Friday, March 22, 2019

Happy Anniversary!

For certain values of "Happy:"

Thursday, March 21, 2019

Policy Loans: The Dark Side

One of the benefits of cash value life insurance plans (eg Whole Life, Universal Life, etc) is the ability to "borrow against" it. That is, as the cash value (equity) increases, it's available as a loan, with the death benefit as the collateral.

This can be very handy when sudden, unexpected expenses rear their ugly heads. For example:

"Unable to secure a large enough bank loan, Walt Disney borrowed against the cash value from his life insurance policy to help finance the creation of his new theme park, Disneyland."

Other famous folks with similar stories include James "JC" Penney and Ray Kroc.

Of course, there's a balance here: while these loans can be quite helpful, they have the potential to be very dangerous, as well.

How's that, Henry?

Well, generally speaking, if one borrows from a policy and fails to pay it back, then the company merely subtracts the balance due from the death claim. No harm, no foul, no taxes. But what happens if one borrows from the policy, and it dies before the insured? That is, if it lapses while the insured is still alive?

Well, in that case, the borrower (and potentially his/her heir) are in for a nasty surprise: Form 1099-R.

Such was the case for a recently deceased client:

In January of '18, she let her Whole Life insurance policy lapse with a substantial loan balance. This January, she passed away. Yesterday, I got a call from her widower asking why he had received a tax form from Acme Life. I asked for the policy number to which it referred, and advised him that when the policy lapsed last year it created a taxable event, and that the balance due is being treated as taxable income (which would have also been the case if my client was still with us).

I always advise clients who take loans against their plans to at least keep up with the interest each year, to avoid the loan balance snowballing until the policy is unrecoverable.

Now you know.

Wednesday, March 20, 2019

A Friend Needs Help

My college roomie and Best Man is married to a wonderful, vibrant, caring woman who has been diagnosed with early onset Alzheimer's. She is fading fast.

Deb and Rich recently moved from Connecticut to Florida to see if the change of environment would be beneficial. Unfortunately, her condition has continued to deteriorate, and she is now in a nursing home. Rich would like to bring her back home to Connecticut, but lacks the funds to do so.

He has set up a GoFundMe to try to resolve that. Please consider donating to it.

Wednesday Roundup: International edition

We've written before about the so-called 'Secondary Market' for life insurance:

"And so, as part of HIPAA, a new word entered the popular lexicon: viatical. Basically, one can sell one's plan to a 3rd party with little (or no) tax consequence."

But of course, the good ol' US of A isn't the only place on Earth where this type of sale takes place. Our Neighbors to the North also have this available, but it's getting a little more 'iffy' as to the buyer's benefits. According to FoIB Allison Bell:

"Manulife Financial Corp. and other Canadian life insurers won a legal battle against hedge funds that contended the insurers should be compelled to take unlimited deposits into high-yielding investment policies."

This basically serves to limit the tax-advantaged growth available to certain plans, and re-focuses on the death benefit itself. Will be interesting to see if these restrictions wend their way here.

One of our most enduring memes here is that coverage ≠ care; that is, insurance doesn't guarantee that actual care will be available, either quickly or even at all. And so we look again at CanuckCare© as a warning to those who advocate MedicareForAll:


Be careful what you wish for.

And piling on, we look Across the Pond to Britain's Much Vaunted National Health Service©:

"HIP replacements, cat­aracts, varicose veins and tonsillectomies are among a string of surgical operations that will no longer routinely be carried out on the NHS "

[Hat Tip: Sally Pipes]


Since even (especially?) socialized medical care schemes have proven unsuccessful at reining in the cost of care, the only viable alternative is to ration deny it.

Cheerio!

Tuesday, March 19, 2019

Monday, March 18, 2019

MVNHS© Winninng: A Story in Two Parts

Part 1:

This is what happens when a country turns its medical care over to government bureauweenies. As a result of consistent and increasing budget cuts, the Much Vaunted National Health Service© is "push[ing] more patients towards paying for treatment privately."

Wait, what?

"paying for treatment privately"

It's a not-so-closely guarded secret that even countries with government-run health "care" have huge markets for private insurance. As we reported 7+ years ago:

"Private Medical Insurance ... allows you to have complete reassurance of knowing that, should the need arise you and your family can receive medical treatment privately, without waiting for the NHS to treat you."

