Wednesday, July 31, 2019

Timing is *Everything*

Suzy, a referral from another client, called me last Friday, asking to set up an appointment to discuss health insurance. We agreed on yesterday afternoon (July 30), and boy did we luck out with that.

First, the backstory:

Suzy's divorce was finalized last November, and it appears that her divorce decree did not require her ex-husband to continue her insurance. So she called his employer to find out about COBRA (it's a fairly large company) and was told that they were in the midst of some kind of audit, but were able to tell her how much the premiums would be ($700+/month - Yikes). They also told her they'd be in touch with the paperwork.

That never happened.

But her medical bills kept being covered, so no harm, no foul, and no $700 a month out of her bank account.

Until early June, when her doc called to say that [insurance company] had denied the latest claim because she no longer had insurance with them.


So she called to find out the story, and as best she could tell, her ex- had neglected to formally tell HR that they were divorced, and apparently hadn't realized they were still dinging his paycheck for her coverage. Eventually, he connected the dots and off she went at the end of May.

Except that neither his employer nor the insurance company had bothered to tell her. So she called HR (several times) and was told they'd send her COBRA paperwork ASAP.

It was at the point of the initial call in early June that the clock started ticking for the employer:

"An employer that is subject to COBRA requirements is required to notify its group health plan administrator within 30 days ... Within 14 days of that notification, the plan administrator is required to notify the individual of his or her COBRA rights."

So basically that's 44 days,  which in this case was July 15th.

Remember I told you the July 30th date would be important?

Well, it's also relevant for another meter that started running June 1: the ACA Special Open Enrollment clock. That is, losing group coverage constitutes a triggering event for Special Open Enrollment, but one must exercise that option within 60 days. Which would have been .... today.


So now we have some issues and challenges: first, since she's never received any COBRA paperwork, it appears she's the subject of a severe COBRA violation, which doesn't bode well for her ex-husband's employer. We decided to table that for the nonce, since our primary concern was getting her covered. To that end we had several choices:

An ACA plan (for which she is not subsidy-eligible), a Short Term Medical plan, or "Dave's Plan." We got online and started looking at ACA plans. As expected, they were pricey, and since she is in good health, the guaranteed issue and pre-ex features weren't all that critical.

For a number of reasons I wasn't too thrilled with the STM plan options.

Then I had her read our post on Dave's Plan, and we actually got to speak with him during this process. He had an online presentation for her, and they agreed (as did I) that this plan was the best fit for her needs. The "catch" is that, since it's underwritten it will take a few days to confirm enrollment and there's always the (very slight) chance that she'd be turned down. Dave (an experienced insurance pro himself) and I agreed that Suzy should also "pull the trigger" on an ACA plan just in case.

So we did that, and then saw that the plan would be effective August 1, 2019.

Wait, what?

My understanding has always been that:

"When you sign up 1-15 you are not covered until the First of the following month. From the 16-31st the plan starts the 1st of the second month"

And since we were signing up on the 30th, how is that even possible?

Now, it's not that big of a deal in this case, since we probably won't even need the plan, but I'd sure love to know how that happened.

Oh, and the COBRA violation? Well, COBRA is jointly enforced by the IRS, the DOL and CMS, and penalties for violating its requirements include:

• Excise tax penalties of $100 per day ($200 if more than one family member is affected)
• Statutory penalties of up to $110 per day under the Employee Retirement Income Security Act (ERISA)
• Civil lawsuits
• Attorneys' fees and interest

Once the dust has settled on Suzy's new coverage, we'll be contacting DOL to get that ball rolling.

A long day, indeed.

Tuesday, July 30, 2019

Cadillac Jack?

Still *Another* Life Insurance Conundrum

This is indeed a poser:

"Judge rules Denver man who 'killed his wife' can use up to $500,000 from her life insurance to pay for his defense"

As we've noted before, folks who commit crimes (such as murdering their spouse or children) are generally not allowed to profit from that action. For example:

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

The idea is that to allow folks to benefit from their crimes would be against the public good. Thus, convicted murders aren't allowed to profit from the sale of their autobiographies, or receive life insurance proceeds from the policy of their now-deceased dependents (whom they caused to be deceased).


