Wednesday, August 31, 2011

Insurance: Because life is full of surprises

Aetna Savings Plus info bleg

Looking for info on Aetna's new Savings Plus plan, currently marketed exclusively in the Cleveland (OH) area. Specifically interested in cost differential with their "regular" plans. Please drop me an email if you have relevant info.


Tuesday, August 30, 2011

States Beat Fed's

In a race to see who can enroll the most sick people in taxpayer subsidized health insurance plans the states win handily.
the Government Accountability Office found, the 27 states that operate their own pools had enrolled 15,781 people with pre-existing conditions. The federally-operated pool for the 23 other states and the District of Columbia, by contrast, only had 5,673 enrollees.
Wonder how many of our dollars have been spent promoting Obamapool?
The report found that enrollment figures ranged from 0 in Vermont and 1 in Massachusetts (both operated by the Department of Health and Human Services) to 3,191 in the state-run Pennsylvania pool.
In fairness, VT and MA are guaranteed issue states (no underwriting) so the only real appeal for these plans is the taxpayer subsidy.
In its response to the report, HHS said it has improved its enrollment efforts since the program first started in June 2010. The department points to increased outreach efforts, lower premiums and expanded eligibility, as well as its decision to pay agents and brokers for getting people enrolled starting this fall.
I doubt there will be much agent involvement. This agent is opting out.

Agents that want to participate in the program must be willing to bend over and submit to the following.

Broker understands and agrees that GEHA may, and is hereby authorized by Broker to, check the NIPR, IRS and any other websites maintained by applicable agencies or entities for information relevant to Broker. Broker also understands that GEHA may take action with respect to Broker that is based on such information, and will act in what GEHA believes is in the best interest of the PCIP Program.

To accept these terms and conditions, click on the "I Agree" button below to complete registration.
Thanks, but no . . .

Paying More, Enjoying Less

From the land of "Duh!" comes this report from the folks at Kaiser Health News.

A survey of ages 18 - 64 with employer paid health insurance found that
  • 60% were unwilling to pay more for brand name drugs
  • 61% were not willing to opt for a higher deductible, even if it meant saving premium dollars
  • 65% would not accept a more restrictive list of docs and hospitals
Well duh!

But a surprising (to me at least) 68% said they would be willing to participate in a wellness program.

I wonder if it is like those New Year resolutions that are well intended but somehow fall by the wayside in a few weeks. Gym rats hate January and February because of overcrowding, but by March things are back to normal.

Kind of like the Easter-Christmas church goers.

The poll found two-thirds of Americans are positive about one new government action on health care: the new rule that requires insurers to cover the full cost of birth control and other preventive health services for women. Not surprisingly, support is strongest among those of child-bearing age, while seniors are split about the plan.

Well of course.

Anything that is free is good, right?

More from the "D'unh!" Dept

There's actually quite a bit of schadenfreude in this article, but this damning indictment of ObamaCare© is actually far, far more damaging than anything we've ever written:

"The uninsured ranks among adults over 27 years old swelled from January through April of this year, according to Gallup, with 27- to 35-year-olds seeing the highest uptick. Nearly 27 percent of them are now uninsured."

What's so interesting about that (unvetted) number is that it represents an increase from the "record 50 million in 2009."

In other words, just like the Spendulus, ObamaCare© has actually exacerbated the problem, rather than resolve it. No worries, though, everything will be just peachy keen come '14.

ObamaCare© Underwater

While the Northeast continues to drown from the effects of Irene, ObamaCare© continues taking on water, as well:

"Americans' opinion of Obamacare has reached an all-time post-passage low according to the Kaiser Health Tracking poll. Only 39% of those surveyed have a favorable view of the law"

That's a further 2 point drop since the spring of '10. What's particularly bothersome for its proponents is that support among Dems and Indies continues to fall. Inexplicably, Pubbie support has risen to 24% (kind of like being the tallest midget, one supposes).

Now, bad polling numbers doesn't equal repeal, but it certainly indicates that as the train-wreck's impact on health care and health insurance continues to further erode its support.

Grand Rounds is up!

Fisher at the Health 3.0 blog has a very cool edition of Grand Rounds today, selecting quotes from each post and "tagging" them based on different themes.

Monday, August 29, 2011

Look out below!

We last noted the fact that ObamaCare©=Doom for group health plans about two months ago. As we've noted all along, any sane employer is going to take a look at the Exchanges, then at the employer mandate and its concomitant fines, do some quick math, and come to the entirely rational conclusion that dropping group health coverage is a "no-brainer."

A few days (months) late and a few dollars short, the McPaper has finally glommed onto this exciting news:

"Nearly one in 10 midsize or large employers expects to stop offering health coverage to workers once federal insurance exchanges start in 2014"

Says whom?

Says Towers Watson, a major employee benefits consulting firm. And it's not just TW; Mercer (another independent health care and financial services research firm) has reached a similar conclusion: "8% are either "likely" or "very likely" to end health benefits once the exchanges start."

The TW report is actually a bit scarier (if one's spooked by these sorts of things), because it identifies another 20% of employers currently straddling the fence. What are the odds that the bulk of these are going to end up keeping their group plans?

Yeah, that's what I thought, too.

As a matter of policy, of course, I'm in the "anti-group" camp; that is, I don't think that one's health insurance should be tied to one's employment. But this isn't the way to get there.

[Hat Tip: Stop The Hit]

MVNHS©: Let's play "Leapfrog!"

As we noted almost 3 years ago, the MVNHS© has (at least) one dirty secret: private health insurance to help pay the bills that their "free insurance" doesn't cover.

