Friday, September 13, 2019

Breaking (Good) News: Dorian SEP

Just now in email from CMS:

"SEP Available for Victims of 2019 Hurricane Dorian"

This addresses concerns that folks who had become eligible for an SEP but unable to finalize a new plan because of storm-related issues will get another bite at the apple:

"Consumers who qualified for an enrollment period, such as an SEP, but were unable to complete a Marketplace application, plan selection, or enrollment process due to Hurricane Dorian, may have access to an Exceptional Circumstances SEP."

They get an extra 2 months (well, 60 days) to log in and enroll, and "request a retroactive start date based on when he or she would have picked a plan if not for Hurricane Dorian."


[Additional info is available here or by calling 1-800-318-2596]

Heads' up Dayton (OH) folks

As part of our Strides Against Breast Cancer fundraising, we're helping out with Brunch & Beer at the 5th Street Brewpub in the St Anne's District:

“Love, Hope & Faith” team for the Making Strides Against Breast Cancer Walk will be hosting a Fundraising Event at the Fifth Street Brewpub on Sunday, September 15th from 10 AM to 2 PM.
Come and join us for Sunday Brunch.
The team will be “Guest Bartenders” during the event and will be raising money for the fight against Breast Cancer. The walk is on October 19th at Fifth Third Field in Downtown Dayton.

Thursday, September 12, 2019

Lowe's blows

Back on August 31, we purchased a new oven from our local Lowe's store (wanted to support the local folks instead of ordering online). That proved to be a mistake.

We were promised delivery by today (September 12), and that was the last we heard from them.

No follow-up, no notification, nothing.

So I called the store this morning, and was informed that the delivery had been pushed out to the 22nd.

Again, no one bothered to communicate this to me. I only learned of it because I initiated the call. I told the manager that this was not acceptable, and that I expected delivery today. He insisted several times that he couldn't promise that. No effort was made to accommodate or offer alternatives.

So I called corporate, and was informed that the oven had been delivered to the local store, but because Lowe's store managers are incompetent, I had to learn from the nice lady on the phone that their rule is that they can't send items out for delivery on the same day, and that tomorrow's deliveries are already booked.

To her credit, she reached out to the "delivery coordinator" and promised me that she'd have him contact me directly to make arrangements. I eventually heard back from the coordinator, who was able to move the delivery up to this coming Sunday (Yay!).

So, all's well that ends well?

Not hardly: I should not have had to call them to find out what was happening, and the fact that each person I spoke with had a different story, is unacceptably poor customer "service."

 We have had been long-time, loyal customers, but no longer.

It's worth noting that  other stores, like Home Depot and Best Buy, will generally match Lowe's prices.

Nataline Redux

In which I play the bad guy:

Regular readers may recall the sad case of  Nataline Sarkisyan, "a 17-year-old girl who died hours after her health insurer reversed its previous decision and said it would pay for a liver transplant planned."

There was a lot of finger-pointing, and plenty of blame to go around, but there were also some key issues that prompted much circumspection:

The insurance carrier (Cigna) had initially refused a liver transplant, the fact that experimental treatments are (at best) problematic, and whether PR should override best practices.

Regardless, Ms Sarkisyan ultimately passed from her condition.

Now, fast forward almost a dozen years, and we learn of a young mother who, having undergone "major surgery to remove thyroid cancer ... has never truly recovered." She was fortunate to find a "world-renowned expert in dysautonomia and autonomic neuropathies," and began treatment.

Unfortunately, these appear to have been largely ineffectual, and she's now at a very dark place indeed:

"The only treatment that is anticipated to help her is expensive, costing $6000-7,000 per infusion, and the doctor has prescribed 6 infusions to enable her body to reconstitute itself and get her on the road to recovery."

To that end, her family has set up a GoFundMe campaign [full disclosure: I have donated to it] hoping to raise enough money to cover most (if not all) of the expected costs.

Okay, a worthy cause, but why isn't her insurance company covering it (or at least most) of it)?

Well, that's because the carrier, Aetna, "has refused to pay for the treatments, calling the drug "experimental" and providing no recourse for her worsening condition."

Seems familiar, no?

[ed: for the purposes of this post, we'll table discussion of an insurer's putative responsibility to offer alternative treatment suggestions]

As noted in the GFM, there have been appeals and advocates, apparently to no avail.

