CCW Insurance (Redux) [Updated]

We've blogged before on insurance designed to protect your assets should you be in a situation where you had to use deadly force:

"Our ErieSecure Home policy with the Select bundle now includes criminal defense cost reimbursement"

Which is nice, but Andrew Branca, the guy who literally wrote the book on self-defense, told me that "it's a reimbursement-type program," with which he wasn't much impressed.

But that was then, and this is now, and our friend Bill M has tipped me to this potentially helpful alternative:

"The United States Concealed Carry Association (USCCA) provides a policy for its members designed to provide immediate assistance after an incident."

The plans, which range from about $150 to $350 a year (depending on level of protection), cover attorney's fees, bail, even counseling (interesting, that). And they're specifically geared to cover intentional acts, not just accidental discharges.

I reached out to the folks at USCCA, asking if we can choose our own attorney or if they assigned one. They replied:

"Yes, you may choose your own attorney. We have a network of criminal defense attorneys that you can choose from. However, you most certainly choose your own. A list of our attorney network is provided to members on their dashboard."

Which is a good thing.

I've reached out to Andrew for his take, and will update this post with his reply.

UPDATE: So it turns out that Andrew is on the USCCA's Legal Advisory Board, so he's very familiar with the program:

"Pluses: They let the member choose their own lawyer, they don't attempt to manage the lawyer-client relationship, they don't question the lawyer's fees or ask what he's doing with the money, and they pay the retainer and other legal expenses as they are incurred.

Those are huge advantages over most of their competitors. The one down-side is that they cap criminal legal coverage [at a less-than-impressive number]. That's fine for pre-trial expenses on a non-killing charge. Too little for pre-trial on a killing charge, too little for an actual trial."

He and his colleagues have advised the USCCA folks of this shortfall, so that may change. The bottom line is that this seems to be a viable, cost-effective insurance plan.

Harvey vs Mrs. O'leary's Cow

The devastation and aftermath of Harvey along the Texas coast could be a lesson in what not to do. For sure, there are those who claim the cities and state did not do enough to protect the citizens against a 600 year flood. Others say the hurricane was caused by global warming.

There is always someone else to blame.

Travel back to 1871 when Chicago was essentially destroyed by a fire that claimed a third of the city and 200 lives.

 The fire burned for nearly 24 hours, cutting a path four miles long and three-quarters of a mile wide through what is today the Loop and the area surrounding the Magnificent Mile. Nearly everything in its path was consumed. Wrote an observer as the flames were finally extinguished by long- overdue rain, “The fire here last night and to-day has destroyed almost all that was very valuable in this city. There is not a business house, bank, or hotel left. Most of the best part of the city is gone.” - Fee.org

Amid all the loss people looked for someone to blame and that blame fell on an Irish immigrant, Catherine O'Leary and her cow.

Perhaps much too late both Mrs' O'Leary and her cow have been exonerated but there is still a lesson to be learned.

Chicago recovered in less than 3 years. More importantly it was done without federal funds and almost no local government money.

How did that happen?

The role of the government immediately following the fire was largely limited to keeping order. Martial law was not officially declared, but it was imposed de facto, enforced by army troops, the police, and specially enlisted volunteers. Mayor Roswell B. Mason also issued executive orders that established the price of bread, banned smoking, limited saloon hours, and prohibited wagon drivers from charging more than their usual rate. Mason appointed Lieutenant-General Philip Sheridan, the Civil War hero, to command the Division of the Missouri in patrolling the streets, guarding relief supplies, and enforcing curfews. Four companies of infantry were also stationed just outside the city for several months. But after only two weeks, Mason discharged Sheridan’s troops on the grounds that they were no longer needed.

FEMA did not exist until created by President Carter. Federal agencies provide funds and low interest loans that essentially take the place of private insurance and charity. The federal government also provides temporary housing (FEMA trailers), food, medical and pre-loaded debit cards to cover incidentals.

Is this really what we want?

Is government dependence really what we need?

Has big government (which never seems to get smaller in spite of promises to do so) become a sugar daddy willing to bail out citizens who do not take personal responsibility?

No doubt it will take years and millions of dollars to rebuild the Texas coast. Private insurance, personal savings and charity will cover a lot of the costs but no doubt the lion's share will fall on the taxpayers.

The lessons from the Chicago fire have been forgotten. Instead of a handout the citizens were given a hand up. Assistance in the form of jobs to help them get back on their feet. How far we have come in 146 years and have we moved in the right direction or not?



#HurricaneHarvey  #ChicagoFire1871

Houston, Flooding and Insurance: A Sad Tale

As Texans (and now Pelican Staters) deal with the devastation wrought by Hurricane Harvey, some are learning that they're on their own, insurance-wise:

"Most Harvey flood victims on hook to pay for home repairs"

That's because "only a small fraction of homeowners in Harvey's path of destruction have flood insurance."

And why is that?

Well, to understand that, we need to go back a bit: regular readers may recall my stint as Answers.com Insurance Content Expert. One of those articles explained how flood insurance works. Unfortunately, those article have since been memory holed. However, I did save them, so here's that explanation:

■ Summary
You may or may not be covered if your home is flooded. In some cases, the National Flood Insurance Program, administered by FEMA, provides coverage. Your homeowners policy does not.

