Stupid Provider Tricks (Coast to Coast)

[Welcome Industry Radar readers!]

Over the past three and a half years, we've chronicled the "exploits" of agents, carriers and patients. It seems, though, that providers are not exactly immune to outrageous games, either.

First up, we learn that the UCLA Medical Center has been bumping legitimate, deserving, long-suffering American organ transplant candidates in favor of yakuza, members of Japanese organized crime groups. The surgeries, conducted between 2000 and 2004, took place while there was a distinct shortage of qualified organs, exacerbating an already-critical problem.

Although the physicians claim not to have known of the, er, character of their erstwhile patients, they also aver that "they do not make moral judgments about patients and treat them based on their medical need."

Riiiight.

On the other side of flyover country, the Washington Post reports that "surgeons across the country receive trips, meals and consulting deals from artificial-hip and -knee makers." Isn't that the textbook definition of "conflict of interest?"

Turns out, the suppliers of various joint-replacement gizmo's [ed: must you use technical medical industry jargon?] allegedly paid certain surgeons to use their equipment. Manufacturers advocates counter that "the arrangement allows doctors and medical-supply companies to collaborate, paving the way for important technology advances in hip and knee replacements."

In the event, a federal investigation was launched to look into this kickback scheme. A settlement has apparently been reached, and the facts are beginning to come to light. In what may be a happy ending (of sorts), "(f)our of the world's top companies last year agreed to pay a combined $311 million to settle a federal probe into whether the manufacturers paid kickbacks to doctors to get them to recommend their products."

Sheesh!

Cavalcade of Risk #53: 2nd Anniversary Edition - Submissions Due

Next week's edition marks our 2nd Anniversay, so we'd like to try something a little different: please send in your favorite risk-related post from the past 12 months. Don't forget to include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

You can submit them via Blog Carnival or email.

We have hosting opportunities available for late summer and early fall, so please drop us a line to reserve yours.

Health Wonk Review: Post-Memorial Day Edition

[Welcome Kaiser Network readers!]

Welcome to this week's edition of all that's wonky in the healthcare world. As a 4-timer, I was tempted to out-shtick myself, but decided to play it straight (for once). And so, without further ado...

Paul Hsieh poses an interesting question at We Stand Firm: What would health insurance look like in a truly free market? I really liked the Q&A format of this post.

The Health Business Blog's David Williams has a chilling post on identity theft, specifically crooks who take advantage of the fact that stolen health information is likely to be useful for much longer than stolen financial data.

Sam Solomon, blogging at Canadian Medicine, draws a connection between global warming and mortality rates.

Brian T. Schwartz, writing at Patient Power, has a real issue with the concept of mandatory health insurance.

Dr Deb Serani reports on a VA facility in Texas, whose cost-conscious administrator has apparently put the kibosh on any more PTSD diagnoses.

HWR's Julie Ferguson is out of the country, but her Workers Comp Insider partner, Jon Coppelman, has his own take on that VA administrator.

Alvaro Fernandez, blogging at Brain Health Business, explores how people can use emerging technologies to keep their brains healthy and productive as long as possible.

Here at IB, we're big fans of transparency in health care (and health insurance). Over at his New America blog, Tom Emswiler talks about the newest HHS program, which lets consumers compare cost data at nearby hospitals.

Vince Kuraitis, principal of e-CareManagement, tells us about the newest delivery and financing model to rescue primary care, the Patient Centered Medical Home (PCMH).

Shaheen Lakhan, the Brain Blogger, presents a Patient Manifesto. He points out that each of us may also be a patient and so many blog posts are about medical topics and issues, but not about the patients.

Over at Health Populi, blogger Jane Sarasohn-Kahn discusses the rising cost of health insurance, especially from the employers' standpoint, and wonders if we'll see more employers dropping cover, or requiring a bigger bite out of the employees' paycheck [ed: Yes].

At the Disease Management Care Blog, Jaan Sidorov discusses the cost/benefit dilemna when looking at med's that treat brain cancers, and how making the decision on whether or not to even use them can cause more stress.

