UHC Says Maybe Not

The Obamacare exchanges are (allegedly) less than a year away and one of the largest health insurance carrier in the country may not be ready to walk down the aisle and get hitched.

**UnitedHealth Group Inc. CEO Stephen Hemsley told analysts the insurer's involvement in online exchanges that are expected to help millions buy coverage will depend on whether it's financially viable for the company.

"We will only participate in exchanges that we assess to be fair, commercially sustainable and provide a reasonable return on the capital they will require," he said.**

Star Tribune

Well this should be fun.

Proponents of the overhaul say the exchanges will help restrain premium hikes because insurers will be competing against each other as customers compare several policies side by side to find the best match.

Obviously written by someone who has no clue and has only listened to sound bites from politicians.

This reminds me of the chant from the 60's:

"Suppose they gave a war and nobody came."

More ObamaTaxes

And in case you were wondering about your W-2: no, it's not just your withholding that'll be affecting your take-home, it's the ObamaTax at work, as well:

"Beginning for the 2012 calendar year, certain employers are required to report in Box 12 of the IRS Form W-2 provided to their employees, the aggregate cost of employer-provided health care coverages."

That's just one of a litany of new tax-related rules that took affect 3 weeks ago. Courtesy of Assurant Health, an easy-to-follow recap of the new W-2 rules and regs is available for download here.

Get 'em while they're hot (or not).

Shecantbeserious hits bottom, keeps digging

[UPDATE: Looks like Nate has scooped me!]

Words fail:

"When patients pay for medical care out of pocket, they should be able to keep doctors and hospitals from telling their health insurers about the care."

This advice is just part of a new, 560+ page compendium of final rules and regs just released by Madame Secretary and her minions. Masochistic readers may peruse them at their leisure here. Oh, and in case you're wondering, the initial projected cost of implementing these new rules is up to $225 million, and up to $43 million annually after that. I think that's low-balling it.

Among the many wonderful new rules are more onerous compliance requirements on private health info, while at the same time expanding school vaccination programs and the sending of a deceased's health information (he's dead, Jim) to survivors.

But the most egregious part is this little gem:

"[A]nother provision restricts "disclosures to health plan concerning treatment for which  the individual has paid out of pocket in full"

The problem is that this hinders insurance carriers from accurately pricing the risk, and it's going to be a major problem for in-network providers, whose contracts generally include this kind of disclosure. Not to mention, how does the doc (or his office staff) know which info to pass along, and which not?

As usual, the rocket surgeons now running our health care system leave a lot to be desired.

ADDENDUM: Our resident Medical Office Manager, Kelley B, noticed something, um, odd:

This is the dumbest thing I have read today:

"Commenters also asked what providers should do when patients said they would pay for sensitive care out of pocket but failed to pay for it"

Uh, if the patient presents at checkout and states he will pay for the service, he does not want it billed, then the money is collected right there, there is no billing the patient, as there is no electronic billing.  If he says, "oh I didn't know you would want my money now," then we tell the patient, too bad, so sad, but now we will bill insurance.

HHS Codifies Insurance Fraud

I would love to see a list of which other industrialized nations with healthcare spending half ours has laws like this;

http://www.lifehealthpro.com/2010/07/08/hhs-doctors-can-help-patients-hide-care-from-plans

"If, for example, a patient received care for asthma and for diabetes from the same physicians and paid for the diabetes-related care out of pocket, the patient could keep the physicians from telling the health plan about the diabetes, officials say.

The health care provider or other covered entity could still contact the health plan if the patient did not really pay the full out-of-pocket costs for the care. If, for example, a patient's check bounced, a provider could contact the health plan for payment, officials say."

So hiding information from your healthplan who is being told to better manage health and cost is going to be law, sounds counter productive.

Plans have filing limits, if the doctor waits until the patient doesn't pay they might miss the time they have to file for reimbursement under the plan, or will plans now also be required to extend the time to file claims based on employees wanting to hide information form them. Not to mention the mess that makes of reinsurance contracts.

My advice to clients, this is reason 328 to go back to reimbursement plans. Dump the PPO and assignment of benefits and let members submit claims and be reimbursed at plan allowable. Solve not only this issue but excessive provider cost as well.

An after thought, employee suffers some condition related to smoking which they lie and tell their healthplan they do not do in order to get the lower premium. In order to continue paying the lower premium they hide any claims related to smoking. Until they get major claim at which time they let the plan pay. 

On Medicare and The ObamaTax

A friend of mine just posted this on his FaceSpace page:

"Participating in one of my favorite annual activities (not)........trying to determine why Medicare cannot accurately, efficiently bill me for my premium! Starting my second year on Medicare, and premium for February is different than January. Same thing happened last year. Last year it took three months for Medicare rep's to give an explanation of why my premium changed during my first quarter on Medicare. Good thing I have a sense of humor."

