Timely Life Insurance Notice...

Joe Kristan at Roth & Co has a timely and important post about some of the games folks have been playing with life insurance policies.

If you're a business owner, and especially if you're using life policies inside your pension plan, this is a must read.

Grand Rounds is up...

Over at Healthy Concerns. This week's host, Elisa Camahort, has organized the posts according to how each one helps laypeople understand the health care delivery system. Nicely done!

HSA and LTCi...

As we continue with the theme “Better Living Through Acronyms,” we turn to how HSA’s can serve another purpose: funding for long term care insurance.

Over the past several posts, we’ve discussed how an ageing America needs to deal with the long term impact of increased life expectancy, and how Health Savings Accounts enable folks to make informed and pre-funded choices about their health care. But these two ideas are also inextricably intertwined [ed – that’s pathetic].

Did you know that you can pay for Long Term Care insurance (LTCi) out of your HSA? And when you do, Uncle Sam is subsidizing your premium. So there’s a double benefit at work: saving premiums on your health insurance by purchasing that High Deductible Health Plan, and using some of those savings to fund insurance against a catastrophic long term care claim. Not bad for a plan that was supposed to destroy the health care system as we know it.

Why is this so important? Well, as Boomers age, the need for long term care increases, as does the cost of that care. According to accepted industry “common knowledge,” 1 out of every 3 retirees are going to need some form of long term care before they pass on. Of course, this doesn’t necessarily mean a long stay at a nursing home: it could mean adult day care, respite care, someone checking in once or thrice a week, as well. And those aren’t necessarily free. And if there’s even a mild stroke, for example, it could take months for a full recovery.

This takes on added import when one considers that, according to a study by MetLife, LTCi is the fastest growing benefit being offered by Fortune 500 companies. These plans are usually offered on a “voluntary” basis; that is, the employer offers the plan (underwritten by an insurance carrier) but doesn’t pay any of the premium. These are usually deducted from an employee’s paycheck, but could come right out of the HSA.

Younger Boomers can also reap rewards from this technique: funneling those tax-advantaged dollars into insurance against a future claim. One particularly intriguing technique now being used is for such folks to purchase limited-pay LTC policies. These plans guarantee that after you’ve paid premiums for, say, 10 years, no more premiums are due, and the policy is fully “paid up.”

Sweet.

Financial Carnivals Update...

The Carnival of the Capitalists is up at CaseySoftware. And the Carnival of Personal Finance is hosted this week by All Things Financial.

The C of the C's tends to be more business-oriented, while the C of PF is geared more toward the consumer. Of course, there's always some overlap.

If you're looking for a break from the mundane, both places offer a smorgasboard of new ideas.

NOLA...

Our thoughts and prayers are with you.

DOI vs CDHC (Part 2)...

In Part I we began our dissection of California Insurance Commissioner John Garamendi’s baseless screed against Consumer Driven Health Care plans. Interestingly, in his own backyard, such plans are helping to drive down the cost of health insurance. The Galen Institute (a think tank specializing in health and tax policies) reports that:

“Premiums for HSA-eligible insurance dropped 15% between 2004 and the first half of 2005...Several California cities, such as Long Beach, had the most affordable rates."

In any case, let’s complete our analysis of Commissioner Garamendi’s dire warnings that Health Savings Accounts and Health Reimbursement Arrangements would:

“Make the health system more complex” If anything, the beauty of CDHC is that it simplifies how medical care is reimbursed. By way of example, let’s compare a typical, ubiquitous “plain vanilla” co-pay plan with a generic HSA plan:

Under the co-pay plan, one has the privilege of paying just $25 at the doc’s office. Let’s say that occurs twice a year. There’s also a prescription drug card that allows one to pay just $15 for that generic medication the doctor prescribed on one of these visits. Already, there’s three things to keep track of (the premium, the doctor’s visit co-pays and the prescription co-pays). Plus, one has to keep in mind the different co-pays on the medication, depending on whether it’s generic, brand name, or even formulary (confused yet?). Add to the mix one’s $1,000 deductible for the “big-ticket” items (like MRI’s. Or bloodwork), and the co-insurance percentage once that deductible is met. Was that 80% or 75%? Was that before or after network discounts were factored in?

