Helpful Thanksgiving ICD-10 Codes

As co-blogger Kelley last mentioned a couple of months ago, the "new and improved" ICD-10 codes are on the way (maybe). And just in time, too; the folks at Health Data Management have helpfully compiled a list of handy dandy ICD-10 codes specifically geared for Thanksgiving:

"Ah, the turkey is roasting and the potatoes are boiling. And Cousin Carl just chopped the end of his finger off while preparing the veggie tray."

Click through for the whole list.

And Happy Thanksgiving to you and yours!

[Hat Tip: FoIB Dr Rob]

"I forgot"

It's hard to beat this Steve Martin excuse:

"You.. can be a millionaire.. and never pay taxes! You can be a millionaire.. and never pay taxes! You say.. "Steve.. how can I be a millionaire.. and never pay taxes?" First.. get a million dollars. Now.. you say, "Steve.. what do I say to the tax man when he comes to my door and says, 'You.. have never paid taxes'?" Two simple words. Two simple words in the English language: "I forgot!"

Funny, but what does this have to do with insurance?

Glad you asked.

The folks at LifeHealthPro have complied a list of the 5 best excuses one might use to duck the (Evil) Individual Mandate. Here's a sampling:

"I don't earn enough to even file a return."

"Missed it [the cut-off date] by that much!"

And this gem:

"I get my care from Drs Tonto and Geronimo."

Jake must be jealous.

Cavalcade of Risk #222: Gratefully risky

Van Mayhall hosts the pre-Thanksgiving round-up of risk-related posts. As usual,Van does a terrific job of tying together seemingly unrelated items, providing a fantastic narrative.

Thanks, Van!

Hunh: CCC's no more

Had a "d'oh!" moment when I received this in email:

"[G]eneration of HIPAA Certificates of Creditable Coverage (CoCC) upon member termination will no longer be necessary because the pre-existing condition limitations are fully eliminated in 2015."

Since 1997, group plans have had to issue Certificates of Creditable Coverage when a covered employee (and/or dependent) dropped off. They were essentially "hall passes" to the next group plan, so that one wasn't subject to pre-existing condition limitations.

[ed: Contrary to popular belief, they were of no avail when moving from group to individual plans - but were applicable when moving from individual to group. Clear as mud, no?]

These cert's have been part of the landscape for so long now that it just didn't occur to me that, once the ObamaTax is in full swing, they're no longer necessary.

Think I'll miss the little buggers.

Missing the Mark, MVNHS©-style

Last month, we questioned whether the Much Vaunted National Health System© was worth saving (assuming it could be, of course). Thanks to co-blogger Bob, we have more evidence supporting the "No" position:

"The NHS in England has repeatedly missed a key target for rapidly treating cancer patients ... Cancer charities said thousands of patients were being failed."

Of course, that pre-supposes that the actual goal was saving lives, not pounds sterling.

So how does that translate into real-world, real-people numbers?

Well:

"[O]f the 33,404 people who started cancer treatment between July and September, more than 5,500 were not treated within the 62 day target."

Depending on the3 type and stage of the cancer, that two months can very easily mean the difference between life and death, lumpectomy or double mastectomy. And it's not getting any better for our Cousins Across the Pond:

"These breaches have become a trend and they are worsening, which is why urgent action must be taken to support the NHS" according to Sarah Woolnough, from Cancer Research UK.

It's also worth noting that the shortage of radiologists, which has exacerbated the problem:

"Patients are waiting too long for imaging test results."

Coming soon to an ObamaPlan near you.

Blast from the Past

I first became a fan of Medical Savings Accounts (since evolved to Health Savings Accounts) way back in 1992, when they were first introduced by Golden Rule Insurance. GR's president at the time, Pat Rooney (whose family, if I recall correctly, founded the company), eventually left to found another carrier, Medical Savings Insurance Company (MSIC), which marketed MSA's exclusively.

In 2008, MSIC went into receivership to protect its over 6,000 policyholders. Having fallen on hard times, the company faced substantial financial hurdles. On the bright side (and in a bit of irony), policyholders were transferred to Golden Rule.

Reason I bring this up is that I had written a couple cases with MSIC back in the day, and over the weekend I received a "Notice of Hearing" for final liquidation of the firm's assets.

Or not:

"[T]he Liquidator reports that all assets and/or property ... have now been recovered ... does not have sufficent assets ... no MSIC assets are available for payment."