■ Intro
Water damage can be expensive: from ruined carpets and furniture to dangerous mold and damaged walls, repairs can cost thousands, even tens of thousands, of dollars. And standard homeowners' and business policies won't cover the cost of these repairs or replacements. That's where flood insurance comes in: to help you pick up at least a portion of these expenses.

■ What's a flood?
Unlike the story of Noah, a flood doesn't have to mean 40 days and nights of rainfall, although heavy rains can be a covered cause. So would a blocked creek or broken water main outside your house or store.

On the other hand, a backed-up sewage system that "floods" your basement with debris is not, in fact, considered an actual flood.

■ What's a flood zone?
The Federal Emergency Management Agency (FEMA) has developed Flood Insurance Rate Maps. These are digital representations of various flood hazards around the United States. There are actually almost 100,000 of these maps currently available, and they identify areas by how prone they are to flooding.

For flood insurance to be available at all,  one's home or business must be in a Participating Community that has partnered with the National Flood Insurance Program (NFIP).

Those areas that are most at-risk for severe flooding are called Special Flood Hazard Areas. These areas are defined as those which might expect to be "inundated by [a] flood event having a 1-percent chance of being equaled or exceeded in any given year." They are also often referred to as "100 year" floods.

■ What other Flood Zones are there?
In addition to the Special Flood areas, there are also "moderate" and "minimal" risk zones. These are less prone to the most severe or devastating floods.

■ What's Flood Insurance, then?
Typical home and business owners' policies don't cover damage from floods. However, flood coverage is available through the NFIP. These policies, which are in addition to ones' standard home or business plan, do cover damages resulting from floods. If you live in a home or own a commercial building in one of the Special Flood Hazard Areas, you'll likely be required by your lender to purchase flood coverage.

■ What do Flood Plans cover?

The structure itself is covered under the basic policy, and optional coverage for your contents may also be available. Renters may also be able to buy coverage for their contents.

Policies are issued by both private insurers and the NFIP. There are currently almost 100 insurance companies that offer the plans, which are sold by Property and Casualty insurance agents.

Rates are dependent on a number of risk factors, including the age and construction type of your home or business, and the risk zone in which it's located. The amount of coverage desired is also critical: coverage for the structure includes the building and foundation, plumbing and electrical systems, HVAC, appliances and even carpeting.

Contents coverage may include clothes and furniture, portable air conditioners and dishwashers, even electronic equipment.

■ How are expenses reimbursed?
Typically, coverage will be for either Replacement Cost or Actual Cash Value. Replacement Cost coverage generally costs more, but includes the cost to replace the damaged or destroyed property with a new version. Actual Cash Value coverage reduces this amount to account for depreciation over time.

■ Conclusion
Homeowners' and business insurance policies don't cover losses caused by floods, and many home and business owners don't even realize this. Up to 25% of all flood insurance claims come from low or moderate risk areas, where premiums may be very reasonable because of the smaller risk.

Unfortunately, this isn't going to be of much help to the folks in Harvey's way.

Time for a Checkup?

A life insurance checkup, that is. Longtime FoIB Jeff M has graced us with this helpful guest post:

Any life insurance agent worth his/her salt will tell you one of the keys to their success is staying in touch with clients on a regular basis.  After all, clients’ needs change via a variety of situations…marriage, divorce, and birth of a child to name a few.  But how many agents revisit the term insurance they wrote just a few years ago?  Here is a case in point.  I have a client who purchased $500,000 of 20-year term with Carrier A in 2010 at the ripe-young age of 30.  He had a new mortgage and was getting married in just a few months.  His policy was issued at a preferred non-tobacco rating with a premium of $37/month.

Fast forward to just a few weeks ago.  I called my client to suggest we meet to review his life insurance now that he has a son.  He thought that was a good idea, so we met to review his goals and objectives in the event he passed away.  Without using any of the online needs calculators, we discussed an amount of life insurance that would fit both his budget and take care of his wife and son in the event of a premature death.  That amount…$1,000,000.  I utilized my broker’s online quoting engine and found that Carrier B's 20-year term at a face amount of $1,000,000, preferred non-tobacco, would carry a price tag of…$64.63/month.

Let’s step back for a moment and take in the facts of this case.  My client is 7 years older with a face amount that is twice what he purchased in 2010.  

We completed the paperwork, scheduled the para-med exam, and off to the races we went.  My client’s policy issued yesterday at a super preferred-non tobacco rate with the waiver of premium for…$50.63/month.

Let this sink in for just a moment…twice the coverage, 7 years older, and a cost that is less than 2x what he was paying.

If you're an agent, make your client’s day…see if you can put them in a better position by re-writing what you wrote just a few years ago.

And if you're an insured with a recent life event (a baby or an adoption, a marriage or a mortgage), then do yourself a favor and let your agent know, and perhaps set up a time to review your current coverage, and possible new needs.

Thanks, Jeff!

Medicare Coverage for Insulin Pumps

An insulin dependent diabetic can be expensive if you are on Medicare. Insulin pumps are usually covered by Medicare.

Insulin is covered by Medicare.

