Thursday, November 14, 2019

Global Underwriting Update

From our friends at Global Underwriters:

"Each year the number of people traveling for business purposes is astonishing. The Global Business Travel Association counts over 488 million trips taken annually. Each year business travelers take an average of 12 trips, typically lasting at least 5 days. An estimated 1.3 million business trips occur daily in the U.S. alone. These figures are expected to grow another 7% this year.

Even with video/web conferencing, online meetings, and daily conference calls business travel continues to increase and is vital to the success of your clients company. Hectic schedules, missed flights, transportation issues, and hotel problems are the least of the employees' worries. Many employees are citing concerns related to personal security, terrorism, political unrest and infectious disease epidemics. 

It's also crucial that companies and organizations embrace Duty of Care obligations and take the necessary steps to reduce potential dangers or problems that could occur while their employees travel. Employers need to have a well communicated plan in place and part of this plan is providing Business Travel Accident (BTA) insurance for their employees. BTA insurance is an inexpensive benefit that supplements any employee benefit program. This World Class Protection is designed to offset the risk and potential loss of a key employee(s) and to compensate families of employees for their loss of income due to accidental death or permanent disability of a loved one."

If international business travel is on your itinerary, this is must-have info.

Tuesday, November 12, 2019

The Correct Words

In the medical world, we have our own language; well,actually multiple languages. The clinical has their languages, usually abbreviations, the medical administration has their own language, and the health insurers have their own language. Throughout my long medical administrative career, I have noted how incorrect language results in problems between health insurers and the medical office.

A case in point is this blaring headline from ProPublica:

How One Employer Stuck a New Mom With a $898,984 Bill for Her Premature Baby

The article was listing under a heading: “Health Insurance Hustle”.

 This is terrible, how could a medical facility and a health insurance company do this to a new mother with a critically ill patient?

A read of the article offers this tantalizing tidbit,

Bard’s saga began, traumatically, when she gave birth to Sadie at just 26 weeks on Sept. 21, 2018, at the University of California, Irvine Medical Center in Southern California. Weighing less than a pound and a half, tiny enough to fit into Bard’s cupped hands, Sadie was rushed to the neonatal intensive care unit. Three days after her birth, Bard called Anthem Blue Cross, which administers her health plan, to start coverage. Anthem and UC Irvine’s billing department assured her that Sadie was covered, Bard said.” [emphasis added]

Right there in the paragraph, Anthem said the baby was covered. Mom took that to mean that baby was enrolled in the plan. This is a very common error on the part of the public. What Anthem meant by the comment was that the plan covered pre term births. What was not said by the Anthem representative, was that mom still had to go onto her employer’s website and enroll the baby in the plan. It had to be done in 31 days.

So, “Meanwhile, believing that everything with her health benefits was on track, Bard spent nine of those first 31 days recovering in her own hospital bed and then had to return to the emergency room because of a subsequent infection. She spent as much time as she could in the neonatal intensive care unit, where Sadie, in an incubator, attached to tubes and wires, battled a host of critical ailments related to extremely premature birth. At times, doctors gave her a 50-50 chance of survival.”

Mom thought everything was fine with her insurance, so she focused on her baby. “Then, eight days past the 31-day deadline, UC Irvine’s billing department alerted Bard to a problem with Sadie’s coverage. Anthem was saying it could not process the claims for the baby, who was still in the NICU.”

Then the bills begin to arrive, totaling almost One Million Dollars. Through the efforts of Social Media, the insurance company relented and retro activated the baby’s enrollment back to her date of birth.

This could have been so easily avoided if both mom and the insurance company had simply clarified what “covered” meant. Any reasonable person should know that you simply cannot call your insurance company and you or a family member are magically entered. It takes some effort on the patient’s part to make that happen.  

The most common complaint that I receive from patients regarding a bill is, “The Insurance Company said you coded wrong”. No, we did not code wrong.  You, the patient, presented with a flu during your Preventive Exam so you were billed for an office visit.

Or, “Why did I receive this bill, my Insurance Company said I was covered.” Yes, you are covered for that service, but not by this provider.

In medicine, as in all businesses, it is imperative that the consumer, the patient be aware of what they are asking. Insurance Companies Representatives are limited as to what they can tell a patient, so when calling your insurance company, make sure that you are both speaking the same language.

