Monday, September 30, 2019

Top 'the Week Spindle Clearing

First up, thanks to FoIB Jeff M, some good news for Tar Heel State insureds:
[click to embiggen]

This applies to their individual ObamaPlans only, but still: Kudos!

We last blogged on insuring drones back in '16:

"[Here] are insurance coverages and how they are likely to apply. Keep in mind all claims are handled on a case-by-case basis, and there may be more exclusions and conditions that apply as drone technology evolves."

But that was about personal use of this tech. Now, the folks at Worldwide Facilities has a new post up about the risks issues faced by businesses using it, and what they can expect insurance-wise:

"The Claims and Litigation Management Alliance has identified privacy, property, and bodily injury as key issues for insurers, along with growing concerns over technology risks."

Interesting stuff.

This is a little off the beaten path for us, but it does relate to an important Long Term Care issue. Our friends at OneAmerica bring us Thorpe's Story:

"Since being appointed power of attorney for his ailing father, Thorpe has faced increasingly difficult decisions about how to best provide care. His dad wants to stay in a house that is no longer safe for him and needs more care than Thorpe is able to provide by himself. This experience has made Thorpe consider the situation he might find himself in one day."

To be sure, POAs are an issue best handled by one's attorney, but it's a conversation all too few of us actually have. And there are important considerations here, both for ourselves and our loved ones.

Sunday, September 29, 2019

L'shannah Tova 5780

This evening marks the beginning of Rosh HaShannah, the Jewish New Year, as we welcome 5780.

We were commanded to observe this holiday in the book of Vayikra (Leviticus). It's interesting because, unlike our secular New Year which begins on the first day of the first month, Rosh HaShannah actually begins on the first day of the seventh month of our lunar calendar. And also unlike typical New Year's revelry and fun:

"It is both a time of rejoicing and of serious introspection, a time to celebrate the completion of another year while also taking stock of one’s life."

So, may the New Year be filled health and happiness:

Shanah Tovah Umetukah - Have a Good and Sweet Year - !שנה טובה ומתוקה

Friday, September 27, 2019

Medicare MSAs: An Update

A couple weeks ago, we posted on a new Medicare Supplement model:

"Medicare MSA's appear to be the post-65 version of what we typically see as Health Savings Accounts (HSAs) in the pre-65 market, with some interesting twists."

At the time, we wondered if beneficiaries could also toss in additional dollars on their own, and reached out to the Lasso folks for clarification.

Well, they were kind enough to reply:


Thank you very much for your interest and question!

Currently, Medicare MSA deposits can only be made by the Medicare Advantage contract holder (Lasso Healthcare) to the MSA plan members’ accounts.  There have been proposals to Congress to change this law and allow individuals to contribute also, but at this time only Lasso Healthcare can contribute to the MSA plan members’ account each year.

The good news is that the deposit is very large relative to health savings account limits, occurs as a lump sum at the beginning of the benefit period and continues annually as long as the individual stays in the MSA plan.

Thanks again and have a great day!

Nope, thank you!

We'll keep track of this and update as appropriate.

[Hat Tip: Jim Handlan]

Thursday, September 26, 2019

Small Group Renewals, ACA, and (False) Promises

Remember this?

Well, that was the promise, anyway. But how is that actually panning out?

Turns out, we have independent, verifiable facts that paint a very different picture.

I'm fortunate to have a number of so-called Grandmothered/Grandfathered small group clients. These are plans that are largely unaffected by various ObamaCare rules and regs, and so provide a clear picture of how small employers are being crushed under those regs.

Here's one such group's actual 2020 renewal:

So, less than 4% increase, reflecting the ever-increasing cost of health care.

Now let's see what would happen if they opt to switch over to a comparable, fully ACA-compliant plan: 

Yes, you're seeing that correctly: an almost 100% rate increase, merely for adding a few bells and whistles.

That's the real cost of Obamacare.

So tell me more about this promise....

[Hat Tip: FoIB Beth D]

Wednesday, September 25, 2019

Mom Insurance, Revisited

Years ago, we discussed the importance of life insurance for a stay-at-home spouse:

"[T]he cost of replacing a SAHS isn't measured in hard dollars coming in, but what it would cost to hire someone to provide all (or almost all) the services of that spouse."

