Saturday, May 31, 2008

Stupid Provider Tricks (Coast to Coast)

[Welcome Industry Radar readers!]
Over the past three and a half years, we've chronicled the "exploits" of agents, carriers and patients. It seems, though, that providers are not exactly immune to outrageous games, either.
First up, we learn that the UCLA Medical Center has been bumping legitimate, deserving, long-suffering American organ transplant candidates in favor of yakuza, members of Japanese organized crime groups. The surgeries, conducted between 2000 and 2004, took place while there was a distinct shortage of qualified organs, exacerbating an already-critical problem.
Although the physicians claim not to have known of the, er, character of their erstwhile patients, they also aver that "they do not make moral judgments about patients and treat them based on their medical need."
Riiiight.
On the other side of flyover country, the Washington Post reports that "surgeons across the country receive trips, meals and consulting deals from artificial-hip and -knee makers." Isn't that the textbook definition of "conflict of interest?"
Turns out, the suppliers of various joint-replacement gizmo's [ed: must you use technical medical industry jargon?] allegedly paid certain surgeons to use their equipment. Manufacturers advocates counter that "the arrangement allows doctors and medical-supply companies to collaborate, paving the way for important technology advances in hip and knee replacements."
In the event, a federal investigation was launched to look into this kickback scheme. A settlement has apparently been reached, and the facts are beginning to come to light. In what may be a happy ending (of sorts), "(f)our of the world's top companies last year agreed to pay a combined $311 million to settle a federal probe into whether the manufacturers paid kickbacks to doctors to get them to recommend their products."
Sheesh!

Friday, May 30, 2008

Cavalcade of Risk #53: 2nd Anniversary Edition - Submissions Due

Next week's edition marks our 2nd Anniversay, so we'd like to try something a little different: please send in your favorite risk-related post from the past 12 months. Don't forget to include:
■ Your blog's url
■ Your post's url
■ The post's trackback URL (if available)
■ A (brief) summary of the post
You can submit them via Blog Carnival or email.
We have hosting opportunities available for late summer and early fall, so please drop us a line to reserve yours.

Thursday, May 29, 2008

Health Wonk Review: Post-Memorial Day Edition

[Welcome Kaiser Network readers!]
Welcome to this week's edition of all that's wonky in the healthcare world. As a 4-timer, I was tempted to out-shtick myself, but decided to play it straight (for once). And so, without further ado...
Paul Hsieh poses an interesting question at We Stand Firm: What would health insurance look like in a truly free market? I really liked the Q&A format of this post.
The Health Business Blog's David Williams has a chilling post on identity theft, specifically crooks who take advantage of the fact that stolen health information is likely to be useful for much longer than stolen financial data.
Sam Solomon, blogging at Canadian Medicine, draws a connection between global warming and mortality rates.
Brian T. Schwartz, writing at Patient Power, has a real issue with the concept of mandatory health insurance.
Dr Deb Serani reports on a VA facility in Texas, whose cost-conscious administrator has apparently put the kibosh on any more PTSD diagnoses.
HWR's Julie Ferguson is out of the country, but her Workers Comp Insider partner, Jon Coppelman, has his own take on that VA administrator.
Alvaro Fernandez, blogging at Brain Health Business, explores how people can use emerging technologies to keep their brains healthy and productive as long as possible.
Here at IB, we're big fans of transparency in health care (and health insurance). Over at his New America blog, Tom Emswiler talks about the newest HHS program, which lets consumers compare cost data at nearby hospitals.
Vince Kuraitis, principal of e-CareManagement, tells us about the newest delivery and financing model to rescue primary care, the Patient Centered Medical Home (PCMH).
Shaheen Lakhan, the Brain Blogger, presents a Patient Manifesto. He points out that each of us may also be a patient and so many blog posts are about medical topics and issues, but not about the patients.
Over at Health Populi, blogger Jane Sarasohn-Kahn discusses the rising cost of health insurance, especially from the employers' standpoint, and wonders if we'll see more employers dropping cover, or requiring a bigger bite out of the employees' paycheck [ed: Yes].
At the Disease Management Care Blog, Jaan Sidorov discusses the cost/benefit dilemna when looking at med's that treat brain cancers, and how making the decision on whether or not to even use them can cause more stress.
Anthony Wright, of the Health Access California blog, asks what, exactly, constitutes insurance coverage? He posits that, at the very least, coverage should protect a consumer against unlimited financial liability.
The Internet Marketing Blog's D. Singh takes a close look at the new, improved Google Health, and comes away concerned about whether or not we should trust the search-engine behemoth with our private medical data.
Speaking of Google Health, Health Care Industry blogger David Hamilton is quite concerned that Google has hedged its exposure in the event a privacy breach occurs. In fact, it appears that the company actually requires users to defend against or settle any suit brought against Google.
Finally, you might think that insurance agents would welcome presidential wannabe John McCain's market-based solutions. Not so fast: Our own Bob Vineyard takes the good senator to the woodshed, instead.
That's all for this week's edition. Please make sure to stop by the Health Affairs Blog on June 12th for the next exciting episode.

Tiered Doc Copays

Here is a novel idea.

Create a system where price AND quality is evaluated. Those who perform at a higher level are paid more, while those who perform at a lower level are penalized.

Then take it a step further.

Inform the provider's clientèle who measures up and who doesn't.

If your clients want to use a practitioner who does not make the grade, they must be willing to pay more out of pocket to use that provider.

This is precisely what the Massachusetts Group Insurance Commission has done.

And is seems the docs are not happy.

In a lawsuit filed in Suffolk Superior Court, the (Massachusetts Medical Society) - which represents the state's doctors - alleges the commission's plan hurts physicians and patients.

The suit claims doctors capriciously ranked lower have been defamed, and that patients who have to pay higher copayments based on their doctor's ranking have been defrauded.


The patients are defrauded.

That's a gutsy claim.

Tiering has become a widespread technique for controlling healthcare costs. For example, many insurers have adopted tiered pharmacy benefits, with higher copayments for name-brand drugs serving as an inducement for patients to choose generics. Such structuring is credited with controlling spiraling drug costs.

But the tiering of physicians has proceeded more slowly. Doctors have fought the cost-control methods, particularly tiering plans that seek to rank individual doctors, as opposed to physician practices.


So, carriers and patients should pay the same price, regardless of the ability of the medical practitioner to treat medical conditions?

In other words, you should pay just as much for top level care as you would for a lower level of care.

Right.