Monday, November 11, 2019

LTCi in the news

Fresh off the presses:

Potential good news for folks considering an LTCi purchase.

Not sure about timing? Well, consider this timeless post from our friend Herman Bruns:
"As more and more baby boomers become aware of the devastating financial and emotional effects that a long term care need can have on their family, the average age at which people purchase LTC insurance has been steadily dropping every year."

Friday, November 08, 2019

A Tale of Two Networks

For plan year 2020, history repeats:

One way carriers have found to reduce their costs has been to offer ever-shrinking networks. For some, this isn't an issue, but for many, who have longstanding relationships with their current providers, this can be a problem.

Take, for instance, Larry: he's a long-time client, lives up in the Cleveland area (Geauga County). As with most of the state, almost all of the plans available on the site are offered by erstwhile Medicaid carriers, with two notable exceptions: Medical Mutual and new kid in town Oscar Health.

Larry's in his late 50's, and has some medical issues that make the Guaranteed Issue/Pre-ex coverage available on ACA plans attractive. He also has some specific doc's that he likes, including some at Cleveland Clinic.

Now, it turns out that The Clinic is in-network for only one carrier here: Oscar. And the question arises, how much is that relationship worth, in actual dollars? I have long wondered this, but until now had no way to quantify it.

Now, I can, and it's breathtaking:

[click to embiggen]

The  plan on the left is from CareSource (one of the aforementioned "Medicaid carriers") and the one on the right is from Oscar. The only substantive difference (other than the fact that the latter actually has higher potential out of pocket exposure) is that Oscar includes the Cleveland Clinic, and CareSource does not.

So, is The Clinic worth $3,600 a year?

Thursday, November 07, 2019 Week One Report


"In week one of the 2020 Open Enrollment period, 177,082 people selected plans using the platform. As in past years, enrollment weeks are measured Sunday through Saturday. Consequently, week one was only two days long this year - from Friday to Saturday."

This tracks with what we've seen in previous years: a big rush up front, then things taper off, and a last-minute flurry as folks actually pull the trigger the last few days of Open Enrollment.

Of course "selecting" a plan doesn't necessarily mean buying one: just as with eBay and Amazon, people often leave their shopping carts unclaimed. Which we can sort of see in this infographic:

[click to embiggen]

I must admit that I'm puzzled by what, exactly, "Consumers on Applications Submitted" means.

Wednesday, November 06, 2019


 [click to embiggen]

But wait, there's more:

But hey: Free!


Tuesday, November 05, 2019

Everything Old...

Regular readers may recall this from a few years back:

"Due to the significant changes carriers have made to their compensation schedules (aka commissions), I don’t believe that I can continue to offer the kind of comprehensive service to which I, and you, have become accustomed."

I still do the annual re-certification, and dabble in the individual market as needed (current clients, referrals, that kind of thing).

Recently, Senator Iron Eyes Elizabeth Warren had this observation about folks like me under her #Medicaid4All plan:


It's true that home and auto insurance share a common principle:

Yes, they are both predicated on the principle of "indemnification," but then so are disability and homeowners insurance."

But that's where it ends. For one thing, they are two completely different licenses, and markets, and marketing strategies.

For another, she seems to be forgetting all the support folks at various home offices, not to mention plan administrators and the like. And of course, this also means the end of Medicare Supplement and Advantage plans (why does her party keep throwing seniors under the bus?).

And, of course, there's the matter of how much this whole shebang's going to cost.

But hey: details, shmetails.

[Hat Tip: FoIB Bob G]

Monday, November 04, 2019

History Lesson

So last week my Better Half and I took a long-anticipated, week-long trip to The Big Easy. I had been there as a very young lad, so no real memories, and she had never been. Had a great time, ate too much really good food, and spent some time in some amazing museums (among other things).

Mid-week we spent the day at the United States World War II Museum. We spent the day, but could easily have spent several more. Just extraordinary.

But what was very special was the completely unanticipated personal connection to one of the exhibits.

As we rounded a corner, we found a display of a carpenter's tool kit, and a plaque explaining it:

[click to embiggen]

The gentleman's name (redacted for privacy reasons, which you'll soon understand) rang a very loud bell:

Some 30 years ago, one of our carriers imported a new rep from Louisiana. Roger D and I soon became fast friends, and he's since become my local Medicare "guy." His last name is unusual for Ohio, but maybe not for Cajun country, and it appeared on that plaque. So I texted him the pic, and asked "Anyone you know?"