And while we're seeking to emulate the British healthcare scheme, they're looking to dump it:

"Private patients will increasingly be able to "leapfrog" those on the NHS due to changes proposed in the Government's health reforms ... Even 14 of the elite group of foundation trusts ended the last financial year in deficit, a grim warning for the future of NHS finances" [ed: "trust" is MVNHS©-speak for "hospital"]

Wait, what?!

There's "grim news" about the British system's finances? But I thought that they're saving money hand-over-fist, all the while delivering healthcare far superior to us? And what's this about "private patients?" Haven't we been told that a nationalized scheme was so much more fair than our current system, since it deletes that very distinction?

It's almost as if we've been lied to all along.

Google Fine

The US DOJ fined Google $500 million for allowing advertising by Canadian pharmacies. According to the New York Times:
Google was aware that some Canadian pharmacies that advertised on its site failed to require a prescription for substances like the painkiller Oxycontin and the stimulant Ritalin. Google continued to accept their money and assisted the pharmacies in placing ads and improving their Web sites, according to the Justice Department.
Sorry, but I fail to see the problem.

One can find almost anything on Google (and other search engines) including items that may be illegal.

If you want to gamble, you can find sites on Google.

If you want to engage in illicit sex, you can find sites on Google.

If you want to research people or places with the intent of planning a crime, you can do so on Google.

Why target online pharmacy's?
After Google became aware of the investigation, it has required that all Canadian pharmacy advertisers be certified by the Canadian International Pharmacy Association and has specified that they can advertise to Canadian customers only. American pharmacy advertisers must be certified by the National Association of Boards of Pharmacy.

Google had previously relied on the private firms Square Trade and to certify pharmacy advertisers
For years I have been recommending Blue Sky Drugs to clients and friends as well as using them personally. The savings are significant.

Just last week I helped a new client save over $100 per month on Lipitor.

Blue Sky is certified by CIPA.

Friday, August 26, 2011

Report from Department of the Blindingly Obvious

Helping Jerry's Kids

Well, that's how I still think of them, anyway.

This year, I've agreed to participate in the "MDA Lockup" program, and hope to raise $1,600 by hook or by, well, phone, email, and the Web:

Please help out - all it takes is a click or two and a few dollars to help finally beat this terrible disease.

CLARIFICATION: I've had a number of folks tell me that they've decided not to participate because of how the MDA HQ (apparently) treated Mr Lewis. No disagreement here; in fact, I also did some soul-searching before agreeing to help out. For me, it came down to the fact that I didn't want to punish Jerry's kids because of rank bureauweenie stupidity. YMMV.

Is this a blip?

From the "Not Sure What to Make of This" Dept:

"Larry Klayman ... just won a round in court against the Obama administration's health care reform effort ... Freedom Watch, filed suit in 2009 against President Barack Obama and what Klayman called the "Obama Health Reform De Facto Advisory Committee."

Takeaway is that Big Pharma, Big Business, AARP and the AMA allegedly conspired to get ObamaCare© passed over the (vociferous) objections of the American People.

As an aside, this is pretty much what doomed HillaryCare, too: secret meetings with no transparency or accountability.

At this point, the judge has ruled only that Mr Klayman (et al) has met a sufficient burden of proof to enable him to get to the next round. It'll be interesting to see what, if anything, ultimately comes of this.

Thursday, August 25, 2011

Brave New Medical World

My wife and I enjoy relatively good health in spite of the fact we are part of the leading edge of baby boomers.

Rachel is a health and exercise nut. Working out at the gym 4 days a week. Popping vitamins and supplements like they were M&M's. Eating a Euell Gibbons diet of rocks and twigs washed down with Kefir.

On the other hand, I eat what I want and get my exercise by jumping to conclusions.

My wife takes one medication for dry eye, I don't take any.

We almost never see the doctor.

Lately both of us have had medical visits that are letting me know that Big Brother in Washington is watching our every move.

Two weeks ago at the dentist my hygienist asked more than the usual number of questions about my brushing and flossing routine. Each time I answered she input the data in a new laptop rather than writing it down in my chart.

When it comes to flossing, I am a bit lax and she knows it.

"How many times per week do you floss"?

The usual, was my response.

"So, is that 14x per week, 7x, or what"?

Just put PRN.

"So would 3x per week be about right"?

Does Washington really care how often I floss?

She rolled her eyes and said, we have to do this as part of EMR.

Earlier today I took Rachel to an urgent care facility. Appears it is nothing major, just some testing and an Rx for what appears to be a UTI.

Checking in, the lady at the desk ask several questions in addition to requiring a picture ID and her health insurance card.

Both were scanned and returned.

Then she was told to sign using an electronic pad to indicate the information she provided was accurate and she was agreeing to her HIPAA privacy rights.

They don't know who they are dealing with. She doesn't sign anything until she has read it.

"We can't provide you with a paper record due to federal privacy laws. You have to sign if you want us to see you".

Say what?

You want me to sign a release but you can't provide me with a copy of what I am signing?

This is nuts.

Is this really the world under Obamneycrap?

Yes, unfortunately it is.

Cancer Drugs in Short Supply

If you rely on Taxol to treat your cancer, you may be in trouble. Several Georgia cancer facilities are reporting difficulty in obtaining some cancer drugs.

According to the FDA:

"We are continuing to see these increased numbers for shortages, especially for older sterile injectable drugs," said Valerie Jensen, director of the FDA Drug Shortages Program. "These drugs are mainly used in hospitals and include cancer drugs, drugs needed for patients undergoing surgery and emergency drugs."

The reasons for the shortages vary. Some drug manufacturers are discontinuing older drugs and replacing them with newer ones, which are usually more profitable, according to the FDA. They are also recalling some drugs because of quality problems.

