Saturday, January 31, 2009


Every time you place a bet, the house get's "juice", or "vigorish" or just plain "vig".

Sweet deal if you can get it.

Did you know AARP collects vig on insurance coverage bought through their organization?

Neither did Arthur Laupus.

Arthur Laupus joined AARP because he thought the nonprofit senior-citizen-advocacy group would make his retirement years easier. He signed up for an auto insurance policy endorsed by AARP, believing the advertising that said he would save money.

He didn’t. When Laupus, 71, compared his car insurance rate with a dozen other companies, he found he was paying twice the average. Why? One reason, he learned, was because AARP was taking a cut out of his premium before sending the money to Hartford Financial Services Group, the provider of the coverage.


Laupus stumbled onto something that many members of the world’s largest seniors’ organization don’t know: The group, formerly called American Association of Retired Persons, collects hundreds of millions of dollars annually from insurers who pay for AARP’s endorsement of their policies.

So how much juice does AARP collect?

The insurance companies build the cost of these so-called royalties and fees, which amounted to $497.6 million in 2007, into the premiums they charge AARP members, according to AARP’s consolidated financial statement for that year.


Friday, January 30, 2009

WHAT Right to Privacy?

Back in the day, a controversial Supreme Court decision turned on the (presumed) Constitutional Right to Privacy. Apparently, someone forgot to inform the new administration of this Right (irony notwithstanding), because buried in the new Stimulus Package is this little gem:
Privacy experts are a bit miffed at this (no surprise) because, in addition to the "normal" aches and pains, these records will include "documentation on abortions, mental health problems, impotence, being labeled as a non-compliant patient, lawsuits against doctors and sexual problems."
We've discussed the viability and advisability of electronic medical record keeping before, but always from the provider's standpoint, and always with an eye toward respecting and protecting the patient's privacy and integrity. This seems to be a giant leap beyond all that; given the gummint's less than stellar record regarding safe-keeping, I think this is -- at best -- worrisome.

Party on, Gramps!

Alzheimers and dementia are no laughing matter, but in addition to other non-intuitive treatments, this unusual advice may be just the ticket:
This is from a new report in the medical journal Neurology, which tracked some 500 senior Swedes, none of whom had been previously diagnosed with dementia. The study lasted six years; by the end, about a third had developed dementia. What was (perhaps) surprising was that folks with more active social lives were about 50% less likely to develop those symptoms.
It appears likely, based on this study, that there are some significant environmental and lifestyle factors that play roles in dementia; that's good news, since these are things we can (at least to an extent) control.

Thursday, January 29, 2009

Don't Try This at Home

Valentine's Day is just around the corner. Love is expressed in different ways.

Sometimes it is candy and flowers.

Other times it may be a romantic evening.

Or maybe even a special gift for one you love. Like maybe, breast implants.

Cosmetic surgery can be a wonderful thing . . . until the break up.

Then things can get nasty.

Prosecutors say a spurned lover ambushed his ex-girlfriend and tried to cut out the breast implants he paid for by stabbing her.

San Bernardino County prosecutor David Foy says 28-year-old Thomas Lee Rowley attacked his ex in July 2006 outside her mother's home in Hesperia, some 70 miles northeast of Los Angeles in the Mojave Desert.

Rowley is on trial in Superior Court in Victorville for attempted murder, assault with a deadly weapon, stalking, burglary, and false imprisonment.

The 26-year-old woman survived six stab wounds and the punctured breast implants were repaired.

Rowley's former roommate Dennis McGill testified this week that the defendant wanted to reclaim what was rightfully his. Rowley allegedly told McGill, "I'm gonna cut 'em out and get em back."

OK, so what was he going to do with them then?

Wednesday, January 28, 2009

Health News Mini-Roundup

■ Looks like Galinda was right: it's good to be popular. But she may have been wrong, as well; some folks may just be born that way:
Here at IB, we've looked at the Alzheimer's gene, the breast cancer gene, even the Down Syndrome gene. But one that could predispose someone to be more popular? Who knew?
Researchers from Harvard and the University of California (San Diego) studied over a thousand teen-aged twins, and found that identical twins seemed to share the same social position than fraternal ones, which the researchers believe suggests a genetic component to social status (aka popularity).
Prince Charming may be wearing a wedding ring:
The comatose woman turned her head toward her husband, pursing her lips and kissing him.
This apparently happened two years ago; she's had a rough time, including some short term memory loss, additional brain surgery, and therapy. But she's coming along well, and seems to be on the road to recovery.
■ MVNHS©: Where's the Beef?
In yet another whimsical, and yet silly, move, Britain's health service has decided to limit its patients' carbon footprint (feetprint? footprints?). First up, taking a page from Domino's, the Service recommends that Brits call it in rather that dropping by:
[ed: Don't be alarmed; "surgeries" in this case means doc visits, not procedures]
Actually, that may not be such a bad idea: there's certainly a justification for using the phone or email for simple, non-emergency consultations.
It's not exactly clear how this will help reduce so-called Global Warming:
"They also want hospitals to achieve their green targets by reducing the amount of meat they serve to patients in wards."
After all, it's well-established that bovine emissions increase greenhouse gases; wouldn't it make more sense to encourage eating beef?
This observation certainly rings true:
"(T)he NHS is responsible for a quarter of all the carbon dioxide emissions produced by the public sector."
That's a lot of gas.

Voted Off the Island

If you have ever watched the reality shows where votes are taken and someone is voted off the island, you can imagine how Jeanne Sather felt.

Or if you are the last one to be picked for a schoolyard game of kickball, then you understand the feeling.

No one wants to play with you. It is an empty feeling that takes a while to get over.

Since Jan. 1, a third of the 82 members of the Washington State Health Insurance Pool whose coverage was terminated have been reinstated after they belatedly provided proof of eligibility.

In 3 weeks time, 82 of Washington state's sickest lost their economic lifeline . . . health insurance.

The risk pool is for those who have no other options.

With premiums that can top $20,000 a year, patients don't exactly clamor to join the state's high-risk health-insurance pool — a public insurer of last resort for patients with cancer, AIDS and other serious diseases.

Until you or someone you know is sick or seriously injured, you probably don't know how much health care, and health insurance, really costs.

Some cancer treatments can run $8,000 per month for a single monthly treatment.

That's scary stuff.

Jeanne Sather, a Seattle writer and blogger who has advanced breast cancer, said she lost — then regained — her coverage because of a paperwork snafu. Sather said she twice had to send proof of her Medicare coverage but still ended up receiving a cancellation notice.

A seasoned patient's advocate, Sather fired off e-mails to both the high-risk pool and the state Insurance Commissioner's Office. She quickly got her coverage restored — but not before she worked up a fury.

