Monday, August 31, 2015

Cheeseburger, Cheeseburger, Cheeseburger

I am trying to write a Medigap policy on a lady. Just about to lose it.

We have met twice. Something I NEVER do.

1st time she asked a lot of questions. Took copious notes.

I took notes too. Followed up with an email reiterating and confirming everything we discussed.

Over the next few weeks she sent several emails, often asking the same question over and over again.

I responded by copying and pasting from earlier email.

Called a couple of weeks later and wanted to meet again. Almost said no, but I was going to be driving by the Starbucks where we met the first time. Agreed to give her 15 minutes more.

She brought her notes, including all the emails.

We talked some more. I thought she had it.

Plan G, Equitable.

A week later she said she had decided on G with AARP.

Of course we had discussed AARP/UHC and I told her they don't have plan G and I don't write through them. I gave her the AARP number and suggested she call them direct.

She didn't take the hint.

Emailed today, said she wanted Aetna, plan G.

Emailed back and told her what I would need, it will take 10 minutes by phone.

She wanted to know why I needed bank info. Of course we had discussed that before, but ........

Me - For the bank draft.

Her - I want to pay by credit card.

Me - No credit card, bank draft only.

Her - Can I use billpay?

Me - No billpay, bank draft only.

Her - I will need the exact address so I can use billpay.

Me - No checks, cash, money order, Western Union, credit cards, billpay .........

Automatic bank draft only.

Her - First month only, then billpay?

Me - Automatic bank draft.

1st month.

Every month.

I feel like I am in a SNL skit.

Your money or your life?

It's estimated that Medicare spends almost $170 billion each year on beneficiaries' last 6 months of life. There's no question that end-of-life care costs a *lot* of money. There's also no question that there's no easy "fix." Heck, Britain's Much Vaunted National Health System© had to ditch its infamous Liverpool Pathway program.

But the issue hasn't gone away, and the questions - moral, ethical, financial - still remain.

FoIB Holly R sent in this rather intriguing possibility:

"Why don’t health insurance companies offer bonuses to patients who are willing to forego standard end-of-life medical care?  When a patient receives a terminal diagnosis, I have to believe that the [insurance] companies have actuaries and data sets that would give them guidance on what the next 6-24 months of medical care would cost."

Well, we already have a pretty good idea of how much that might be (almost $80,000, by one estimate). So what if Humana or UHC or whomever offered their terminally ill clients a check for, say $50,000 in exchange for a release from additional liability for medical expenses?

Note that this would be entirely voluntary, and probably taxable. But here's a way for that person to perhaps check off just a few more bucket-list items, for example.

Interesting idea, no?

Friday, August 28, 2015

Risk-free term insurance? Not so fast...

At LifeHealthPro, Brad Cummins (a fellow insurance pro and Buckeye) has an interesting, provocative article on the risks associated with buying term life insurance.

Here's a taste:

"[S]ince every life insurance company has financial underwriting requirements, what you are eligible to get (as opposed to what you want to receive) may be exponentially different than what another applicant in another age bracket can buy."

This is key because most folks think that the only applicable underwriting criteria is one's health (which is important, of course, but only one facet of the process).

Here's another:

"There are further age-related limitations, which prevent you from purchasing coverage for as long as you may prefer."

Another salient point; it's become increasingly more difficult to find 20 (or even 15) year lock-ins for my mature clients, as carriers pull back from offering these options.

Definitely read the whole thing - it's not terribly long, but it is packed with good info.

PSA: Lo$t & Found

So, got this in email:

"My Money Monitor Asking Medical Mutual Members for Social Security Numbers and Other Identifying Information to Help Get Unclaimed Funds"

First, it should go without saying that one should never send this type of information without verifying the recipient.

Second, I was a bit curious as to how this outfit was able to ascertain the names of MMO insureds: was the carrier selling its client list?

Turns out that my fears were unfounded:

"This company ... pulls publicly available unclaimed funds reports from states"

So if you've never received or cashed that refund check (for example), it'll eventually show up on the list (both the amount and source). On the one hand, props to this outfit for its resourcefulness.
On the other, the company charges a recovery fee. One supposes that might be fair (they did, after all, have to scour 58 states' lists for this info), but, as Medical Mutual notes:

"[P]eople on the list are able to get their money for free by contacting the department in their state that handles unclaimed funds"

Methinks that might be a better (and safer) idea.

