Couple interesting product news

■ What if you could add collision coverage to your car after hitting that tree? Well, thanks to FoIB Holly R, we learn that health insurance startup Bind offers pretty much that for its self-insured corporate clients:

"Technology has made on-demand services a reality for everything from food deliveries to gym classes and car-sharing. What if you could have on-demand health coverage for big-ticket procedures like knee surgery?"

It does sound kind of 'too good to be true,' but it's apparently a legit service available to companies willing to take the leap. Bind in't actually an insurance company, but a third party administrator for some of UHC's self-funded groups.

Interesting.

■ Thanks to the folks at United Healthcare, we're privy to next year's new IRS limits for group and HSA-compliant plans:

"Maximum out-of-pocket limit for 2019 group plans:

•$7,900 for self-only coverage ($7,350 in 2018)

•$15,800 for family coverage ($14,700 in 2018)"

That's an increase of almost 10%, and of course the premiums will also be headed north, although we don't yet know by how much. There's a term for this: "unsustainable." And it makes alternatives like sharing ministries and Direct Primary Care (not to mention Short Term plans) more and more attractive.

On the other hand, maximum HSA contributions are increasing almost $50 a year for individuals. WooHoo!

Ladies and Gentleman: The *Ultimate* HSA

It can be difficult to pay for healthcare services not covered by insurance. #OnJuly1inTN a new law allows physicians to accept a barter of goods and services in exchange for healthcare services.

— TN Senate GOP Caucus (@tnsenategop) June 26, 2018

Much ado about ... A rounding error?

Despite ample evidence to the contrary, I really don't relish playing the role of naysayer. But when  folks who should know better deceptively suggest that a particular "solution" is having a major impact on health care delivery and financing, well, I think it's important to offer perspective.

What in the heck are you babbling on about, Henry?

Glad you asked. This:

"Why health care sharing ministry memberships now top 1 million"

I beg your pardon?

In a country of about 326 million, this is barely a rounding error. So why is this "news?"

Look, I'm a fan of sharing ministries (up to a point): they're a low cost, ACA-compliant alternative to ObamaPlans, and they encourage lifestyles and behaviors that promote good health. And I like that they're not network-driven, meaning pretty much complete freedom to actually "keep your doctor."

But there's also no backstop: that is, there's nothing to force the organization to actually pay the bills, or accept someone with pre-existing conditions. And for catastrophic claims, well, those can be problematic:

"[T]hough they set aside a slightly larger amount as part of an optional agreement to help other members facing catastrophic needs." [emphasis added]

Do I think they have a place? Of course: it's not like ObamaPlans are any great deal, either. And I'm glad that they serve the needs of (many) of those who participate, FoIB Thomas L, for example:

"So far so good on all things Samaritan.  All current expenses are already paid, the money for the obgyn is pre-paid to the clinic (which for whatever reason they hold in escrow), and the money for the hospital’s delivery estimate I have in a separate account ready to go."

But to pretend that sharing ministries are some unstoppable, substantial force with which to be reckoned? No.

Death Be Not Proud - But Being MVNHS© Is Fine

Last time we looked, we saw that Britain's Much Vaunted National Health System© was delighted to spend prodigious pounds to enforce its death sentence on an innocent toddler:

"NHS spent almost a quarter of a million dollars asserting its right to let this child die instead of allowing his family to take him to Italy at no cost to the British taxpayerWhen they say it's time to die they mean it"

Indeed.

And as if further proof was necessary [ed: no, it's not, really!], the folks at LifeNews tell us that "at least 450, and probably more than 650, people’s lives were ended as a result of being given dangerous amounts of unnecessary opiates."

And to what purpose?

Well, it certainly wasn't for their recreational enjoyment.

Rather, it was to make darned sure that they knew their place. Which was, as it turns out, *6 feet 1.8288 meters under:

"Hospital Staff Caught Euthanizing Hundreds of Patients: “If a Nurse Didn’t Like You, You Were a Goner ... the ones most likely to get the treatment appeared to be not the sickest, but the most ‘difficult.'"

Well, that explains it then: can't have unruly or unlikeable patients, dont'cha know.

To be fair, and as we've repeatedly pointed out, this is certainly a time-tested way to rein in soaring health "care" costs under the MVNHS© model. Since it's free, how else to ration it .... fairly?

Tales from the (Health Care) Front

■ First up, the joys of Government-run health "care," wherein the VA continues its #Winning ways:

"Secret data: Most VA nursing homes have more residents with bed sores, pain, than private facilities"

Sad and frustrating:

"More than 100 VA nursing homes scored worse than private nursing homes on a majority of key quality indicators."