"You have to remember that people like me are sick," Sather wrote in one e-mail. "So making trips to Kinko's to make copies uses up precious energy and time. I deeply resent being asked to do something like this."

This can happen to anyone, but when it is a government run plan, funded (at least in part) by taxpayer dollars, it really gives you pause about the future of public plans.

By law, the high-risk pool is open only to residents of the state. It also must ensure that members who have dual coverage with Medicare tap those federal benefits first. Last year, a state audit recommended that the pool obtain proof of eligibility from all its 3,300 members.

Only 3,300 members state wide. That is a bit surprising.

The high-risk pool provides coverage for people who can't buy individual insurance from Regence BlueShield, Premera Blue Cross, Group Health Cooperative and other commercial insurers. Washington permits insurers to screen out the sickest 8 percent of the applicants. In return, the insurers pay a subsidy — totaling nearly $40 million last year — to help offset the cost of operating a separate pool.

Each state that operates a risk pool has different criteria. In most, if not all cases, funding is provided through member premiums, taxes and carrier assessments.

In other words, everyone shares in the cost.

Risk pools are a good thing but, like anything else, are subject to abuses. States must constantly audit to make sure the pool remains solvent for current and future participants.

Cavalcade of Risk #70 now online

Health Business Blog's David Williams hosts this week's collection of risk-themed posts. Take a chance and stop on by.
And consider hosting your own Cav - just drop us a line.

Tuesday, January 27, 2009

UHC vs Diabetes: The Interview

Last week, we noted that United HealthCare has introduced a new program to help insured diabetics (and "pre-diabetics") cope with and finance their expensive health care. In a followup, I asked to speak with someone from the program's development team in order to help our readers understand how it came about, and how it's intended to work.
Alex Nelson, their PR contact, graciously arranged for me to interview Tom Beauregard, the CEO of UHC's R&D arm, United Essentials [ed: oddly, and after much searching, I could find no link to that entity]. Mr Beauregard and I spoke for some time, and we're delighted to present the fruits of that discussion:
So, who is Tom Beauregard?
Mr Beauregard runs the Research and Product Development arm of UHC. He's been with them for about 3 years; the previous 20 were spent consulting in this area.
What prompted this new effort?
Demand from employers, primarily. They want to move away from cost-shifting toward more "Value Based Insurance." The goal is to target communications to modify behaviors.
Some employers have begun encouraging voluntary efforts in this regard, and UHC decided to set up its own program to augment these, starting with diabetes and weight management.
How is this program different from previous endeavors?
The goal is to offer incentives based on compliance with ADA (American Diabetes Association) standards. It's both a carrot and stick approach: folks who continue to comply with the stated objectives receive extra benefits, at no cost, while those that "fall off the wagon" are directed back to the basic insurance plan.
[ed: Some might view this as somewhat "Big Brotherish;" I think it's good business sense - up to a point. More on that later]
I can see how this could help those currently suffering from diabetes, but what, exactly, is a "pre-diabetic?"
According to UHC and the ADA, these are folks with elevated levels of HBIC and cholesterol, who haven't - yet - developed full-blown diabetes, but are at increased risk of doing so. The standards, set forth by the ADA, aren't arbitrary; they estimate that up to 26% of adult Americans are "pre-diabetic."
[ed: And here's where I have to draw a line. I take issue with UHC's apparently uncritical acceptance of this whole "pre-diabetes" phenom. The ADA claims that "(p)re-diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. There are 57 million Americans who have pre-diabetes, in addition to the 23.6 million with diabetes."
And just where does that 57 million come from? The ADA doesn't say, and, at something like 20% of the population, it doesn't pass the smell test. I think that this whole idea of alarming the public over obviously inflated numbers does more to harm a cause than to help it. The other "23.6 million" is similarly suspect. If you're wondering why the ADA would be okay with these inflated, perhaps spurious numbers, remember that many organizations rely on public perception for fundraising purposes]
One very simple way to decrease this risk is through weight loss, so the program includes numerous tools to help facilitate this.
Sounds like a plan. But why only self-insured groups? Is there a plan to expand it to fully insured plans?
UHC decided to focus on SI groups first, to get a feel for how many people would both sign up, and subsequently stay with it. It's easy for folks to say "sure, I'd be interested in such a plan," but the real test comes when it's actually offered to them, and they have to make the conscious decision to participate. And once they're on the plan, how many will stick with it? That can only be determined by trying it out in a controlled setting.
If the metrics bear out, then the company will consider expanding the program (in one form or another) to their fully insured groups.
We truly appreciate Mr Beauregard's time and candor, and will keep an eye on the plan's progress. He also indicated that he'd be happy to answer any other questions we might have, so readers are invited to suggest them in the comments.

Is SCHIP the Answer?

Congress is set to introduce legislation, and the President is expected to sign, a plan to expand SCHIP to millions of children in homes where the income is $63,000. Some pundits believe the income threshold could be as high as $80,000.

This is not what most consider poor.

But is SCHIP really the answer?

Not so for Michelle. A single mom in Geneva, Illinois working 6 nights a week as a bartender. She has not signed up for All Kids (Illinois' SCHIP) for her 7 year old son.


many doctors in her area won’t see kids with this kind of coverage.

“I looked into All Kids and it’s affordable, but it seems to be seen as a kind of second-class insurance where I live,” she told me.

"Second-class insurance."

This is the reality behind the promise of universal access to health care for Illinois children. Payment rates are so low and state payment for services so slow that many providers, especially those in the suburbs, simply refuse to see kids with All Kids coverage.

Washington, we have a problem.

I asked Susan Phillips, director of marketing at the Dreyer Clinic, why these patients were turned away. She cited the state’s low reimbursement rates and tardy bill-paying practices as well as complicated administrative requirements associated with the program.

Low reimbursement, tardy payments, administrative red tape.

And this is supposed to be the answer to America's health care crisis?

Nearly 150 doctors at the for-profit Dreyer Clinic, an affiliate of Advocate Health Care, stopped accepting new patients with government-funded Medicaid coverage in 2006, Phillips said. Medicaid is part of All Kids.

Well there's your problem.

Dreyer is for profit and we all know that for profit operations are bad.

The lesson here is that true universal coverage depends on more than a promise of health insurance for all. It requires medical providers willing to serve those with coverage.

I don't like the word . . . "requires".

The Shoe is on the Other Foot

[Welcome Industry Radar readers!]

I imagine most of us have our share of spam email flooding our boxes every day.

The theme is usually grandiose. Pass this along to 10 people or your nose will fall off. Bill Gates wants to give you free software for life. Buy this pill and you can last all night in the bedroom and roar like a lion in the morning.

And of course there is a never ending flow of wealthy Nigerians who are promising to deposit millions in my bank.

