Yom Kippur 5781 / 2020

Today, September 27, 2020 is Yom Kippur. Normally Hank would proudly share information about this high holy day. Sadly and regrettably, he is not here so I will attempt to fill his giant shoes.

This shall be a statute forever for you: In the seventh month, on the tenth day of the month, you shall afflict your souls, and do no work at all, whether a native of your own country or a stranger who dwells among you. For on that day the priest shall make atonement for you, to cleanse you, that you may be clean from all your sins before the Lord” (Leviticus 16: 29-30). - Townhall

The linked article appeared in my daily newsfeed and comes from a conservative newsletter. Some may find it odd that a "political" source has religious information but readers may be surprised to find all kinds of topics. 

Below is a partial summary of the article followed by an invitation to read more if you so choose. The author is Myra Kahn Adams, born and raised Jewish in the "Bagel Belt" (her words, not mine). She continues . . .

Decades later, I learned the reason why our neighborhood in the Boston suburb of Needham was overwhelmingly Jewish when Jews were a small minority in the town. My mother said that in the 1950s post-war exodus from the city, Jews looking to reside in Needham were only allowed to buy homes in newly built neighborhoods.

I grew up in the 50's and attended school with two Jewish children who were my age. There may have been more but they were the only two I knew. I have no idea where the temple was but there must have been at least one in Knoxville, Tennessee.

Myra Kahn Adams, born a Jew who later converted to Christianity. Her story about Yom Kippur and the Messianic "connection" continues.

“Yom Kippur is simply known as Yoma, ‘the day’ in rabbinic literature. On that sacred day, two goats were central to Israel’s atonement system. The first was put to death for the sins of the nation while the second was sent into the wilderness, carrying away Israel’s sins. Yeshua [Jesus] fulfills these two roles, dying for our sins and carrying them away. In Him, we are forgiven and free.”

You may want to read the complete article or not. If so the link is here.

L'shanah tovah

#HenryStern #YomKippur #MyraKahnAdams

NFIB v Sebelius

Five people said it was OK for the government to REQUIRE you to buy something you may not have wanted. Most folks found the new plan was NOT AFFORDABLE. They also said what you currently owned was dangerous and MUST be replaced with a new plan designed by the GOVERNMENT.

Those 5 people changed the course of commerce, and in so doing DICTATED what businesses could and could not sell to the public.

Those 5 individuals who exercised their power over 100 million people have names. Chief Justice John Roberts and joined by Justices Ruth Bader Ginsburg, Stephen G. Breyer, Sonia Sotomayor, and Elena Kagan.

How to Compare Medicare Plans

Medicare plan premiums are only PART of the story. If you don't look at out of pocket cost you made a big mistake. No premium or low premium plans are attractive but they are also a TRAP!

Compare Medicare plans. Premiums are PART of the story. If you don't look at out of pocket cost you made a big mistake. No premium or low premium plans are attractive but they are also a TRAP!

Get more Medicare tips here

https://www.youtube.com/c/georgiamedicareplans

More on Our Dear Friend Henry G. (Hank) Stern

In reviewing comments in last weeks "tribute" post to Hank I noticed one with a link. Often "link" comments are suspect as spam, but this one definitely is not.

Following the excerpt you will see a link to Greg Fann's original post. I suggest you read the post, along with the comments. Hank touched the lives of so many people in different ways. It seems impossible there was enough of him to go around, but apparently there was just barely enough.

The Loss of an ACA Voice: A Tribute to Henry Stern

“Your cold, hard facts frighten and confuse me”, he would often respond. I always took those words as an approving “job well done” complement, and presumed they were a recognition of objective truth being transparently communicated in a sea of contrary opinion narratives intended to confuse the masses; just as he liked it. Most of our correspondence was about improving the dynamics in the individual health insurance market. We shared a passion of making insurance markets work and advocating for transparency and optimal options for consumers. We encouraged each other and made each other better. We exchanged a few emails and introduced some business connections, but most of our relationship was over Twitter. We never met or spoke on the phone, but Henry was a friend.

Read more here . . .

https://www.linkedin.com/pulse/loss-aca-voice-tribute-henry-stern-greg-fann/

I leave you with one of Hank's recent FB posts. A good illustration of his sometimes off-the-wall sense of humor.

If you don't get it, use ASL to ask someone to explain it to you.

