Thursday, August 16, 2018

Making Strides Against Breast Cancer: v2018

Once again, I'm raising money with my team: Love, Hope and Faith. Our walk is Saturday, October 20th, and I'd really like to break the $500 mark.

Will you please help out by making a donation - Thank You!!

Thank you!

We've got questions

Some may recall the tragic story of a star-crossed love affair that ended tragically on the Hudson River on a Spring afternoon in 2015:

"[Angelika Graswald] pulled the drain plug on Viafore’s kayak while they were paddling on the Hudson River in 2015 and watched him drown."

This seems to have been as cold-blooded a murder as I've ever read of, and compounded by the fact that she and the victim, Vincent Viafore, were actually engaged to be married. He had apparently named her as one of the beneficiaries of his almost half a million dollar life insurance policy.

Okay, we know that criminals aren't allowed to profit from their crimes: arsonists don't get their houses paid off, murderers don't collect on their victim's life insur....

Wait, what's this?

"A woman dubbed the “kayak killer” -- who drowned her fiancé by pulling the plug on the couple's small boat -- was awarded a portion of his $491,000 life insurance payout Monday."

How could this be? I get that the arrangement included her dropping her appeal, and the victim's family dropping their wrongful death lawsuit, but I didn't understand how this deal worked until I got to almost the end of the article:

"The criminal plea did not disqualify our client from taking these funds. They still had to prove that she recklessly or intentionally committed this murder."

Okay, but how would that work? I'm not aware of any law that says "well, if you commit just plain vanilla murder you get the cash, but if it's reckless or intentional you get zip." This seems ... illogical.

So I reached out to FoIB Brian D (a carrier rep of outstanding repute) for insight, and he offered this explanation:

When carriers have a disputed claim (such as a murder or other suspicious circumstance), they will pay it out to the state to be held in escrow until the matter is resolved. Looks like this is what happened with the Kayak Killer case here.

Thanks, Brian!

Wednesday, August 15, 2018

Another CanuckCare© success story

For certain values of "success," of course.

Friend of mine (Canadian ex-pat) just posted this on Twitter*:


"My cousin just called. She was diagnosed with thyroid cancer in March, was put on the urgent list for surgery. It’s mid-August. “Oh well I just have to wait”, she says. Every day untreated means progression of disease. #CanadaWaits #socializedmedicinekills"

Then:

"It’s “a good cancer to have”, in that typically they can just cut out the affected organ. But who knows if, in the ensuing time, it’s affection other systems?"

"I am so angry that people are treated like this. Six months almost with no surgery date. In a first-world, technologically advanced country."

From another friend in response:

"I’ve had arguments online w/Canadians about how this kind of thing doesn’t happen & I’m a stupid American & don’t know what I’m talking about. A friend of a friend came to the US for hernia surgery because he was in excruciating pain & the wait was 1.5 years."

And finally, from my ex-pat pal:

"My father’s first oncologist appointment was scheduled for after he died."

But hey: Free.

(*Anonymized to protect her identity)

A Triggering Scenario

Back in July, I posted my skepticism of a claim by Life Settlement industry players that insurers were (surreptitiously?) raising the cost of insurance in viaticated policies:

"Some life settlement companies have responded to universal life cost-of-insurance increases by suing the life insurers  that issued the policies"

Of course, they're free to pursue their own interests, but I suspect that they'll have quite the uphill battle.

Why's that, Henry?

Well, as I noted in that previous post, there's no mechanism for singling out specific policies for increases. For another, policies themselves have specific, stringent definitions on how, why and when these internal costs may be raised. I took the liberty of screencapping the relevant verbiage from one such policy I recently wrote (and which I believe to be fairly typical):


 [click to embiggen]

As one can plainly see, the cost of insurance (COI) is pretty well locked down, and applies to only a few specifically-worded populations, none of which are "life settlement brokers."

The other interesting thing to note is that the other internal costs are left more freely to the carrier's discretion, so it's possible that policyholders could experience those, regardless of the company's mortality experience. But again, there's no singling out of the life settlement folks.

Based on this, I don't see how they'll prevail.

But then, I'm not a lawyer, and I didn't stay in a ...