"... the higher court ruled that the statute does not to apply to a third party - in this case a legal defense team - that is paid for a 'legally enforceable obligation"

That's because the accused is entitled to the "presumption of innocence."

Which actually makes sense: notice that in my example above, I referred to the convicted murderer. But in this case, the accused is just that: accused, not (yet?) convicted. My question would be: okay, but what if he's ultimately found guilty? Does he have to repay it?

And how?

[Hat Tip: NDH]

Monday, July 29, 2019

Good(Rx) News

From FoIB Holly R:

Eticovo, is a "biosimilar" med for the dreaded condition, which is "an autoimmune disease in which the body’s immune system ... mistakenly attacks the joints." This usually leads to major pain and mobility issues, so the increased availability of an affordable treatment option is most welcome.

Related (sorta):

Beyond the obvious things like flu shots and doc visits, sunscreen and even contact lens solution can be run through your account.

Caveat: Once you've used funds for trivial expenses, you may be hard-pressed to come up with the scratch if something serious arises.

And speaking of Bonds

Last week, we talked about appeals bonds; today we're treated to an interview with Mutual of Omaha's Demerri Bond, who manages the company's long-term care insurance underwriting team. Before joining MoO some 20 years ago, she was actually a long-term care nurse.


Here she is explaining some of the ins-and-outs of underwriting long-term care plans:

[Special IB Thanks to MoO's Allen Gregoire]

Friday, July 26, 2019

Gibson/Oberlin Update

Yesterday, we reviewed the ramifications of Oberlin College's courthouse loss to Gibson Bakery, to the tune of some $36 million. With which, it appears, Oberlin is loathe to part.


So during the appeals process, the clock continues to tick on the interest accruing on this award, to the tune of $4,000 a day.


As we noted, this could very easily lead the college to an even more dire financial situation, and the Gibson's are (also understandably) concerned about there being anything left to collect.

In such cases, one is required to post a bond to 'insure' against that eventuality, but Oberlin officials requested to be relieved of that burden.
Turns out, Judge Judge John Miraldi was having none of that:
Failure to comply would trigger the required payment of the total award.

Of course now comes the 'fun' part: actually securing said bond. As we noted yesterday, this will likely require Oberlin to put some (all?) of its endowment, and perhaps other physical assets, "on the line."

One almost feels sorry for its erstwhile students.

Thursday, July 25, 2019

Bond, College Bond

Readers may recall our post last month regarding the plight of Oberlin College in Ohio. At the time, they had just lost a lawsuit brought against them by a local bakery that the college had apparently victimized. As we noted at the time, the institution's insurers may balk at covering it at all:

"[I]t appears that the insurer, Lexington Insurance Company, is likely to disclaim coverage for the intentional torts which gave rise to the verdict."

But wait, it gets better (well, for certain values of "better"):

"Will Oberlin College be able to secure a bond? Probably, but it might not be as easy as you would think."

What's this about a bond, you ask?

Well, as expected, the college is appealing the rather large judgment; the challenge is that such appeals take a while, and the interest alone on that sum is over $4,000 a day. The Gibson family is concerned that Oberlin might metaphorically "bleed out" and have nothing on which they can collect:

In Ohio, folks (and institutions) that wish to appeal an award are free to do so, but must post a bond which essentially guarantees that the amount will be paid if the appeal is lost. It's important to note that, as our good friend and guru of P&C Bill M points out, a bond is not an insurance policy, but a 'financial instrument.'

Okay, so what?

Well, in the post we excerpted above, it's claimed that the carriers "writing these appeal bonds want to take zero risk."

Which is kind of the anti-thesis of insurance, which is acknowledging and underwriting for a specific risk. In this case, the carrier(s) will want to have some pretty substantial collateral to back up their guarantee of such a large sum. This could be in the form of cash (as in the school's endowment), and/or buildings and equipment. The point is that, unlike a typical insurance policy, these plans are not risk-based.

That may yet prove to be critical.

[Special IB thanks to Bill M for taking the time to help us understand this]

Wednesday, July 24, 2019

Area 51 Insurance?

I could have sworn we'd blogged on this topic before, but apparently not:

"Florida company offering 'alien abduction insurance' has sold nearly 6,000 policies"

And such a deal, too: for under a Jackson (or two sawbucks) one can buy $10 million worth of coverage.

But there's a slight catch.