Shorter: if you think MSIC owed you anything, don't count on it.

The better, more positive lesson for me, though, is that this doesn't affect policyholders: the system worked, and they weren't left holding the bag.

Well, at least not by the Indiana Department of Insurance.

Chicken Soup for the Health Care Policy

We've long documented the utter failure of nationalized "health care" schemes to rein in costs any more efficiently than our previous, market-based system. From Jolly Old to The Great White, failure is, in fact, an option.

And so it goes in the Holy Land, as well:

"The cost per household for supplementary health insurance from one’s public health fund and for commercial (private) health insurance increased significantly – by 8.5 percent – in 2013, compared to only 4% in 2012."

Catch that? Even (especially?) in nationalized systems, "supplemental" coverage is de rigueur . And what does that portend for the Israeli (to name just one) system?

Well:

"This is a likely sign that public insurance coverage is not regarded by citizens as enough and that accessibility to care from the public health funds and hospitals is declining."

No kidding.

[Hat Tip: FoIB Holly R]

MVP Struggling - Part 2

A few days ago, we broached the subject of Minimum Value Plans, and their potential role in mitigating group health insurance costs. In that post, co-blogger Nate shared with us a TPA's view of how this might play out.

At the time this whole concept hit my radar, I was invited to interview a benefits attorney with expertise in this area for another perspective. Kurt Anderson has specialized in employee benefit, and especially ERISA, plans for the past quarter century, and is co-author of a book on health care reform.

Kurt, like myself, believes that insurance should really focus more on risk-based, catastrophic events (such as illnesses or injuries) and less on predictable, routine items (such as preventive care, vaccines, etc). In fact, he offered this absolutely terrific take on the problem with mandated benefits and the ACA:

"If you can budget for it, you shouldn't have to purchase insurance for it."

This comports precisely with our own comparison of auto insurance paying for oil changes.

This led us to a discussion of how the employer mandate/tax will be enforced. To understand the current controversy, it's necessary to understand the stakes:

An employer (of specified size) that offers no group health plan is subject to a $2,080/employee fine tax penalty, period. This is called the "strong" penalty because it counts all employees.

If that same employer offers a group health plan, but that plan is either "unaffordable" or lacks "minimum value" the penalty is $3,120 per employee, but applies only to the number of full-time employees that opt out of the group plan and buy subsidized plans on the Exchange instead (and rotsa ruck with that). This is known as the "weak" penalty. What's interesting is that an employer that offers a "minimum value" plan that costs less than 9.5% of take-home pay ducks this penalty.

And that's the crux of the proposed IRS ruling: as Kurt explains it, employers want to save money while (legally) avoiding taxes, but still provide basic coverage. The problem is that, if the employer's affordable plan offers "minimum value" but that plan is so skinny that it doesn't provide coverage for hospitalization and other costs that folks need "real" insurance for, then the employee is screwed – he isn't eligible for a subsidy if he chooses to reject the skinny plan and get "real" insurance from the Exchange. By regulating that a "free oil changes only" plan can't satisfy minimum value, the IRS "fix" means that more employees would be subsidy-eligible. And from the employer perspective, it's still (likely) cheaper to pay the penalty for those employees who get subsidies than to provide and pay for more comprehensive coverage.   Win-win.

A big IB Thank You to Kurt Anderson for his time and expertise, and Joan Heider for putting us together.

Cavalcade of Risk #222: Call for submissions

Van Mayhall hosts next week's edition. Entries are due by Monday (the 24th).

To submit your risk-related post, just click here to email it.

You'll need to provide:

■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like). And please only submit if you are willing to link back to the carnival if your submission is accepted.

Close enough for gummint work

So it seems that, as we'd already surmised, the reports of how many people actually bought ObamaPlans were, well, less than truthy:

"A report by Bloomberg’s Alex Wayne revealed that the administration quietly lumped as many as 400,000 dental plans into the total enrollment number without telling anyone."

So almost a half million "false positives." Par for the course, no?

Unintentional Medical Tourism

Before we begin, it's important to note that there's a LOT of information missing here. Of course, that hasn't stopped folks from piling on. As best we can tell, these are the bare facts:

A 6-months pregnant Canadian woman took a personal trip to Hawaii. While there, she gave birth to a daughter, who ended up in the Neonatal ICU for several months, racking up $1 million in medical bills. Her national health insurance plan paid $20,000, and (for some undisclosed reason) the US paid an additional $12,000.