Tuesday, August 14, 2018

Medicare Open Enrollment

Medicare Open Enrollment. Not to be confused with Obamacare Open Enrollment.

Time to review you Medicare Advantage or Medicare drug plan.

Medicare supplement plans do NOT have annual enrollment periods in most states.


Medicare open enrollment begins October 15 and ends at midnight December 7.

Medicare Open Enrollment Pre-Planning


Before enrolling in Medicare at age 65 for the first time, or planning your next move during Medicare open enrollment, there are things you need to do first.


  • Make a list of all doctors including name, address, phone
  • List all area hospitals, especially the ones you have used
  • Make a list of all medications including dosage, refills, prescribing doctor and pharmacy
  • Be aware of the donut hole and look for ways to avoid that trap
  • Make use of generics and off plan purchases
  • Look for FDA approved generics and ask your doctor before making a change
  • If renewing, get your drug list ID and password date from your last drug plan finder
  • If renewing, study your ANOC for changes
  • Use Medicare.gov for reviewing Advantage and drug plan options
  • Avoid using Medicare.gov for drug plan comparisons prior to October 25
  • Medicare.gov and your state DOI site are essentially useless when comparing Medicare supplement options
  • Most Medigap quote engines only list a handful of options and rarely have plans with the best value
  • Many quoting sites will sell your information to numerous agents; some don't provide instant quotes


Never put anything on auto-renew unless you like unpleasant surprises.

You have questions. We have answers.

#MedicareOpenEnrollment




Monday, August 13, 2018

Promising Cancer Treatment Breakthrough

In a promising development, a new kind of weapon in the fight against cancer is about to be deployed:

"His oncologists delight in observing that if you saw Rulli on the street, you’d never guess he was sick. At 66, he still is 6-foot-1, still 215 pounds thanks partly to golf-course beer, still an easygoing husband and father of two children, now rejoicing in granddaughters"

In 2013, Bob Rulli was diagnosed with a glioblastoma, a rare but extremely nasty brain tumor. I know, because I lost my baby sister to one a few months ago. These are almost always a death sentence, and difficult to treat; the average life expectancy is about a year and a half.

Now, thanks to some true medical adventurers, there appears to be a real reason for hope, and so far it also appears to have few (if any) side effects):

"On that day in September 2016, for the first treatment, Rulli spent the day at UC with Wise-Draper and Morris keeping vigil for bad reactions. He had none. He felt fine."

Over the next year and a half, Mr Rulli continued to receive the medicine, called BXQ-350, in ever increasing dosages. Repeated MRI's showed that the tumor continued to shrink.

And then there was a glitch...

This is such a great story, I really recommend it. There's no rosy glasses here: there are definitely hurdles left. But so, so promising.

[Hat Tip: FoIB Holly R]

Oh, SNAP! (vs Medicaid)

So, FoIB Michael Bertaut offers 1,000 words on how Medicaid really reimburses providers, and its implication viz both Medicare and commercial health insurance:


[click chart to embiggen]

Money quote:

Friday, August 10, 2018

That was then, and this is now...

On the one hand (nine years ago):


On the other (6 years ago):



On the Gripping Hand (a few days ago, as tipped to us by FoIB Holly R):


Okay, wait a minute, "analysis" is very different from "results." What gives?

Ah:

"Confounding is a classic problem of selection bias ... But that’s hard to do with a wellness program."

And thus, when accounting for the actual variables being  measured, there "seemed to be no causal effects."

Which is, of course, disappointing to those with an axe to grind, but I'd also point out that there didn't seem to be any evidence, or even any suggestion, that engaging in wellness activities was harmful.

So we've got that going for us, which is nice.

Thursday, August 09, 2018

EBA whiffs it - Again

So the rocket surgeons at EBA (which, ironically, touts "benefits" in its very title) continue to double-down on the stupid:

"Here’s one option advisors can help them explore: health savings accounts. These accounts, which are offered in combination with high-deductible health insurance plans"

First of all, they keep conflating "High Deductible Health Plan" with "HSA-compliant" plan, thereby confusing laypeople (and irritating us pro's). As we pointed out on Monday:

"[U]ntil the age of ObamaCare, HDHP's meant HSA-compliant true Catastrophic coverage, no bells or whistles, just policies that paid for the truly disastrous claims (think cancer or brain surgery, for example)."

