40 years and Pfft! The HealthSpan Story

"We’ve been helping Ohio families be healthier for more than 40 years"

That's the claim of small-time health insurer HealthSpan (located in scenic Cleveland, Ohio). The carrier offers (well, offered, bear with me) Medicare supplements, and individual and group health insurance plans.

That is, until it ran into the ObamaTax buzzsaw.

From email a few minutes ago:
 

After carefully assessing its Small Group business and its volatility, it is adjusting broker commissions for its 2016 Small Group Plan policies on and off the exchange.

• New Small Group business:
• No Broker commissions will be paid effective February 1, 2016.

• Existing Small Group business:
• No Broker Commissions will be paid after the contract renewal date. This is effective starting February 1, 2016.
• No Renewal Plan Options will be made available for renewing small groups. There will be no options or changes allowed for renewal, only the existing plan will be presented.

To be fair, they did give agents who represent them the requisite 30 days notice, which is nice.

Some questions arise, of course:

■ Since it will no longer be paying commissions, will HealthSpan now refund the portion of its clients' premiums that represent that cost?

■ How are agents already on the hook (ie with HealthSpan clients) supposed to be paid for their service work? Or are they required to provide this for free?

■ How long will HealthSpan survive?

Inquiring minds want to know.

[Hat Tip: Cornerstone]

Another CO-OP foundering

As the list of failing CO-OPs continues to grow, it's beginning to seem like the model may, in fact, be fatally flawed. When the only such example to actually turn a profit make money* starts faltering, well then perhaps it's time to re-think the whole concept:

"Maine's Community Health Options lost more than $17 million in the first nine months of this year, after making $10.9 million in the same period last year."

There's now less than a dozen of these organizations left, just under half of the total number of them started.

On the other hand, how many new carriers of any model actually break even (let alone make a profit) in their first years of operation?

So, will they still be standing this time next year? Uber-wonk Bob Laszewski is skeptical, and he's got a pretty good track record on these kinds of things. I've actually been pretty impressed with the local one (InHealth): strong network, good plan designs, decent rates.

Time will tell, of course.

*These are, after all, non-profits, so....

Some additional thoughts on the ObamaTax

Yesterday, we discussed the utter futility of the penalty/tax/fine/pumpkin as an inducement for folks to buy over-priced ObamaPlans vice paying a basically nominal amount for failure to "comply."

It occurs to me, though, that there's an inherent flaw in how the ObamaTax is actually calculated and applied:

One's premium and subsidy (if applicable) are based in part of where one lives (zip code, county), but the penalty is simply a flat percentage of income regardless of one's location. This seems completely capricious and unjust: that percentage of income is going to have a much bigger effect on folks in certain areas where the cost of living is higher.

So how come no one's taken up this battle (yet)?

Mysterious Carrier Tricks: UHC edition

What the heck?

From email just now:

"As of the end of today,12/10/15,  the option to quote Bronze plans will no longer be available on E-Store!

Please go on to E-Store and print off any saved quotes you have as they will no longer appear as of the end of today."

But never fear:

"You can still earn commissions selling Off Exchange"

In this market (Southwest Ohio) there are no non-Bronze level plans available on- or off-Exchange.

What game are they playing here?

[Hat Tip: Cornerstone]

Still sexist after all these years

So, Ms Burntwell and her minions have released the new guidelines on first-dollar preventive care services. These include:

■ Lactation services, including breastfeeding devices and counseling
■ Enhanced breast cancer detection coverage, including genetic screening (for women only)
■ Anorexia (overwhelmingly female)

Notice anything (still) missing?

Here's a clue.

On the plus side, one of the major "glitches" in colonoscopy coverage has been resolved:

"After colonoscopy is performed as a screening procedure based on USPSTF recommendation, the plan or issuer must cover any pathology exam on a polyp biopsy without cost-sharing."

That's nice.

[Hat Tip: United Healthcare]

Much ado about the ObamaTax

FoIB Jeff M alerts us to this terrifying news:

"[H]ouseholds that opt to go without health insurance in 2016 are set to get hit with an average Obamacare fine of $969."

Oy vey!

That's almost $81 per month; better hurry up and lock down some of that sweet, affordable health insurance right away.

