Weird Insurance Tales #3,726

Over the years, we've posted about some very unique, even weird insurance policies. From love to virginity to moon-watching, I thought we'd pretty much covered it all.

Not so much:

"Ernest Digweed was a retired schoolteacher from Portsmouth. When he died in 1976, he left behind approximately $44,000, with instructions that the money should go to Jesus Christ, if Christ should return to Earth in the next 80 years."

Okay, Henry, that is unique, even weird, but what does it have to do with insurance?

Well:

"Digweed's relatives ... weren't happy at all with the will and sued to get the money. Eventually ... the courts [agreed] to give it to them, but with one condition. The family had to take out an insurance policy that would pay back the money, should the original benefactor (Jesus) make an appearance."

As one might expect, this was indeed a case for that most famous of insurance markets:

"A Lloyd's [of London] broker has arranged coverage through a private insurance firm ... One problem was identification: There had already been two unsuccessful claims."

Just the two?

[Hat Tip: Ace of Spades blog]

Disappointing Customer Service, then some Love(Pop)

I have been a longtime customer of LovePop, very imaginative and well-executed "pop-up" greeting cards. I've bought them for my wife for Mother's Day, and at various times throughout the year for significant holidays. They are (as my much missed sister used to say) "spendy," but I thought they were worth it.

So my most recent experience was disappointing (to say the least), though:

On December 18, I ordered a Chanukah-themed card. For the holidays, the site was offering free shipping which was attractive; unfortunately, it turned out that "free shipping" actually meant "very slow shipping." I waited and waited, and watched the delivery tracker slowly change. And I do mean slowly: it wasn't until the 23rd that I saw any actual movement. It's now the 27th, and the tracker says the card was delivered yesterday.

Unfortunately, even if true, it want to me, and it should haven't have taken over a week (even this time of year).

So I reached out to the LovePop folks to express my displeasure.

To my delight, I received a prompt reply:

"I'm so sorry to hear your card hasn't arrived yet! As you state, the tracking indicates that the card was delivered this morning, December 26th at 9:46 am. Because of how tracking works, occasionally packages are marked as delivered too early.

If you still haven't received the card with the mail tomorrow, please confirm the shipping address for me and I'd be happy to send a replacement Mennorah Lights card, a different card of your choice, or a full refund.

Thanks for reaching out, Henry. I'm so sorry again the card hasn't reached you."

So I re-confirmed my address, and then sat back to see what would happen.

Soon, I received this:

"We've got your order

Thank you for placing your order with us - we know you're going to love it. We'll process your order and send you an update once it's shipped"

Hunh. What's that about?

Ah, another email:

"Thanks for following up! I'm Rebeca​ and I'll be taking over. I read through your previous emails and I'm here to help.

I'm sending out a replacement ASAP through FedEx's expedited 2 business day shipping. Your new order number is #2352355 and you should receive an email update shortly.

I really apologize for the inconvenience because as you mentioned, it shouldn't have to take this long for you to receive your card. We always aim to provide our customers with the best experience possible and I really appreciate your patience."

Now that's how it's done.

Kudos (and Thank You) LovePop! 

404Care.gov Enrollment: Week 6 (Final) Results

Even with the illegal extension, these numbers are abysmal:

[click to embigen]

Called it.

Life Lesson Update

Our recent post on Alcoa's latest life insurance kerfluffle left unanswered an important question. From the comments, posed by co-blogger Bob:

"I would think at least some of the cash settlement would be taxable. But perhaps not."

As promised, I reached out to longtime FoIB Joe Kristan, who kindly replied:

"Without knowing more, I don't see any reason why it wouldn't be taxable. It doesn't seem to fit in the rules for tax-free insurance settlements."

So potential double-whammy for the company's "valued" retirees.

#Fail

Miracles and Blessings

Christmas is a time of miracles and blessings. But so is every other day of the year.

You see, miracles and blessings can happen any time. You just need to learn how to spot them.

Questions That Bother

Regardless of your religious affiliation, most everyone knows the story of the first Christmas. They may not know all the details, and some may have doubts about veracity of the story.