Medicare Open Enrollment - Understanding the Claim Process

If you are looking at Medicare Advantage plans you really need to consider the way they pay claims.

More Medicare tips on my YouTube channel

https://www.youtube.com/c/georgiamedicareplans

Tribute to Henry G. Stern

Henry G. Stern, Hank, was my friend, mentor and an all around good guy. We have known each other for a dozen years, perhaps longer. Our connection was a consumer forum run by a local (Atlanta) radio personality. We quickly discovered many things in common and some areas where we were opposites.

A Bit of History

My home is in Atlanta, his in Dayton. He is Jewish, I am Christian. Our insurance careers have spanned 35+ years (mine a little longer). Both of us are "students" of the industry and share a strong desire to help others navigate the insurance maze.

He referred to me as a mensch.

I had to look it up. 

That in itself is not unusual. Many of his posts included words known only to a handful of people in the world. I would often chide him for salting his blogposts with 25 cent words, Yiddish and acronyms that would confound a cryptologist. He just laughed.

I failed to appreciate the humor.

In some ways we were the odd couple, but that's OK.

He was Felix Unger to my Oscar Madison.

We only met physically once, perhaps half a dozen years ago, when Hank, Gail and Hannah (or Sara, but I think it was Hannah) traveled through Atlanta on their way back home from Florida. We met on "neutral ground", a restaurant favorite that my wife Rachel and I enjoy.

Good food. Good wine. Good company.

Legacy

InsureBlog was Hank's "baby". He fancied himself as a journo and the blog was his hobby, helping him fulfill a passion for writing.

Hank invited me to join him initially as an occasional contributor and eventually promoted to co-editor.

However the pay remained the same.

Zero.

Going forward, InsureBlog will change but the commitment to providing insurance related information will remain. The focus may shift away from individual and group health insurance and toward Medicare, which is my focus. It just depends on how many of the other contributors choose to stay connected.

Some weeks may only see one or two new posts. Other weeks perhaps more. And a few weeks could be barren.

My wife once asked "Does anyone other than you and Hank read that thing?". I guess we will find out.

The reading audience will decide how long this blog survives.

Hank left us unexpectedly on Thursday, September 3, 2020. He left behind Gail, his wife of 38 years, and two daughters, Hannah and Sara.

Hank adored Gail, Hannah and Sara. What better tribute than to say he loved his family? He will be missed by all.

Life has challenges but God gives us the ability to move forward, even when we stumble.

Hank has slipped the surly bonds of earth, and put out his hand to touch the face of God.

Rest in peace, Hank. Rest in peace. L'chaim.

Accept my apology if my Yiddish was used inappropriately. I learned it from the movies.

A Beneficial Conundrum

Well, actually a Beneficiary poser: Long time life insurance client needs to change/update his beneficiaries, which is normally the most mundane thing we do (other than maybe address changes). But, there a twist: he has four (4!) primaries listed, including a trust for one of his adult children.

Of note: my client named zero (0) contingent beneficiaries. Typically, these are folks "second in line" in case the primary predeceases the insured. Not required, or even typically critical, but kinda comes into play here.

Okay, so far not really a big deal, but then he throws me a curve-ball:

"Question, in the unfortunate event that [spouse] and I should pass away together, would her portion automatically go to [son]? How does that work and how do I make sure there is some sort of waterfall to protect my money and those beneficiaries I have listed?"

Hunh.

So, I had a thought, but really not very certain of its validity. So I reached out to our carrier rep, who also had an opinion, but wasn' very confient oin that, either. ZSo, he bumpled it up to the Vice President of Claims, who (very) helpfully replied:

"The rules vary by state and are usually called the Simultaneous Death Act (or similar).

In Ohio, the statute says this:

Except as provided in section 2105.36 of the Revised Code, an individual who is not established by clear and convincing evidence to have survived an event by one hundred twenty hours is deemed to have predeceased the event for purposes of a provision of a governing instrument that relates to the individual surviving an event, including the death of another individual.

So, what that means is that, if the husband and wife die in the same accident, then it would be assumed that the insured died first, unless there is clear and convincing evidence that the beneficiary survived for 120 hours after the accident.   The contingent beneficiary would receive the proceeds.  If no contingent, then it would go to the policyowner’s estate.

If the spouses die two days apart, then it would still be the same scenario, since the beneficiary did not survive for 120 hours.  If it is six days apart, and we have clear and convincing evidence of such, then the proceeds would go to the Estate of the beneficiary, because they survived the insured by more than 120 hours."