Thursday, August 27, 2015

New Mexico Singing the Blues

If you live in New Mexico and want Obamacare with a subsidy, Blue Cross will not be one of your choices in 2016.
Blue Cross and Blue Shield of New Mexico has confirmed that it will not offer on-exchange individual health insurance products on the New Mexico Health Insurance Exchange in 2016. 
According to the insurer, the premium rates BCBSNM charged for individual insurance products in 2014 and 2015 did not cover the claims costs the insurer incurred — ultimately resulting in a $19.2 million loss. - Biz Journals
Some will suggest these losses are not due to Obamacare, but when have you known a Blue plan to boycott a segment of the health insurance market?
We have been serving New Mexicans for 75 years and we hope to provide more options to individuals in the future," said Kurt Shipley, president of BCBSNM. "While we are committed to helping communities expand access to health insurance, we cannot offer products in a sustainable and predictable manner without adequate rates. We will continue to offer an HMO product off-exchange in 2016, which will be available to all consumers."
HMO is "code" for narrow network.

Losses for those served from the dollar menu must be severe to completely pull their product from the exchange.

Wednesday, August 26, 2015

No Crystal Ball Necessary

Another co-op bites the dust. This time it's Dirty Harry's home state of Nevada where operations will cease at the end of 2015. Just a short 15 months ago Bloomberg touted the "successful" start of the Nevada Co-Op in this article and referenced how they had the lowest rates in Las Vegas.

Fast forward to today's press release. Here's a few quotes from the company, one of it's board members, and the co-op CEO. Definitely not the success they envisioned.

“It is with deep sadness that based on challenging market conditions, the Board made a painful decision to wind down operations of the Nevada co-op at the end of this year.”

“Rather than spending resources on next year’s uncertain market, we would rather make sure we protect our current members. This is all about providing the most affordable, effective health insurance and service possible.”

“With a second year of high claims costs and limited opportunities for new investment, it has become clear that the amount of growth required to provide quality care at reasonable rates will be unlikely in the next plan year.”

The odds makers really missed the mark on this one. With enrollment of only 14,000 the company still lost $15,000,000 since it began enrollment in 2014. Not to mention the $66,000,000 they received from the federal government to get started.

Mid-Week Linkfest

From SoIB Gail S, we learn that a "common heart drug called a beta blocker was associated with a striking increase in survival for women with ovarian cancer in a study that suggests a possible new strategy for treating a variety of tumors."

Although the test subjects were taking the med to treat their hypertension, not specifically for cancer, the effect was such that they ended up living up to four years longer.

There were a few wrinkles such that the results aren’t necessarily dispositive, but they're certainly powerful enough to warrant additional research, and perhaps lead to even better cancer treatment options.

Your tax $$'s at work. We've mentioned the myriad problems related to the ObamaTax risk adjustment program before, but this news lends additional fodder:

"Before an insurer in a market can collect the risk-adjustment program cash transfers it's expecting to receive for the 2014 benefit year, the insurers in the market that owe the payables have to pay their risk-adjustment program bills."

That is, Company B must wait to collect its share until Company A ponies up what it was dinged. And what happens when a carrier goes south? Well then, all bets may well be off.

Talk about a chilling effect on the market.

Continuing our IRS-bashing theme (and a more deserving group of folks it would be hard to imagine):

"How slow are the project trackers helping the Internal Revenue Service (IRS) keep tabs on Patient Protection and Affordable Care Act (PPACA) administration system projects?"

They're so slow that the folks tasked to gather, collate and analyze the info have been left twirling their thumbs. In some cases, info that was supposed to be available in two weeks or less ended up dragging out for almost 3 months. One wonders how helpful that information, now quite stale, turned out to be.

Finally, some good news. Back in March, we reported that The Old Line State was toying with the idea of bringing actual licensed agents onto the state's HIX (as opposed to unlicensed, unvetted amateurs). Now, it seems, they're actually pulling that trigger:

"Maryland’s state-run exchange ... will start a pilot program during this year’s upcoming open enrollment that will transfer consumers calls from a call center directly to a broker, who will then enroll the consumer."

Will be interesting to see how this works out, and whether other states will follow suit.

Unwise Traveler Tricks

First, our thoughts and prayers to Ms Jimenez and Mr Fox.

It doesn't get much worse than this:

"A Tampa-area college student lies in a Cuban hospital bed, having been injured in a collision outside Havana, and her friends and family are desperately trying to scrape together the $50,000 they need to get her airlifted to Florida."

The collision, it turns out, was not her fault (she was a passenger in a taxi that was hit by a truck).

But that's about all that's not her fault.

Let's begin here:

"Not having any health insurance..."

Now, go back to that first paragraph: "Tampa-area college student." A few minutes on the USF site seems to confirm that undergraduates aren't required to have health insurance (although they're obviously in violation of the Mandate). One also wonders why she's not on her parents' plan (assuming they have coverage).