And folks think that these same bureauweenies can run the rest of our health care system any better?

Finally: Some good news from the Much Vaunted National Health System©

It appears that a significant number of providers have had enough with treating illegal immigrants:

"While [MVNHS©] hospitals are allowed to charge foreign patients for treatment if they do not come from a country with a reciprocal arrangement, GPs are forced to take on people without charging."

What to do, what to do?

Ah:

"A survey of GPs has found that the majority think this is too generous and the rules should be changed."

The docs claim that the rules themselves are quite confusing, and reimbursement levels for illegals is significantly reduced. They even manage to work in medical tourism as a potential culprit. In an eerily prescient statement, Dr Paul Roblin, who chairs the Berkshire, Buckinghamshire and Oxfordshire Local Medical Committee, notes:

"GPs are expected to practice with limited healthcare funding and if we are using that money for treating visitors, the taxpayer loses out."

On this side of The Pond, we call that The ObamaTax.

Cavalcade of Risk #175: Call for submissions

Julie Ferguson hosts next week's Cav. Entries are due by Monday (the 21st).

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.

Fascist Health Care

The CEO of Whole Foods compared President Obama's health care law to "fascism" in a radio interview on Wednesday, a turnabout from earlier comments in which he compared the signature reforms to socialism.

"Technically speaking, it's more like fascism," John Mackey told NPR's Morning Edition. "Socialism is where the government owns the means of production. In fascism, the government doesn't own the means of production, but they do control it — and that's what's happening with our health care programs and these reforms."

Washington Times

Health Wonk Review: 2nd Inauguration edition

Chris Fleming hosts this week's historic roundup of interesting and provocative posts from around the wonkosphere.

What's so great about Chris's efforts is that he's woven a lot of disparate posts into a cohesive narrative - no easy feat.

They ain't birthin' no more babies

In case you missed it, another ObamaTax domino has fallen. Pregnant women in southwestern Pennsylvania don't get to keep their doctors, after all:

"The Windber Medical Center will stop delivering babies after March 31 because its obstetricians are either leaving or refocusing their practices, and because hospital officials believe they can't afford it based on projected reimbursements under looming federal health care reforms." [emphasis added]

That's a big problem with the ObamaTax: at the same time as it (purportedly) expands the number of insured folks - either in the marketplace or on Medicaid - the actual amount that docs can expect to earn from them is dropping. Kind of reminds me of those crazy car commercials of yesteryear, "sure we lose $100 on each sale, but we make it up in volume!"

Or, as this case so vividly illustrates, not.

[Hat Tip: FoIB Jeff M]

Mental Health and "Gun Control"

This is a strange confluence of two seemingly unrelated items. Yesterday, the New York legislature passed a far-ranging "gun control" agenda, one portion of which apparently requires "mental health professionals to report patients they believe could harm themselves or others."

As we learned yesterday, HIPAA privacy regs don't seem to prohibit this, but that doesn't really address the underlying problem: just because we can do something doesn't (necessarily) mean that we should. In 2002's "Minority Report," the police can arrest a potential perp under the concept of "pre-crime." While that's an interesting sci-fi "hook," is that really where we want to be?

On the one hand, there's no question that mentally unstable folks could pose a threat, but I think it's more nuanced than that: are we really going to lock people up because they might become dangerous? I realize that there's a difference between "reporting" and arresting, but what would be the point of the former if the latter wasn't a potential outcome? I have an issue with this – it’s related to our discussion the other day about the young lady having the double mastectomy because she might get breast cancer someday. In that case, though, it’s her choice. This one is the state (“government”) deciding. Not exactly a slam-dunk.

We talk a lot here at IB about "risk," and that's appropriate (after all, insurance is all about risk - or at least it used to be). So we have the risk that a mentally unstable person could commit violent crimes, versus the risk that society (or its duly appointed agents) might abuse an individual's rights. To paraphrase another iconic movie, do the needs of the many outweigh the needs of the few?

Or the one?

[Hat Tip: FoIB Holly R]

Rahmbo's Master Plan

Chicago is in financial trouble and is looking to save bucks anywhere they can. Last year their retiree health plan cost the city $109 million and that is expected to balloon to $541 million in 10 years.

Enter Rahmbo Dead Fish to the rescue.

Phasing out coverage for most retired city workers would leave the bulk of retirees dependent on the Affordable Care Act, also known as Obamacare.

The report goes to Emanuel for review. "Any proposal the city chooses will strike the right balance between meeting the needs of the retirees and providing them healthcare choices with protecting the interests of the city's taxpayers," 

Chicago Tribune

Sounds like a plan, especially since DC can pay for it with those trillion dollar platinum coins

HIPAA vs "Gun Control"

HIPAA (the Health Insurance Portability and Accountability Act; note that, unlike the ObamaTax, there was no pretense regarding affordability) is a widely misunderstood piece of legislation. But it's in its application that we often find the most trouble.