Click on through to find out what that might be.

Oh, and no word on whether or not that Edgar suit is covered.

[Hat Tip: FoIB Sam B]

Disability Insurance Case Files: Grey Collar edition

Grey collar folks are generally defined as those that fall in-between traditional white collar (accountants, engineers) and blue collar (mechanics, truck drivers). In this case, my client (we'll call him Steve) owns and operates a drywall contracting company, and splits his time about 75/25 between being on the job and manning the office.

Disability Insurance (DI) is designed to replace income lost from a serious illness or injury, and one of the key components in computing a premium is assigning an occupational rate class. A typical white collar class might be 3A or 4A, while a typical blue collar might be 1A. The higher the class, the lower the rate, so obtaining a favorable rate class is desirable.

In Steve's case, he might be a 3A but for the amount of time on the jobsite. For that reason, Assurity Life (which is the carrier we'll likely be using here) classifies him as 1A., but then bumps him up to 2A because he owns the business.

A very nice compromise, resulting in both substantial savings and additional benefits options.

When Steve called me about buying DI, I also asked if he knew about Business Overhead (BOE) insurance. Turns out, he didn't, and so I explained that, while DI puts food on his table and keeps a roof over his family's heads, BOE coverage helps pay the office bills (rent, lights, phones, etc). He immediately expressed an interest in that coverage, as well.

But here's the rub: for Business Overhead Expense plans, Assurity still considers him a 1A category, and ineligible for coverage.

What to do?

Well, as usual when I hit a brick wall, I called on the fine folks at Petersen International, who did, in fact, have a market for this coverage (in normal-speak, that means they could write such a plan). Which was the good news. The not-so-good news is the coverage, which has a 3 month waiting period before benefits are paid and a 1 year benefit period, clocks in at roughly $3,000 a year premium. . At $5,000 a month benefit, there's a total of $60,000 of potential claims, but that premium (which does include some helpful riders) tops $250 a month.


Unlike "regular" DI plans, BOE premiums are (generally) tax deductible to the company, which helps lower the plan's net cost. Still, it's a big chunk, especially when one isn't used to paying for such coverage.

Will be interesting to see if he pulls that trigger.

Tuesday, July 23, 2019

Tuesday Linkage

In no particular order:

As we've long documented here, Britain's Much Vaunted National Health Service© has a fetish for offing innocent children:

"Coroner demands NHS 111 changes after six-year-old Sebastian Hibberd's death"

The poor 6 year old was another victim of free health "care."

Fortunately for Oliver Cameron, his parents were afforded a unique, lifesaving opportunity:

"[T]hanks to the tireless efforts of his parents and doctors at Boston Children’s Hospital, Oliver is alive and thriving today."

He had been born with a non-cancerous tumor, the likes of which British doc's were unable to treat.

#MedicalTourism tourism in action.

Meanwhile, on this side of The Pond, our northern neighbors, subject to whims and vagaries of CanuckCare©, seldom fare so fortuitously:

But hey: Free!

And finally, our friend Allison Bell alerts us to the latest Health Savings Account news:

Unfortunately, this will be of benefit only to those who own HSA-compliant plans, which of course means duplicate and unnecessarily expensive coverage for folks in ACA versions.

Once again I'll ask: why must one own a specific type of insurance plan (or, indeed, any plan) to have an HSA?

(Yeah, I know)

Monday, July 22, 2019

Some Good LTCi News

John Hancock, long a fixture on the Long Term Care insurance scene, is enhancing some in-force plans, at no additional cost to their insureds):

"We are excited to let you know that John Hancock is planning to pilot a variety of wellness programs for our Long Term Care (LTC) policyholders that will provide them with information that may help them live longer, healthier, and more independent lives


(Particularly for those with lifetime benefits)

The first one, called LIFT Wellness is a voluntary program that includes an in-home visit by an RN who will "conduct an assessment, and may recommend certain [lifestyle] changes and/or home modifications with a focus on fall prevention."

The program itself is being offered free of charge, one presumes that the cost of any actual renovations done will be borne by the insured (which is fair).

And speaking falling, our friend Roger D reminds us that some Medicare Advantage plans offer a complimentary fall detection device with 24 hour monitoring. Be sure to ask if your plan offers such a benefit, too.

