Monday, July 31, 2006
Kerry, a potential presidential contender in 2008, unveiled a health care plan that would cover every child in America, give Americans access to the same type of health care members of Congress receive and lower costs for employers.
"But if we're not there by 2012, we will require that all Americans have health insurance, with the federal government guaranteeing they have the means to pay for it," Kerry said.
He said his plan could be financed by repealing the Bush administration's tax cuts for people earning more than $200,000 a year. He did not say how he would enforce the proposal to have all Americans insured if his plan is not implemented by 2012
Sunday, July 30, 2006
Friday, July 28, 2006
Thursday, July 27, 2006
U.S. Health and Human Services Secretary Michael Leavitt today signed a waiver that will allow Massachusetts to receive $385 million in federal funding to help pay for the care of the poor and enable low-income workers to purchase insurance.
Repeat this chant.
It is my money, not theirs.
It is my money, not theirs.
It is my money, not theirs.
Wednesday, July 26, 2006
Tuesday, July 25, 2006
Monday, July 24, 2006
Sunday, July 23, 2006
Usually only once, ma'm.
Or even something like "What is their rating with the Better Business Bureau?".
Carriers are not rated by the B.B.B., ma'm.
But when they say something like, "I have never heard of this company and my doctor probably won't accept them".
Yeah, right. Like I have nothing better to do than go around recommending companies that don't pay claims, and doctor's never heard of, just so I can spend the rest of the year answering subpeona's from attorneys and irate phone calls from clients.
All of the plans I use are tied to PPO or HMO contracts. Any provider that has signed a PPO or HMO contract is obligated to accept payment from the carrier as "in full" and will not balance bill the patient for covered services.
So guess what happens next?
The same person who said they never heard of NoName Insurance goes and buys some junk from a rookie who was changing tires at a Wal-Mart last month. They buy a plan that has no deductibles, no waiting period and no limit on stupidity. It is called a medical discount plan and . . . here is the kicker . . . most doc's will not accept the card unless you pay cash up front.
So what does that have to do with health care?
Turns out that the Sceptre'd Isle* has its own little lotto going on:
“Because I was articulate and well-informed and also, I suspect, because I had connections with the Department of Health, I got the right to my treatment...
(B)rachytherapy, which carries fewer side effects than a surgical operation and is less invasive than the alternative, a radical prostatectomy” is being made available to a select few Englishmen. It’s a little complicated, but apparently the NHS (Britain’s National Health Service) will approve only a select few to receive this potentially life-saving treatment.
As one can imagine, this has resulted in quite the hew (or "hue") and cry:
“Thousands of prostate cancer sufferers in Scotland are facing a "postcode lottery" over a new treatment for the disease.
The drug Zometa, has not been approved for use in Scotland, despite being available in England and other EU countries.”
The lesson here is that, while a nationalized health care system may seem like a good idea, remember the old saw:
You can have it cheap, you can have it fast, you can have it good. Pick any two.
* Thanks, Matthew!
Thursday, July 20, 2006
If you lack insurance, your amount at risk is the full amount. If you have insurance, the amount at risk will be determined by a number of factors. Things to consider in evaluating your at risk amount include:
Plan coinsurance stop loss limit
Hidden provider charges
Amounts excluded by contract
Amounts covered by supplemental insurance
Most of the plans I write for clients have an at risk amount of $150 or less on accidents and anywhere from $3000 - $5000 on illness.
So what is at risk when it comes to health insurance?
Your monthly premium is an amount at risk. The amount is a known entity from month to month (at least until renewal) but is a factor in calculating your at risk amount.
Add to that your outlay for copays and deductibles. Some plans have a separate deductible for Rx vs. major medical. Most plans have a family limit on number of deductibles that must be satisfied.
Add in your out of pocket (stop loss) limit under the coinsurance clause. Again, many plans will have a family stop loss limit.
Add in your out of pocket for items excluded under your policy and for charges by non-par providers. This is also known as hidden provider charges.
Sum it all up and you have your at risk amount for the year.
Some things are relatively easy to calculate for an at risk total. Your monthly premium is simple. The number of trips to the doctor or your medication may be a bit more of a challenge.
Figure the routine medical charges as just that . . . routine and something you can manage financially. Look instead at the worst case scenario by adding your premium to the deductible and stop loss limit.
As an example, a family of four can choose a low deductible plan and pay about $500 per month in premium. Their at risk for any one family member is limited to $1000 per year with deductibles & stop loss. Total at risk is $7,000 ($6000 in premium + $1000 at risk on a major claim).
Same family, higher deductible. This time the premium is $280 per month and the amount at risk on a large claim is $2500. The total at risk for the year is $5860 ($3360 in premium + $2500 on any single claim).
