Tuesday, April 30, 2019

The Much Vaunted National Health Service© Strikes Again

Entirely preventable:

Another Life Insurance Conundrum

We've previously discussed how one is prohibited from collecting life insurance proceeds on folks one has murdered:

"California dad charged with insurance fraud after he drove off cliff, killing autistic sons"

But what about a person who's a beneficiary of a life insurance policy, who then goes on to murder someone else? In other words, two completely different circumstances, connected only by the person in the middle?

The facts:

The mother of the monster responsible for last year's Parkland shootings passed away a few months prior to the tragedy. It then took about a year and a half for her life insurance claim to be processed [ed: it's unclear why the long delay]. After her death, but before the claim was paid, her son murdered his classmates and teachers.

And here's where it gets, well, murky (and we're only going to discuss the life insurance issues here):

The murderer is due approximately $430,000 from his mother's policy, and so he's about to lose access to his public defenders:

"Parkland school shooting suspect['] ...public defenders asked to withdraw from his case on Wednesday because the defendant stands to inherit more than $432,000 through an insurance policy."

Okay, that makes sense, PD's are (ostensibly) for those in poor financial straits. But this raises a few issues, as well:

If he hasn't actually received the money, then how can they withdraw?

And what if he doesn't actually receive it?

How would that work, you ask?

Well, according to the (poorly written and researched) news article:

"A judge could award the money to families of the shooting victims, some of whom have sued [the defendant] in civil court."


How would that work? These are two completely separate cases and courts: one civil, one criminal. The defendant's mother had no connection to the murders; indeed, he would have received the money before them had the claim been processed more quickly. Would he have then been forced to just hand over the cash in that circumstance? One doubts it, absent a plaintiff's win in civil court.

What would compel the insurance company to write the check to ... well, who knows? This just seems very unlikely.

Or am I missing something obvious?

(And by the way, if the judge did funnel the insurance money directly to ... whomever ... wouldn't that necessarily obviate the PD's recusal request?)

Monday, April 29, 2019

Twitter asks ... I Answer

I am not sure why, but Twitter seems to be filled lately with complaints or comments about service at their Doctor’s. To an outsider, I suppose some of the things that are done in a Doctor’s office seem inappropriate, but there really are reasons for everything that is done. I will try to answer some of the more basic questions.

Twitter Post: “Does anyone else feel like they give a full history every time you go to the doctor? I asked the girl today “maybe try writing some of this shit down.”

Reason: The Government (this will become a recurring theme) has mandated many, many questions that have to be asked once a year to ensure that you as a person are following the rules of society:

Questions such as, “Do you have a gun in the house?” My favorite answer to this one was “What does a gun have to do with a vagina?” Or, “Do you feel safe in your house?” or “Do you have fall risks?”

Sometimes the questions change based on societal changes, such as “Have you traveled to an area that had the zika virus?”

All these answers are entered into the EMR, which is uploaded to Insurances and the Government for tracking purposes.

"Why?" you may ask.

Well, falls account for the majority of Hospital Visits for elderly, costing Medicare money. If a fall can be prevented, then that is money that Medicare does not have to spend. If you do not feel safe in your house, is there a domestic violence issue, which could result in a visit to the ER which costs money? The Government (there it is again) mandates that these questions are asked once a year and then reviewed at appointments as needed.

Twitter Post: Regarding a post in an exam room explaining the difference between a problem visit and preventive visit: “From the “is it bait and switch or just dumbassery” files, this. Posted in exam room. Guarantee billing for two visits, or just some bureaucratic bullshit?”

Reason: The Government (told you this would get old) has mandated through the Center for Medicare and Medicaid Services appropriate billing. Billing is done through a series of codes defined as the Current Procedural Terminology. There are two sets of codes for Office Visits, Preventive Visits and Problem Visits. The Preventive visits are your yearly checkups to ensure you are healthy, i.e. preventive care. These visits cannot be combined with any Problems you may have, such as that rash on your foot that has been there for 6 months but you waited for your preventive visit to talk about it.

The ACA ruled that Preventive visits are paid for at 100% by Insurance companies. Since Insurance companies are paying in full for these visits, they do not want to pay for any Problems that by coding rules are financially the patient’s responsibility.