He replied "Wow, will have to ask my Dad about this."

A few minutes later he texted again:

"Turns out this is my grandfather's brother. My dad knew about him and told me stories about how he went to Hawaii to help rebuild. Came back and opened several grocery stores. Thanks for sharing this photo."

Wow, traveled over 800 miles for that connection...

Worth the trip all by itself.

Saturday, November 02, 2019

How much is $52 trillion?

$52 trillion is the amount Elizabeth Warrens campaign is conceding her Medicare for All proposal will cost over its first 10 years.  That would be $5.2 trillion each year.  All of this ignores inflation which Senator Warrens plan would supposedly make vanish.

Anyway, after the laughter subsided, I wondered how to express $5.2 trillion in more understandable terms.    Here’s one way.

The CBO projects 2019 federal spending to be about $4.4 trillion. 

Senator Warren is saying that the projected annual cost of her plan is greater than this year’s total annual federal expenditures.

Show of hands please.  Who wants your taxes more than doubled? Anyone?  Anyone?

Wednesday, October 30, 2019

Sure, sure, but hey: Free!!

In case you were wondering:


Tuesday, October 29, 2019

Medicine Should Not Have a Buyer Beware Clause

There are preventive tests that we should all do regularly, and for women that includes the annual Mammogram. This simple, but albeit, uncomfortable test is very effective in finding breast cancer which can lead to early treatment. Additionally, it falls under Preventive Care, thus it is paid for at 100% by insurance companies. Seems relatively simple, but there are a few landmines that can catch women unawares, turning a no-cost procedure into one that will result in a bill.

The first landmine is when you enter the room. The technician will ask the women if she has any problems with her breasts. If the women answers in the affirmative, regardless of the issue (sore from an ill-fitting bra, soreness from exercise, etc.), that test has suddenly become a Diagnostic Test, no longer covered at 100% and it now needs a diagnosis of a problem from a doctor. I lost count of how many times a lab would contact our office asking for a diagnosis to do a Diagnostic Mammogram, instead of a Screening/Preventive test. We would tell the lab that there was not a problem, we ordered a Screening Mammogram and please do what was ordered. Meanwhile, the patient is worried that there is something wrong and the patient needs to reschedule, thus delaying the test. 

The second landmine is the new 3D Mammograms. These have been available for several years, but incur a cost to the patient. While in the past, it was a passing question to the patient when the test was scheduled, it has now become a worrisome impediment to a vitally important screening test. 

When Dr. Worta McCaskill-Stevens made an appointment for a mammogram last year, she expected a simple breast cancer screening―not a heavy-handed sales pitch.

A receptionist asked if she wanted a free upgrade to a “3D mammogram,” or tomosynthesis.

“She said there’s a new approach and it’s much better, and it finds all cancer,” said McCaskill-Stevens, who declined the offer.

A short time later, a technician asked again: Was the patient sure she didn’t want 3D?

Upselling customers on high-tech breast cancer screenings is just one way the 3D mammography industry aggressively promotes its product.”

A Kaiser Health News investigation found that there is a strong marketing push to the general public that the 3D Mammogram is better. These tactics include manufacturers paying influential doctors for their endorsement, there is marketing directly to consumers, manufacturers have lobbied state lawmakers to have insurers cover 3D Mammograms, and the funding of experts and advocates for positive reviews.

Taxpayers write the check for many 3D screenings, which add about $50 to the cost of a typical mammogram. Medicare, which began paying for 3D exams in 2015, spent an additional $230 million on breast cancer screenings within the first three years of coverage. By 2017, nearly half the mammograms paid for by the federal program were 3D, according to a KHN analysis of federal data.

Thus for all the hype, 3D Mammograms have not shown to be better at diagnosing Breast Cancer over the conventional digital 2D scan. Unfortunately, where there is money to be made, it seems the facts be damned. In the end, the only loser is the American Patient, by having additional costs added to their already expensive healthcare.

Monday, October 28, 2019

The VA has a Cleanliness Problem

The Veterans Administration gets a lot of bad press for inadequate services, most of it deserved, but now there is an issue with cleanliness.

A new report from the Office of Inspector General for the Veterans Health Administration found VA facilities generally met requirements, but cited problems with facility cleanliness and panic alarms.