I mention this because we're nearing the end of Life Insurance Awareness Month, and I recently received this interesting infographic on the topic from our friends at Issue Insurance:

[click to embiggen]

Something to consider, no?

(And of course, same would apply to stay-at-home Dads, as well)

Tuesday, September 24, 2019

Cook spoils the broth

As in Britain's venerable (and newly defunct) Cook Travel Agency:

"Hundreds of thousands stranded after travel firm Thomas Cook collapses"

The agency had grown substantially since it was founded in 1841, to include not just airline bookings but also operating "hotels, resorts and airlines for 19 million people a year." As it stands, some 600,000 travelers are out their booking fees and will likely have to cough up additional cash for new travel and lodging plans.

This caught my attention: the firm "will need the help of governments and insurance firms to bring them home."

So I reached out to our friend Peter Schulteis at Global Underwriters who told me:

"Yes sir, this is why you buy trip cancellation and interruption insurance.

I knew they were having trouble, but this is really bad. They were over extended and made some really bad business decisions that ultimately crippled them.

He also provided a link to their Trip Cancellation & Interruption Plan, and added:

"Henry, here’s an interesting fact – A new study by the U.S. Travel Insurance Association (USTIA), suggests that U.S. consumers are spending as much as $4 Billion on travel insurance annually."

Wow, that's a lot of travel insurance.

[Hat Tip: FoIB Michael Bertaut]

Monday, September 23, 2019

When Socialized Medicine happens to Good People

A recent article in the Daily Mail caught my attention with the headline: 

I always like to read about medical issues, but what caught me most about the article was the location, the Naval Medical Center Portsmouth. I am acquainted with that hospital, as my first born child had cleft palate surgery there when she was one year old. As we had excellent care in that facility, I was curious as to what happened and I found an arbitrary policy led to an unintended consequence.

LeeAnn Bienaime, 27, was suffering from painful and consistent contractions when she and her husband Leo Bienaime, 29, headed to Naval Medical Center Portsmouth on August 23 ⁠at around 8:30 p.m. — just hours before their son Joachim's birth.
'In all of our classes and appointments, they told us that when you're having contractions five minutes apart for a minute long, for one hour, you should come into the hospital,' she said.
LeeAnn was two centimeters dilated at the time but was told she wouldn't be admitted until she was further along, despite the painful contractions that made her 'sick.'

She said that after spending two hours at the hospital without any change, two doctors advised her to go home and come back when she was five centimeters dilated

 The patient did everything correctly, but her body was not behaving as it should. Within 4 hours of going home, mom delivered her baby in the family’s bathtub. The doctors relied on a policy instead of their medical training to determine if the patient should be admitted. Her contractions indicated that her body was ready to birth, even if she was only dilated two centimeters.

Giving birth can have serious consequences if anything goes wrong. As Mrs. Bienaime points out in the article, “'We were able to have a healthy birth, a healthy baby boy ⁠— that’s why I’m not completely enraged,' she told WTKR. 'I feel like if it had gone another way, it would’ve been a different story.'  

She is absolutely right and correct in her feelings of anger at what happened. However, unlike the civilian world, where a patient can sue, there is no ability to do that in the Military System.

To those who want Socialized Medicine, this story is the canary in the coal mine.


Friday, September 20, 2019

CanuckCare, EHR, and Wait Time #Fail

So, what do you get when you mix together government-run health "care," electronic health records and "quality measures?"

Regular readers probably already know:

"Emergency room wait times at The Ottawa Hospital were the longest in the province this summer, in part because of the introduction of a new electronic medical records system."

When the person whose ostensible job is to provide care is instead clicking and typing, well, that's what you get.

In fairness, EHR has become quite the bane here in the US, as well.

If you want proof, and are on Twitter, you should be following @EPICEMRparody.

From the P&C Files: Rocky and the Insured

Thanks to our good friend Holly R:


Wednesday, September 18, 2019

CanuckCare© FTW


Baruch Dayan HaEmet: Cosmo DiPasquale

Some three and a half decades ago, as a newbie agent, my then sales manager introduced me to my new-to-me client, Cosmo. He was nothing like I'd have expected of someone in his mid-sixties: vivacious, friendly, fun and just the best sense of humor. And warm, so cordial and welcoming.