Which then raises another question [ed: gee, wouldn't it be nice if the MSM actually did its job, and asked them?]: if she was uninsured, how did she get into Cuba in the first place?

After all:

"All overseas visitors to Cuba must have a travel insurance policy in place with sufficient cover for medical evacuation by air, the Cuban government has said"

So how, exactly, did she gain entry in the first place?

But Henry, travel medical insurance is expensive!

No, no it's not:

A plan that would pay up to $100,000 (more than enough to cover her expenses, according to the article) with a very modest $500 deductible would have set her back all of $28 for a month of coverage (and that would include air evac and hospital-related charges).

And by the way, this took less than 3 minutes to quote; one supposes that's still too much time for the "reporter" to invest.

Penny wise....

Tuesday, August 25, 2015

The Skinny on Obamacare Access to Healthcare

Coverage for all sounds great. Maybe a politician will use that line some day. In the meantime, back to
Georgia had the highest percentage of “narrow’’ insurance networks in the 2014 health exchanges, a new report says.
Five of six Georgia “Silver” exchange plans last year had medical provider networks with a limited choice of doctors, the report said.
The 83 percent of Georgia plans having narrow networks surpassed that of all other states, according to University of Pennsylvania researchers. - Georgia Health News

Gosh, wonder why the carriers would do such a thing?
The report, released Monday, said health insurers are using narrow networks to keep premiums down as consumers shop for coverage on the exchanges, created under the Affordable Care Act. 
Got to make Obamacare affordable, even for those ordering off the dollar menu.

#Obamacare #NarrowNetworks

PSA: On Waiving Provider Fees

Not sure when this became "news:"

"Recent changes to policy and plan language and increased litigation by third-party payers suggests that out-of-network providers who waive co-pays and deductibles may be in for some rough sailing"

One supposes it's a symptom of ObamaPlan "skinny networks," but the concept is quite established.

I reached out to co-blogger Kelley Beloff (herself a medical office manager), who confirmed that "you cannot routinely waive any portion of a patient's responsibility. This is stupid, you are leaving money on the table and trains patients that they do not have to pay. Come to think of it, I have not heard in a while, "My other doctors don't collect a copay." Old news."

So there ya go.

BIDT (Back in the Day)

In early 1991, the venerated Mutual Benefit Life Insurance Company (Mutual Ben) closed its doors, signalling the end of an era. Mutual Ben was well-regarded in the industry, with a great reputation, good products fairly priced, and field reps second-to-none. Unfortunately, it succumbed to an unkind real estate market (insurance companies generally love real estate for its long term stability and growth).

Long before HIPAA and EOB's, carriers like Mutual Ben had a more personal touch. FoIB Jeff M has kindly agreed to share with us correspondence he came across in his grandmother's effects. It's a fascinating glimpse into a simpler, arguably kinder time.

Here's a sample:

 [click picture to embiggen]

The whole set is available here. Thanks for sharing, Jeff!

Monday, August 24, 2015

Dumb Carrier Trick: Redeemed

So, 20+ years ago, I had the privilege of writing my first single-pay Long Term Care policy. What was so special about it was that the client, the prototypical little old lady with the most beautiful smile, called me a few months later to buy another one.

Fast forward a couple of decades, and she passes away. A sad time for her family, to be sure, but the best time of all for any life insurance carrier to shine.

Or screw up mightily.

Unfortunately, "Ajax Life" chose the latter.

[ed: I've redacted the carrier's real name because they've demonstrated a willingness to resolve the issues.]

When Emily (not her real name) passed away, her son originally called the home office instead of me; his brother, with whom I had met alongside Emily in those early days, had since died. Eventually, the surviving son (we'll call him Les) called me for help. He had never received the forms that Home Office had promised to send him.

To further complicate things, there were multiple beneficiaries on multiple plans, so I had to coordinate them. So, I called Home Office and requested the proper forms and instructions on how to put this together. To their credit, Ajax promptly emailed me the forms and instructions.

I eventually received all the completed forms and appropriate documentation, packaged everything up (sans pink ribbon, natch) and sent them to Ajax.

And waited.

And waited.

Finally, I called to ask where the checks were, and was told any number of different stories: first, they'd never received the package. Then, they'd received it, but it was still being processed.

No one could (or would?) tell me exactly what needed "processing;" these were 20 year old policies, the insured had died of natural causes, this was not rocket surgery. I was finally able to get them to commit to having their claims "processor" call me.

Which he did. And then told me that the reason it took so long was that they had to get an exception because I'd sent in the wrong forms.