Between Oct. 16, 2017 and Sept. 14, 2018, the OIG conducted surprise inspections to 51 randomly selected VA health facilities across the country. Issues that were discovered were dirty vents in patient care areas, furniture in patient care areas that were either dirty or broken and dirty floors.

I have spent time in VA facilities with my husband. He has received tremendous care, but I must agree with the report on cleanliness. Recently, sitting in a waiting room while my husband underwent outpatient surgery, a mouse ran across the floor and went into some cabinets. This room was on the interior of the facility and on the third floor. In all my years working in medical facilities, I have never encountered a mouse. Needless to say, it was a bit disturbing to those of us in the waiting room. One family member tried to alert a staff member to the mouse. Her response, “Well, that’s not good,” and then she walked away.

The report found that “environmental cleanliness noncompliance was often due to lack of oversight and staffing challenges.” Based on my experience, I would say the researchers got that right. 

The OIG made 16 recommendations, I hope pest control was one of those recommendations.

Friday, October 25, 2019

Government-run Health "Care" and Salad Bars

Helpful video about the pitfalls of Medicaid4All:

[Hat Tip: FoIB Mike B]

Medicare 2020 | $0 Everything Medicare | GA Medicare Expert

 #FreeMedicare #NoPremiumMedicare #MedicareOpenEnrollment2020

Thursday, October 24, 2019

ObamaPlan Re-Cert Report [UPDATED]

[Scroll down for Update]

So, did my annual training/re-certification for the individual Marketplace (aka

[click to embiggen]

On the one hand, they've actually streamlined the process for those of us with prior certification, which is nice.

On the other, they've really gone to town on codifying what behaviors are kosher (helping clients set up an account) and which are not (setting one up for them). This latter seems, well, stupid, but of course they aren't interested in feedback.

Which is probably just as well...

UPDATE: Imagine that!

LTCi Rate Increases: The More You Know

From FoIB Scott Olson, the REAL reason why older long-term care insurance policies have had such large rate increases:

Wednesday, October 23, 2019

The World Turned Upside Down

Children are society’s future. We have designed laws to protect children from harm, from fire proof pajamas to when a child is considered mature enough to make life altering decisions. As a Social Worker, my job was to protect children from unsafe home conditions. As a Medical Manger, my job is to protect both doctors and their patients from “never events”. A “never event” in Medicine is an event that, with proper safeguards, will or should never happen.

In Texas a Custodial Court Case over the gender transition of a 7 year old male child is, in my Professional Opinion, a travesty in regards to what is best for the child. The full account of the trial can be read here: “BREAKING: Dallas Jury Grants Mother Sole Custody of Purported Transgender Child”.

The case revolved around divorced parents regarding the medical care of their 7 year old son. The mother, a pediatrician, is maintaining that the child is a female and is desirous of allowing him to transition, up to and including hormones. The father is maintaining that the child is happy being male. The case rested on two questions: "First, did they think that the current joint managing conservatorship should change to a sole managing conservatorship? Second — if they said “yes” to the first question — did they think Younger should be the sole managing conservator?

The jury decided “yes” on the first question and “no” to the second, which results in the mother being the sole manager conservator.

Child rearing is the most difficult task a person can do, even in the best circumstances. Child rearing with an ex-spouse can add another layer of stress, especially if those opinions differ. In this case however, the issue is not whether or not the parents agree, but what is best for the child. An amicus attorney (one appointed by the court to be a neutral observer, recommended:

Contending that both parents loved James, as acknowledged by everyone who interviewed both Younger (father) and Georgulas (mother), he asked the jury to choose for the parents to remain joint managing conservators, and leave the rights and duties of that custody agreement for the judge to rule on in a way that would address the concerns of the father.

The attorney recommended a path that is considered the best plan for a child, whose parents are deemed appropriate to care for that child. In this decision, by allowing the mother full decision making powers, this child’s life could be permanently altered before he is mature enough to understand the consequences.

There are many things we do not let a 7 year old child do, that adults do, because these activities are either dangerous or beyond the comprehension of a child: driving a car, being alone for any length of time, voting, and - obviously -  making medical decisions. It is a parent’s responsibility to keep a child safe and healthy, live in an environment where the child is allowed to grow, and nurture their personalities so that they become a functioning member of society.