We wondered at the time about why this was necessary, given the free and widely available health care that is the MVNHS©. Now we know.

Part B):

One of our most enduring memes here at IB is the fact that health care ≠ health insurance. That is, what good is the coverage if there's no one to provide the care?

Well, our British Cousins are learning this lesson good and hard. From FoIB Rich W:


A lesson to be learned as we rush headlong toward #Medicare4All: Be careful what you wish for.

Friday, March 15, 2019

*True* Junk Plans: A Retrospective

So big news on Capital Hill:

What they really need to be reviewing are the true junk plans:

"Twenty percent of Ohio adults reported that they or a household member go without medical care because of the cost even though more than 90 percent of them have health insurance"

Hint: They're not talking about STM's....

Thursday, March 14, 2019

Blue Cross: Word Salad edition

So this morning, FoIB Jeff M emailed this item about the planned merger of Blue Cross Blue Shield of North Carolina "with Portland, Ore.-based insurer Cambia Health Solutions. The two not-for-profit organizations with combined revenue of $16 billion and more than 6 million customers said the alliance will make health care "simpler, better and more affordable."

Wait a minute: what does "simpler, better" actually mean?

Well, it depends. According to the official email announcement:

It might mean "Each company retains its current assets, such as its reserves and capital, and there is no change to the underlying business in our states."

On the other hand, it could be that "The companies will share services, which will cause some resources to shift."

On the gripping hand, perhaps it notes that "Our long-term goal is to make health care more affordable for the individuals and families we serve ... Our expertise, common management and increased resources will allow us to better address rising costs in the health care system by reinvesting shared savings, enhancing price transparency tool."

Okay, but why does all of that remind me of this?

In the end, one suspects that it means "business as usual," only with a bigger footprint.


And as Jeff notes, a look at their website seems to indicate that "they still think healthcare and health insurance are the same."

Yay?

HIPAA, HIPAA Horray?

[click to embiggen]
So, FoIB Holly R sent us this:

"Just had a doctor's office tell me the doctor couldn't discuss test results over the phone because of HIPAA. This is false, and another reminder that medical facilities constantly use HIPAA as a bogus excuse for being opaque and difficult."

Interesting take, and one I've heard before. But is it true?

I reached out to co-blogger Kelley B, herself a medical office manager, for her reaction. She replied:

"The reality is that the doctor will be paid nothing to tell the patient his test results over the phone. Since this requires medical decision making on the doctor's part, he/she is entitled to be paid and that means that the patient has to come in for an appointment. The patients hate this because it costs them money.

Is it a HIPAA violation. It could be as you cannot confirm that the person on the other end of the phone is the patient. It is in the doctor's best interests not to give out results over the phone and have the patient come in."
That makes sense, although I would point out (before others do) that under the nascent DPC (Direct Care) model, that first point would be moot, since the doc's already been paid.

Interesting.

Wednesday, March 13, 2019

The (New, Improved?) ACA is Working

Regular readers may recall that the current administration loosened a lot of the rules surrounding Short Term Medical (STM) plans, and the ensuing hue and cry from 'the usual suspects' about the world ending (or worse!) as a result.

Well, preliminary results are in, and guess who comes out standing tall (hint: it's not the naysayers):

 
Turns out, folks who bought these plans are, for the most part, completely satisfied that they worked as promised; in fact, over 80% of buyers who actually had claims were either satisfied or even very satisfied.

Hunh.

And most of the folks who had claims also "said their policies covered what they thought the policies would cover."

Imagine that.

Would that ObamaPlan victims insureds were so satisfied.

Meantime, Colorado becomes the latest state to ban sales of STM plans altogether:

"The Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), has amended the regulation governing short-term limited duration health benefit plans, requiring these plans to provide many of the same protections afforded by Affordable Care Act (ACA) qualified plans."

In other words, no more short term plans for Centennial Staters.

Wonder why their leaders hate choice.

[Hat Tip: FoIb Lynne]

Tuesday, March 12, 2019

Outstanding Vendor Tricks: Dental edition

Over the years, we've detailed any number of really stupid vendor tricks; the list of terrific ones is, unfortunately, much shorter.