Anthony Wright, of the Health Access California blog, asks what, exactly, constitutes insurance coverage? He posits that, at the very least, coverage should protect a consumer against unlimited financial liability.

The Internet Marketing Blog's D. Singh takes a close look at the new, improved Google Health, and comes away concerned about whether or not we should trust the search-engine behemoth with our private medical data.

Speaking of Google Health, Health Care Industry blogger David Hamilton is quite concerned that Google has hedged its exposure in the event a privacy breach occurs. In fact, it appears that the company actually requires users to defend against or settle any suit brought against Google.

Finally, you might think that insurance agents would welcome presidential wannabe John McCain's market-based solutions. Not so fast: Our own Bob Vineyard takes the good senator to the woodshed, instead.

That's all for this week's edition. Please make sure to stop by the Health Affairs Blog on June 12th for the next exciting episode.

(Extremely) Stupid Agent Tricks

[Welcome Industry Radar readers!]

We all do stupid things from time to time, but this one takes the proverbial cake:

"The insurance agency owner charged in the death of a state examiner initially consented to a search of his office and car but withdrew after police found areas on carpet and a computer cord that tested positive for blood."

Seems that the owner of Dilworth Insurance in Charlotte, NC was being investigated based on an "administrative complaint;" Sallie Rohrbach, the DOI investigator, went missing while conducting her investigation. At one point, "(e)ight armed law-enforcement investigators with the North Carolina Department of Insurance [joined] the search." Never heard of armed insurance investigators before (maybe that's a good thing).

Ms Rohrbach's funeral was this past Sunday. The 40-year-old agent, Michael Howell, has been charged with first-degree murder. The authorities believe that "her death is connected to her duties as an auditor."

Rest in Peace, Sallie.

[Hat Tip: IB reader Jeff Milne]

And the Answer is: 42!

Well, that was Douglas Adams' answer, anyway. The question was: what's the answer to life, the universe and everything? A better question might be: how come so many people think nationalized health care is such a good idea? A common answer is that we'd do away with those eeeevil insurance companies, and that everyone would have access to affordable, competent health care.

Oh, yeah?

Better tell that to our Neighbors to the North©:

"Mark Degasperis was furious his mother spent five days on a stretcher at Toronto Western Hospital waiting for a room with 25 patients ahead of her ... Heather Degasperis, 60, has a dangerous bacterial condition and was sent by her doctor to Toronto Western because it has the experts for her condition."

Yet she spent almost a week without treatment, and was seen by a doc only after the newspaper called and raised a fuss. Still, dangerous waits and provider shortages are rare in the medical utopia, right?

Not so much:

"This is a terrible environment. I suggested taking her to another hospital, but we were told there are long waits across the region and the doctors we need are here."

Ooops!

Too bad Mrs Degasperis didn't know about CoverMe, the health insurance supplement for our Canadian friends:

"Concerned about the many medical expenses you’ll have to start paying for out-of-pocket because of the increasing gaps in your provincial health insurance coverage? ... With four different levels of affordable health insurance coverage to choose from, you’re certain to find the plan that meets your specific needs and budget."

That's right, folks Up North can buy insurance for their, um, insurance. Which begs the question: if nationalized health care is so good (not to mention "free"), how come they still need medical insurance supplements?

Oy Canada!

Grand Rounds now available

Parallel Universes hosts this week's roundup of medblog posts. Dr Emer presents a "Top 5," followed by two dozen other interesting (and often provocative) entries.

Our friends at the Colorado Health Insurance Insider blog take a look at how some insurance carriers are pushing healthy lifestyle programs.

Memorial Day Carnival of Personal Finance

Canadian Dream hosts this week's edition of the Carnival of Personal Finance. There are a lot of posts, each one with a brief explanation.

For those of us who wonder (and worry) about what Social Security will look like a few years hence, Bob McDonald tells us that it may not be as bad as we think.

Health Wonk Review at InsureBlog

We're delighted to host this week's edition of the Health Wonk Review.