Some may disbelieve the virgin birth. Sadly, even some clerics openly state that followers are not required to accept everything in the Bible as factual.

Molding Religion in Our Image

Even those who have left the church in search of God still cling to many of the tenets of faith while rejecting the parts that make them . . . uncomfortable. It's almost like a child that eagerly comes to the family dinner and picks at their food. They eat the chicken and mashed potatoes but push the peas to the side.

"Seekers" as they are called are not necessarily unbelievers. They just want to create a new religion that allows them to live the way they want . . . without constraints.

Sanitized Christmas

The nativity scene in this post has been circulating on the web and social media for a while now. I don't know who created it, or why they chose to draw the picture this way.

Perhaps it was to create a non-offensive representation of the birth of Jesus. By drawing a picture "without color" neither Jews, nor Arabs nor anyone of color would be offended.

But without Jesus it is just a shelter for animals. Just a simple barn with no real meaning or significance.

Evolving 

The same can be said for those who want to change religion to fit THEIR style. Keep the "good". Discard the "bad".

Life doesn't work that way.

The saying goes, that "Man plans and God laughs".

So true.

No matter how much we plan for our future, life get's in the way.

God, or life, or Mother Nature, or the universe has a way of telling you that life does not always go the way YOU planned.

You can live your life in a God-centered manner.

Or you can live it me-centered.

Your choice.

True Belief

From a personal perspective, this year has taught me that, no matter how much I want to BELIEVE I am in control of my destiny, I am not. Stuff happens. Things that I never expected, or planned for.

Yet there it is. It happened. What comes next can be labeled as a coincidence . . . or a miracle. It is up to the individual to decide which one fits.

God had a way of reminding me that HE is in control. But at the same time, he also showed how miracles can happen right before your eyes. All you have to do is believe.

I DO believe in miracles. But I also know that sometimes I don't recognize them, until long after the event has passed.

Rachel and I faced some difficult times this year, but we also experienced miracles. Too often we missed the miracle until it had passed.

But that is the way life is.

We are so focused on what is happening at that moment that we miss the big picture.

The nativity scene is so focused on being non-offensive, that the true miracle is overlooked. The miracle of a baby that will become a man who forever changed history.

December 25th is a time for celebrating miracles and blessings.

But so are the other days of the year.

Peace and Blessings. Merry Christmas to all!

(Potentially) Exciting HSA News

Keep in mind that this has been proposed, it is far from law.

But it's a start:

"U.S. Sens. Ted Cruz (R-Texas) and Mike Braun (R-Ind.) this week introduced the Personalized Care Act (PCA), legislation to make Americans' health care more portable, accessible, and tailored to meet their unique needs by dramatically expanding Heath Savings Accounts (HSA) - a pre-tax savings tool millions of Americans use to cover the costs of their health care."

Some highlights:

• Expand HSAs to Millions of Americans

This is perhaps the most important feature, since, as we've been proposing for years, it "decouples HSAs from high deductible health insurance plans (HDHP)." In fact it seems to go even further, and, as we've also long endorsed, it includes alternative mechanisms and policies like Sharing Ministries and Short Term Medical plans.

• Allow HSAs to Pay for Direct Primary Care and Other Direct Medical Care Arrangements

This is fantastic: by allowing folks to use HSA funds to pay for DPC, these plans should become even more popular, both with patients and as a model for doc's.

One disappointment is that it doesn't seem to contain any mechanism for re-legalizing true catastrophic plans. Still, it's a great step in the right direction.

Kudos, Senators!

[Hat Tip: FoIB Dr Lee Gross]

A Life Lesson

Well, a life insurance lesson.

I've recently been working on an outreach program to our agency's clients to remind them that we also do life insurance, and to educate them on why that's important. One of the most common responses has been that "I already have life insurance at work." What they mean, of course, is that their employer provides them coverage while they are employed there (although some may, in fact, also have coverage like AFLAC which they do own). That employer-provided plan is called 'group term life' and it almost always terminates when one's employment does.