Wednesday, May 28, 2008

Incredibly Stupid Carrier Tricks

Stupid carrier tricks has been a recurring theme at InsureBlog, proving that we are not shills for the industry that has provided us a way to make a living for a number of years. There are no perfect carriers, nor perfect industries for that matter. For the most part, the carriers get it right . . . except in areas of customer service.

And some times they do the right thing from a contractual perspective but forget that they could have made a better decision from a perspective of goodwill.

Customer service is virtually non-existent in the carrier world.

So far this year I have encountered more issues on relatively simple things that have frustrated my clients and taken up more of my time than is necessary. Here are some examples.

Carrier notifies client they have a dependent who appears to be aging off the plan. Client calls carrier asking when coverage will terminate and if their premium will change. Carrier promptly cancels coverage on ALL family members dropping the premium to $0. Client calls carrier who says "Oops!" and reinstates all family members . . . including the over-age dependent.

At this point the client calls me for assistance. I get involved and send an email followed by a call to the carrier. They (eventually) send me a form for the client to complete. It is a clean application that is to be completed (sans medical information) and the client is instructed to check the appropriate box to delete the over-age dependent.

The following month the dependent is dropped, retroactive by two months but the premium is not adjusted. We wait another month for premium accounting to catch up to the dropped dependent.

Nothing happens.

I start calling and emailing (again) the local manager about the issue.

No response.

I call and email, this time copying my client (so she knows I am working on the problem).

No response.

I call again, this time getting the manager instead of her voice mail. She apologizes and tells me I will be called within an hour with a response.

4 days pass and no word.

I call again. This time the manager sends me a terse email telling me that I am not to reveal her name to clients as a contact point for service issues.

This escalates the issue and I am finally told the problem will be resolved at the next billing cycle. If so, this means my client has overpaid some $65 per month for 4 months.

We are still waiting to see what will happen.

I am not holding my breath.

Situation number two involves a different carrier. My client (who is pregnant) wants to spin her husband and son off the current plan to a less expensive plan with the same carrier. She has been trying to accomplish this for 4 months on her own with no success.

She was not originally my client, but contacted me because I came recommended by another client. She names me her agent of record and I start to work on her problem. The carrier assures me this can be handled with a letter, requesting the dependent change.

Of course, they were only kidding.

Seems there is also a form for the client to sign, plus a form for their PCP to sign, before the change can be effected.

The change was finally effected . . . after 2 months with me working on it. Fast forward another month. The baby is born and is taken to the doc at 3 weeks of age for an initial visit.

Only problem, the baby is not on the plan. A call to the carrier from the doc's office and an hour later here is the result.

The carrier will only agree to add the baby to the plan if she signs a letter and faxes it to the carrier (from the doc's office) naming the carrier as agent of record (essentially firing me) and she gives them a credit card for $520 to cover adding the baby on for April and May.

All this for a $100 office visit.

She signs the letter and gives them a credit card.

Her next call is to me.

She wants to change to another carrier and this cannot be done quickly enough.

One more situation (even though I have quite a few I could relate).

Client applies for coverage with a high deductible ($5700). He takes Lexapro for anxiety.

The medication runs $83 per month.

They surcharged his premium by $96 per month.

Three months later, they came back and said they were only kidding. They are going to refund his $96 overcharge and lower the premium in future months.

At least, that is their story for now and they are sticking to it.

(Extremely) Stupid Agent Tricks

[Welcome Industry Radar readers!]
We all do stupid things from time to time, but this one takes the proverbial cake:
Seems that the owner of Dilworth Insurance in Charlotte, NC was being investigated based on an "administrative complaint;" Sallie Rohrbach, the DOI investigator, went missing while conducting her investigation. At one point, "(e)ight armed law-enforcement investigators with the North Carolina Department of Insurance [joined] the search." Never heard of armed insurance investigators before (maybe that's a good thing).
Ms Rohrbach's funeral was this past Sunday. The 40-year-old agent, Michael Howell, has been charged with first-degree murder. The authorities believe that "her death is connected to her duties as an auditor."
Rest in Peace, Sallie.
[Hat Tip: IB reader Jeff Milne]

Tuesday, May 27, 2008

The Graduate

No, not Benjamin Braddock & Mrs. Robinson.

Your graduate.

The one who just finished high school, or college.

Yes, that one.

Have you considered medical insurance?

Probably not.

That isn't high on the list of requests by the grad.

But here is a heads up.

Your college freshman has a few options, most of them are not good.

One option is to continue on the parents plan. Usually this is the most expensive option. Depending on how your health insurance is structured, you could be paying $300/month or so to cover your child.

There are less expensive options.

But the student health plan through college is one you probably want to bypass. Most of these plans are relatively inexpensive, but also lacking in benefits.

At least one carrier (Time) is promoting student health plans but this one also falls short.

The Time plan limits coverage to $100,000 for any single illness or accident and $1M overall. There is no coverage for outpatient Rx and pre-existing conditions are not covered for 12 months.

Actually, there is nothing wrong with any of these plans . . . until you actually need them.

Your college grad will run into the same situation, except coverage through the university is not an option.

They may also "age off" your family plan but with a COBRA option . . . usually in the $300+ range.

Your grad, high school or college, should have their own major medical plan. Not a student plan, or even an extenuation of the family plan.

Many times they can pick up exactly what they need for less than $100 per month. I have quite a few students as clients. The savings is significant and, unlike most student plans, they are not subject to arbitrary limits in coverage.

And the Answer is: 42!

Well, that was Douglas Adams' answer, anyway. The question was: what's the answer to life, the universe and everything? A better question might be: how come so many people think nationalized health care is such a good idea? A common answer is that we'd do away with those eeeevil insurance companies, and that everyone would have access to affordable, competent health care.
Oh, yeah?
Better tell that to our Neighbors to the North©:
Yet she spent almost a week without treatment, and was seen by a doc only after the newspaper called and raised a fuss. Still, dangerous waits and provider shortages are rare in the medical utopia, right?
Not so much:
"This is a terrible environment. I suggested taking her to another hospital, but we were told there are long waits across the region and the doctors we need are here."
Ooops!
Too bad Mrs Degasperis didn't know about CoverMe, the health insurance supplement for our Canadian friends:
That's right, folks Up North can buy insurance for their, um, insurance. Which begs the question: if nationalized health care is so good (not to mention "free"), how come they still need medical insurance supplements?
Oy Canada!