Thus, these visits are separate and identifiable from one another and must either be done at separate times or if done at the same visit, both codes are billed and you the patient will pay your portion. 

Twitter Post: There is so much turnover at my doctor’s office, new staff every 6 months.

Reason: Good employees are hard to find for any business, but healthcare is even more difficult. The reason is very simple, healthcare is hard work and pay is low. Many staff find that they can make more money in other career fields and get tired of the abuse from patients and doctors, the long hours, and the Government (yep) regulations that they must follow.

Well, that one seems easy to fix, pay the staff more.

There is one problem: Doctor’s make the money in a Medical Office and payments from Insurance Companies have not kept up with the cost of overhead. The fee schedule is based on the Government Medicare Fee Schedule, which has been kept flat since 1996. What this means is that for 20 years, the reimbursement for medical services has not significantly increased to allow for Doctor’s to stay in business. The result of this is Doctor’s selling their practice to large groups or Hospitals and salaries staying flat.

Due to Government Regulations (yep, it is here, too), the average staff to Doctor ratio is 3 staff to every Doctor. So, the Doctor must make enough money to pay his or her staff and the overhead of the medical office, we all like electricity and running water. I know of many, many offices where staff do not get raises or must take on more of the benefits costs themselves, that is if the office can afford to offer benefits.

If you have any burning questions about why your doctor’s office does something feel free to ask.

Friday, April 26, 2019

Ooooh! We get to break *another* "Embargo

Several weeks ago, I mentioned that I would now be routinely breaking so-called "embargoes" foisted upon us by self-important PR flacks:

So here's the second in this presumably on-going series:

"I’m reaching out with the embargoed news that Limelight Health, the most efficient and compelling quoting, underwriting, and proposal platform for the employee benefits industry, is announcing a unique integration with [a] global financial services provider."

Well good for them!

In the unlikely event that readers might be interested, here's the link to Limelight Health.

[Caveat clicker]

Friday FunLinks

Despite the fact that there are currently no true catastrophic health insurance plans available, Health Savings Accounts remain popular:
Very interesting.

Seems like things will have to get worse before (if?) they get better:


Some time ago, we posted on a unique service that helped facilitate end-of-life care decisions:

The Vital Decisions service still provides "counseling services to advanced illness patients near end-of-life." And now, at least one insurance carrier is getting on the bandwagon (of sorts):

Thursday, April 25, 2019

(Un?)Intended Consequences #1,483

About eight years ago, we noted that one of RomneyCare's explicit promises was to reduce ER visits. RomneyCare being, of course, a precursor to ObamaCare, and the ER one of the most expensive pieces of the health care pie.

Of course, that's not what happened:

"... according to a report from the Division of Health Care Finance and Policy, expanded coverage may have contributed to the rise in emergency room visits"

Why's that, you ask? Well, because "newly insured residents entered the health care system and could not find a primary care doctor or get a last-minute appointment with their physician."


But that was then, and this is now, and surely the ACA has tamped down on ER (over-)utilization, right?


Well, you may want to sit down for this:


Wednesday, April 24, 2019

Medicare, Social Security, in Trouble - AGAIN

Here we go again. Another year, another Trustee report, stating Medicare and Social Security will be insolvent in a few more years.

The solution?

Increase Medicare premiums and cut Social Security benefits.

Solving the Medicare Problem

Medicare Part B premiums are paid by Medicare beneficiaries. Most are retired. A few (like me) still work because we enjoy what we do.

But many of those age 65 and older work because they HAVE TO.

There are 160 million people in the U.S. labor force.

Currently 44 million are on Medicare.

Rather than raising premiums and cutting benefits on the 44 million on Medicare, why not RAISE TAXES on those still working?

Just saying . . .

read more - https://www.gamedicarenews.com/2019/04/23/medicare-social-security-unsustainable/

#GAMedicareExpert #GAMedicareNews

Tuesday, April 23, 2019

Tuesday Morning LinkFest

The good news is that we're starting to see real progress in the world of 3-D printed medical items, from prosthetics to tissue to actual working organs. But that latter may pose some interesting (and, perhaps unexpected) concerns. As FoIB Holly R alerts us:

"Within a decade, manufactured hearts could obviate the need for organ donations; ethicists highlight potential pitfalls along the way ... But not everybody is gung-ho about the heart breakthrough, citing ethical implications — like whether it will widen the gap between rich and poor, and whether superhuman hearts or other mutations can also be manufactured."