Hunh!

So the bottom line is that, if they're both hit by a bus and die simultabeously, the wife's portion of the policy would be paid into my client's estate. Which is I think what he was trying to ascertain.

Regarldess, I was told that the carrier would even be using this as part of a training module. Cool beans!

Also, #LearnedSomethingNew.

[Hat Tip: FoIB Brian D]

Re-thinking transparency

We first blogged on transparency in health care pricing and consumer-centric health care in 2005:

"One of these tools is the pilot transparency program."

So yes, we've long been advocates of what I called the McDonald's Model:

[click to pic to embiggen]

But FoIB Bob Graboyes of the Mercatus Institute offers a contrarian's take:

HEALTHCARE TRANSPARENCY MANDATES — FIRST, DO NO HARM: Op-ed on a point that Jessie McBirney and made in a recent @mercatus paper: why broad-brush healthcare price transparency mandates can paradoxically REDUCE competition and INCREASE prices. https://t.co/o2X1YoAYoQ

— Robert Graboyes (@Robert_Graboyes) August 31, 2020

Interesting.

Teacher's Pet?

This isn't necessarily huge, but it was kinda heartwarming:

Earlier this week, got a call from a nice lady, referred to me by another client (always a nice warm fuzzy), who had a dilemna:

She had just retired from teaching, and was trying to decide between taking the State Teacher's Retirement (STRS) health insurance plan, which was quite extensive, and quite expensive or opting for a short term plan (she wasn't interested in even discussing an ACA-compliant plan). Better still, she had to decide literally that day, because she had to let the STRS folks know by the following morning.

And yeah, I wondered why she'd let such a potentially financially impactful decision go 'til the last last minute, but I could sense the distress in her voice, so I simply said:

"Look, if you can swing the STRS premium for a month or two, then pull that trigger. Doesn't mean you're married to it, just gives us space to find other alternatives."

I could literally hear the sigh of relief as she took that in. She thanked me profusely, and said she'd be in touch.

I really like my job, and sometimes I really love it.

Spoiled baby food

This in from FoIB Jeff M:

"The [North Carolina insurance] department says an examination of 300 claims from over seven years revealed many violations with Gerber Life’s accidental death and dismemberment policies."

Ooops!

The carrier, primarily known for its "$1 for the first 6 months" juvenile life insurance plans, has been ordered to pay over $3.5 million in fines, recoveries and interest.

Not a good look there, folks.

Interesting HSA query

Recently, one of my clients had occasion to interview a potential new hire, and to explain how their benefits include both an HSA-compliant health insurance plan and that the employer contributed a non-trivial amount into it.

The potential new hire replied that he was a big believer in HSA's, and already had an established one. My client reached out to me to see if that would pose any issues.

I, of course, reached out to our gurus at FlexBank/Navia, who replied:

"As long as he hasn’t fully contributed, the employer can contribute into his already established HSA."

Nice!

Fom the P&C Files: Flo meets Darth

 

Medical Kidnapping. Wait. What?

You may have read about a young teenager named Justina Pelletier, from West Hartford, CT. In 2013 Justina was kidnapped by a hospital where she had been admitted for treatment.   Her kidnapping and other similar incidents have given rise to the term "medical kidnapping".  Medical Kidnapping is a growing phenomenon that bears watching.  

I think there is not a more accurate term for what happened to Justina Pelletier than kidnap.  Justina’s ordeal, and that of her family, is described here and here.  Her story is worth reading.  Fair warning:  The story will upset you, especially if you are a parent or a medical care professional

 

The accounts are comprehensive so I’ll add only the following observations of my own. 

 

 (a)  the core issue in the Pelletier case seems to be a scientific and clinical fight about whether mitochondrial disease is actually a physical ailment or primarily psychological.   This type of issue may be present in other cases where there is overlap between the physical and the psychological. Connection with insurance = Do insurers consider a diagnosis of mitochondrial disease consistently as either medical or psychological? 

 

(b)  It is clear that cases of Medical Kidnapping are on the rise. See here and here and here and here.   You can search for yourself by entering Medical Kidnapping and just start reading 

 

 Connection with insurance = How might insurance for mitochondrial disease change as the incidence of the disease rises?  