To submit your post on "(h)ealth policy, funding, insurance, managed care, infrastructure, IT, the uninsured, economics and trends," click on over to Blog Carnival or drop us a line.

Memorial Day Miracle...

Although Memorial Day is really about those who have served our country, I was quite intrigued by this story of a woman's near-death experience:

"A West Virginia woman is at the Cleveland Clinic after walking the line between life and death...[she] suffered two heart attacks and had no brain waves for more than 17 hours. At about 1:30 a.m. Saturday, her heart stopped and she had no pulse. A respiratory machine kept her breathing and rigor mortis had set in..."

By all accounts, and by current medical definition, Val Thomas was dead. But as her family met with doctors to discuss organ transplant harvesting, she "woke up and started talking."

There's video, as well:

[Video courtesy of NewsNet5]

She's currently at the Cleveland Clinic for observation.

Wow.

Healthcare Transparency: More Good News

It's not just commercial insurers and providers who've jumped enthusiastically onto the transparency bandwagon:

"The Bush administration [has launched] a $1.9 million advertising campaign touting its effort to rate hospitals and urging patients to check a government website before choosing one. "

Notice that these measures include not just price, but some two and a half dozen metrics. According to the Department of Health and Human Services:

"CMS [Center for Medicare & Medicaid Services] is adding information about the number of certain elective hospital procedures provided to those patients and what Medicare pays for those services. For the first time, consumers have the three critical elements -- quality information, patient satisfaction survey information, and pricing information for specific procedures -- they need to make effective decisions about the quality and value of the health care available to them through local hospitals."

Cool beans!

The site itself is pretty basic and easily navigable. It looks and works much like an insurer's "Find A Provider" page: you can choose to look by a procedure or condition, or by hospitals in your area. Kudos to the CMS folks!

Questionable Healthcare Advertising...

We've seen some pretty, um, interesting advertising in the past, but this one takes the cake:

HealthPartners, a Minnesota-based healthcare provider, is a non-profit operation, but that doesn't necessarily mean a "non-humor" one.

Cavalcade of Risk #52 is up and running...

Jason Shafrin, the Healthcare Economist, hosts this week's collection of risky posts. Don't miss the great example of risk mismanagement at the top.

There's very little risk involved in hosting your own Cav, just drop us a line to sign up!

Why you need health insurance, redux

[Welcome Industry Radar readers!]

I was just talking with an employee of one of my clients. A few months back, she spent a day and a half in the hospital, having three vertebrae fused. The contracted price for the services? Almost $48,000. The price for the hospital's services as originally billed? Somewhat over $600,000. Her out-of-pocket cost? $250.

Let's see...

■ No insurance: $600,000

■ With Insurance: $250 (plus her portion of the insurance premium)

On top of that are her physician's charges, which are also not an insignificant amount.

Googling for (Health) Info

We've all heard that phrase. You know the one, where you just can't believe what you've just been told, and your friend says "Don't believe me? Google it!" Well, those two little words are about to take on a whole new meaning.

Back in February, we reported on the search engine behemoth's plans to join other internet biggies in offering on-line storage of one's medical records:

"Thousands of patients at the Cleveland Clinic will be able to turn to Google to access their medical records online — everything from their prescriptions to diagnoses — in a pilot program announced Thursday..."

Now, that "pilot" has gone live, and national:

"Google Inc on Monday unveiled Google Health, a long-anticipated U.S. health information service that combines the leading Web company's classic search services with a user's personal health records online."

They've partnered with Walgreen's, CVS, even the aforementioned Cleveland Clinic. In addition to hosting your medical records, it's got a directory of local providers.

But the centerpiece of this effort is the actual warehousing of medical data. The EMR (electronic medical record) initially includes one's basic medical history, and is then updated as "things happen." The major difference between this model and ones already "in the wild" is that this record is actually owned by, and under the control of, the patient. This makes the record portable and easily accessible.

If there's a downside, it's the security aspect. As Bob reported a year and a half ago:

"medical identity theft is the last straw; after crooks steal their wallet and max out the credit cards, they turn to the health insurance card for even more freebies. "An insurance card is like a Visa card with a $1 million spending limit," says Byron Hollis, national anti-fraud director of the Blue Cross and Blue Shield Association."

