, since this concept shows real promise, and there are some key questions that we'd like to see addressed.

For assistance: how do they deal with atheists who express an interest in this service?

And what metric do they employ to measure "success?" That is, they claim that this service reduces expenses, but how do they know this?

Oh, well, they missed an opportunity.

Sunday, October 19, 2014

About Those Obamacare Subsidy Calculations ..........

If you are among the millions waiting on 2015 plans and wondering about your premium
subsidy, worry no more. The folks at About have broken down the process into these simple steps.

The premium assistance tax credit is lower of the following two amounts:
  • The premiums for the second lowest cost silver plan minus an individual's required contribution for health insurance. A person's required contribution is household incomemultiplied by an applicable percentage.
  • The premiums for a qualified health plan for the individual, the individual's spouse and any dependents enrolled through a health insurance exchange.
The premium tax credit can be calculated using the following method:
  1. Calculate household income.
  1. Calculate household income as a percentage of the federal poverty line.
  1. Calculate the applicable percentage.
  1. Calculate the required contribution.
  1. Find the second lowest cost silver plan on the health insurance exchange.
  1. Subtract the required contribution from the second lowest cost silver plan.
  1. Then compare that number to the premiums for the health plan in which the person or family actually enrolled.
  1. Whichever number is lower is the amount of the premium assistance tax credit for the year.
But wait, there's more!
Information Needed to Estimate the Premium Assistance Tax Credit in Advance
  • Page 1 of Form 1040 (completed at least through line 37) for each person in the family
  • The premiums for the second lowest cost silver health insurance plan that covers the family
  • The premiums for the health insurance plan or plans you are thinking of or actually enrolled in
Information Needed to Calculate the Actual Amount of the Premium Assistance Tax Credit
  • Page 1 of Form 1040 (completed at least through line 37) for each person in the family
  • Form or Forms 1095-A received from the health insurance company
The premium assistance tax credit can be calculated using Form 8962.
Still not done ...........
You will also need to know how to calculate your household income, then calculate your household income as a percentage of the Federal Poverty Level, calculate the applicable percentage, calculate your required contribution, find the SECOND lowest cost Silver plan on the exchange, subtract your required contribution from the cost of the second lowest cost Silver plan then compare your maximum annual premium assistance to the actual premiums for the plan you chose. Whichever number is lower is your credit.
Got that?
But before you start all this you will need:
To estimate the premium assistance tax credit for 2014:
  • Use your 2013 tax return to calculate your modified adjusted gross income and household income.
  • Revise your household income based on any changes in income you expect for 2014.
  • Use the 2014 poverty guideline chart to calculate your expected household income as a percentage of the federal poverty line.
  • Use the 2014 applicable percentages chart.
  • Use applicable percentage and household income to calculate the required contribution.
  • Use the second lowest cost silver plan for the area in which you live to calculate the premium assistance amounts.
  • Consider using Form 8962 as a worksheet to do your calculations, so you can become familiar with this form.
To calculate the actual amount of the premium assistance tax credit for 2014:
  • Use your 2014 tax return to calculate your modified adjusted gross income and household income.
  • Use the 2014 poverty guideline chart to calculate your expected household income as a percentage of the federal poverty line.
  • Use the 2014 applicable percentages chart.
  • Use applicable percentage and household income to calculate the required contribution.
  • The second lowest cost silver plan is shown on Form 1095-A line 33B.
  • Use Form 8962 to do your calculations. This form is then included with your tax return for the year.
To estimate the premium assistance tax credit for 2015:
  • Use your 2014 tax return to calculate your modified adjusted gross income and household income.
  • Revise your household income based on any changes in income you expect for 2015.
  • Use the 2015 poverty guideline chart to calculate your expected household income as a percentage of the federal poverty line.
  • Use the 2015 applicable percentages chart.
  • Use applicable percentage and household income to calculate the required contribution.
  • Use the second lowest cost silver plan for the area in which you live to calculate the premium assistance amounts.
  • Consider using Form 8962 as a worksheet to do your calculations, so you can become familiar with this form.
  • Compare your calculations to the calculation provided by the insurance exchange.
No big deal, right? 

Here is that link again in case you missed something.