Grand Rounds now available

Parallel Universes hosts this week's roundup of medblog posts. Dr Emer presents a "Top 5," followed by two dozen other interesting (and often provocative) entries.
Our friends at the Colorado Health Insurance Insider blog take a look at how some insurance carriers are pushing healthy lifestyle programs.

Monday, May 26, 2008

Life Insurance Shenanigans

When does a life insurance policy pay?

When the insured dies.

Unless of course the insurer decides the policy holder bought too much insurance.

U.S. District court judge William Acker ruled that Mega life must pay $960,832 in death benefits plus interest.

Kellie Pieniozek, 23, of Calera, died Dec. 14, 2004, in a one-car accident in Shelby County. The Pieniozeks were driving home when a deer ran onto the road and Kellie Pieniozek lost control of the vehicle and struck a culvert. She died at Shelby Baptist Medical Center.

Donald Pieniozek's attorney, Roland Gamble, said Pieniozek attempted to claim a life insurance policy the couple took out in September 2004, but the company denied it because the insurance form listed Kellie Pieniozek's yearly income as $35,000.

Mega Life contended she made far less, as she was employed in a series of temporary jobs. The company would never have issued a policy with a high death benefit for someone with a smaller income, it stated in court documents. Mega Life's underwriting guidelines called for a death benefit 15 times the insured person's yearly income.


Nothing in the article confirms Mega's contention that Mrs. Pieniozek earned less than $35,000. Trying to fight a claim on a vague claim that the insured earned "far less" is shallow at best.

"That figure and the method it was arrived at were never questioned by Mega Life's underwriters until after the insured's accidental death," Acker wrote. "Mega Life perhaps, in its own interests, should have been more careful in establishing and enforcing underwriting guidelines."

More careful indeed.

Memorial Day Carnival of Personal Finance

Canadian Dream hosts this week's edition of the Carnival of Personal Finance. There are a lot of posts, each one with a brief explanation.
For those of us who wonder (and worry) about what Social Security will look like a few years hence, Bob McDonald tells us that it may not be as bad as we think.

Health Wonk Review at InsureBlog

We're delighted to host this week's edition of the Health Wonk Review.
To submit your post on "(h)ealth policy, funding, insurance, managed care, infrastructure, IT, the uninsured, economics and trends," click on over to Blog Carnival or drop us a line.

Sunday, May 25, 2008

Memorial Day Miracle...

Although Memorial Day is really about those who have served our country, I was quite intrigued by this story of a woman's near-death experience:
By all accounts, and by current medical definition, Val Thomas was dead. But as her family met with doctors to discuss organ transplant harvesting, she "woke up and started talking."
There's video, as well:

video
[Video courtesy of NewsNet5]

She's currently at the Cleveland Clinic for observation.

Wow.

Friday, May 23, 2008

Thursday, May 22, 2008

Questionable Healthcare Advertising...

We've seen some pretty, um, interesting advertising in the past, but this one takes the cake:



HealthPartners, a Minnesota-based healthcare provider, is a non-profit operation, but that doesn't necessarily mean a "non-humor" one.

Wednesday, May 21, 2008

John McCain's Health Insurance Scam

[Welcome Kaiser Network readers!]

This is not a political blog.

Well, maybe.

Sometimes.

But not really.

However, we received a "heads up" from Michelle Lange about Prez hopeful John McCain and his secret plan to change the way health insurance is bought and sold.

This article seeks to tie the future of McCain Health Insurance to the credit card industry.

Frankly, not only do they make a strong case, but a scary one as well.

Why do most of us send our credit-card bills to South Dakota or Delaware? The answer to that seemingly arcane question illustrates the dangers of replacing state regulation with no regulation at all. It also offers a cautionary tale about a little-understood provision at the center of John McCain's health care plan.

The details about the credit card industry are in the link, so I won't bore you with that portion of their argument. Let's just say the reason why banks prefer to offer credit cards from Delaware or South Dakota is because they can make more money by ripping off anyone with less than perfect credit.

So what does that have to do with health insurance?

Apparently Mr. McCain's proposal includes a provision whereby "families should be able to purchase health insurance nationwide, across state lines."

That is also a proposal put forth by NFIB.

How do I know?

I was contacted by two individuals who are high up in the organization a few months back. They wanted my feedback on their proposal to lower health insurance rates by making it possible for anyone to purchase across state lines.

Let's just say they were not pleased with my response, and decided I would not be a good mouthpiece for their misinformed proposal.

So why is it bad to allow individuals to purchase health insurance from another state, particularly if rates are lower than in their home state?

An insurance company that chose to be regulated under Arizona law could sell policies in New York without following New York rules. Arizona, like most states, lets companies charge what they want to people who are sick—or simply deny them coverage altogether. Under Shadegg's bill, insurers wouldn't even need to pick up and move their operations; it would be enough to file some paperwork with a state insurance commissioner and pay that state's relevant taxes.

New York requires carriers to cover anyone, including their pre-existing medical conditions.

Arizona does not.

The result is, NY residents pay much higher rates for similar coverage than those in AZ.

Why is that bad?

This is a zero sum game.

If all the healthy NY residents buy from AZ then only the sick ones are left in the NY pool. The result would be, fewer carriers in NY and much higher rates than they have now.

How is this a positive?

John McCain may know about the military and his wife knows beer, but that does not make either of them an expert on health insurance.

This is a dumb idea.

Cavalcade of Risk #52 is up and running...

Jason Shafrin, the Healthcare Economist, hosts this week's collection of risky posts. Don't miss the great example of risk mismanagement at the top.
There's very little risk involved in hosting your own Cav, just drop us a line to sign up!

600,000 May Drop Health Insurance

[Welcome Industry Radar readers!]

According to a published report, as many as 600,000 people now covered by private health insurance could drop their coverage.

Why you ask?

Because they can get coverage for free, or at a much lower cost, by allowing the taxpayers to provide coverage.

Those most likely to drop health insurance?

The young, healthy individuals.

This will create an imbalance in the private system leading to an increase in premiums for those who keep private insurance. The additional drag on taxpayer funded plans will lead to deficits on that side, creating more cost shifting back to the private sector.

Dr Armitage estimated that even after a $600 million budget injection into surgery waiting lists, public hospitals would be $43 million a year worse off. Premiums would increase for those who stuck with private insurance, he said.

Those leaving private insurance would opt for Medicare instead.

But AMA president Rosanna Capolingua said it could be a signal to Australians that they could drop their private health insurance or not buy it in the first place.