At risk amount is similar but by rebalancing the risk premium against the amount at risk the client saves almost $1200 per year in a “bad” claim year and around $2600 in a “good” claim year.
If you don’t know how much is at risk you are in danger of having financial and credit issues.
If you have not balanced your at risk amount with the premium paid you are probably paying too much for coverage.
[NOTE: Judge Motz based his decision on elements of ERISA, which implies that such a law would be equally invalid in any other state]
Wednesday, July 19, 2006
Q: Our son, who just graduated from the University of Miami's law school, was diagnosed with cancer in mid-February and had surgery at Jackson Memorial Hospital later that month. He began nine weeks of chemotherapy the day after he graduated in May. His student insurance runs out Aug. 15, but he'll still need treatment after that
A. Unlike employees, students aren't eligible for 18 months of continued coverage under federal COBRA rules
Herein lies the problem with treating a long term issue with a short term fix. Student insurance, like other short term medical plans, can be woefully inadequate in some cases. Saving a few dollars on student plans can cost much more than expected when a medical crisis hits.
Tuesday, July 18, 2006
EMR (Electronic Medical Records) is a hot topic these days. HIPAA has some EMR mandates that are coming on-line [ed: ugh! now that's a bad pun], and, of course, there are economic benefits, as well.
Dr Rob Lambert has more on this over at The Medical Blog Network. As a practicing physician himself, he has a unique - and helpful - perspective on the issue.
Monday, July 17, 2006
Sunday, July 16, 2006
Friday, July 14, 2006
A 25-year-old male from Northern California perusing the Web site of the nation's largest independent agent can choose from 84 different plans.
These plans range in price from $468 per year ($4,000 deductible, no co-insurance) to $2,952 per year (HMO with $0 deductible, no co-insurance and $25 office visits).
Unfortunately, not every state is so lucky:
A 25-year-old male living in Kentucky could get an individual insurance policy for $960 per year.
That same male, were he a resident of New Jersey, could expect to pay $5,880 per year for similar coverage.
Kansas would price the policy at $1,548, and New York state would rate it at $5,172.
1) Consumers find it almost impossible to pick the right plan when shopping in their back yard. Here in GA the top 8 carriers offer over 1800 plans & variations. How will consumers pick from possibly 100,000 or more combinations?
2) The cost of care in TX may be higher or lower than similar care in GA. Since claims determine premiums there is a good chance that once price differences are factored in the "savings" may no longer exist.
3) Large numbers of insureds does create economies of scale which can lower administrative costs. But admin fees are usually 15% of the total premium or less. If you shave 5% off admin is the net savings enough to warrant making a change.
4) Large groups such as those proposed COULD offer coverage on a guaranteed issue (no health questions) basis if they like. They could also offer full coverage for pre-ex conditions. If so this will virtually guarantee the pricing will be more than fully underwritten individual coverage.
Thursday, July 13, 2006
Wednesday, July 12, 2006
Some of the same interests that tried to derail Mrs. Clinton’s health care overhaul are providing support for her Senate re-election bid. The Health Insurance Association of America ran the famous “Harry and Louise” commercials mocking the Clinton health care plan as impenetrably complex. Some companies that were members of that group are now donating to Mrs. Clinton.
Tuesday, July 11, 2006
Hepatitis C is caused by a virus that attacks the liver. You are at risk for Hepatitis C if any of the following situations affect you.
were notified that you received blood from a donor who later tested positive for hepatitis C.
have ever injected illegal drugs, even if you experimented a few times many years ago
received a blood transfusion or solid organ transplant before July, 1992
were a recipient of clotting factor(s) made before 1987
have ever been on long-term kidney dialysis
have evidence of liver disease (e.g., persistently abnormal ALT levels)
"Clinicians with a low hepatitis C patient load appear to be undertreating the disease," said Mary Fletcher-Louis, analyst at Decision Resources. "Clinicians who have a high hepatitis C case load (more than 50 patients per month) say they treat 52% of hepatitis C patients at the time of initial diagnosis. The corresponding estimate by clinicians with a lower case load is only 40% of patients."
Medical Connectivity has some real concerns about how more of your private health info is available (and vulnerable?) than you might have thought.
Lowering premiums by reducing state mandates which means fewer claims will be paid under the plan. At least they understand the only way to legitimately lower the cost of health insurance.
Of course this does nothing to lower the cost of health CARE.
Another piece of the legislative package creates a reinsurance fund that would subsidize health insurance premiums for firms whose average pay is below a certain amount.
Sounds great. How will they pull this rabbit out?
This subsidy is dependent upon creation of a financing source, which lawmakers have yet to address.
Not surprising . . .