And second, they seem oblivious to the fact that HSA contributions are down for a very good reason: with premiums and out-of-pockets continuing to soar, who the heck has extra cash laying around to put in the account?

They even offer proof of this in their article:
[click chart to embiggen]

So, a 1,000 words in self-rebuttal.

Nice job, guys.

CanuckCare© Takes a Shot

So it seems that Britain's Much Vaunted National Health Service© has some competition in the race to the bottom. From our friend The Political Hat:

"Canadian Hospital Pushes Euthanasia on Disabled Patient"

As we've oft-noted, killing off pesky, expensive patients is a sure-fire way to rein in out-of-control health care costs.

(And by the way: have we noticed yet that even nationalized schemes have been unable to keep health care costs in line? Just wondering)

And it seems to be becoming a pretty routine, if final, "solution:"

"Foley tells the man that he’s “always thinking I want to end my life” because of the way he’s being treated at the hospital and because his requests for self-directed care have been denied."

This is far form Dr K's assisted suicide apparatus: no matter what one thinks of that process, at least it was (ostensibly) voluntary. This is full-blown actively pushing for the patient to pull his own plug not for his own betterment, but for the savings to the health "care" system.

Which begs the question: what, they ran out of ice floes?

Wednesday, August 08, 2018

When health care is a "right"

We've long maintained that this notion of health care being a 'right' is fraught with peril:

"The noble-sounding idea that "health care is a right" doesn't even pass the smell test: health care must be delivered by a provider, so if it's a "right" then that person is being forced to provide that care whether or not he or she is remunerated for doing so."

But it goes even further: if health care is a 'right' then, by extension, the government can force health care professionals to provide their service regardless.

Think that's far-fetched?

Well, our Neighbors to the North© are about to put that into practice in real-time:

"Vowing to maintain public dental services in the province, Quebec’s health minister said Thursday he would sign a ministerial decree to block dentists from withdrawing from the public health system amid a bitter standoff over contract negotiations."

Now, I have no idea how much force of law the gentleman can bring to bear on this, or whether he has the ability to actually force these dentists to provide care, but the fact that he believes that he does is chilling, no?

Next up: pediatricians.

Hat Tip to Physics Geek, who notes "Hey, so Canada is kind of cool with forced servitude. Kind of thought slavery was illegal, but whatever."

Yup.

On BernieCare

Medicare For All (M4A) has been front and center in health care news this past couple of weeks.

Charles Blahous of Mercatus Center performed a study showing that the cost to move to this program would be $32 Trillion over 10 years. In his analysis he used some very favorable assumptions that the law would hit all of its targets - including dramatically reducing payments to health providers, reducing drug prices, and lowering administrative costs.

Senator Sanders countered with a Tweet claiming that the study shows that our country will save $2 Trillion dollars in moving to M4A. He thanks the Koch brothers and Mercatus for "proving" that his plan will work.

So where does the savings and funds to pay for the government program of Bernie's? If you read the media reports it will come from higher taxes, elimination of the insurance industry, and pay cuts to doctors who will accept 40% less at Medicare reimbursement.

On top of the likelihood that M4A will have to double tax rates what is most telling is the last point. For M4A to "show savings" the entire medical world will have to see their average reimbursement cut by 40%. Who all is in the medical world? Well, lets start with a few of those who would see their incomes whacked or in many cases see their jobs eliminated:

Nurses
Nurse Practitioners
Pediatricians
Hospitals
Billing Specialists
Insurance Agents
Speech Pathologists
Insurance Customer Service Representatives
Medical Device Manufacturers
Insurance Underwriters
Surgeons
Occupational Health and Safety Specialists
Therapists
Dental Hygentists
Physician's Assistants
Pharmacy Technicians
Lab Technicians
Home Health Aides
Certified Nursing Assistants
Medical Transcriptionists
Medical Records Technicians
Research Associates
Pharmaceutical Research Investigators
Optometrists

Maybe Senator Sanders should send out another tweet thanking all of these fine people who work hard to save lives and provide us with care needed to remain healthy. Because if his plan ever comes to fruition they will be the one's paying for it.