So far, this is all hypothetical (the 3-D printed heart is not yet functional), but that day may be fast approaching.

After all, just because we can ...

As we've often pointed out, coverage ≠ care, and one of the most significant challenges facing the Medicaid4All folks is the question of just who will provide that care:

"The CMS saw a sharp decrease in the number of providers opting out of Medicare in 2017, after several years where thousands indicated that they did not want to participate in the program."

This is what is known in the nomenclature as a "trend."

See also: "Be careful what you wish for..."

A little over 5 years ago, co-blogger Patrick sounded the alarm about "tier creep" as it relates to Actuarial Value. His thesis was that rate and cost-sharing increases were essentially baked into the ObamaCare cake:

"However, there are a few big secrets they aren't telling you - ones that year after year will negatively impact everyone. They are called actuarial value, cost sharing limits, and indexing."

I highly recommend that folks read the whole thing.

And now, half a decade later, FoIB Greg Fann continues to bang the drum:

Good (if alarming) stuff.

BONUS: Remember when they said that suspending the tax/fine/penalty mandate would result in millions of people losing their insurance?

Funny thing and (you may want to sit down for this), but that didn't actually happen:

Imagine that.

Sunday, April 21, 2019

Holy Week and Notre Dame Cathedral

I doubt there is nary a soul anywhere that is not aware that "Our Lady" of Paris, Notre Dame Cathedral, suffered a terrible tragedy this week. One does not need to be Catholic to feel at least some sense of loss.

Even those who are not religious seem to at least share a sense of loss in this building that has stood for over 800 years.

The Cathedral averages over 30,000 visitors per day. More than even the Eiffel Tower.

While this is a great loss, some view it as a symbol of rebirth for the building, Catholics worldwide and many others with no affiliation with the church.

Donations to rebuild the structure exceed $1 billion in just a few days. Last week fund raising efforts for restoration hovered around $50 million.

Unexpected loss has an unusual impact on people.

"There is something about the brick and mortar stones, placed there by believing people, that can communicate to people. They know they are on holy ground, and it's not because the place is holy, but because it is made holy by the faith of the people there," he said. - The Church News

The fire occurred at the start of Holy Week.

"If there is a moment when Christians should be ready to mourn the death of something, but to believe in the resurrection of something, it's Holy Week," Father McCarthy said.

"It is my belief that something is going to rise from these ashes," he said, noting that even the pagan myth of the phoenix and the ashes can bring hope after the day's events.

When Jesus was on Earth he said "Tear down this Temple and I will rebuild it in three days".

Those who heard him, including his followers, did not understand the true meaning of his words. Some even scoffed and said "It took 46 years to build this Temple. How can you build it in 3 days?".

He was of course referring to his body as the Temple. And he was prophesying about his death, followed by the resurrection three days later.

Notre Dame will not be rebuilt in 3 days or even 3 years. But I have no doubt the Cathedral will one day return and welcome all who come.



Friday, April 19, 2019

Chag Pesach Sameyach!

This evening marks the beginning of our annual observance of the Exodus, beginning with the lighting of candles. We will recount the story itself, and, as always, I've found some interesting readings to supplement that.

Of course, beyond the ritual and the special foods lies the central theme of liberation and freedom. May we never take either of these for granted.

Thursday, April 18, 2019

An #InconvenientTruth

About that CanuckCare being such a great deal:

[Hat Tip: FoIB Michael B]

Wednesday, April 17, 2019

Hungary in line [UPDATED]

[Scroll down for Update]

We often post about these things in England and Canada, maybe Sweden, but this marks the first time we've blogged on the (troubled) Hungarian health care system:

By way of background:

Talk about double-billing.

And for all that, they still can't provide timely care to their citizens, many of whom actually have to wait years for necessary surgery and other services. The truth is that, as with ObamaCare, coverage ≠ care.


UPDATE: Speaking of England (see top of post), here's more devastating info from its Much Vaunted National Health Service©:

"Tens of thousands of elderly people in UK are left struggling to see because of NHS cost-cutting drive that relies on them dying before they can qualify for cataract surgery"

I see.