A year and a half later I had made the jump to independent agent, and Cosmo came with me. Over the years we helped with his life and business insurance, and more. In recent years, I most often spoke with his beloved daughter Pat.

Yesterday afternoon, I got "the call;" Pat let me know that he'd passed away on Sunday, just a wee bit shy of his 100th birthday.

It's odd to think that this wonderful person, whom I've known since my very first week in this industry, is really gone. And I'm humbled, as well, by the thought that, while I've delivered many claim checks over the years, this will be for one of, if not the, first policies I ever wrote. How many agents can make that claim?

So as Pat and I reminisced, it was difficult for either of us to refrain from crying, but we did share some wonderful memories. One of my fondest was maybe 30 years ago at a local restaurant where Cosmo and a group of friends were playing jazz for Valentine's Day dinner. He invited my better half and me to join him, and he serenaded us for quite a while with his amazing clarinet (or was it the sax?).

He was able to live independently until just very recently, and has been a joy and inspiration to his family, his friends and his community.

He will be missed.

May your memory be for a blessing, Cosmo.

Tuesday, September 17, 2019

Heads' up, Insurance Agents & Brokers

Just now on the Ohio DOI website:

We are aware of a phishing scam targeting insurance producers regarding a falsified insurance claim related to their company that has been submitted to the National Association of Insurance Commissioners. This fraudulent email displays the NAIC and CIPR logo, can originate from a naic or gmail account and asks the recipient to click on a link to download the complaint notification.

Certain anti-virus products will detect this is a malicious email but if you receive a similar email and have any concerns, contact the NAIC Service Desk at (816) 783-8500 or

Lowe's Doubles Down on Customer Dis-Service

So the saga finally played out this past Sunday.

What saga, you may ask?

This saga:

As one might imagine, I was unconvinced that the rocket surgeons at Lowe's would actually come through with the promised Sunday delivery, so I started calling the store a little after 8:00 in the morning. I was told that they were still loading, and to try again later. Knowing that if the truck left the store without my oven there was zero chance of delivery that day, I called again at 9:00 and 10:00. Each time I was put off, and it wasn't until after 11:00 that I was able to confirm that the oven was, in fact, out for delivery.

Again, there was zero effort to reach out to me until after noon, when Shawn called to tell me that the oven would be delivered between 2:00 and 4:00. Had I not diligently called that morning, I wouldn't have known.

To his credit, Shawn arrived on-time.

I cannot stress enough how badly Lowe's screwed this up, with zero communications from the time of the order until a few hours before delivery.

But wait, it gets "better."

What's most remarkable may be that I would have *bet money* that Lowe's couldn't make this already dreadful experience worse, and I would have lost that bet:

Last evening, a corporate critter called to "reach out to me" and to apologize for the "miscommunication," and to assure me that they were reviewing their processes to make sure this wouldn't happen again. I assured him that there was no miscommunication since there was no actual communication to begin with.

I also assured him that there was no likelihood of it happening again to me, since we will never buy another big ticket item from Lowe's, and that we would diligently work to ensure that none of our family or friends do, either.

He never asked for details of our story, just kept saying "I want to reach out" and "I want to make sure you know." Nothing says "we care" like completely ignoring the customer's concerns while focusing on corporate strategies.

I assured him that I couldn't care less, and that the only thing I wanted to hear was how they proposed to change my mind about any potential future sales.

One can imagine how that went.

He did make some vague offer of gift cards (which just means money they'd be recirculating to their corporate coffers). I of course demurred, and gave him the opportunity to make a cash bid. He just said that was up to in-store management (whom we already know is incompetent).

So, we have a very nice new oven, installed by my guy, and Lowe's has lost a heretofore loyal customer (and hopefully many more).

Nicely played!

Monday, September 16, 2019


Britain's Much Vaunted National Health Service© just can't seem to catch a break:

Well, that'll happen when you're diverting over 16% of your current budget to cover shortfalls that were baked into the cake 20 years ago.