Shanda.

[Hat Tip: ginny j]

■ Second, a report on one of the 58-state laboratory models (the concept of which I'm a big fan):

"Instead of starting with the hospital’s list price and negotiating down for discounts, [Montana] began telling these facilities how much it was willing to pay — a “reference price” — for each type of hospitalization."

In a kind of "reverse transparency," the state is using Medicare pricing as its benchmark, and so far it seems to be working:

"Two years in, the state calls the effort a success, saving $15.6 million this year over the estimate of what it would have paid without the change."

Will other states follow? That remains to be seen, but one wonders if the demographics here (Montana ranks in the bottom 15% in population) play a big part.

[Hat Tip: Elisabeth Rosenthal]

■ And finally, "Is The Cash Price The Best Price?" Well, that certainly seems to be the argument put forth by DPC proponents (and others, of course). The idea is that paying cash for medical services actually results in lower out of pocket costs (although for those with insurance, there's additional paperwork to get those payments to count towards one's out-of-pocket).

The folks at Green Imaging think this is the way to go, though:

"[W]hile the idea of big health insurance companies negotiating lower prices with the hospitals sounds excellent on paper, the reality is that negotiated prices may be more expensive, sometimes much more expensive, than if patients simply had no insurance to begin with."

Or choose to skip using it.

There are, of course, downsides, including doing that negotiating oneself (which many folks are loathe to do).

Unfortunately, Dr Dickerson has missed one excellent reason to go this route: "paying cash" can also mean using one's HSA (or HRA/FSA) funds for an additional economic boost.

Too bad, really.

Does Medicare Pay for Routine Physicals?

I get this question a lot. "Does Medicare pay for routine physical exams? I hear they are not covered".

I don't know who started this rumor but I wish they would stop.

Original Medicare includes a "Welcome to Medicare" physical exam. As long as you have the exam within the first 12 months of going on Medicare Part B there should be no charge.

Thereafter you are entitled to what Medicare calls the Annual Wellness Visit. At this time your doctor will update your records, check your blood pressure, height and weight. There may also be a cognitive impairment test and / or a balance and mobility test.

Rather than making you read all this, sit back and watch this 3 minute video.

Additional reading here.

https://www.georgia-medicareplans.com/welcome-to-medicare-sort-of/

Medicare. 

You have questions. We have answers.

Never any charge.

#WelcomeToMedicareExam #MedicareRoutinePhysical #AnnualWellnessVisit

Px: Revisited

Px as in pre-ex, as in Pre-existing conditions. We generally define these as health issues for which we are currently being treated, or have been in the recent past. As we know, ObamaCare requires health insurance plans to cover these immediately (subject to one's eligibility to buy a plan), and also forbids carriers from charging those with these conditions a different (ie higher) premium for the privilege.

Kind of like how auto insurers can't decline someone with 4 DUI's and 3 at-fault accidents, or charge them more than someone with a pristine driving record.

But what if the ObamaTax was itself a pre-existing condition?

That's the premise of this article in The Hill, tipped to us by a regular reader:

"As a physician whose career in medicine was dedicated to preserving and improving my patients’ health, I know firsthand how important it is for everyone to have access to care ... Before the ACA, having pre-existing conditions did raise the cost of health insurance — sometimes to unaffordable levels — for some Americans, and the key word here is “some.”

As we've pointed out over the years, the actual number of folks that were adversely affected by the ability of insurers to actually assess and rate risk was negligible. Dr Hayworth quantifies this for us:

"Their numbers were very few relative to our population of over 300 million, and we can make a rough estimate of less than 120,000 — that is, well under 4 people per 10,000 nationwide."

Now, for those few, the results were daunting, and expensive. But there were already plans in place (PCIP comes to mind). And these could be quickly re-implemented if, as Dr Hayworth urges, we let the market provide the cure. She offers 3 very specific steps to get that rolling, starting with eliminating all the fluff that plans are required to include, but which really don't neet the definition of insurance. And she also endorses a tried-and-true strategy of assessing carriers to fund risk-pools for those who need that coverage.

There's more, and I especially like the way Doc H presents her case in a straightforward way, without relying on scare tactics or sob stories.

Recommended.

You, Your Money, and Nursing Homes

Allison Bell is one of my very favorite insurance journalists, and we've quoted her work quite often. Her articles are typically first-rate: understandable, accurate and complete.

You just knew there'd be a "but" here, didn't you?