Contrast that with the High Deductible Health Plan that’s at the heart of CDHC. There’s no co-pay, no drug card, no co-insurance. It’s your pocket (the deductible) or the insurance company’s (after the deductible is met). So which plan is more complex?

“Result in inefficient use of resources” The argument here is particularly disingenuous:

“It is estimated HSA’s will cost the federal government $7 billion in lost tax revenue over the next 10 years.”

Leave it to a member of the political class to claim that letting people keep more of their own money, and make more empowered decisions about their own health care, will cost the gummint money. That’s just silly. And it has nothing to do with how resources are used, efficiently or otherwise.

And finally:

“Increase inequities in access” While that’s nice alliteration, it’s without factual foundation. His argument is that these plans “favor and will be used predominantly by upper income individuals.” But the facts don’t bear that out. Don’t take my word for it, let’s see what one of the carriers that spearheaded HSA in the marketplace has to say:

“Assurant Health, an HSA provider, says the rich and healthy are not the only consumers opting for HDHPs in conjunction with a tax-free account. The insurer reports that as of Feb. 28, 75% of its HSA enrollees have an income of $50,000 or less, with 27% reporting a net worth of less than $25,000.”

$50,000 doesn’t sound like “upper class” to me. So despite all the dire warnings that CDHC will lead to the immediate and catastrophic collapse of our health care system, the facts indicate otherwise. Kinda makes one miss (former CA) Commissioner Quackenbush.

UPDATE: David Hogberg, senior research analyst at the Capital Research Center, also has a good article about this subject at The American Spectator.

More on CDHC...

Health Business Blog has a post on how more and more large companies are beginning to offer some form of Consumer Driven Health Care, including HRA’s and HSA’s.

One of proprietor David Williams’ conclusions – one with which I wholeheartedly agree – is that “(a)s more employees try out consumer directed plans, expect consumers to demand better information about quality and cost.”

Read the whole thing.

It's Carnival Time!

WoW! Three blogbursts today:

Grand Rounds is up over at Straight From The Doc.

The Carnival of the Capitalists lands at Strange Brand.

And this week's Carnival of Personal Finance can be found at Frugal For Life.

This is a fun and easy way to experience a lot of different blogs that share common themes. Have fun!

DOI vs CDHC (Part 1)...

Recently, California’s Insurance Commissioner blasted consumer driven health care in general, and Health Savings Accounts in particular. Commissioner Garamendi claims that these “skeletal” policies will:

-Put the entire health insurance system at risk (yikes!)

-Cause patients to forego needed care

-Increase cost shifting

-Exacerbate loss of benefits

-Make the health system more complex

-Result in inefficient use of resources

-Increase inequities in access

-Raise your cholesterol

-Increase global warming

Okay, I threw those last two in to see if you were paying attention. Seriously, though, it’s these “the end is near” doomsday scenarios which bureaucrats like Commissioner Garamendi bandy about that cause them to lose credibility, since they are so easily debunked. Let’s examine (and put to bed) each of these claims one by one:

“Put the entire health insurance system at risk” Putting this one first was probably a bad strategy: after all, if you’ve already destroyed the whole system, then the rest of these objections seem fairly paltry. About 15 years ago, when MSA’s first came out, the then-president of a large health insurer wrote a whole book about what a catastrophe Medical Savings Accounts would be, and that their very existence threatened to destroy the health care system as we knew it.

Sound familiar? Well, as we can see, the industry, and the country, survived our experience with MSA. The truth is that the concept of consumer driven health care is one of personal responsibility and choice: if one doesn’t care to participate, one is free to choose from amongst many other health insurance options.

“Cause patients to forego needed care” If anything, CDHC plans encourage folks to take care of themselves: if you’re spending your own money, then you want the most bang for your buck. And we already know that it’s cheaper to see a doc than visit the ER. Or the ICU.

“Increase cost shifting” Coming from someone in the gummint, this one is pretty funny. After all, when it comes to cost-shifting, there is no bigger culprit than Uncle Sam (or Uncle Arnold, etc). Between Medicare and other government programs, the private sector really takes it on the chin. The problem here, though, is that it’s a red herring: the type of plan one has doesn’t dictate what costs – if any – get shifted. The Commissioner’s beef seems to be that providers will get stiffed on uncollected deductibles and co-insurance. He makes no attempt to bolster this claim with any hard numbers.

