Friday, April 20, 2018

The MVNHS© Giveth, and the MVNHS© Taketh Away

A few weeks ago, we reported that the Much Vaunted National Health Service© had granted not-quite-two-years-old Alfie Evans a (temporary) reprieve:

"Alfie Evans’ Life Support Won’t be Switched Off, Delayed After Pope Francis Intervenes on His Behalf"

And it's critical to remember that his parents were willing to foot the entire health care bill themselves (likely with a little help from their friends).

Well, it seems that the poor toddler's time has, in fact, now run out:

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

And so the plug will be pulled, and little Alfie will be gone (but certainly not forgotten by anyone with a heart).

Here's the thing: while reasonable folks could disagree about the utility of further treatment (he's "in a "semi-vegetative state" as the result of a degenerative neurological condition"), and it could further be argued that public health care dollars pounds would be wasted, in this case it's actually cost the MVNHS© more money to fight his being flown elsewhere for treatment at his parents' expense.

But hey: Free health "care."

Case Study: Life plus LTCi

So, working on an interesting case for a long-time client. Doris is in her early 60's, has an existing Universal Life policy but is looking at replacing it with a new plan that would include both life and long term care coverage (please don't ask why she's replacing a perfectly good UL plan; she apparently has her reasons).

After some discussion, we've narrowed things down to 2 (well, technically 3) options. All include $250,000 of life insurance and $5,000/month of long term care benefits:

Option 1: Term life + Stand-alone Long Term Care (LTCi) plan

15 Year term + LTCi = $4,551/year, or
20 Year term + LTCi = $5,189/year

The stand-alone LTCi plan offers 3% inflation protection and is Partnership-compliant; benefits payable for up to 48 months.

Option 2: Hybrid Guaranteed Universal Life/LTCi has a 50 month benefit period, and is built on an indemnity chassis (no receipts or invoices to submit past the initial claim form). On the other hand, it has no inflation protection and is not Partnership-compliant. On the gripping hand, the life insurance pays someone if there's no long term care claim (to her age 120!). The annual premium for this plan is $5,000 (Thanks to commenter Scott O who pointed out this omission - Mea culpa!)

There are a few other details, of course, but that's the gist.

So which option will she pick? I have no idea, but would be interested in our readers' prognostications (and feel free to explain why in the comments section below):

Thursday, April 19, 2018

Spring has Sprung!

And so has this month's Health Wonk Review, with a wonderfully fresh variety of posts on health care wonkery.

Louise Norris hosts, offering items ranging from "rumblings at CMS" (yay Silver plans) to the horrendous opioid crisis, not to mention the state of Medicaid (oops, mentioned!).

Do head on over for a great bouquet of interesting topics.

Wednesday, April 18, 2018

Tort reform, MVNHS©-style?

As previously noted, government-run health care schemes like the Much Vaunted National Health System©  have never really managed to rein in health care costs:

"It's kind of funny that their data actually shows real socialized medicine (UK NHS) has annualized cost growth higher than that in the US."

But co-blogger Mike tells us that they're at least trying (for certain values of "try"):

"Health leaders have written to Justice Secretary David Gauke urging him to reform the payout system for negligence claims against the NHS."

Seems that all those (costly) mistakes (such as leaving patients "dying prematurely in corridors") have begun to add up. A pound here, a pound there, and pretty soon you're talking real money:

[click to embiggen]


Monday, April 16, 2018

HHS makes its move

Via email from our friends at Cornerstone regarding next year's individual health insurance market:

The Bureauweenies in DC
© have published their "Notice of Benefit and Payment Parameters for 2019," which includes another reprieve for Transitional ("Grandmothered") plans for another year, as well as info on:
• Qualified Health Plan (QHP) Certification Standards
• Exemptions
• Risk Adjustment
• Advance Premium Tax Credit (APTC) Program Integrity
• Special Enrollment Periods (SEPs)
• Medical Loss Ratio
Among other items. There's also additional guidance on those underwhelming SHOP plans (oh, goody).

Interested (or insomnia-stricken) readers may click here for the not-so-gory details.

Friday, April 13, 2018

Rich Man, Poor Man

It was the best of times, it was the worst of times.

Benjamin Hynden had an abdominal pain and made an appointment to see his doctor. During the examination his doctor suggested a CT scan to look for abnormalities.