But it gets worse (for certain values of "worse") for families that don't qualify for free money premium subsidies:

"Households without insurance that earn too much to qualify for financial aid to buy Obamacare plans will pay an even larger fine for 2016 — an average of $1,450"

My goodness, that's almost $121 per month!

Or, as any rational person would put it: 1/10th of a typical family's insurance premium (with a very high deductible, at that).

Yeah, no.

Aggregate vs Embedded: Interesting "Glitch"

So the other day I was quoting a case for a family (HSA plan, natch), and ran across this rather interesting puzzler:

[click to embiggen]

It appears that the plan with the lower deductible (and thus total out-of-pocket) is substantially less expensive than the one with more family finances at-risk. In all other respects that I could see they were identical: deductible then 100%. So I reached out to the folks at InHealth for clarification.

Regular readers may recall that ACA-compliant health insurance plans are no longer allowed to use aggregate deductibles, but must now use embedded ones only. What I learned from our IH rep is that there's a rather obscure, but notable, exception. When IH (re-)filed its rates for 2016, it mistakenly included a plan with an aggregate deductible. I thought for sure that this was a no-no, but as JR explained to me, they're allowed to do that if an individual's actual out-of-pocket is no more than $6,850 for the year.

So in our example, let's assume that the Smith's choose the lower priced plan with a $3,750 deductible. In this case, the aggregate deductible means that the family checkbook would need to spend $7,500 before the 100% coverage kicks in (obviously this excludes mandated first-dollar items). But if Little Joey actually accrues $6,850, then he's good to go at the 100% from that point on (the rest of the family still has a few hundred to go).

I would presume that this plan will go away for the 2017 plan year, but interesting nonetheless. And hey, learned something new!

UHC Doubles Down on Comp

We noted a few weeks ago that the rocket surgeons at United Healthcare were dramatically reducing agent compensation for on-Exchange business. This of course has the direct and immediate effect of substantially reducing the carrier's risk from that demographic.

Apparently, though, the reduction wasn't drastic enough. From email this morning:

"Effective January 1, 2016, no commissions will be paid for any new UnitedHealthcare Individual On-Exchange ... enrollments received on or after this date, in most states."

This means applications enrollments proffered as of January 1 will generate zero agent comp. In fairness, at least they're giving us a heads' up on this, although one would expect exactly zero backlash from the agent community regardless (long story).

As I mentioned before, this is entirely their call to make, although one might expect to see other carriers begin to follow suit. Interesting times.

[Hat Tip: Cornerstone]

Frustrating Carrier Trick, Resolved

Last year, we signed Suzy up for a Silver plan from Humana; she also chose to add the dental rider. This year, despite that well-known promise ("If you like your plan..."), she received the dreaded "Your plan has been discontinued" letter from them. In and of itself, this wasn't really a huge deal: she was disappointed, of course, and quite interested in keeping at least the dental plan with them. We determined that she could, and went shopping.

Ultimately, we ended up staying with Humana (albeit under a slightly different plan), including the dental.

All seemed good.

Unfortunately, things did not go as seamlessly as we'd hoped (and been promised): Humana levied a $35 (re-)activation fee on the dental, then double billed the actual premium in November.

Suzy tried calling, spending over an hour on the phone, to no avail. That's when I stepped in.

I also spent almost two (ultimately unproductive) hours on the phone with Humana, including being shunted to multiple people (all with different, often contradictory, answers) and being hung up on (twice). Eventually, I threw in that towel and reached out to their media relations folks to let them know I'd be sharing the gory details with our readers.

To their credit, they responded promptly, and efficiently. I was contacted by Natalie, who's in a special problem resolution area, who asked me how she could help. I explained the circumstances, and my three goals:

1 - Refund of the $35 fee
2 - Accounting for the second premium withdrawal
3 - That they review and correct the various service issues I'd experienced (so that the next poor shlub who called wouldn't have such a hard time).

Natalie proved to be very helpful, and noted that this was actually a good learning experience for their customer service folks. Within a day we had Humana's agreement to refund the errant $35 application fee, as well as the extra month's premium.

I understand that MLR has greatly exacerbated the already difficult challenges of hiring (and keeping) adequate service staff, but my (and Suzy's) experience was unacceptable under any circumstances. So I'm pleased that Humana has resolved this quickly and fairly, and really appreciate Natalie's persistence and help.