Dr. Bancroft Lesesne, chief executive officer and president of Georgia Cancer Specialists, said the drugs affected are most commonly used in breast, lung, lymphoma and colon cancer treatments. "There's a standard treatment we might recommend to a patient based on the disease and the stage," he said. "If the drugs aren't available we have to make substitutions. We think they're just as effective but you can never be quite sure."

"I don't see [the shortages] getting any better," he said. "One drug will become available and then there's a shortage of another. It's seems to be a moving target."

​This is a serious problem for Georgia cancer patients.

Many health insurance policies issued today do not cover brand name drugs. Plans issued by Blue Cross, Golden Rule and many others include a drug discount plan, not real insurance.

The only thing worse than discovering your cancer drug is unavailable, is not being able to pay for it because you tried saving a few premium dollars by purchasing an inadequate health insurance plan.

Wednesday, August 24, 2011

Good News/Bad News: Cardio edition

Unlike our unfortunate Neighbors to the North© or Cousins Across the Pond©, our hospitals are setting records for how quickly patients are seen:

"[H]ospitals are treating almost all major heart attack patients within the recommended 90 minutes of arrival, a new study finds. Just five years ago, less than half of them got their clogged arteries opened that fast."

In fact, whereas it took (on average) better than an hour-and-a-half "on line" only 6 years ago, that time was cut by about a third, to just over an hour in 2010. And that's not a one-off, rare occurrence, either:

"Americans who have heart attacks can now be confident that they're going to be treated rapidly in virtually every hospital of the country"

Says whom?

Says Dr. Harlan Krumholz, a cardiologist at Yale. And he should know, since he's the one who led the study that unearthed these terrific findings.

But that's still not the best part. This is:

"[I]t occurred without money incentives or threat of punishment. Instead, the government and a host of private groups led research on how to shorten treatment times and started campaigns to persuade hospitals that this was the right thing to do."

Too bad that this great news will be short-lived.

Why I Dropped My Series 6: Reason #4,392

In addition to their "regular" insurance license requirements, agents who sell variable (ie securities-based) products must also have special licenses regulated by the Feds. These kinds of products would be mutual funds, and variable life insurance policies and annuities.

They do not (currently) include equity-indexed products (but don't be surprised...)

In the event, I used to hold such a license, and sold a few variable policies (and a handful of mutual funds, mostly as pre-HIPAA HSA vehicles ). After a short while, I realized that I didn't enjoy all the extra bookkeeping, accounting, and research that went with that territory, to say nothing of fielding the calls from clients unnerved by the vagaries of Wall Street. So, I turned it in and never looked back.

And boy, am I ever glad I did:

"Financial Industry Regulatory Authority Inc. communications record retention rules apply to all communications devices and technologies ... [including] member firms’ use of social networking websites and personal communications devices."

Yup: Twitter, FaceBook and text all count (no word yet on sexting or MySpace).

That means all those little messages buried in your BlackBerry or iPhone memory, and heaven help you if you delete older ones to recapture storage space.


Cavalcade of Risk #138: Global to Personal

Nina Kallen, Esq hosts this week's collection of risky posts, neatly categorized from the macro to the micro.

HOSTING BLEG: We're currently scheduling for Fall Cavs. Just
drop us a line to claim yours.

Tuesday, August 23, 2011

How safe are your medical records? Are you sure?

It's a bit startling to consider, but we began blogging about the relative safety of medical records over 5 years ago:

"In a time zone 17 hours ahead, a radiologist in Australia, working for a company called NightHawk Radiology Services, had been sitting before the same images."

More recently, we noted that the MVNHS© had put the kibosh on their latest and greatest:

"A plan to create the world's largest single civilian computer system linking all parts of the National Health Service is to be abandoned by the Government"

The Brits were unable to justify the huge sums of money already sunk into that doomed effort, let alone throwing in even more. But there's a more pressing issue than just funding: just how safe is the information being stored in these data warehouses?

Why so serious, Henry?


"Until recently, medical files belonging to nearly 300,000 Californians sat unsecured on the Internet for the entire world to see ... Among the files were summaries that spelled out, in painstaking detail, a trucker's crushed fingers, a maintenance worker's broken ribs and one man's bout with sexual dysfunction."

More ooopsies.

Our co-blogger Kelley B (herself a Certified Medical Office Manager), has told me that the gummint has in place special funding incentives to get providers to move to electronic records-keeping. Early adopters are eligible for thousands (often tens of thousands) of dollars in "free money" if they opt for new data storage systems.

But is this "rush to adopt" really a good thing?

The benefits of this brave new world are touted as increased efficiency and better patient outcomes, but I've seen scant evidence of either - at least no direct links controlled for other factors. Which is not to say that such do not exist, but if that's truly the case, show me the data.

One of my favorite computer aphorisms is "garbage in, garbage out;" which is to say, these systems are subject to human error at any number of stages. I'm no Luddite, and I can see where there are certainly efficiencies in moving away from paper-based files, but I'm not convinced that these replacement systems are a step forward.

Grand Rounds - Pretty as a Picture

The estimable Dr Bates hosts this week's collection of interesting (and often provocative) medblog posts.

Monday, August 22, 2011

Life sales up?

The Medical Information Bureau (MIB) is often the frontlines when it comes to life insurance underwriting. Typically, participating carriers turn to the clearinghouse to check up on new applicants. So this little tidbit may be more significant than might be apparent:

"U.S. life insurers researched more requests for individual coverage in July than they did in July 2010."

As we noted a few weeks ago, sales of Long Term Care insurance are on the rise; and so, it would appear, is the sale of life insurance. This shouldn't be surprising, really: with an uncertain economy, very few (if any) risk management vehicles beat life insurance for creating certainty.

I found this little nugget particularly toothsome:

"(G)rowth in activity for older applicants [age 60 and up] has been strong."