It would lead to longer waits for elective surgery and other treatment.

"Those people who genuinely cannot afford (hospital cover) will actually be pushed further down elective surgery waiting lists," she said
.

Oh yeah. I forgot to mention, this is in Australia.

Tuesday, May 20, 2008

Why you need health insurance, redux

[Welcome Industry Radar readers!]

I was just talking with an employee of one of my clients. A few months back, she spent a day and a half in the hospital, having three vertebrae fused. The contracted price for the services? Almost $48,000. The price for the hospital's services as originally billed? Somewhat over $600,000. Her out-of-pocket cost? $250.

Let's see...

No insurance: $600,000
With Insurance: $250 (plus her portion of the insurance premium)

On top of that are her physician's charges, which are also not an insignificant amount.

Diabetes + E. D. = Heart Disease

So what does diabetes and E.D. (erectile dysfunction) have in common?

A lot according to the Journal of the American College of Cardiology.

E.D among diabetic males is a "strong marker" for early heart disease.

Such men had twice the coronary heart disease incidence as those without erectile dysfunction (19.7 versus 9.5 per 1,000 person-years)

That's pretty significant.

While erectile dysfunction signals cardiovascular problems in the general population as well, the risk is "especially relevant to the diabetic population where erectile dysfunction is common

Diabetics often have circulatory issues, and E.D. is part of the same system.

Among the 291 men in the study, 40.5% reported erectile dysfunction in the year before detection of heart disease.

Good information to know.

Googling for (Health) Info

We've all heard that phrase. You know the one, where you just can't believe what you've just been told, and your friend says "Don't believe me? Google it!" Well, those two little words are about to take on a whole new meaning.
Back in February, we reported on the search engine behemoth's plans to join other internet biggies in offering on-line storage of one's medical records:
"Thousands of patients at the Cleveland Clinic will be able to turn to Google to access their medical records online — everything from their prescriptions to diagnoses — in a pilot program announced Thursday..."
Now, that "pilot" has gone live, and national:
They've partnered with Walgreen's, CVS, even the aforementioned Cleveland Clinic. In addition to hosting your medical records, it's got a directory of local providers.
But the centerpiece of this effort is the actual warehousing of medical data. The EMR (electronic medical record) initially includes one's basic medical history, and is then updated as "things happen." The major difference between this model and ones already "in the wild" is that this record is actually owned by, and under the control of, the patient. This makes the record portable and easily accessible.
If there's a downside, it's the security aspect. As Bob reported a year and a half ago:
Granted, Google has a major incentive to keep this info secure, but then again, so did the VA. It seems to me that the onus will be on Google to keep a tight rein on these files, and for participants to keep a close watch on their info, as well.

Thus Spake Grand Rounds...

Ye Olde Dinosaur hosts a truly heavenly Grand Rounds today. Modeled after the first chapter of Genesis, it's well-written, easily navigated, and full of inspirational posts.
As we've noted here, HIPAA and privacy go together like sunshine and bicycles. The Health Care Law Blog's Bob Coffield has some fascinating (perhaps scary, cerainly startling) statistics on new gummint enforcement efforts.

Revived Resource

Time magazine has revived and revamped Health.com and they hope to draw 50,000,000 eyeballs each month.

A quick look shows a wide variety of topics and resources in a user friendly layout.

They have links to research drugs, natural remedies and also have a symptom checker. For those who like to stay on top of things, they have a weekly e-newsletter.

Bravo!

Movie Time Snacking

[Welcome Industry Radar readers!]

Why does popcorn taste so much better when you are watching a movie? And apparently it comes with a plus.

A recent study indicates "popcorn eaters have almost a 250 percent higher daily intake of whole grains and a 22 percent higher daily intake of fiber than non-popcorn eaters."

Oatmeal or popcorn?

Tough choice.

Popcorn has been linked to many health benefits, including reduced heart disease and diabetes risk, Dr. Ann C. Grandjean of The Center for Human Nutrition in Omaha, Nebraska, and her colleagues said.

Health benefits in popcorn.

Who knew?

Do the benefits of fiber offset the butter and salt you add?

“Popcorn may offer a healthful alternative to energy-dense, low-nutrient-dense snacks, and may have the potential to improve nutrient status in Americans of all ages and help them meet dietary guideline recommendations to consume three whole-grain servings per day,” researchers concluded.

And just who are these researchers?

Research was funded by ConAgra Foods, Inc.

The owners of Orville Redenbacher popcorn . . .

Victor - Victoria

Are you a woman trapped in a man's body?

Do you think the taxpayer should pay for your gender reassignment surgery?

Apparently the Ontario (Canada) Human Rights Commission agrees with you.

Seems these procedures were covered, then discontinued in 1998.

Now they will once again be covered.

At $200,000 each.

"the resumption could generate controversy since other rare and life-threatening ailments require more funding. "I think that people should be careful not to use what is $200,000 on a $40.2 billion health budget as an excuse to try a bit of 'them and us' conversation',"

Encouraging restraint.

Isn't that special?

Monday, May 19, 2008

Can You Hear Me Now?

Just when you thought it was safe to use your cell phone, along comes a new warning.

Women who use mobile phones when pregnant are more likely to give birth to children with behavioural problems, according to authoritative research.

Authoritative research.

Sounds much better than random survey.

A giant study, which surveyed more than 13,000 children, found that using the handsets just two or three times a day was enough to raise the risk of their babies developing hyperactivity and difficulties with conduct, emotions and relationships by the time they reached school age. And it adds that the likelihood is even greater if the children themselves used the phones before the age of seven.


Mom, take the Hanna Montana cell phones away from little Suzie.

mothers who did use the handsets were 54 per cent more likely to have children with behavioural problems and that the likelihood increased with the amount of potential exposure to the radiation. And when the children also later used the phones they were, overall, 80 per cent more likely to suffer from difficulties with behaviour. They were 25 per cent more at risk from emotional problems, 34 per cent more likely to suffer from difficulties relating to their peers, 35 per cent more likely to be hyperactive, and 49 per cent more prone to problems with conduct.

Certainly something worth considering.

The Carnival of Personal Finance is now up...

Penny Nickel presents this week's jam-packed edition of the Carnival of Personal Finance. It's in a unique Q&A format, which actually makes for easier navigation among the categories.
Is the Crystal Skull deductible? Bligger Rickey Henderson snagged a copy of a letter from Dr Jones' accountant which raises a number of interesting (and amusing) questions.

