November is LTC Awareness Month

While we're primarily focused right now on Open Enrollment v7.0, November is also a time to be thinking about Long Term Care, both its cost and how to fund it.

One issue is a common misconception that getting older automagically means a decrease in one's quality of life:

"Most older adults and caregivers mistakenly believe that sharp declines in quality of life are inevitable with age ... The majority of seniors think that depression, dementia and lack of mobility can’t be helped."

But are they correct?

Not necessarily:

"Nearly 40% of respondents are not aware that certain prescription medications can impact cognition, and only half know that certain medicines should be avoided as a person gets older."

And that's just the tip of that iceberg. Click on through for more.

Oh! And click here for the survey results themselves.

[Hat Tip: FoIB Randy G]

What started out as a dream cruise became a nightmare hospital stay for one Atlanta-area couple:

"The two sailed out of Galveston, Texas, on Nov. 11 .... Days later, [Stephen Johnson] went into diabetic shock."

And as if that wasn't bad enough, the ship's doctor recommended that he be airlifted to a hospital in Progreso, Mexico. What happened next should come as no surprise to regular readers:

"When it came time to check out of the hospital, however, the two were not allowed to leave without paying their $14,000 hospital bill in full."

To be fair, the hospital is claiming that it's not the money, but the fact that, in their opinion,  Mr J is still too ill to travel. The good news is that actor/director Tyler Perry has stepped up to cover their bill.

There are actually a number of issues here, pretty much all of them falling on Mr J. For starters:

"Austin said her fiance does not have private insurance."

Why not?

After all, it's the law, right?

According to sources, Mr Johnson is 31 years old. We'll assume that he doesn't smoke, and that since he's wealthy enough to self-insure and pay for a cruise, doesn't qualify for a tax credit (aka "subsidy). A quick trip to 404Care.gov yields this (for example):

An Anthem Bronze plan with a $5,500 deductible is about  $11 per day. Seems pretty affordable to me.

Of course, we already know that most American health insurance ends at the border, which is why we always recommend an inexpensive travel medical plan. The good news is that that's also pretty affordable, as well. We'll assume a 10-day cruise:

Our friends at Global Underwriters offer a "Diplomat International" plan with $1,000,000 of coverage and a $2,500 deductible for $15.

Looks like Mr J chose poorly. 

Oh, and by the way: It took me less than five minutes to track down his age (already know he was from Sandy Springs) and run 404care.gov and travel medical quotes. All these so-called "journalists" had to do was call their own freaking agents. But here we are, doing the job "journalists" can't be bothered to do.

It’s All About the Optics

Recently it came to light that Google and Ascension Health have entered into an agreement wherein Google has been given access to medical health data held by Ascension. It now appears that Congressional Leaders have requested information from Google on “Project Nightingale”. Google has until December 6 to respond to the four Democratic Leaders of Congress.

According to the Wall Street Journal report, at least 150 Google Employees have access to the data on tens of millions of patients. On the surface it looks bad, but let’s drill down on what is happening.

“Although the project is HIPAA-compliant, not all policymakers are sold on the deal.

"Despite the sensitivity of the information collected through Project Nightingale, reports indicate that employees across Google, including at its parent company, have access to, and the ability to download, the personal health information of Ascension's patients," the letter reads, according to CNBC.”

First, let’s look at who has control of the patient’s records. In America only one State (New Hampshire) stipulates in its laws that the patient owns information in the medical record. In all other States it either stipulates that the Provider (Hospital and/or Physician) owns the medical record or there is not such stipulation. In states where there is no stipulation in law, it is recognized that the Provider owns the information in the Medical Record. While the Medical Record is about a patient, it is created by the Provider and his/her staff.

Second, what a Provider can or cannot do with those medical records. If the Provider wants to let a third party, not the patient or insurance company, have access to the records, then the Provider and the Vendor sign a Business Associate Agreement (BAA). A BAA is designated as a HIPAA compliant way to ensure that Private Health Information (PHI) is protected by the Vendor.

“Once a covered entity has identified their applicable business associates, it is necessary to ensure that these third-parties will only use any provided PHI in a secure and established manner.

“Covered entities may disclose protected health information to an entity in its role as a business associate only to help the covered entity carry out its health care functions – not for the business associate’s independent use or purposes, except as needed for the proper management and administration of the business associate,” HHS maintained on its website.”

Providers utilize Vendors for various tasks that revolve around the use of PHI. There are storage facilities for actual paper charts. There are vendors that create electronic communication that the Provider can send out to Patients reminding them of appointments or letting them know about a new service offered by that Provider. There are billing companies hired by Providers to handle their patient revenue. And, finally, there are companies like Google that do analysis on Patient Data for Quality Improvement.

Finally, since a BAA is a tool from HIPAA, all the guidelines of HIPAA apply to the vendor and to the vendor’s employees, so the information is secure.