Claims Management: A Tale of Two Carriers

A ways back, I wrote some disability insurance coverage on a young surgeon: some with Union Central Life (now Ameritas) and then later some more with MassMutual. Both solid carriers with excellent reputations.

Recently the surgeon became unable to work due to a series of severe (and acute) medical issues, and may actually need an organ transplant as a result. Needless to say, he's out of the OR for a while, maybe permanently.

Because these plans were written so long ago, and I no longer actively represent either carrier, there are hoops through which we need to jump to bring me "back in the loop" so that the various claims folks will talk to me about the pending claim. No problem, understand completely.

So my client asks the claims rep for each carrier how to make that happen. Both basically say they just need to hear from me and they can get that ball rolling. So I emailed both and, after not hearing from either for a day, called and left voicemail.

The MassMutual rep promptly returned my call, and explained that she'd never received my email. I went and looked and, sure enough, I had mistyped it (I blame fat fingers); so re-sent it, and we're all good. We had a lengthy conversation, much of it taken up with my concern about why they were asking for tax records (so is UCL/Ameritas). I'll circle back to why that was even an issue in a moment, but for now I'm satisfied with the MassMutual rep's explanation.

As for the Ameritas rep?

Well, it took a week, but she finally emailed that she'd been out of the office, and that she needed something in writing from the client to be able to speak with me about his claim.

Fair enough.

While I await that, let me explain my initial reluctance about letting my client provide tax returns:

In general, the carrier only gets to underwrite for health and finances at the time of application. After that, it's really none of their business, and I bridled at the idea that they were going to attempt some kind of post-issue financial underwriting.

When I questioned the MassMutual rep about this, she said they needed it if and/or when he goes back to work; it wasn't necessary to get the claim ball rolling.

And that was the mental "click" I needed to remind me that we had included a Residual Disability benefit in the plan, and that this would absolutely need the kind of income verification that a tax return could provide.

Oh, what's a Residual Disability benefit?

Basically, it's a partial benefit the company pays to help make up for any loss of income one may incur when going back to work after having been disabled. I usually describe it as being paid "when you're okay but your wallet's still disabled." This could be due to reduced hours or fewer duties (and thus lower a lower paycheck).

So, I'm okay with th MassMutual rep's explanation, and anticipate a similar conversation with the Ameritas/UCL claims person, as well.

Friday, July 19, 2019

Insurance Fraud & Complacency: A Tweet Story

This is at once fascinating and disturbing:
UPDATE: Here's the #Unroll if you'd prefer that format.

[Hat Tip: FoIB Holly R]

Interesting (and sad) case

Had a call the other day from an acquaintance whose 30-something daughter had been experiencing severe and debilitating health issues for the past two or so years. She had lost significant weight (and she was hardly exactly 'zaftig' to begin with), and had begun seeking non-traditional, "alternative medical" treatments, to the tune of tens of thousands of dollars.

My acquaintance called because he knew I dabbled in the health insurance field, and hoped I could give his family some advice and insight on what options might be available.

Oh, there's an interesting twist, which may play an integral part: the daughter, who had never given up her US citizenship, had nonetheless spent the past few years living abroad, and had moved back here just before she became ill.

This is important, because one of the Special Open Enrollment triggers is "Changed your primary place of living." Now, it actually gets more specific:

"Moves that may qualify you for a Special Open Enrollment Period [include] ... To the US from a foreign county."

Which seems a slam dunk, but then there's this caveat:

"Important: To qualify for an SEP, you must prove you had qualifying health coverage for at least one day during the 60 days before your move except moves from a foreign country)." [emphasis in original]

This is crucial because it seems to be referring to the so-called "60-day rule;" that is, you must exercise your SEP opportunity within 60 days of becoming eligible for it. I think she's missed that window, but I'm not entirely sure, and so I urged my acquaintance to call the nice folks at the Marketplace to confirm, and also to see if the daughter might be eligible for a subsidy.

We then looked at what plans and carriers were available in their area, to get an idea of costs and benefits. The less expensive Bronze level plans were, of course, very affordable even without the subsidy, but the out-of-pockets were pretty hefty. The other issue is that, at least in Ohio in 2019, all plans are built on an HMO chassis, which means basically zero out-of-network coverage, which might be an issue (or maybe not: after all, she doesn't have insurance now).