In Part 2, we finish out the list, and look at how CDHC is actually improving the system.

Healthy AND Wealthy...

Back in May, we discussed how some physician’s may be eligible for cash bonuses for keeping their patients well. Now there may be an opportunity for us patients to get in on the action, too.

In an effort to differentiate themselves from their competitors, carriers are always on the lookout for ways to offer “value-added” benefits. In recent years, more and more insurers have begun to offer all kinds on non-insurance products as adjuncts to their plans. For example, several carriers now offer membership discounts to health clubs, stop-smoking clinics, even massage therapy.

Why the (not so) sudden largesse?

One reason is undoubtedly marketing, but there are other factors, as well. It’s been shown that healthy employees are generally productive employees. And particularly in small businesses, the impact of even just one or two chronically ill employees can have a drastic effect on overall efficiency. And, of course, the proportionate cost of health insurance is magnified in such cases.

According to a recent article, “(e)mployees are embracing the idea, using healthy living habits to save themselves money. Those who don't participate aren't penalized.” In other words, the “carrot but no stick” approach. There are numerous ways to accomplish this, but a typical model allows participating employees to earn “credits” for participating in, for example, stop-smoking clinics, or monitored weight-loss programs, or even stress and anger management courses. Credits can be used to “buy down” the employees’ share of the health insurance premium, or even as a cash or vacation day bonus.

On a more modest level, many carriers employ an “affinity” model; that is, they’ll partner with local (or national) health clubs, diet workshops, and sporting goods stores to offer their insureds discounts on products and services. This is not unlike the plans that offer dental or vision services discounts. The point here, though, is to both encourage and empower the employee to take better care of himself, thus lowering the group’s claims experience, and premiums.

Some employers and their insurers “kick it up a notch” by adding disease management options for folks with chronic conditions, such as diabetes or pulmonary disease. Such employees have access to dedicated nurses, social workers, even dieticians.

The crux of the matter may be as simple as lifestyle choices. Obesity, tobacco use, alcohol and drug abuse, blogging are all behaviors that affect one’s health, and insurance premiums. Can something as simple as modifying such behaviors make a difference in the bottom line? According to UHC’s Dr Sandy Lewis, “(m)any studies over the years that have shown a strong correlation between a person's lifestyle and their health."

Food for thought.

Life’s a Beach, Part 2...

In Part 1 we looked at how life expectancy has improved over the years, as well as some of the reasons that it’s not even longer. One prediction in particular really hit home:

“(B)y 2050, “seasoned citizens” are expected to make up over 20% of the population.”

If this turns out to be the case, it has tremendous implications for both this industry and our culture. There is a great deal of conjecture, on both sides of the political aisle, about when Medicare will become insolvent, but no one on either side seriously believes that it will last until another 45 years without major changes. As well, a lot of these folks are going to need (or may already be receiving) some form of long term care, to be paid for by, well, whom?

In the insurance industry, when speaking with folks about retirement planning, we often use a leading question: “What if you live too long?” Now on its face, that seems a rather impertinent, if not obnoxious, question. It’s rooted, though, in the old adage that most folks don’t “plan to fail, but fail to plan.” That is, most folks have great intentions, but as we’ve seen in previous posts, those intentions are all too often ignored. So, if we don’t have adequate funds for our golden years and we’re healthy, what about folks who are in the same boat, but are ill?

And it’s not just about nest eggs: current statistics indicate that about 20% of those 50 and older will need some form of long term care. And as our population ages, that number is likely to increase. Medicare and Medicaid take up some of the slack, but not nearly as much as most folks think.

And these concerns carry over to the other study, as well: as we continue to make such wonderful advances in modern medicine, a lot of people that used to die from cardiovascular diseases and cancer are surviving the experiences. That’s a good thing, of course, but it’s not a cheap thing. Tests, MRI’s, chemo and medications all cost money.

And the cycle renews.

Conflict of Interest?

“About 10 percent of the nation's physicians have signed up as consultants to the investment industry, according to the New York Times. There's nothing necessarily wrong with that except that some of these investors are looking for proprietary data on clinical trials that can affect their sponsors' valuations.”

So reports Health Business Blog, in two posts that quickly and comprehensively sum up some of the ethical issues of physicians serving two (incompatible) masters. Recommended.

Grand Rounds...

is (are?) up at Circadiana. This is a unique blog, dedicated to the study of chronobiology. Take a gander, won’t you?

Anthem vs Premier vs Patients...

The contemporary comedian Gallagher is perhaps best known for smashing watermelons with a sledgehammer, covering his audiences with bits & pieces of the delectable fruit. I’m reminded of the resulting mess by this article in the Dayton Daily News:

“When Premier's network contract with Anthem expired on Jan. 1, Anthem stopped paying Premier directly for services at Miami Valley and Good Samaritan hospitals. Anthem sent reimbursement checks of four and five figures to enrollees instead.”

As one might imagine, not everyone who received this windfall forwarded the cash to Premier. And that’s where this whole messy episode gets complicated:

“Now Premier wants its money, taking legal action on what Shaw called "the most egregious cases." He said most of the suits are for bills in the neighborhood of $5,000, but they range from $1,000 to a $99,000 reimbursement check, which the patient said her estranged husband left town with.”

As with an onion, there are multiple layers here (not to mention a distinct, if unpleasant, odor). On the one hand, there is no contract between Anthem and Premier, thus Anthem would seem to be within its rights when it sends checks to its insureds instead. On the other hand, Premier did provide the services, and is entitled to be compensated.

On the gripping hand, however, is this:

“Anthem executives also said the suits were unnecessary because Anthem had offered to pay Premier the money that patients had not passed on to Premier.”

So, Anthem reimburses their insureds for medical services provided by Premier facilities, then agrees that perhaps that was ill-advised and offers to re-pay the claim directly to Premier, and Premier sues Anthem for – what, exactly?

“Citing Ohio law and the terms of Anthem's agreements with enrollees, Premier also has complained to the Ohio Department of Insurance over Anthem's payment policy for emergency services.”

Well, as we know from this episode, “(A)n indemnity insurer licensed to do business under Title 39 of the Ohio Revised Code would not be prohibited under applicable Ohio law from implementing the practice described in Anthem's notification.” So, Premier’s not likely to get very far with the DOI.

Premier’s position is that, regardless of the fact that there is no contract between them and Anthem, they still should have been paid directly; their contention is that “(i)f they'd done that, the patients wouldn't have gotten this windfall and spent it.”

As the saying goes, “what’s your point?” There is no contract, thus Anthem is under no obligation to adhere to Premier’s SOP. My only question is whether Anthem intends to 1099 those folks who received checks, as seems appropriate.

This whole situation reminds me of 2nd graders fighting over who gets to use the monkey bars first. Both sides need to grow up.

When $1.5 Million Still Isn't Enough...

I've always believed that the $3 and $5 Million lifetime maximums on medical plans was more than sufficient. Fact is, I've been known to claim that, for most folks, maximums higher than $1 million was more marketing than anything else.

Looks like I've been wrong:

"Chandler High School assistant principal Chris Knutsen reached the cap of his medical insurance policy last week and now must wait in limbo as his daughter’s life wanes."

Bob at Healthinsurance411 has the whole sad story.

UPDATE: Elisa over at HealthyConcerns informs us that one can make a donation on Haley's behalf at Hope For Haley.

Wearing Genes to Work...

Back in May we looked at the debate about using genetic testing in underwriting insurance policies. Recently, though, I’ve come across some examples, potentially either good or bad, of how genetic testing is changing the workplace.

For example, Chicago Bulls center Eddy Curry, a 22 year old in seemingly fine shape, was found to have an enlarged heart and an irregular heartbeat. According to an article in the Seattle Times, there is concern that he may have hypertrophic cardiomyopathy, which can be caused by a genetic defect.

According to the article, there’s a simple test that can identify up to 60% of folks who inherit such conditions. Seems like a no-brainer, right? Take the test, see if it’s congenital, go from there.

Not so fast. As we discussed in May, these things have consequences. Depending on the results of the test, Curry’s career could be over, and he may have trouble purchasing insurance (after all, this is now a known condition). Or he may be one of the 40% for whom the test doesn’t work, and thus may never know for sure.

Now, most of us aren’t NBA stars (or even wannabe’s), so we may be thinking that this doesn’t really apply to “regular folks.” How many of us type (hint: if you’re using a keyboard with your PC, you’re typing)? Well, buried toward the bottom of the article is this little nugget:

“A couple of years ago, the Burlington Northern Santa Fe Railway tested the genes of injured workers, without their permission, to try to detect a genetic predisposition to carpal tunnel syndrome. The railway, apparently, was looking for a way to avoid workman's compensation claims by using an unproven genetic test.”

So, at least some people believe that there’s a carpal tunnel “marker” in the genome. Who knew? And what other “markers” lurk in our genes, which insurers, or employers, or even government bureaucrats might exploit?

Now, I’m not a member of the tin-foil hat brigade, but this bugs me. Since the focus of this blog is insurance, I’ll try to stay on that track. As we learned in May, health insurers (at least in Ohio) can’t use genetic testing in their underwriting, and life insurers don’t have to rely on it. But what about other states? Well, the bills we discussed in May related to health insurance, not life, although S 306 discusses “the potential misuse of genetic information to discriminate in health insurance and employment.” I could find no current federal legislation addressing genetic testing in life insurance underwriting.

So, where does that leave us? Well, it’s an issue that appears to be under most everyone’s radar, at least right now. But as more articles like the Seattle Times’ appear, perhaps we’ll see an effort to address it.

UPDATE: Dr. Hsien Hsien Lei of the Genetics and Public Health Blog has a related article. Check out "What's the Point of Finding Genes?" [ed - links are fixed now]

PBM’s, RPM’s, Whatever...

Here’s a way to help control the cost of health insurance.

PBM’s, or Pharmaceutical Benefit Managers, are essentially middlemen who buy med’s directly from manufacturers, and then re-sell them to health care plan sponsors. Along the way, they receive rebates and discounts. Problem is, they don’t always pass these savings along.

David Williams at Health Business Blog sets the record straight, and tells about how some of those plan sponsors are insisting on sharing in the savings.

Life’s a Beach...

When I first started in this business, lo those many years ago, the industry relied on something called the Commissioners 1958 Standard Ordinary Mortality Table, or 1958 CSO for short. The CSO was a means by which insurance companies (and litigants in wrongful death suits) could determine the likely lifespan of an “average” individual. Insurers relied on it (as well as other factors) in setting their rates for various life insurance products.

As time went on, and our lifespans increased (Yay, modern medicine!), there arose a need to update these tables and, in 1980, the NAIC (National Association of Insurance Commissioners) approved a new version, which showed significant increases in how long the average American could expect to live.

Every so often, these tables are revisited and revised, and we get an interesting snapshot of our own mortality. For example, one who turned 65 at the turn of the previous century had a much shorter expected lifespan than someone who turned 65 just 3 years ago – almost 7 years shorter!

The most recent table paints an interesting picture of America today (or at least late 2004): we’re living longer than ever before, for example, with about 12% of our population now over age 65. That number, by the way is growing: by 2050, “seasoned citizens” are expected to make up over 20% of the population. This would appear to be quite a challenge as we try to decide what to do with Social Security and Medicare.

In a somewhat related study, Tillinghast (a business which studies these things, so we don’t have to) recently published an Older Age Mortality Study which tracked causes of death among folks with life insurance. That study found that in general, cardio-vascular disease is the number one killer, but cancer killed more (insured) folks ages 50 to 69.

There are some interesting industry and social implications that arise from both of these surveys, and we’ll discuss those next time.

Grand Rounds...

Is up over at Parallel Universe. Dr Emer has done an outstanding job organizing over 40 links, covering a wide range of medical and medical-related topics. Take a gander.

The Classic Definition of Chutzpah...

Is the child who murders his parents, and then throws himself on the mercy of the court because he’s an orphan.

In today’s Dayton Daily News, there’s a story about a Cincinnati-area insurance agency that’s suing Anthem. Now, for those of us familiar with the recent shenanigans in which Anthem’s been involved (see here and here), this isn’t so surprising.