A (Metaphorical) Trainwreck

This is a case of "TMI" (Too Much Information), and how it can actually hinder the decision-making process. Early last week, I got a call from "Suzie," whose COBRA plan will expire when this month does, and who has severa "issues:" she's overweight, diabetic and has sleep apnea. The nature and severity of her diabetes alone renders her "uninsurable." And then there's this: she's 63 years old, due to turn 64 this summer. At least two of the carriers she mentioned won't write anyone over age 63 and a half (don't ask; that's another post). Still, she continues to call agents trying to find her own Holy Grail.
I explained the problem(s) to her, and asked if she was aware of how HIPAA works in these cases.
[ed: briefly, HIPAA says that if one has elected COBRA and kept the plan in force the full 18 months, one is eligible for a mediocre, over-priced plan that can't exclude pre-existing conditions]
She indicated that she had, and named a figure which, while pretty hefty, was less than what I knew such a plan would be at her age. I patiently explained that the carriers she mentioned (as well as the rest of those in this market) would not take her. She insisted that at least one agent had told her "no problem." I know when I'm licked, so I suggested that she call that agent back and submit her application. She balked at this, saying that it "sounded too good to be true."
Progress at last!
I reiterated that her best bet would be the HIPAA plan, but that there was one other alternative: a guaranteed issue mini-med ("limited benefit") plan. The advantages of these plans, I explained, is that one needs only a pulse and a checkbook (not necessarily in that order) to qualify, and that they are much less expensive than the HIPAA plans. Still, I cautioned her, there were reasons for this: one, these plans typically exclude pre-existing conditions for the first 6 months (some for 12 months) and that, as their name implies, the benefits are extremely limited. But if one's budget dictated that it's a mini-med or nothing, it may be an appropriate choice.
I am always careful in these situations to stress that the mini-med is an alternative, not necessarily the best one.
She didn't like the 6 month wait on pre-ex, and I replied that that was fine with me. Then she asked a question about the prescription drug benefit. Since I didn't have the answer at hand, I offered to call her back, which I did the next day. She still felt uncomfortable with the mini-med, and I again assured her that this was no problem, I was sorry I couldn't help. She then asked how much time she had to make a decision, and I told her that, as long as she had the paperwork in by the 20th, the plan could be in force for June 1. We hung up, and I put my notes away.
Lo and behold, she called again last Friday. She had finally become convinced that she had to either go the HIPAA route or the mini-med way. I listened, and waited for her to tell me her decision. But she still couldn't choose. She had called still another agent, who essentially told her the same things I had (one would think this was a major clue, but apparently not). And again, she stressed how the 6 month wait for pre-ex was unsatisfactory. And again, I empathized with her (at this point, I was beginning to feel a bit like Bill Murray). I reminded her that she has until the 20th (tomorrow) to "pull the trigger" on the mini-med, and bade her a nice weekend.
I have no idea what route Suzie will take, and I empathize with her dilemna. Still, I think that, at some point, it should have become clear to her that her choices were limited. I don't mind spending the time "holding her hand," but I can certainly understand other agents' reluctance to spend so much time on such a case. Obviously, a second (perhaps even a third) opinion is appropriate for this kind of situation, but she's on her 6th or 7th, and hence in imminent danger of information overload.
Which really helps no one.

Saturday, May 17, 2008

Ch-Ch-Changes: HSA Edition

Each year, the gummint publishes the updated guidelines for the following year's Health Savings Accounts (HSA). These are generally adjusted for inflation, and reflect the reality of increasing costs of health care. For example, this year's limit on how much one can contribute to an HSA is $2,900 ($5,800 for a family). That's scheduled to increase next year (2009), to $3,000 for individuals, and $5,950 for families.
Keep in mind that the amount one can contribute to the loss fund (HSA) is not bound to (or by) one's actual deductible. This year, the minimum deductible for an HSA-compliant plan is $1,100; that's slated to increase by $50 next year. For families, this year's minimum is $2,200, and increases to $2,300 in 2009.
For those so inclined, that means that one can "stuff" more dollars into the loss fund to pre-pay a future expense, or as an additional retirement resource.
I know, that's a lot of numbers, but if you own an HSA, they're pretty important.

Friday, May 16, 2008

John Ritter Update

Most of us know John Ritter.

Son of Tex Ritter, star of "Three's Company" and later "8 Simple Rules."

And most of us remember his sudden death in 2003 due to aortic dissection.

It is the story after the story that caught my eye. Dr. Jeffrey Segal posted on em-news.com a commentary that looks at the numbers in medical malpractice.

Mr. Ritter's wife settled a wrongful death suit with a number of defendants, including the hospital where he was treated, for $14 million.

The trial went forward for the two remaining defendants, radiologist Matthew Lotysch, MD, and cardiologist Joseph Lee, MD. In March, a jury found the two were not negligent in their treatment of Mr. Ritter. The plaintiffs had asked for $67 million in damages. Let me repeat that: $67 million.


"Not negligent."

Sounds like they dodged a bullet.

Or did they?

Their attorney said the family wanted that figure so they could use the proceeds from the lawsuit to educate the public about aortic dissection disease. There was no mention if they intended to use the full $67 million for the useful goal of education, or if the lawyers wanted to use two-thirds of that amount for education and one third, or roughly $22.3 million, for educating themselves about how their homes would look with Bentleys in the driveway or with a new driveway altogether, say, leading up to a new house in Malibu.

No doubt, money can be a great motivator.

What I do know is that there is a sizable disconnect here, between what is expected in the case of a high net-worth individual who alleges medical malpractice and what physicians can realistically be expected to pay in damages. Most physicians carry a mere $1 million in professional liability coverage, which means that they have to write a sizable check.


I found that figure shocking. "Only" $1M in med mal coverage? Really thought it would be higher . . . at least $5M.

I have more than $1M on my car and then an umbrella over and above that.

Most physicians are flattered if they are among the few to be asked by high-profile politicians, entertainers, sports stars, or billionaires to provide care. But is it possible that such high earners could possibly seek full indemnification for their salaries if something goes wrong? Most physicians never think about it. Maybe they should because the Ritter trial shows us that the legal system actually does allow forcing the physician who commits a wrong to make Tiger Woods, Bono, or Robert DeNiro whole again if negligent care is proven.

That's a scary thought.

Most high earners value their earning capacity and insure against it on their own. They buy disability and life insurance, so that if something untoward does happen, they actually can be made whole. But the law doesn't recognize that solution. The law says you take the plaintiff as you find him. So, if you negligently injure a billionaire, bankruptcy might be the only way out.