The radiologist didn’t see anything wrong on the images, and Ardesia didn’t recommend any treatment.
A few weeks later, Hynden, who has a high-deductible health insurance policy with Cigna, got a bill for $268. He paid it and moved on. -

Three months later the pain returned. This time Dr Ardesia wasn't available so he saw a nurse practitioner. The NP, fearing possible appendicitis, told Benjamin to have a CT scan at the hospital.

The triage nurse told him the problem wasn’t his appendix, but she suggested he stick around for some additional tests — including another CT scan — just to be safe.
 “It was the exact same machine. It was the exact same test,” Hynden said.
The results were also the same as the October scan: Hynden was sent home without a definitive diagnosis.

But what happened next was a complete shock.

Total Bill: $10,174.75, including $8,897 for a CT scan of the abdomen

Things such as this happen every day. So how can you protect yourself?

Follow this link for the rest of the story.

It was the age of wisdom . . . .

#CTScan #MedicalPriceGouging  #Medicare  #ProviderNetworks

Wednesday, April 11, 2018

Does Medicare Pay For Dental Work?

What kind of dental coverage is included with original Medicare? Does Medicare pay for routine care like exams, cleaning and X-rays? Or crowns and bridges.

The answer is no.

No basic dental coverage. No routine exams. No cleanings or X-rays.

The next question is . . . why not?

Auto insurance doesn't cover routine items like tires, brakes and oil changes. Why do people THINK they need dental insurance to see a dentist?

I have no idea.

But maybe this will help.

The retail cost of dental and oral health care services varies widely, from practice to practice and from one geographic region to another. But according to one consumer website, a standard cleaning typically costs between $70 and $200. Dental X-rays can cost $250 or more. - Insurance News Net

Split the difference in $70 vs $200 and call it $185 for a routine exam and cleaning. With twice a year cleaning that works out to a little more than $30/month, stuffed in your mattress, to cover the cost of routine dental care.

Why does someone need insurance to "help pay for" something you could pay from petty cash?

Most individual dental insurance plan premiums run $25 - $45 per month. Almost all require you to use participating network dentists. They have annual limits of $1,000 - $1500. Major work like crowns, bridges and root canals are not covered until you have had the plan 6 to 12 months.

Does it make sense to pay $500 - $600 per year for a dental insurance plan you can only use with maybe 15% of the dentists in your area? When you finally do get to use it for major work it may only pay 30% of what the dentist bills.

You decide.

#Medicare #DentalCare #DentalInsurance

More Rocket Surgery from the MVNHS©

So, underscoring once again that ("free") coverage ≠ care, the Brits' Much Vaunted National Health System©, FoIB Sally Pipes tips us to this item:

"Megan flew to Istanbul for private surgery late last year, having been told she faced long delays for an operation to fix the deformation of her spine, which was causing her problems breathing."

As we know, the bureauweenies who run the MVNHS© aren't too keen on the next generation, so I was actually surprised that the young lady was allowed to travel elsewhere for potentially life-saving treatment. Perhaps this was due more to the fact that she's Irish, not English.

And adding insult to injury, we learn that these kinds of national health care schemes don't actually rein in costs:


Monday, April 09, 2018

Told ya so!

Back in late '16, we pointed out that "going bare" had begun to make sense since health insurance had become too expensive to use:

"It might be a ticket to get you into certain medical facilities, but in these days of narrow networks, it will keep you out of others."

Believe it or not, it's gotten worse:

"Obamacare is now so expensive it keeps patients away from their doctors"

And, I would add, their hospitals and specialists, as well.

As Heartland Institute's Justin Haskins points out:

"In a recent survey ... 47 percent of those surveyed said they chose within the past 12 months not to see a doctor or dentist for a routine checkup ... because of the high costs associated with healthcare."

But how could that be; after all, annual physicals are "free."

Well, except for that whole pesky thousands-of-premium-dollars-later thing.

And then there are the non-routine costs, with additional out-of-pockets in the thousands (often tens of thousands) of dollars.

The point, of course, is that the ultimate end-goal of ObamaCare has always been  Single Payer; by that metric, these unworldly prices are features, not bugs.

Definitely click through to read the whole thing.

[Hat Tip: FoIB David Fluker]

Friday, April 06, 2018

CanuckCare© Off the Rails

Back in Aught Nine, we noted that "[a] group in British Columbia has offered medical waiting-list insurance to members whose government treatment is on hold."

Well, turns out that the folks in charge of Canadian health "care" haven't taken too keenly to these kinds of work-arounds:

"The B.C. government has moved against doctors who engage in illegal extra billing, enacting a law that aims to end queue-jumping by patients who pay to fast-track access to publicly funded medical care."