[Hat Tip: Holly R]

Tuesday, April 16, 2019

Ten Years On: Updating an InsureBlog Exclusive

Long-time readers may recall our series of interviews with attorney Kent Brown about his lawsuit against the Fed's "because Social Security officials claim that folks must forfeit their Social Security benefits if they withdraw from (or choose not to enroll in) Medicare."

[ed: Original and follow-up posts are here and here]

One would think that since neither of these are in any way legislatively connected, this would be a non-issue.

One would think that, but one would be incorrect:

"Is there something in the original Medicare legislation that dictated this? Surprisingly, the answer is no ... Nothing in the Social Security or Medicare statutes state that one must take Medicare in order to receive Social Security payments (or vice versa)"

So how did this come about?

Two words: Washington, DC.

Now, fast forward a decade, and there seems to be some light at the end of the tunnel:

Nice! So I once again reached out to Mr Brown for his thoughts, and to confirm that this was in fact related to his case, and he graciously replied:

"Good evening to you!

Yes. It has EVERYTHING to do with my case. The whole purpose of the Retirement Freedom Act is to address what the U.S. Court of Appeals refused to do, but should have done. I hope this matter can be addressed legislatively.  The Washington Examiner article is very good. Thanks for sending it along

So we'll be watching this closely as it wends its way through The Hallowed Halls.

Healthcare Down Under

It's been almost 8 years since we last wrote about Oz's version of the MVNHS©:

"Australia's national health care system (which is called, interestingly enough, Medicare) seems to have a problem. Although "(p)rimary health care remains the responsibility of the federal government," said government isn't actually keen on providing it."

But that was then, and this is now:


By contrast, current Medicaid For All proposals all outlaw private plans.

One wonders why...

Monday, April 15, 2019

Under the Radar Long Term Care issue

We blog pretty regularly about Long Term Care (LTC), and more specifically about Long Term Care insurance (LTCi). But we haven't really spent much time discussing the impact of caring for a loved one can have on one's own finances. The last time we addressed the issue was almost a decade ago:

"About 73% of the primary caregivers – and 40% of the secondary caregivers – said they had reduced contributions to savings accounts as a result of caregiving responsibilities, and 80% of the primary caregivers and 55% of the secondary caregivers said they had reduced retirement contributions."

So we see that immediate and long term consequence in terms of savings. But what about earnings?

Recently, colleague Ian Kremer alerted us to this article that addresses the question of re-entering the workforce after an extended absence to care for a loved one:

"For the individuals that had to take a long break from their career to become a full-time caregiver the prospect of re-entering the workforce can be intimidating. Most likely you will find unique challenges that may make it difficult to land the job that you want. There are some ways that you can prepare for success."

As I replied on Twitter:

"This is an important issue, and one that very few people (especially those caregivers) have thought out beforehand."

Really recommended.

Friday, April 12, 2019

Sloppy Carrier "Service"

How long does it take to add a person to a small group plan?

Apparently a lot longer than the 48 hours we were promised on Monday.


Anthem small group client, looking for April 1 effective date for new hire (when he became eligible). Sent in the paperwork mid-March.

Which paperwork was apparently not entirely legible on Anthem's end (it happens), so they requested another, cleaner copy, which we then provided.

April 1 comes and goes, no sign of his ID card, nor any indication that he's been added to the group. I keep calling our contact person, who keeps checking, and on Monday was told would be done in 48 hours.

That was something like 100 hours ago, and still no sign of him on the group roster, and no ID card , temporary or otherwise.

And he's still not on the group billing roster.

Now, because I'm basically a nice guy, yesterday afternoon I gave their media folks a heads' up, and invited them to address the issue.

Which they did and, to their credit, responded very quickly. Meanwhile, my Cornerstone rep was also working her magic. I was hopeful that between the two of us, we could help this client out.

This morning, she came through, and I learned just what the holdup was: Anthem was conflating the employee's hire date and eligibility date. Once she was able to help them resolve this, we were able to obtain usable ID information.

I'd like to say that this was resolved to my satisfaction, but it really wasn't: for one thing, the time it took to get it resolved was ridiculous, and the fact that Anthem didn't reach out to me to confirm these dates was just dumb. I'm clearly listed as the agent, and they have both my phone number and email address.