Monday, July 10, 2006
In Ohio, insurance companies usually cover no more than 20 mental health visits and 10 hospital days a year for hundreds of thousands of families. The maximum coverage for general health is typically $1 million over a lifetime, compared to $10,000 for mental health.
This is not unique to Ohio. Most health plans place restrictions on coverage for DAMN (drug, alcohol, mental, nervous) coverage.
For Susan and Donald Mikolic, treating bipolar disorder in both of their teenage sons and other mental health problems in the family, including their own depression, has created $500,000 in debt over the past decade. They have had to sell their suburban Cleveland house, and have paid as much as $500 a week, mostly from their own pocket, so all four of them could see a psychiatrist
Mental health treatment can be expensive. Many times there is no cure and no way to measure progress. Sometimes there are abuses of the system by providers who will treat up to the point where insurance runs out and then announce the patient is better.
Some Ohio lawmakers have tried to prevent insurers from restricting coverage for mental health. In 35 states, insurers are required to cover mental illnesses the same as physical ones.
There is also a federal law, the Mental Health Parity Act (1996) but this law only applies in certain situations.
MHPA applies to most group health plans with more than 50 workers. MHPA does NOT apply to group health plans sponsored by employers with fewer than 51 workers. MHPA also does NOT apply to health insurance coverage in the individual market.
But insurance companies and small business owners argue that such coverage would increase their costs
There is no question that premiums would have to rise to cover this additional liability. Just as HIPAA has created an undue burden on small employer group plans, expanding the MHPA to small employer plans and individual coverage could cripple an already pricey plan.
Sunday, July 09, 2006
Instead of overregulating insurers, he trusts in letting new products flourish and, in turn, disclosing risk and rewards to consumers.
Not surprisingly, he's a fan of high-deductible health plans and mandate-light insurance policies that give consumers greater flexibility to shop for the benefits and services they want.
Less government intervention, what a remarkable idea.
Anytime you give consumers the ability to make a decision that's best for their individual circumstances, that's preferable to having government make that decision for them. But you always run the risk of a consumer making the wrong decision
Of course there are no guarantees government will make the best decision. The same can be said for employer choices.
You've also said that overuse of health care is the main contributor to rising premiums
Finally, SOMEONE get’s it right.
Botello has insurance and was told it would cover the hospital visit because the hospital was part of her insurer's medical-care network.
While Botello's son was at the hospital for less than three hours in late April, the total bill exceeded $21,000. Her portion of that, after insurance kicked in their share of costs, was $7,000.
Part of the reason Botello's bill was so high was because while the hospital was an in-network provider, many of the doctors who worked on her son were out-of-network
As hospitals seek to lower their cost of providing emergency care they frequently contract with independent doctors to provide treatment rather than using staff physicians. Many will also use off-premises contract radiologists in other countries to read the X-ray or MRI.
These non-par providers are free to charge whatever they wish while the insurance contract will only pay reasonable & customary. Many times the gap between what the carrier pays and the providers charge is 30% or more of the bill.
The real oddity in this story follows.
"Most of our programs are geared toward the uninsured. We don't (typically) discount for insured patients," said Billie Jo Debolt, system director for business services at Lee Memorial Hospital. "But, we do have some programs, like our prompt payment discount. If the bill is paid in full within 30 days, it can be 30 percent of the balance. We have sliding-scale discounts based on a person's income. If a person falls within 300 percent of federal poverty guidelines, they may be entitled to a 40 percent discount. If they fall within 400 percent, there may be a 30 percent discount."
For those with no insurance, full charity care is available, providing the patient falls within federal poverty guidelines.
People who are uninsured receive a better break than those WITH insurance.
Most of the area hospitals also have social workers on staff who help patients enroll in Medicaid so they have coverage
Here is another interesting fact. Many times you can enroll in Medicaid AFTER you have incurred charges and have your bill covered retroactively.
So where is the incentive to take personal responsibility?
Saturday, July 08, 2006
Friday, July 07, 2006
Prescription drug advertising has swelled to a $4.8 billion industry since the U.S. Food and Drug Administration relaxed its restrictions on the ads in 1997, allowing for descriptions of the drugs' purpose. Many doctors say the ads are coming so fast that they don't have time to learn about the benefits and risks of a new drug before patients start requesting prescriptions.
Thanks to the internet, patients are not only diagnosing their ills but come prepared to prescribe the treatment. All the doc has to do is collect the $20 copay and write out the script.
What is wrong with this picture?
Dr. Melvyn Sterling, an internist who practices in Orange, attended the medical association meetings that led to the policy changes. He said people should consider the source when reading or watching drug ads.