Tomorrow, President Obama is threatening promising to release a slew of Executive Orders to more rigidly control legal access to firearms:

"Actions the president could take on his own are likely to include ... compelling federal agencies to improve sharing of mental health records"

Now, there's been some chatter on the internets that this would be a flagrant violation of HIPAA privacy rules. The thinking seems to be that signing a HIPAA privacy form prohibits health care professionals from releasing information to, for example, federal authorities without prior authorization.

This would be untrue:

"5b.9

(1) Except as provided in paragraph (b) of this section authorizing disclosures of records without consent, no disclosure of a record will be made without the consent of the subject individual.

(b) Disclosures without the consent of the subject individual. The disclosures listed in this paragraph may be made without the consent of the subject individual. Such disclosures are: (7) To another government agency or to an instrumentality of any governmental jurisdiction within or under the control of the United States for a civil or criminal law enforcement activity if the activity is authorized by law"

So like it or not, HIPAA offers no "safe harbor" in this scenario.

How not to play poker

The New York Times reports that the White House says it will give states more time to comply with the new health care law after finding that many states lag in setting up markets where millions of Americans are expected to buy subsidized private health insurance.

We've heard this before.

Sebelius is just bluffing.  She's bluffing because she holds no winning cards.

By law, the Exchanges must be fully operational by January 1, 2014, and must be able to accept & process enrollments by October 1, 2013.  By law, HHS must set up and operate the Exchange in any State that does not set up its own.

As of now, there are about 30 refusenik states.  Sebelius knows HHS doesn't have the resources, does not have the time even if it did have the resources, and therefore cannot fulfill its obligation to set up Exchanges for all the states that refuse to set up their own Exchange.  This is a slow-motion disaster that now appears impossible to prevent - and it will take place on her watch.

We know - and Sebelius knows - that Obama will instantly blame her for this failure.  (Without, of course, ever reflecting on why his plan failed).  She's desperate and and that explains why she's bluffing.  But bluffing never works when everyone in the game knows you hold losing cards.

MassMutual vs College Debt

The ObamaTax placed the administration of student loans under the (benign?) authority of HHS Secretary Shecantbeserious. What student loans and "affordable health care" have to do with each other is anybody's guess, but there you are. Partly as a result of this, student loan debt is at record levels, threatening the future solvency of our best and brightest (among others). MassMutual, about which we lauded their innovative LifeBridge program last Fall, wants to help out:

"[S]tudent loans in the U.S. has topped $1 trillion, surpassing both credit card and auto loan debt. The 90-day serious delinquency rate is also higher than credit cards. One-in-five households are affected by student debt with the average graduate having about $20,000 in loans."

And that's the average - seems to me that a lot of our young people have already accumulated debt well into the 6-figures (how wise that may have been is another matter).

"In an effort to provide Millennials with the support they need, MassMutual [has] launched a new initiative – “Down with Debt” - aimed at addressing the student debt crisis by providing helpful financial tips and offering a $20,000 reward for the most creative strategy to pay down debt."

I like it: creative thinking with a potential reward. Just click here for details (and perhaps to sign up).

[Hat Tip: Caitlin Bricker]

RELATED: United Home Life Insurance asks "What do Twinkies, Flu Shots and Cabbage Patch Kids have in common?"

That would be Econ 101: supply and demand. At one time or another, each of those items has been in scarce supply (and Twinkies continue to be - alas!).

There's a follow-up question, too: "What's that got to do with life insurance?"

Fair question; after all, when was the last time you saw lines around the corner of people clamoring to buy life insurance?

But as UHL points out, our time here is uncertain and scarce - it can run out any moment. The longer we wait, the more expensive life insurance becomes. And consumers urgently need to protect their lives - and their loved ones - NOW, while there's still time.

A friend of mine likes to point out that we don't buy life insurance with our wallets, we buy it with our health. LifeHealthPro's Corey Dahl asks, "what’s more uncertain and scarce than our time here, the seconds and minutes of which are rapidly ticking away and could be set to run out … now … or now … or now. No one knows for certain when his number is going to get called, so doesn’t it make sense to get a life policy for loved ones — without delay?"

Indeed.

Stupid Patient Tricks - ER Edition

Stop me if you have heard this one. A guy walks in to the Emergency Room, complaining of a sore throat. Seems he swallowed something "that felt like a razor blade" while dining in a restaurant.

According to his account (posted on a community bulletin board) he "immediately went to the emergency room".

First thing they did was take my billing information and then told me to wait in the waiting room lobby. 

About one hour in a nurse took me to have an xray and then sent me back to the lobby and told me to wait to be called back to a room to see a doctor. 

I waited for three more hours for a total of four hours in the lobby. Several times I asked how much longer to no avail. 