I do appreciate the help offered by Anthem's media folks, Jill B and Leslie P. And, of course, the immeasurable aid rendered by my Cornerstone rep, Beth D.

They say that all's well that ends well, but I don't think that applies here. I realize that no one's perfect, and that companies have processes, but when you have sick or injured folks who've done their part in getting you the information required of them, it seems to me that you have an obligation to also act expeditiously on their behalf.

We'll see if that happens going forward.

Cancer & Life Insurance: A Step Forward

Our friends at Issue Insurance sent along this news from life insurer Symetra (A M Best Rating A):


With over 14 million people receiving a diagnosis each year, cancer is one of the world’s most pressing health challenges.2 However, thanks to progress in research, cancer patients today are living longer than ever before—many in full remission. That’s why at Symetra, we believe your clients deserve a second look when it comes to qualifying for life insurance coverage.

Designed for clients with low-grade cancer histories, our Symetra Preferred Cancer Program is an underwriting program that can help provide your clients with the opportunity to receive up to a Preferred underwriting rate, allowing them to get more affordable life insurance coverage.

Check out our Symetra Preferred Cancer Program flyer to learn more about this underwriting innovation

Great news!

Thursday, April 11, 2019

Thursday Newsbitz

Contra the MVNHS©:
We last blogged on the Much Vaunted National Health Service©'s problems achieving its (apparently unattainable) goal back in '17:

"Nearly a quarter of patients waited longer than four hours at A&E last week with just one hospital hitting its target."

Now they've just thrown in the towel.

Contra the MSM:

Here in the States, meanwhile, we have a much prettier picture:
And that's including the impact of ObamaCare.

Contra the Spinmeisters:

You may have read that a Canadian couple, faced with "outrageous" US medical care costs, elected to drive their beloved father back to Canada. Problem with that story is:

Bonus Round:

Maybe the Brits' wait time problem stems from this inconvenient factoid:

#Medicare4All FTW.

Wednesday, April 10, 2019

Ah, the joys of socialized medicine


Why is Medicare So Confusing? - GA Medicare Expert Answers

Rx for Big Pharma?

One of the subtexts of the healthcare transparency movement is something called Pharmacy Benefit Managers (PBM's):

"PBM's are (allegedly) a cost-efficient way for carriers to offload the administrative functions of filling prescriptions ... The stated reason for this business model is that it helps carriers to rein in the cost of medications, which make up a disproportionate percentage of claims."

Of course, intentions ≠ results.

While the concept seems innocuous enough, it's apparently become a major source of tension in the health care community, and is frequently cited as a major driver of increasing health care costs.

So when I got this link from FoIB Holly R, I just had to pass it along:

Perhaps coincidentally, I also recently received an email from local insurer CareSource about their new efforts to bring about more transparency, and to rein in the power of PBM's:

"CareSource, a leading nonprofit multi-state health plan serving government sponsored programs, announced its intent to implement a new, integrated approach to administering pharmacy benefits and services."

The new push will focus on:
* Full price transparency validated by an independent third-party

* Custom pharmacy network to provide the same access members have today while protecting independent pharmacies
And several other worthy endeavors.

Although I'm generally skeptical about "feel good" insurance company campaigns, this one at least seems focused on something real, not just lofty.


Case in point: A client who takes synthroid recently refilled her 90 day scrip. Through her insurance (and thus, PBM), the cost would have been about $100. Uncharacteristically, GoodRx was almost $120. As usual, though, BlueSky clocked in at about $30. Heh.

Tuesday, April 09, 2019

It's Tuesday, let's see what's up with the MVNHS©


It's what inevitably happens when health care becomes a "right."

Monday, April 08, 2019

Old school or Gold Rule?

So here's the scenario:

I sell a life insurance policy from Carrier A. The insured dies, and her beneficiary files the claim directly with the carrier (likely out-of-area relative who doesn't know I'm even involved). The carrier not only doesn't send the check to me for delivery, but doesn't even notify me that the claim has been made.

So I call them on this, and they say that they have no way to make the connection (even though they eventually notify me when he claim is settled, after the check's cleared, so they obviously can connect those dots).

I think that:

1) The carrier is obligated to inform me that a claim has been made, and

2) Is also obligated to send me the check unless I tell them otherwise.

I am livid.

But am I wrong?