'Tis a poser

So, FoIB Holly R sent this along:

"Every NICU bed at this hospital is equipped with a webcam so parents can always check on their babies."

Hunh.

I replied:

"I like that!

Although: I guess there could be privacy issues?"

Parents can stream the live feed to their phone or other device. The story doesn't say whether or not the feeds are monitored at the hospital, but one presumes this would be the case.

My concern is that with the spate of hospitals and medical equipment hacking, is there a legitimate concern about this from the parents' perspective?

Whaddaya think?

From the P&C Files: Collison Report

Heh:

A Good Cause

From a friend's daughter:

"Hi, I'm Vanessa Leahr and I live with multiple chronic health conditions including a connective tissue disorder called Ehlers-Danlos Syndrome, Postural Orthostatic Tachycardia Syndrome, Complex Regional Pain Syndrome, Gastroparesis, and more.

 I recently  started an online shop called DAZZLING THEM: DESIGNS BY VANESSA L. as a creative way to make money to help pay for my medical expenses and raise awareness for my conditions. 

Please check out my shop, and share this link with friends and family to help me grow my business."

On Vanessa's behalf, thank you for taking the time to read this message, and I hope it piques your interest.

And speaking of #Medicaid4All

Britain's Much Vaunted National Health Service© continues to cover itself in .... glory (for certain values of "glory"):

Or left in hallways to die. https://t.co/LJvZpXKyIg

— Beau Geste (@BeauGeste11) November 21, 2019

But hey: Free!

Self awareness and Health "Care"

Heh:

#Medicaid4ALL

Unions and Health Care Don’t Mix

I entered the field of Health Care through Social Work and moved into Administration because of a desire to not only help patients, but to also protect Medical Professionals. Prior to the 1980’s it was possible to profitably run a medical office or facility. With the dawn of HMOs and other restrictive payment programs to Providers, it is now impossible to be profitable. Payments have been decreased so that now not only are the majority of Providers employees of large hospitals or groups, but Hospitals are also having difficulty making ends meet. As a result, policies are put into place that may seem draconian to some, but are done to ensure that the lights stay on.

In America there is the ability to protest against an employer if a group of employees feel that they are not being treated correctly. We have a system of Unions and Labor Laws to protect the employees. In recent years medical staff have jumped on the Union bandwagon, but the financial realities are not compatible.

On November 26, if negotiations between University of Chicago Medical Center and the National Nurses Organizing Committee/National Nurses United are not concluded the Nurses will strike. This strike will result in the closing of this Level 1 trauma center for adult and pediatric patients:

“In preparation for the strike, UCMC announced earlier this week that it is moving about 50 babies and 20 children in its neonatal and pediatric intensive care units to other facilities.”

“Negotiations between UCMC and National Nurses Organizing Committee/National Nurses United began earlier this year. Medical center leaders say incentive pay — and whether the hospital should end the pay for newly hired nurses — is a sticking point in negotiations, according to the Chicago Tribune. The union has continued to express concerns about staffing levels.”

Usually strikes impact a business’s finances because the workers make the widget that the business sells for profit, thus without the widget the business does not make money. In this case, however, Nurses are not money generators for medical facilities. Nursing Care is a net loss for hospitals. In the Medical Field, only Providers generate money. That is, the Doctors, Technicians, Therapists, etc. who provide a medically necessary service or procedure to a patient, and for which they can then bill the patient, usually through a Managed Care Organization, i.e. Insurance Company. Through this billing, funds are generated to pay for the person who performed the service or procedure. Funds are also generated to pay for the equipment used in the procedure.

Nurses do remarkable work, but their services are not billable for payment. Thus any salary paid to a nurse has to come from monies generated by Providers. Thus a strike will not affect the bottom line of a Hospital, it will only affect care that the Hospital can provide.

“The nurses said they plan to strike unless an agreement is reached.”

Why MLR is such a joke

It's been a while since we last visited MLR (Medical Loss Ratio):

"In case you didn't know, the ACA requires carriers to pay out (at least) 80% of premiums collected in claims. For large groups, that requirement is 85%. Anything less and they have to send the difference to their insureds."

The idea was to encourage (require) carriers to be more carful stewards of the premiums they receive and their obligation to pay out as much of those in claims as possible.

Anyone else see the glaring logical fallacy here?

Well, FoIB Ed Swan sure did:

Understanding MLR.

15% of a higher number is...a higher number. This is why insurance carriers have no incentive to negotiate lower prices for healthcare services. They just pass the costs back to the insured in the form of higher premiums. https://t.co/dDEcS9fa4E

— Ed Swann (@Epic_Ed) November 8, 2019

#PieceOfThePie

Medicare Advantage - What's the Catch? - GA Medicare Expert

It's funny because it's true

Our friend Rick B sends us the link to this satirical(?) piece on modern health "care:"

"Supreme Court Allows Victims Of Heart Disease, Obesity To Sue Utensil Manufacturer"

He points out that there are some very real issues at play here:

"I know this is a joke but interesting idea for a blog post. Who is responsible for us?"