Good thing Dr. Ben Sobel was able to help Paul Vitti .

Move Over Richard Simmons

Want to get fit?

Maybe not Tina Turner fit, but more than a couch spud.

Nintendo has an idea to get you up, moving and having fun.

Wii Fit will hit the shelves next week.

Next week, the video game producer will unveil its latest product aimed mostly at women, the Wii Fit, as part of its strategy to vastly broaden the world of gaming. Marketing to women has helped Nintendo defy industry expectations and garner blockbuster sales, soaring profits, and an audience of loyalists along the way including senior citizens, teen girls, and working moms.

Working moms.

Isn't that redundant?

In Nintendo-speak, women and moms in particular were the "chief household officer" that they were eager to attract.

Chief Household Officer.

Beats the heck out of Rosanne's "Domestic Goddess."

Nintendo Canada is wooing women through ad placements for Wii Fit in "pink collar" magazines such as Best Health and with the web site getupandplay.ca, launched to help teach moms about the Wii system and offers instructions on how organize a Wii party.

Wii party.

Move over Pampered Chef.

It also features recipes.

Perhaps I was a bit hasty.

Now if it can teach them to dance like Tina Turner, they might have a winner.

Cavalcade #52: Submissions Due

Fresh off of a tremendous Health Wonk Review, Jason Shafrin hosts next week's Cavalcade of Risk. Submissions are due by Monday (May 19th). Jason reminds you to include:

■ Your blog's url
■ Your post's url
■ The post's trackback URL (if available)
■ A (brief) summary of the post

You can submit them via Blog Carnival or email.

We have slots available for July and August, so PLEASE drop us a line to reserve yours.

Thursday, May 15, 2008

Breaking News: Health Wonk Review is up!

Our favorite health care economist, Jason Shafrin, hosts this week's issue of health care wonkery. Read all about it!
Dr Paul Hsieh shares our preference for free market solutions to health care delivery and financing. In this Q&A-formatted post, he explains why.

Over-medicating Chronic Conditions?

[Welcome BusinessWeek readers!]

I am not a doctor, nor do I play one on TV. But I do take a lot of medical histories as part of the pre-screening process in evaluating risk and guiding clients through the underwriting maze.

One thing that always amazes me are the number of meds used by individuals, especially at younger ages.

Many of these individuals have been on copay plans where there were no financial barriers to accessing primary care including maintenance meds. If you are covered by an employer plan, and the employer pays a substantial portion of the premium, it is easy to develop a copay mentality toward health care.

In a fast pace society, we want a quick fix and one that is financially painless.

What could be easier than a 7 minute visit with the doc who flips through your chart, writes a script and sends you on your way. Total cost for the office visit is $20. Add another $20 for the "latest & greatest" wonder drug and you are back to your old self.

Or are you?

Most medications do not provide a cure, but either mask symptoms or keep them in check. Many times a cure lies in a lifestyle change, such as losing weight, exercising more, or both.

A recent study by Medco indicates that "51 percent of insured Americans were taking prescription drugs to treat at least one chronic health problem."

This is a staggering statistic.

Surprisingly, nearly half (48 percent) of women ages 20-44 are being treated for a chronic condition, as compared to one third of men their age. Antidepressants are the most commonly used medication among this group, with 16 percent of 20-44 year-old women taking them. This demographic also claimed the sharpest increases in the number of patients on chronic medications, rising more than 20 percent between 2001 and 2007.

Is Prozac Nation a reality?

Treatments for high cholesterol and high blood pressure were the top medications used by the general population, with more than one-in-five people on antihypertensives and almost one-in-seven on cholesterol-lowering drugs, according to the research that reviewed prescription claims of some 2.5 million insured Americans. These were also among the top four medications taken by 20-44 year-old men, whose use of cholesterol drugs surged more than 80 percent over a seven year period.

Anxiety, depression, hypertension, high cholesterol.

All conditions that can, in many cases, be controlled or cured by exercise.

One of the least expensive (and most effective) ways to reduce health care costs is to make lifestyle changes and give meds the boot.

Resource Update

We don't often update our blogroll, preferring instead a more minimalist format. Once in a while, though, we come across something so unique and helpful that we feel an addition is in order.
Such is the case with David Baker's "Employee Benefits Links." David's a former employee benefits attorney; he started his site some 13 years ago, and updates it regularly. If you're an employee with benefits questions (or an HR person with some of your own), the Benefits Link site is the place for you. Its no-nonsense, zero-fluff layout may be a bit startling at first, but it's easy and intuitive to use, and full of helpful links and articles.
Look for it in our "Resources" list on the right of your screen.

Wednesday, May 14, 2008

Earthquake Relief: China

I am always amazed at the generosity of InsureBlog readers. Whether for hurricane victims in New Orleans or folks crushed by a falling bridge in Minneapolis, our readers are unstinting.
In China, tens, perhaps hundreds, of thousands of people are dead or injured following a massive earthquake. I looked around the web to see who had appropriate assets in place, and who could deliver the necessary aid with a minimum of problems. Every place I looked, the answer seemed to be Mercy Corps. They're already in place, and have the infrastructure, personnel and reputation to get the job done.
I encourage all our readers to click over and donate something, anything, to help the struggling people of Sichuan province. Feel free to leave a comment letting us know.

Universal Care Run Amok

Behold, the reality of state-run health care, courtesy of the MVNHS©:
The couple, married for over 60 years, were seldom apart. Nancie Hughes suffered from dementia, while husband Tom seemed to be in good mental shape. Unfortunately, the gummint, in its infinite wisdom, decided that some 6 decades together was long enough, and was planning to move them into two different facilities.
Now, of course, they're both dead, saving the MVNHS© even more money.
Please tell me about compassionate government-run health care again.

Self Service

It's not like the old days. Self serve is the rage.

It doesn't matter if it is gasoline, fast food restaurants or bank ATM's.

Or health insurance.

Thanks to the miracle of the internet, you can go online, get a quote, then apply for coverage in a matter of minutes.

You are now entering the self serve economy.

Carriers have stepped up to the plate as well.

Want to talk to a live person?

Good luck.

If you can even find a number to call you are forced to speak and punch your way through an endless menu of choices that would make Survivor seem like a walk in the park.

Most health insurance companies have plowed resources into self-service Web sites for their policyholders -- Web site portals that display page after page of details on coverage. A handful even provide systems for maintaining electronic health records.

