Friday, October 09, 2015

Training Day Update 2


Figured I'd update readers who've been following the saga of my 2016 Exchange training travails.

So, received this from the CMS folks:

"Thank you for contacting the Marketplace Learning Management System (MLMS) Helpdesk.

When you enrolled, you were not assigned the curriculum for Navigator – it was not added to your record.  The Navigator curriculum has 14 courses.  You still need courses 011, 012, 013 and 014

Only one problem, which I quickly pointed out to the rocket surgeons at CMS:

"I am NOT a Navigator, I am a licensed insurance agent."

That was Tuesday; I re-sent it an hour or so ago.

And the wait continues....

BREAKING: Mid-sized Groups dodge a bullet

President Obama has signed into law the PACE Act, which allows each state to continue to determine the definition of "small" group. Without it, the definition would become 2-100 lives nationally.

It's expected that Ohio will continue to define "small" as between 2 and 50 employees.

About that 3000% rate decrease: Part 6,549

Bill and Susan have a grandfathered HSA-compliant health insurance plan which covers them and their three children. Because it's Grandfathered, it's immune from some ObamaTax requirements (such as maternity coverage), but it also means that they can't make any changes (such as increasing the deductible to save premium dollars).

Their December renewal landed on my desk the other day, and it's a doozy. Their plan has a $6,000 family maximum out-of-pocket (MOOP), and their rate jumped 30% to just under $1,000 a month. They're not subsidy-eligible, so no help there.

Of course, I suggested that we shop around, but (as usual nowadays) I warned them not to get their hopes up.

Which turned out to be good advice:

Company A offered a plan which doubled their family MOOP to over $12,000, and cost $15 a month more than their renewal, Yippee!!

Company U had a slightly better "deal:" Bill and Susan could shave $20 a month off their premium, and only double their out-of-pocket.

Or they could choose a plan with only $1,300 additional exposure, and a slight premium increase of only $200 more than their renewal.

Such a deal!

Early Fall Health Wonk Review is up

As usual, Joe Paduda has an outstanding selection of wonky posts, including a fascinating inside look at the role of IT and automation in health care.

Good stuff.

Thursday, October 08, 2015

La Plus ca Change

Hey Mr Peabody!

Wayback (SWIDT?) in 2006, we blogged about Minnesota Blue Cross/Shield's new, bleeding edge health care transparency program:

"So, pick up a box of cereal, a package of pasta, or a can of peas, and you’ll find a handy little chart on the side. This is the Nutrition Facts label ... HealthcareFacts goes one (or three) better, by disclosing not just prices, but quality of care, outcomes, and more."

The idea was to distill critical, relevant health care cost information into as simple (and helpful) a form as possible. And it was indeed genius: who among us haven't at least glanced at the label on, say, that can of beans, or carton of milk? How great would it be to have that kind of detailed, but easily understood, information at one's fingertips when considering various health care options?

Fast forward 9 years, and, as Allison Bell reports, the federal SBC (Summary of Benefits) info required of all health care insurance plans have become bloated and useless:

"Federal regulators eventually decided that "four pages" could mean both sides of four sheets of paper."

Eight pages of fine print? Who reads that?

But it's "the law," so carriers are forced to toe the line.

Now, there's a movement afoot to reform that:

"When text boxes are long and full of complex terms, consumers will avoid reading the information in its entirety," officials say"

No kidding.

The reality is that people, as a rule, don't read their insurance policies any more than they read the EULA they agree to when they download a new app for their phone. Which is a shame: the whole point of the exercise is to produce a more well-informed health care and health insurance consumer, no?

Wednesday, October 07, 2015

Promise: Broken

Not to sound like a broken record, but remember when President Obama swore that "if you like your insurance, you can keep your insurance?"

Just got email from Humana that the following letter is going out to at least one of my clients:
Re:    Policy Number:
Your current Humana plan will no longer be available in your area for 2016
You will need to select a new health plan between November 1 – December 15,2015

Dear :

Unfortunately, your current Humana plan will no longer be available in your area beginning January, 2016; however, it will remain the same as it is today until December 31, 2015, as long as you continue to make your monthly payment. We know how important it is to select the health plan that best fits your needs, so we would like to help you understand your options and what to do next.
The entire letter is available here.

Color me shocked.

Urgent for our NJ readers

New Jersey health officials say nurse reused syringes while giving flu shots; testing urged.

Unintended Consequences #2,584

Back in 2013, we posted on the travails of an Old Line State same-sex couple trying to untangle their health insurance:

"I got a call today from a woman who needed to find new coverage. She had been covered by her same sex partner as a domestic partner, but since Maryland passed gay marriage, she's now been told that she can no longer stay on the policy unless they get married."

Fast forward two years, and the post-Obergefell era is claiming another scalp:

"The Obama administration reversed a policy Monday that had allowed unmarried federal employees and retirees in same-sex domestic partnerships to obtain insurance coverage for children of their partners"

That is, until now, same-sex couples could cover their children on their gummint-issue health insurance even if they weren't married. Back in Aught 14, "the Office of Personnel Management broadened eligibility ... It made children of an employee or retiree’s same-sex domestic partner — although not the partner himself or herself — eligible." That is, they could add their "step-children" (but not their Significant Other) to their health insurance plan.

As a result of the SCOTUS Obergefell ruling, that's no longer the case, and these folks will now have to join us great unwashed in searching for affordable health insurance.

Be careful what you wish for.