In consulting with colleagues around the country, it seems that I am a bit behind the times on insisting on delivering the claim check personally (where possible). And I'm okay, albeit disappointed, with that.

But there's also agreement that the carrier needed to alert me the instant the claim was filed.

So, I'd be interested in our readers' take:

Friday, April 05, 2019

End of Week Link-a-rama

■ Last week, I asked about the value of a proposed new Ohio law mandating that "[b]usiness owners with less than 100 workers would be allowed to see data on employees' health claims." I was wondering specifically why we even needed this, and what good it might be expected to do.

My co-blogger Patrick has provided me with a great answer, and I thought it'd be helpful to share it:

"This is only for 50+. Right now in the ESI market segment from 50-99 there is no data shared. This is a good step in the right direction for transparency but will also have to be accompanied by projected data if it’s going to be efficient."

Thank you, Patrick!

■ Our friend Holly R has tipped us to this item, which becomes even more relevant as we head into the Spring and Summer:

"To produce a malaria vaccine for mass deployment, biotech firm Sanaria has to decapitate and dissect out the salivary glands, which hold the malaria-causing parasite, for each individual mosquito—by hand. Enter the mosquito guillotine."

Cutting edge.

■ Finally, actuary and FoIB Greg Fann offers an inside look at the truth behind one of the most controversial aspects of health insurance:

Thursday, April 04, 2019

On Hoops and Value

I know next to nothing about college basketball, and even less about March Madness, but I do know a little something about insurance. So when FoIB tsrblke tipped us to this story, my interest was piqued:

"Citing sources, Rovell tweeted that Duke paid for an $8 million policy for its star freshman, with the premium for such a policy typically costing around $50,000. Schools are allowed to pay for such a policy under NCAA rules."

Now, it's true that one trenchant Twitter commenter opined that "
Health insurance is a totally different universe than Disability insurance," but neither of those is in play here. Rather, this falls under the category of 'special risk' cover, about which we've posted before. Here, for instance:

Which, as it happened ... happened, and the store owner's special risk policy paid out over $300,000. Smart buy, that.

The key here is that, unlike health or disability income insurance,. special risk plans fall under the category of Property/Casualty (not Life/Health). They're designed to cover a specific and identifiable circumstance or event, shifting the risk of that event or circumstance happening (or not happening) onto the insurer.

In fact, this "loss of value" plan is closer to diminished value coverage for your wrecked car than it is either DI or health.  And at a very reasonable cost, as well.

Wednesday, April 03, 2019

Here's to your embargo

We occasionally get "Embargoed" news releases from various sources, none of which are very interesting, but all of which apparently presume that we are obligated to honor the "embargo."

Today was no exception, and I'm taking this opportunity to flout it.

And by no exception, I mean that I've been told that this is "embargoed" and I can see that it's not terribly interesting. So I'll spare the details and just break the "embargo" thusly:

"Given your interest in climate change, I want to offer you the following statement from JupiterIntelligence in support of tomorrow's release of a new report by the Independent Advisory Committee on Applied Climate Assessment: EvaluatingKnowledge to Support Climate Change."

Now, I have no idea how these folks determined that we have any interest in "climate change," since it's not an insurable risk (AFAIK). But if you're really interested in the report, it's available here.

That is all.

Be careful what you wish for: When Health Care is a Right Part 756

Courtesy FoIB Holly R:

"Quebec nurses to strike against mandatory overtime Monday"

When the system is run by the government under the principle that access to health care is a right, it means that providers of that care must sacrifice their own autonomy and are then forced to provide it.

Thank goodness no one's suggesting it here.

Tuesday, April 02, 2019

Why Do Sick People Leave Medicare Advantage Plans?

Follow Sol Shipotow's journey into and out of the Medicare Avantage jungle.

Full NPR story at this link.

A Friend Needs Help

My college roomie and Best Man is married to a wonderful, vibrant, caring woman who has been diagnosed with early onset Alzheimer's. She is fading fast.

Deb and Rich recently moved from Connecticut to Florida to see if the change of environment would be beneficial. Unfortunately, her condition has continued to deteriorate, and she is now in a nursing home. Rich would like to bring her back home to Connecticut, but lacks the funds to do so.

He has set up a GoFundMe to try to resolve that. Please consider donating to it.