Medicare Part D covers insulin except when it is covered by Part B.

Insulin under Part D can cost you several hundred dollars per month. If covered by Part B  your out of pocket can be $0.

CGM's (Continuous Glucose Monitors) are covered by Medicare . . . except when they aren't.

Some pumps may be CGM's but not all CGM's are pumps.

Continuous Glucose Monitors have sensors that are not covered by Medicare. Unless you have a specific brand and model of CGM.

The Dexcom G5 CGM is approved by Medicare but only if you do not use your smart phone to monitor your glucose.

For more information on the challenges of dealing with Medicare when you have a Continuous Glucose Monitor, read Does Medicare Pay for Glucose Monitors?

#CGM #ContinuousGlucoseMonitor #DexcomG5#InsulinPump 

Science is Marvelous…sometimes

A group of researchers has discovered that people will do things when they are rewarded.

The headline that caught my attention this morning in my daily medical information was this:

“Incentive Payments Encourage Primary Care Visits for Newly Covered Patients”

The article went on to describe an experiment wherein low income people were given cash incentives ranging from $0 to $50 and they discovered that “(s)ubjects in the $50 and $25 incentive groups were more likely to see a primary care provider (77 percent and 74 percent, respectively) compared to the $0 group (68 percent). In the control group, 61 percent received care.”

Okay, we got them to the doctor (with a bribe). Now what are we going to do to make sure that they follow through on their doctor’s instructions? The issue is not getting them to the doctor, but making sure that they follow the directions to stay healthy.

Over the course of my 20-year medical career, both as a mid-level provider and as an Administrator, the most frustrating part of medical care is the non-compliant patient. My first job out of Graduate School as a newly minted Social Worker was working with non-compliant Adolescent Type 1 Diabetics. The facility where I worked was created by a doctor who was tired of seeing his patients ending up in the ER for blood sugar issues, when it could be so easily controlled.

The easy part is getting them to the doctor, the hard part is having them follow their treatment plan.

So let's follow the the logic of this study: patients will only go to a Primary Care Doctor if they are externally rewarded, and the prospect of getting medical care to help them feel better is not incentive enough. Then what, pray tell, will motivate them to follow directions to stay healthy?

• A c-note for every 10 lbs the morbidly obese patient loses?
• $25.00 every time a Diabetic tests their sugar?
• How about $150.00 if that COPD patient uses their inhaler every day?

With enough “incentive,”all patients will be motivated to be compliant.

Next week’s big scientific breakthrough: Water is wet.

Medicare Won't Pay for CPAP

It doesn't matter if you have used a CPAP for sleep apnea for years. Unless you can convince Medicare you need the machine, they won't pay for your CPAP.

Your doctor says you need a CPAP.

The AASM (American Academy of Sleep Medicine) says you have OSA (Obstructive Sleep Apnea).

But until Medicare says you need a CPAP, they won't pay for it.

Until 2013, getting Medicare Part B to cover the cost of a CPAP was not a problem. But in 2009 the Obama administration ordered the IAG to review claim payments by Medicare to determine ways to eliminate waste, fraud and abuse.

The IAG study, released in June of 2013, said the following.

"beneficiaries receiving CPAP treatment may have received more supplies than were medically necessary"

Emphasis added.

The report further stated,

Even though the report showed that the number of supplies did not exceed the recommended replacement schedule it also stated that if someone DID receive more supplies than necessary that would be wasteful spending.

Let that sink in for a moment.

Medicare is always looking for ways to save money. Problem is, their way is to shift more of the cost of care to folks who can least afford to pay.

Most Medicare beneficiaries have pre-paid for their benefits over many year via FICA payroll taxes. Now that we have reached the age where we have earned a right to collect, DC is finding ways to deny us access to Medicare benefits.

For more information on the challenges of getting Medicare to cover the cost of your care, read Does Medicare Pay for CPAP?


#CPAP #Medicare #Apnea #OSA

Hurricane Harvey Help

From our friends at the Insurance Information Institute:

Save this link! The Texas Department of Insurance (@TexasTDI) offers a list of "Help after #Harvey" resources: https://t.co/EZH7xHDa1T

— I.I.I. website (@iiiorg) August 25, 2017

And prayers for all those in its path.

Customer Service Done Right

Regular readers may recall that our poor little puppy has had some knee issues; last Friday was the third (and final) procedure. While we couldn't be more pleased with the professionals at Cincinnati MedVet (and especially orthopedist Dr Maritato), it's pretty frustrating for the poor thing to have spent something like 25% of her life in the "cone of shame."

Part Most of the problem is that she makes the Energizer Bunny look like a sloth, and so she's on multiple sedatives and anti-anxiety meds to help keep her calmed down some (although, as I observed to Dr M, they could be Skittles for all the good they seem to do). Anyway, in an effort to keep at least some of our out-of-pocket in check, we're using an online prescription service. Which is fine, except that we asked for only a few days' worth last Friday, presuming that we'd have everything put to bed quickly.