And just what was that "secret ingredient?"

So glad you asked:

The "private finance initiative" is actually a fairly efficient mechanism when costs can be controlled:

"(PFI) is a way of financing public sector projects through the private sector. PFIs alleviate the government and taxpayers of the immediate burden of coming up with the capital for these projects."

Shorter: Kicking the can down the road.

Eventually, of course, all that money (plus interest) needs to be repaid, and if one hasn't been careful with cost control, well, that's the pickle in which the Brits now find themselves.

Lest we on this side of The Pond feel tempted to gloat, however, let's stop to consider the impact that MedicaidForAll is likely to have. After all, that's a perfect example of a PFI.

[Hat Tip: FoIB Holly R]

Friday, September 13, 2019

Breaking (Good) News: Dorian SEP

Just now in email from CMS:

"SEP Available for Victims of 2019 Hurricane Dorian"

This addresses concerns that folks who had become eligible for an SEP but unable to finalize a new plan because of storm-related issues will get another bite at the apple:

"Consumers who qualified for an enrollment period, such as an SEP, but were unable to complete a Marketplace application, plan selection, or enrollment process due to Hurricane Dorian, may have access to an Exceptional Circumstances SEP."

They get an extra 2 months (well, 60 days) to log in and enroll, and "request a retroactive start date based on when he or she would have picked a plan if not for Hurricane Dorian."


[Additional info is available here or by calling 1-800-318-2596]

Heads' up Dayton (OH) folks

As part of our Strides Against Breast Cancer fundraising, we're helping out with Brunch & Beer at the 5th Street Brewpub in the St Anne's District:

“Love, Hope & Faith” team for the Making Strides Against Breast Cancer Walk will be hosting a Fundraising Event at the Fifth Street Brewpub on Sunday, September 15th from 10 AM to 2 PM.
Come and join us for Sunday Brunch.
The team will be “Guest Bartenders” during the event and will be raising money for the fight against Breast Cancer. The walk is on October 19th at Fifth Third Field in Downtown Dayton.

Thursday, September 12, 2019

Lowe's blows

Back on August 31, we purchased a new oven from our local Lowe's store (wanted to support the local folks instead of ordering online). That proved to be a mistake.

We were promised delivery by today (September 12), and that was the last we heard from them.

No follow-up, no notification, nothing.

So I called the store this morning, and was informed that the delivery had been pushed out to the 22nd.

Again, no one bothered to communicate this to me. I only learned of it because I initiated the call. I told the manager that this was not acceptable, and that I expected delivery today. He insisted several times that he couldn't promise that. No effort was made to accommodate or offer alternatives.

So I called corporate, and was informed that the oven had been delivered to the local store, but because Lowe's store managers are incompetent, I had to learn from the nice lady on the phone that their rule is that they can't send items out for delivery on the same day, and that tomorrow's deliveries are already booked.

To her credit, she reached out to the "delivery coordinator" and promised me that she'd have him contact me directly to make arrangements. I eventually heard back from the coordinator, who was able to move the delivery up to this coming Sunday (Yay!).

So, all's well that ends well?

Not hardly: I should not have had to call them to find out what was happening, and the fact that each person I spoke with had a different story, is unacceptably poor customer "service."

 We have had been long-time, loyal customers, but no longer.

It's worth noting that  other stores, like Home Depot and Best Buy, will generally match Lowe's prices.

[Part 2 now available here]

Nataline Redux

In which I play the bad guy:

Regular readers may recall the sad case of  Nataline Sarkisyan, "a 17-year-old girl who died hours after her health insurer reversed its previous decision and said it would pay for a liver transplant planned."

There was a lot of finger-pointing, and plenty of blame to go around, but there were also some key issues that prompted much circumspection:

The insurance carrier (Cigna) had initially refused a liver transplant, the fact that experimental treatments are (at best) problematic, and whether PR should override best practices.

Regardless, Ms Sarkisyan ultimately passed from her condition.

Now, fast forward almost a dozen years, and we learn of a young mother who, having undergone "major surgery to remove thyroid cancer ... has never truly recovered." She was fortunate to find a "world-renowned expert in dysautonomia and autonomic neuropathies," and began treatment.