Recently, she posted an article on the cost of nursing home care depending on whether one was self-pay (including long term care insurance), Medicare and Medicaid:

"If nursing home owners had a choice, they might prefer to see Medicare patients come through the door."

That;'s because (apparently) Medicare pays about 60% more for nursing home care than private payers (including the aforementioned LTCi policyowners) do.

Which makes sense, actually, since Medicare doesn't actually pay for long term care, which is where the nursing homes would then make up any shortfalls. And for short term, Medicare-eligible stays, it's unlikely that very many LTCi plans would pay a nickel, since most will have a 20 or 90 (or longer) day waiting period. It's also important to note that the criteria for Medicare reimbursement is quite different than what would trigger an LTCi claim, further reducing the number of those actually paid for such short term stays.

Now what would be interesting would be to include those newfangled short term care plans in this mix.

One wonders how they might fare.

MVNHS© in Three Acts

■ What's it all about, Alfie?

The Much Vaunted National Health System© is famous for its enthusiasm for infanticide, the most recent example of which would be the Baby Alfie Evans case. We noted at the time that, as usual, this wasn't really about health care dollars (pounds?) or delivery, it was about control, period:

"[I]n this case it's actually cost the MVNHS© more money to fight his being flown elsewhere for treatment at his parents' expense."

Ah, but how much more, you ask?

This much more:

NHS spent almost a quarter of a million dollars asserting its right to let this child die instead of allowing his family to take him to Italy at no cost to the British taxpayer

When they say it's time to die they mean it https://t.co/ypUW4jSkBa

— DaveinTexas (@DaveinTexas) June 17, 2018

Indeed they do.

■ O say can you see?

We've long been aware of the horrendous wait lists to which British victims "patients" are subject, and now we have a picture-perfect metric of just how tragic that can be:

"Hundreds of people are going blind every year because of long waits for NHS treatment, medics have warned." https://t.co/Pas6vhg1pX via @TelegraphNews pic.twitter.com/KwoK4gmi6k

— Sally Pipes (@sallypipes) June 17, 2018

Spectacular.

■ Food Fight!

And now for something completely different: (alleged) insurance fraud and travel insurance. Seems that Brit's have found a veritable pot of gold across the channel:

"The number of bogus food-poisoning and gastric illness claims filed by Britons traveling abroad is reported to have reached epidemic proportions"

Turns out, it's been amazingly easy to file a claim on the travel insurance available with vacation packages, often just needing a copy of a receipt for a bottle of Imodium. The practice has swelled of late, to the tune of over 100 of these claims a day. Some of this has been due to the fact that it's often cheaper to settle than to fight .... up to a point.

That point, apparently, is now:

"Between 2013 and 2016, the number of allegations skyrocketed 500 percent  ... spurring some hoteliers in Spain and Turkey to threaten that they would suspend vacation deals from the UK market entirely."

I have a suggestion.

Kid's a major liability

You've likely read by now about the young lad, attending a wedding reception replete with expensive (and apparently fragile) art work, who (apparently accidentally) knocked over a priceless glass statue.

Well, not "priceless," exactly, more like $132,000:

"A Kansas mother says an insurance company wants her family to pay $132,000 after her 5-year-old son accidentally knocked over a sculpture at a city community center."

Now, one may argue over whether or not it was "worth" $132 large (the artist himself apparently didn't think so, since he chose not to insure it). And, ultimately, the parents' homeowners insurance would likely cover the expense.

But as is often the case, the lede gets buried for the sake of clicks:

"All the city did was file an insurance claim," Overland Park communications manager Sean Reilly told CNET ... We are NOT seeking payment from the family"

Oh, so non-story, then.

But hey, there's clicks to be had and papers to move.

And they wonder why we don't trust the MSM.

Early Fraud Warning

Our very first substantive post (way back in January of Aught Five) was about folks who thought they could cheat their way to big time insurance bucks. As one can imagine, they were not exactly successful in these endeavors, although they may have earned an "A" for effort.

But that was then, and this is now, and it appears that bad actors get early starts:

[Hat Tip: Bits & Pieces via FoIB MisHum]

Critical Illness Plans: A refresher

It's been a while since we've looked at Critical Illness (CI) plans:

"For several years now, colleagues (and marketers) have been urging me to offer Critical Illness (CI) plans."

A few days ago, I learned of a real life example of one of these plans in action:

Tammy was recently diagnosed with breast cancer. Fortunately for her, she had purchased a CI plan a few years ago; she went ahead and filed a claim on it, has been approved, and soon she'll have a check for $50,000 to help pay off any medical insurance out-of-pocket expenses, clean up some debts, and keep groceries on the table while she recovers.