[Special IB Thanks to Humana's Natalie K and Jeff B]

Health Wonk Review Parade is up

Peggy Salvatore hosts this week's Parade of (Wonky) Posts, covering everything from healthcare service guarantees to fun with diabetes (commercials), even a proposed Patient Bill of Rights.

Just a terrific job - kudos, Peggy!

Promising Life Insurance/HIV news

Generally speaking, it's very difficult to find life insurance coverage for folks with fatal illnesses. It can be done, but at great expense and with substantial restrictions. Now, the folks at Prudential Life have partnered with ÆQUALIS to offer coverage to folks stricken with HIV.

There are, of course, certain underwriting requirements to be met, and they're currently offering only term plans. Still, this represents a potentially big step forward for folks living with HIV; previously, their choices were limited to restrictive guaranteed-issue plans or viaticals.

Kudos to Pruco and ÆQUALIS.

Blue Grass Bevin HIX Blues

Some Obamatax supporters have their knickers in a twist over KY Governor-elect Matt Bevin's plans to shutter his state's ill-conceived and potentially illegally founded health insurance exchange, called (oh so cleverly) Kynect:

"Bevin's plan to end Kynect has brought a strong rebuke from Obamacare advocates and outgoing Kentucky Gov. Steve Beshear"

In fairness, Ben Miller (author of the piece linked above) points out that it's really not clear that one form of Exchange is superior to the other. That is, the jury's still out on whether it's in a given citizen's (or state's) interest whether that state has its own portal or just piggybacks onto the 404Care.gov site.

Talk about damning with faint praise.

Meantime, as FoIB David Adams, proprietor of the Kentucky Progress blog, points out, the whole Kynect effort was actually never anything more than a massive overreach by (shortly former) Governor Bashear:

"Governor Steve Beshear "created" the Kentucky Health Benefit Exchange, Kynect, with an executive order in 2012 and then after the legislature declined to ratify his order as required by law, he tried again in 2013, 2014 and 2015."

So, our first 'rump Exchange.' And one that cost over a quarter of a billion dollars to implement, to boot.

Sounds like it's about time to to dis-Kynect the Blue Grass Exchange.

(Male) Cancer Wars

A year-and-a-half ago, we noted the shameful discrepancy in the kinds of "first dollar" care offered women (and children) versus us Y-chromosome types:

"All ACA-compliant plans must include a laundry list of Essential Health Benefits, including very specific preventive care coverage ... there is no corresponding requirement to cover, say, prostate exams or even STD screening for [menfolk]."

[ed: "first-dollar" coverage means not subject to deductibles or co-pays; ie "freebies"]

And it looks like the unstated goal of that omission is bearing fruit:

"The administration wants to penalize doctors who routinely order the PSA blood test."

So it's not enough just to make it expensive, we must go even farther, by punishing those recalcitrant doc's - who show no compunction about amputating feet willy-nilly - who care enough about their male patients to order a simple test that could very likely save their life (one sees no corresponding threat against mammography).

#MaleLivesMatter

[Hat Tip: Co-Blogger Mike F]

What Comes Down Must Go Up?

Readers may recall the September Daraprim kerfluffle, regarding the preferred treatment of the potentially deadly (but rare) "parasitic infection called toxoplasmosis." Briefly, Turing had purchased the rights to the medication used to fight the infection, and then boosted its price from about $13 to $750. The company eventually promised to back off the spike.

But that was then (two months ago) and this is now:

"Turing Pharmaceuticals is reneging on its pledge to cut the $750-per-pill price.Instead, the small biotech company is reducing what it charges hospitals, by up to 50 percent, for its parasitic infection treatment"

Which is great news (well, for certain values of "great:" after all, it does represent a pretty hefty increase over its pre-Turing cost) for hospitalized patients, but what about those playing along at home?

The bad news is that the $750-a-copy price will apparently stand.

The good news is that Imprimis Pharmaceuticals, a competitor, is making available a low-cost alternative.

How low-cost?

This low-cost:
 

The only real challenge right now is getting insurers to cover it. My take is that, at $1 a pop, that really shouldn't be a major issue.

Peggy & Your Private Health Data

We've been writing about who really has access to your personal health info for a very long time:

"In a time zone 17 hours ahead, a radiologist in Australia, working for a company called NightHawk Radiology Services, had been sitting before the same images ... Once your medical information travels to Australia, India or wherever you basically lose your HIPAA rights."