Unfortunately, that was not to be: one of the meds was taking a lot longer than we'd anticipated:

I initially placed the order on Saturday, but was told that I needed the vet to call or fax the prescription to them. Okay, no problem, I'll get on that first thing Monday. And they did, in fact get the scrip up to HealthWarehouse, at which point the process came to an abrupt halt. For the next two days, I diligently checked the little "order tracker" tool, but it never budged from "Processing." The meter was running, though: remember, I'd only asked for a few days worth from the vet.

So on Wednesday, I called and spoke with the very nice (and most helpful) Andrew. He checked and saw that the holdup was that they were waiting for a new shipment from their supplier. I pointed out that A) no one had told me this and B) there seemed to be no effort to keep their customers in the loop. I also told him about our timing problem, and he was quite sympathetic, promising to check into it and then get back to me.

Which, a few hours later, he did. And informed me that the major speed-bump was that they only had about two thirds of the order on hand; would I be willing to accept that and then they'd ship the balan -- "YES! Do it!"

So, we've now received most of the order, and the rest will come in due time. I could not be more pleased with how this turned out (well, other than I do wish they'd do a better job keeping their customers updated when there's a glitch).

So, Kudos to HealthWarehouse, and especially to Andrew.

Compassion Bleg (for the knitters)

A dear friend, whose father is dying of cancer, is trying to raise funds for continued travels back to see him. If you're a knitter who appreciates unique patterns, and you have a few shekels to spare to help out a fellow knitter, head on over here.

Thank you!

Life and Death, Back and Forth

Back and forth across The Pond, that is.

The ever outstanding folks at CanuckCare© continue as a credit to the medical profession:

"Despite their demands and pleadings, the doctor would not budge from his decision. In fact he deliberately hastened H’s end ... In less than 24 hours, H was dead."

At age 63, still in chemo, apparently responding to it.

But as with all government-run health "care" schemes, who pays the piper calls the tune. Best part? No recourse or accountability.

#Winning

And the "across" part? Well, that would be the heroes of the Much Vaunted National Health System©. In what certainly appears to be a replay of the Baby Charlie tragedy, "Lottie Woods-John was diagnosed with Stage 4 Neuroblastoma on June 30, 2016. She was just 2 years old."

The good news is that she received chemo and then surgery that removed 95% of the tumor, and is currently "undergoing immunotherapy to zap the rest of the cancerous cells in her body, but desperately needs an innovative vaccine treatment only available in the US."

The cost of this, which is of course not covered by the MVNHS©, is on the order of a quarter of a million dollars.

Ouch.

But there are still heroes in Jolly Old:

"A former Royal Marine who served in the Iraq War is selling his war medals to help pay for a little girl's ... cancer treatment."

His motivation is pretty remarkable, please read the whole thing.

But also remember why it's necessary.

[Hat Tip: Ace of Spades]

Buh-bye, Gramps (And More)

We've noted previously that it was only a matter of time before grandfathered (and grandmothered) health insurance plans would begin to be phased out. Now (thanks to FoIB Jeff M) comes the first confirmation of the impending slaughter:

"50,000 BCBSNC grandfathered customers will have to switch to ACA plans"

The Tar Heel State's Blue Cross affiliate notes that since the pool's been closed to newcomers for 7 years now, it's getting a bit, well, rank:

"[T]he group as a whole has gotten older and sicker ...That means they have also become more expensive to insure."

We in the biz even have a term for this: Death Spiral.

So what kinds of plans do these folks have to look forward to?

Well, since you asked.

Related: FoIB Scott M tips us to news from The Hawkeye State. The good news is that there's no apparent move afoot to scuttle grandfathered plans.

Specifically.

On the other hand, perhaps this message isn't exactly subtle:

"Iowa's only ObamaCare insurer seeks 57 percent rate increase"

Uh-oh, looks like someoene missed the memo.

Someone please remind me: what's that first "A" in PPACA stand for?

Misbehavin' Agents and Enrollers

Sigh:

"Agents may have enrolled some consumers in health coverage through HealthCare.gov for 2016 or 2017 without the consumers' permission"

That, according to the folks at CMS.

Now, how exactly does this happen? I mean, eventually someone has to pay a premium, no?

Well, no, not precisely:

"Income information on the [victims'] applications was misstated in ways that maximized premium tax credit subsidy amounts and eliminated any need for monthly out-of-pocket premium payments."

So Uncle Sugar was just sending checks to Anthem, or Kaiser, or whomever. And they only found out, apparently, when folks started getting notices from CMS and the IRS about coverage info.

So, no harm, no foul, you say?

Au contraire:

For one thing, that's our money going to the insurers. And for another:

"[C]onsumers who reported being affected by the enrollments did not have to pay any premiums out of pocket while the coverage was in effect, [but] they may now face tax bills and tax filing problems because of the unauthorized enrollments."

So here's a question: agents are licensed by the states, but this would seem to be a Federal issue (US tax dollars). So how will the offending agents perps be held to account?

Or even will they?

Be interesting to know, no?

[Hat Tip: Co-blogger Bob V]

Speaking of Pro's

A month or so ago, we noted that "it would suck to be in Nevada;" this in light of the fact that there will be so few insurance options available there this coming plan year. Well, our friend Rich W alerts us to this (heart-)breaking story. Turns out, one demographic is particularly hard-hit:

"Nevada sex workers fear loss of Obamacare ... Her six-figure earnings mean she cannot get government insurance for the poor. Her status as an independent contractor means she does not get insurance from an employer. Her profession is another complication."