Tuesday, August 07, 2018

What to make of *this*?

Hmmm. On the one hand, monetizing my health habits (or lack thereof) is appealing.

OTOH: This smells so much of Big Brother.

On the Gripping Hand: not sure how'd I'd be harmed even if the data were hacked.

What say you, dear readers?

(And would love to hear your thoughts on this in the comments)

Medicare Doesn't Cover Everything

Medicare doesn't cover everything. Here is a partial list of what is not paid by Medicare.

Routine dental care, dentures, crowns, bridges, routine eye exams, eyeglasses, contacts, cosmetic surgery unrelated to illness or injury, OTC vitamins and supplements, hearing exams, hearing aids, long term care, medical treatment outside the country.


Most of these items were not covered by your employer group health plan either. Things like vision, dental and hearing were covered by insurance plans OTHER THAN your major medical. You probably had a separate plan for dental and another for vision care.

Different policy.

Different insurance carrier.

Should You Buy Extra Insurance?


In many cases you can purchase separate insurance coverage for the following.

- dental care
- vision coverage
- hearing exams and hearing aids
- international travel medical
- hospital indemnity
- cancer plans
- critical illness

The list goes on.

But before spending good money on these kinds of insurance, ask yourself if you really need it?

I make an exception for International Travel Medical. That is something you should definitely consider when traveling outside the country. But for the rest of the list . . .

Do you need to spend $40 - $60 per month for a dental plan that limits your annual benefit to $1,000?

Do you need to pay monthly premiums of $50 per month for a plan that pays $600 per day for inpatient care only?

Most people would be better off stuffing that money in a mattress than paying for additional insurance that may never pay off.

Monday, August 06, 2018

They keep using that word....

Tweet from EBA Magazine about Congress' current effort to expand HSA's:
Thing is, folks in the "benefits press" (for lack of a better term) keep referring to ACA-compliant "High Deductible Health Plans" as if this has any actual meaning.

Okay, Henry, what the heck are you going on about?

Well, until the age of ObamaCare, HDHP's meant HSA-compliant true Catastrophic coverage, no bells or whistles, just policies that paid for the truly disastrous claims (think cancer or brain surgery, for example). Not low cost maintenance meds, flu shots or simple primary care. In other words, what insurance should be.

Now comes O'Care, with $6,000+ deductibles and $14,000+ out-of-pockets, but with a panoply of first dollar preventive care "benefits" (well, mostly just for women), and premiums that look like mortgage payments on a mansion.

These are not what we should be calling "HDHP's," confusing non-industry folks who just want to be able to afford their premiums (and to use their plan).

Sheesh.

Friday, August 03, 2018

A most cromulent question

From FoIB @dabz:

Well?

O frabjous day!

Well, it's that time of year again, when agents must decide whether or not to participate in ObamaCare Open Enrollment (this year: v6.0). For most folks, this year's festivities run from November 1 through December 15 for a January 1, 2019 effective date.

I say "most folks" because DC and Golden State citizens have their own, quirky schedules:

"California has enacted legislation that permanently establishes different enrollment dates within the state, both on and off-exchange. From now on, open enrollment in California will begin on October 15, and end on January 15. So for 2019 coverage, California residents will be able to enroll starting on October 15, 2018, and will have until January 15, 2019 to enroll."

Californians who sign up after December 15 will have February '19 effective dates.

"[O]open enrollment in DC will begin November 1, 2018, and will continue until January 31, 2019. DC residents who enroll between December 16 and January 15 will have coverage effective February 1, while those who enroll in the second half of January will have coverage effective March 1."

Everyone got that?

Good!

Adding a little fuel to the fire is the fact that folks in DC will get their own insurance mandate:

"[T]he District of Columbia City Council approved a requirement for all DC residents to purchase health insurance ... The D.C. mandate contains three elements that make it just as bad as, if not worse than, the federal mandate it is intended to replace."

Sweet!

(Click on through for the details)

As for my part? Well, regular readers know that I've long since bailed from actively engaging in the Open Enrollment circus process, but that I continue to do the online training necessary should I change my mind (or, as in recent years, be available to help folks out from the sidelines). This week, I got email from CMS announcing that:

"Marketplace agent and broker registration and training for plan year 2019 is now live!"