Okay, that's the insurance side, but maybe there's another line of attack open to us?

And indeed there may well be:

I then suggested that they also consider other options. For one thing, a call to the local Medicaid office might be helpful: those folks have access to information on all kinds of medical financing options.

I also asked if he was aware of Direct Primary Care. I explained that these practices worked like a gym membership, with monthly dues granting 24/7 access to a physician. They also often have big-ticket diagnostic equipment in the office, saving even more (eg: MRI's costing hundreds of dollars, not thousands), as well as discounted prices on meds. They are also very helpful in referring patients to fellow cash-only-type providers in the area for non-primary care services.

I promised to send him the link to the latest directory of DPC practices, but I also cautioned him to beware that they aren't much help with catastrophic medical issues, and that's something to consider, as well.

Looking forward to seeing how this plays out and, of course, always happy to help.

Thursday, July 18, 2019

A Deadly Conundrum: Updated

Last fall, we reported on this tragic story:

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

Turns out, "Father of the Year" (non-)contender Ali Elmezayen had purchased the policies just over two years prior, presumably planning ahead to avoid the contestability clause which "allows the carrier to review a recently approved policy to see if there were any misstatements or misrepresentations" and goes away after the first two years. So it appears that Mr E thought that a two week "cushion" would be sufficient.


"A father has been charged with capital murder after his two autistic sons tragically drowned when he drove his family off a Port of Los Angeles pier in California ... Just before the incident, Ali had purchased several accidental death insurance polices.."

And of course "accidental death" nature of the plans was a nice touch: these policies are generally a fraction of the cost of a regular term or whole life plan. And if the goal is to collect in a couple years anyway, who needs long term premium guarantees?

Be a darned shame if anything untoward happened to him in prison.

Stupid Agent Tricks: Sometimes I despair

So one of my hats is CE (Continuing Education) provider. My primary role in that capacity these days is "back office support;" that is, I file courses for state approval, create and provide class rosters and completion certificates, and file completed class rosters to the states in which I'm a licensed provider. Unfortunately, I don't get much opportunity these days to actually teach, and I miss that dearly.


One of my CE clients taught a couple classes the other day (well, technically, the same class, twice, at two different locations). She had previously taught this same class last fall (at the same locations). In Ohio (and, I imagine, in most if not all other states), one cannot get credit for taking a course more than once in a cycle. Determining whether or not this applies is fairly simple; agents can check their transcripts online in a matter of seconds.

Of course, this doesn't always happen, and in today's little object lesson, 5 of the 15 students at Location 1, and 2 of the 8 at Location 2, had taken this exact same course within the past 6 months.

And it gets better (for certain value of "better"): for at least 15 years, agents have been required to use their National Producer Number (not their social security or state insurance license number) to sign in and get credit for a course.

Let me repeat that: the NPN requirement is a decade and a half old.

Which of course 2 students completely ignored, causing me to then go to the state insurance department website and drill down to their personal info and obtain that information so that they could get their CE credits.

And these rocket surgeons "advise" their clients on transactions worth thousands of dollars.


Wednesday, July 17, 2019

Heads' up for cancer

Today is especially relevant for my late sister's friends and family:

Please pass the word.

Medicare Questions You Never Asked

Medicare questions you never asked (because there are things no one ever told you about). Don't you hate it when you buy something and then find out it didn't work as promised? Some things can be returned for a refund.

Others cannot . . .

Your Medicare plan is one of those things. Easy to get into at age 65. But you could run into a roadblock if you later have buyer's remorse.

Gary is a friend and is learning about Medicare the hard way. Gary is just now learning prior authorization.

Before he can have a test ordered by his doctor, the carrier must APPROVE the test. It’s all about the money.

His oncologist wants him to have proton therapy but his plan will only pay for a less expensive protocol. Dollars drive many medical decisions when an insurance carrier controls your benefits.

Proton Therapy – It Helps Only a Few at a Wildly Extravagant CostMedPage Today

All he wants to do is get well but his Advantage plan is running interference. His carrier is interested in saving money. THEIR money. Not his.

It’s all about the dollars. Just another Medicare thing he did not know.

#MedicarePriorAuthorization #MedicareAdvantage

Tuesday, July 16, 2019

Are Medicare Advantage Plans Good?