Whether this is for estate planning purposes, or because investment values have declined so sharply of late (increasing the need for estate creation), who can say? But the MIB says that "activity" in this cohort is up over 9% from just a year ago. Food for thought.

On Packages and Details

Years ago, we discussed a (then-new) effort by Blue Cross of Minnesota to standardize how the costs of various medical procedures would be explained to insureds. We lauded this effort because, for most people, EOB's (Explanation of Benefits) provided little in the way of detailed information about those costs and how insurers made them understandable to "normal" folks.

We also appreciated that this effort was undertaken voluntarily bu Blue Cross, and hoped that it might pressure other carriers to follow suit.

So one might think that we'd also laud the latest stupidity from the still-unconfirmed CMMS Administrator Donald Berwick:

"We are telling insurance companies that they need to be more transparent about the benefits they offer, what they are spending premium dollars on, and justifications for any proposed rate increases"

Right, Donny-boy, because you've been so forthright all along.

The fact is, plain-language rules have been in place for many years, and consumers don't read those policies. So what possible reason is there to increase admin costs on carriers?

But wait, it gets stupider [ed: is that even possible?]:

"This is all grounded in the idea that the more informed the patient is, the better decisions he or she can make."

Um, no.

First, because unlike Minnesota Blue's transparency effort, it's about plan design, not claims adjudication. Your car's owner's manual may be helpful in telling you how to change a headlight bulb, or reset the clock, but it's not going to tell you how much a new transmission costs or what brand of tires to buy.

Second, this is a direct assault on ERISA (aka "self-funded") plans:

"[S]ince most large employers customize the benefit packages they provide to their employees, some health plans could be required to create tens of thousands of different versions of this new document"

So much for that much-touted 3000% premium savings.

Friday, August 19, 2011

Cavalcade of Risk #138: Call for submissions

Nina Kallen hosts next week's CavRisk. Entries are due by Monday (the 22nd).

NB: We're now using this submission tool: The BC WorkAround

Once there, you'll be asked to provide:

■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post ("Remarks")

At the bottom of the form, you'll see a drop-down menu; simply select "Cavalcade of Risk" then press "Submit" and you're good to go.

And PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).

HOSTING BLEG: We're currently scheduling for Fall Cavs. Just drop us a line to claim yours.


Thursday, August 18, 2011

Alzheimer’s? I'll drink to that!

About a month ago, we mentioned a few preventive measures that seem to stave off this dreaded disease (of course, since we don't really know what causes Alzheimer's, it's all pretty much circumstantial evidence). Be that as it may, new research shows another potential "vaccine" of sorts:

Loyola University's Stritch School of Medicine "reviewed studies dating to 1977 that included more than 365,000 participants ... Moderate drinkers were 23 percent less likely to develop cognitive impairment or Alzheimer’s and other forms of dementia."

Wine showed the most promise, although the researchers were quick to point out that "this finding was based on a relatively small number of studies, because most papers did not distinguish types of alcohol."


Still, not sure what harm can be done by following the implied prescription.

Up, Up and Awaaaaay!

No, not my beautiful balloon, but ObamaCare© costs:

Wednesday, August 17, 2011

Stupid "Beneficiary" Tricks

They say that the difference between comedy and tragedy is time. I would add "and common sense," as well:

"The suspect in the case of a Maryland woman who disappeared in Aruba took out an insurance policy before heading out on the trip"

Now, it's possible that the missing woman also took out a policy on Mr Giordano, but of course our press is too wrapped up in the story of the moment to check out this rather obvious point.

The perp Mr Giordano made a rather interesting choice in policy design, as well, opting for the "accident only" plan rather than one which might have required additional underwriting. The article mentions that he chose "the pricier one-year plan instead of a cheaper, five-year policy," which of course makes no sense unless they're comparing a "regular" term policy with the accident-only plan, thereby completely contradicting themselves in the process.

Of course, buying a large, non-underwritten plan in anticipation of an "accident" is itself rather poor judgement: after all, one is forbidden to profit from one's crimes in this manner. More critical, of course, is that if it's an accident-only policy, and there's no body, then there's no way to prove how (let alone if) the victim died, thereby neatly letting the insurer completely off the hook.

For now, anyway.

Prof James Moriarty this guy ain't.

Stupid Government Tricks

From the "What Were They Thinking?" Department:

"The Equal Employment Opportunity Commission today sued a Raleigh insurance office for not hiring a recovering drug addict who tested positive for methadone in his system."

Yes, druggies and their pals could probably use additional insurance coverage (although Underwriting may have some reservations), and of course existing clients would probably be thrilled to know that their private financial information (not to mention a nice list of all their valuables) would be under the watchful eye of a meth-user.

Pure. Genius.

End to Dialysis?

The federal government is looking for ways to save tax dollars and one way is to encourage those with ESRD to enter hospice rather than go on dialysis. Congress established this "entitlement" program In 1972 when treatment options for End Stage Renal Disease were limited. According to the New York Times,

dialysis and transplants were new procedures that were not covered by health insurance. There were horrifying stories — rich people got dialysis and lived while poor people died.

A bit of class warfare that decides who lives and who dies.

grim reaper

Now Congress is looking for ways to save money and one way is to encourage those on Medicare to just go ahead and take one for the team.

at that time (1972) fewer than 40 patients per million would need dialysis, and that most of those patients would be healthy — except for their failed kidneys — and under age 54.

Now more than 400 people per million start dialysis each year. More than a third of the patients are 65 or older, and they account for about 42 percent of the costs. People over 75 make up the fastest-growing group of dialysis patients. And most elderly dialysis patients have other serious diseases like diabetes, heart failure, stroke and even advanced dementia. One-third of them have four or more chronic conditions.