The controversy arises due to the fact that, prior to departure, she had apparently purchased a travel plan from a Canadian Blue Cross affiliate, and they have denied the claim. According to Ms Huculak, they are citing pre-existing conditions as the basis for their denial.

[ed: In case you're wondering, one of the worst kept secrets about the Canadian national health care scheme is that folks "in the know" purchase private coverage to supplement it]

And here's where it gets, well, interesting. For example, Ms (Mrs?) H claims that her doctor had given her a "green light" to take the trip, despite the fact that, only two months previously, she'd had a bladder infection and hemorrhaged. She says that her "doctor saw no reason for me not to go." Which is nice, but entirely irrelevant. Perhaps she could turn the delinquent bills over to him for payment.

She also says that "her doctor sent a letter to Blue Cross confirming that Huculak’s pregnancy was stable when she went on vacation, but the claim was still denied." Again, without more detail as to why the claim was denied, we can only speculate. Regardless, an insurance company has no obligation to give any weight or credence to anything a doctor not in their employ has to say.

I reached out to the folks at Saskatchewan Blue Cross to see if they could shed some light on some of these issues, and will have an update when (if?) I hear from them. The Canadian Blue Cross is not affiliated with the one here in the states, and has a different product line, including travel medical plans.

So, since traditional media continues to do such a shoddy job of basic research, I went to the SBC site and took a look at the policy details, and specifically the exclusions. And lo and behold, we find this at the #3 spot:

Any expenses related to a medical condition (whether or not the condition has been diagnosed or the diagnosis has changed) for which any symptoms occurred during the six (6) months prior to the Effective Date for Covered Persons:

• consulted a physician
• was hospitalized

Well, she'd obviously consulted a physician, and it's entirely likely that she'd been hospitalized for the hemorrhaging. The fact that she had failed to read the policy (and note its exclusions) is on her.

Oh, the most profound lesson here: turns out nationalized health care doesn't work. Who'da thunk it?

Health Wonk Review: Gobble, gobble edition

David Harlow presents a veritable brain-feast, replete with interesting, thought-provoking posts and mouth-watering illustrations.

Enjoy!

Movember: Men's Health Alert

A few weeks ago, we highlighted October as Breast Cancer Awareness Month, and raised $800 towards research to fight this terrible illness. This month, we turn our attention to the Y-chromosome side:



(And watch through to the end for more info on how to help)

PresBo lied, Healthcare Died

The right-wingers at CNN have released a video showing - conclusively - that the goal of the ACA ObamaTax was always to destroy the previous system and increase taxes:

[Hat Tip: Ace of Spades]

Web (in)Security

Yesterday,  I received the following from CoveredCA: 

New!  iPad Online Application:  Replace "HTTPS" with "HTTP" in URL Address

If you are using your iPad for enrollment and already have an URL saved to get to the open enrollment online application, you will need to update the URL Hyper Text Transfer Protocol Secure (HTTPS) address by removing the “S” from the “HTTPS” in the URL address so you can access the open enrollment online application. 

Seriously?   HTTPS is the secure protocol for transmitting information over the internet. HTTP is open text that's readable by anybody who intercepts the transmission.  Nobody should EVER use HTTP for any kind of sensitive work...even Facebook uses HTTPS:

GruberGate in 2 1/2 Minutes

[Hat Tip: Ace of Spades]

Stupid Carrier Tricks: Timing is Everything edition

A few weeks ago, I mentioned that Anthem had sent out a batch of December 1 individual medical plan renewals for these "grandmothered" plans. Yesterday, I received a similar batch of January 1 renewals for some Medical Mutual clients.

Keep in mind that I received these on November 17th:

And when were they actually mailed?

[ed: date highlighting added]

Great timing there, MMO.

Sheesh.

GruberGate: The Musical

[Hat Tip: PowerLine Blog]

MVP Struggling - Part 1

Minimum Value (aka MVP) Plans have been touted for groups over 100 (this year, and 50 next year) wishing to meet the letter of the ObamaTax law and yet minimize their costs. The Government published an online calculator where employers could enter their plan benefits and determine whether it met the minimum value test themselves, and avoid the cost of hiring an actuary. As we blogged a few months ago, the calculator included a "glitch" which allowed employers to exclude in-hospital services (and some other high cost benefits) and still pass the 60% threshold, and therefore some of the penalties taxes.