Granted, Google has a major incentive to keep this info secure, but then again, so did the VA. It seems to me that the onus will be on Google to keep a tight rein on these files, and for participants to keep a close watch on their info, as well.

Thus Spake Grand Rounds...

Ye Olde Dinosaur hosts a truly heavenly Grand Rounds today. Modeled after the first chapter of Genesis, it's well-written, easily navigated, and full of inspirational posts.

As we've noted here, HIPAA and privacy go together like sunshine and bicycles. The Health Care Law Blog's Bob Coffield has some fascinating (perhaps scary, cerainly startling) statistics on new gummint enforcement efforts.

The Carnival of Personal Finance is now up...

Penny Nickel presents this week's jam-packed edition of the Carnival of Personal Finance. It's in a unique Q&A format, which actually makes for easier navigation among the categories.

Is the Crystal Skull deductible? Bligger Rickey Henderson snagged a copy of a letter from Dr Jones' accountant which raises a number of interesting (and amusing) questions.

A (Metaphorical) Trainwreck

This is a case of "TMI" (Too Much Information), and how it can actually hinder the decision-making process. Early last week, I got a call from "Suzie," whose COBRA plan will expire when this month does, and who has severa "issues:" she's overweight, diabetic and has sleep apnea. The nature and severity of her diabetes alone renders her "uninsurable." And then there's this: she's 63 years old, due to turn 64 this summer. At least two of the carriers she mentioned won't write anyone over age 63 and a half (don't ask; that's another post). Still, she continues to call agents trying to find her own Holy Grail.

I explained the problem(s) to her, and asked if she was aware of how HIPAA works in these cases.

[ed: briefly, HIPAA says that if one has elected COBRA and kept the plan in force the full 18 months, one is eligible for a mediocre, over-priced plan that can't exclude pre-existing conditions]

She indicated that she had, and named a figure which, while pretty hefty, was less than what I knew such a plan would be at her age. I patiently explained that the carriers she mentioned (as well as the rest of those in this market) would not take her. She insisted that at least one agent had told her "no problem." I know when I'm licked, so I suggested that she call that agent back and submit her application. She balked at this, saying that it "sounded too good to be true."

Progress at last!

I reiterated that her best bet would be the HIPAA plan, but that there was one other alternative: a guaranteed issue mini-med ("limited benefit") plan. The advantages of these plans, I explained, is that one needs only a pulse and a checkbook (not necessarily in that order) to qualify, and that they are much less expensive than the HIPAA plans. Still, I cautioned her, there were reasons for this: one, these plans typically exclude pre-existing conditions for the first 6 months (some for 12 months) and that, as their name implies, the benefits are extremely limited. But if one's budget dictated that it's a mini-med or nothing, it may be an appropriate choice.

I am always careful in these situations to stress that the mini-med is an alternative, not necessarily the best one.

She didn't like the 6 month wait on pre-ex, and I replied that that was fine with me. Then she asked a question about the prescription drug benefit. Since I didn't have the answer at hand, I offered to call her back, which I did the next day. She still felt uncomfortable with the mini-med, and I again assured her that this was no problem, I was sorry I couldn't help. She then asked how much time she had to make a decision, and I told her that, as long as she had the paperwork in by the 20th, the plan could be in force for June 1. We hung up, and I put my notes away.

Lo and behold, she called again last Friday. She had finally become convinced that she had to either go the HIPAA route or the mini-med way. I listened, and waited for her to tell me her decision. But she still couldn't choose. She had called still another agent, who essentially told her the same things I had (one would think this was a major clue, but apparently not). And again, she stressed how the 6 month wait for pre-ex was unsatisfactory. And again, I empathized with her (at this point, I was beginning to feel a bit like Bill Murray). I reminded her that she has until the 20th (tomorrow) to "pull the trigger" on the mini-med, and bade her a nice weekend.