Unintended consequences . . .

Recent studies have found that dialysis does not prolong life for many elderly people with other serious chronic illnesses. One study found that the procedure’s main effect is to increase the chances that such patients will die in the hospital rather than at home.

Save tax dollars. Send grandpa home.

A committee of the Renal Physicians Association recently formulated guidelines to use in deciding when dialysis is appropriate. It provides questions that doctors should ask themselves before suggesting the treatment. One is the “surprise” question: Would I be surprised if this patient is dead within a year?
Well that is certainly comforting!

Don't be surprised if Congress doesn't come up with a way to encourage dying over dialysis.

Tuesday, August 16, 2011

MassCare© meets ObamaCare©: Travesty Ensues

It's generally accepted, "conventional" wisdom that RomneyCare© begat ObamaCare© (hence Bob's newest buzzword, ObamneyCare). Along with the (Evil) Individual Mandate, RomneyCare introduced other problems, many of which have (until now) flown under the radar.

Remember back during the original ObamaCare© "debate," when we first learned about the "Cornhustler" deal? Nebraska was vying for the very first ObamaWaiver©, wherein it would be exempted from onerous new Medicaid financing requirements. Well, that particular effort failed to pay off for the Cornhusker State, but over on the east coast, there's a new storm a-brewin':

"Sen. John Kerry inserted a provision into Obamacare that changed Medicare reimbursements for hospital pay ... The Globe reported that Massachusetts hospitals will rake in an extra $275 million a year from the change."

Or, more accurately: hospitals in most of the the other 57 states are on track to be screwed out of almost $300 million. Per year. How many indigents would this pay for? How many new doc's or nurses? How many MRI's?

This pretty much sums it up:

"It is a massive wealth transfer from the rest of the country to those seven states."

Pretty tasty ketchup, Sen Kerry.

Coming up short?

Maybe, maybe not:

We've written pretty extensively about Long Term care insurance (LTCi), but there's a new kid in town, goes by the name of Short Term Care insurance (STCi).

Issued by Banker's Life (#7 on the LTCi charts, and rising), it offers some interesting twists on the LTCi concept. For one thing, the maximum benefit amount available is $100, and there's no real "choice" in product design: there's a 30 day waiting (elimination) period and a maximum benefit period of 180 days My bad: the maximum daily benefit amount can be up to $200, and other elimination periods and benefit multipliers are available.

There's one inflation protection option (5% compound), and it's available as a facility-only or facility and home care plan.

Two things I really like about this design:

First, it's issued based on a "simplified underwriting" basis; that is, the application is fairly simple, with just a few "gatekeeper" questions. This makes it appealing for folks who may not qualify for a full-blown underwritten LTCi plan.

Second, it's a "pool" based plan. That is, once you settle on a plan, you're given a "pool" of money on which to draw, which makes it a little more flexible than it might appear at first blush.

Let's say you pick the $100 a day plan. That immediately gives you $18,000 worth of care dollars to play with. So let's say you're in a nursing home for 2 months (60 days), and the cost is actually $80 a day. Starting in the second month, Banker's would pay out $2,400 ($80 times 30 days), but you'd still have over $15,000 in your "bank."

Pretty cool.

Of course, it's not Partnership Compliant, but I'm of the opinion that, for folks looking at this kind of policy, that's not a major issue.

In any case, it's nice to see some outside-the-bun thinking.

Customer Service Carnivale - The Good Mix edition

We usually participate in only a few "carnivals" (CavRisk, of course, and Grand Rounds and Health Wonk Review). But I was so impressed with my recent experience with the Sirius radio folks that I submitted that post to the Customer Service Carnivale.

Little did I know that that submission would get top billing...

Just Like a Bad Penny

Health insurance scams seem to keep coming back. We have addressed the AIM Health plan on numerous occasions including this post where the plan was exposed.

You might think that was the end of it, but apparently not. We were recently contacted by an agent that sold the AIM Health plans who is looking for some advice on how to track down the promoters and hopefully get his clients claims paid.

A snowball has a better chance in Hell.

When you have been around long enough you can smell these scams a mile away. Henry and I were approached by the promoters of AIM a few years back. Wild promises were made and talk of riches for agents that sold these plans.

Henry checked with the OH DOI and I with the GA DOI.

In both cases we got similar responses.

The DOI had no knowledge of the plans, they were not filed (and consequently never approved) by the states of Ohio or Georgia and never would be.

In short, the folks selling these as "approved" plans were lying.

Been there, done that.

Employers Mutual was one of the biggest health "insurance" frauds in the last 10 years. Not the only one, but certainly one of the larger ones.

Eventually the folks who conspired to manufacture and promote Employers Mutual were tracked down and sent to prison. You can read the tale of woe here and here.

Obamacare has added to the confusion as some people believe 1) health insurance will be free, and 2) they can wait until they get sick and buy health insurance at that time.

Come 2014 some 18 million or so will indeed have free health insurance since they will qualify for Medicaid under relaxed rules but the rest of us will have to pay a premium that will be considerably higher than rates currently charged.

And unless things change, you will be able to wait until you get sick and buy health insurance but that is then, this is now.

Desperate people do desperate (and sometimes foolish) things. People who wanted to believe they could buy health insurance after they get sick and expect the plan to pay their bills forked over hard earned cash to buy plans like Employers Mutual, AIM and other frauds.

No doubt these type of scams will continue, especially after 2014 when some slick marketing organization will come up with a "health insurance exchange approved plan" that is half the rate of plans in the Exchange and folks will buy it.

Too bad the folks that push these plans don't wear a mask and carry a gun. If they did maybe fewer people would fall prey to the scam.

Grand Rounds, Rants and Whines edition

Dr Pullen hosts this week's interesting (despite the title) collection of medblog posts.