That's from 2006, and things haven't improved. As we noted last month, even something as innocuous as your Fitbit is fair game for data hunters. Fortunately, the folks behind that product have voluntarily agreed to comply with (some?) HIPAA privacy regs.

On the other hand, the bigger picture is much less sunny:

"At-home paternity tests fall outside the law's purview. For that matter, so do wearables ... that measure steps and sleep, gene testing companies such as 23andMe, and online repositories where individuals can store their health records."

This can lead to unfortunate consequences, primarily because the government agencies responsible for enforcing HIPAA's privacy reg's much authority to do so:

"A 2009 law called on HHS to work with the Federal Trade Commission ... to submit recommendations to Congress within a year on how to deal with entities handling health information that falls outside of HIPAA. Six years later, however, no recommendations have been issued."

Shocking, I know.

The bottom line is that, at this point, a lot of our ostensibly private health info is potentially freely available to any number of government agencies, vendors, even fellow consumers:

"Part of the lab's website address caught her attention, and her professional instincts kicked in. By tweaking the URL slightly, a sprawling directory appeared that gave her access to the test results of 6,000 people."

How many others are out there?

Another ObamaTax "Success" Story

Speaking of rates going down 3000%, here's the story of a family doing its best to not only provide for itself, but to take on another unfortunate. The Smith's had already adopted a baby several years ago, and have just recently completed the grueling task of adopting another.

In the meantime, their current medical plan - an HSA with a $12,000 family deductible - renews on January 1 with a 30% rate increase No problem, let's go shopping:

Company A offers a $13,100 family deductible for $1,006 (saving $670 a year in premiums, but raising the potential out-of-pocket by $1,100)

Company U's plan has a $13,000 family out-of-pocket, but saves the family only $300 a year (for an additional $1,000 potential exposure)

Company I's plan seems to be the "bargain:" it saves the family $840 a year in premiums, and only increases the max out-of-pocket by $500.

So, which would you choose?

404Care.gov strikes again

Via email from Anthem:

"Healthcare.gov missing information will require some individual members to re-enroll for 2016 - We recently learned that the Health Insurance Marketplace (also called the exchange) is missing some information that some of our members provided on their applications last year when they bought their plans through the exchange."



The good news is that Anthem (and, presumably, the other carriers involved) is moving quickly to notify its affected insureds and get the issue resolved. Private sector to the rescue!

If you're insured through an Exchange-based plan, might be worth your while to get ahead of this by contacting your carrier right away.

Gaba, Gaba does

Ask some great questions:

"CMS is doling out just 12.5% of the monies owed to various carriers ... **evenly** to every carrier which is owed money, regardless of how much or little they're owed ... Are they legally required to make the payments this way, or could they use their discretion to prioritize certain carriers over others if they wanted to?" [emphasis in original]

Aye, thar's the rub, no? After all, if they do "prioritize" payments, then they're guilty of playing favorites, and if they don't, they're still doing so, no?

The crux of Charles' concern is that the Big Boys can likely weather the storm, but these delays pose the very real risk of sinking smaller players (think CO-OPs writ large).

In your humble blogger's opinion, this is really just going according to plan; that is, single-payer has always been the end-game (just ask Herr Gruber), and this is just another step along that path.

Unexpected! Carrier Trick

So UHC finally decided to dip its toes into the 404Care.gov market, only to immediately yank them back out:

"The nation’s largest health insurer fired a shot across the bow of ObamaCare on Thursday, citing flagging enrollment and high-risk customers in suggesting it may have to pull out of the exchanges in 2017"

What, 2 years of miserable ObamaTax numbers were hiding in plain sight?

So what's their solution? Well, one way to dampen enthusiasm would be to drastically cut agent comp for Exchange-based business. But that would be an incredibly slimy, cynical move.

So, naturally, UHC has drastically reduced agent comp for on-Exchange business.

Now, is this their prerogative? Of course it is. Does it make sense? Well, from their perspective, perhaps: after all, if they essentially suppress the agent-driven market, they're less likely to have to face the major loss ratio music. And what with the risk corridor money looking pretty iffy, that may be the only realistic strategy.

Oh well, easy come, easy go...