That's now changed. The IRS and HHS have now warned plans that they will fix the calculator, and the definition:

"[C]ertain group health plan benefit designs that do not provide coverage for in-patient hospitalization services are being promoted to employers. A plan that fails to provide substantial coverage for these services would fail to offer fundamental benefits ... plans that fail to provide substantial coverage for in-patient hospitalization services or for physician services ... do not provide the minimum value intended by the minimum value requirement."

Shorter: no, MVP's with no hospital coverage don't make the cut. Interestingly, so-called "skinny" plans with hospital and other Minimum Essential Coverage are still okay.

[ed: I'll refrain here from opining as to whether or not it's really the place of unelected, unaccountable bureauweenies to make these determinations]

So, what to do? A whole cottage industry has sprung up touting these plans as an affordable alternative to full-blown (and expensive) group plans, and at some point in the (presumably near) future, new rules will be put in place to cut them off. What then?

One option, of course, would be to just stop offering group coverage altogether, and just pay the tax penalty fine (which is likely to be a LOT less than any premiums). Another would be to offer a slightly "less skinny" plan that does cover in-hospital charges in a way that satisfies Our Betters in DC©.

The folks at OptiMed Health claim that their plan offers "independent actuarial certification and statement of compliance." Which is nice, and perhaps a viable alternative for employers who want to avoid both the penalty and bankruptcy.

My co-blogger Nate Ogden has another, intriguing, thought: why not offer a good plan, with around a 55% Actuarial Value, that covers the majority of people’s healthcare expenses. It would exclude hospital inpatient, therapy, and prolonged treatment. But it would cover, at a low cost, the majority of people’s needs for the year. This way most healthy people can get on a low cost plan and the employer won’t pay any penalties for them. Sick people in a group would still be subsidy eligible, so they could buy a more comprehensive plan on the Exchange, and their net cost is reduced by a subsidy. This appeases the government officials who concern with MVP minus hospital was they precluded individuals that needed coverage from getting a subsidy

The purpose is to satisfy the "80/20 Conundrum:" insure the 80% of the group that only accounts for 20% of the cost, then pay the $3,000 penalty on the 20% of the group that accounts for 80% of the costs.

Of course, you'd want to work closely with your agent and/or TPA to make sure all the i's are crossed and the t's dotted.

In part 2, we'll hear from a Benefits Attorney with another take on this development.

Winner, Winner Chicken Dinner!

So a colleague recently clued me in to a way that the free market is responding to the new reality of an Obamacare-dominated health insurance market. The good news is that the concept seems to be perfectly legit, serving the interests of both the client and the agent (and his carrier). The bad news is that the plan is only available in a dozen states so far, although it has been filed and is pending approval in almost all states (although it's available only from agents of one carrier).

Still, it's a fascinating glimpse into how one can "reverse engineer" a desired outcome. I'll let Dave take it from here:

"You're going to like this, it's damn brilliant. Basically we're offering a limited benefit product that's very cheap compared to Obamacare. Assuming that no major illnesses or injuries come up, it'll pay almost all of one's medical costs with no deductible. The capper, though, is that the plan has a rider that allows the insured, at their discretion (and with with no additional underwriting) to convert it to a major medical plan with a $3,000 deductible and 100% coverage after that.

That major medical plan runs until the insured's next open enrollment period. So, cheap insurance for as long as you need it, the option to switch to a major medical plan even AFTER you get ill (but not requiring you to pay for it until you need it), and a guaranteed transition to O'Care (which, being guaranteed issue, is the appropriate place for high risk individuals). I'm going to sell a boatload of this product, and best of all, nobody loses."

Indeed. The only real drawback I see would be the potential for the individual mandate tax penalty fine. On the other hand, I'm told that it's priced to have a lower premium than a "metal plan," even with the tax penalty

Now here's where it gets, well, weird: almost six years ago, the (now defunct) American Community insurance company rolled out a very similar plan:

"Called "Community Flex," it starts out as an accident policy (major claims are only paid for injury, not illness), with some coverage for doc visits, preventive care, and a drug discount card ... if you want more coverage, such is available through a "Gold Plan" buy-up. This gets you coverage for more doctor's visits, more preventive care, and better prescription drug coverage."

So, not exactly the same, but similar concept. Currently, my colleague's company is the only one (of which I'm aware) that has developed this new-fangled ObamaPlan alternative.

Be nice if there were others (hint, hint).