Unfortunately, these appear to have been largely ineffectual, and she's now at a very dark place indeed:

"The only treatment that is anticipated to help her is expensive, costing $6000-7,000 per infusion, and the doctor has prescribed 6 infusions to enable her body to reconstitute itself and get her on the road to recovery."

To that end, her family has set up a GoFundMe campaign [full disclosure: I have donated to it] hoping to raise enough money to cover most (if not all) of the expected costs.

Okay, a worthy cause, but why isn't her insurance company covering it (or at least most) of it)?

Well, that's because the carrier, Aetna, "has refused to pay for the treatments, calling the drug "experimental" and providing no recourse for her worsening condition."

Seems familiar, no?

[ed: for the purposes of this post, we'll table discussion of an insurer's putative responsibility to offer alternative treatment suggestions]

As noted in the GFM, there have been appeals and advocates, apparently to no avail.

As a parent and husband myself, I can certainly sympathize with the family's plight, but I have some questions.

So I've reached out to both Sarah's family and her insurance company, and would like to share what I've learned:

Her father, who was very nice and forthcoming, had no direct knowledge of the plan's details. He in turn put me in touch with his son-in-law (whose employer's coverage is the insurance at issue). Unfortunately, he has yet to respond (I'll update the post if/when he does).

In the meantime, I also reached out to Aetna:

"Good morning!

We're working on a post about [the GoFundMe], and would like to have Aetna's side, as well. We understand that you can't comment about this case specifically, but would be interested in speaking/emailing with a claims person who can address the dynamic between experimental vs medically necessary treatments.

Looking forward to hearing from you

About which co-blogger Bob gently prodded me:

"Still tilting at windmills?

Carriers RARELY set their own standards for medical necessity, experimental, provisional. Much easier to follow CMS guidelines as in  "it's not my fault, this is how Medicare handles it."

Doubt you will get very far with this, even without factoring PHI complexitie

I knew that he was right, but "in for a penny...."

In the event, I did, in fact, hear back from them:

"Hi Henry:

My name is Ethan Slavin and I work in the Communications department at Aetna. While we can’t comment on this specific situation (as you noted), we can provide you with our general overview on how we make coverage decisions.

You are welcome to use information from this page for your post, as you see fit.

Please let me know if you have any questions

Which was not unexpected, and actually helpful.

I would still like to know whether or not the plan in question is self-funded (because that could make a difference), but the reality is that Bob's correct, and while sad, this is pretty standard, and not subject to online petitions and the like.

Again, I'd ask why the venom is being directed at Aetna and not the folks with the high-priced meds, or the providers who would administer them.

But that's just me.

Wednesday, September 11, 2019

Offered with no comment

Okay, one comment: Heh.

[Hat Tip: The Gormogons]

Medicare MSAs

[Full disclosure: I am not active in the Medicare Supplement/Advantage market]

Recently received this in email:

"New for 2020: Lasso Medicare Savings Account Plan"

Medicare MSA's appear to be the post-65 version of what we typically see as Health Savings Accounts (HSAs) in the pre-65 market, with some interesting twists:
• $0 Premium
• MSAs are one type of Medicare Advantage (MA) plan that the Centers for Medicare and Medicaid Services (CMS) partners with private insurance companies to offer. MSAs combine a high deductible health plan covering Medicare A/B expenses with an IRS-approved trust/ custodial savings account.
• No admin/monthly fees for MSA account while beneficiary is on plan
• See any provider or hospital that excepts [sic] Medicare!
• Individual must enroll in a stand-alone [Part D Rx Plan].
• HSA account funds can transferred into new MSA accounts. 
• Plans are available in every county in the states where they are available [ed: go figure].

I checked with co-blogger Bob V (who's very active in the Medicare market) and he confirmed that the idea is legit.

This particular iteration is intriguing, since the vendor, not the insured, is making the actual deposit. Once that's made into the insured's account, it's immediately vested, and can be used for medical-related items (like doctors' visits and rx co-pays). Since it's 100% the insured's money, there's definitely some 'skin in the game,' and we can see that in action:

"[A]s of September 1, 2019, 81% of all Lasso Healthcare MSA plan members had spent less than $1,000 in their current benefit period!"