Yet the general perception, even among many industry insiders, is that health insurance providers are not customer-friendly.


Not customer friendly? Say it isn't so!

I am afraid it is.

Not only are carriers downright abusive and elusive to policyholders, they aren't much better with the agents who bring them business.

I know.

As one who has been in this industry for over 30 years, I know how frustrating it can be to handle even simple tasks. Recently I spent a good part of 2 and a half months getting a simple change effected for a new client who had been trying for 4 months to swap her low deductible plan for a higher deductible.

Why are health insurance companies so lacking in the customer service department?

Essentially, it's because customer satisfaction really doesn't matter to them,


Sadly, this is true.

If you are a pain to deal with they would just as soon you go away as they would invest resources to solve your problem.

After all, it is YOUR problem, not theirs.

An agent who is actively feeding them new clients has a much better chance of getting issues resolved than does a DIY policyholder.

Indeed, health insurance is such a distinct, unique product that it may not even make sense to compare its customer service outreach to that of, say, the telecom industry -- which also has a reputation for low marks.

Ouch!

Doctor's Watch List

Just how good is your doc? How much do you really know about him or her?

According to the WSJ, a report compiled by American Medical News says that "disciplinary actions against docs have been falling for the past several years, with serious moves like license revocations and suspensions down 17% between 2004 and 2007."

Is this good news?

Does this mean the docs are "cleaning up their act", less likely to get caught, or that the sanctioning boards are more lenient?

Over the past few years, Alaska has averaged more than eight serious disciplinary actions per 1,000 physicians, higher than any other state, according to this recent ranking from Public Citizen. Kentucky, Ohio, Arizona and Nebraska round out the top of the list, each with more than five serious disciplinary actions per 1,000 docs.

What exactly does this say about docs in general in these states?

Meanwhile, this morning’s New York Times takes a local slice of the data, drawing on the FSMB report to point out that more than 2% of NY docs were on the state’s watch list last year because of concerns about their professional conduct or personal problems that could spill over into work life, such as substance abuse.

Wolfe may think it’s a good thing to have lots of docs on a watch list. But as New Yorkers, the notion that one in fifty of our local docs made the list does give us pause.


Give us pause, indeed . . .

Polly . . .

I subscribe to many industry newsletters in an attempt to keep abreast of this changing market. One such publication is The Industry Radar.

Recently they posted a link to an article penned by an Episcopalian Priest. "Polly" was a parishioner who died following a massive stroke.

Polly was a hard worker who paid her bills on time. Including her medical bills.

But Polly was uninsured.

The priest hits many of the points viewed by many as justification for a universal health care system.

Alleged price gouging, cost shifting, cost containment, social conscience.

Let's examine a few of the comments.

I saw some of Polly's healthcare bills before she died. She was charged the highest possible rates that her hospital and most of her providers could charge. I know because I carefully track my own, everyday costs—and I am reasonably healthy—and I saw the difference that the same hospital charged Polly and what they charged me and my insurance company, and what my insurance company and I actually paid.

This seems to be a hot button for many.

Carriers negotiate a lower rate in exchange for prompt payment . . . in full (at the negotiated rate).

Individual's can do the same.

More often than not, the amount actually COLLECTED by providers is far less than is billed, and less than carriers pay.

The amount billed for services is truly a non-issue.

The real issue is how much is collected.

Between the two of us, I was the lucky one. Not only do I have insurance, but generally I do not have to pay the difference between what the hospital charges and what the insurance pays,

Why is it that those with insurance are "lucky" while those without are not?

It is mostly a matter of personal decision, not luck.

Those without the "buying" power of a group pay full freight because they cannot negotiate a “discount.” That means the uninsured. That meant Polly

We are not told how much Polly actually paid, only that she had unpaid bills after her death.

If her situation is typical, it would not matter if the bills were discounted 50%, 60% or more.

She still would not have paid anywhere close to the "negotiated" rates, much less the full amount billed.

Most uninsured's pay around 10% of the billed amount.

If we as a society are going to seriously and adequately address the health-care crisis in this nation, we will have to come to terms with the moral question of how we all share in the cost of each other's care. Are we responsible for each other, or not? Do we have obligations to each other, or not? We will bear, even on the most minimal level, each other's burdens, or not?

The real question is, how do you want to pay for the uninsured?

Changing the game to have health care covered by taxes is just rearranging the deck chairs.

It accomplishes nothing.

Hiyo, Silver (Alert)!

[Welcome Industry Radar readers!]
We've discussed Alzheimer's and other forms of dementia here in the past, as well as other senior care issues. Generally, these are related either to health insurance or to health care trends.
But there's another dimension to dementia, one which often isn't discussed: affected seniors who wander away, and face potentially dangerous consequences.
We're all familiar with Amber Alerts when children go missing. But there's something new afoot at the other end of the age spectrum:
Currently in its (you should excuse the expression) infancy, the Silver Alert system seems to be gaining ground slowly. With the graying of the population, especially as Baby Boomers reach their Golden Years, we'll likely see this picking up steam.

Tuesday, May 13, 2008

Is Your Doc Using the Term S.O.B Around You

If so, you might want to pay attention. It might save your life.

If you are referred to as a rock, that is not a compliment.

Every field has its' own lingo, and the medical field is not immune. Thanks to shows like "House" and "E.R." it seems most of us know what a CBC is and "stat" means you need to act quickly.

But the folks at the Chicago Tribune have a few more terms for us to learn.

a "rock" describes someone whose condition never seems to get better or worse, creating a hassle for doctors who often see their job as moving patients smoothly through the system.

Quick diagnosis, quick fix, out the door.

Please don't tie up their time by asking questions.

A 1978 novel (The House of God) introduced the term GOMER, "short for "Get Out of My Emergency Room"—an epithet usually reserved for elderly patients with difficult, chronic illnesses."

Gotta confess, that one set me back on my heels.

"Oh, we never use that word anymore," said Dr. Alexis Dunne, a third-year internal medicine resident at Northwestern University School of Medicine. "That's old school."

Good to know.

I guess . . .

Here is another term. Turfing.

"(Turfing) refers to discharging the person or transferring him to another department. Residents often refer to newly admitted patients as "hits," sometimes lamenting, "I got 10 hits last night." A shift with no admissions is a "no-hitter."

No hitter.

When you check out (permanently) does that go as a "K" on the board?

And S.O.B.?