But Henry, I've worked at XYZ Widgets for years, plan to retire from there, so why should I worry?

Well, friend, here's why (and Thanks to co-blogger Bob for the heads' up):

"Alcoa is terminating life insurance policies for its retirees ... the letter contains a bold-face warning: cash the check and you're waiving all claims for life insurance from Alcoa."

Is this right? Maybe, maybe not, but it's real, and I bet the folks that also bought their own coverage are sleeping a little easier right now.

More to the story?

Bob also sent along this update from a colleague:

"Yes we have an Alcoa plant near us. I had the first walk in with one of those policies in the cancellation paperwork and a check in his hand yesterday.

They can send the check back to Alcoa and fill out a form and have life insurance continue. But the only problem is they don’t tell them how much coverage to have or if they have to make any premium payments in addition to the check. When we called the phone number it was with the letter they acted like we didn’t need to know all the information they could just cash the check and put it in the bank or they could send it in and have some life insurance.

The man I was helping was almost 90 years old and not in great health so I feel very certain the G.I. option on the life insurance is what he needs to go with. But you can’t make decisions like that without knowing how much that check is going to buy.

That check was for $6000. If that gets him $10,000 of paid up coverage then it’s a no-brainer. But if it gets him $7500 of coverage plus he still needs to continue his monthly payment then I probably wouldn’t do it. It was way beyond the scope of what they could help us with getting that information. They said they can have an insurance agent calling within five business days. The man is 90 years old and he was overwhelmed with it and very frustrated. They should have people on those phone lines that can give you the basic information you need or better yet put it in the letter that you sent out to the retirees along with the check."

This is unconscionable. So I reached out to Alcoa, and their Director of Communications, Jim Beck, offered this reply:

"While any action that affects our retirees is difficult, this decision is in alignment with our strategy to improve Alcoa for the long term, including through balance sheet improvements. As a voluntary action, however, we are offering affected retirees cash payments that can be used for any purpose, including finding alternative insurance. If a retiree does not cash the check, that will not change the planned termination of coverage on December 31, 2019. We took similar action with other retirees in 2018.”

Make of that what you will.

What does it mean?

By now, readers have no doubt heard the news that the 5th Circuit Court of Appeals has (also) found the (Evil) Mandate/Tax/Penalty unconstitutional:

"The 5th Circuit U.S. Court of Appeals by a 2-1 vote concluded the original law’s key funding mechanism ... was properly eliminated by Congress and therefore the entire law could not be enforced."

That last is due to a little something called "severability," about which we last wrote a year-and-a-half ago:

"Severability simply means that if one part of a particular law is deemed unenforceable, the rest of it could still be fine. But its absence would mean that if one part is tossed, then the rest is, too."

The key is whether or not the law as written contains a clause explicitly stating that severability does not apply, which clause was glaringly omitted in the ACA itself. This ruling is the latest in the Saga of the 19 (states suing to eliminate ObamaCare altogether).

At issue now is how the Supreme Court (where all of this will eventually end up) will finally rule. I suspect that Chief Justice John "It's Not A Tax" Roberts will side (again) with the Democrat Associate Justices and scuttle this effort, leaving ObamaCare largely in place.

Mutual of Omaha LTCi Underwriting: Behind the Curtain

Over the past few months, we've been featuring videos from the folks at Mutual of Omaha, which in turn feature some of that carrier's senior Long Term Care insurance underwriters. They're an opportunity to peek "under the hood" at how carriers assess and price risk.

In this final installment, MoO's Director of Underwriting, Allen Gregoire, "discusses the effort his LTC underwriting team puts into quick turnarounds, and wonders how the future of insurance underwriting, especially concerning genetic testing and cognitive diagnoses like Alzheimer's and dementia."

We've touched on genetic testing before, and all I can say is that we'd better be aware of just how insidious its inclusion in the underwriting process would be.