Be sure to thank your Congress critter when you go to the polls.

Obama is not on the ballot this year, but his policies are.

Double Whammy, ObamaTax-style

First the bad news:

"ObamaCare shoppers in search of the lowest-cost plan may come down with a mild case of rate shock when 2015 exchange enrollment begins next month ... the cost of the cheapest bronze plan will jump an average of 13.9%"

Remember when we were promised that we'd have 3000% rates decreases?

Good times, good times.

But wait, it gets better worse:

Turns out, the folks who actually buy these plans can't afford to use them:

"[E]ven among those who receive enough subsidy money from the rest of us to offset the high premiums, killer deductibles make their coverage much more expensive in practice, to the point of rendering them virtually useless."

It's simple mathematics, after all: thousands (perhaps tens of thousands) of dollars in premium plus thousands ((perhaps tens of thousands) in out-of-pocket costs means that a lot of folks now can't afford to use the insurance they scrimped and saved to buy.

But hey: so much better than the old system, no?

Saturday, October 18, 2014

Cancer Walk Thank You [Updated!]

So, the Making Strides Against Cancer walk took place this morning, and I'm happy to report that we all made it through the grueling 3.1 mile course. Thankfully, the rain held off until we'd finished (Yay!); some 10,000 people took part in ours.

Our team finished a very respectable 21st out of 539 (top 4% - WooHoo!), and my terrific contributors donated $800 as of this morning. But don't feel left out: you can still donate here.

Thank You!

I'll post our team picture shortly.

Friday, October 17, 2014

ICYMI: We already *had* an Ebola Czar

Prior to appointing political hack well-regarded activist Ron Klain to the position, actual Dr Nicole Lurie was the official frontman .. er, woman for this important post.

What, you didn't know that?

Don't blame yourself:

"Nicole Lurie, M.D., M.S.P.H., has been completely M.I.A. ... She's the Assistant Secretary for Preparedness and Response"

What, now she's in isolation? Hunh.

It's a Feature, Not a Bug

Slick, fast talking sales people (and politicians) it seems can sell anything. Just make sure you avoid telling the

If you like your current plan, even if it is an Obamacare design, you probably can't keep it. If by chance that plan will continue next year, you might keep it via auto-enrollment.

But if you decide to change carriers, you might want to make sure you have enough money to pay double (or more) premiums for a few months.
Insurers expressed concern about consumers who choose to leave one health plan and sign up for another offered by a different insurance company. The federal government is not planning to send a notice to the first insurer terminating the consumer’s enrollment. As a result, consumers may receive bills or invoices from both companies. And conceivably, insurers said, if premiums are paid from bank accounts by electronic funds transfer, the money could be deducted twice.

Isn't that swell?

First the government tells you that you MUST buy health insurance, then they abandon you on the renewal.

Put more lipstick on this pig.

Econ vs Engineering: A Case Study

Uber-wonk John Goodman has an outstanding piece at Forbes contrasting the perspectives of various players in the health care arena, focusing specifically on the (mis-)handling of the Ebola crisis at the hands of the CDC.

Basically, he argues (persuasively) that engineering-oriented folks focus primarily on planning as a function of organization, and that self-interest is largely unimportant. They believe, he argues, that "incentives don’t matter [very much]."

Economics-oriented individuals, on the other hand, believe that incentives matter a great deal; that "people find that when they pursue their own interests, they are also meeting the needs of others."

You can see the problem.

His thesis is fairly simple, and therein lies its elegance:

"[M]ost people in health policy take the engineering approach. That is why there have been so many mistakes and so many failures of policy – ranging from Obamacare to Ebola control."

Read the whole thing for his explication of this unfortunate truth. You'll be glad you did.

Another Day, Another Czar

What's up with the czar titles? I remember studying "Czarist Russia" in school. Why does
this term make me cringe when it is used by the administration in Washington?

Who decides the qualifications? What kind of training and experience do you need to be a czar? Can I get a Bachelor of Czarism? Or is this a trade school kind of thing? Is a level of competence to be expected or is it all political cronyism? Who does the czar report to? Is a czar ever fired due to incompetence?