Excuse me?!

I got those forms from you!

Well, you see, he'd also (allegedly) sent the correct ones to Les in May and again in July, but never heard back. Which was news to Les when I told him about it: he'd never received any such forms. But even supposing he had, how is it relevant? Ajax sent me the claim form, which I in good faith passed along to the beneficiaries. The only clock that counts here is the one that started when I sent in the completed forms and documentation.

The "good" news is that (supposedly) the claim has been approved and the checks will go out shortly.


This was my very first death claim with this company, and there are very few things they could have screwed up worse. Topping the list is the complete stupidity of sending me the wrong form in the first place: how does that happen, exactly?

And no one thought it’d be appropriate to reach out to me to indicate that there'd be a delay, and why?

Until now, I'd had no reason to doubt the capabilities of this carrier, and felt good about recommending them to my clients.

What to do?

So, I reached out to the Vice President of Claims & Operations, expressing my frustration, explaining its source, and offering a path to redemption. Several days later, I received a very satisfactory reply, including an unqualified apology and a detailed explanation of the steps being undertaken to ensure that this kind of thing doesn't happen again (or at least, will minimize the chances).

I was particularly impressed that this executive admitted that he "was embarrassed to see the timeline and claim form confusion associated with this claim. The claims management team will be discussing the coaching and additional processes we need to implement to prevent future experiences such as this." That was just one of several steps he mentioned towards remediation.

Although I was quite disappointed that this whole situation occurred, I am quite satisfied with the outcome. People do make mistakes, and this company's willingness to unequivocally acknowledge (and correct) theirs is a very positive sign.

Friday, August 21, 2015

Patrick @ The Federalist

Co-blogger Patrick makes The Federalist (again!):

"Obamacare’s Transitional Reinsurance Program screwed you and helped pad insurance company pockets"

Details at The Fed(eralist).

Media Misses

From FoIB Jeff M:

"Local hospitals see increase in Medicare fines ... Combined, the nation's hospitals are losing $420 million, government records show."


Question for the MSM:

Who do you think actually pays those fines?

(Hint: It ain't the hospitals)


DPC Insurance, "The Wrap"

As promised in the Update to our previous Direct Primary Care (DPC) post, we have details about Pan-American Life's "wrap" plan.

Pan-American VP Carlo Mulvenna was kind enough to walk me through the basic idea behind the plan's design, as well as share product details. In a nutshell, the carrier has staked out a niche in what Carlo calls the "limited benefit space," and focuses its efforts there. They were approached by the folks at MedLion (the DPC bundler) because there was a perceived need for at least some non-primary care coverage.

The folks at Pan-American basically took their off-the-shelf limited benefit plan and carved out the primary care pieces (which would be redundant in this application). This gives insureds access to specialists and lab work via reimbursement (there are prescription med options available, as well). Because the plan is built on a "hospital indemnity chassis," it's approved as an "excepted benefit" and thus exempted from major pieces of the ACA. The whole program is designed to meet the ACA individual mandate requirement.

Both the MedLion and Pan-American programs are offered as employer-sponsored arrangements, not (currently) available to individuals ("retail"). The wrap plan is guaranteed issue and imposes no pre-existing condition exclusions; it does require a minimum enrollment of 50 employees.

Carlo told me that he understood that MedLion's DPC fee runs about $85 a month per adult; coupled with a typical "wrap" plan the total cost comes to about $180 per member, per month.

I still have reservations about this: as Carlo conceded, there is no provision for catastrophic claims. I know that DPC proponents tend to focus on how good primary care can help prevent a lot of major claims. And that's a legitimate point, but entirely irrelevant to the discussion of insurance:

I don't think anyone disputes that primary care is important; the issue is why the heck it should be covered by insurance. As one who looks at these things through the lens of risk management, I can't help but think of the old saw about "penny wise, pound foolish." So taking it out of the insurance realm, as DPC does, is a positive step. And I grant that Pan-American's wrap program is indeed better than nothing, especially to folks at the lower end of the income spectrum. But when we're talking about nearly $200 a month per adult, then I'm just not seeing the value when a cancer or heart attack or kidney failure can quickly wipe out any possible savings.

Color me unconvinced.

[Special IB Thanks to PALIG's Carlo Mulvenna for his time and insights]

And the 2015 Award for Excellence in Product Positioning goes to...

Aetna for their new ACO in Southern California: Aetna Whole Health - MemorialCare.

I don't know about you, but it makes me think of funeral homes and tombstones.

(Yeah, I know, it uses Long Beach Memorial Medical Center and MemorialCare Medical Group, but honestly guys, you ever think of running focus groups?)