Well, that latter list just grew a little larger today, as Superior Dental Care joins that august group.

And why is that, you ask?

Well, because they are an absolute joy to work with. Case in point:

Recently, I was privileged to write a brand new small group (as in, they'd never had group health insurance before). A month or so later, they asked about adding voluntary dental ("voluntary" in this context means employee paid, no employer contribution). I don't do a lot of dental, but Superior Dental (SDC) is one of my two go-to's for it. Superior especially is a delight, because they just make things so easy. In this case, we were going for a March 1 effective date, and the employer emailed me the forms on February 27.

Except I never received that email. So I presumed that they had decided to either change their minds, or were opting for an April 1 start date. So last week I followed up to see if they were still interested. They replied "of course, we sent you the paperwork last week!"

Oy.

So I called our SDC rep to see if there was any chance we could still get that March 1 effective date, even though it was already the 7th. And the answer was "of course, just send us the forms right away and we'll get that done for you."

So I called the client and they re-sent the forms, which I dutifully forwarded to SDC.And this morning, I received confirmation that the plan was activated on March 1, and that ID cards would be on the way shortly.

Doesn't get any better than that.

Kudos to Superior Dental Care.

Monday, March 11, 2019

More MVNHS© #Winning

Saturday, March 09, 2019

#Winning: Socialized Health "Care" edition

Friday, March 08, 2019

Friday O'Care Reminder

Shot:
Chaser:

Thursday, March 07, 2019

A (Timely) Blast from the Past

I had completely forgotten this post from co-blogger Mike, but it is incredibly relevant today. For one thing, it echoes a longstanding principle here that health insurance health care. And it presciently touches on the (Evil) Individual Mandate and the Death Panel that have been ObamaCare hallmarks. Finally, it seems to be an early, distant warning about what lies in store for us if (when?) Medicare4All is actually implemented.

Oh, what's it called?

"Why isn't health care compulsory?"

Here's a taste:

"I’m not talking about health insurance. I’m talking about health care. Health insurance is not the same as health care. Who calls their insurance agent when sick or injured? Who calls an actuary? Don’t real people call their doctor or go to the emergency room?"

Indeed.

And there's this:

"First, all health care professionals become employees of the Federal Government, paid a living wage from public funds. Second, hospitals, clinics, labs and other facilities are nationalized and their staffs also become employees of the Federal Government ... it is illegal to seek or receive health care from anyone except a Federal health care professional."

Yes, yes it is rather scary.

And that's the point.

Read the whole thing here.

Wednesday, March 06, 2019

The More Things Change: 2019 edition

So, FoIB Steve Downey alerted us to this item at CNN:

"A woman received nearly $375,000 from her insurance company over several months for treatment she received at a California rehabilitation facility. A man received more than $130,000 after he sent his fiancée's daughter for substance abuse treatment."

Okay, that's (very) nice for them, but what's that got to do with the price of tea in China, or insurance, well, anywhere?

Well, these folks got these checks as a result of Anthem's (alleged) strong-arm tactics being brought to bear on non-network providers to join up. Generally, carriers pay even out-of-network providers directly (although at less than in-network rates, natch). This has the non-network providers unhappy...

What? So what's the big deal,  you ask?

Well, if you're General Hospital and your patient just got the $375,000 from Anthem, how quickly do you think said patient's going to run it down to your business office to sign it over? Or even bother to do so? And yes, you can sue the patient, but that adds to your own wait time, as well.

Yeah, that's the big deal.

What will be interesting is to see whether the plaintiffs prevail. I doubt it, since Anthem's actions don't seem to be illegal. To the contrary, it could very easily be argued that the carrier has a higher duty to the insured, since there, at least, is a contract (the insurance policy). Not so with the non-network provider.

Oh, and lest one thing that this is some crazy new tactic: well, it's not. As I replied to Steve:

"We blogged on something like this *years* ago (will take a while to dig up), so nothing new under the sun, But *does* point out the lengths to which some carriers will go to get their way."

Well, I eventually did find that (very) old post, and I was right:

"When Premier's network contract with Anthem expired on Jan. 1, Anthem stopped paying Premier directly ... Anthem sent reimbursement checks of four and five figures to enrollees instead.”