Monday, August 15, 2011

You Lied!

Remember “Under [our] plan, if you like your current health insurance, nothing changes, except your costs will go down by as much as $2,500 per year,” ? That was then, this is now. As Joe Wilson said, "you lied".

Cost of Health Care to Triple Under Obamacare

According Medicare actuary Richard Foster, implementing Obamacare will triple the cost of health care:

In 2014, the actuaries find that growth in the net cost of health insurance will increase by nearly 14 percent, compared to 3.5% if PPACA had never passed. The growth rate of private insurance costs will rise to 9.4 percent, from 5.0 percent under prior law: an 88% increase.
Say it ain't so!

You add new benefits such as "free" preventive care, "free immunizations", "free counseling for diabetes, smoking and weight loss, so what? Just because more people are seeking medical services that are perceived as free, what's the big deal?

Taking 18 million people who have limited access to health care and putting them on Medicaid surely won't increase the cost of health care.

And requiring insurance companies to issue policies to people AFTER they are sick or injured can't possibly increase the cost of health care.

And here is a bonus of Obamacrap.

For 2015–20, growth in private health insurance premiums is expected to slow somewhat and average 5.6 percent annually. Underlying this expectation is that some employers of low-wage workers will stop offering health coverage (and many of their employees will move to the exchange plans, while others move into Medicaid or become uninsured).
But what about the penalty tax employers must pay if they fail to follow the government rule and provide health insurance?

The penalty tax is much less expensive than paying premiums.

Regardless of whether the employer pays the penalty tax or pays health insurance premiums, the customers are the ones who will pay in the form of higher prices for goods and services.

Corporations Don't Pay Taxes

You see, Romney was right when he said "Corporations are people too".

Corporations don't pay taxes.

People pay taxes and those who buy goods and services from corporations that have to follow stupid government mandates are paying in the form of higher prices.

This isn't rocket surgery.

Movin' on up....

It is with deep-felt pride and pleasure that we are able now to announce that our own Kelley Beloff has accepted the position of Medical Office Manager for a much larger practice, in...wait for it...Tampa, Florida!

The good news for us is that she'll continue as a contributing member of the InsureBlog team; her new position, both professional and geographically, will give her even more opportunities and insights to share with us.

Mazel Tov, Kelley!

Thursday, August 11, 2011

Free Health Care

Obamacare says "Bring us your tired, your poor, your illegal immigrants and we will give you care". Seriously. Washington is using OUR tax dollars to provide free health care to anyone regardless of citizenship or legal status.

Illegal immigrantsTaxpayer Funded Health Care Centers Won't Check Immigration Status

According to CNS News:

“Health centers do not, as a matter of routine practice, ask about or collect data on citizenship or other matters not related to the treatment needs of the patients seeking health services at the center,” Andrews said.

Further, the grant recipients are required to serve "all residents" who walk through their doors.

“The Program’s authorizing statute does not affirmatively address immigration status,” said Andrews. “Rather, it simply states that health centers are required to provide primary health care to all residents of the health center's service area without regard for ability to pay.”

You are probably thinking, this isn't what we were told when Obamacrap was signed in to law.

You would be correct.

“The reforms I'm proposing would not apply to those who are here illegally,” Obama said then.

Of course that was then, this is now.

I suppose the part that does not apply to illegal immigrants is the requirement to buy health insurance.

But why buy health insurance when you can get treated for free?

Keeping Abreast of Cancer: Double-Standard edition

When we hear that someone has been diagnosed with breast cancer, our immediate reaction is most likely to be "oh, poor Sally, hope they caught it early."

But what if it wasn't "Sally," what if it was "Steve?"

Our first reaction in that case would probably be "hunh?!"

Sad to say, every year about 2,000 men are diagnosed with the dread disease, accounting for about 1% of all cases. But it is breast cancer, regardless of the sex of the victim.

Well, make that should be "regardless of the victim's sex."

Because, thanks to a tip from FoIB Patrick P, we learn that Raymond Johnson, a 26 year old with no health coverage, just found out two horrible things:

First, that he has breast cancer.

And second, that even though there's a special Medicaid program for breast cancer victims, he's not eligible. That's right, the obscenely mis-named "Breast and Cervical Cancer Prevention and Treatment Act" is available only to those without the Y chromosome.

And it gets worse:

New rules promulgated by HHS Secretary Shecantbeserious require regular health plans to cover:

■ Well-woman visits
Screening for gestational diabetes for all pregnant women
Human papillomavirus DNA testing for all women 30 years and older
Annual sexually transmitted infection counseling for all sexually active women
Annual counseling and screening for HIV for all sexually active women
FDA-approved contraception methods, sterilization procedures and contraceptive counseling
Breastfeeding support, supplies, and counseling, including costs for renting breastfeeding equipment
Domestic violence screening and counseling

But guess what?

There are no corresponding benefits for men. What about condom coverage? Or domestic violence screening for the estimated 835,000 male victims of domestic violence each year?

How come HIV screenings for men aren't covered?

Fair's fair.

Wednesday, August 10, 2011

Here's a Puzzler

You wake up one day with a growth in your nostril, big enough to interfere with your breathing and hinder your sense of smell. Most folks might not be too upset at the latter, but what if your job requires you to discern between varieties of wine?

So, you schedule an appointment with the local surgeon to have it removed. It's medically necessary (since it impedes breathing), so it's most likely covered by your medical plan, but you have a high deductible, HSA-style policy; you're responsible for the first $2,500, and the procedure, after in-network re-pricing, comes to only $1,200.

You understand that it's also a tax-deductible medical expense, but only if you itemize and it's part of a bunch of medical expenses that hit that magic 7.5% of Adjusted Gross Income.