This is the sad story of Alice Little, who makes too much to qualify for a subsidy, is self-employed so no group plan or employer contribution. Oh yeah: she's a card carrying member of the world's oldest profession.

The good news is that she's founded a support group called Hookers for Healthcare. Seems like they have another natural constituency to tap, as well.

Which brings us to our old friend Herr Gruber, who got caught with his hands in the till:

"Vermont’s Attorney General has settled the state’s claims of fraud against Jonathan Gruber"

Poor Jon is out as a "taxpayer-funded economic consultant for the state’s health care system;" he's also out any balance due him by The Green Mountain state.

One's actually more sympathetic to the gals up top.

Come fly with me, ObamaCare style

Some time ago (3 or so years, to be exact). FoIB Todd made this video, comparing aviation with the still nascent ObamaCare. It's eerily prescient, and absolutely spot on:

About that Obamacare Poster Child

After two years of the media and government gushing over their success, Obamacare darling Molina is having a rough 2017. How rough? Well...

• In February Molina announced losses from the 4th quarter of 2016 to be $110 million. They also report a profit of $52 million. This is a huge fall from their 2015 record profits of $143 million coupled with 2014 profits of $62 million.

• On May 2nd they fired CEO J. Mario Molina and CFO John Molina. The move came as a surprise and the board claimed it was due to poor financial performance.

• The following day they announced 1st quarter 2017 earnings that actually beat Wall Street expectations. Coupling this with the ouster of Brothers Molina and speculation began of a possible sale of the company.

• On May 4th Mario Molina went on record suggesting that the board ousted him due to his political views. Mario Molina has been a vocal critic of President Trump and a significant supporter of the Democratic party contributing well over $70,000 to various campaigns and PAC's in 2016 alone. Shoot, he gave the Hillary Victory Fund $33,400! Talk about lighting money on fire. But, I digress.

• On May 15th the board voted to retain Brothers Molina on their board of directors. This is an interesting twist based on their abrupt departure.

• July 24th, Molina slashes 1400 jobs - 10% of their workforce - in what the interim CEO calls "Project Nickel".

• The latest, on August 2nd, Molina announces a 2nd quarter of 2017 loss of $230 million. They also announced that they will be leaving individual markets in two states - Wisconsin and Utah. Piling on, they stated that 2018 rates will increase on average of 30% (I'm assuimg CSR's will be funded).

The question is, why is this 180 degree turn happening?

Back in 2013 Molina insured nearly 2 million Medicaid patients in 9 states. Managing Medicaid was their core business but they saw a need within the individual market. The need was to serve the low income population that Molina felt big insurers weren't interested in. They went on a hiring frenzy to help with their enrollment efforts as they entered the new individual Obamacare market. Molina's individual market offerings included very narrow networks, limited geographic availability, low premiums, and razor thin profit margins.

Membership has grown in all of their business. Medicaid, their core business, jumped approximately 1.7 million new members from 2014 to the end of 2016. Almost half (673,000) came from Medicaid Expansion. For their new endeavor into the individual insurance market, at the end of 2014 they had 15,000 individual customers. By the end of 2015 that number had exploded to 205,000 then catapulting to 526,000 at the end of 2016.

Profitability for Molina in the early Obamacare years is likely attributed to Medicaid growth with their individual Marketplace participation being limited. This is where the tide has changed. Over the last two years Molina's growth in Medicaid has slowed while growth in their individual market has risen exponentially. This is the inverse of what is happening to overall markets. Medicaid has continued to accelerate and the individual market has flatlined.

With competition exiting the markets due to losses and uncertainty, this leaves Molina to take on the risk. It's well known that the higher risk population gravitated towards health plans that had broader networks. Molina thrived because of their limited networks where by not having major high cost specialty facilities in their network led to a healthier risk pool.

Molina's "competitive" advantage was tied to avoiding high dollar risks (adverse selection) and that advantage is now gone.

From the P&C Files: I have issues

As regular readers know, I tend to be a purist when it comes to insurance. So I've railed on medical necessity as regards health insurance; the whole point is risk management.

And specifically the concept of Frequency vs Severity.

For example, it's unlikely that any one person will contract cancer (frequency), but those who do face some pretty steep bills (severity).

Or, closer to home, what are the odds that a 9 month old puppy will need expensive (and multiple) knee surgery? Again, not often, but a true pain-in-the-checkbook.

One more thing: insurance is (or ought to be) more about covering the unexpected, which is why your auto policy doesn't pay for oil changes or new wiper blades.

On the other hand, birth control convenience items are generally bought fairly often, but at a very nominal cost, so: frequency, but not severity, so not really appropriate to insure.

But insurance has a cousin: warranties. Typically, one purchases these to cover things like dishwashers and refrigerators and the like. But again, these aren't insurance (notice they never use the words "risk" or "premium"). Nothing wrong with that, and I'm not aware of any company offering these plans that claim to be.

Wish I could say the same for the insurance industry.

Our longtime guru of all things P&C, Bill M, asked me the other day if I'd heard about the newest trend in his side of the biz: equipment breakdown and service line coverage.