As a Social Worker, I can attest that these tasks are not always performed by all parents, but that is why Social Work was created. Helen Northern noted that in the early 20th century in America, there were laws protecting Animals from abuse, but not children. From hers, and many other individuals, laws protecting children were enacted. A major premise of these laws is to protect children from danger, be it from society or from their family situation.

Based on these laws, it is not appropriate to make such a drastic, life altering change to a child when that child is unable to have a decision. Especially, when one parent does not agree.

As a Medical Professional, there are two troubling aspects to this case, both of which revolve around the fact that the parent who wants the transition to be done is a Pediatrician.

In Medicine, it is considered unethical for a doctor to treat a family member. For example, a doctor cannot write a prescription for a family member or be the primary provider of a family member. This is especially important in regards to spouses, parents, and children. The reason is obvious: we as humans are not always objective when it comes to family members, and in the medical profession, it is necessary to be able to objectively make medical decisions. As a Social Worker it appears to be a clear conflict of interest, since the mother is a Pediatrician, between her medical decision making and parental love to give a child what they want. As a Medical Practice Manager, I view this as a doctor overly involved in a medical process with a family member. For the doctor who would perform the treatment, this could become a possible malpractice case by the child, or the objecting parent, over a “never event” being done.

Political correctness should never be a reason to overturn basic parental rights and responsibilities and standard Medical Ethical Guidance.

The Purple Squirrel in Healthcare Employment

In Human Resources, a “Purple Squirrel” is the perfect employee. The “Purple Squirrel” will have every box checked on the employer’s list, the degrees and certifications will match exactly, as well as previous job descriptions. As you, dear reader, may surmise, it is very hard to find the perfect employee.

In Healthcare, the Purple Squirrels are women in management positions. A new study has confirmed what we in healthcare already know, “While many women work in the healthcare services industry in entry-level roles, there is a scarcity of women in top health management positions, according to The Wall Street Journal.

"New data cited by the newspaper from LeanIn.Org and McKinsey & Co shows women in entry-level roles, such as nurses, home health aides and recently graduated physicians, represent 75 percent of employees in a sample of more than 20 companies. In those same companies, which includes hospital systems and other direct-care providers, women in C-suite roles represent 33 percent of employees, while women in senior vice president positions represent 41 percent. Women in vice president roles represent 47 percent."

Women over-represent men in all aspects of healthcare, with the exception being Medical Doctors. Women are the managers in the Medical Practices, nurses, medical assistants, clerks, mid-level providers, billers/coders, to name a few of the positions we occupy.

In a typical visit to a medical office, a patient will have a minimum of 3 interactions with a women and only one (the doctor) with a man. If that patient has a concern or a question, then the manager that they deal with will in 9 out of 10 occurrences be a women. So with so many women in all positions in Healthcare, why then such a lack of women in the Executive Level.

Janette Dill, PhD, a professor of health policy and management at the University of Minnesota, told The Wall Street Journal that in healthcare, one of those barriers may be not having the education required for certain management roles.

In healthcare, other than clinical, there is no formal training required or expected in order to do a particular job. Thus, women usually begin working at a Medical Office as a front desk check in clerk and if all goes well, will work their way up the ranks until many years later they are now in management. However, there was no expectation or opportunity for the women to improve their expertise through classes or training. Thus, when there is an opening in an Executive Level job, the women will have the work experience but lack the professional training to qualify. Men, on the other hand, will have the professional training without the work experience. In rare cases you will find a women in an Executive Level that worked her way up, but that is usually only found with a women who has worked in that organization her entire career. She is trapped in that organization, as she has no professional training to qualify for a similar position in another company.
Overall, LeanIn.Org and McKinsey& Co conclude that "women continue to be underrepresented at every level. To change the numbers, companies need to focus where the real problem is. We often talk about the 'glass ceiling' that prevents women from reaching senior leadership positions."
"In reality, the biggest obstacle that women face is much earlier in the pipeline, at the first step up to manager. Fixing this 'broken rung' is the key to achieving parity," researchers added.
I recognized that in order to move up the ladder in this career field, I would need to obtain the needed degrees and certifications in addition to my work experience. Even with my credentials, I have lost out on job opportunities to men (and to women who have worked in the organization their entire career, but do not have the educational credentials). While I always knew this was the case, it is nice to have it validated.