Here's Allen:

You have GOT To Be Kidding Me

Because of course, let's just pretend there are no rules (because clearly there aren't: 

"CMS Statement on Health Insurance Exchange Open Enrollment Extension 

In an abundance of caution, to accommodate consumers who attempted to enroll in coverage during the final hours of Open Enrollment but who may have experienced issues, starting at 3:00PM EST today, December 16 we are extending the deadline to sign up for January 1 coverage until 3:00AM EST December 18."

Oh for crying out loud. This has nothing to do with "caution," and everything to do with number padding. Those final ACA sign-up tallies must look truly awful.

#Disgusting

[Hat Tip: Health Agents for America]

Top of the Week Roundup

#1: Golden State heads' up:

Californians Without Health Insurance Will Pay A Penalty — Or Not 🤔https://t.co/iqNtoEsHGy

"Californians must have health insurance starting next year or face a HEFTY tax penalty. But..."#California #Healthcare #Obamacare pic.twitter.com/MNMlW1Gd44

— Steve Downey (@DowneyInsSvc) December 16, 2019

We previously covered this at the beginning of this year, when California "enacted legislation that permanently establishes different enrollment dates within the state, both on and off-exchange."

Hunh.

#2: Across the Pond, the Much Vaunted National Health Service© continues swirling:

"Nearly half of [NHS] cancer patients in Wolverhampton are being kept waiting to start treatment for longer than the recommended two months." https://t.co/2gt5NuzbXC

— AssocAmerPhys&Surg (@AAPSonline) December 15, 2019

As we've long noted, this is a feature, not a bug.

#Medicaid4All

#3: Finally, as we wait for final numbers from Open Enrollment v7.0, this interesting observation from FoIB (and actuary) Greg Fann:

Only 1 of the 3 ACA individual market population groups has had an enrollment increase from 2017-2020, and it did so in the two years that outreach funding declined. We need to concern ourselves with other aspects that drive enrollment results. https://t.co/Vi1plXTIxU

— Greg Fann (@greg_fann) December 3, 2019

Sharing is Caring - Or maybe not

Over the years, we've written pretty extensively about Health Care Sharing Ministries (HCSMs), both their advantages and their flaws.

On the one hand, they are ACA-compliant, which means that they technically check the Mandate/Tax/Penalty-avoidance box. And, they are typically far less expensive than comparable ObamaPlans.

On the other hand, they are underwritten, and they are not insurance, which means that there are few (if any) consumer protections available for folks who enroll (notice that we can't call them "insureds"). They often have religious restrictions, as well, which could be problematic for some.

Back in August, we noted that Washington State insurance regulators were taking a hard line against Aliera's HCSM arrangement:

"The top insurance regulator in Washington state is accusing a high-profile health care cost sharing ministry, and its program manager partner, of trying to avoid state insurance regulation by wrapping ordinary health insurance in a health care sharing ministry wrapper."

Fast forward to now, and co-blogger Bob tips us to this item from the Peach State:

"... health shares marketed by Georgia-based Aliera, the company through which Greer bought his plan, exemplify those risks, with the company under investigation or ordered to stop selling plans by regulators in at least four states."

I can sympathize with Alierra's clients: as anyone who's recently shopped at the 404Care.gov site can attest, plans are increasingly expensive, both in premium and potential out-of-pocket, even with subsidies (tax credits). So it's easy to understand the allure of alternatives like health sharing, while overlooking the very real pitfalls.

I must say, I'm not sure how insurance regulators think they have the authority to ban an explicitly non-insurance product, but maybe that's just me.

#CaveatEmptor

MVNHS© & Medicaid4All: A Study In Health "Care"

As we've long noted, when health care is a "right" bad things happen:

"Quebec’s health minister said Thursday he would sign a ministerial decree to block dentists from withdrawing from the public health system amid a bitter standoff over contract negotiations."

Here, of course, we have the 13th Amendment.

For now.