The equipment breakdown rider "covers the perils of mechanical, electrical and pressure systems breakdown," such as A/C units, TV's, even kitchen appliances. And service line coverage is for coverage "provides protection against a leak, break, tear, rupture, collapse or arcing of a covered service line," such as water and sewer lines, even from ordinary wear and tear.

How in the wide world of sports are any of these insurable risks? Well, obviously, now they all are, which offends my sensibility as an insurance purist.

But now I want to add both of those to my own policy.

Go figure.

Interested for yourself? As always, ask your agent (or seek out a local, independent one).

Health Wonk Review is up

Peggy Salvatore hosts the jam-packed Lulls of Summer edition. From the philosophical to the urgent, you'll be glad you stopped by.

Batting Averages, The Weather, Businesses & Obamacare Co-ops

In baseball being successful 3 out of 10 times at the plate will likely get you into the Hall of Fame.

A meteorologist forecast projecting out 10 days is right about 40% of the time. 

The Farmers Almanac claims a success rate of 80%.

Start up businesses - according to the SBA - make it beyond the first year 50% of the time. 

According to a Harvard study, new businesses using venture capital succeed 25% of the time.

So what about those non-profit, government funded, competition enhancing, Obamacare Co-ops? You know, the newly formed "insurance companies" that would create more competition and force the big bad insurance industry to play fair and quit price gouging with high premiums to pay fat cat CEO's and shareholders fists full of money.

Well, they are batting a whopping .174 - below the Mendoza Line. Of the 23 co-ops that actually got off the ground (there were 24 but we won't count the Vermont debacle) as of 2018 only 4 will remain. One of them, Montana, took measures last year to halt enrollment amid concerns they wouldn't be able to meet their financial obligations.

What's worse than the 17% success rate? That would be the "venture capital" we (taxpayers) gave Co-ops for start up funds. Of the $2.4 billion low/no interest loans given, the four remaining Co-ops received $402 million - a loss of close to $2 billion.

Yet government wonders why we don't trust them to be good stewards of our hard earned money.

Mid-Week Linkpourri

■ From FoIB Holly R we learn about a "start-up called Aledade [that] has figured out a way of reducing healthcare costs while improving care." Founded by the "national coordinator for health information technology at the [HHS] in the Obama administration," the firm is focused on reducing the cost of healthcare (and, hopefully, health insurance).

Promising.

■ A pair of items courtesy of FoIB Rich W. First up, individual plan enrollment continues to crater:

Individual plans purchased without taxpayer support decreased from 11 million in Mar 2016 to 9 million in Mar 2017. https://t.co/42OsTBaj77

— AssocAmerPhys&Surg (@AAPSonline) August 11, 2017

■ Next, Rich wonders who remembers Obama's promise that the ACA would entail no tax increases. Turns out, get this, that was a lie. He provides a link to "newly imposed Obamacare tax per person by state."

Ouch!

Death be not proud (But....)

I'm beginning to sense a theme from the medical front these days. If it's not ObamaCare's death toll, it's a culture that seems not just "okay" with assisted suicide but apparently insists on it.

Wow, Henry, that's quite a claim there, care to back it up?

Sure. (Literally) Ripped from the headlines:

"California Hospital Sued for Refusing to Assist Suicide"

The patient eventually died of cancer, and now her children are suing the medical facility which treated her because it "conceal[ed] its oncologists’ decision not to provide life-ending drugs to patients who ask for them."

Oy.

I'm assuming they also deny diet pills to anorexics who request them, as well.

Meantime, FoIB Holly R alerts us that the Much Vaunted National Health System© apparently has no such problem reducing its patient load:

"One-Third Of Life Support Patients Die Under British Health Care System."

#Winning!

Turns out that "free" health "care" is absolutely worth every penny, er, farthing. So, if you're on a vent or other life support system provided by the MVNHS©, best make sure your affairs are all in order.

The sooner the better, natch.

But wait, there's more good news (well, for certain values of "good"):

"CBS Reports Iceland Has 'Virtually Eliminated' Down Syndrome with Abortion"

Well first, as Patricia Heaton points out, killing unborn Downs babies isn't eliminating "Downs," it's eliminating babies:

Iceland isn't actually eliminating Down Syndrome. They're just killing everybody that has it. Big difference. #Downsyndrome #abortion https://t.co/gAONIzqRXW

— Patricia Heaton (@PatriciaHeaton) August 15, 2017

Notice that the trend, here and abroad, is to ration care by rationing life.

Pretty rational, I guess.

Scary, too, no?

[Hat Tip for CA hospital story: The Political Hat]

Better than a crystal ball

From 5 years ago, predicting the impact of ObamaCare. Eerily prescient:



[Hat Tip: Co-blogger Bob V]

A *Really* Big Case (of fraud)

We seem to be on something of a life insurance fraud roll here. Almost exactly a month ago we reported on the case of a rocket surgeon greedy wife's efforts to collect on her husband's life insurance policy after arranging his premature demise (spoiler alert: she failed).

The case now at hand is particularly intriguing; at first, I was somewhat dumbfounded as to how the insurer could have been so easily duped, but as the story unfolded, it got even weirder. And that this all took place about a half hour away from me added a sense of the macabre.