We'll keep you posted on this latest attempt.

Tuesday, March 05, 2019

Anthem/Peach State Update

Whew boy!

So, readers may recall our post from a month ago regarding a class action lawsuit brought by a large Georgia law firm "on behalf of thousands of Georgia healthcare consumers misled by Anthem's “deceptive marketing scheme.” The story is that these insureds were (allegedly) promised that "if you like your doctor, you can keep your doctor" [ed: ISWYDT]. This turned out to be, wait for it .... not the case, which left these poor folks with a lot of out-of-network issues. We promised to update this story as it developed.


There are developments:

It wasn't clear at the time just what relief these clients sought, turns out to be out of left field: instead of (or, perhaps, in addition to) monetary damages the firm "is asking a federal court to allow thousands of consumers victimized by multiple false marketing claims to be granted a “special enrollment period” to switch to a new health insurance company."

If the request is granted, it would be a first, and could set an interesting precedent.

Oh, and it's not just that the providers are out-of-network, but the carrier has also "revers[ed] its marketing promise that consumers would not be required to seek referrals before seeing specialists."

Still, I don't see how Anthem's (alleged) bad faith has anything to do with the ACA, nor that the Feds have the authority to make such an accommodation.

As before, we'll keep you posted.

[Hat Tip: Whitney D]

Monday, March 04, 2019

Monday Morning LinkFest

We've posted fairly often about Health Care Sharing Ministries, most recently here:

"After some online research Mazie, who lives in Miami, found something he thought was a godsend: United Refuah HealthShare, a Jewish alternative to traditional insurance ... He was thrilled by the bargain-priced plans."

This was news because this model of health care financing is typically offered with a Christian slant (NTTAWWT). Regardless, they're gaining in popularity (sort of: there are about 1 million folks on these plans, which makes it a rounding error), and the movement wants a seat at the table as we look for ACA alternatives:

"The health sharing plan movement made itself felt recently at the Inter-Company Marketing Group’s 2019 annual conference."

Good for them!

It's true that we spend a lot of time dissing on Britain's Much Vaunted National Health Service©, and with (very) good reason. For example, FoIB Sally Pipes alerts us to this latest news:

"NICOLA Sturgeon has admitted she is not “surprised” that NHS waiting times are still getting worse despite bringing in a legal guarantee to prompt treatment seven years ago ... [Last] week, official figures showed a record 27.3 per cent of patients waited longer than 12 weeks in the last quarter of 2018, the equivalent of 200 breaches each day."

But hey, it's free!

And on its way here, if the M4A folks have their way.

Even with ObamaCare's actual body count, we're still doing pretty darned well in the health care results metric. From FoIB David Balat:

"The world’s leading medical journals report the U.S. has superior results, including for cancer, heart disease, high blood pressure, diabetes, and high cholesterol."

The Tweet links to an article behind WSJ's paywall, so...

Friday, March 01, 2019

Meanwhile, at the MVNHS© [UPDATED]

[Scroll down for update]

Ooops:
So about that bending the cost curve down by way of nationalized health "care:"

"Friday’s report by the public accounts committee into the cost of clinical negligence in hospital trusts reveals that the bill has quadrupled in 10 years to [~$2 billion] and is expected to double again by 2021."

So why are these expenses climbing so high and so rapidly? Well, there seem to be a couple of factors in play:

"As well as increasing damages for a small and stable number of “high value” ... there is a growth in the number and cost of “low value” claims."

The vast majority of those "high-value" claims, by the way, are maternity-related.

But why the increase in claims themselves?

Apparently, there's a mysterious connection between "steeply rising demand and chronic staff shortages." I mean, who could have foreseen that in a government-run system? And this in turn has led to "endless examples of deteriorating patient safety."

Hunh.

#Unexpected #MedicareForAll

UPDATE: And just when you thought things couldn't get worse under this mess:

"NHS 'backs plans to scrap four-hour A&E maximum waiting target'"

Because it had been working out so well previously. From 2 years ago:

"Nearly a quarter of patients waited longer than four hours at A&E last week with just one hospital hitting its target."

Hey, at least they're admitting that they can't meet their own (rather modest) goals.

[Hat Tip: FoIB Sally Pipes]