Medicare Advantage plans good or bad? Like everything else, it depends on your perspective. But how will you know if an Advantage is right for you if you don't know the right questions to ask?

Too many people don't UNDERSTAND MAPD plans. No premium to pay. Dental and vision coverage included. What's not to love?

How about access to health care?

Some folks have medical conditions that require specialized care and there may only be a handful of Medicare Advantage providers in your area that offer that kind of treatment. There are patients who have a level of trust with their provider that cannot bridge saving $$$ to follow the path allowed by the HMO.

The choice of plans is not JUST dollars and cents. Too many agents either ignore this aspect or don't understand it. How Medicare Advantage plans are sold, what you are told and what is omitted, can make Advantage plans bad for you.

Learn more about Medicare Advantage plans -


Monday, July 15, 2019

Congress Won't Whack the Cadillac

The resurgence to repeal the Cadillac Tax is front and center - again. This time it is due to the overwhelming support in the House of Representatives which allows for a bill to move to the floor when there is a supermajority of co-sponsors.

In this case the Middle Class Health Benefits Tax Repeal Act of 2019 has 361 co-sponsors - 83% of all members.

So, why then with such huge bipartisan support will repeal fail? It is simple, from an IB post back in January of 2018:

"But here's the truth. Congress needs the Caddy Tax. They need it for the revenue on paper. When CBO scores in ten year windows it shows an accounting sleight of hand that many of us don't know. It shows as revenues - whether collected or not. 
Having IOU's is how they trick us in to believing that they are good stewards of our tax dollars. Sad truth is they simply don't care about spending your money. They care about you voting to re-elect them. Which is why kicking the can down the road is the avenue of choice for those we elect in DC."

In this installment of Congressional drama the supermajority will use the opposite angle saying that they can't kill the tax without offsetting revenues. They will again claim to be good stewards of our tax dollars and voice how much they dislike the tax.

But when the dust has settled the Cadillac Tax will live. Probably to never see the light of day except on those occasions where playing politics allows it to briefly see the light of day.

No good deed....

From our friend Holly R:
Which is a sweet gesture, until one realizes the unintended consequence:

"According to the IRS, if you have canceled, forgiven, or discharged debt for less than the amount you pay, the amount of the canceled debt is taxable income."


Now, the taxes on this difference are, obviously, a lot less than the debt itself, so this isn't a slam on the idea. But if the recipients are unaware of the largess, or of this tax rule, they may be in for a nasty surprise at year's end.

"You get a car, and you get a car..."

Adds up.

Friday, July 12, 2019

Rx Anecdate: Contra-Narrative

At my recent annual physical, i was prescribed, at the tender age of 39(shut up), my first-ever maintenance med: 10 mg daily of Lisinopril for moderately high blood pressure.

[ed: this came as somewhat of a shock, inasmuch as I'd heretofore been considered a carrier]

It's become fashionable of late to dump on Pharmacy Benefit Managers (PBM's) and specifically Aetna and CVS. Well, I'm insured under an (HSA-compliant) Aetna plan, and I had the scrip filled at my local CVS for the princely sum of .... wait for it ... $2.21 for a monthly supply.

I think we can swing that (at least for the nonce).


Thursday, July 11, 2019

Bon voyage! [UPDATED]

UPDATE: Monsieur Lambert has passed away.

"Vincent Lambert, 42, died Thursday in a hospital in Reims nine days after doctors stopped providing artificial feeding and hydration, ending years of legal flip-flopping over whether to keep him alive."

[ed: original post below]
The name of the French national health care system, La Sécurité Sociale, pretty much guarantees that this would be the outcome:

"French Quadriplegic Being Starved To Death By The State"

In 2008, then 31 year old Vincent Lambert was left in that condition as a result of a terrible car accident.

Flash forward 11 years, and the poor man has been ordered starved to death by the (warm, compassionate, caring) French government:

"The Cour de Cassation overruled an appeals court which had directed doctors to keep Mr Lambert alive pending a review of his situatoin by the Unitoed Natons Committee on the Rights of Persons With Disabilities."

This echoes Iceland's take on Down Syndrome babies:

"Iceland is on pace to virtually eliminate Down syndrome through abortion."

Inconvenient, non?