But what is surprising is why Total Benefits Planning Agency is suing them:

Apparently, TBPA put out a booklet called “How to Beat the High Cost of Health Care,” which advocated that employers should “shift certain employees 'away from the group policy' and replace their group coverage with individual policies.” I suspect that the primary reason that Anthem terminated their contract with TBPA has less to do with what TBPA advocated, and more with the very public way in which they did so. In other words, “don’t make waves.”

According to TBPA, their plan resulted in substantial savings for their clients. Other agents, however, took a dim view of this technique, citing the potential for adverse selection (that is, when the healthiest members of a group opt out, leaving only the sickest).

In any case, Anthem “pulled their ticket,” and TBPA is suing; I suppose for “damages” and for reinstatement.

The reason I find this so amusing is threefold: First, I teach Continuing Education classes in Cincinnati, so I know some of the players involved. The Cincinnati market is highly competitive, but in a particularly friendly way. So I find it somewhat amusing to see insurance folks sniping at each other in the local paper.

Second, I haven’t actually pulled out my most recent Anthem contract, but I presume it says what every other such contract says: this is an “at will” agreement, and can be cancelled at any time, for pretty much any reason, by either party, as long as proper notice (30 days IIRC) is given. Thus, we are both free to walk away, no harm and no foul. It’s also hard to see how TBPA can seriously argue that the termination “is denying consumers the right to explore alternative health care options." Last I looked, there were dozens and dozens of insurance carriers vying for business in the Cincinnati market.

Third, the underlying “tension” here is just plain silly: If the story is accurate (which I’ll assume it is) then TBPA was doing nothing particularly either controversial or unusual. With the proliferation of EOP’s (Employee Only Plans), cafeteria plans, carve-out scenarios and the like, there is no “there, there.” Heck, we’ve even had posts on this blog where we deleted the group coverage altogether, and substituted individual plans.

In the words of the Bard, this appears to be “Much Ado About Nothing.” And yet, it is obviously serious business: there’s a lawsuit. As a rule, I tend to side with fellow agents on issues regarding insurer behavior, but this one looks to me like a lot of smoke, and very little fire.

Still, it’s instructive in this sense: there are agents out there that do try to think “outside the box” on their clients’ behalf. It’s very easy to just quote the generic, cookie-cutter way: “Sure, Mrs Smith, we’ve got the $20 co-pay and $10 drug card benefit.” But as agents, we really need to be more creative, and really start talking more about alternatives such as HSA’s, and layering coverages.

Most clients would respect that, and most clients should expect that.

Talk About a Disconnect...

A lot of folks get their insurance coverage through their employers. And most pay at least a portion of the premium; the employer subsidizes the rest.

NB: I agree with Prof Sowell that this is “smoke and mirrors” economics, but that’s really not the focus of this post. Another time, perhaps.

In any case, most of us who get our insurance from our employer’s group plan have the premiums deducted from our paychecks (often pre-tax: c.f. IRC Section 125), and many come to believe that that contribution is the sole sum and substance of what the insurance costs. In other words, we believe that it really only costs $50 a week to insure our entire family, and we’re shocked to find out, when it comes time to elect COBRA continuation, that our measly weekly amount is the proverbial “tip of the iceberg.”

I had always suspected that most folks were woefully misinformed about the true cost of their insurance, but a recent study by MetLife bears this out:

" More than one-third of employees ages 21 to 30 and 28% of workers overall believe their companies spend less then $1,000 annually toward each individual's health insurance and about half the respondents believe the annual figure is less than $2,000. ”

If we take that $2,000 at face value, that means that almost 50% of our co-workers believe that their insurance costs less than $40 a week. According to the study, the true cost for family coverage is more like $7,200 a year, or almost $140 a week. That’s a pretty big disconnect.

So how does industry resolve this fundamental difference of opinion? Well, corporations can be more proactive in communicating with their employees. There are several services available that actually take the raw data (premiums, claims, etc) and massage them into a comprehensive, but quite readable, newsletter that goes to each employee. These personalized notes point out how much one’s employer really spends on health insurance, as well as worker’s comp and other coverages.