Melvin & The SubPar Plan

Readers may recall when President Obama called out pre-ACA plans as "sub-par;" that is, that they had both unreasonably high out-of-pocket exposure plus high premiums. The ObamaTax was touted as the fix-it for both problems.

Let's take a look at how well that's worked out, shall we?

IB regulars may recall the saga of Melvin and the tricky prescription. Melvin's plan, issued by Medical Mutual of Ohio, is a "grandfathered" HSA plan with a $3000 per person, $6000 per family deductible, then 100% covered after that. We just got his 2016 renewal in the mail, complete with a 14% rate hike. The good news is that that's about half of what I'm seeing with ObamaTax-compliant plans. The bad news (sort of) is that his family's premium is increasing from $516 a month to $586. This includes Melvin, Mrs Melvin, and two Mini-Melvins. If you're looking at that $586 skeptically, I don't blame you: that is a heckuva bargain.

If you're thinking that it's way out of line, well, here's a comparable quote from another carrier (several to choose from, this one seemed the most photogenic, and is right in line with all the others number-wise):

Yes, almost $1200 a month, plus much higher potential out-of-pocket.

On the other hand, it does include "free" birth control and maternity (for his 40-something better half). Some deal.

And this is why The Grey Lady recently reported breathlessly:

"[F]or many consumers, the sticker shock is coming not on the front end, when they purchase the plans, but on the back end when they get sick: sky-high deductibles that are leaving some newly insured feeling nearly as vulnerable as they were before they had coverage."

To be fair, the new plans provide "free" colonoscopies in addition to the birth control convenience items and maternity. But most of these plans aren't even HSA-compliant, so there's no opportunity to sock away extra dollars (what few there may be left after paying the grossly inflated premiums). And of course, one wonders how many folks actually take advantage of the "free" routine exams and such.

As we've averred many, many times here at IB, insurance is - well, should be - a risk management tool, and thus cover  big-ticket items, not $9-a-month pills. What did the rocket surgeons in DC think was going to happen when they crammed all those freebies in, while simultaneously proscribing carriers from underwriting new applicants?

Having health insurance may confer access, but what good is that access if one can't afford to actually benefit from it?

Pre-Thanksgiving Health Wonk Review

Brad Wright hosts this week's round-up of wonky posts full of helpful info and unique insights.

Who knew Norman Rockwell was a health policy wonk?

1,000 Words on O'Care

[Hat Tip: Co-blogger Bob V]

Leaving money on the table - An Update

Almost two months ago, we reported on the (sad?) fact that over "2 million public exchange enrollees eligible for cost-sharing reductions are not receiving the subsides because they selected a non-qualifying plan"

This referred to the curious way in which certain plans are eligible not just for premium subsidies, but also with out-of-pocket expenses (deductibles and co-insurance). Now, this isn't necessarily a major problem: if you don't have (a lot of) claims, it really doesn't impact your bottom line.

But it turns out that folks are also leaving actual cash dollars on the table in the form of premium subsidies that would directly impact their wallets:

"[M]ore than 24 million people were eligible for ObamaCare tax credits last year. By March, only 41 percent of them had selected a plan on a government insurance exchange."

That's less than 10 million folks who even bothered to add them to their "cart;" it shouldn't surprise regular IB readers than only about a third of those folks actually pulled the enrollment trigger. For perspective, this means that out of 24 million eligibles only about 3 million actually signed up.

Now why is that?

Well, as usual, the rocket surgeons in DC have done a crappy job of getting the word out: "of the uninsured people who are probably eligible for tax credits but not enrolled, about half of them said that they had not heard of the tax credits." Nor had they clicked on over to the 404Care.gov site (arguably a wise decision, that).

And who's to blame?

Here's a clue:

Over 6 years ago, Mike asked "Why has Medicaid failed to protect the poor?" He pointed out that (as of 2009) over two thirds of uninsured folks were likely eligible for Medicaid, but were not enrolled. This was (and continues to be) a failure of government, and it seems reasonable to conclude that it's the same dynamic (or lack thereof) that's leaving so many folks in the ACA subsidy dust.

Happy days, indeed.

Worse Insurance, Higher Cost

Obamacare: Is it broken promises or were we fed a line of BS? The answer is both. The fact is, your insurance is going to get worse and you are going to pay more for it.