A brief underwriting refresher: when applying for life insurance (especially anything over $100,000) one is required to undergo (at least) some sort of physical exam. Depending on the amount at risk, this can range from simple blood and urine tests to EKG's and stress tests. In this case, West Coast Life was set to be on the hook for just shy of $3 million, so of course the medical underwriting would be vigorous.There's another angle (financial) but we'll elide over this for purposes of this post.

Here's where it begins to get weird: the application was apparently written in Ohio, but the applicant chose to have the exam done in Texas. I'm thinking that right there's a red flag, but apparently WCL wasn't bothered by it (or perhaps, they became retrospectively concerned). In the event, a person claiming to be the applicant shows up, all 176 pounds of her.

Which would not necessarily be weird in and of itself, but the person who actually died clocked in at almost 400 pounds [ed: Hey. it could happen! Spend a few days at the Golden Corral and Bob's your uncle]. Kind of a clue. The fact that the applicant indicated no substantial health history, and yet was dead within a few short years of (presumably) natural causes was likely another.

And so now the family of the insured is being charged with life insurance fraud; one presumes a lawsuit on behalf of West Coast Life will follow directly.

[Hat Tip: FoIB Holly R]

Something Different

So here's a question: you're in your 50's or 60's, retired (or about to be), and looking around wondering "what's next?"

For some folks it's travel, for others it's gardening or bucket lists.

For some, though, it's time for a second (or third, or whatever) career. But how to find "just the right one?"

Well, there's a cool new answer:

"Welcome to Retirepreneur, a collaborative community for executives in their 50s and 60s, striving for a smooth segue from full-time job to part-time consulting."

Check it out.

[Hat Tip: FoIB Mark G]

From the P&C Files: Hopefully not a client

Doing it wrong, defined:

Baby Charlie Redux

As we noted regarding the tragic case of little Charlie Gard, government-run health "care" really isn't about the care at all: it's actually all about control:

"Charlie's parents weren't asking for special care, or special funding, or that the Much Vaunted National Health System© (because ultimately, they own this) do anything more than get out of the way"

Now, another young Briton's health is in danger, this time a teenaged dancer participating in Britain's Got Talent, with a severe spinal condition:

"15-year-old Julia Carlile, who appeared on Cowell’s show "Britain’s Got Talent" along with her interpretive dance group ... she was going to need corrective surgery shortly after the performances on the show."

Problem is, the only treatment allowed by the Much Vaunted National Health System© would require steel rods that would effectively end her just-now-burgeoning dance career.

Enter Simon Cowell (really!), who has graciously donated almost a quarter of a million dollars to pay for her surgery - in the US.

That's right:

"Carlile opted for a medical procedure only offered in the United States called vertebral body tethering"

This procedure eschews rods for screws, promising her greater range of motion and a real shot at resuming her dancing. It's not even *offered* by the Much Vaunted National Health System© (or that other beacon of healthcare brilliance, Cuba).

Good thing she wasn't in hospital (as they say Across the Pond), else the rocket surgeons running the MVNHS© may well have locked her down, too.

Oblivious Carrier Tricks

This isn't really a big deal, but I sometimes wonder about Home Office Critters and whether they actually read what they write.

Case in point:

I'm currently working on a Retirement Income Disability plan quote for a physician (like this). So as I'm reading through one proposal (to be fair, not from the carrier in that link), I notice among the included benefits:

[click to embiggen]

Um, no you don't.

/sigh.

Evolution of Medical Tourism

It's been a while since we looked at medical tourism in-depth, although we did mention it yesterday when we noted that upwards of 60,000 Candians sought care outside that country's failing government-run health scheme.

And, perhaps more to the point, we reported in January that the "cost of international private medical insurance is climbing globally, with an inflation rate of 9.2 percent reported for 2016."

And, of course, the ACA has been steadily chipping away at physicians' incomes here at home.

Okay, Henry, very interesting, if disparate, items. What's your point?

Well, FoIB Dr Valerie Jones alerted us to this rapidly growing opportunity that uses virtual medical tourism to help boost actual physician income:

"This Startup Connects U.S. Doctors with Patients in China ... that deal in the domain of telemedicine, sometimes called telehealth, which uses technology to remotely connect doctors and patients otherwise separated by physical distance."

After all, what difference does it make if the patient is 10 miles away, or 6000? Other than the slight inconvenience of time-zone shifting, why not? And it's certainly a potential money-making powerhouse:

"Estimates on telemedicine’s market size vary  ... projects it will more than double from $25.53 billion in 2015 to $57.92 billion in 2020."

That's a lot of revenue for a few minutes on the phone (or Skype, etc).

Telehealth itself isn't all that new, but this application of it seems to be burgeoning. Definitely something to keep an eye on.

Breaking News from Our Neighbors to the North

CanuckCare© continues to auger in:

"“Free” Canadian healthcare is not free, according to a report released Tuesday ... a “typical Canadian family of four will pay $12,057 for health care in 2017—an increase of nearly 70 percent over the last 20 years.”

So how's that Single Payer system working out?

Still, that $12 large may be a bargain since it buys great care, right?