[Hat Tip: Ace of Spades]

From the 'Be Careful What You Wish For' files


"Cone Health CEO Terry Akin urged staff to contact legislators to advocate for hospitals' position on the issue."


"Burn in hell, you sorry SOBs"


Short take:  North Carolina Health Plan honchos have proposed a new reimbursement scheme for Tar Heel State hospital systems that include some pretty draconian caps, and one provider's manager followed orders (maybe a bit too zealously).

[Hat Tip: Co-blogger Bob]

Wednesday, July 10, 2019

Sigh: Some folks just don't 'get it'

So, working with a customer who needs a short term medical plan for his wife, who is an American citizen living abroad. I was able to find only one carrier that didn't require a recent stateside residence, and so I quoted that carrier. As always, I quoted using the maximum lifetime benefit (in this case, $1 million). The client asked about $1,000 and $2,000 deductibles (which I think is a mistake, but that's what he asked for).

So I quoted as he asked, and the premium came out to $325 per month for the $1,000 deductible plan, and $256 a month for the $2,000 version.

He balked at that, claiming that I'd previously quoted a much lower rate. I pointed out that we had been looking at a $5,000 deductible (which would have been well under $200 a month). He thought that still might be spendy, and he would check with his home country's options. I wished him well and told him that I'd be happy to write this plan if the home country option didn't pan out.

This morning, I get this in email:

"This quote sounds good to me.

What if I take insurance for 250 G instead of million and keep deductible to 1000 or so?

This [home country plan] is world wide known. May be you can also use them check it out.

The currency conversion is Rs 70 to a dollar, so the premium is about $150 for 3 month.

Please let  me know your thoughts

[ed: it was unclear if that was $150 a month for 3 months, or $150 one-time premium]

This is becoming tiresome (we make very little on Short Term plans, and he's quickly using up the commission)(and my patience).

I replied:


No, I can’t sell for non-USA companies.

>> $250 G

No, I can’t do that: I will only sell the maximum benefit (for a number of reasons: E&O liability chief among them, also you really don’t save all that much lowering the maximum vs raising the deductible)

We'll see what he does.

Not really on tenterhooks here.

By the way: there's another very good reason to not skimp on that policy max: insurance is, essentially a gamble (yeah, yeah, I know) and it's a lot easier to come up with an extra three or four thousand dollars than 10's or 100's of thousands.

Tuesday, July 09, 2019

Another STM Dilemma

A Twitter friend pointed out that:

Although I knew what she was saying, I asked for clarification (to make sure we were on the same page), and she helpfully responded:

"When you sign up 1-15 you are not covered until the First of the following month. From the 16-31st the plan starts the 1st of the second month."

That is, if you sign up on June 3rd, your coverage doesn't begin until July 1st. And if you sign up September 17, your coverage doesn't start until November 1st.

This is where a Short Term Medical plan could come in mighty handy (too bad for the folks in states such as Connecticut and California, that outlaw them).

Sexist Stats

So, got this yesterday from the CDA (The Council for Disability Awareness):

"In a new survey of the awareness and ownership of disability insurance across today’s workforce, The Council for Disability Awareness (The CDA) uncovered that the 32 million, unmarried women workers, who make up 25 percent of today’s American workforce are underinsured for a disability."

Which is, no question, a shame.

But I immediately replied:

"That’s interesting.

How about similar stats on men, who make up 66% of the workforce?

I’ll wait…

Breath status:

[x] NOT held.

Monday, July 08, 2019

Off Topic: Two Great Causes

So last Friday evening, we attended a local food truck rally (and very cool fireworks display) and learned about two very worthy causes:

Warrior Weekend to Remember honors combat injured vets and Gold Star families (and even first responders and their families) with an incredible weekend experience that includes:

- Indoor Kart racing
- Skydiving
- Hot air balloon rides
- A bonfire and concert

And more!

Click here to learn more about this fantastic program.

■ The 1st Annual PNC Community Mutt Strut is coming up in October, and includes a dog parade, vendors and food, even door prizes. Approximately 22 veterans a day commit suicide, and it's the Mutt Strut's purpose to change that by providing service dogs to vets with PTSD, brain injuries, and other combat-related mental health issues.

You can learn more about the organization, and the parade, by clicking here.