This, in spite of the fact most Nigerians live on less than a dollar a day.

So it is almost ironic that a country that spams the world offering money for nothing would reject health insurance.

The National Health Insurance Scheme was introduced in 2005, but has not gained wide acceptance. Perhaps removing the word "scheme" from the plan might improve the odds . . .

Idowu, whose organisation went into health insurance 11 years ago, said, “We saw patients die because they did not have money to pay for health services. Eleven years ago, we decided that out-of-pocket for health expenditure was not the answer.”

Somehow this has a familiar ring.

Idowu said, “Some members of staff of such organisations make a lot of money from doctors, just to get their bills approved for payment. There are some that you have to give 10 per cent or 15 per cent before your cheque can be written.

Doctors demanding money from insureds? The very idea!

He also said that some beneficiaries also abused the scheme. The managing director said, “They are supposed to be registered with the wife and kids. When the mother or girlfriend is ill, they will take her to the hospital to use the wife’s card. When the neighbour’s child is ill, they would take him to the hospital to use the son’s card.”

Fraud and abuse?

Say it ain't so.

“Most Nigerians obtain insurance cover for their cars only because they don’t want the police to harass them and not because they believe they could have accidents. Indeed, if you tell any Nigerian that he or she could fall sick, he or she would be angry with you and forbid it ‘in the name of Jesus.’ So, if they buy insurance because they don’t want to be harassed and that they don’t believe they would have accident, how would you expect them to pay for health care when they are not ill?

Sounds like some of the excuses I have heard for not buying health insurance.

“There exists a religious group that believes that health insurance is equivalent to gambling.

Gambling is bad, but spamming is good?

What a country.

Not Just for the Ladies: Grand Rounds at Chronic Babe

Jenni Prokopy, the hostess with the mostest, presents this week's roundup of the best medblog posts.
We're tickled pink to be included.

Monday, January 26, 2009

Humana Network Fallout

Fresh on the heels of Humana's recent faux pas, FoIB Rick Byrne alerts us to this important change to the way Ohio DOI handles network changes. Effective (apprently) immediately, health insurers must now report "significant changes to their medical provider networks to the Ohio Department of Insurance." They'll also have to tell the Department just how they intend to communicate these changes to their insureds.
What's more, they have to notify the state at least 15 days before they contact their insureds. One supposes this is to enable the Department to oversee the transition, and (perhaps) protect policyholders from the potential for significant reductions in how their claims are covered.
I'm pretty sure that this is a "good thing."
[Hat Tip: Rick Byrne]

A Different Type of Stimulation

[Welcome Insurance Forums readers!]

Speaker of the House, Nancy Pelosi, addresses the proposed stimulus package . . . including contraceptives and family planning.

Fat Bug

It's not your fault you are fat.

It's not genetic, so you can't blame mom & pop.

It's not because you super-size every meal.

You are fat because someone sneezed on you.

As many as one in three obese people may have become overweight after falling victim to the highly infectious cold-like virus, known as AD-36.

Only one third can make this claim.

So for the rest of you . . .

Saturday, January 24, 2009

Santa Claus is Coming to Town

[Welcome Insurance Forums readers!]

Just like those Christmas in July promotions, Santa Claus is coming in the next few weeks to a state near you.

It doesn't matter that the national debt is $10 TRILLION and counting. Or that Congress has saddled every one of us with almost $35,000 in debt (over and above our personal debts).

Your Congressmen and Senators are here to help.

In the next few weeks Congress is expected to deliver a Christmas bundle of money for the President to sign that is estimated to be $850 billion dollars. Unlike you & me, Congress has the ability to write checks even though they do not have any money in the bank.

Sweet deal, huh?

Included in the stimulus package are such items as this.

"Hundreds of millions" of dollars for contraceptives. This provision failed to pass in an earlier version. It remains to be seen if it will be included in this version or not. If included, this expands the definition of "economic stimulus."

Some $30 billion for COBRA subsidies. If passed, the subsidy would cover up to 65% of the cost of COBRA.

The bill would provide a subsidy for up to 12 months for those with COBRA coverage, allow retroactive enrollment into COBRA coverage, and extend the eligibility window for COBRA coverage for those 55 or older and for those who had been employed by their previous employer for over 10 years.

As of December there were 11 million unemployed. Many of those were covered under plans that no longer exist. As employers go out of business, the group plan is terminated leaving displaced workers and their families to find other options.

The average annual employer-based family policy in 2008 cost $12,680.[

Even with a subsidy, many families could pay $300 or more per month for coverage. I work with a lot of individuals and families who have lost their job, and their employer sponsored coverage, to help them find ways to keep their costs in check while they are unemployed.

Most of the time the options available are significantly lower than COBRA.

The bill would also provide 100 percent of federal funding for states to expand their Medicaid programs to cover unemployed workers and their families whose income did not exceed 200 percent of the Federal Poverty Line and did not receive food stamps.

This means a family of 4 can earn up to $42,000 and still qualify for taxpayer funded health care.

This new spending does not include $90 billion already in the package to bail out state Medicaid shortfalls.

Yes, it does appear that Santa Claus is indeed coming and he has a sleigh full of money bags for everyone.

Nothing is said about being naughty or nice.

Friday, January 23, 2009

Cavalcade of Risk #70: Submissions Due

Health Business Blog's David Williams hosts next week's Cavalcade of Risk. David asks you to include:
■ Your blog's url
■ Your post's url
■ The post's trackback URL (if available)
■ A (brief) summary of the post
PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).
You can submit your post via Blog Carnival or email.
It's fun and easy to host - just drop us a line to find out how.

Lights out for CFL?

Insurance, which is the primary theme of this blog, is about identifying and managing risk. But it's not the only risk-related subject; sometimes risk is simply about assessing whether or not it's safe to change a lightbulb.
Anyone who's had to change a light bulb recently [ed: quick - how many insurance agents does it take to change a lightbulb? Answer: no one knows, we don't mind being kept in the dark] has seen those nifty new "twisty-bulbs," aka Compact Fluorescent Lights (CFL). Touted as a substantial energy savers, they're now actively creeping into widespread use.
Of course, our nanny-state gummint-class has mandated that these little marvels must soon replace the familiar "regular" bulb (notwithstanding their potential danger). But are they good for our health?
In addition to toxic mercury, our Neighbors to the North are becoming increasingly concerned that they may also be giving off "potentially harmful ultraviolet radiation." Health Canada (the "department responsible for helping Canadians maintain and improve their health") recently studied CFL's to determine whether they pose a radiation risk. Oddly, I couldn't find any mention of this study on the HC website; perhaps it's too new.
But it's not just Canadian authorities in a dither:
It's so bad, in fact, that the Brits are recommending that folks spend no more than an hour a day in their immediate vicinity (the bulb's vicinity, not the Brit's). There's also concern that these little wonders may negatively impact those with lupus.
Stranger still, our own Consumer Product Safety Commission is completely silent on the subject.
Why is that?