[ed: I reached out to see if the insured/beneficiary could also contribute to the account, and will update this post if/when they reply]

Currently, the Lasso plan is available in over 25 states (almost half of them!).

Cool idea.

[Hat Tip: TLC Recruiting]

Tuesday, September 10, 2019

Contra Conventional Wisdom

Our friend Holly R sent this along:

"The share of Americans with health insurance fell last year, despite a strong economy that lifted families out of poverty." [emphasis added]


More likely: because (better wages = lower/no subsidy)

It's just common sense.

That sinking feeling

You've likely read about the tragic story of the diving boat incident that claimed almost 3 dozen lives last week. One of the unexpected things that happened pretty quickly was a lawsuit ...

Wait a minute, Henry: why would that be a surprise? Of course the families of those killed would seek some kind of compensation.

Well, that's true, of course, but this lawsuit was actually filed by the boat's owner against those families.


Well, it seems that there's a longstanding maritime law that enables a boat's owners to limit (or even prohibit) monetary damages as a result of this kind of tragedy:

"The owners of the diving vessel that caught fire in California and killed 34 people last week filed a pre-emptive lawsuit last week, seeking to limit payouts to the families of victims. The lawsuit was filed three days after the boat caught fire, while families were still grieving, and bodies of the victims were still being removed from the water."

Wow, talk about heartless.

But maybe not:

"The owners ... have blamed their insurers for a lawsuit that they  filed to limit their payouts to victims' families, calling it an "unfortunate side of these tragedies."

Oh sure, blame the insurer.

On the other hand, it's the insurer's duty to its policyholders and owners (stockholders) to limit those damages, and that's why they keep lawyers on hand for just this kind of situation. It does seem rather crass, but the insurer is also bound to do all it can to mitigate the damages. And the timing, while unfortunate, may have little to do with lack of compassion, and much to do with timely filing.

Our hearts, of course, go out to those families, but this seems to be strictly business.

Monday, September 09, 2019

Problem solved? Sorta, maybe.

Just about two years ago, we reported on a potential problem still lurking under the radar:

"For decades, life insurance carriers ... sold permanent universal life insurance policies, marketed as "insurance for life," utilizing outdated mortality tables that did not take into account the fact that Americans were, and are, increasingly living to and past the age of 100."

To be sure, there are still quite a few other permanent-type plans out there with the same issue.

And what issue is that, Henry?

Well, when these plans "mature" while the insured is still alive, that person is likely to be hit with a pretty hefty tax bill; that is, the policy is paid out as a lump sum to the insured, and any excess over the total premiums paid are taxable. That could be a sizeable sum indeed, and is a double whammy (since that policy is now canceled).

Until now, there really wasn't much one could do about in-force plans (hence the clarion call for a class action lawsuit).

But in a Long Term Care insurance (LTCi) product training session last week, I learned about another product that might be a solution to the tax issue:

OneAmerica Life offers an annuity product that's available to folks up to 99 years old, and doesn't require forced annuitization (or Required Minimum Distributions). While marketed as a potential LTCi alternative, it struck me as solving at least part of that "maturation" problem, since there's no immediate funds to pay out and thus be taxed. Called "Legacy Care®,"  it lets one roll-over the cash value of an existing life insurance policy and continue to defer taking the tax "hit" (although it's going to fall to one's heirs eventually).

Not perfect, of course, but at least a little light at the end of the tunnel.

[Hat Tip: FoIB Randy G]

Friday, September 06, 2019


So a while back, we blogged on the potential issues one might face as a trans/other-American in the market for life insurance. It's now back in the news (sorta) due to this rather silly Tweet:

It's silly because (for starters) trans/other Americans comprise barely a rounding error of the general population. Actuaries, by definition, work with very large groups, not infinitesimally-small ones, which would yield an essentially meaningless sample.

But wait, it gets "better:"

Actuaries estimate "probability of risk," that is, the likely number of expected deaths from a (again, large) population; it's merely a pricing tool.

The only opinion that matters here is the underwriter's, because his job is assessing the specific risk, and then deciding whether or not it's acceptable, and at what premium (rating factor).