Saturday, July 06, 2019

Friday, July 05, 2019

Sidebar News: Life Happens

Been meaning to do this for a while, but was challenged finding "just the right one."

People often ask me "how much life insurance do I really need?" I have a special form that I give these folks to do their own assessments (lest they think I'm "goosing" the numbers). But in this digital age, I realized that it may be preferable to offer an online tool, preferably one that keeps such information anonymized.

A friend suggested that I have a gander at the Life Happens site, and sure enough, there's a very nice, intuitive, anonymous widget that I think fits the bill quite nicely. Available now in the sidebar, under "Resources."

Check it out!

Thursday, July 04, 2019

Happy Independence Day!


Wednesday, July 03, 2019

Who knew?

That India had adopted the HMO model:

"An Indian man who had been declared dead woke up just before he was set to be buried during a funeral ceremony."

He'd apparently been in an accident and was taken off life support, "coincidentally only after the man’s family told the hospital that looked after him they no longer had the funds to pay for his care."


Yeah, go with that.

Confounding Case Bleg

Co-blogger Bob offers a poser:

"Unusual situation referred to me by agent in another state.

Mother-in-law relocated to Atlanta from Pakistan. Green card holder, age 71. Health status unknown (didn't ask). Looking at possible options. Coming up empty or "are you kidding".

■ Medicaid - possibly the best option depending on how they define household income.

■ Obamacare - I assume she can qualify but no subsidy. Outrageous premiums and OOP

■ International travel medical - pre-ex snake pit

■ Health share ministry - must be Christian? Other religious affinity including Muslim? Pre-ex? Not readily accepted by docs/hospitals since no guarantee of payment. HSM is a very remote possibility but want to throw that out as an option

I checked the site, and was surprised to learn that "Gained citizenship or lawful presence in the U.S." triggers a Special Open Enrollment opportunity.

So, armed with her new zip code, I went plan shopping. The least expensive option was a Bronze level Blue Cross plan with a $6,750 deductible and a $740 a month price tag.

The advantage, though, is that it's guaranteed issue and pre-existing conditions are covered right away.

Since we don't know her health status, it's impossible to determine whether or not other non-Medicaid options would work (since they all have either underwriting, or pre-existing conditions limitations, or both).

I also thought about "Dave's Plan," but the age cut-off for that is

Alas and alack.

So, suggestions welcome.

Tuesday, July 02, 2019

Tuesday LinkFest

■ Item #1:

"Medtronic recalls MiniMed insulin pumps as FDA warns about hacking risk"

This is a major issue with the whole Internet of Things phenom. The danger, of course, is not just the threat of ransomware 'per se,' but that actual lives could be put at risk.


■ Item #2:

We haven't heard from our friends at the MVNHS© lately, let's correct that, shall we:

"NHS beds crisis 'critical' as more sick Brits left stranded in hospital corridors last month than at the height of winter"

Which is even more alarming, in that the stated goal is to have no more than 85% of available beds occupied.


■ Item #3:

So-called "balance billing" (aka "surprise billing") is nothing new to regular readers:

"These hidden providers are like gunslingers in the wild west. They are not beholding to any rules and are free to charge whatever they want. If you don't pay they can ruin your credit and there is little you can do about it other than pay up."

The problem has only gotten worse over time, and there are all kinds of ideas being proposed to try to rein it in (including forcing out-of-network providers to accept in-network pricing). Some folks even think t should be illegal to engage in the practice.

But what about the other side of the coin?

Former Solicitor General Paul Clement makes the legal case for balance billing:

"The ability to refuse to accept an insurance plan is what gives doctors leverage when negotiating their rates ... [which] would likely violate the First Amendment's guaranteed freedom to assemble, as well as the Fifth Amendment's protection against government "takings"


Monday, July 01, 2019

It pays to read the mice type

How many times are we told to "read the fine print" versus how many times we actually do?

Well, here's a case where someone did, and it paid off bigly:

Which turned out to be quite providential:

"We estimate that less than 1 percent of travelers that purchase a travel insurance policy actually read   all of their policy information — and we’re working to change that.”

That's nice, but how, exactly?

So glad you asked:

"[T]he first person to email the company and mention the fine-print contest [will] win $10,000."

And so she did, and so she did. 

Mazel tov!