Thursday, July 18, 2019

Stupid Agent Tricks: Sometimes I despair

So one of my hats is CE (Continuing Education) provider. My primary role in that capacity these days is "back office support;" that is, I file courses for state approval, create and provide class rosters and completion certificates, and file completed class rosters to the states in which I'm a licensed provider. Unfortunately, I don't get much opportunity these days to actually teach, and I miss that dearly.


One of my CE clients taught a couple classes the other day (well, technically, the same class, twice, at two different locations). She had previously taught this same class last fall (at the same locations). In Ohio (and, I imagine, in most if not all other states), one cannot get credit for taking a course more than once in a cycle. Determining whether or not this applies is fairly simple; agents can check their transcripts online in a matter of seconds.

Of course, this doesn't always happen, and in today's little object lesson, 5 of the 15 students at Location 1, and 2 of the 8 at Location 2, had taken this exact same course within the past 6 months.

And it gets better (for certain value of "better"): for at least 15 years, agents have been required to use their National Producer Number (not their social security or state insurance license number) to sign in and get credit for a course.

Let me repeat that: the NPN requirement is a decade and a half old.

Which of course 2 students completely ignored, causing me to then go to the state insurance department website and drill down to their personal info and obtain that information so that they could get their CE credits.

And these rocket surgeons "advise" their clients on transactions worth thousands of dollars.


Wednesday, July 17, 2019

Heads' up for cancer

Today is especially relevant for my late sister's friends and family:

Please pass the word.

Medicare Questions You Never Asked

Medicare questions you never asked (because there are things no one ever told you about). Don't you hate it when you buy something and then find out it didn't work as promised? Some things can be returned for a refund.

Others cannot . . .

Your Medicare plan is one of those things. Easy to get into at age 65. But you could run into a roadblock if you later have buyer's remorse.

Gary is a friend and is learning about Medicare the hard way. Gary is just now learning prior authorization.

Before he can have a test ordered by his doctor, the carrier must APPROVE the test. It’s all about the money.

His oncologist wants him to have proton therapy but his plan will only pay for a less expensive protocol. Dollars drive many medical decisions when an insurance carrier controls your benefits.

Proton Therapy – It Helps Only a Few at a Wildly Extravagant CostMedPage Today

All he wants to do is get well but his Advantage plan is running interference. His carrier is interested in saving money. THEIR money. Not his.

It’s all about the dollars. Just another Medicare thing he did not know.

#MedicarePriorAuthorization #MedicareAdvantage

Tuesday, July 16, 2019

Are Medicare Advantage Plans Good?

Medicare Advantage plans good or bad? Like everything else, it depends on your perspective. But how will you know if an Advantage is right for you if you don't know the right questions to ask?

Too many people don't UNDERSTAND MAPD plans. No premium to pay. Dental and vision coverage included. What's not to love?

How about access to health care?

Some folks have medical conditions that require specialized care and there may only be a handful of Medicare Advantage providers in your area that offer that kind of treatment. There are patients who have a level of trust with their provider that cannot bridge saving $$$ to follow the path allowed by the HMO.

The choice of plans is not JUST dollars and cents. Too many agents either ignore this aspect or don't understand it. How Medicare Advantage plans are sold, what you are told and what is omitted, can make Advantage plans bad for you.

Learn more about Medicare Advantage plans -


Monday, July 15, 2019

Congress Won't Whack the Cadillac

The resurgence to repeal the Cadillac Tax is front and center - again. This time it is due to the overwhelming support in the House of Representatives which allows for a bill to move to the floor when there is a supermajority of co-sponsors.

In this case the Middle Class Health Benefits Tax Repeal Act of 2019 has 361 co-sponsors - 83% of all members.

So, why then with such huge bipartisan support will repeal fail? It is simple, from an IB post back in January of 2018:

"But here's the truth. Congress needs the Caddy Tax. They need it for the revenue on paper. When CBO scores in ten year windows it shows an accounting sleight of hand that many of us don't know. It shows as revenues - whether collected or not. 
Having IOU's is how they trick us in to believing that they are good stewards of our tax dollars. Sad truth is they simply don't care about spending your money. They care about you voting to re-elect them. Which is why kicking the can down the road is the avenue of choice for those we elect in DC."