A most cromulent question, no?

#Medicaid4All

404Care.gov Enrollment: Week 2 Results

Hunh:

[click to embiggen]

Let's see how that compares to last week.

[ed: recall that week one comprised but 2 days]

Plan Selections were up an average of 23%/day, and the number of New Consumers also increased (by about 15%/day). Current policyholders renewing coverage were up by almost 25%.

On the other hand, Window Shoppers fell an incredible 57% per day (to be fair, not sure that's meaningful, yet).

Interesting, no?

Outstanding Agent Tricks

This is so cool:

"Quick-thinking hunters in central Michigan have rescued two deer who literally became locked in battle."

And Insurance Agent Mark Johnson saves the day.

Kudos!

[Hat Tip: Ace of Spades]

Global Underwriting Update

From our friends at Global Underwriters:

"Each year the number of people traveling for business purposes is astonishing. The Global Business Travel Association counts over 488 million trips taken annually. Each year business travelers take an average of 12 trips, typically lasting at least 5 days. An estimated 1.3 million business trips occur daily in the U.S. alone. These figures are expected to grow another 7% this year.

Even with video/web conferencing, online meetings, and daily conference calls business travel continues to increase and is vital to the success of many companies. Hectic schedules, missed flights, transportation issues, and hotel problems are the least of the employees' worries. Many employees are citing concerns related to personal security, terrorism, political unrest and infectious disease epidemics. 

It's also crucial that companies and organizations embrace Duty of Care obligations and take the necessary steps to reduce potential dangers or problems that could occur while their employees travel. Employers need to have a well communicated plan in place and part of this plan is providing Business Travel Accident (BTA) insurance for their employees. BTA insurance is an inexpensive benefit that supplements any employee benefit program. This World Class Protection is designed to offset the risk and potential loss of a key employee(s) and to compensate families of employees for their loss of income due to accidental death or permanent disability of a loved one."

If international business travel is on your itinerary, this is must-have info.

The Correct Words

In the medical world, we have our own language; well,actually multiple languages. The clinical has their languages, usually abbreviations, the medical administration has their own language, and the health insurers have their own language. Throughout my long medical administrative career, I have noted how incorrect language results in problems between health insurers and the medical office.

A case in point is this blaring headline from ProPublica:

“How One Employer Stuck a New Mom With a $898,984 Bill for Her Premature Baby”

The article was listing under a heading: “Health Insurance Hustle”.

 This is terrible, how could a medical facility and a health insurance company do this to a new mother with a critically ill patient?

A read of the article offers this tantalizing tidbit,

“Bard’s saga began, traumatically, when she gave birth to Sadie at just 26 weeks on Sept. 21, 2018, at the University of California, Irvine Medical Center in Southern California. Weighing less than a pound and a half, tiny enough to fit into Bard’s cupped hands, Sadie was rushed to the neonatal intensive care unit. Three days after her birth, Bard called Anthem Blue Cross, which administers her health plan, to start coverage. Anthem and UC Irvine’s billing department assured her that Sadie was covered, Bard said.” [emphasis added]

Right there in the paragraph, Anthem said the baby was covered. Mom took that to mean that baby was enrolled in the plan. This is a very common error on the part of the public. What Anthem meant by the comment was that the plan covered pre term births. What was not said by the Anthem representative, was that mom still had to go onto her employer’s website and enroll the baby in the plan. It had to be done in 31 days.

So, “Meanwhile, believing that everything with her health benefits was on track, Bard spent nine of those first 31 days recovering in her own hospital bed and then had to return to the emergency room because of a subsequent infection. She spent as much time as she could in the neonatal intensive care unit, where Sadie, in an incubator, attached to tubes and wires, battled a host of critical ailments related to extremely premature birth. At times, doctors gave her a 50-50 chance of survival.”

Mom thought everything was fine with her insurance, so she focused on her baby. “Then, eight days past the 31-day deadline, UC Irvine’s billing department alerted Bard to a problem with Sadie’s coverage. Anthem was saying it could not process the claims for the baby, who was still in the NICU.”

Then the bills begin to arrive, totaling almost One Million Dollars. Through the efforts of Social Media, the insurance company relented and retro activated the baby’s enrollment back to her date of birth.

This could have been so easily avoided if both mom and the insurance company had simply clarified what “covered” meant. Any reasonable person should know that you simply cannot call your insurance company and you or a family member are magically entered. It takes some effort on the patient’s part to make that happen.  