This is my first experience with someone I know who had one of these plans - now that I've seen it in action, I really think I need to be more proactive in marketing them.

For those who are interested, one of our vendors (Guarantee Trust Life) has provided this very helpful video explaining how these plans work:


GTL's New Cancer, Heart Attack and Stroke Insurance from Guarantee Trust Life Insurance on Vimeo.

A Midsummer Night's Health Wonk Review

Bill Shakespeare's classic wedding comedy is about the nuptials of the Duke of Athens and the (former) Queen of the Amazons, and has absolutely nothing to do with this month’s 'Review (I just liked the wordplay for the title).

Fortunately for our readers, we do have some amazing posts to share with you, so consider this your Playbill:

■ Roy Poses looks at CVS's recent "own goal" regarding donations to "a Sketchy Non-Profit."

Including exec's who (allegedly) made some pretty nasty remarks.

■ HWR newcomer Vincent Grippi offers us this interesting podcast with HWR veteran David Williams, discussing (prescription) drug pricing issues and challenges here in the US.

■ Fellow insurance blogger - and another longtime HWR favorite - Louise Norris explores the brave (not so) new world of Association Health Plans (AHPs), and what role (if any) they may play in reining in health insurance costs. As usual, Louise makes otherwise dry material quite interesting.

■ And speaking of our friend David Williams, his own submission is this fascinating post on whether or not the proposed merger between Partners HealthCare and Harvard Pilgrim Health Care is actually ready for prime time.

Will they or won't they? Time will tell.

■ Workers' Comp Insider's Tom Lynch has this take on GOP efforts to (finally?) take out ObamaCare, and what it means if their current efforts are successful. But the best part is his touchstone question: What happens if they "win?"

■ 'Review co-founder (and all-around nice guy) Joe Paduda offers a round-up of his own, including a report on Purdue Pharma's opioid issues and Medicaid's on-going problems with work requirements.

■ Friend Tinker Ready has news about the proposed CVS/Aetna merger, and the CVS plan to offer more than just urgent care services [ed: let's hope the plan is shorter than their typical receipt!]

■ Over at xpostfactoid, Andrew Sprung offers an "elastic idea" for Democrats looking to expand Medicare, from a buy-in option for near-seniors all the way to "Sanders' Big Rock Candy Mountain." Sweet.

■ And finally, our own entry, in which we offer a disturbing glimpse at the true, grisly human costs of nationalized health "care:" dismembered babies.

On a brighter note, please join us next month at Peggy's Place (on July 12th).

Interesting HSA news

Regular readers know that we're big fans of HSA's, primarily because they encourage more efficient use of healthcare-related dollars. After all, when one has skin in the game, one tends to be more careful about the use of resources.

One unfortunate canard, though, is that they discourage folks from spending their hard-earned savings on necessary care.

Well, thanks to the Association of American Physicians and Surgeons, we learn that this has (again) been debunked:

"Study: High-deductible Plans May Impede Preventive Care ... unless tied to HSA. "[W]e found reduction in the number of primary care visits among individuals with deductibles, particularly higher deductibles, except for those with health savings accounts."

The research, reported by the American Academy of Family Physicians, found that high deductible plans did, in fact, seem to undermine folks' use of primary and preventive care. The silver lining, though, is that those who couple those plans with Health Savings Accounts were more likely to seek out that care.

One can only imagine the (positive) effect that would redound to this were DPC subscriptions made HSA-eligible.

Vendor Kudos Two-fer

■ Once again, our friends at Cornerstone prove that they're not just great to work with, they're also great to work for:

"For the fourth consecutive year, Cornerstone has been awarded a 2018 Top Workplaces honor by The Cincinnati Enquirer."

In fact, they're ranked at number seven on the 2018 list, up five spots from last year.

■ Driverless vehicles have been much in the news of late. They promise to offer convenience and (perhaps) increased safety, but they also pose a challenge for the folks who insure them. The folks at Cincinnati Insurance provide some insight on this poser:


Charting the Future of Driverless Cars: Are You Ready? from The Cincinnati Insurance Company on Vimeo.