In this installment of Congressional drama the supermajority will use the opposite angle saying that they can't kill the tax without offsetting revenues. They will again claim to be good stewards of our tax dollars and voice how much they dislike the tax.

But when the dust has settled the Cadillac Tax will live. Probably to never see the light of day except on those occasions where playing politics allows it to briefly see the light of day.

No good deed....

From our friend Holly R:
Which is a sweet gesture, until one realizes the unintended consequence:

"According to the IRS, if you have canceled, forgiven, or discharged debt for less than the amount you pay, the amount of the canceled debt is taxable income."


Now, the taxes on this difference are, obviously, a lot less than the debt itself, so this isn't a slam on the idea. But if the recipients are unaware of the largess, or of this tax rule, they may be in for a nasty surprise at year's end.

"You get a car, and you get a car..."

Adds up.

Friday, July 12, 2019

A Deadly Conundrum: Updated

Last fall, we reported on this tragic story:

"California dad charged with insurance fraud after he drove off cliff, killing autistic sons"

Turns out, "Father of the Year" (non-)contender Ali Elmezayen had purchased the policies just over two years prior, presumably planning ahead to avoid the contestability clause which "allows the carrier to review a recently approved policy to see if there were any misstatements or misrepresentations" and goes away after the first two years. So it appears that Mr E thought that a two week "cushion" would be sufficient.


"A California man has been charged with murder for allegedly driving his family, including his two autistic sons, off a Los Angeles pier after buying $6 million insurance policies in case of accidental deaths."

And of course "accidental death" nature of the plans was a nice touch: these policies are generally a fraction of the cost of a regular term or whole life plan. And if the goal is to collect in a couple years anyway, who needs long term premium guarantees?

Be a darned shame if anything untoward happened to him in prison.

Rx Anecdate: Contra-Narrative

At my recent annual physical, i was prescribed, at the tender age of 39(shut up), my first-ever maintenance med: 10 mg daily of Lisinopril for moderately high blood pressure.

[ed: this came as somewhat of a shock, inasmuch as I'd heretofore been considered a carrier]

It's become fashionable of late to dump on Pharmacy Benefit Managers (PBM's) and specifically Aetna and CVS. Well, I'm insured under an (HSA-compliant) Aetna plan, and I had the scrip filled at my local CVS for the princely sum of .... wait for it ... $2.21 for a monthly supply.

I think we can swing that (at least for the nonce).


Thursday, July 11, 2019

Bon voyage! [UPDATED]

UPDATE: Monsieur Lambert has passed away.

"Vincent Lambert, 42, died Thursday in a hospital in Reims nine days after doctors stopped providing artificial feeding and hydration, ending years of legal flip-flopping over whether to keep him alive."

[ed: original post below]
The name of the French national health care system, La Sécurité Sociale, pretty much guarantees that this would be the outcome:

"French Quadriplegic Being Starved To Death By The State"

In 2008, then 31 year old Vincent Lambert was left in that condition as a result of a terrible car accident.

Flash forward 11 years, and the poor man has been ordered starved to death by the (warm, compassionate, caring) French government:

"The Cour de Cassation overruled an appeals court which had directed doctors to keep Mr Lambert alive pending a review of his situatoin by the Unitoed Natons Committee on the Rights of Persons With Disabilities."

This echoes Iceland's take on Down Syndrome babies:

"Iceland is on pace to virtually eliminate Down syndrome through abortion."

Inconvenient, non?


[Hat Tip: Ace of Spades]

From the 'Be Careful What You Wish For' files


"Cone Health CEO Terry Akin urged staff to contact legislators to advocate for hospitals' position on the issue."


"Burn in hell, you sorry SOBs"


Short take:  North Carolina Health Plan honchos have proposed a new reimbursement scheme for Tar Heel State hospital systems that include some pretty draconian caps, and one provider's manager followed orders (maybe a bit too zealously).