Now here's the puzzler:

“Can I write this off as a business expense? After all, I need my nose for my job.”

This is pretty important: since you're generally pretty healthy, it's unlikely that you'll hit that 7.5% of AGI's worth of medical expenses.

The Fox News story on which this post is based offers several possible outcomes, but I've just added a twist that makes it a lot simpler.

See if you can spot it, and let's discuss in the comments...

Cavalcade of Risk #137: Headline Grabbers edition

Jason Shafrin presents this week's terrific collection of risk-related blogetry. Do stop by.

HOSTING BLEG: We're currently scheduling for Fall Cavs. Just drop us a line to claim yours.

Tuesday, August 09, 2011

CLASS Warfare

FoIB Avik Roy has some profound thoughts on the mis-named CLASS Act, and especially on a recent article in Foreign Affairs magazine by former Obamastration official Peter Orzag. In the FA piece, Mr Orzag acknowledges what we said some time ago, namely that:

"There is a serious risk that healthy people may be reluctant to join the program, whereas those who most need long-term care will be eager to do so, jeopardizing the idea of a broad and stable risk pool."

No kidding?

Avik then quotes, verbatim, Mr Orzag's proposed "solution:"

"[T]o make the purchase of such insurance mandatory or to require employers to provide it by default unless employees opt out."

Hmmm....a mandatory health insurance program. What a novel idea!

In response, Mr Orzag took Avik to task for...wait for it...quoting him verbatim:

"You (and Sen. Thune, for that matter) mischaracterize and misunderstand the sentences cited from my Foreign Affairs article. It was not that we should mandate CLASS. "

Seriously? You're going with that? Because that's precisely what you said, Mr Orzag. It's one thing to "walk back" what you said, but to deny it altogether?

I'm actually a bit disappointed that Avik let that go; frankly, Mr Orzag should be embarrassed by his own amateur attempt at spin.

What's worse, of course, is Mr Orzag's - and, by extension, this regime's - understanding of even basic insurance principles. Long Term Care insurance is a complicated product, but it's not rocket surgery. Folks like Mr O appear to be totally clueless as to how these risk management tools work, and for whom they're designed.

Let's start with some basics:

The LTCi market is, by definition, narrow and focused. That is, neither the very wealthy nor the poor need it. One of the most fundamental rules of the insurance business is that first there must be a need for the coverage.There's a specific, well-defined middle-class swath that most benefits from LTCi, and that's further diminished by the fact that it's not inexpensive coverage.

Perhaps the most important benefit of modern LTCi products is Partnership Compliance, which encourages folks to buy policies in order to stave off the Medicaid folks. But CLASS Act plans are not Partnership compliant, making them even less attractive and less valuable.

On the other hand, one must admire the chutzpah of Mr Orzag to suggest that purchasing these plans must be mandatory, with an optional opt-out mechanism. One can easily imagine the nature of that mechanism, by the way: how soon until we see HHS Secretary Shecantbeserious selling handing out CLASSWaivers©?

Mr Orzag and his ilk may protest all they wish, but it is past disingenuous to claim that he's not calling for a CLASS Act mandate.

Several years ago, my eldest misplaced her keys. She became increasingly frustrated as we tried to help her noodle out where she might have left them, until, finally, she bellowed "they're not lost - I just can't find them!"

Where are your keys, Mr Orzag?

Stupid Insurance Company Death Claim Tricks

Perhaps the most important part of my job is delivering death claims. This is never a "fun" experience, but it's very rewarding to hand a grieving widow or widower, or son or daughter, or business partner a check that will help ensure that the kids get to college, or the house is paid off, or the business will go on.

Although I almost always prefer to handle these personally, sometimes that's just not possible, and I'll let the carrier handle it for me. I expect my companies to handle the claim in a professional but kind manner, and to treat the beneficiary with the respect and dignity that he or she deserves.

And then there's these bozo's:


[Hat Tip: Someecards]

Grand Rounds: Music Lovers edition

Dr Deb takes the term 'Rounds" pretty seriously - and it shows in the great job she does with this week's collection of great medblog posts.

Monday, August 08, 2011

Obamacare Sinks Ships

Five more health insurance companies become casualties in the Obamacare war on consumers. Aetna, Cigna, Guardian, American Community and Pekin will all leave the individual major medical market in the next few months. Together, these 5 insurance companies cover about 10% of those with individual health insurance in the state of Indiana.

Obamacare sinking

As reported by the IBJ . . .

Their major complaint is about the new health law’s requirement that at least 80 percent of premiums be spent on medical bills. That new rule, known formally as a medical loss ratio or MLR, takes effect this year for all individual policies the insurers hold, not just new policies.

The insurers argue that the marketing and administrative expenses on individual policies are so high that they cannot transition so quickly to the new standard.

Even if they could make the change, policyholder services are already suffering due to downsized customer service departments. This means longer hold times and a greater chance of getting voice mail in lieu of a real person.

Many carriers have already shifted their customer service overseas to places like India and Pakistan where wages are lower.

Imposing loss ratio's on company's operating in a competitive market is stupid to say the least. If a carrier spends too much on themselves and it leads to an increase in premium rates they will lose market share.

The idiot's in DC look at pockets where market saturation is dominated by one or more carriers and claim this is proof positive that more regulation is needed. According to the report, Anthem Blue Cross has a 65% market share which politicians use to defend their position.

I look at the same thing and say they must be doing something right, delivering good value, or else their market share would be significantly less.

Golden Rule health insurance is number 2 in Indiana with 10% of the market.

If Blue Cross has 6.5x the market share of Golden Rule one must conclude that Blue delivers a better value than Golden Rule. Their pricing has nothing to do with how much, or how little, either carrier spends internally on administration.