As we've also long noted, Britain's Much Vaunted National Health System© (which is based on that premise) continues to prove my conclusion true:

One of the worst nights in A&E

It’s not safe

It’s not fair

Not fair on patients

And it’s not fair on staff

Im so angry because this hasn’t ‘just happened’

Result of decisions by politicians, who ignored warnings

They need to take responsibility
Start taking this seriously pic.twitter.com/XCnclzNE9t

— Dr Sonia Adesara (@SoniaAdesara) December 7, 2019

And that, dear readers, is what awaits us with #Medicaid4All.

Google vs Privacy

"I'm the Google whistleblower. The medical data of millions of Americans is at risk - Anonymous"

Hunh?

Well:

"I didn’t decide to blow the whistle on Google’s deal, known internally as the Nightingale Project, glibly. The decision came to me slowly, creeping on me through my day-to-day work as one of about 250 people in Google and Ascension working on the project."

The challenge, of course, is how we define privacy these days. As co-blogger Kelley recently pointed out about this very story:

"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."

And when we use devices, we've given explicit permission about what the folks on the other end may do with it.

From 4 years ago:

"[I]f a person receives a wearable device through their hospital or doctor, the healthcare data that device collects is covered by HIPAA. At least, the data HIPAA defines as protected healthcare information (PHI) is safeguarded."

And we've seen how well that's worked out.

[Hat Tip: FoIB Shari G]

Weird 404Care.gov Tricks

Working with a new (to me) client on an Exchange plan, husband and wife, $28,000 annual income (2020). Very vanilla, no real issues. Plug in their demographics, hit the button, and see that they qualify for a fairly substantial subsidy tax credit. The only 'off' thing is that the income is 100% from hubby (this comes into play in a moment).

So continue on to the quote screen, see that they can buy a $5,250 deductible HSA-compliant plan for about $50/month (total for the two of them, after applying $1,250 subsidy). Nice.

Yesterday, Suzy stopped in to pull the trigger, and we went to sign them up. We carefully went through each screen, and confirmed that we'd entered all the relevant personal info for both of them. But when we got to the "checkout lane," the premium had gone from $50 to almost $80, and - weirder still - it seemed to only list Suzy.

Hmmm.

So, we call the 404Care.gov hotline, and sure enough, they were only showing her as on the plan; keep in mind, we both saw me click the buttons to include hubby. Okay, no big deal, nice guy at the other end got us all hooked up, hubby added and, lo and behold, a miracle:

Instead of $80 for Suzy alone, it was $40 for the two of them.

And yeah, I'm thinking this, too.

Apparently the gummint also works in mysterious ways. How else to explain why it's half the cost to insure both of them?

404Care.gov Enrollment: Week 5 Results

As we head into the home stretch:

[click to embiggen]

Total plan selections are down from last week, which makes sense: at this point it's primarily fence-sitters finally taking the plunge. Ditto on new consumers, down by about 25%.

Will be interesting to see how this week, the final one of Open Season Enrollment '19, shapes up.

Is this the "Next Big Thing?"

Probably not, but still very promising:



Regular readers will be familiar with Dr Rob, one of the pioneers of the Direct Primary Care (DPC) practice model. As the video explains, he's expanded the practice to include family medicine and even an obesity focused doc. As always, we wish Dr Rob the greatest success, and are delighted that he's taken this to the next level.

Oh, you wondered why I said it's probably not "the next big thing?" Well, for starters, lacking availability of true catastrophic health insurance plans (which are illegal under ObamaCare), folks still need to have some kind of insurance coverage for big ticket items, which means double coverage.

For another, DPC proponents decry the lack of choice offered by narrow networks (now the norm), but this seems to me to be the epitome of such.

I do like that they're looking beyond the scope of individual subscriptions ("retail") and seeking to partner with employers. The issue there, of course, is capacity and scalability. Will be fascinating to see this develop.