[Hat Tip: HotAir]

Tuesday, October 06, 2015

An embarrassment of linkage:

In no particular order:

■ Up to 3 million ObamaTax victims enrollees stand to forfeit their subsidies next year because they're behind on filing their taxes:

"Fully 40% of taxpayers who received ObamaCare subsidies last year haven't filed their taxes yet and are at risk of losing their subsidies for next year"

This, in addition to looming rate increases - Yikes!

■ Fear of going to the dentist is a major issue for a lot of folks; in fact, it affects 75% of us to some extent. But that may become a thing of the past with new Scottish tech (no, not that Scottish tech):

"Remineralization is a natural process ... Reminova's prototype device can speed up this process to the same amount of time it would take to have a filling -- but painlessly, without injections and drilling.'"

Sign me up!

■ LifeHealthPro's Allison Bell alerts us to something that's generally been under the radar:

"[I]nsurers that participated in Gen Re's latest critical illness issuer survey reported a total of $380 million in 2014 critical illness premium revenue, up 15 percent from the 2013 total."

It seems that the Critical Illness (CI) market is exploding, and it's not difficult to understand why: these plans pay actual cash dollars to their insureds who suffer a listed condition (such cancer or stroke).

Something to consider if you have one of the new high out-of-pocket ObamaPlans.

Monday, October 05, 2015

Training Day Update 1

First, the good news: I received email this morning from the training "Help" Desk in reply to my pleas for assistance.

The bad news is what it said:

"After you have completed all registration requirements for the Individual and/or SHOP Marketplace, you may print your completion certificate specific to the Marketplace(s) for which you completed registration.

Note: your certificate will be marked Incomplete if you have completed training but you have not completed identity proofing. After you have completed training and identity proofing, your registration completion certificate will be marked Complete

Here's the problem:

[click to embiggen]

I've obviously completed step 1 and, as noted previously, completed all the training (as confirmed by the site itself).

So I replied that I had, in fact, completed both the identity proofing (?) and the training, but am still unable to print the certificates.

Wait and see, I suppose.

Sunday, October 04, 2015

ICD-10 Arrives

Co-blogger (and Medical Office Manager) Kelley B is working on an interesting ICD-10 post, but I couldn't resist blogging on some of the more ... esoteric ... examples:
■ Other Contact With Pig (W55.49X)

■ Problems in Relationship With In-Laws (Z63.1)
[Methinks this one will become a Top 10]

■ Sucked Into Jet Engine (V97.33X)
[That's gonna leave a mark!]

■ Prolonged Stay in Weightless Environment (X52.XXX)
[Really? How prevalent is this?]

■ Struck By Turkey (W61.42XA)
[Paging Les Nesman!]
Welcome to the brave new world of health care.

[Hat Tip: Ace of Spades]

Friday, October 02, 2015

Runnin' on empty

As we've long noted (here, for instance) the ObamaTax 'risk corridor' (essentially a slush fund to cover excess claims) was always unsustainable. But hope springs eternal (at least in DC).

Until, of course, Mrs Thatcher's observation kicks in.

Frustrating Government Tricks

So, it's that time of year again: Federal Marketplace training for Open Enrollment v3.0.

So, as I've done for the past few years, I set aside a day to get it all done, logged in and started learning. This year, there are 10 "modules," including 2 exams that must be passed (minimum of 70% correct answers). About halfway through, get this delightful message:


So, pick it back up an hour or so later, and complete the training (acing both exams, by the way). So far, so good.

Click over to print my certificates of completion, and am told that, despite the fact that I've completed all the modules (and the site confirms this) my training is "Incomplete," so no certs for me.

Are you kidding me?

So I futzed around on the site for another half hour or so, then decided enough for one day, will come back and pick it up - fresh - in the morning.

Which I do, to no avail. However, I find an online form to use to report a problem and an email address to accomplish same. Being a belt-and-suspenders kinda guy, I did both (keeping copies, of course). That's Wednesday (two days ago).

Wednesday comes and goes, no response from either inquiry, so repeat.

Thursday comes and goes, still no joy.

So this morning, I repeated (again), and then poked around a bit more until I find an actual phone number to call to report and/or discuss training issues. So I call the number, and a very nice young man named Jeremy explained that there is nothing he or anyone else at the "Help" Center can do, I'll just have to wait to hear from the folks at the online "Help" Desk. And no, he can't tell me how long that might be.

So here I sit in training limbo: yes, Open Enrollment doesn't start for a month, but I'd really like to put this behind me, and I can't do that. And I am completely powerless here: no one to threaten with bad ink (well, pixels), or to take my business elsewhere (only game in town).

Just call me Indy.

Private Fitbit Reporting for Duty

As we noted this past summer, the privacy challenges posed by folks using their FitBits (or similar exercise tracking devices) remain murky. One problem is that one doesn't necessarily know where the data will actually land, and whether or not that end-vendor (for lack of a better term) is a "HIPAA covered entity." The sticking point is defining just who (or what) is a "HIPAA covered entity."

The good news is that the situation recently became a bit less murky, at least for some folks:

"Fitbit announced it will enter into HIPAA business associate agreements with covered entity health plans and self-insured employers that will offer Fitbit’s wellness platform to employees and insured individuals."

So what does this mean in practice?

Basically, that FitBit will need to "implement the security controls required by the HIPAA Security Rule, but only with respect to data it is receiving from or collecting on behalf of covered entity health plans or healthcare providers."

So if your health plan includes FitBit-style tracking, then your info is likely  a bit more private than it has been. Of course, this applies only to FitBit users: if you're using some other similar device, you may want to do a little research on how your ostensibly private info is being treated.