Turns out, not so much:

"[T]here is still a long waiting list for a host of operations, both routine and urgent."

And over 60,000 Canadians sought actual care outside the country last year.

But "free" (or, you know, not).

[Hat Tip: FoIB Holly R]

P&C Files Update

Last Fall, we blogged on Kanye West's health issues, specifically as they applied to the cancellation of much of his concert tour schedule. In that post, we noted that Mr West had apparently purchased an insurance policy to cover that eventuality:

"[H]e's since cancelled the balance of his tour, at a cost of at least $30 million. That's a lot of scratch even for a successful musician, which is why he (reportedly) has an insurance policy that likely covers this kind of situation."

As it turns out, he did, in fact, make that purchase. And the story might have ended there, but for one small problem:

"Kanye West has filed a lawsuit claiming insurers failed to pay nearly $10 million for the singer's canceled Saint Pablo Tour last year."

As an aside, I'm curious about the rather substantial discrepancy between the $30 million loss cited in the original post, and the $10 million in dispute.

Nevertheless, this is an interesting case: it seems to turn on the definition of "accidental bodily injury or illness," which being hospitalized seems to pretty much qualify.

One wonders whether this will be settled out of court, or taken to trial. We'll keep you posted.

[Hat Tip: FoIB Jeff M]

The Creation of Obamacare's Individual Market Mess

It has been four years since insurers submitted their initial rates to buy market share in Obamacare's individual market. Back then insurers were using assumptions that the segment would grow through government forcing people to purchase their product, existing policyholders coming over from "crappy" insurance plans, the promise of enforcing the rules, huge transfers of funds from competitors, and large sums from taxpayer funded subsidies.

Nevermind the ginormous turd of a website, the bigger problems occurred when those in power issued major changes - literally weeks into the first open enrollment. Some problems have continued because of a lack of enforcement. Others have come from bipartisan Congressional changes that were signed by President Obama.

The first was a reprieve for those already insured who found out that "if they liked their plan" they couldn't keep it. These transitional plans (Grandmothered) kept a large number of healthy folks out of the Obamacare markets when HHS issued a rule allowing people to retain their medically underwritten insurance.

The second problem was the expansion of - but no policing of - "hardship waivers". There are a plethora of waivers people can take advantage of. Some are legit. Others, not-so-much. The most egregious (IMO) is the exemption for Christian Health Care Sharing Ministries (HCSM). HCSM's aren't insurance products. They don't have mandated benefits nor do these Ministries pay in to the Obamacare taxes and fees. Don't get me wrong, if it's the right fit for a person they should look at it as an alternative. My objection is the double standard that Obamacare considers this "good" but a mini-med/limited benefit plan is considered crap.

Lack of enforcement continues to be a significant contributor. The primary culprit on the enforcement front stems from Special Enrollment Periods (SEP). While these have been tightened under the Trump Administration, the first three years under Obama was a free-for-all. In discussions with insurance company underwriters and executives, all had a similar response to how HHS policed SEP's. The short answer was, they didn't. As one insurer put it:

"They (Obama's HHS) rubber stamped everything. Politically they had to. Think of it this way. If someone was without insurance in January then was diagnosed with cancer in March they would have to wait until January of the following year to obtain coverage. These type of situations happen more often than you know. Imagine the backlash if people were diagnosed with major health conditions then were denied insurance due to Obamacare's own rules? The simple way to make it work was to allow people in, then place blame on insurers when rates went up."

A final problem is revenues. "Not one dime to the deficit" was BS. When you have an initial CBO score that uses 10 years of revenues but only 6 years of expenses and it barely is at breakeven we know it won't be true. Making matters worse, the expenses continue to exceeded expectations. The bending of the cost curve is going in the wrong direction. Instead of shoring up the costly overruns Congress does the opposite - cuts revenues. Look at this list of changes to Obamacare that are causing the fiscal crisis to rise:

• Doc-Fix Tax
• 1099 Repeal
• CLASS Act Repeal
• Defund of CO-OPs
• Risk Corridor Budget Neutrality
• Cadillac Tax Delay
• Delay of Medical Device Tax
• Delay of Health Insurance Tax

Every one of these revenue cuts had bipartisan support.

There are lots of nails in the coffin of the individual health insurance market. Many come from the sledgehammers that Obama's administration pounded. Some have come from a Republican controlled Congress.

Both sides continue to point fingers. Which brings me to something I was told as a young child. When you point a finger at someone remember that three fingers are pointing at you.

CongressCare: A Reminder [UPDATED]

One of the issues that's just now coming into view is just how sneaky ObamaCare-enablers have been in exempting themselves from its disastrous effects.

And which enablers are those, you may be wondering?

That would be Congress, which has been (illegally) benefiting from the law's small group exemption. Last I looked, there were 535 members CongressCritter (plus various support staff). And yet, we have this (courtesy of Phil Kerpen):

 

[click to embiggen]

#EndTheCharadeNow

UPDATE: Meanwhile, the Golden State's fine citizens have this to look forward to:

"Anthem Blue Cross is pulling out of 16 of 19 regions in California's individual market next year."

And that apparently apples to both on- and off-Exchange plans.

Ah, the Good Ol' Days...