Thursday, January 22, 2009

Post-Inaugural Health Wonk Review

Jaan Siderow hosts this week's roundup of interesting and provocative health care policy posts. It's a true rock concert of a 'Review.

10 Feet Tall and Bulletproof

[Welcome Industry Radar readers!]

OK, maybe not 10 feet tall, but still bulletproof.

So, let's say you want to protect your health.

You can eat right, get plenty of exercise, maybe even take vitamin supplements and wear bulletproof clothing.

Barack Obama had more than the Presidential 'beast' limo taking care of his safety yesterday.

According to some reports, he wore a suit made by a clothier specializing in bullet-resistant clothing during the inauguration ceremonies.

Of course the Secret Service isn't commenting one way or the other.

So how much would something like this cost if you decided you just can't live without it in your wardrobe?

Caballero is well known for his super tough but flexible and business appropriate clothing, such as the $7,500 polo shirt that can stop a shot from a 9-mm revolver.

Wonder if this is wash and wear or dry clean only?

Wednesday, January 21, 2009

Admirable Carrier Tricks: Good News for Diabetics

Currently, the program is available only to self-insured groups, and is available for both diabetics and what UHC calls "pre-diabetics." One supposes that these are folks who, because of genetics and/or lifestyle choices, are more at-risk of developing the disease.
Folks participating in the Diabetes Health Plan receive on-line monitoring and special disease-related educational tools and training. They also receive some diabetes-related meds, including not just insulin but even anti-depressants.
I've asked Stacy about interviewing someone from the plan's development team, and hope to have that set up and posted in the near future. I'd also like to know if there's any chance of porting this program to fully-insured groups down the road; given UHC's stated concern about the "rapidly growing numbers of diabetics and pre-diabetics," one would think that this is on someone's drawing board.
In the meantime, here's a quick video with some background, and an explanation of how the program works:

Healthcare Stakeholders: A Perspective

We're delighted to welcome guest-blogger Deron Schriver, blogmeister of Healthcare Rx. Deron recently proposed a post about physician/insurer relations, and we're happy to oblige. He's worked in the health care field for for ten years, with the last three spent as a medical group administrator for a large OB/GYN practice. Deron tells me that his "daily interactions with the various healthcare system stakeholders have enlightened me and sparked my interest in system reform, which has lead to my other life as a rookie healthcare blogger."
Deron believes that there is a tremendous amount of room for improvement in that area. Given today's political climate, this seems like a capital idea, and we are pleased to present his take on where we "go from here:"

The high per capita spending of the U.S. healthcare system has been widely published. As a result, we have seen a renewed interest in system reform. Despite the large number of people and organizations developing and proposing reform strategies, no single strategy has emerged as the best solution.
Considering the magnitude of the problem, we would be best served if we could identify synergistic reform opportunities. I would like to suggest one very important opportunity that could produce significant benefits: a focused effort to improve and enhance the relationship between physicians/hospitals and health insurers/managed care organizations (MCOs), with a goal of improving quality and reducing cost.
In a well-functioning healthcare system, providers and payers would partner in the name of improving the health status of their mutual customers: the patients/covered members. However, patient-centeredness has taken a back seat in the current environment. Factors such as market share and leverage have played a big role in fee schedule negotiations and provider network development and maintenance. Instead of identifying common goals and opportunities to work together, the two sides have been guided by short-term financially-motivated thinking.
So where do we start with an initiative like this? My suggestion is that we get the two factions to sit down and discuss 1) the measures they can take to improve the health status of their mutual customers and 2) the steps they can take to reduce waste and complexity in their relationship.
The two must identify key indicators to help guide their efforts. Clinical measures such as average spending per condition, hospital infection rates, and screening rates (mammograms, cholesterol checks, bone density tests, etc.) should be routinely analyzed and acted upon when necessary. Administrative measures such as claim denial rates, phone hold time, and consistency of policies with national standards (ex. CCI) should also be considered.
As someone who sees this relationship play out on a daily basis, I can tell you that there is tremendous room for improvement. Turf protecting is a big problem within the U.S. healthcare system, and all stakeholders, particularly the two mentioned, engage in it routinely. If it’s done right, reform does not have to mean that insurance companies, physicians, or any other stakeholder needs to take a big financial hit. Reductions in revenue will be offset, to at least some extent, by corresponding reductions in cost. When the focus is where it needs to be, waste will be eliminated and everyone will come out stronger. This is a best-case scenario, but I can’t imagine striving for anything but the best.

Many, many Thanks, Deron! It's obvious that there's a lot more to the challenge of health care delivery and financing than meets the eye, and that a good place to start is by opening up these lines of communication between providers and insurers.

Tuesday, January 20, 2009

Moronic Carrier Tricks: The Aetna Story

I tend to write a fair amount of individual medical. For one thing, a lot of agents in my area have given up on this market; for another, I actually enjoy the one-on-one nature of this type of business (as opposed to group).
There are a number of carriers available, but of course the market is dominated by one or two. As a firm believer in competition, I'm always on the lookout for alternatives. Recently, I've started using Humana and Aetna in an effort to broaden the marketplace. Unfortunately, I've had to (at least temporarily) curtail placing business with Humana, so I had high hopes for Aetna.
Which have been dashed to little, teensy weensy pieces:
First, despite their insistence on how well they do online applications, I can rarely get their link to work. I have clients sitting in front of their monitors, waiting patiently for the page to load, only to see the page time out. And time out. And time out.
So back to paper apps, which are cumbersome and add even more processing time. Not to mention additional, stupid procedures. Recently, two brothers and a sister applied for major medical this way. We tried, in vain, to get the online app to work. When that proved futile, we switched to paper. I had their father (who's initially paying the premium) write one check for all three, hoping to at least save some effort.
This is what I received:
"We will need once [sic] check for each applicant because technically each application is it's [sic] own separate policy, and will have it's [sic] own ID #"
To which I reply:
So. Freakin'. What?!
What possible difference does it make that there's one check for each application, when the only thing that matters is that they got the money?
In another case, we were finally (and after much technical support) able to get the online application to work. The underwriter then decided that he (she? it?) needed additional info, and tried to call my client. Unfortunately, they were calling his home number during business hours; when I called to suggest that they use his business number (which was on the application), they countered that he should call them back at their special, super duper toll free hotline. Here's how that worked out:
"Boy have I been having a hard time with Aetna. They do not answer or return calls. But finally, I got through. They want stuff faxed from [my] doctor--last three ... and last ... reading. The doctor is faxing it to them."
Why would a carrier offer a "streamlined" service which was itself so difficult?
Oh, I know: because they're...well, see the title of this post.
Needless to say, I won't be writing any more Aetna individual plans.