The most common complaint that I receive from patients regarding a bill is, “The Insurance Company said you coded wrong”. No, we did not code wrong.  You, the patient, presented with a flu during your Preventive Exam so you were billed for an office visit.

Or, “Why did I receive this bill, my Insurance Company said I was covered.” Yes, you are covered for that service, but not by this provider.

In medicine, as in all businesses, it is imperative that the consumer, the patient be aware of what they are asking. Insurance Companies Representatives are limited as to what they can tell a patient, so when calling your insurance company, make sure that you are both speaking the same language.

LTCi in the news

Fresh off the presses:

Just Released: 2020 LTC insurance premium deduction and tax-free benefit increases! https://t.co/GFpR5KIDrX pic.twitter.com/9viLCFMYY1

— Bill Comfort, CLTC® (@comfortltc) November 7, 2019

Potential good news for folks considering an LTCi purchase.

Not sure about timing? Well, consider this timeless post from our friend Herman Bruns:

"As more and more baby boomers become aware of the devastating financial and emotional effects that a long term care need can have on their family, the average age at which people purchase LTC insurance has been steadily dropping every year."

A Tale of Two Networks

For plan year 2020, history repeats:

"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."

One way carriers have found to reduce their costs has been to offer ever-shrinking networks. For some, this isn't an issue, but for many, who have longstanding relationships with their current providers, this can be a problem.

Take, for instance, Larry: he's a long-time client, lives up in the Cleveland area (Geauga County). As with most of the state, almost all of the plans available on the 404Care.gov site are offered by erstwhile Medicaid carriers, with two notable exceptions: Medical Mutual and new kid in town Oscar Health.

Larry's in his late 50's, and has some medical issues that make the Guaranteed Issue/Pre-ex coverage available on ACA plans attractive. He also has some specific doc's that he likes, including some at Cleveland Clinic.

Now, it turns out that The Clinic is in-network for only one carrier here: Oscar. And the question arises, how much is that relationship worth, in actual dollars? I have long wondered this, but until now had no way to quantify it.

Now, I can, and it's breathtaking:

[click to embiggen]

The  plan on the left is from CareSource (one of the aforementioned "Medicaid carriers") and the one on the right is from Oscar. The only substantive difference (other than the fact that the latter actually has higher potential out of pocket exposure) is that Oscar includes the Cleveland Clinic, and CareSource does not.

So, is The Clinic worth $3,600 a year?

404Care.gov: Week One Report

Hunh:

"In week one of the 2020 Open Enrollment period, 177,082 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday. Consequently, week one was only two days long this year - from Friday to Saturday."

This tracks with what we've seen in previous years: a big rush up front, then things taper off, and a last-minute flurry as folks actually pull the trigger the last few days of Open Enrollment.

Of course "selecting" a plan doesn't necessarily mean buying one: just as with eBay and Amazon, people often leave their shopping carts unclaimed. Which we can sort of see in this infographic:

[click to embiggen]

I must admit that I'm puzzled by what, exactly, "Consumers on Applications Submitted" means.

MVNHS© News

Courtesy FoIB Dino R:

"NHS waiting list hits another record high: 4.4million people are now waiting for routine operations as the figure is the worst ever for a third month in a row"

And for those right-brained among us:

 [click to embiggen]

But wait, there's more:

NHS 'abandoning' thousands by rationing hepatitis C drugs https://t.co/e25kltBgiA. @JoeSilverman7

— Jim Schneider (@vaoncsurgeon) November 4, 2019

But hey: Free!

#Medicaid4All

 

Everything Old...

Regular readers may recall this from a few years back:

"Due to the significant changes carriers have made to their compensation schedules (aka commissions), I don’t believe that I can continue to offer the kind of comprehensive service to which I, and you, have become accustomed."

I still do the annual re-certification, and dabble in the individual market as needed (current clients, referrals, that kind of thing).

Recently, Senator Iron Eyes Elizabeth Warren had this observation about folks like me under her #Medicaid4All plan:

Q: Where do those who work in health insurance go when private insurance is eliminated?

Sen. Warren: "No one gets left behind. Some of the people currently working in health insurance will work in other parts of insurance. In life insurance, in auto insurance, in car insurance." pic.twitter.com/KGJ4Eg9VKR

— The Hill (@thehill) November 2, 2019

Hunh.

It's true that home and auto insurance share a common principle:

"Yes, they are both predicated on the principle of "indemnification," but then so are disability and homeowners insurance."

But that's where it ends. For one thing, they are two completely different licenses, and markets, and marketing strategies.

For another, she seems to be forgetting all the support folks at various home offices, not to mention plan administrators and the like. And of course, this also means the end of Medicare Supplement and Advantage plans (why does her party keep throwing seniors under the bus?).

And, of course, there's the matter of how much this whole shebang's going to cost.

But hey: details, shmetails.

[Hat Tip: FoIB Bob G]