I can choose the free (no Continuing Education credit) version from CMS itself, or pay for the training (which includes CE for most folks) from their preferred vendor, AHIP.

Not an AHIP fan, and don't need the CE. So: hard pass.

Thursday, August 02, 2018

Obamacare Rear View Mirror

Way back in 2013 #JohnHawkins had this to say about Obamacare. No one has a crystal ball but he got some things right, and some not so right.

What he got right.

If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.”
 Well, that promise turned out not to be true and I can tell you that from personal experience. - https://townhall.com/columnists/johnhawkins/2013/10/29/i-lost-my-health-insurance-because-of-obamacare-n1732782
Mr. Hawkins was notified he would be losing coverage well before the clock struck midnight ending 2013.

It's difficult to blame my insurance company for that (cancelling his coverage). After all, it's hard for a service to be viable when the government forces consumers who buy it to pay a massive new tax for the privilege

Yup.

Currently, I pay $191 per month. That will go up to $274. That's nearly $1000 a year more for a service that I already have. In addition, the deductible on my current plan is $200 and that will be going up to $6000.

And that's just for 2014. Wonder what he is paying now?

What he got wrong.

Originally, my health insurance provider told me that my plan wasn't going to be canceled. The agent just said it wouldn't qualify under Obamacare and so, I'd have to pay a tax to keep it.

Grandfathered plans exempted.

Technically his agent was wrong. Can't put all the blame on John.

When you hear about people who are going to be paying an extra $6000 a year out of $47,000 in income 

Those folks SHOULD have qualified for a subsidy. A rob-from-the-rich-give-to-the-poor taxpayer funded subsidy. Depending on many factors, their premium could have been $0.

What a country!

The law couldn't pass today and had Obama told the truth instead of lying shamelessly, even Democrats would have never voted for this law in the first place

Half right. Half wrong.

The law would not pass in 2018. But I do believe the left wing party would still vote for it if given a chance.

Pretty damn scary.


Wednesday, August 01, 2018

Finally, some *good* ACA news

Our Betters in DC© have released their final regs on Short Term Medical plans.

On the only piece that truly matters, they fall short (again):

"Such coverage can now cover an initial period of less than 12 months, and, taking into account any extensions, a maximum duration of no longer than 36 months in total"

The good news is that they've lifted the 3 month max, the bad is that they've left a potentially huge gap in that 365th day.

Still, one should avoid letting the perfect be the enemy of the good, and this is at least a step in the right direction.

As to why they've made this change, well, let's just say that ObamaPlan signups have been ... disappointing:

"[T]he number of people enrolled in the individual market without subsidies declined by an alarming 20 percent nationally in 2017 ... Many state markets experienced far more dramatic declines, with unsubsidized enrollment dropping by more than 40 percent in six states"

Ooops.

Now, it's important to remember that coverage ≠ care, and these plans have their own limitations, including exclusion of pre-existing conditions. But they are generally much more affordable, and offer much lower out-of-pocket options, than ACA-compliant policies.

Will be interesting to see how this plays out, and what impact it has on Open Enrollment v6.

[Hat Tip: HAFA]

Tuesday, July 31, 2018

Good News from UHC

United Healthcare is expanding its Cancer Support Program for many if its insureds:

"The Cancer Support Program helps save clients money associated with treatment costs, while improving health outcomes and providing support to members facing cancer."

More info available here.


And there are new preventive screening benefits, too, with zero out-of-pocket (well, other than premiums) for maternity health, hepatitis B, skin cancer prevention and others.

Interesting news from HHS

Via email this morning:

"[On Friday], July 27, the Centers for Medicare & Medicaid Services (CMS) [began] implementing a new policy that allows consumers to request same day Marketplace coverage termination (i.e., the termination takes effect on the date of their request) instead of the previous requirement to give 14 days prior notice."

This is actually very helpful, since sometime folk can't know two weeks out whether or not their coverage really will take effect.

For example, you start a new job, and your coverage is set to take effect on August 1. Previously, a Marketplace insured would have had to have cancelled their ObamaPlan mid-July. But what if something came up - such as being fired or quitting - and one needed that Marketplace plan, after all?