Change You Can Believe In

[Welcome LGF readers!]

How do you feel about free health care coverage for families earning less than $63,000 per year?
Citizenship not required.

Funding will come in the form of increased taxes,including a 64% hike in federal taxes on cigarettes.

Is the new prez still smoking?

World Net Daily reports this sweeping change in SCHIP is one of the first acts President Obama want's to sign into law.

It seems Pelosi and company have been busy.

Last week, the House voted 289-139 to expand HR 3963, the State Children’s Health Insurance Program, or SCHIP, a federal program providing coverage to children whose families have higher incomes than those who qualify for Medicaid. The bill, sponsored by Rep. John Dingell, D-Mich., renews the program for five years, increases funding from the current $35 billion to $60 billion and expands coverage from million to 11 million uninsured children.

Somehow this flew under the radar.

Sounds good on paper.

But SCHIP requires funding at the state level as well. So where will states, that are already coming up short on tax collections, get the money? Unlike the federal government, states don't have the ability to print and spend money they don't have in the bank.

More than 2 million children who currently have private insurance could be covered under the expansion, causing a shift that could pose a burden to taxpayers.

Why pay for insurance when you can get it for free?

This is an issue with anything, not just health insurance.

The House bill also allows illegal aliens access to SCHIP because it no longer requires identification such as green cards or passports for enrollment. Illegals would be allowed to receive coverage for up to 90 days while states attempt to verify Social Security numbers. If they do not provide valid numbers, they will be dropped from enrollment after three months.

That's comforting.

Illegals who have stolen Social Security numbers could continue to receive SCHIP benefits unless the Social Security Administration tracks the thefts.

So the SSA is going to play the part of Sgt. Friday and track down stolen SS numbers.

Yeah, like that is going to happen.

Not all change is for the good.

One of our readers shared THIS interesting piece about SCHIP and fraud.

An arrest warrant alleges that the couple, both age 47, enrolled themselves and their three children in the HUSKY program in 2006 by saying Epstein was unemployed and Friedman had no income.

According to the warrant, Friedman had substantial income from her pediatrics practice during 2007 and Epstein was covered by a teachers' insurance plan when claims were submitted to Medicaid.

Some people like to game the system. Sounds great until they are caught.

Inauguration Day Grand Rounds

FoIB Val Jones presents an inspiring and thoughtful Grand Rounds, including eye-catching pics and thought-provoking posts.
Do check it out.

Monday, January 19, 2009

Back in the Pool

Last fall, we took a look at the North Carolina high-risk insurance pool. And tomorrow, of course, heralds a new day in Washington, where health care delivery and financing will take on new urgency.
So it seems rather timely that the National Association of State High Risk Insurance Pools (NASCHIP) has released their comprehensive report on state high risk insurance pools, and how these mechanisms may play a vital role in both state and federal reform efforts.
The report itself is available here.
According to Noah Rouen, Vice President for Accounts, "(t)he paper is particularly timely as Congress and the Obama administration seek to add coverage for millions of Americans. You may recall that Sen. McCain had proposed expansion of state high risk insurance pools as a cornerstone of his reform proposal."
Of course, we had our own take on Senator McCain's dubious proposal.
Nevertheless, the NASHIP report makes compelling reading, and underscores how important it is to address the problems facing our health care system on a state-by-state basis before overhauling it on a national level.

A Classic Carnival of Personal Finance

Penelope Pince, blogging at Pecuniarities, hosts this week's Jane Austen-themed Carnival of Personal Finance. If you're a fan of the classics - literature or finances - this one's for you.

Sunday, January 18, 2009

Food Pyramid Update: Good News, Java-style

Turns out that El Grande double-mocha-frappa-latte espresso may help decrease your chances of developing Alzheimer's:
Of course, we've discussed the "nuances" of Swedish scientists before, but teaming with the Finn's may have been a good idea. Those of us in that nebulous demographic called "middle aged" may benefit from a few Cups o' Joe every day, to the tune of as much as a 60% reduction in the risk of Alzheimer's.
There's no word on why coffee has such magic properties; oddly, I couldn't find a report on the study which indicated whether or not decaf obtained similar results. Miia Kivipelto, a professor at the University of Kuopio in Finland and lead researcher on the project, noted that "coffee contains strong antioxidants, which are known to counter Alzheimer's."

Friday, January 16, 2009

MVNHS© Dirty Little Secret

Proponents of nationalized health care systems often tout the benefits of gummint control, with no need for nasty, profit-driven "private insurance." After all, the thinking goes, health care is "free," and "available to all."
As we've repeatedly demonstrated here at IB, this is simply wishful thinking.
But don't just take our word for it:
Well, that looks like pretty much every health insurance ad we've seen around here.
Except for one thing:
"New Enquiries: 0800 072 6712"
That, dear readers, is a British phone number. That's right, the "dirty little secret" is that, despite the hoopla, Brits still need that evil insurance. In fact, there are a number of different plan options available, all reasonably priced.
Well, they're in Euros, so who knows, really?
According to Jennie Burraway, Digital Strategy Consultant for HSA Healthplans, the company is looking to expand its marketing efforts, presumably to all those Brits currently enjoying their free health care.
The company even touts its own long history of "helping individuals, families and organisations access affordable healthcare since 1922, a history that pre-dates the NHS."
The truth is, even the Much Vaunted NHS has numerous holes which need to be addressed, and it appears that Brits actually pay for their health insurance twice: through expensive taxes and additional premiums.

Wednesday, January 14, 2009

Cavalcade of Risk #69 is online

Debbie Dragon hosts an outstanding Cavalcade, the first of the new year. Head on over and check it out!
And please consider hosting your own Cav, just drop us a line.

Who is Scamming Who?

[Welcome Insurance Forum readers!]

New York Attorney General Andrew Cuomo made headlines over a settlement reached with United Healthcare (UHC) and a subsidiary (Oxford Health Plans) over alleged abuses in the handling of claims by Oxford.

Much has been said in the news over the $50M "settlement" and the fact that UHC admitted to doing nothing wrong.

Frankly, I concur. I see nothing wrong in their actions.

The headline story is about Mary Jerome of Yonkers, NY, a policyholder of Oxford Health Plans. Ms. Jerome was diagnosed with ovarian cancer and in 2006 (according to the news report) "chose to go to Memorial Sloan-Kettering Cancer Center in New York, an out-of-network hospital under her insurer".

That should be the end of the story, but apparently not for some.