Finally, frustrated I decided to go home and hope I will be ok because after four hours waiting and never even making it to a room must less seeing a doctor. 

I received two separate bills in the mail for this "visit" , one for the doctor of $500 and on for the xray of $1500. I never got treated nor did I see a doctor. How can I dispute this? The hospital has called me repeatedly demanding payment and I feel it is wrong to charge me for this. 

Yes, Tommy, the hospital was wrong to charge you for the use of their facilities including the X-ray machine and attendants. The triage attendant does not deserve to be paid, nor the X-ray technician

They took all of my insurance info and billing info before I ever got an xray. After giving my billing info a nurse took me back for an xray then sent me back out in the lobby. After four hours I was never consulted by a nurse or a doctor. I never seen the xray, and was never treated nor was I examined and no one went over the xray with me.

Really? Could it be because you walked out before they were through treating you?

Early January Alzheimer's Update

We haven't really discussed Alzheimer's since this past Fall, but there's some potentially hopeful news coming from the folks at Rensselaer Polytech in New York:

"Antibodies developed by researchers at Rensselaer Polytechnic Institute are unusually effective at preventing the formation of toxic protein particles linked to Alzheimer’s disease and Parkinson’s disease"

And these little guys are apparently helpful in the fight against Type II diabetes, as well. They're able to "target" certain cells (or clumps of cells) to proactively shut down the bad ones.

It's apparently still pretty new, but appears promising.

[Hat Tip: Ace of Spades]

PCIP Turnabout

Over the years, we've lamented the poor participation rates and stupid eligibility rules for the Pre-existing Condition Insurance Plan, aka PCIP. Now comes word that HHS Secretary Shecantbeserious is in a spitting contest with Ohio Insurance Commish Taylor. Perhaps the most interesting part is whose side each of these fine ladies are on:

"[Ms Shecantbeserious] has ordered 14 people to be dropped from Ohio’s temporary high-risk pool for the chronically uninsured ... after determining they had previous coverage that disqualified them from enrolling."

Yup, one of those stupid eligibility rules is that one must not have had "creditable" insurance coverage for the preceding six-months.  A while back, we investigated just what comprised "creditable" coverage, and were left pretty confused. In theory, only major medical plans counted; so-called "mini-med" (or limited benefit) plans did not.

But there's no actual verbiage which specifies this, it's all inference. It seems that Ms Taylor's position is that "lousy" coverage is, in fact, not creditable, and therefore passes the PCIP "smell test." It's an interesting theory, but one which is open to lots of interpretation. On the other hand, Ms Shecantbeserious contends that the quality of the previous insurance (if any) is immaterial, it's enough that the person had any coverage.

Medical Mutual, the carrier tasked with implementing the Buckeye State's PCIP program, has gone to court asking for clarification. Of course, it's most likely a moot point: by the time a decision is reached, The ObamaTax will be in full implementation mode and the plan itself will be a memory.

Too bad, really, coulda been interesting.

[Hat Tip: FoIB Patrick P]

Flu insurance

The good news is that I spent a chunk of the weekend replenishing the supply of Jewish penicillin for friends and family. The bad news is that the nation is in the grips of a "flu epidemic," caught shorthanded on vaccines:

"We're hearing of spot shortages," said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention ... manufacturers already have shipped nearly 130 million doses to doctors' offices, drugstores and wholesalers, out of the 135 million doses they had planned to make for this year's flu season."

Ideally, you got your shot a month or two ago, and are sitting pretty. If not, all is not (necessarily) lost:

"Health insurers are trying to do their part to keep the current U.S. influenza outbreak from becoming anything to write home about ... Massachusetts Blue [Cross] gives advice about preventing the flu from spreading, treating flu at home, seeking professional medical attention for flu symptoms, and insurance coverage for flu vaccination shots."

Many plans cover flu shots, sometimes at 100% (YMMV). We got ours at the nearest chain drugstore, and it was quick and (relatively) painless. And it's not just about your own health, either. As one insurer notes:

"You could infect other people even if you don't get that sick yourself, especially those at high risk such as infants, nursing home residents and people with chronic conditions"

The bug seems to be especially hard on our seasoned citizens, with "about 90 percent of flu-related deaths and more than half of flu-related hospitalizations occur[ing] in people ages 65 and older." So if you (or someone you know) is in that age cohort, seriously consider tracking down a dose or two.

Oh, and: gesundheit!

Sunny in Malaysia

While it's easy to forget that this is indeed a global economy, sometimes the news has a way of reminding us:

"Canada's Sun Life Financial and Malaysian state investor Khazanah have agreed to buy Aviva's Malaysian [life] insurance ... Britain's No.2 insurer Aviva is exiting marginal markets across the world with the aim of boosting its underperforming share price"

Whoa, they're concerned about profits? How provincial of them.