Comes now Ron Klain the new Ebola czar. According to CNN ......
President Barack Obama is expected to name Ron Klain, a former chief of staff to two Democratic vice presidents, as the country's Ebola czar, knowledgeable sources told CNN's Jake Tapper today.
And what qualifies this man to be an Ebola czar?

From Wikipedia ............
Ronald A. "Ron" Klain is an American lawyer and political operative best known for serving as Chief of Staff to two Vice Presidents - Al Gore (1995–1999) and Joseph Biden (2009–2011).[1][2] He is an influential Democratic Party insider.
Now, don't you feel much safer knowing a political operative and insider is in charge?

I know I do.

Friday LinkFest

■ The Bay State's Medicaid explosion, er, expansion looks to be growing at a much faster clip than originally anticipated. Wonder why?

Wonder no longer:

"[A]nalysis of financial filings indicates that the subsidized Medicaid program known as MassHealth has for the past four years incurred $500 million in deficits that have been hidden by a quirk in the state’s budget process."

Ooops. And this has been going on for quite a while, racking up "billions in cash shortfalls."

■ While we've been focusing on the financial implications of The ObamaTax, the impact on the delivery of health care is equally critical. And equally in shambles:

"Doctors are ramping up our protests against the government's expanding role into health care ... We are instead protesting silently through our practice decisions."

And the "practice decision" being made by an increasing number of doc's is: we're outta here.

■ We've posted before on the fact that the Exchanges are quick to take folks cash, not so quick to pay out commissions to those who actually helped people navigate (heh) the onerous 404Care site. That may be changing:

"The long-awaited fix to the National Producer Number (NPN) is expected to be in place by Nov. 15 and will allow brokers to enter their identifiable information and receive commissions"

What's stupid is that we've been using the NPN numbers for a long time now - in fact, it's the only acceptable form of identification for many states' Continuing Education requirements. Why am I not surprised that the Feds are so far behind on this simple piece of infrastructure?

Thursday, October 16, 2014

Life imitates The Onion

Bob posted on this earlier, but I wanted to add my $.02, as well.

It seems we've been down this road before, but this time with a twist:

You're forgiven if you thought "gee, musta been a heckuva subsidy," but in this case, it's simpler: the perps were passing off medical discount cards as true insurance. We've actually blogged on this practice before; back then, various state insurance departments were cracking down on these outfits. Now they've made an honest-to-goodness Federal case out of it.

Now, you're probably asking yourself: "how did the Fed's know that these were scam sites?"

Simple: They worked.

And speaking of frauds, the Feds are fairly nonplussed at pulling their own little scam, at least according to the legal eagles at Judicial Watch:

Turns out, our Betters in DC© have been buying coverage off the Capital's Small Business (SHOP) Exchange site [ed: even more evidence of their recklessness, no?]; the JW folks argue that this avenue is open only to small businesses, of which Congress isn't one. Even better, at least a few of these rocket surgeons seem to have applied, and been approved for, a subsidy.

Your tax dollars at work.

This Can Happen to You

Theater patrons were asked to leave their cell phones on. This is what happened.

From the Mailbag: Now you see it, now you don't

FoIB Jeff M, commenting on the curious case of the missing renewal numbers, wonders:

"Our most transparent administration ever has announced that ACA plan renewal rates won't be released until after election day. But don't renewal rates have to be released 60 days prior to renewal?"

Great question.

Our own Pat Paule has your answer:

"The 60 day written notification applies to grandfathered plans in the individual market, as well as grandfathered and non-grandfathered plans in the small group market. Non-grandfathered coverage in the individual market doesn't have to receive their written notice until "BEFORE THE FIRST DAY OF THE NEXT ANNUAL OPEN ENROLLMENT PERIOD." Insurers in this market are not allowed to send written notices of renewal until the QHP (Qualified Health Plan) Issuer Agreements for the plan year have been signed, "to ensure that the correct information is included."

It is my understanding that a few states have approved rates available to view - without benefit summaries - and others are still waiting on their Compliant Issuer Agreements to be approved. Any guess where these agreements are at? Also, none of the plans take into account the beloved subsidies. Without that information we really have no idea how much more these plans will cost people until they have the ability to enroll beginning on 11/15

Thank, Pat!