What makes this so funny ironic is that the province leads the country in these types of practices.

For now.

Which may be good news for American providers, no?

[Hat Tip: Sally Pipes]

Thursday, April 05, 2018

BREAKING: What's it all about, Alfie - A Hopeful Update

Almost exactly a month ago, we reported on the Much Vaunted National Health Service©'s latest infanticide effort:

"Alfie Evans, a 21-month old Brit, has been fighting hard for his young life. But the Powers That Be at the MVNHS© are (literally) pulling his plug"

Now comes word that thanks (at least in part) to Pope Francis, he's been given a reprieve:

"Alfie Evans’ Life Support Won’t be Switched Off, Delayed After Pope Francis Intervenes on His Behalf"

Keep in mind, of course, that the MVNHS© has ultimate authority in these cases, even when the parents offer to pay for his care outside the system.

Let that sink in, Single Payer advocates.

[Hat Tip: FoIB Moxie Mom]

The check is in the mail (Seriously)

We've talked about transparency, Direct Primary Care, and other strategies to try to rein in health care costs. But this item, tipped to us by FoIB Holly R, may just be the most effective method yet:

"Need a medical procedure? Pick the right provider and get cash back"

Most of us are likely familiar with the "Find a Provider" button on our carrier's website, or a referral from one's Primary Care doc, and these can indeed be money savers. But until now, I'd never heard of a plan that actually pays you cash on the barrel-head to choose a specific facility.

Now, there's always the question of quality vs cost, and that's a valid concern. But one would think that negative feedback about any given provider would be taken into consideration buy the insurer (or not).

Nice to see more outside-the-bun thinking.

Wednesday, April 04, 2018

Wednesday Links-a-lot

We've made the case that "going bare" can certainly be a rational choice:

But what's it like actually making (and living with) that choice?

Well, FoIB Bill M points us to this rather interesting (and, I must say, relatively balanced) article on just that:

Interesting and thought-provoking.

Second up, FoIB Jeff M (no relation) seems to have problems with the idea that health insurance rates have decreased buy some 3000%:

And by stabilization, of course, they mean "throwing more money at it."

  I can see no possible way for this to go wrong:

BONUS ITEM: Co-blogger Bob V tips us to this interesting story on why folks choose - often at their own peril - not to buy whole life plans. What's special about this is that Burt is an industry giant, and knows whereof he speaks:

Spoiler Alert: He tried.

Tuesday, April 03, 2018

Let's make a (Health Care) Deal!

So, an interesting confluence of seemingly disparate health care financing lawsuits. First, the Golden State is suing an outfit called Sutter Health for a number of issues, including "[g]ag clauses on hospital prices, 'All-or-nothing' contracts, [and] 'Punitively high' out-of-network charges."

I think it's safe to say that other provider networks and hospitals are watching this case very carefully, since it's likely that Sutter isn't a "lone wolf" in this. And of course, with all the mergers and hospital acquisitions the past few years, there are quite a few communities that have only one or two such organizations, and thus little (or no) competition to keep their prices in check.

Speaking of hospitals and pricing, our second story involves a concept called "reference-based pricing." Briefly, this is where an employer enters directly into a contract with a hospital (or other health care provider, one supposes, including DPC). This has some important advantages for the employer (else why would they bother?), but can carry additional risks, as well, namely balance billing. This is where the provider charge the patient/insured the balance between what's billed and the amount the insurance company pays. In a regular PPO-model insurance plan, this is verboten, but since this is a direct relationship  between the employer and the provider, it's perfectly legal (although apparently frowned upon).

And here's where that risk can become a real problem:

"The conventional wisdom is that this is rare ... And if balance billing does occur, it is easily resolved via a little back-and-forth negotiation between the hospital and the third-party administrator or employer. "

And that, your honor, is when the fight started.

[ed: one wonders, also, if that backroom "negotiating" isn't full of potential pitfalls and perils as well, including anti-trust and discrimination issues]

The thinking had been that no provider is going to risk the bad press that would come with suing a patient. But in this case, that thinking is wrong. Now it may have something to do with the size of the (balance) bill: over $80,000. But it also may be related to the phenomenon we noted above: that is, if you're the only game in town, then why would you care about bad PR?

Something to consider, no?

Monday, April 02, 2018

Re-writing History

I'd forgotten this: