Get Fit, Save Money...

Having just devoured the Thanksgiving turkey, and looking forward to holiday shopping, many of us are looking at our waistlines, cholesterol levels, and wallets, wondering: what to do now?

Sure, joining a health club is a great idea – exercise, swimming, nutrition education – but who has the time and, just as critical, who has the money?

Believe it or not, now’s a great time to gym shop, you just need to do your homework. Many fitness clubs offer great incentives this time of year, it‘s a matter of tracking them down.

In a recent article for Market Watch, Kristen Gerencher tells us that “shopping for a gym during the last weeks of the year can yield surprising discounts -- if you know how to ask. At Curves International, the company is pushing franchisees to waive their monthly fees through the end of the year for women who sign up for a year's contract before January.”

Saving money’s not the only reason to consider joining a fitness club, though; "(d)uring the holidays when everyone's stressed out and pressed for time, if you're working out you'll sleep better, have more energy."

On the other hand, after Christmas sales work as well in the health club industry as the toy store. The folks at Gold’s Gym offer their best deals in January, as consumers look for ways to implement those New Year’s resolutions. According to Gold’s spokesman Dave Reiseman, "January is to the gym business what December is to the retail business.”

In fact, even if the club you’d like to join isn’t officially offering any deals, it never hurts to ask for one, anyway. By negotiating, you may be able to save the equivalent of a month’s – or even several months’ – fees.

Another favorite club gambit is the ‘bring a friend’ sale. For example, Bally’s pre-Christas offer is a free one-year gift membership for a friend to anyone who signs up for a 3-year contract.

But saving money is only one benefit. According to the Archives of Internal Medicine, folks who get off the couch, and engage in moderate to high levels of physical activity, can add almost 4 years to their lives by delaying heart disease. And the Centers for Disease Control says that “(a)dults should get at least 30 minutes of moderately intense physical activity most days.” The benefits include not just weight loss, but also reduced risk of depression, osteoporosis, even arthritis.

And if the year-end (or year-beginning) deals at the health club still don’t fit your budget, they’re not the only game in town: according to the CDC, walking or biking, walking the dog, even gardening (next spring) can contribute to your good health.

More (Shameless) Self Promotion

Hot on the heels of the Weblog Awards is The 2005 Medical Weblog Awards.

The InsureBlog seems to be eligible in two categories: Best New Medical Weblog and/or Best Health Policies/Ethics Weblog. Either one is fine with your humble host.

Grand Rounds

This week's episode is hosted at Over My Med Body.

Given the study and work schedule of a 3rd year medical student, I'm really impressed with this week's Grand Rounds.

This Week In Finance...

■ The Carnival of Personal Finance is up at Financial Fruition. I like the simple, easy-to-follow format (maybe 'cuz I'm pretty simple, myself).

■ And Gill Blog hosts this week's Carnival of the Capitalists. Be sure to check out Roth & Co's entry about some of the hidden implications of the new tax bill, and perhaps bid on Joe's "tacks shelter".

A Healthy Date (Tree)...

It’s not every day that ancient plants can inspire our modern-day, disposable, get-it-quick society.

But scientists at the Natural Medicine Research Center (NMRC) in Jerusalem, have just the ticket:

“A sapling germinated earlier this year from a 2,000-year-old date palm seed is thriving, according to Israeli researchers who are cultivating the historic plant.”

The seeds were found more than 30 years ago, at the ancient site of Masada. Ironically, they were kept in a drawer, all but forgotten, for over 3 decades, before Dr Sarah Sallon, director of the NMRC, asked for a few. She planned to give them to a desert agricultural expert, to see if they could be “revived.”

This is a really fascinating story, of patience and science and a little biblical input, as well. For instance, in biblical times, dates were "were widely used for different kinds of diseases—cancers, TB [tuberculosis]—all kinds of problems."

A really interesting read. Recommended.

A healthy environment...

Elisa over at Healthy Concerns has an interesting post about the increased use of enviro-friendly medical supplies.

In the words of Johny Carson, I did not know that.

Shameless Self-Promotion

Nominations closed...

The folks over at WizBang have opened nominations for the 2005 Weblog Awards. There are, of course, many worthy blogs out there, but your humble correspondent wouldn't mind if folks nominate InsureBlog in, for example, the Best Business Blog category, or even Best of the Top 5001-6750. Or both.

I'm just sayin'.

Oh, if you have any questions about the Weblog Awards, here's the faq.

Happy Thanksgiving!

Light blogging ahead.

Have a great -- and safe! -- Thanksgiving.

Good (Insurance) News for Cancer Survivors

Not so very long ago, marking “yes” to the cancer question on a life or health insurance application meant an automatic decline. Well into the 90’s, in fact, it was exceedingly difficult for folks with a cancer history to find life insurance (and almost impossible to find health insurance).

But times, and the industry, have changed.

For one thing, diagnosis and treatment have both come a long way. Advanced screening technology and alternative medical treatments have opened up the market in a way not anticipated only a few years ago. Survivors are finding that it’s even possible to buy insurance at standard rates.

A recent article in the National Underwriter mentions one life insurance carrier which “will now offer individual life insurance at standard rates to many women over 40 who have early-stage (Stage 1) breast cancer, who have strong prospects of survival and who have no major health problems.”

There have always been life carriers who specialize in the “high risk” or “substandard” markets, and who have offered quality plans, at often less-than-competitive rates, or with waiting periods before full coverage takes effect (so-called “guaranteed issue” plans). Health carriers have been even more reluctant to offer cover; of course, this is a different risk, with the potential for multiple claims.

Historically, carriers have either declined cancer survivors outright, or placed such onerous additional premium requirements that plans were unaffordable. But in a nod to increased recovery rates, carriers are beginning to reassess how they price policies. For example, one trend is toward limiting how long these rate-ups (commonly called “flat extra’s”) remain in force. By automatically dropping off after a few (usually 2 to 3) years, they encourage folks to stick with the plan, and ultimately reward them for doing so by permanently reducing the premiums. Very much a win-win.

The health insurance side has also seen some improvement, although not as dramatic. Since this type of policy allows for potential repeat claims (as opposed to life insurance plans), underwriters tend to be more circumspect. Still, there seems to be an acknowledgement that at least some survivors can be underwritten. The more information an underwriter has, the more likely he (or she) is to take a serious look a survivor’s insurance application.

The message here is simple, really: if you’re a cancer survivor, don’t assume that you’re uninsurable. It’s at least worth trying.

UPDATE: Post on cost of treatment here, and more good life insurance news here.

Thanksgiving Week Grand Rounds

is up, hosted this week by Geena over at Codeblog. Grand Rounds offers posts from around the medblogosphere [ed: is that even a word?], including one that informs us that the number one cause of death in women is cardiovascular disease - not breast cancer.

Check it out.

Thanksgiving Week Carnivals

While you're waiting for that turkey to brine (you do brine your bird, right?), take a few moments to check out this week's Carnival of the Capitalists. Host Brian Gongol chose an easy to digest format for this installment.

At Frugal for Life, you can whet your appetite with this week's Carnival of Personal Finance. While you're there, check out Roth & Co's roast of a not-quite-legal "Lawman."

"Dead Peasant" Insurance is Dead

Joe Kristan over at Roth & Co informs us that so-called "Dead Peasant insurance" -- technically known as Corporate Owned Life Insurance (COLI) -- has been laid to rest under a new bill passed yesterday by the Senate.

You can catch the obit here.

The “A” in HSA

Health Savings Accounts include the ability to sock money away to pay for potential claims. And they enjoy a special tax advantage, to boot. I’ve been selling HSA’s (and they’re forerunner, MSA’s) since about 1992, and I’ve always been impressed at how consistent my clients have been in putting dollars in their accounts. I’ve also found it interesting that these accounts do grow every year, because – for the most part – my clients choose to leave the funds untouched.

So it was heartening to learn that they’re not alone:

“HSA Bank...announced its third-quarter account statistics, which indicate that most HSA Bank accountholders are saving at least a portion of their health savings account (HSA) funds.”

We know from previous posts that well over a million HSA’s have been purchased, and HSA Bank says that they've sold over 60,000 plans in 2005 alone. In fact, 9 out of 10 of their customers choose to contribute at least some money in their accounts. That’s over 55,000 folks last year alone, just at HSA Bank.

Another interesting factoid is that the average balance in these accounts is almost $1,600. If one assumes that most individuals choose the $2,000 deductible, that means a lot of folks who’ve got quite a nice cushion against a catastrophic claim. Of course, families would have a higher deductible still, but that $1,600 is a nice safety net even there.

It would be interesting to know the average income level (and net worth) of those folks who’ve set up accounts with HSA Bank. The article doesn’t disclose this information, but I wonder whether or not it would support my contention that it isn’t the very wealthy who are buying these plans.

I’ll post an update if/when this information becomes available.

Discount Plans Debunked...

An InsureBlog reader writes:
“If a person walks into a doctor's office without health insurance, they will pay more for their care than someone with insurance. That's because the insurance companies are big and powerful and can negotiate lower rates. If I ask for that rate for myself, I'd get laughed out of there.

So why don't all of the uninsured people band together into some sort of membership organization? Kind of like how AAA or AARP can negotiate lower rates for hotels. Neither is in the hotel business, but they have enough clout to get discounts.

Would this organization, which is not in the insurance business, be able to negotiate rates for its members? (The members could, of course, go somewhere else if an office refuses to negotiate. You would end up with "in club" and "out of club" providers.) Would this violate the contract doctors sign with insurer networks?

Of course, this would be a ridiculously huge undertaking. But is it theoretically possible?”

Here was my reply:

“Thanx for writing; I always appreciate fan-mail ;-)

Actually, what (I believe) you've proposed is neither random nor new. There are many "provider discount plans" on the market (e.g. CareEntree, etc) which purport to accomplish just what you've suggested.

For folks who are truly uninsurable (and they represent a very small fraction of those who are uninsured), such plans can be a big help, but they are not without drawbacks.

For example, every plan I've seen requires the member to pay the entire cost either upfront, or within a very short timeframe (10-30 days, max). For a relatively inexpensive procedure (setting a broken finger, for example) this would be no problem. But for a substantial claim (surgery, MRI, etc) how many folks have thousands of $$ in ready cash?

Another problem with such plans is that they are often sold by unscrupulous folks who gloss over the fact that it is NOT insurance, and so the consumer unwittingly believes that he is insured when, in fact, he is not.

Finally, in looking at such plans myself (in the event that I wanted to market one), I've noticed a large discrepancy in prices; some plans cost hundreds of $$ a year for what is, essentially, a modest service.

Have a great week, and feel free to drop me a line any time.”

The ostensible point of these plans is to encourage folks to seek medical attention, and in some way soften the financial hardship of doing so. Theoretically, this is admirable, but like so many such endeavors, this one is fraught with peril.

As I mentioned in my reply, such plans are often wrongly sold as alternatives to insurance, or even as insurance products (which they are not). This is dangerous because, as I told my correspondent, it may give the purchaser a false sense of security.

But there’s another, more insidious reason: because of HIPAA, folks going onto a group plan may qualify for a reduction in, or complete waiver of, the 12 month exclusion for pre-existing conditions. Individual major medical plans count as such creditable coverage, and in some states even short term medical plans do, as well. There is even (at least) one guaranteed issue medical plan which counts as creditable.

But these “discount” plans do not, and thus may leave the purchaser even worse off than before, out many hundreds of dollars in premiums, without creditable coverage.

There are better solutions.

This Week's Carnivals

Professor Jeff Cornwall host's this week's Carnival of The Capitalists over at the Belmont University Blog. It's based on a particularly clever theme: a university catalog.

And the Carnival of Personal Finance is posted over at Consumerism Comnmentary. The scheduled host apparently bailed, so kudos to "Flexo" for stepping in.

The best of MedBlogging, Grand Rounds, is now up over at Doc Shazam's place. If you read nothing else, do not miss "Kim's Letter" (but keep the tissues handy).

Transparency Revealed (Conclusion)

In Part 1, we introduced Dr Dexter Campinha-Bacote, Medical Director for Aetna, and one of the folks responsible for that company’s pilot transparency program. Today, we conclude InsureBlog’s exclusive interview, and offer some thoughts on the program's benefits, and potential shortcomings.

7) One of my readers is concerned with "glass pockets;" that is, consumers looking only (or primarily) for the lowest price on procedures without regard to provider credentialing or success rates.

According to Dr Campinha-Bacote, all of Aetna’s providers are Board certified, and Aetna conducts frequent member surveys to determine the level of satisfaction each provider enjoys. Of course, the company isn’t responsible for the decisions that its members ultimately make.

8) As a follow-up to the last question, what safeguards are in place to prevent “upcharging?” For example, an expectant couple looking for the lowest price on L&D may not factor in services like anesthesia vs going for natural birth.

The negotiated rates that one sees on the website include only those procedures that the doctor provides in his office, and of course exclude outside lab charges, etc. If and when the whole transparency phenomenon expands, then the other pieces will come into play.

For now, though, the idea is to keep things simple, and thus post only the limited number of procedures done in-office.

The doctor also told me that all the numbers available on the site are posted in real-time; that is, the rates are all current, not based on 6 month old data. To some extent, this should help mitigate “upticking,” although this is still a concern.

Dr Campinha-Bacote couldn’t have been more gracious, or open. This whole program is so new, though, that there are a number of unanswered questions, which will hopefully be addressed as the program matures and expands.

Other carriers are watching, too: I’ve noticed an uptick of my own, in terms of hits from carrier websites to my previous transparency posts, and by requests for links to this interview.

Which is not to say that the program is without warts. As Dr Siegrist notes in the comments section of Part 1, “(b)y listing prices only (with no context of the rationale behind prescribed tests and treatment), patients are left with only big dollar signs.” And I think this is a valid concern. To a great extent, the biggest challenge confronting more widespread “buy-in” to Consumer Driven Health Care (CDHC) is the willingness of the consumer to actually take an active role in determining courses of treatment. This means, for example, getting on the web (using Google, or WebMD, or even Intellihealth) and researching the pro’s and con’s of various treatment options.

In some ways, this is counter-intuitive: on the one hand, we need to trust that our physician will steer us in the right direction, and on the other hand, we need to be willing to ask hard questions to determine if that is, in fact the case.

There is no question that this can be a valuable tool for those covered by any qualified reimbursement plan (HSA/HRA/FSA). At the same time, there is a danger that folks will lose sight of what’s truly important: their health. Making health care decisions based solely on the price of a service seems to me to be a dangerous sort of game.

Still, I find it encouraging that this tool is available (albeit on a very limited basis). As we saw in the QwikHealth model, there is a demand for this kind of upfront information:

The other day, I had occasion to call on a new prospect, a pediatricic practice to which I was referred. As I walked in the front door, I noticed a sign on the receptionist’s window: “Yes, we do ear piercing.” At first, I smiled at the apparent incongruity. But then I realized that this was simply a way for that practice to let its patients know of another service they provide. All that was missing was “Just $9.95 an ear.”

That day may soon be coming.

Beam Me To Grand Rounds, Scotty!

Rita at The Nexus Blog hosts an out of this world Grand Rounds this week. It's definitely the "Real McCoy."

Financial Fun (Carnival Time)

The good folks over at Bargaineering (who knew that was a verb?) are hosting this week's episode of the Carnival of Personal Finance.

You'll find the current Carnival of the Capitalists over at Part Time Pundit's blog. And while you're there, be sure to check out Joe Kristan's timely advice on how to Harvest the Fall Tax Deductions.

Transparency Revealed...

INSUREBLOG EXCLUSIVE!

Recently, I had the opportunity to interview Dr Dexter Campinha-Bacote, Aetna Medical Director. He’s the “go to guy” for Aetna’s new transparency pilot program in the Cincinnati area. We covered a lot of ground, and he was quite forthcoming and comprehensive in his answers. If you’re the least bit interested in the future of CDHC, I think you’ll find the following to be quite helpful:

First, I asked Dr Campinha-Bacote to tell InsureBlog readers a little bit about himself and his position.

Dr Campinha-Bacote’s training was in Family Practice, and he’s been involved in Managed Care since 1992. With Aetna for about 5 ½ years now, he’s currently Medical Director for southwest Ohio, southeast Indiana, and all of Kentucky.

Could you tell InsureBlog readers a little about how Aetna came up with the idea, and a brief description of how it works?

Actually, this is a great example of consumer driven health care (CDHC): several employers (whose companies use Aetna for their group coverage) approached Aetna with their concern that, as more and more of their employees opted for high deductible plans (HDHP), they lacked vital information. These employers asked Aetna to develop tools that their employees could use to make “better informed decisions.” One of these tools is the pilot transparency program.

As Dr Campinha-Bacote explained it, Aetna lists the 25 most common services for each physician (provider) in the Cincinnati-area market, and the negotiated reimbursement rate for each service. This way, the patient (insured) knows ahead of time what a given service will cost.

These services will vary from provider to provider; after all, a vascular surgeon will offer different services than a pediatrician.

Aetna insureds can access this information a couple of ways: through Aetna’s web portal, Navigator or by phone. Interestingly, Dr Campinha-Bacote told me that one doesn’t have to be in a HDHP to access this info: any Aetna insured can pull it up. This is helpful for those who have co-insurance requirements as part of their plan.

What criteria will you use to judge whether or not to expand this program to other markets?

Dr Campinha-Bacote explained that Aetna will base that decision on three criteria:

a) Physicians response

b) Member feedback, and

c) Employer feedback

So far, the response has been very positive from all three.

A year or so ago, I was involved in a CE class with Humana’s Medical Director, who was touting what he called “Consumer-Centric Health Care;” Humana’s version of CDHC. His emphasis was on encouraging insureds to be more pro-active in their health care, especially with regard to researching options.

I discussed this with Dr Campinha-Bacote, who agreed, but felt that only a small percentage of insureds really take advantage of the wealth of knowledge available, but that he sees this changing. He gave an example of how this would work: a patient consults with his vascular surgeon, who recommends an invasive surgical procedure. In researching the procedure, the patient learns that there is also a non-invasive alternative. Armed with this information, he can now discuss treatment options more effectively, by asking why the physician recommended the invasive procedure over the non-invasive one.

In fact, Aetna now has an online service called IntelliHealth that’s available to the public.

Are you concerned that providers, knowing what their competitors are charging, will seek more aggressive increases in their own negotiated rates?

Frankly, I was surprised by the answer: while all of this information is available to Aetna insureds, it’s not available to the physicians themselves (unless, of course, their insurance is with Aetna). In other words, a given doc doesn’t have access to his competitors’ negotiated rates. Dr Campinha-Bacote went on to explain that, in this market, the rates tend to be pretty level across the board, so it’s not likely to be a bone of contention, anyway.

He also explained that another benefit to this transparency of rates is that the doctor has an opportunity to discuss his own value in the transaction: “why I’m worth more than Dr Smith.” After all, you get what you pay for.

Dr Campinha-Bacote added that another facet is that such decisions are not made “in isolation.” In other words, he anticipates that patients will discuss these issues with their family doctors, not just specialists.

We’ll conclude the interview, and I’ll offer some observations, in Part 2.

A special Thank You to Wendy Morphew of Aetna’s Media Relations Department, whose persistence and cooperation made this project possible.

Battling Cylons: Coda

Well, I received an email today from the Department of Insurance. It included the official reply from VID regarding my client’s recent “troubles.”

In their official reply, VID’s “Regulatory Advocate” restates the situation as it developed, and neatly inserts a CYA clause: “There is no indication that [VID] received this request on [stipulated date].” In other words, even though they’ve acknowledged that they erred in not processing the change which started the whole mess, and in fact acknowledged that error in writing, they apparently did so even though there was no indication that they were, in fact, at fault. And notice the weasel wording “there is no indication;” they don’t explicitly deny having received the change request, only that we offered no proof that they had. Of course, I don’t recall ever being asked for any such proof.

It does, however, get even better, because according to the Regulatory Advocate, once he reviewed the situation (nine days after it was submitted to VID by the Department of Insurance), he decided that my client was right, after all, and notified the appropriate department to reinstate Oriental Hut’s coverage because “the amount due to be reimbursed was more than the amount due for the October premiums.” Nice, and it only took him an extra 9 days to determine this.

But it gets even better.

Imagine his surprise when he learned that, shortly before he (allegedly) called for reinstatement, my client had indeed called in the payment, thus obviating the need for this Regulatory Advocate to have done anything in the first place. If you find this all confusing, you’re not alone. I’m also a bit flummoxed by the idea that a carrier can make a mistake and yet my client faces potential financial ruin, and there’s precious little that can be done about it. In reading the final report, I also noticed something else that was missing:

A simple apology.

As it is, I answered the DOI’s email, thanking the Claims Specialist for her help, and posing two additional questions:

It appears that not only did [VID] err in how they applied the credits, but that [my client] actually owed no premium for October, yet was cancelled anyway. Apparently, [VID] will face no consequences for this. Is that correct?

It also appears that [VID]'s procedure for reinstatement looks a lot like extortion: "we made a mistake, but you must follow our rules in resolving it, meantime you have no coverage." Is this acceptable insofar as the DOI is concerned?

In her response, the Claims Specialist explained that her role is “to make the consumer "whole", if there is a violation of our insurance statutes or the insured's contract. As an administrative agency, our legal authority is limited to ensuring that [the] insurance company abide by the consumer's insurance contract with them, and with our Ohio insurance statutes.”

Which is a roundabout way of saying “hey, it’s in the contract, and they haven’t actually killed anyone, so deal with it.”

She then deftly sidestepped the whole issue by explaining that “(o)ur Market Conduct Division tracks repeated "errors" or statue violations.” Ahah! It’s someone else’s problem! Good to know that.

If you detect a drop of bitterness in this post, it’s because the underlying issue – company makes a mistake, insured pays the price – has not been addressed, or resolved.

Maybe next time…

Marcus Welby meets Jiffy Lube

We’ve discussed medical care alternatives before, but – as Emeril would say – this idea “kicks it up a notch:”

In a little strip mall in San Mateo, California, nestled “between a UPS store and a hair salon” is a new type of doctor’s office.

“A large banner hangs across the top of the entrance, advertising doctor visits for $39. Another sign encourages passersby to "Get your flu shot now!"

The office itself is as much coffee shop as medical center: prices for various services and procedures are prominently displayed above a reception desk, and there are even “packages” of related health care services available for one’s convenience.

It’s apparently first in the nation to implement this model. The San Mateo location “is [their] prototype store and [they] hope to roll it out to many locations.”

Called QwikHealth, the Burlingame, CA based company is the brainchild of entrepreneur David Mandelkern. Mr. Mandelkern looked at the millions of uninsured folks clamoring for medical attention, and saw a business opportunity. In addition to serving as a primary care provider for these folks, the convenience of a “drop in” medical service is appealing to insured people who need (or just want) quick service.

QwikHealth offers a panoply of services at relatively low rates because there’s no 3rd party (i.e. insurance) involved; it’s a strictly cash business. That helps cut down both overhead and wait time for payment, and keeps things simple, as well.

Of course, California itself is home to a lot of, shall we say “undocumented” workers, who don’t have insurance. Such a facility would appeal to that population for a number of reasons, not the least of which would be that since there’s no insurance, there’s probably not a lot of other personally identifiable information changing hands, either.

Regardless, the concept seems sound, and it will be interesting to see if Mr. Mandelkern can transfer it to other areas. Or, perhaps some other forward-thinking business critter will capitalize on it.

I’m actually pretty impressed with the idea: it is, after all, the ultimate in transparency. One area of concern, however, is quality of care. Typically, network providers are subject to multiple layers of quality control, which seem to be absent in this model. On the other hand, one gets what one pays for.

UPDATE: In a related post, Health Business Blog has an item on "TelaDoc, which provides telephone consults to patients 24x7." Interesting read.

Of Interest...

This week's installment of Grand Rounds may be found at KidneyNotes, a blog hosted by a nephrologist.

And if you either own an HSA, or are considering one, Joe Kristan at Roth & Co has the latest info on the 2006 contribution limits.