"The reason those ads are there is to sell the drug, not to educate the public," Sterling said
I am shocked! Next we will be hearing all those car commercials are not about educating us on safety but rather to sell cars.
Patients should be aware of safer, cheaper alternatives, doctors said
Unfortunately, too many people don’t want alternatives; they want the latest and greatest . . . especially when it only costs a $30 copay.
"The ads sometimes are for very expensive drugs when there are much less expensive drugs available that the patient should try first … A lot of patients are looking for that magic pill. "
And magic is nothing more than illusion.
Thursday, July 06, 2006
Wednesday, July 05, 2006
There is plenty that is wrong with the health care delivery system, and the risk management side, but all in all it works better than it should and much better than socialized systems in our country and others as well. Most of the complaints about health insurance can be summed up in the immortal words of Pogo.
We have met the enemy and he is us.
We, as consumers, are truly our own worse enemy. We fail to understand the dynamics of health care and health insurance pricing and then complain when we can’t get what we want. We make demands on health insurance that would, in other situations, be considered foolish and then complain that the price is too high.
When it comes to health insurance, consumers want doctor visit insurance, prescription drug insurance, and yearly physical exam insurance. We have been conditioned to believe a doctor visit really only costs $20 and medicine is $30. We also want our annual exams covered under a copay, even though females are the only ones in the family who go regularly.
We believe nothing bad will ever happen to us, but if it does we have comfort in knowing we only have to satisfy a $500 deductible.
All of this luxury comes at a price. A price few can afford and even those who can afford it are unwilling to make the sacrifice. A family of four in Atlanta will pay about $1000 per month for the plan described above. For many, that is a house payment.
That is $1000 per month for a plan that will rarely be used, even for minor ailments and will still cost you around $3,000 in out of pocket expenses on a major claim.
That is $12,000 per year in premiums plus incidentals in a “good” year; over $15,000 in a bad year.
Contrast that with a catastrophic plan that will discount your doctor visits by 40 – 50%, discount your prescription meds by around 30% and limit your out of pocket in a calendar year to $5,000 if you have a really bad year from a health standpoint. The premium for this plan is about $250 per month, or $3,000 per year. In a “good” year you save almost $9,000 and in a bad year you still save about $7,000.
Now will someone please explain why most people would rather have the $12,000 plan over the $3,000 plan?
Tuesday, July 04, 2006
The proposal is very simple. All health insurance plans offered in the State would be available to all people who are residents in the geographic areas served by the plans
This already exists in one form or another. HMO’s are limited by county or zip and can only serve a specific geographic area. Some states mandate community rating which accomplishes some of the same ideas. All those who apply for coverage within a defined community pay the same rate, regardless of age or health.
Throughout the various modes of employment you retain the same insurance, and pay the same rate that everyone else pays
This is a perfect description of community rating which never works. Why would a healthy 25 year old want to pay the same as a 55 year old with emphysema?
The new system simplifies health insurance procedures and reduces process cost across the state, and this offsets the new cost of the firms coordinating insurance benefits. Going from decentralized to centralized insurance benefit administration gives us the opportunity to streamline and automate the total process of benefit administration throughout the state
Basically, this is the way the current Workers Comp system works . . . kind of. All workers in the state have the same benefits even though they are administered by different firms. Rates vary from employer to employer depending on payroll, industry, job classification and other factors.
Of course WC is not 24 hour coverage but only addresses on the job injury.
Under this proposal, it is possible that health insurance costs might go up slightly, since we would be covering people who currently are not insured
More than possible, it is a sure bet. And “slightly” is an understatement.
This proposal obviously does not solve all problems with health insurance, nor does it address many of the cost drivers in the medical system
Actually it does not address ANY of the factors that influence the cost of health insurance.
Was this all wrong? What has changed?
I too have wondered the same. I also maintain we have become a society that is over-reliant on meds that do little more than address symptoms and do nothing to treat the underlying problem.
The first commonly available beta blocker was propranolol. Note the “olol” ending. Now we have atenolol, metoprolol, bisoprolol, sotalol and so on. Cimetidine was a new drug for ulcer treatment; then along came ranitidine with a huge advertising budget and supplanted cimetidine. Omeprazole, another “ulcer drug”, was soon joined by lansoprazole and esomeprazole.
The original drugs, such as propranolol, are long out of patent. Anyone can make them and anyone does. They cost a few pence a month. The profit has gone for Big Pharma. There is nothing to be gained from flying doctors to Acapulco to discuss propranolol.
I have heard similar complaints about sulfa drugs. At one time they were widely used to treat infection. Once antibiotics came along the sulfa drugs were no longer used. Now we have new, antibiotic-resistant strains. Should we return to some of the "old" remedies to combat new illness?