And on the other side of this coin:

 "Consumers can also set their Marketplace coverage end date to a day in the future."

Sort of post-dating a cancellation. As  noted above, I'd be less inclined to advise this course of action.

These new rules are definitely more consumer-friendly, and a welcome change.

Monday, July 30, 2018

Details, shmetails

Oh:

But hey, "free" healthcare!

What to make of this?

I've wondered for a while now about how the life insurance industry is going to handle the inevitable case of a transgendered male requesting (lower) female rates.

Or transgendered females asking for (lower) male disability income insurance rates.

(And my apologies if I have the nomenclature backwards)

As I discussed with a life field rep friend a while back, the life company is likely to decline the case altogether because of the increased suicide risk. Assuming, of course, that the situation is disclosed. If not, well, the misstatement of age/sex clause in life policies would come into play, no?

As they say, a can of worms.

Which a Canadian national just opened, bigly:

"Alberta man changes gender on government IDs for cheaper car insurance ... I just basically asked for it and told them that I identify as a woman, or I'd like to identify as a woman, and he wrote me the letter I wanted."

Now, the gentleman doesn't actually identify as a woman (NTTAWWT), he's simply playing the game by the rules the government has laid out. By claiming to so identify, he got his birth certificate and driver's license changed, and was able to save almost $100 a month on his car insurance.

Sweet.

[Hat Tip: FoIB Brian D]

Friday, July 27, 2018

Coverage ≠ Care: MVNHS© Anecdata

One of our most oft-repeated mantras here at IB is that health insurance is not health care. Now, that may seem self-evident, but far too many people conflate the two.

Well, the Much Vaunted National Health Service© provides today's lesson:



That is, the Brits may have free health insurance, but rotsa ruck obtaining care.

Good Intentions, Awful Execution

So to all the alphabet soup that is modern American heath care, we can add QSEHRA (Qualified Small Employer Health Reimbursement Arrangement):

"This new legislation specifically "enable[s] small employers with fewer than 50 full-time employees to fund qualified stand-alone HRAs. Employees may use the HRA to pay for qualified out-of-pocket medical expenses, including individual polices purchased through the public exchanges."

So far, so good: I've long been a big fan of the "defined contribution" model. That is, instead of a "one size fits all" small group health insurance plan, employees are given a budget to pay for a plan of their own choosing (or forgo a plan altogether). Call it a "health insurance gift card" that's good both on- and off-Exchange.

What's not to love, right?

So, I reached out to our gurus of all things Alphabet Soup (HSA, HRA, etc) for their take.

Turns out, they've been offering to help set these up for a while now, going so far as to sponsor Continuing Education classes for agents to help sell the concept to their small group clients. The response from agents was tremendous: a great deal of enthusiasm both for the free CE and the plans themselves. Which is fine, but far from the most important metric: what about their clients?

Their reaction, once learning about the caveats and limitations, has been a resounding /crickets.

But why is that? After all, it only takes a pretty simple (and inexpensive) set of documents to be up and running, and then each employee can go choose whatever plan best suits him or her (or, again, none at all).

Aye, there's the rub: yes, the setting one up part is pretty low-cost and straightforward, but the devil truly is in the details. For one thing, there are all kinds of non-discrimination rules (for example, one can't give managers more than those they manage), and you can't have any group-type plan at all (like dental or vision) in place. Even though these are what we call "non-medical," if they're group you're outta luck. And there are other speedbumps, as well. From our gurus:


"When we receive calls inquiring about the QSEHRA plans, we explain to the employer that it is like peeling back the layers of an onion to determine if they meet the requirements to offer the QSEHRA.  Below are the peels that we go through that usually become the challenges:
• They are a subsidiary of another company.

• Corporation Type:  Sole proprietors, partners within a partnership, owners of an LLC (filing as a S or partnership), owners of an LLP and more than 2% owners of an S Corporation are prohibited from participating in the plan and the rules of attribution apply to more than 2% S Owners, thus owner’s spouses, parents, children and grandparents cannot participate. – In the majority of the calls the corporation type is what puts a “STOP” in the peeling process.

• They offer some type of other group plan including dental and/or vision.  Even if it is voluntary it disqualifies them from being eligible to offer the QSEHRA.

