Time's running out on this year's Making Strides Against Breast Cancer campaign: the walk is just a few days away, and you can participate without even taking a step:
Just click here to make your donation, secure in the knowledge that you're helping to bring a cure one step closer.
As with most such initiatives based more on good intentions than sound economics, that hasn't worked out so well in practice. For example, as Patrick mentioned earlier this morning, the Blue Grass State's incarnation of this program has assumed room temperature (no surprise, as it's due to receive less than 12% of the risk corridor funds it was promised).
But it gets worse (depending on one's perspective, I suppose). Co-blogger Bob tips us to this disturbing (but inevitable) news:
The WashPo folks have even included a handy table to track these oncoming train-wrecks; it's not a pretty sight. If one were a betting person, I'd recommend $20 on Louisiana to go next.
The Kentucky Health Cooperative announced it will be ceasing operations December 31, 2015 leaving 31,000 without their current health insurance plan. The federal government had funded them with approximately $58 million for start up and reserves. How much of that taxpayer money is given back is anyone's guess.
WINhealth, a Wyoming based insurance company announced that it will not be participating in the federal exchange this upcoming year. The decision is directly tied to the federal government's failure to have a timely, effective, and stable risk corridor program. Didn't Hank just mention this?
This shouldn't come as a surprise. When the government can't tell you how much you are owed and when/if you will be paid, even a risk based industry is unable to manage.
"Thank you for contacting the Marketplace Learning Management System (MLMS) Helpdesk.
When you enrolled, you were not assigned the curriculum for Navigator – it was not added to your record. The Navigator curriculum has 14 courses. You still need courses 011, 012, 013 and 014."
Only one problem, which I quickly pointed out to the rocket surgeons at CMS:
"I am NOT a Navigator, I am a licensed insurance agent."
President Obama has signed into law the PACE Act, which allows each state to continue to determine the definition of "small" group. Without it, the definition would become 2-100 lives nationally.
It's expected that Ohio will continue to define "small" as between 2 and 50 employees.
Bill and Susan have a grandfathered HSA-compliant health insurance plan which covers them and their three children. Because it's Grandfathered, it's immune from some ObamaTax requirements (such as maternity coverage), but it also means that they can't make any changes (such as increasing the deductible to save premium dollars).
Their December renewal landed on my desk the other day, and it's a doozy. Their plan has a $6,000 family maximum out-of-pocket (MOOP), and their rate jumped 30% to just under $1,000 a month. They're not subsidy-eligible, so no help there.
Of course, I suggested that we shop around, but (as usual nowadays) I warned them not to get their hopes up.
Which turned out to be good advice:
Company A offered a plan which doubled their family MOOP to over $12,000, and cost $15 a month more than their renewal, Yippee!!
Company U had a slightly better "deal:" Bill and Susan could shave $20 a month off their premium, and only double their out-of-pocket.
Or they could choose a plan with only $1,300 additional exposure, and a slight premium increase of only $200 more than their renewal.
The idea was to distill critical, relevant health care cost information into as simple (and helpful) a form as possible. And it was indeed genius: who among us haven't at least glanced at the label on, say, that can of beans, or carton of milk? How great would it be to have that kind of detailed, but easily understood, information at one's fingertips when considering various health care options?
Fast forward 9 years, and, as Allison Bell reports, the federal SBC (Summary of Benefits) info required of all health care insurance plans have become bloated and useless:
But it's "the law," so carriers are forced to toe the line.
Now, there's a movement afoot to reform that:
"When text boxes are long and full of complex terms, consumers will avoid reading the information in its entirety," officials say"
No kidding.
The reality is that people, as a rule, don't read their insurance policies any more than they read the EULA they agree to when they download a new app for their phone. Which is a shame: the whole point of the exercise is to produce a more well-informed health care and health insurance consumer, no?
Not to sound like a broken record, but remember when President Obama swore that "if you like your insurance, you can keep your insurance?"
Just got email from Humana that the following letter is going out to at least one of my clients:
Re: Policy Number: Your current Humana plan will no longer be available in your area for 2016 You will need to select a new health plan between November 1 – December 15,2015 Dear : Unfortunately, your current Humana plan will no longer be available in your area beginning January, 2016; however, it will remain the same as it is today until December 31, 2015, as long as you continue to make your monthly payment. We know how important it is to select the health plan that best fits your needs, so we would like to help you understand your options and what to do next.
That is, until now, same-sex couples could cover their children on their gummint-issue health insurance even if they weren't married. Back in Aught 14, "the Office of Personnel Management broadened eligibility ... It made children of an employee or retiree’s same-sex domestic partner — although not the partner himself or herself — eligible." That is, they could add their "step-children" (but not their Significant Other) to their health insurance plan.
As a result of the SCOTUS Obergefell ruling, that's no longer the case, and these folks will now have to join us great unwashed in searching for affordable health insurance.