She could have used a par (network) provider with lower out of pocket costs to both her and the carrier, but instead CHOSE to go elsewhere. She did not just wander in to SK, she voluntarily CHOSE to go out of network in spite of the penalties outlined in her policy.

The carrier reviewed the claims and determined that many of her treatments did not fit the guidelines of their policy and denied or reduced benefits. This resulted in some $46,000 in out of pocket costs to Ms. Jerome . . . a figure that no doubt would have been much less had she CHOSEN to use network providers.

The news article revolves around two primary players (other than the Attorney General). Ms. Jerome is the catalyst that led to the AG's investigation but Ingenix is identified as the major culprit.

Ingenix is a subsidiary of UHC and a major source of cost data for medical procedures. According to their website they sell data to some 1500 carriers. The data is used by the carrier to set premium rates and benefits for non-par procedures as well as factored in to claim reimbursement levels.

For years this kind of data was collected by an organization known as HIAA, the Health Insurance Association of America. That data was sold to carriers and used in the same manner as data from Ingenix is today.

At some point HIAA merged with other associations and eventually became AHIP (America's Health Insurance Plans) and they exited the data mining business. Whether they sold that data to Ingenix or not is not known.

It really doesn't matter, the point being, carriers have relied for years on independent data farmed from literally millions of claims to provide a relative cost basis for health care. Absent such a database providers could charge whatever they wish and the carrier, and the patient, would have to pay.

I was recently shown some figures for bilateral insertion of venting tubes (CPT 69436) for a patient in Wisconsin. The variance in surgical charges were nominal, ranging from $1950 - $2146 (before network repricing).

Nothing remarkable there.

But the differences in gross hospital billing was palpable. Facility charges ranged from a low of $3600 to a high of $12,000 on a gross billing basis.

Without data like this, neither carriers nor patient will know what to expect and would be at the mercy of the provider.

Claim data serves to reduce costs for everyone that can be passed on in the form of premium savings as well as OOP savings to the patient.

The fact that Ingenix collects this data and resells it to 1500 carriers (including UHC and Oxford) is immaterial. It is not like the data is manufactured or even massaged. It is what it is.

Also, no one wants to shift the blame to Ms. Jerome who had the opportunity to use par providers which would have resulted in a much lower OOP for her and the carrier.

So why is this news?

Mr. Cuomo, whose previous job included HUD Secretary from 1997 through 2001 during which time there was a major expansion of sub-prime lending programs especially those backed by Fannie Mae (FNMA), has an interesting past. He assumed his present position as N.Y. Attorney General following the fall of Eliot Spitzer.

This makes one wonder, is this an election year?

UPDATE [HGS, 1/17/09]: Well, well, well:
So is this the end of Ingenix?
Time will tell.

Tuesday, January 13, 2009

CDHP Wins Another Round

Consumer Driven Health Plans (e.g. HSA's, etc) continue to help solve one of the underlying, persistent problems facing health care delivery: cost.
As we continue to demonstrate here at IB, health care costs drive health insurance costs. That is, increases in the cost of care directly affect the cost of financing (insuring) that care.
One proven method for reining in that trend is through health plans that empower and involve the consumer. Recently, UnitedHealthcare underwrote another major study of Consumer Driven Plans, and how they have affected costs. They studied their own claims experience for the past 5 years, and found that these plans "consistently delivered lower cost than PPO plans in four of the five years, even after adjusting for differences in health status, demographics and other influencing factors. Importantly, the bulk of the savings are attributable to changes in health utilization, not cost shifting to the employee."
That last part is key: one of the major arguments against consumer-centric plans has been a (false) perception that they come at the expense of the insured. Turns out, not surprisingly, that that's not the case.
The study comprised over 400,000 insureds, which seems like a pretty decent sample size. Folks (and fellow wonks) who'd like more details can access the results by clicking here.

Connecting with Grand Rounds

Hostess Barbara Kivowitz presents a fun and informative 'Rounds, built around the (perhaps non-intuitive) connection between health care and sci-fi. It's worth a read if only for the clever way she brings the two together.
Good stuff.

Monday, January 12, 2009

Not tonight Honey, I have a 339.82

[Welcome LGF readers!]
[Another timely update from our Favorite MOM (Medical Office Manager), Kelley Beloff, MSW, CMM]
I recently attended one of my yearly Medicare updates. This one focused on changes in the coding for medical conditions in the medical field, known as ICD-9s.
Women around the world have now been vindicated by the world’s medical association. There is a new ICD-9 for this year, code 339.82: Headache associated with sexual activity. As a woman -- and for my long suffering sisters -- it is about time that the medical field recognized the condition of how the thought of sexual activity can bring on a headache. So, as a service to the many readers of Insure Blog, I felt it necessary to report this breaking news on the medical front.
Yes, Virginia, the headache is real.

Sunday, January 11, 2009

And now for something completely different...

Cox Arboretum is a beautiful, lush learning environment in one of Dayton's southern suburbs. Open year 'round, it offers breathtaking flora and interesting fauna. If you're in the area, it's worth (at least) an afternoon.
But a year?
Actually, that's exactly what a friend of ours did: she devoted a whole year to documenting the seasonal changes that take place at Cox. Shot over 53 weeks, from two specific vantage points, one can almost feel the chill winds, warm rains, even the snwflakes crunching underfoot. And she's even written a book chronicling these changes, complete with gorgeous photos with accompanying journal entries.
Here's a sample:
The book is available here, both for sale in softback and as a downloadable pdf. Enjoy!

But is it Right?

Where do we draw the line between healthy babies and eugenics? Should we even consider drawing it?
I ask these questions because:
The process involved the use of multiple embroyos, which were each screened for the target "breast cancer gene." Note that the selected embroyo itself was not genetically altered, it was enough that it was free of the offending gene. Note, too, that having the gene is not in and of itself a guarantee that one will develop breast cancer; it's believed that absence of the gene effectively eliminates that particular risk.
All well and good, so far.
The dilemna arises out of the potential other uses of this technique: will "designer babies" be screened for the presence (or absence) of the "blue eye" gene? The "freckles" gene? How about the "shortness" gene?
Or perhaps the one which determines whether we're looking at pink or blue blankets?
Or poor report cards?
I'm concerned that this is a slippery slope, and we're not really sure how, or where, it will end. If the genetic marker for Alzheimer's show up, what then?
Brave new world, indeed.