• If they are considering offering the QSEHRA to include eligible out-of-pocket medical expenses, they are surprised and often not thrilled that they have to offer it to all employees (even those on spouses plan).

• Impact on the subsidies if an employees is receiving a subsidy of tax credit.  Many employers who contact us have employees with plans that do receive the subsidy of tax credit."
So what happens is that the initial enthusiasm gives way to reality, and thus very few (if, indeed, any) of these actually get implemented. Which is a shame, since the concept holds such promise.

Leave it to the DC Rocket Surgeons to mess up a (potentially) good thing.


Oh! One more thing: it seems that neither DPC fees nor Sharing Ministry "dues" are QSEHRA-eligible since they don't include Minimum Essential Coverage (MEC) requirements (list of acceptable individual plans here). Which is a bummer, since both are otherwise ACA-compliant (just like on- and off-Exchange plans are).

Thursday, July 26, 2018

In a nutshell: Medicare-4-All

Truth bomb:

That's *not* how this works

So this comes across my timeline:

A little over 2 years ago we blogged on a similar suit against TransAmerica Life:

"Universal life insurance policyholders behind a multimillion-dollar class action are asking a Miami federal judge to stop Transamerica Life Insurance Co. from drastically raising their monthly charges."

In brief: Universal Life (UL) policies are made up of two components, the death benefit and the cash value. When one pays a premium, part of that premium goes into the cash value and part pays the Cost of Insurance. That cost of insurance is basically an annual renewable term policy, the cost of which increases each year as one ages. The policy contains language limiting the absolute maximum the carrier may charge, but I've never heard of one actually doing so. Generally, companies charge the "current" rate, which is based primarily on their own mortality experience (how many of their insureds passed away last year). If a company has a bad year, then it can choose to increase the internal cost of insurance.

In no case, however, can a specific policy or policyholder be singled out for such an increase (after all, that person is still on this side of the grass). Which is what the Life Settlement folks want us to believe is happening to them. Now, it's certainly conceivable (although unlikely) that carriers could track which policies have been sold off in this manner, but there is absolutely no mechanism for them to raise the internal rates for those plans, and those plans alone.

I call BS.

Wednesday, July 25, 2018

Let's be Franc about health care costs

Almost two years ago, we reported that Belgium's then-new regs permitting "assisted suicide" for minors was up and, er, running:

"The first child to be killed by “assisted suicide” since Belgium legalized the practice for minors has had his life snuffed out."

[ed: and how is it that minors are able to give consent for this "assistance?"]

But that was then, and this is now, right?

Oh:


Yay for cost containment strategies?

Tuesday, July 24, 2018

Southwest Ohio Heads' Up

From our friends at Cornerstone:

"Ohio Department of Insurance Director Jillian Froment reported Monday about an insurance fraud scam involving individuals posing as representatives of Dayton-based Premier Health Plan"

Premier health has long since opted out of the health insurance market, but apparently not everyone's gotten the word. As a result, folks are forking over hard-earned dollars for, well, nothing:

"Ohioans need to know that Premier Heath Plan is not selling health insurance products in Ohio. The individuals behind the scam want to steal consumers’ bank account information and money, and have no intention of providing health insurance.”

Check out the link for valuable tips on how to avoid becoming another victim.

Hey buddy, can you spare a hip op?

Shot:

Chaser:

"Patients are being allowed to jump growing NHS queues by paying up to £15,000 for a hip replacement."

Now I personally have no problem with this as a matter of practice. After all, Americans with million dollar homes get care at the Mayo Clinic, and those in Section 8 have the free clinic (yes, I am that cynical). The difference is that we don't pretend otherwise. A (nominally) free market-based system such as ours is going to have this result.

But in a government-run system like the Much Vaunted National Health Service©, everyone is supposed to be treated equally. So while it doesn't surprise me that folks who can afford better care get it, it beautifully illustrates the hypocrisy of that system's proponents (and, of course, those who agitate for it here).

Now there was one intriguing item in the linked article, which was quickly elided over, but which I think may hold some promise here:

"Many hospitals offer all-inclusive packages that work out significantly cheaper than charging separate fees for the operating theatre time, the consultant and occupying a hospital bed."