[Hat Tip: Co-blogger Bob]

Wednesday, July 10, 2019

Sigh: Some folks just don't 'get it'

So, working with a customer who needs a short term medical plan for his wife, who is an American citizen living abroad. I was able to find only one carrier that didn't require a recent stateside residence, and so I quoted that carrier. As always, I quoted using the maximum lifetime benefit (in this case, $1 million). The client asked about $1,000 and $2,000 deductibles (which I think is a mistake, but that's what he asked for).

So I quoted as he asked, and the premium came out to $325 per month for the $1,000 deductible plan, and $256 a month for the $2,000 version.

He balked at that, claiming that I'd previously quoted a much lower rate. I pointed out that we had been looking at a $5,000 deductible (which would have been well under $200 a month). He thought that still might be spendy, and he would check with his home country's options. I wished him well and told him that I'd be happy to write this plan if the home country option didn't pan out.

This morning, I get this in email:

"This quote sounds good to me.

What if I take insurance for 250 G instead of million and keep deductible to 1000 or so?

This [home country plan] is world wide known. May be you can also use them check it out.

The currency conversion is Rs 70 to a dollar, so the premium is about $150 for 3 month.

Please let  me know your thoughts

[ed: it was unclear if that was $150 a month for 3 months, or $150 one-time premium]

This is becoming tiresome (we make very little on Short Term plans, and he's quickly using up the commission)(and my patience).

I replied:


No, I can’t sell for non-USA companies.

>> $250 G

No, I can’t do that: I will only sell the maximum benefit (for a number of reasons: E&O liability chief among them, also you really don’t save all that much lowering the maximum vs raising the deductible)

We'll see what he does.

Not really on tenterhooks here.

By the way: there's another very good reason to not skimp on that policy max: insurance is, essentially a gamble (yeah, yeah, I know) and it's a lot easier to come up with an extra three or four thousand dollars than 10's or 100's of thousands.

Tuesday, July 09, 2019

Another STM Dilemma

A Twitter friend pointed out that:

Although I knew what she was saying, I asked for clarification (to make sure we were on the same page), and she helpfully responded:

"When you sign up 1-15 you are not covered until the First of the following month. From the 16-31st the plan starts the 1st of the second month."

That is, if you sign up on June 3rd, your coverage doesn't begin until July 1st. And if you sign up September 17, your coverage doesn't start until November 1st.

This is where a Short Term Medical plan could come in mighty handy (too bad for the folks in states such as Connecticut and California, that outlaw them).

Sexist Stats

So, got this yesterday from the CDA (The Council for Disability Awareness):

"In a new survey of the awareness and ownership of disability insurance across today’s workforce, The Council for Disability Awareness (The CDA) uncovered that the 32 million, unmarried women workers, who make up 25 percent of today’s American workforce are underinsured for a disability."

Which is, no question, a shame.

But I immediately replied:

"That’s interesting.

How about similar stats on men, who make up 66% of the workforce?

I’ll wait…

Breath status:

[x] NOT held.

Monday, July 08, 2019

Off Topic: Two Great Causes

So last Friday evening, we attended a local food truck rally (and very cool fireworks display) and learned about two very worthy causes:

Warrior Weekend to Remember honors combat injured vets and Gold Star families (and even first responders and their families) with an incredible weekend experience that includes:

- Indoor Kart racing
- Skydiving
- Hot air balloon rides
- A bonfire and concert

And more!

Click here to learn more about this fantastic program.

■ The 1st Annual PNC Community Mutt Strut is coming up in October, and includes a dog parade, vendors and food, even door prizes. Approximately 22 veterans a day commit suicide, and it's the Mutt Strut's purpose to change that by providing service dogs to vets with PTSD, brain injuries, and other combat-related mental health issues.

You can learn more about the organization, and the parade, by clicking here.

Saturday, July 06, 2019

Friday, July 05, 2019

Sidebar News: Life Happens

Been meaning to do this for a while, but was challenged finding "just the right one."