This, in addition to looming rate increases - Yikes!
■ Fear of going to the dentist is a major issue for a lot of folks; in fact, it affects 75% of us to some extent. But that may become a thing of the past with new Scottish tech (no, not that Scottish tech):
It seems that the Critical Illness (CI) market is exploding, and it's not difficult to understand why: these plans pay actual cash dollars to their insureds who suffer a listed condition (such cancer or stroke).
Something to consider if you have one of the new high out-of-pocket ObamaPlans.
First, the good news: I received email this morning from the training "Help" Desk in reply to my pleas for assistance.
The bad news is what it said:
"After you have completed all registration requirements for the Individual and/or SHOP Marketplace, you may print your completion certificate specific to the Marketplace(s) for which you completed registration.
Note: your certificate will be marked Incomplete if you have completed training but you have not completed identity proofing. After you have completed training and identity proofing, your registration completion certificate will be marked Complete."
Here's the problem:
[click to embiggen]
I've obviously completed step 1 and, as noted previously, completed all the training (as confirmed by the site itself).
So I replied that I had, in fact, completed both the identity proofing (?) and the training, but am still unable to print the certificates.
Co-blogger (and Medical Office Manager) Kelley B is working on an interesting ICD-10 post, but I couldn't resist blogging on some of the more ... esoteric ... examples:
■ Other Contact With Pig (W55.49X)
■ Problems in Relationship With In-Laws (Z63.1) [Methinks this one will become a Top 10]
■ Sucked Into Jet Engine (V97.33X) [That's gonna leave a mark!]
■ Prolonged Stay in Weightless Environment (X52.XXX) [Really? How prevalent is this?]
■ Struck By Turkey (W61.42XA) [Paging Les Nesman!]
As we've long noted (here, for instance) the ObamaTax 'risk corridor' (essentially a slush fund to cover excess claims) was always unsustainable. But hope springs eternal (at least in DC).
Until, of course, Mrs Thatcher's observation kicks in.
So, it's that time of year again: Federal Marketplace training for Open Enrollment v3.0.
So, as I've done for the past few years, I set aside a day to get it all done, logged in and started learning. This year, there are 10 "modules," including 2 exams that must be passed (minimum of 70% correct answers). About halfway through, get this delightful message:
Sigh.
So, pick it back up an hour or so later, and complete the training (acing both exams, by the way). So far, so good.
Click over to print my certificates of completion, and am told that, despite the fact that I've completed all the modules (and the site confirms this) my training is "Incomplete," so no certs for me.
Are you kidding me?
So I futzed around on the site for another half hour or so, then decided enough for one day, will come back and pick it up - fresh - in the morning.
Which I do, to no avail. However, I find an online form to use to report a problem and an email address to accomplish same. Being a belt-and-suspenders kinda guy, I did both (keeping copies, of course). That's Wednesday (two days ago).
Wednesday comes and goes, no response from either inquiry, so repeat.
Thursday comes and goes, still no joy.
So this morning, I repeated (again), and then poked around a bit more until I find an actual phone number to call to report and/or discuss training issues. So I call the number, and a very nice young man named Jeremy explained that there is nothing he or anyone else at the "Help" Center can do, I'll just have to wait to hear from the folks at the online "Help" Desk. And no, he can't tell me how long that might be.
So here I sit in training limbo: yes, Open Enrollment doesn't start for a month, but I'd really like to put this behind me, and I can't do that. And I am completely powerless here: no one to threaten with bad ink (well, pixels), or to take my business elsewhere (only game in town).
As we noted this past summer, the privacy challenges posed by folks using their FitBits (or similar exercise tracking devices) remain murky. One problem is that one doesn't necessarily know where the data will actually land, and whether or not that end-vendor (for lack of a better term) is a "HIPAA covered entity." The sticking point is defining just who (or what) is a "HIPAA covered entity."
The good news is that the situation recently became a bit less murky, at least for some folks:
Basically, that FitBit will need to "implement the security controls required by the HIPAA Security Rule, but only with respect to data it is receiving from or collecting on behalf of covered entity health plans or healthcare providers."
So if your health plan includes FitBit-style tracking, then your info is likely a bit more private than it has been. Of course, this applies only to FitBit users: if you're using some other similar device, you may want to do a little research on how your ostensibly private info is being treated.
The first problem is that subsidies are supposed to be available only to folks in a narrow swath of income; those that fall below the minimum and are thus Medicaid-eligible aren't eligible for tax credits (subsidies). But in some states using the Federal Exchange system, "a small number" of Medicaid-eligible folks received these credits by mistake.
Never fear, though:
"The agency says these people will have to ... pay back the amount of the credit they've received."
Which gets to the second problem: um, good luck squeezing blood from that particular turnip:
"Many people will not understand what they need to do. Low income families tend to move often, so many addresses may be inaccurate.”
Not to mention that they're Medicaid-eligible for a reason.
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