Here's to hoping you never, ever, get sick!

 Here's to hoping the economy sucks and you don't get pay raises!

Nothing like living the American dream.

On Anecdotes & Data

So, about that 3000% rate decrease:

Working on a renewal (actually, one of several dozen at the moment, but this one's pretty representative); mom, dad, some ankle biters. Grandfathered HSA plan, $3,000 per person, $6,000 per family deductible, then 100%. As with all plans nowadays, first-dollar preventive care coverage (for mom and the kids only, of course, except for dad's colonoscopy every 5 or 10 years).

Current rate is $770 per month, heading north by 30% to a nice round $1,000. That's $12,000 in premiums before any meds or any major medical expense is covered, but after that, no worries. Plan is Grandfathered, so no coverage options (like a higher deductible to bring down that rate).

So, start shopping, and of course, the "best" alternative I can find is $1,140 per month, with a $6250 per person, $12,000 family deductible. So that's almost $1,700 a year in additional premium, plus thousands of dollars in potential additional out-of-pocket.

It does come with "free" birth control, though...

Oh, did I mention that Mom's 43 (and done)?

Sweet deal.

New Republic vs EPC

"The Equal Protection Clause of the 14th amendment of the U.S. Constitution prohibits states from denying any person within its jurisdiction the equal protection of the laws."

Reason I bring this up is because of the recent shuttering of the Empire State's New Republic (NR) CO-OP. Most of the time, there's a "cushion" between the time a plan is told to shut down and when folks actually lose coverage. This isn't the case with NR: coverage for its insureds ends on November 30th, period. This leaves them with a couple of challenges:

First, obtaining new coverage for December. The state has figured out a way to "auto-enroll" these folks in a new plan with intact carriers. One supposes that they could also choose a Short Term Medical plan (assuming those are still available in New York). And, of course, losing coverage in this manner is itself a Special Open Enrollment trigger (as regards December coverage).

The problem is that some (many? most?) of these folks will have met some or all of their 2015 deductibles (and, perhaps their entire maximum out-of-pockets). These are not going to be acknowledged by their new carrier; that is, they'll have an entire new annual out-of-pocket for December then again starting January 1st.

This is truly a bummer.

And it's also not legally correctable.

Here's why:

There is no way to compel the new carrier to credit expenses covered by a previous one, regardless of when they were incurred. So the fact that these poor folks are left high-and-dry for December is too bad, but there's nothing that can legally be done to resolve that. If the state (or the Feds, for that matter - CO-OPS are purely an invention of the ObamaTax) were to grant this kind of relief to victims previous NR insureds, they'd have to do that for everyone who's been in that situation.

And who would those folks be?

Well, anyone who lost employer coverage in, say July (or March, or a week ago) and had to obtain a new plan with another carrier. Or anyone else who's been recently eligible for a Special Open Enrollment and had (or chose) to switch carriers. If the NR folks are entitled, then everyone else in similar straits are, too.

Thanks, EPC!

Friday Spindle Clearing

In no particular order:

■ The Ohio Department of Insurance is touting its (not-so-new) lost insurance policy service, available to Buckeyes (and/or their beneficiaries) looking to see if Grams or Gramps had any unaccounted-for life insurance policies or annuities. It's a free service, but there's some paperwork involved.

■ The much-touted new Agent Hotline set up by the rocket surgeons in DC has turned out to be a big dud:

"A hotline set up ... to assist brokers with the public exchanges will only assist agents with user IDs, site registration and training questions — not client issues."

Which was to have been the whole point of the exercise in the first place.

Shocking, I know.

■ FoIB Jeff M tips us to this bolt from the blue:

"North Carolina consumers who buy their own health insurance are facing major price increases  ... it’s approved rates covering about 610,000 people that will be one-third to one-fifth higher in 2016"

Fortunately, that'll all be offset by the promised 3000% rate decreases any day now.

Right?

■ And now for something completely different:

The Pastry Artist's Adventure is a blog written (and updated frequently) by an aspiring pastry chef (and delightful young lady, to boot), currently in her 2nd year at the prestigious Sullivan University Culinary Arts program. It's fun to see the next generation of great bakers and chefs starting to spread their wings.