People often ask me "how much life insurance do I really need?" I have a special form that I give these folks to do their own assessments (lest they think I'm "goosing" the numbers). But in this digital age, I realized that it may be preferable to offer an online tool, preferably one that keeps such information anonymized.

A friend suggested that I have a gander at the Life Happens site, and sure enough, there's a very nice, intuitive, anonymous widget that I think fits the bill quite nicely. Available now in the sidebar, under "Resources."

Check it out!

Thursday, July 04, 2019

Wednesday, July 03, 2019

Who knew?

That India had adopted the HMO model:

"An Indian man who had been declared dead woke up just before he was set to be buried during a funeral ceremony."

He'd apparently been in an accident and was taken off life support, "coincidentally only after the man’s family told the hospital that looked after him they no longer had the funds to pay for his care."


Yeah, go with that.

Confounding Case Bleg

Co-blogger Bob offers a poser:

"Unusual situation referred to me by agent in another state.

Mother-in-law relocated to Atlanta from Pakistan. Green card holder, age 71. Health status unknown (didn't ask). Looking at possible options. Coming up empty or "are you kidding".

■ Medicaid - possibly the best option depending on how they define household income.

■ Obamacare - I assume she can qualify but no subsidy. Outrageous premiums and OOP

■ International travel medical - pre-ex snake pit

■ Health share ministry - must be Christian? Other religious affinity including Muslim? Pre-ex? Not readily accepted by docs/hospitals since no guarantee of payment. HSM is a very remote possibility but want to throw that out as an option

I checked the site, and was surprised to learn that "Gained citizenship or lawful presence in the U.S." triggers a Special Open Enrollment opportunity.

So, armed with her new zip code, I went plan shopping. The least expensive option was a Bronze level Blue Cross plan with a $6,750 deductible and a $740 a month price tag.

The advantage, though, is that it's guaranteed issue and pre-existing conditions are covered right away.

Since we don't know her health status, it's impossible to determine whether or not other non-Medicaid options would work (since they all have either underwriting, or pre-existing conditions limitations, or both).

I also thought about "Dave's Plan," but the age cut-off for that is

Alas and alack.

So, suggestions welcome.

Tuesday, July 02, 2019

Tuesday LinkFest

■ Item #1:

"Medtronic recalls MiniMed insulin pumps as FDA warns about hacking risk"

This is a major issue with the whole Internet of Things phenom. The danger, of course, is not just the threat of ransomware 'per se,' but that actual lives could be put at risk.


■ Item #2:

We haven't heard from our friends at the MVNHS© lately, let's correct that, shall we:

"NHS beds crisis 'critical' as more sick Brits left stranded in hospital corridors last month than at the height of winter"

Which is even more alarming, in that the stated goal is to have no more than 85% of available beds occupied.


■ Item #3:

So-called "balance billing" (aka "surprise billing") is nothing new to regular readers:

"These hidden providers are like gunslingers in the wild west. They are not beholding to any rules and are free to charge whatever they want. If you don't pay they can ruin your credit and there is little you can do about it other than pay up."

The problem has only gotten worse over time, and there are all kinds of ideas being proposed to try to rein it in (including forcing out-of-network providers to accept in-network pricing). Some folks even think t should be illegal to engage in the practice.

But what about the other side of the coin?

Former Solicitor General Paul Clement makes the legal case for balance billing:

"The ability to refuse to accept an insurance plan is what gives doctors leverage when negotiating their rates ... [which] would likely violate the First Amendment's guaranteed freedom to assemble, as well as the Fifth Amendment's protection against government "takings"


Monday, July 01, 2019

It pays to read the mice type

How many times are we told to "read the fine print" versus how many times we actually do?

Well, here's a case where someone did, and it paid off bigly:

Which turned out to be quite providential:

"We estimate that less than 1 percent of travelers that purchase a travel insurance policy actually read   all of their policy information — and we’re working to change that.”

That's nice, but how, exactly?

So glad you asked:

"[T]he first person to email the company and mention the fine-print contest [will] win $10,000."

And so she did, and so she did. 

Mazel tov!