I have no idea what route Suzie will take, and I empathize with her dilemna. Still, I think that, at some point, it should have become clear to her that her choices were limited. I don't mind spending the time "holding her hand," but I can certainly understand other agents' reluctance to spend so much time on such a case. Obviously, a second (perhaps even a third) opinion is appropriate for this kind of situation, but she's on her 6th or 7th, and hence in imminent danger of information overload.

Which really helps no one.

Ch-Ch-Changes: HSA Edition

Each year, the gummint publishes the updated guidelines for the following year's Health Savings Accounts (HSA). These are generally adjusted for inflation, and reflect the reality of increasing costs of health care. For example, this year's limit on how much one can contribute to an HSA is $2,900 ($5,800 for a family). That's scheduled to increase next year (2009), to $3,000 for individuals, and $5,950 for families.

Keep in mind that the amount one can contribute to the loss fund (HSA) is not bound to (or by) one's actual deductible. This year, the minimum deductible for an HSA-compliant plan is $1,100; that's slated to increase by $50 next year. For families, this year's minimum is $2,200, and increases to $2,300 in 2009.

For those so inclined, that means that one can "stuff" more dollars into the loss fund to pre-pay a future expense, or as an additional retirement resource.

I know, that's a lot of numbers, but if you own an HSA, they're pretty important.

Cavalcade #52: Submissions Due

Fresh off of a tremendous Health Wonk Review, Jason Shafrin hosts next week's Cavalcade of Risk. Submissions are due by Monday (May 19th). Jason reminds you to include:

■ Your blog's url
■ Your post's url
■ The post's trackback URL (if available)
■ A (brief) summary of the post

You can submit them via Blog Carnival or email.

We have slots available for July and August, so PLEASE drop us a line to reserve yours.

Breaking News: Health Wonk Review is up!

Our favorite health care economist, Jason Shafrin, hosts this week's issue of health care wonkery. Read all about it!

Dr Paul Hsieh shares our preference for free market solutions to health care delivery and financing. In this Q&A-formatted post, he explains why.

Resource Update

We don't often update our blogroll, preferring instead a more minimalist format. Once in a while, though, we come across something so unique and helpful that we feel an addition is in order.

Such is the case with David Baker's "Employee Benefits Links." David's a former employee benefits attorney; he started his site some 13 years ago, and updates it regularly. If you're an employee with benefits questions (or an HR person with some of your own), the Benefits Link site is the place for you. Its no-nonsense, zero-fluff layout may be a bit startling at first, but it's easy and intuitive to use, and full of helpful links and articles.

Look for it in our "Resources" list on the right of your screen.

Earthquake Relief: China

I am always amazed at the generosity of InsureBlog readers. Whether for hurricane victims in New Orleans or folks crushed by a falling bridge in Minneapolis, our readers are unstinting.

In China, tens, perhaps hundreds, of thousands of people are dead or injured following a massive earthquake. I looked around the web to see who had appropriate assets in place, and who could deliver the necessary aid with a minimum of problems. Every place I looked, the answer seemed to be Mercy Corps. They're already in place, and have the infrastructure, personnel and reputation to get the job done.

I encourage all our readers to click over and donate something, anything, to help the struggling people of Sichuan province. Feel free to leave a comment letting us know.

Universal Care Run Amok

Behold, the reality of state-run health care, courtesy of the MVNHS©:

"Retired dentist and wife 'in suicide pact' after being told they have to move into separate care homes"

The couple, married for over 60 years, were seldom apart. Nancie Hughes suffered from dementia, while husband Tom seemed to be in good mental shape. Unfortunately, the gummint, in its infinite wisdom, decided that some 6 decades together was long enough, and was planning to move them into two different facilities.

Now, of course, they're both dead, saving the MVNHS© even more money.

Please tell me about compassionate government-run health care again.

(Hat Tip: The Drawn Cutlass)

Hiyo, Silver (Alert)!

[Welcome Industry Radar readers!]

We've discussed Alzheimer's and other forms of dementia here in the past, as well as other senior care issues. Generally, these are related either to health insurance or to health care trends.