As a parent and husband myself, I can certainly sympathize with the family's plight, but I have some questions.

So I've reached out to both Sarah's family and her insurance company, and would like to share what I've learned:

Her father, who was very nice and forthcoming, had no direct knowledge of the plan's details. He in turn put me in touch with his son-in-law (whose employer's coverage is the insurance at issue). Unfortunately, he has yet to respond (I'll update the post if/when he does).

In the meantime, I also reached out to Aetna:

"Good morning!

We're working on a post about [the GoFundMe], and would like to have Aetna's side, as well. We understand that you can't comment about this case specifically, but would be interested in speaking/emailing with a claims person who can address the dynamic between experimental vs medically necessary treatments.

Looking forward to hearing from you

About which co-blogger Bob gently prodded me:

"Still tilting at windmills?

Carriers RARELY set their own standards for medical necessity, experimental, provisional. Much easier to follow CMS guidelines as in  "it's not my fault, this is how Medicare handles it."

Doubt you will get very far with this, even without factoring PHI complexitie

I knew that he was right, but "in for a penny...."

In the event, I did, in fact, hear back from them:

"Hi Henry:

My name is Ethan Slavin and I work in the Communications department at Aetna. While we can’t comment on this specific situation (as you noted), we can provide you with our general overview on how we make coverage decisions.

You are welcome to use information from this page for your post, as you see fit.

Please let me know if you have any questions

Which was not unexpected, and actually helpful.

I would still like to know whether or not the plan in question is self-funded (because that could make a difference), but the reality is that Bob's correct, and while sad, this is pretty standard, and not subject to online petitions and the like.

Again, I'd ask why the venom is being directed at Aetna and not the folks with the high-priced meds, or the providers who would administer them.

But that's just me.

Wednesday, September 11, 2019

Offered with no comment

Okay, one comment: Heh.

[Hat Tip: The Gormogons]

Medicare MSAs

[Full disclosure: I am not active in the Medicare Supplement/Advantage market]

Recently received this in email:

"New for 2020: Lasso Medicare Savings Account Plan"

Medicare MSA's appear to be the post-65 version of what we typically see as Health Savings Accounts (HSAs) in the pre-65 market, with some interesting twists:
• $0 Premium
• MSAs are one type of Medicare Advantage (MA) plan that the Centers for Medicare and Medicaid Services (CMS) partners with private insurance companies to offer. MSAs combine a high deductible health plan covering Medicare A/B expenses with an IRS-approved trust/ custodial savings account.
• No admin/monthly fees for MSA account while beneficiary is on plan
• See any provider or hospital that excepts [sic] Medicare!
• Individual must enroll in a stand-alone [Part D Rx Plan].
• HSA account funds can transferred into new MSA accounts. 
• Plans are available in every county in the states where they are available [ed: go figure].

I checked with co-blogger Bob V (who's very active in the Medicare market) and he confirmed that the idea is legit.

This particular iteration is intriguing, since the vendor, not the insured, is making the actual deposit. Once that's made into the insured's account, it's immediately vested, and can be used for medical-related items (like doctors' visits and rx co-pays). Since it's 100% the insured's money, there's definitely some 'skin in the game,' and we can see that in action:

"[A]s of September 1, 2019, 81% of all Lasso Healthcare MSA plan members had spent less than $1,000 in their current benefit period!"


[ed: I reached out to see if the insured/beneficiary could also contribute to the account, and will update this post if/when they reply]

Currently, the Lasso plan is available in over 25 states (almost half of them!).

Cool idea.

[Hat Tip: TLC Recruiting]

Tuesday, September 10, 2019

Contra Conventional Wisdom

Our friend Holly R sent this along:

"The share of Americans with health insurance fell last year, despite a strong economy that lifted families out of poverty." [emphasis added]


More likely: because (better wages = lower/no subsidy)

It's just common sense.

That sinking feeling

You've likely read about the tragic story of the diving boat incident that claimed almost 3 dozen lives last week. One of the unexpected things that happened pretty quickly was a lawsuit ...

Wait a minute, Henry: why would that be a surprise? Of course the families of those killed would seek some kind of compensation.

Well, that's true, of course, but this lawsuit was actually filed by the boat's owner against those families.


