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 404Care.gov 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

404Care.gov: Week One Report


Hunh:

"In week one of the 2020 Open Enrollment period, 177,082 people selected plans using the HealthCare.gov 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

MVNHS© News



 [click to embiggen]

But wait, there's more:

But hey: Free!

#Medicaid4All
 

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:



Hunh.

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]