But there's another dimension to dementia, one which often isn't discussed: affected seniors who wander away, and face potentially dangerous consequences.

We're all familiar with Amber Alerts when children go missing. But there's something new afoot at the other end of the age spectrum:

"North Carolina is one of only seven states with a new type of missing persons program called Silver Alert that experts say is urgently needed to address a growing problem."

Currently in its (you should excuse the expression) infancy, the Silver Alert system seems to be gaining ground slowly. With the graying of the population, especially as Baby Boomers reach their Golden Years, we'll likely see this picking up steam.

Oy Canada: Dog Pound Edition

Ah, it just doesn't get any better than this:

"Need to see a specialist fast? Too bad you're not a dog."

Our Neighbors to the North© have apparently outdone themselves. As we've repeatedly noted here at IB, that "Free Health Care" comes at a steep price: actual, you know, care. If you're a Canuck with cancer, you'll likely wait well over a month to see an oncologist.

But if your Siberian Husky has a suspicious growth, he'll be seen in a few days. I'll let Barbara Righton and Nicholas Kohler (who co-wrote the linked article) have the last word:

"Trouble is, when it comes to medical care in Canada, our pets are often getting what we get — and a whole lot more besides. And they're getting it faster too."

[Hat Tip: RWN]

Grand Rounds is up!

Five-time host David Williams presents this week's round-up of the best of the medblogs. There are over 2 dozen interesting posts, and each one comes with a terrific explanation and context. Kudos, David!

For a bit of nostalgia, I recommend Peter Zavislak's post on his favorite medical-themed TV shows. I expected M*A*S*H and House, but General Hospital? Fun post.

Insuring Mom (or Dad) the Homemaker

[Welcome Industry Radar readers!]

Some time ago, we discussed disability insurance coverage for stay-at-home mom's (in fairness, pretty much everything we'll discuss in this post is equally applicable to stay-at-home-dad's, too). As noted then, it's difficult to obtain, because it's well-nigh impossible to verify a loss of actual income in such cases. One alternative would be to consider a critical illness plan, and perhaps an accident plan. These would pay a lump-sum based on a diagnosis or injury, regardless of actual financial loss.

But what about life insurance on that stay-at-home-spouse (SAHS)? Recently, I had an interesting conversation with a prospect who had asked me about additional life insurance for her husband. At the time, he worked for a company which provided a modest amount of group life insurance, which "Jane" felt was inadequate. She asked me to run some numbers for "Joe," with an eye toward a more realistic amount. I did so, and have periodically checked back to see when (and if) they would be moving forward. After more than a year of this, I dropped it, since it was obvious that they didn't feel it was a particularly pressing problem (despite my best efforts).

Last week, Jane dropped by the office to go over her home insurance with my P&C colleague. I figured "what the heck," and asked if they would like updated figures for Joe. She answered that they no longer needed the coverage, since he had left that job to become a stay-at-home-dad. Since he wasn't contributing (directly) to the household finances, she said, he didn't need any life insurance.

Good point, right?

Not really: the cost of replacing a SAHS isn't measured in hard dollars coming in, but what it would cost to hire someone to provide all (or almost all) the services of that spouse. The day after Jane and I had our conversation, I saw this article, which puts the real value of those services in perspective:

"If a stay-at-home mom could be compensated in dollars rather than personal satisfaction and unconditional love, she'd rake in a nifty sum of nearly $117,000 a year."

Wow!

Surprisingly, it wasn't the nature of the job(s) so much as the hours:

"The biggest driver of a mom's theoretical salary is the amount of overtime pay she'd receive for working more than 40 hours a week."

So what does Jane have to say about all this? Well, I forwarded a copy of the article to her, and will wait to see how (if?) she responds.

Meantime, if you (or someone you know) is a SAHS, perhaps it's time to review that life insurance portfolio. Right after the laundry's folded.

Carnival of Personal Finance is up...

Hosted this week by Money Under 30, it's jam-packed with helpful financial tips. This week's Carnival continues the new tradition of a few "Editor's Choice" entries, followed by the rest of the submissions, categorized and with helpful summaries.