Well, it seems that there's a longstanding maritime law that enables a boat's owners to limit (or even prohibit) monetary damages as a result of this kind of tragedy:

"The owners of the diving vessel that caught fire in California and killed 34 people last week filed a pre-emptive lawsuit last week, seeking to limit payouts to the families of victims. The lawsuit was filed three days after the boat caught fire, while families were still grieving, and bodies of the victims were still being removed from the water."

Wow, talk about heartless.

But maybe not:

"The owners ... have blamed their insurers for a lawsuit that they  filed to limit their payouts to victims' families, calling it an "unfortunate side of these tragedies."

Oh sure, blame the insurer.

On the other hand, it's the insurer's duty to its policyholders and owners (stockholders) to limit those damages, and that's why they keep lawyers on hand for just this kind of situation. It does seem rather crass, but the insurer is also bound to do all it can to mitigate the damages. And the timing, while unfortunate, may have little to do with lack of compassion, and much to do with timely filing.

Our hearts, of course, go out to those families, but this seems to be strictly business.

Monday, September 09, 2019

Making Strides Against Breast Cancer: v2019

Once again, I'm raising money with my team: Love, Hope and Faith. Our walk is Saturday, October 19th.

Will you please help out by making a donation - Any amount helps.

Thank You!!

Problem solved? Sorta, maybe.

Just about two years ago, we reported on a potential problem still lurking under the radar:

"For decades, life insurance carriers ... sold permanent universal life insurance policies, marketed as "insurance for life," utilizing outdated mortality tables that did not take into account the fact that Americans were, and are, increasingly living to and past the age of 100."

To be sure, there are still quite a few other permanent-type plans out there with the same issue.

And what issue is that, Henry?

Well, when these plans "mature" while the insured is still alive, that person is likely to be hit with a pretty hefty tax bill; that is, the policy is paid out as a lump sum to the insured, and any excess over the total premiums paid are taxable. That could be a sizeable sum indeed, and is a double whammy (since that policy is now canceled).

Until now, there really wasn't much one could do about in-force plans (hence the clarion call for a class action lawsuit).

But in a Long Term Care insurance (LTCi) product training session last week, I learned about another product that might be a solution to the tax issue:

OneAmerica Life offers an annuity product that's available to folks up to 99 years old, and doesn't require forced annuitization (or Required Minimum Distributions). While marketed as a potential LTCi alternative, it struck me as solving at least part of that "maturation" problem, since there's no immediate funds to pay out and thus be taxed. Called "Legacy Care®,"  it lets one roll-over the cash value of an existing life insurance policy and continue to defer taking the tax "hit" (although it's going to fall to one's heirs eventually).

Not perfect, of course, but at least a little light at the end of the tunnel.

[Hat Tip: FoIB Randy G]

Friday, September 06, 2019


So a while back, we blogged on the potential issues one might face as a trans/other-American in the market for life insurance. It's now back in the news (sorta) due to this rather silly Tweet:

It's silly because (for starters) trans/other Americans comprise barely a rounding error of the general population. Actuaries, by definition, work with very large groups, not infinitesimally-small ones, which would yield an essentially meaningless sample.

But wait, it gets "better:"

Actuaries estimate "probability of risk," that is, the likely number of expected deaths from a (again, large) population; it's merely a pricing tool.

The only opinion that matters here is the underwriter's, because his job is assessing the specific risk, and then deciding whether or not it's acceptable, and at what premium (rating factor).

In the event, neither of these folks would ever even see such an application in the first place, for a very simple reason: all life applications require one to provide name, social security number, date of birth, and sex (among other things). Applications missing this information will be returned to the agent for completion.

There's also the small problem of the "misstatement of age or sex" clause, which would come into play at claim time.

But even more important, from that underwriter's point-of-view, is this:

"As I discussed with a life field rep friend a while back, the life company is likely to decline the case altogether because of the increased suicide risk."

By the way, these issues would also come into play with auto, disability income, long term care and other types of insurance, as well. Which means a lot of wasted time for a trifle.

Talk about much ado ....

Thursday, September 05, 2019

Up next from MoO

Mutual of Omaha, that is:

"We hope the first video interview we did with Demerri Bond was helpful and insightful. Now, we're excited to bring you the next in the series, an interview with underwriter Carol Carville."

MoO is currently our primary LTCi carrier (due to great value and strong financials), but the points Carol makes apply to pretty much all carriers.