So-called "bundled billing" may well be a pipe dream, but seems to me to be a worthwhile goal.

Monday, July 23, 2018

What's up with West Coast Life?

Readers may recall this story from last summer:

"[T]he application was apparently written in Ohio, but the applicant chose to have the exam done in Texas. I'm thinking that right there's a red flag, but apparently WCL wasn't bothered by it (or perhaps, they became retrospectively concerned). In the event, a person claiming to be the applicant shows up, all 176 pounds of her."

Which would have been fine, except that the actual applicant clocked in at over 200% of that. And of course, come claim time, WCL finally thought it maybe oughta take a look into these ... unusual ... circumstances, and at that point determined that they'd been had.

Well, it turns out that the case actually happened right down the road from us, and thanks to FoIB Holly R, we have new news:


"Mason family who faked life insurance policies, bought Bentley convertible, pleads guilty"

On the one hand: Bentley. Kudos to the Stevenson's for enthusiastically embracing the concept of "go big or go home."

On the other hand: Every few years, I'm required to take an industry-approved anti-money-laundering course (which one of our field reps refers to, unironically, as "a how-to course"). We still don't know who actually wrote this case, although it's certainly not the accused  who, in an ironic twist that defies disbelief, "operated Lego Demolition out of the family’s home."

I bet.

On the gripping hand: how is it that a well-known and financially strong (AM Best rating A+ Superior) carrier can be so easily duped? There is no way that death benefit gets "EZ Issue" underwriting.

Methinks some West Coast Life heads will roll.

Friday, July 20, 2018

Oy, Canada - Part 7,285

Previously on Oy, Canada:

"Patients also experience significant waiting times for various diagnostic technologies."

And that's just to be seen and treated. But what happens next? Often, the provider prescribes a med (or meds) to help treat the issue.

That's the easy part:

That's right: in at least one province CanuckCare© doesn't cover oral cancer treatment.

And if one follows the comments, one is reminded of this dirty little CanuckCare© secret:

"[P]rivate insurance is responsible for oral chemo (different from province to province"

That's right, our Neighbors to the North© recognize the devastating limitations of "free" health care, and have developed (and market) supplements, much like our own government-run health care system (Medicare).

The more you know....

Thursday, July 19, 2018

The MVNHS© very strange fixation on Medical Tourism

Specifically, enforced medical tourism.

For example, just a week or so ago we learned of a teeneager with a heart condition that the Brits' "free" health care was unable to treat, thus forcing his parents to seek help from the much-maligned American health care system:

"'Teen 'not sick enough' for NHS heart transplant has urgent op in US'"

And, of course, the Much Vaunted National Health Service© is (in)famous for its gleeful slaughter of the most vulnerable:

"UK Supreme Court declines appeal from parents of ill toddler"

But sometimes, the bureauweenies lose, and the patient wins:

Turns out, little Baby Oliver was born with a rare heart problem that the "free" British health "care" system was unable to treat. So, of course, the compassionate and warm-hearted government-run service denied care doomed the baby to death. The parents, understandably, demurred, and successfully sought treatment in the United States.

Specifically, the Boston Children's Hospital, which, unlike its counterparts in the UK, boasts a 100% success rate.

Okay, that's not fair, allow me to clarify:

Boston's Children's Hospital, unlike the MVNHS
©, boasts a 100% survival rate.,

Ah, that's better.

Wednesday, July 18, 2018

Check's in the mail

Well, it's that time of year again, when the temps soar, folks head to the beach and the pool, and insurance companies announce when they'll be cutting checks to comply with ObamaCare's Medical Loss Ration (MLR):

"Final Medical Loss Ratio (MLR) rebate reports for UnitedHealthcare customers will be available on the broker portal the week of Sept. 15, and customers will receive their rebate payments in the mail at the end of September."

In case you didn't know, the ACA requires carriers to pay out (at least) 80% of premiums collected in claims. For large groups, that requirement is 85%. Anything less and they have to send the difference to their insureds.

By the way, that MLR check's no bargain for insureds. As co-blogger Patrick pointed out a few years ago:

"MLR was designed to leverage insurance company profits and administrative expenses. Reality is all we have seen from MLR is an increase in profits and expenses."

True then, true now.