An Embarassment of Riches: Transparency Edition

Recently, Bob wrote about cost-efficiency and claims management. In that post, he said "The more you learn about using tools that are readily available the better equipped you will be to maximize ALL your health care dollars."

And he's right [ed: you're surprised?]

But it gets better. Knowing my penchant for transparency in healthcare, Bob sent me a handful of relevant links and articles, which I'll share with IB readers in our first "mini-carnival:"

First up, Physician Reports is a sort of "self-serve" site that rates (dunh!) physicians. It's a free service, which is nice, but I'm a little turned off by the lack of accountability. That is, I poked around quite a bit, and still have no idea who runs the place, or how to contact them. It seems to me that there needs to be transparency in transparency, too.

Next, Florida's looking to increase the availability of cost information. A bill currently in the state Senate would require "pricing information from hospitals for 150 of the most commonly performed medical procedures to be posted on a state website." While I applaud this effort, I have two reservations: first, pricing information without matching outcomes (results) is potentially dangerous. Second, I'm not sure that legislation is really needed here: it seems to me that the market is beginning to drive carriers and providers to make these tools more widely available.

Regular readers know that we accept no paid advertising here, but we do "plug" carriers and providers whom we think deserve mention. Such is the case with HSA Trustee Services, an online Health Savings Account (HSA) administrator. What sets them apart are two interesting services they provide "over and above" just plain HSA oversight. First, they've added a "price negotiation service" to help keep their clients' out of pocket costs down. Second, they've teamed with a private lab service to help keep diagnostic expenses down, as well.

We're all familiar with the ubiquitous "name your own price" services for travel and the like. How would you like to bid on how much you'd pay for a nosejob? How about a colonoscopy? Forbes Magazine reports that "Medicine Online's network of 35 surgeons can bid for a job by responding with their fees and credentials." The service went online and live in March, and has already stirred up quite a debate. In terms of transparency, this may well be too much of a good thing.

Howdy, Pardner!

Ohio is in the vanguard of states offering the new "LTCi Partnership Program." Enabled by the Deficit Reduction Act of 2005, PP's are the latest signal from the gummint that it wants out of the long term care financing business. Briefly, the Ohio Partnership Program (OPP) allows one to "shelter" more money if and/or when one "spends down" to become Medicaid-eligible.

Many folks believe, erroneously, that Medicare will pay for their long term care needs. It doesn't: Medicare pays for medical expenses, which may sometimes include brief stints at a skilled nursing facility. But this is limited to a total of 100 days, which isn't exactly "long term." So, we turn to our long term care policies (if we have them) to foot a chunk of the bill. Often though, it isn't enough, so one turns to the state for assistance. The mechanism for this is called Medicaid, which is a federal program administered by the states. In order to qualify for this assistance, though, one must "spend down" one's assets. There are some allowances made for a spouse that's still well, and some personal belongings. But in general, one is allowed to keep only $1,500 in assets (Ohio's the lowballer here: most other states allow one to keep $2,000).

The Ohio Partnership Program changes that by allowing one to keep more assets if one buys a qualifying Long Term Care policy (PQ). Let's say you buy a plan that pays $100 a day for 3 years. That's a maximum benefit (or "pool of money") of about $110,000. If it's a PQ policy (more on that in a moment), then you're allowed to take $110,000 (plus the original $1,500) "off the table" when spending down. It's a way to preserve some, perhaps most, of your assets. Not a bad deal.

PQ plans are pretty simple, too, and most LTCi policies currently being sold would probably qualify. There are really only three criteria:

1) The plan must be federally Tax Qualified (most are)

2) Generally, the plan must include some cost-of-living or inflation protection

3) The carrier must be "approved" to participate

I'd daresay most plans sold these days fit at least the first two, and more carriers are signing on to participate. Still, it pays to ask your agent about your own plan.

If there's any downside to the program, it's this: since most plans sold prior to February of 2006 (when the DRA took effect) aren't Partnership Qualified, I suspect that there will be a rash of folks replacing their older, non-PQ plans with the newer model. This may or may not be a good idea, but I would be very suspect of any agent who suggests this course without a thorough fact-finding about one's current physical and financial health.