In the event, neither of these folks would ever even see such an application in the first place, for a very simple reason: all life applications require one to provide name, social security number, date of birth, and sex (among other things). Applications missing this information will be returned to the agent for completion.

There's also the small problem of the "misstatement of age or sex" clause, which would come into play at claim time.

But even more important, from that underwriter's point-of-view, is this:

"As I discussed with a life field rep friend a while back, the life company is likely to decline the case altogether because of the increased suicide risk."

By the way, these issues would also come into play with auto, disability income, long term care and other types of insurance, as well. Which means a lot of wasted time for a trifle.

Talk about much ado ....

Thursday, September 05, 2019

Up next from MoO

Mutual of Omaha, that is:

"We hope the first video interview we did with Demerri Bond was helpful and insightful. Now, we're excited to bring you the next in the series, an interview with underwriter Carol Carville."

MoO is currently our primary LTCi carrier (due to great value and strong financials), but the points Carol makes apply to pretty much all carriers.

Wednesday, September 04, 2019

That Word Doesn’t Mean What You Think It Means

What do you think of when you hear the word emergency?

According to Webster’s Dictionary an Emergency is “an unforeseen combination of circumstances or the resulting state that calls for immediate action.”

However, insurers in Minnesota think it means something different.

Minnesota lawmakers are seeking more transparency from air ambulance companies about the prices of their rides, according to the Post Bulletin.”

Why would lawmakers be interested in making these prices transparent, since the only time you would use an Air Ambulance is in an Emergency?

Because customers have received “surprise air ambulance bills …from insurers that have denied claims for emergency transport, saying the rides weren't preauthorized or weren't necessary.”

I have seen my share of unwarranted denials, but this takes the cake. In an emergency there is no time to get a Preauthorization. A Preauthorization is usually required for any type of surgery, lab, test, or medication that will require a significant reimbursement by an insurer. Preauthorization’s can take anywhere from 48 hours to weeks to obtain. Obviously if you are bleeding on the side of the road and will die without immediate medical coverage you cannot wait for a Preauthorization.

As to the necessity, once again, it is self-evident.

It is this idiocracy of thinking by insurance companies that hinder medical decision making. While this is an extreme of insurance meddling in medical decision making, this interference occurs hundreds of times a day in every medical facility across the nation.

Tuesday, September 03, 2019

Privacy issues, anyone?


[Hat Tip: FoIB Holly R]

Insulin: A Dilemma

As with "surprise billing," coverage for insulin is currently a major shanda in the news:

"Diabetic, 27, dies after taking cheaper insulin as he lost private health insurance."

Josh Wilkerson had recently come off of his stepfather's health insurance (he had reached that magical age of 26) and had elected not to buy his own. As usual, the reporter doesn't bother to ask why Mr Wilkerson chose to "go bare;" at his age a catastrophic ACA plan would have cost about $300 a month (assuming he didn't use tobacco). At least one plan appears to cover insulin.

Be that as it may, the high cost of "regular" versions of the med have become quite expensive, which is a problem for any number of reasons, not the least of which is this:

"Remember those guys who actually discovered insulin back in 1921? Dr. Frederick Banting and Charles Best were the main two, along with Dr. James Collip -- all three had their names attached to the patent awarded in January 1923 to their method of making insulin.Well, did you know that their original intellectual property rights were sold for just $3 in Canadian money?"

(It's more now)

How we got here is outside the scope of this post, but there appears to be more than enough blame to spread around.

So what is the point of this post, you ask?

Well, it's actually quite simple (for certain values of "simple"):

Regardless of how we got here, it's a big problem, so how do we fix it?

Of course, many folks would have the government wave its magic wand and legislate that it be covered at little or no expense (for those who are insured) or provided at little or no cost (to those who are not).

Which seems reasonable on its face, until one considers this:

It would also likely have a chilling effect in development of other vital medications: how does the manufacturer know that his expensive, hard-won work won't be confiscated by the government?

One possible ray of sunshine is the possibility of importing less expensive versions from Canada, but then, that also creats (unintended?) side-effects.

As I said, there don't seem to be any easy answers.

[Hat Tip: FoIB Sam B]