Shortness of breath.

So when a GOMER waltzes in to the E.R. and is labeled S.O.B. you might figure they are going to be turfed in S.O.

(That is short order).

Oy Canada: Dog Pound Edition

Ah, it just doesn't get any better than this:
Our Neighbors to the North© have apparently outdone themselves. As we've repeatedly noted here at IB, that "Free Health Care" comes at a steep price: actual, you know, care. If you're a Canuck with cancer, you'll likely wait well over a month to see an oncologist.
But if your Siberian Husky has a suspicious growth, he'll be seen in a few days. I'll let Barbara Righton and Nicholas Kohler (who co-wrote the linked article) have the last word:
"Trouble is, when it comes to medical care in Canada, our pets are often getting what we get — and a whole lot more besides. And they're getting it faster too."
[Hat Tip: RWN]

Grand Rounds is up!

Five-time host David Williams presents this week's round-up of the best of the medblogs. There are over 2 dozen interesting posts, and each one comes with a terrific explanation and context. Kudos, David!
For a bit of nostalgia, I recommend Peter Zavislak's post on his favorite medical-themed TV shows. I expected M*A*S*H and House, but General Hospital? Fun post.

Monday, May 12, 2008

Insuring Mom (or Dad) the Homemaker

[Welcome Industry Radar readers!]
Some time ago, we discussed disability insurance coverage for stay-at-home mom's (in fairness, pretty much everything we'll discuss in this post is equally applicable to stay-at-home-dad's, too). As noted then, it's difficult to obtain, because it's well-nigh impossible to verify a loss of actual income in such cases. One alternative would be to consider a critical illness plan, and perhaps an accident plan. These would pay a lump-sum based on a diagnosis or injury, regardless of actual financial loss.
But what about life insurance on that stay-at-home-spouse (SAHS)? Recently, I had an interesting conversation with a prospect who had asked me about additional life insurance for her husband. At the time, he worked for a company which provided a modest amount of group life insurance, which "Jane" felt was inadequate. She asked me to run some numbers for "Joe," with an eye toward a more realistic amount. I did so, and have periodically checked back to see when (and if) they would be moving forward. After more than a year of this, I dropped it, since it was obvious that they didn't feel it was a particularly pressing problem (despite my best efforts).
Last week, Jane dropped by the office to go over her home insurance with my P&C colleague. I figured "what the heck," and asked if they would like updated figures for Joe. She answered that they no longer needed the coverage, since he had left that job to become a stay-at-home-dad. Since he wasn't contributing (directly) to the household finances, she said, he didn't need any life insurance.
Good point, right?
Not really: the cost of replacing a SAHS isn't measured in hard dollars coming in, but what it would cost to hire someone to provide all (or almost all) the services of that spouse. The day after Jane and I had our conversation, I saw this article, which puts the real value of those services in perspective:
Wow!
Surprisingly, it wasn't the nature of the job(s) so much as the hours:
"The biggest driver of a mom's theoretical salary is the amount of overtime pay she'd receive for working more than 40 hours a week."
So what does Jane have to say about all this? Well, I forwarded a copy of the article to her, and will wait to see how (if?) she responds.
Meantime, if you (or someone you know) is a SAHS, perhaps it's time to review that life insurance portfolio. Right after the laundry's folded.

Carnival of Personal Finance is up...

Hosted this week by Money Under 30, it's jam-packed with helpful financial tips. This week's Carnival continues the new tradition of a few "Editor's Choice" entries, followed by the rest of the submissions, categorized and with helpful summaries.

Foolhardy Publicity Stunt

Quite a few people do not have health insurance.

Some cannot qualify for medically underwritten coverage, do not have a job with benefits, and have not taken advantage of plans available in all states for those considered uninsurable.

Others make too much money to qualify for taxpayer subsidized coverage and say they cannot afford coverage.

And quite a few have no health issues, have plenty of disposable income and voluntarily choose to go without coverage.

Steve Kagan is one of those people.

Kagen, a Democrat and an allergist, is the only Congressman to refuse insurance, Scientific American reports this week.

He announced his insurance status to the world last year on the Huffington Post, and this year he introduced a bill that would bar insurers from denying coverage or raising rates because of pre-existing conditions. He’d also require companies to disclose all of their rates.


Apparently Dr. Kagan is not familiar with what happens when insurers are required to cover everyone, regardless of pre-existing health conditions.

Coverage becomes more expensive and less accessible to all, including the healthy.

So he’ll remain without insurance. If he were to get sick, he tells SciAm, “I’d be just like the 47 [million] to 50 million American citizens who don’t have coverage, and I’d have to negotiate with hospitals and doctors for the best-priced coverage.”

Negotiating works . . . as long as you have the money to pay the bills.

One would assume someone with M.D. after their name would have significant assets to pledge toward payment of health care.

For Dr. Kagan's sake, let's hope this foolhardy publicity stunt does not result in a major loss of assets.

Sunday, May 11, 2008

For Our Mothers

Who can find a virtuous woman? for her price is far above rubies.

The heart of her husband doth safely trust in her, so that he shall have no need of spoil.

She will do him good and not evil all the days of her life.

She seeketh wool, and flax, and worketh willingly with her hands.

She is like the merchants' ships; she bringeth her food from afar.

She riseth also while it is yet night, and giveth meat to her household, and a portion to her maidens.

She considereth a field, and buyeth it: with the fruit of her hands she planteth a vineyard.

She girdeth her loins with strength, and strengtheneth her arms.

She perceiveth that her merchandise is good: her candle goeth not out by night.

She layeth her hands to the spindle, and her hands hold the distaff.

She stretcheth out her hand to the poor; yea, she reacheth forth her hands to the needy.

She is not afraid of the snow for her household: for all her household are clothed with scarlet.

She maketh herself coverings of tapestry; her clothing is silk and purple.

Her husband is known in the gates, when he sitteth among the elders of the land.

She maketh fine linen, and selleth it; and delivereth girdles unto the merchant.

Strength and honour are her clothing; and she shall rejoice in time to come.

She openeth her mouth with wisdom; and in her tongue is the law of kindness.

She looketh well to the ways of her household, and eateth not the bread of idleness.

Her children arise up, and call her blessed; her husband also, and he praiseth her.

Many daughters have done virtuously, but thou excellest them all.

Favour is deceitful, and beauty is vain: but a woman that feareth the LORD, she shall be praised.

Give her of the fruit of her hands; and let her own works praise her in the gates.



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