Oh, and the Law of Unintended Consequences comes into play on the agent's side, as well: we now have a new Continuing Education requirement. Effective September 1, we can't sell any LTCi plans (PQ or no) unless we're "certified;" the certification requires us to take a special 8 hour class on long term care in general, and the Partnership Plan in particular (and also requires us to have 4 hour "refresher" courses every two years after that). Nothing inherently wrong with that, but the class I took crammed 3 hours of material into 8 hours of instruction. Not the instructor's fault, of course, but completely unnecessary.

Long Term Care insurance is among the most complicated of the products we sell, so intensive training is not necessarily a bad thing. But I just don't think that it's 8 hours worth of material.

Still, it was worthwhile, if only because I'm now certified [ed: don't you mean "certifiable?"] to sell LTCi and the Ohio Partnership Program.

Cavalcade of Risk #51 is up!

Three-time host Spencer Hill presents this week's Cav. It's chock full of risky posts.

You don't have to be a three-timer to host: we have slots available for June and July. Just drop us a line to claim yours!

Interesting HSA "Gotcha"

I have the privilege of working with some truly great talent here in "Southwest Flyover Country" (aka Dayton, Ohio). One of my favorites is Pete Deist, who runs FlexBank, a local FSA/HRA/HSA administrator. Pete has a long and storied career "in the biz," and so has a unique and helpful perspective for those of us still in the trenches.

As part of an FAQ he recently compiled, he posed the following:

James enrolled in a High Deductible Health Plan (HDHP) with family coverage effective February 1, 2007. He contributed the maximum permissible amount of $6,450 ($5,650 plus the $800 "catch-up"). James turned 65 in January, and enrolled in Medicare effective January 1. As of that date, he was no longer eligible to contribute to his Health Savings Account. Is there a problem with his 2007 contribution?

I must confess that I have never run into this particular scenario before, but I suspect it will become more prevalent with the "graying" of the population. The answer was surprising, and enlightening:

Yes. Under the "no-proration" rule, he was treated as having been an eligible individual during every month of the year (2007) and was permitted to make contributions for those months during the year before he actually enrolled in the HDHP. However, he did not remain HSA-eligible during the 13 month "testing period" (beginning in December of the year for which those contributions were made and ending on the last day of the 12th month following that December) [ed: who writes these laws, anyway?!]. Therefore his contribution must be pro-rated based on the number of months he was an eligible individual.

Whew!

Believe it or not, there's still more: He'll have to notify the bank which holds the account that over $500 was contributed that shouldn't have been. Plus, he'll have to take that $500+ as a distribution and report it as "other income" on his taxes. Ouch!

If nothing else, this underscores the need to have a competent administrator for your HSA loss fund.

Thanks Pete!

[Hat Tip to Cornerstone]

Grand Rounds is up!

Suture for a Living hosts this week's edition. It's jampacked with interesting posts and beautiful photographs of Arkansas' flora and fauna.

David Williams, at the Health Business Blog, has a book review with a twist: the book's on not-for-profit health care providers.

Carnival of Personal Finance is up!

This week's edition is hosted by Money & Business blog's Kimberly Palmer. Kim offers 6 posts in her "Editor's Choice" category, then the rest of the links (too numerous to count!). Definitely worth a look around.

Cavalcade #51: Submissions Due

Spencer Hill hosts next week's edition of the Cavalcade of Risk. Submissions are due by Monday the 5th, and the Cav will be up and out on the 7th. As always, please make sure to include:

■ Your blog's url
■ Your post's url
■ The post's trackback URL (if available)
■ A (brief) summary of the post

You can submit them via Blog Carnival or email.

We have slots available for June and July, so PLEASE drop us a line to reserve yours.

Health Wonk Review is up!

Over at Medical Humanities Blog, Daniel Goldberg hosts this week's compilation of thought-provoking, interesting posts. With over a dozen and a half wonky choices, you're sure to find something to pique your interest.