(c)  Justina’s parents sued Boston Children’s Hospital charging medical malpractice.  Nearly 7 years after Justina’s 2013 admission to BCH, a jury took fewer than 6 hours find BCH not guilty.

Connection to insurance = How might hospital and professional liability insurance coverage/ limits  be affected as the incidence of this diagnosis continues to rise?  

(d)  I have been unable to find any account of specific reasons behind the jury verdict.  For whatever reasons, the jury believed the hospital not the parents.  But consider.  Boston Children’s Hospital is widely thought to be America’s #1 pediatric hospital.  Its teaching affiliate is Harvard Medical School. BCH is also a primary source of professional expertise in child abuse cases before the Massachusetts Department of Children and Families.  No doubt there are many strong ties among BCH officials and physicians; influential Harvard officials and alumni; and DCF officials regarding medical care, politics and even the courts. Especially in Boston.  The influence of these ties naturally extends over the general public, from which jury members are selected.  One can appreciate how difficult it is for anyone not inside that circle of influence, to prevail when taking action against it.

I suppose a teaching hospital anywhere has similarly widespread influence within its community and can be similarly immunized from scrutiny and full accountability - as appears true regarding BCH and the Justina Pelletier experience.  

 

Connection to insurance = Same as in (c).

 

(e)  Aside from medical and insurance issues, the growing number of medical kidnap cases is a social problem, increasingly encountered in the care of minor children.  The Pelletier case illustrates the kinds of problems encountered.  Here are a few that stand out to me, there must be others:

 

1.  Significant differences of opinion among physicians treating minor children

2.  Scientific disagreement over the nature of some condition(s) affecting minor children

3.  Legislative flaws e.g., do States' children & family services bureaucracies abuse their authority? 

4.  Inadequate consultation among attending physicians

5.  Inconsistencies among insurers over terms of coverage for medical & legal liabilities

6.  HIPAA protections of minor children’s patient privacy can be used to keep parents from knowing what treatment their minor children are receiving.  This can effectively remove parents from participation in decisions involving their own minor children’s care.  

7.  Growing influence of the regulatory state, in which persons accused of regulatory violations are presumed guilty, and have the burden of proving themselves innocent.  This negates the presumption of innocence historically imbedded in our legal system.

Don't Make These Common Medicare Mistakes

You are turning 65. For most of your life your health insurance came from an employer group health plan. The next 20 years or so will be different. Why?

You will be enrolling in MEDICARE.

If you are a year away from your 65th birthday you are already being bombarded with junk mail and robocalls from folks who want to "help" you navigate the Medicare maze.

Be careful! That first step and be a doozy.

All your friends are giving advice. "You need what I have. No premiums. Small copay's. Free annual exam. Dental, vision and even a gym membership."

"Did I mention there is no premium to pay?"

Others will tell you to stick with tried and true original Medicare with the red, white and blue card. You can never go wrong with a plan that has been around over 50 years.

Whatever you do, CHOOSE WISELY. The decision you make could be one you will have to live with for a long time. Not everyone will have an option to change and many can only change plans when Medicare allows you to do so.

Let me offer a few words of advice.

Medicare is not as simple as it looks. There are a lot of moving parts.

Medicare Part D looks like a Rube Goldberg contraption. Just when you think you have figured it out things change. New rules. New preferred pharmacy's. New copay's.

And then there is the mystical Donut Hole. It should be called the Black Hole. The few people that figured it out have never been seen again.

Medicare Annual Open Enrollment

But wait! There is always the annual Open Enrollment. I can take a Mulligan and start over. I don't have to keep the plan I bought. Open Enrollment is like a Get Out of Jail Free card.

Hold on there Skippy. Not so fast. Open Enrollment is by invitation only. Some folks can attend. Some can't.

If you have a Medicare Advantage Plan, come on in. You can window shop for a new plan or keep the one you have. Changing plans is easy. 

Almost.

Just make sure you can keep your doctors and all your medications are covered. If the plan you want is an HMO be especially certain you understand the rules. This isn't Kansas anymore.

If you have a stand alone Part D plan, you are also invited to the annual Open Enrollment. Change plans or keep what you have. Don't forget to compare costs and preferred pharmacy's against your EXISTING plan before taking the leap.

Medicare Supplement Plans Open Enrollment

If you currently have a Medicare supplement plan and want to TRADE IT IN for one of those shiny no premium Advantage plans, you can join the party.