Sure, sure, but hey: Free! A #Medicaid4All Story

Shot:

Rationing—in the form of waiting lists—has left hundreds or even thousands of Canadians to die without surgeries, the Vancouver Sun reports. #canada #healthcare https://t.co/p5gHucPziZ

— Texas Public Policy Foundation (@TPPF) December 5, 2019

Chaser:

“In the U.S., we already have a single-payer health care system, called the Veterans Administration Hospital system. A 2015 internal audit of the VA reported, ‘307,000 veterans may have died waiting for care.’” @DavidBalatHC @RightOnHC https://t.co/iZ80TcyO16

— Texas Public Policy Foundation (@TPPF) December 5, 2019

Interesting ACA case: Tax Credit Conundrum edition

Sometimes Open Enrollment can be interesting. Case in point: Pastor Jerry.

Pastor Jerry is the newly hired clergyman for a local church, with a nice compensation package made up of three parts: a salary, a housing allowance, and a reimbursement arrangement for medical insurance. The salary and housing allowance are fixed, known costs, while the health insurance budget is "up to $2,000 a month." And therein lies the rub:

Based on his salary/housing allowance, his family qualifies for about $800 in tax credits (aka "subsidy"). Nice, but not the end of the story. The problem is that if his employer reimburses him for the premium and/or out-of-pocket expenses that increases his annual income and screws up the subsidy calculation. It's kind of chasing its own tail. I spent quite a bit of time in separate phone calls with the nice folks at 404Care.gov; the best advice (well, the easiest advice) was to just forgo the subsidy and avoid the whole mess.

There's a lot to be said for this: indeed, the KISS Principle holds much sway. But I really hate to leave (government) money "on the table," and wracked my brain trying to come up with a better way.

Lying in bed the other evening, it hit me: when choosing how much of one's subsidy to use, folks almost always pull the trigger for the full amount (which makes sense: results in lowest premium). But one can, in fact, choose to use $0 upfront, and just claim it the following April. This was a true epiphany: it means there's no real downside, nor is there any possibility of "clawback." Indeed, the worst case scenario is that he gets very little money back, but it's still better than having to cough it up in the following year's taxes.

Pretty nifty.

Oh, we also discussed precisely how to handle that out-of-pocket reimbursement, and decided on an HSA over an HRA. They'll be working with our friends at FlexBank on this.

Exit question:  given the facts above, what potential issue do you see regarding the employer's reimbursement versus the delayed tax credit?

The Importance of Life Insurance: Real Life

Co-blogger Bob V tipped us to this important, all too common story:

"My husband is my caregiver, and spending $45 a month on his life insurance means I won't be alone if he dies."

Rebecca Chamaa was diagnosed with paranoid schizophrenia, and relies on her husband as her primary caregiver and advocate. If he were to die, she would need to be able to afford a full-time nurse (or equivalent), which can get pretty spendy. Hence, the importance of life insurance:

"Like many people, my husband had a small life insurance policy at work, but that policy wouldn't cover our mortgage or provide enough cash for me to stay in our home, pay for funeral expenses, and arrange for someone to help me with household tasks, or at a minimum some caregiving activities."

Very moving, very timely.

Waiting on the MVNHS©

And we do mean waiting:

[click to embiggen]

Thanks to our friends at the Association of American Physicians and Hospitals, we learn that north of four-and-a-half million Brits are on waiting lists. For those keeping score, that totals out to almost "7 percent of the entire British population."

Talk about a 7 percent solution...

And it's not just in hospitals:

Girl, 12, dies after waiting for an hour for an ambulance@JoeSilverman7 https://t.co/FfH2fUTkGx @MailOnline

— Christopher Gaska (@ChristopherTodd) November 23, 2019

#Medicaid4All

404Care.gov Enrollment: Week 4 Results

According to email from the Feds, "in week four of the 2020 Open Enrollment period, 703,556 people selected plans using the HealthCare.gov platform."

Of course, this just means that folks have added plans to their carts, the real numbers will be when (if?) they actually pull the trigger and send in a check.

In any case, here's last week's snapshot:

[click to embiggen]

Total plan selections are down about 7% from Week 2 (we missed last week dues to Thanksgiving travel). New consumers are down, as well, as are renewals.

This makes sense, however: we're already a month into the process, and (presumably) most of the folks who are going to make a choice have already done so. I do expect a slight uptick the final week as procrastinators make their choice.

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.