So far Georgia is pretty much immune to the wholesale withdrawal by health insurance companies but our time is coming. I would not be surprised to see Aetna or Cigna pull out of Georgia before the end of the year.

MVNHS©: That does not compute!

Last time we looked at Electronic Medical Records (EMR), we noted that early-adopter Google had finally thrown in the towel. Now, that still left more than a few players in that market, but it (again) raised the question as to the viability, let alone the effectiveness, of this phenomenon.

Well, we need wait no longer:

"A plan to create the world's largest single civilian computer system linking all parts of the National Health Service is to be abandoned by the Government after running up billions of pounds in bills."


The premise behind this effort was a centralized data repository, administered (for lack of a better term) by the Much Vaunted National Health Service© itself. As is typical of nationalized health care "systems," of course, the whole effort cost, well, tonnes of pounds, with precious little (to be charitable about it) to show for it:

"The department has been unable to demonstrate what benefits have been delivered from the £2.7bn spent on the project so far," Margaret Hodge, chair of the PAC, said." [ed: PAC is The Commons Public Accounts Committee, which seems to be analogous to our own CBO]

So we have a bloated, inefficient bureaucracy which spends wads of taxpayer cash on a gargantuan and ill-conceived system, which is finally scrapped when it becomes blindingly obvious that it's an epic waste of resources.

Sound familiar?

Friday, August 05, 2011

More Swedish Meatball Medicine

Again and again we've documented the utter failure of the alternative medical schemes on which ObamaCare© has been modeled. Less than two months ago, we reported on how Swedish "medical authorities" dealt with a critically injured young girl:

"After sustaining an open chest wound of 10cm long while trimming her horse’s mane, Sweden’s emergency response services refused to send an ambulance, suggesting the 11-year-old girl take aspirin instead."

As if to prove their incompetence - or is it just lack of compassion? - these same "authorities" risk the life of a senior citizen:

"Rather than send an ambulance to respond to a call from an injured woman in Borlänge in central Sweden, emergency services operator SOS Alarm elected to call on an elderly couple living nearby to check on her instead."

In fact, the couple thus called upon couldn't even find the injured woman's apartment, wasting precious time.

But remember: nationalized medicine is so much more efficient, and compassionate, than our "broken" system.

We'll have a gay old time (Revisited)...

So this week's National Underwriter/Life & Health edition hits my desk, and the cover catches my attention:

"Born This Way: Could same-sex couples be the next big market opportunity?"

Okay, I'll bite (metaphorically speaking, of course).

Truth is, I've never really cared one way or the other about my clients' sexual orientation. On the few occasions that it's been brought up, it's always been the clients who do so. Off the top of my head, I can name just 2 cases where this information was discussed, and in neither case was it particularly relevant.

Still, the marketing possibilities are intriguing: if one takes the generally-accepted percentage of gay Americans as about 3%, well, that's a lot of potential clients. And with gay marriage a hot-button issue, and now legal in several states, that number seems to be growing.

In many regards, one supposes that gay couples (married or otherwise) face pretty much the same financial issues that their straight counterparts must address: life insurance and estate planning, retirement plans and health insurance. I've noticed for a while, for example, that most of the health insurance quote engines no longer automatically assume an "F" for the secondary when the primary is an "M." Of course, one presumes that two guys won't really worry too much about maternity coverage.

But where it gets really interesting is when we take a look at life insurance.

There are typically two ways that heterosexual couples buy life insurance: either two separate policies (with the other spouse as the beneficiary), or one policy with a primary and secondary insured. In the first case, John and Mary each buy a life insurance policy; John names Mary as his beneficiary, and Mary names John as hers. The second way would be for John to buy a life insurance policy, and then add Mary as a rider (of course, it could be the other way around, as well). The second way is typically less expensive (at least early on), but has some disadvantages (but that's another post). The point is, both methods are tried and true.

But let's suppose that instead of John and Mary, we're talking about Bruce and Tim. Traditionally, the only way that they could go the first route - naming each other as beneficiaries of separate policies - would have been as a business-related buy-sell agreement. There would have been no way for them to access the second method.

Now, though, with the onset of legalized gay marriage, the rules have changed, and it's not just in states which recognize them. I spoke with the underwriter at my primary life company, and asked how this would play out now in this Brave New World. Turns out, both the times and the opportunities have changed.

The key principle here is "insurable interest;" that is, whether or not one person would be financially harmed by the death of the other [ed: yes, this is an oversimplification, but it'll do]. Let's assume that Bruce and Tim live in a state that does not recognize same-sex marriage. Could they name each other as beneficiaries of their (separate) life insurance policies? Turns out, they probably can: the key is that insurable interest. If they can honestly claim to be life partners, or have bought a property together (for example), then the carrier is most likely going to issue those policies (assuming they pass underwriting).

In states that do recognize same-sex marriage, the second method becomes relevant, as well. My primary carrier no longer offers spouse riders at all, so I turned for help to the insurance department of a state which recognizes same-sex marriage. On condition of anonymity (really!), my source confirmed what I had already suspected: that state's law recognizes "marriage," period, and so a company which offered spousal riders to hetero-sexual married couples would have to extend the same courtesy to same-sex married couples.

Bob brought up another interesting point as regards this issue: the increased likelihood of running into an HIV-positive applicant. I'm side-stepping that issue for now, because it's really an underwriting question, not an insurable interest one.

Something else that the article failed to mention was long term care insurance: very often, these plans are written on married couples. Would a a healthy same-sex couple in, say, their 50's be declined? It would seem to be less and less likely, especially in same-sex marriage states.

So, is there really a great new untapped market out there? It seems logical that there is. Now, how to tap into that market is a whole 'nother question.