There are NO HEALTH QUESTIONS. Come one, come all. In the past ESRD patients were excluded but that will change in 2021.

But if you LIKE having a Medigap plan, but want to change to a different plan, you will have to get in a different line. Changing supplement plans means proving you are healthy enough to be accepted by a new Medigap carrier. If you are in good health, you can change plans. If not you stay where you are.

Even if you ARE healthy, Open Enrollment is the WORST time to change plans. You can change ANYTIME during the year. Pick any time OTHER THAN October, November or December.

You have Medicare questions, I have answers. Take advantage of my "offer you can't refuse".

You can find Bob Vineyard here on YouTube

#MedicareAnnualOpenEnrollment

Fallout From a Political Pandemic?

In the movie "Something's Got To Give" one of Jack Nicholson's lines is "I have never lied to you. I have always told some version of the truth."

#COVID19, #coronavirus, #WuhanFlu . . . no matter what you call it, the disease is still the same. It is deadly, but how much MORE lethal than earlier influenza strains that originated in Asia?

But how can a disease be political?

The disease isn't political, but the way the INFORMATION about COVID perhaps was politicized.

When did the CCP (Chinese Communist Party) know about the seriousness of the disease and when did they tell WHO (World Health Organization)? How many other organizations in the information chain withheld or minimized details of the illness that would rapidly become a pandemic?

Paraphrasing Sen. Howard Baker, "What did these people know, and when did they know it?".

ER physician Dr. Dan Erickson is quoted. "We decided to keep people at home and isolate them, even though everything we’ve studied about quarantine…[says] you quarantine the sick. When someone has measles you quarantine them. We’ve never…[taken] those without disease and without symptoms and lock[ed] them in [their] homes. So, some of these things [given] what we’ve studied from immunology and microbiology aren’t really meshing with what we know as people of science… - RedState

Readers may say this is new information. Something they have never heard or read before.

What if social media, main stream media and others have FILTERED the news to hide the real truth? This would not be the first time it happened.

Social media is relatively new, but consider this opening line from the Washington Post. Until 1968, Walter Cronkite believed what his government told him about the Vietnam War. He was an old-school journalist, a patriot, a man who came of age covering World War II as a wire-service reporter and then taking over as the anchor of “The CBS Evening News” at the height of the Cold War. Like most journalists of his generation, he embraced the fight against communism and understood why the United States had intervened in the war raging in Vietnam.

The news media and the public have been played before. What if it has happened again?

Dr. Erickson continues. "Was the lockdown successful? I say yes very successful. Successful in things like this. Anxiety hotline calls up 1000 percent. Child abuse both sexual and non up. Financially, emotional distress, Suicide. Alcohol. 150,000 Americans a month not receiving cancer screening. It’s been effective alright, in all the wrong metrics — in all the areas we didn’t want it to be effective. Delay in medical care. We talked about that. Orthopedics, nonessential. Suicide calls up 600 percent. Suicide calls. We heard other doctors mention this. So was the lockdown effective? If that’s the effect you were going for, then yes."

Has the COVID pandemic been mishandled? Is the long term economic and psychological impact of the disease worse than the illness?

Is the "cure" worse than the disease?

What if we have only been told some version of the truth?

Where do we go to get our world back?

Bob Vineyard administers Medicare advice on his YouTube channel

Someday Your Health Will Change

No one PLANS on being sick. If you have been blessed with good health most of your life that is wonderful.

But things can change, often when you least expect it.

Donna (not her true name) has been a client a little over 3 years. She never cared much for insurance carriers or agents. We have never met. I believe she found me on Facebook, or maybe one of my clients gave her my name.

I don't hear from her very much. That's probably a good thing. Clients call for one of two reasons.

Their rates are increasing, or their health has changed.

Donna did not call, but she did send an email. Here is her story, in her own words:

Well life is interesting. I’m only sending this to thank you for pointing me in the correct direction years back.

Within the last 3 weeks I was fine felt like I was having a gall bladder attack and ended up having a laparoscopic hysterectomy.

I’m recovering but absolutely fine.

I went to the best doctors and the top gynecologist oncologist.   I can’t imagine what this would have looked like in a managed care situation.  (My friends) were stunned at the level of care I received as well as the immediacy in this crazy pandemic.

So thank you Bob. You know your Medicare and I’m here in good health because you do !!

Her story continues . . .