Saturday, January 10, 2009

Bitten in the Asp

[Welcome Kaiser Network readers!]
The good thing about COBRA (the Consolidated Omnibus Reconciliation Act of 1986) is that it exists at all.
On the other hand, the bad news about COBRA is that it exists at all.
Briefly, and as it pertains to health insurance, COBRA enables an insured to continue his group insurance coverage even if he's no longer an employee of that company. This is both a boon and a bust: the boon is that unhealthy folks, who might otherwise have trouble finding coverage in the individual market, can keep their coverage for up to a year and a half (and sometimes even longer). If one is in the midst of a claim, this can be a lifesaver (literally).
COBRA also dovetails with HIPAA so that, if one continues to have significant health problems, one may transition to a guaranteed issue individual plan with no exclusion for pre-existing conditions (pre-ex). Again, this can be a major benefit.
There are also (at least) two substantial problems with the law: the first is that, contrary to popular myth, belief and advertising, group coverage is almost always more expensive than individual (for a variety of reasons), but this cost is hidden from the employee because most employers subsidize the coverage. That is, most folks think their health insurance costs, say, $50 a week, but aren't aware that the employer is also chipping in at least that amount [ed: as we've noted before, this isn't exactly accurate, but we'll leave it be for this post]. So, the premium that one pays under group is really only a portion of the total, real cost.
When one elects COBRA continuation, one pays "full freight" for the coverage, which includes the amount the employer had been kicking in. This usually results in "sticker shock:"
Because few people can afford that, the authors say, the result is a growing number of people being hit with the double whammy of no job and no health coverage."
Well, that's part of the story, anyway.
The truth is that very few people are truly uninsurable, but many (most?) folks don't know this, and so they don't even bother to look for alternatives to COBRA. And there are many such: individually underwritten major medical plans, short term medical, even mini-med plans all fill some (often significant) gap, and are usually less expensive than the COBRA offering.
Of course, with unemployment quickly edging back up (after years of being below historic levels), this is becoming more relevant, and urgent. The challenge is that Congress is going to be pressured into offering even more gummint-styled solutions (which, of course, is exactly what gave us COBRA in the first place), when the individual market is far more capable of crafting and providing more realistic alternatives.
And that begets another problem: how to cut through the political rhetoric to get that message out. If industry trade groups, such as NAHU and AHIP, were truly focused on market solutions (which, of course, they are not), then they would be blitzing the airwaves educating the public about these cost-effective alternatives to COBRA.
I'm not holding my breath.

Friday, January 09, 2009

Cavalcade of Risk #69: Call for submissions

Debbie Dragon hosts next week's edition of the Cav, and she asks that you include:
■ Your blog's url
■ Your post's url
■ The post's trackback URL (if available)
■ A (brief) summary of the post
PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).
You can submit your post via Blog Carnival or email.
We have some hosting slots available - just drop us a line to reserve yours.

Thursday, January 08, 2009

Wallet Biopsy

Have you ever had a wallet biopsy?

Probably not, but according to Business Week this is a practice that can be eye opening.

Hospitals are forbidden from refusing service, regardless of ability to pay, when you have a life threatening emergency. They are required to treat you, at least up until the point your condition is stabilized.

But after that, they can withhold services if you lack the ability to pay.

Debbie Maupin, 41, already has felt the procedure's sting. The Dallas resident fractured her skull, neck, and back in a car crash in April 2005. Parkland Health & Hospital System gave her free care worth more than $100,000 because her job as a mortgage adviser offered no health insurance. When she returned in June 2006 for a scheduled CAT scan, however, Parkland told her she no longer qualified as a charity case "because my credit score was too high," she says.

Granted, a high credit score means you have demonstrated an ability to manage your money . . . it does not mean you have money in the bank.

Still, I have a problem with someone who does not have health insurance and uses the excuse that they do not have insurance because their job doesn't offer it. We know nothing about her health before the accident, or her income, but apparently it was too high to qualify for Medicaid. It is possible she could have purchased health insurance, but simply chose not to.

So why didn't she purchase health insurance on her own?

Parkland analyzes credit scores when deciding who can afford to pay for care.

They also look at credit card balances, 401(k) balances and estimates of income. What's wrong with that?

"We are very generous in our charity care, giving over $100 million in free care last year,"

Hospitals give away millions each year in uncompensated care. One of our favorite topics here is Grady hospital, the local taxpayer funded, charity hospital. We recently pointed out that Grady is auditing those who receive free care and letting them know the party is over.

Evelyn Leonard earns $18,000 per year. According to Halifax Medical Center in Daytona Beach, she meets their standard for charity care. When she wanted a procedure for a non-emergency treatment they offered a 50% discount.

She indicated she could not pay, so they asked about her 401(k) funds. She has opted not to tap those funds to pay for care.

Halifax's vice-president for patient business and financial services, won't comment on Leonard's case, citing patient confidentiality. "Part of our mission is to provide care to people who fall through the cracks, but we cannot incur a cost that taxpayers and the community cannot bear,"

Halifax is a taxpayer funded facility that gave away $41 million in uncompensated care last year.

I have no problem with my taxes going to pay for care for those who do not have the ability to pay, but I do take issue with those who fail to accept personal responsibility and purchase insurance or pay their debts.

All of us need to eat to sustain life. If someone walked into a grocery store, or restaurant, and helped themselves to food then walked out without paying, no one would think there was anything wrong with the grocer or restaurant owner pursuing payment.

But for some reason when someone has the ability to pay for health care, but refuses to do so, then there is a public outcry.

Something is terribly wrong with this picture.

MVNHS© on a Roll

But not necessarily a good one:
That last bit is especially frightening: if it's "officially" as bad as 60%, and the "actual" number could be much higher, what does this say about socialized medicine, and the efforts of our own political class to implement a similar scheme here? We're constantly subjected to the (oft-debunked) canard that our health care system is "failing," and "too expensive for the benefits received," ad nauseum.
But here's a real life example of a system which apparently takes killing its "patients" a little too casually (as we've seen before). It's reminiscent of the silly "infant mortality" myth, because we count every live birth, regardless of potential problems, whereas most other countries (and hence health care systems) only count those that survive a specific number of days.
So how many folks has the MVNHS© killed today?

Split Personality

I have a confession to make.

I have a split personality.

No, not the psychological disorder, but let's just say I am multi-faceted. In addition to my indentured servitude here on InsureBlog, I really do have another life.

I am a full time health insurance broker in Atlanta (technically, Sandy Springs) specializing in health insurance for individuals and small businesses.

In addition to InsureBlog, I post on my own site at Health Insurance 411. If you check the stats, H I 411 has about 100 posts while InsureBlog over 10,000 (or something like that).

InsureBlog focuses mostly on health insurance, particularly as it relates in a "big picture" kind of way.

H I 411 is/will be focused more on issues as it relates to individuals and small businesses located in Georgia.

I will continue to be the insurance curmudgeon on InsureBlog that many have come to know and despise, but will also be reviving my interest in H I 411 by addressing local issues, particularly as they relate to my client base in Georgia.