Another, perhaps more disturbing, issue that came out of this study is that over half the employees surveyed "say they value immediate-term benefits such as paid vacations more than income-protection products such as retirement plans, disability benefits, life insurance and long-term care." This seems to track with our cultural bent toward instant gratification, but it also results in a national savings rate of just a little over 1%, which is the lowest since the early 1930’s. Again, I think that this has to do with a fundamental lack of knowledge of how much the things we need really cost.

So, how do we overcome this communication shortfall? Well, as consumers, we should be more proactive: ask our providers about alternative treatments, and about how much services cost. And we should really read those annoying EOB’s: sometimes, the bills are wrong (surprise!).

Smaller employers should ask their agent to periodically come in and meet with employees, answering questions and explaining benefits. Larger employers should at least consider using one of those “benefits newsletter” service I mentioned above.

And I think that carriers should re-examine what information they put on EOB’s. Here’s a thought: how about, in plain English, explain exactly what was covered, how much of that went to the deductible, how much was paid at 80% (or whatever) – all in big type in the middle of the page, instead of mice-type in different areas, making it hard to piece together.

OK, rant over.

Tuesday Update...

This week’s Grand Rounds is up at AloisMD. This blog, by a 2nd year medical school student, chronicles life in med school and a future doc’s perspective on various social issues.

Tales From The Trenches 2...

When we left off, I had called XYZ Boxes, from whence Bill and Loni had been “let go.” I was transferred to Zack, who claimed that he was (in true Alexander Haig mode) “in charge.” After identifying myself and the nature of the call, I asked Zack for information about Bill and Loni’s COBRA situation. Zack bluntly told me that he had “no knowledge whatsoever” of any COBRA-related issues. In fact, he seemed rather proud of his ignorance. I explained to him that COBRA violations run to $1,000 a day, levied not just against the company, but potentially to him, personally. Apparently, this was of no real concern for Zack. So, I asked him for the phone number of the new company, which he was loathe to give. When I explained that it would take me a few seconds on Google to find it, he rather heatedly said “then do that,” and hung up on me.

Hmm…

Mama always told me “don’t get mad, get even.”

So, I Googled Acme Bags (you may recall that they were the older, larger company which had recently acquired XYZ Boxes), got the phone number of the home office, called, asked for HR, and left a message on HR’s voice-mail.

Oh, then I made one more phone call: to Shari at the Department of Labor, to “drop a dime” on Zack and XYZ Boxes. Seems that the DOL takes a dim view of such shenanigans, and I recommended that they open an investigation into how XYZ was dealing with its COBRA-eligible ex-employees.

By now it was pushing 4:00 in the afternoon, and after 2 hours of non-stop insurance fun, I sensed that my new clients were growing tired of the whole situation. So I reassured them that everything would be fine, and bade them farewell for the day.

When I arrived at the office at 7:45 the following morning, I had two messages awaiting me on my voice-mail. The first was from the Chief Financial Officer (CFO) of Acme Bags, expressing concern, and assuring me that they would be looking into the matter immediately. The second was from the VP of XYZ Boxes, who informed me that Zack was most definitely not the guy in charge, that his attitude was not indicative of XYZ Boxes, and that they, too, would immediately take steps to make sure that “all the t’s are crossed and i’s are dotted.”

Who could ask for anything more?

And thus ends this saga of two folks who just wanted to be sure that they received that to which they were entitled. As it turns out, we ultimately forewent Bill’s COBRA, in favor of a Medicare Supplement policy; since he was still working at age 65, he could exercise most of those “guaranteed issue” rights at age 75, which he did.

Lessons learned: First, don’t assume that employers do, in fact, have a clue when it comes to COBRA. Second, even if one misses the “window” at age 65, some MedSupp plans are available later if one continues working. Third, insurance can be a difficult maze; it helps to have an experienced guide, and ask lots of questions.

Oh, and Shari (from the DOL) called me back the next day, to clarify a few things before she opened the investigation. By that time, of course, I had heard from Mr CFO and Mr VP, so I suggested to Shari that it looked like things were working out after all, and that it would be fine to let it go. She agreed, but assured me that if things went south, she’d be more than willing to reopen the case.

Well, the high road may be lonely, but it’s the only way to go.