(Before enrolling in Medicare) I never had an IV. I never had an operation . Not taking any drug 

So truly I had every reason to get managed care (no premium Medicare Advantage plan). Things change quickly. 

Did I mention from urgent care to surgery was 3 weeks with one of the top doctors in Atlanta. 

Yeah it’s been a whirlwind but great. 

Feel free to use my story for your use. 

People need to take heed and listen to you !!  

Forever grateful 

Her email made my day, and my year.

You can find me on YouTube.

P&C Files Bleg: COVID vs Football

 I'd be very interested if one of our readers has the inside scoop:

If you know a casualty actuary, pass this along. I’d love to hear their thoughts on this perspective. https://t.co/qTUg0KjGQ3

— Greg Fann (@greg_fann) August 12, 2020

Thanks!

Tell us again about "Affordability"

 So this pops up:

ACA Affordability Threshold for 2021 Announced https://t.co/UEO6O9t0EM

— Healthcare Reform (@Health_Reforms) August 11, 2020

The article to which that refers explains:

"In order to avoid triggering a penalty ... an applicable large employer must offer full-time employees health plan coverage that provides minimum value and is affordable."

Of course, the gummint's definition of "large employer" is somewhat .... perplexing:

"... if you employ more than 49 people, you've either got to offer (and help pay for) a group plan or pay a penalty tax."

In this case, the income test - "affordable" - for next year is just shy of 10% of one's income. And keep in mind, that's just counting the premiums, not the thousands (or, commonly, tens of thousands of dollars in potential out-of-pocket costs).

Pretty bizarre definition of "affordable," no?

Monday Linkage

■ First up, interesting product news from Anthem:

"Beginning January 1, 2021, for new and renewing business, your clients will receive affordable access to groundbreaking gene replacement therapies through our new benefit protection program, Anthem Gene Therapy Solutions."

That's the good news. The catch?

"The program will be embedded in Large Group administrative services only (ASO) plans with 51 or more eligible employees (CA & CO 101+) ... New York is excluded from this program
offering."

So if you're a small group anywhere in the US, or any group in New York, no soup for you.

■ Next, another in our seemingly endless series of Business Interruption vs The 'Rona" posts:

"Legal experts Glenn Jacobsen and Mark Binsky examined the Houston Rockets lawsuit and expressed doubt that the suit would be viable or eventually prevail at trial ."

The issue is that the team's games were suspended by the NBA, and thee was no actual physical damage that would net a successful claim.

■ And last (but most assuredly not least), this:

U.S. residents under age 45 spent July shopping for life insurance as if it were a hot new phone, or hand sanitizer. Consumers in that age group filed close to 20% more life applications last month than they did in July 2019, according to MIB Group.https://t.co/zFVFypqgij

— ThinkAdv Life/Health (@TA_LifeHealth) August 10, 2020

Not-So-Intransigent Providers: An Update

The other day we posted about what appeared to be a rather unfortunate problem for one of my clients:

"Dr. [redacted - for now] is in our system under 2 separate Tax ID’s. Only one is actually in our network, and the location the patient's supposed to go to isn't."

So, I reached out to co-blogger (and certified medical office manager) Kelley B, who reached out to the doc's practice manager, who shed a great deal of light on the matter:

"We reached out to the patient to explain that [the doctor] is not in network through our practice.

There was a renal physician who passed away suddenly earlier this year in a different practice. [Our doctor] is also a nephrologist and offered to help them a little while they got their staffing situated.

[Our doctor] is in-network through them for this plan as a nephrologist not an endocrinologist."

Ah-hah!

At about the same time, I got an email from the practice's Accounts Manager, who added that they had long ago decided - as have *many* providers - to forego contracting with ACA-plan networks, and aren't presently interested in reconsidering that decision. And of course she (and the aforementioned practice manager) stressed that since my client would be out-of-network she was on her own (which we already knew).

She also mentioned something that my client and I had discussed: that she'll want to be careful about any lab work that might be ordered, in case that becomes a network issue, too.

One bright spot: the plan is HSA-compliant, and she has socked away a few shekels into it, so she can use some of those to pay for the visit (and, if necessary, lab work). Oh, and I suggested that she ask the practice if there's a discount for paying cash (never hurts to ask).

So, mystery solved, just not a very satisfying answer.

By the way, there are some great comments on that original post, worth going back and reading.

[Special Thanks to co-blogger Kelley B, as well as the folks from the doc's practice]