Hank has garnered thousands of regular readers from around the world through his quality work here at InsureBlog but I am putting him on notice. I fully expect to draw untold numbers of regular readers to H I 411 over the next few months.

As my wife said not to long ago, "Does anyone other than you & Hank actually read that stuff?".

Well my dear, we will see. And, thanks for the vote of confidence.


Tuesday, January 06, 2009

Fitness Mandate

Want to lose weight and get in shape for the New Year?

Move to Maryland.


A local (LaVale, Maryland) gym owner wants the Maryland General Assembly to support the Personal Health Investment Today Act which allows residents to use flex and health savings accounts "purchase fitness club memberships and equipment".


Sounds great, right?

While such a move is noble, how do you rectify the use of qualified funds in a federally tax favored account to pay for these things when the U.S. Treasury does not allow such a use?

Using your HSA to fund expenses that are not allowed means you must pay a tax and penalty.

I don't suppose anyone thought this through.

Things Your Provider May Not Be Telling You

Does your doc tell you about health insurance? Does he or she inform you of different plans available to you?

If not, things may be changing soon.

If legislators in New Jersey get their way, you may not be able to leave your providers office without getting a pitch for health insurance.

Assembly Bill 3488 would require all licensed kennels, pet shops, shelters, pounds and anyone in the business of selling pets to provide written notice to customers regarding the availability of pet health insurance offered in New Jersey.

OK. I took some liberties in introducing this story, so get over it.

For certain, pet care can be expensive. Even beyond the routine immunizations, check ups, shampoo and nail trimming you can also get into canine dental work.

A "routine" cleaning can run $400 or so.

Who knew?

If this passes, when you purchase a pet you might hear "would you like health insurance with your dog?".

Another bill introduced in the state would increase fines to pet stores that violated certain laws and regulations, such as licensing requirement. Current penalties range from $5 to $50; the proposed penalties would range from $100 to $1,000.

According to the bill, the purpose of the measure is to “enhance the power of the state and its municipalities to enforce certain laws regulating the treatment of animals.”

Are we legislating stiffer requirements for pets than humans?

Sounds that way.

Apparently the N.J. legislators have a lot of time on their hands. Why don't they do something really important like finding Jimmy Hoffa.

Grand Rounds: First 2009 Edition

Edwin Leap hosts this week's collection of great medblog posts. There are a lot of good items here, and he obviously read them all: each one has a helpful summary.
I must say, though, that I was a bit put off by the rather lengthy intro Edwin wrote; it's his take on the theme ("profit in health care"), which is fine, but it's also nine paragraphs long. I think that's a bit much.

Monday, January 05, 2009

Hair Transplant Insurance

I have long resolved that there is nothing I can do to stop the loss of hair follicles, but some folks are willing to invest thousands of dollars in an attempt to look youthful. They pay someone to transplant hair from the back of their head to the front & top.

For sure, this is not medically necessary. I mean, you don't really NEED hair. It is just something to tease, style, color, cut and maintain.

Perhaps that is why hair transplants are not covered by health insurance.

But some folks think, and I know I will catch heat over this, that insurance should pay for testing and even treatment, just because you want to have a baby.

I am not one of those in favor of covering any fertility testing under an insurance policy but there are some in the Show Me state who want to make it a law.

one Missouri legislator is proposing a bill that would require health insurance companies to pay for infertility diagnosis and treatments.

"We spend millions upon millions of dollars trying to assist people, even in terminal situations with cancer, with a lot of different things," said the bill's sponsor, Rep. Steve Hodges, D-East Prairie.

So the logic behind this is, we spend all this money on terminal cancer patients, why not spend a few more to make babies.

OK, why not make it a zero sum game?

You can have fertility testing covered but we no longer cover treatment for terminal cancer patients. Anyone want to buy into that deal?

Seriously, there are only so many dollars to go around. For certain, you can pass laws requiring carriers to cover everything from removing splinters to brain transplants. The question is, do you really want that?

Every time something new is added the cost goes up for everyone.

But what about this bill?

This is not a proposal to cover the cost of IVF (in vitro fertilization), but rather a bill requiring carriers to cover testing of males to see if the reason why they cannot impregnate someone is because of low sperm count.

I am dead serious.

"Men that have concerns about their fertility don't always know where to turn," said Erma Drobnis, an andrologist at Columbia Regional Hospital. "And actually having a semen analysis at a fertility clinic is very simple, very noninvasive and not terribly expensive."

I have been out of the game for some time, and never had a problem siring children. But if the cost of a "semen analysis" is reasonably low, why do we need insurance to cover the cost?

So what causes a low sperm count?

Obesity, smoking and alcohol use can lower sperm counts. Researchers suspect the quality of drinking water as well.

"There was no relationship determined between (sperm counts) and actual pesticides in the water they were drinking because there was no study of even where they drank the water," Carlson said. "It was just a general statement that certain areas of the country, the Midwest, where there was more agricultural work going on, that there was more pesticides used, and therefore, it would be logical that some of that pesticide could be getting into drinking water."

So now for some good news.

No bills have been prefiled that deal with water quality in general or water as a root cause of infertility.

Now, about those hair transplants . . .

Insurance by the Mile?

On a consumer-oriented online forum at which Bob and I frequently post [full disclosure: we've both received golf shirts for our "services" there], a poster recently brought up the idea of auto insurance based strictly on the number of miles driven. Neither Bob nor I are P&C agents, but we have enough knowledge of insurance principles to know that, when something sounds too good to be true, it often (usually?) is.
Another frequent poster, who happens to be a state insurance regulator, also weighed in with his opinion of the phenom. The three of us concurred that the scheme, while unique and interesting, had a number of flaws.
Briefly put, "insurance by the mile" is designed so that one signs up, and pre-pays for insurance based on the number of miles one anticipates driving for the next six months. These miles are audited, of course, lest one be tempted to "lowball" the company. There is apparently no other underwriting.
I probably wouldn't even blog on this had not alert IB reader Holly R sent me this link this morning:
In other words, they like the idea, but implicitly question drivers' honesty as regards miles driven.
The TNR article contains another even more serious, if less obvious, error:
"This process, better known as adverse selection, is what causes individually-purchased health insurance to cost a lot more than a comparable employer-provided plan."
As we've repeatedly pointed out here at IB, the only advantages to employer-based coverage are guaranteed issue and the "convenience" of payroll deduction. Individually underwritten plans for health folks are always less expensive than group (this may not seem obvious, until one recalls that the employer "subsidizes" the group premium).
Now, I have no horse in this particular race, but I would be very concerned about sharing the road with someone who didn't understand basic risk management, and how carriers determine risk and premium.
Methinks that there's a very good reason that there's only one carrier even testing these waters.