Ch-ch-changes: Adult "children"

The ObamaTax allows "adult children" to stay on their folks' insurance until age 26. Here in Ohio, the rocket surgeons in Columbus upped the ante, and let them stay on to age 28.

Now that's changing: as of January 1, 2016 the Buckeye State will fall into line with the other 57:

"I have my adult dependent child on my insurance coverage.  Will he/she still be able to stay on my health insurance? 

◦Dependent children can stay on their parent’s insurance until they turn 26."

Small steps.

[Hat Tip: Medical Mutual of Ohio]

MVNHS© Taking on Water

Last time we checked in with Britain's Much Vaunted National Health System©, we learned that new mums with breast cancer don't fare very well, healthcare-wise. Turns out, that was just a harbinger of things to come.

To wit:

"UK now has one of the worst healthcare systems in the developed world, according to OECD report"

Now what in the wide wide world of sports would prompt that pronouncement?

Oh:

"Hospitals are now so short-staffed and underequipped ... Staff are too rushed to improve levels of care ... obesity levels are “dire”

In other words: Thursday.

Here's the best part, though: all those folks bemoaning how we spend so much money on health care with poor results, and point to schemes like the MVNHS© as models to follow?

Guess what:

"Mr Pearson said the UK was spending “considerably less” than many OECD countries and that “you get what you pay for” in healthcare."

So if spending more doesn't help, and spending less doesn't, either, then maybe (just maybe) there are other factors to consider?

Wonder what those could be...

And the winner (loser?) is...

LifeHealthPro has just released the results of its survey of consumers' rankings of various health insurers.

Coming in dead last is United Healthcare, with just 62% of respondents willing to recommend it.

Interestingly, Aetna and Coventry are in 11th and 12th place (respectively); I don't really "get" this, since they're joined at the hip corporately. Perhaps the survey was conducted prior to Aetna's Coventry acquisition?

Our old friend Anthem is solidly in the middle, holding down 8th place.

Leading the pack, though, is Horizon Blue Cross/Shield of New Jersey, with a solid 85% of those surveyed willing to recommend it.

Two observations:

First, over half of the list is made up of various Blue Cross/Shield affiliates; this makes sense when you consider market share.

Second, and more discomfiting, is that it's not clear whether this reflects group plans or individual ones, nor on- or off-Exchange purchases. I think this is a major oversight, and would like to see it addressed in any future versions.

Health Wonk Review @ HBB

Health Business Blog's David Williams hosts this week's interesting, healthful collection of health care punditry and wonkery. Good info, helpful summaries, what's not to love?

Piling on: A physician's perspective

Right about the time that Kelley posted on the very real challenges that she's seeing at her practice (as well as her colleagues'), I received this in email from a physician:

"I've had issues with the way insurance is moving with caring for patients.  Many patients on high deductible plans want me to go over ALL their medical problems/concerns during their preventative visit then code it as preventative since that has to be covered 100%.  That just seems like fraud to me, and when I tell them I can go over their back pain and their side effects from their blood pressure medications but it's not preventative so there may be some charges, multiple patients have gotten very angry at me."

I of course pointed out that it is, in fact, fraud, and that it was wise to have declined the request. The rest seems to confirm what we learned from Kelley, and is likely to get worse.

I actually received a follow-up email this morning (in direct response to Kelley's post):

"I was seeing a patient for blood pressure and adjusting their medication because her blood pressure was still high.  She hadn't paid her bills yet, but I was still happy to see her for a follow up (we can set up a payment plan if a patient has difficulty paying their bills).  She asked my secretary if there would be an additional charge for that visit that day.  When my secretary said that, yes, a charge for that day's visit would be sent to the insurance company, the patient had a break down.  She started screaming that it's a follow up and should be covered under the same charge as her first visit.  She then said that if she dies it's our fault, refused to be seen if the visit wasn't guaranteed to be free, and stormed out of the office."

That'll teach that awful doc.

Right?

It seems to me that there are actually a number of different issues at play here:

First, it'd be interesting to know how many of these folks are newly-insured, and thus unfamiliar with how office visit co-pays have worked for a very long time. After all, the idea that co-pays apply to each discrete visit isn't new. And even on plans without co-pays (such as HSAs) it's always been the case that each visit generates its own charge.

I'd also be interested to see if this trend holds, and whether it drives more physicians to DPC or Concierge models.

Oh brave new world, indeed.