The Joys of Single Payer

Not to be outdone by the Brits, our friends (way) south of the border are bringing back the oldies:

Polio has been reported in Venezuela, where the disease had been eradicated decades ago, according to the Pan-American Health Organization https://t.co/O1RWWVMbHA pic.twitter.com/mnnDc0xW6U

— AFP news agency (@AFP) June 10, 2018

[Hat tip: Mujahed]

LTCi News: Up & Up

As our population ages, Long Term Care insurance has become more and more popular as a cost-effective way to preserve one's hard-earned nest egg. After all, the cost of a nursing facility stay (or even at-home care) runs into the thousands of dollars a month, and can quickly eat up one's savings.

The challenge,of course, is that as we age we tend not to get healthier, and the odds of having such a claim increase each year. Which begs the question: how is this affecting carriers' bottom lines?

Well, we have one answer here, thanks to co-blogger Bob:

"Unum Falls as Long-Term Care Loss Ratio May Prompt Reserve Charge"

Um, Henry, what does this even mean?

Quite simply, their actual loss ratio was almost 10% higher than last year's (loss ratios are metrics of how much is paid out versus premiums paid). That's not exactly a prescription for long term financial stability. A big part of the problem is that those on claim for cognitive impairment (eg Alzheimer's and the like) are living longer, which is nice (kind of) for them, but a direct impact on the insurer's bottom line.

Which may mean another round of rate increases.

Or not:

1,000 Words on Single Payer

Or, "How Much is that CanuckCare© in the Window?"

[click to embiggen]

Courtesy of the Fraser Institute.

Business, Interrupted

Recently FoIB tsrblke alerted us to this story:

"A fire destroyed The Southerner food truck at a charity concert Friday ... My truck caught on fire and is a complete loss"

Thank goodness the truck was insured, but as tsrblke notes, one wonders if the owners had thought to purchase business interruption coverage "to cover lost revenue."

Good question. But what,exactly, is business interruption (BI) coverage?

So glad you asked:

Briefly, when a business must temporarily close its doors due to damage to or destruction of business property, Business Interruption insurance coverage pays for business income lost while the property is rebuilt. This coverage is intended to help keep the company in business while recovery is underway.

But wait, there's more!

When Hurricane Harvey hit Houston, not just homes were damaged or destroyed. Many businesses had to close, at least temporarily, until power was restored, buildings repaired or replaced, and inventory re-stocked. Even just a few days of downtime can translate to thousands, perhaps millions of lost sales. Business Interruption coverage, generally available as part of a broader commercial policy, can help mitigate the loss.

■What's covered?
As the name implies, Business Interruption insurance reimburses losses when a covered peril forces a business to temporarily close its doors. For example, a major storm causes a power outage, and Joe's Grocery Emporium can't stay open for business. Joe is left wondering how to pay his employees and vendors, not to mention the rent and electric bills.

Business Interruption coverage is designed to help pay all of these items, for a limited time, to enable the business to re-open. The coverage is included in a BOP (Business Owner's Policy) but separate when written with a package plan.

■What triggers a claim?
Typically, there are three types of events that would result in a Business Interruption claim. First, physical damage to the business severe enough that it must temporarily close its doors.

Second, covered damage to another property which then results in preventing employees or customers from accessing the business itself.

And third, if the government closes off an area because of property damage caused by a covered risk (such as a fire or tornado).

■How does the coverage work?
First, the business owner must purchase the appropriate commercial insurance policy, which may include Business Interruption coverage or make the coverage available as a rider. Once a covered event occurs, the coverage generally requires a waiting period, often several days. Once the waiting period is satisfied, the plan will begin to pay for covered losses. The coverage is not infinite, however: typically expenses are paid for a maximum of a year. Of course, the business owner will have to provide the insurer with proof of his or her losses.

■What are the limitations?
Losses due to an unfavorable business environment aren't covered. The business owner's salary also isn't covered. It’s important to note that the policy is only going to cover actual losses sustained, and won’t pay more than the policy limits.

Now you know.

Global Insurance Alert

From our friends at Global Underwriters:

"In just a few short weeks in June and July, the 2018 FIFA World Cup is being hosted by Russia and the matches are scheduled to take place in various cities throughout the country. The excitement surrounding the every 4 year World Cup tradition, isn’t the only thing peaking interest globally. The world is closely watching as the heightened diplomatic tensions and geopolitical developments unfold in the coming weeks.

We’re starting to see more requests for International Travel Medical and Kidnap & Ransom coverage for travel to Russia. Now is the time to consider purchasing this valuable coverage, so you can have peace of mind and valuable protection while enjoying the games!"

Global Underwriters are our go-to folks for clients traveling from, and to, the US. If you're planning a trip to the World Cup, or even just a European summer getaway, be sure to check out the various options available, all at very affordable rates.