Thursday, July 31, 2008
Wednesday, July 30, 2008
Tuesday, July 29, 2008
(Sirens, lights, To Catch a Predator film crew . . .)
"Excuse me officer, but was I driving too fast?"
"No son, but you are about to enter a fast-food-free zone."
It seems the folks in la-la land have determined that low income families are no longer entitled to two-all-beef-patties-with-special-sauce-on-a-sesame-seed-bun and triple Whoppers.
The Los Angeles City Council has approved a one-year moratorium on new fast-food restaurants in a low-income area of the city.
The moratorium unanimously approved Tuesday is a bid to attract restaurants that offer healthier food choices to residents in a 32-square-mile area of South Los Angeles.
And the reason is?
Councilwoman Jan Perry says residents at five public meetings expressed concern with the proliferation of fast-food outlets in the community plagued by above-average rates of obesity.
Well there you go.
I guess they will have to start "brown bagging" their Happy Meals.
Let's just hope there aren't any strip searches.
About a month ago, we reported that Oregon's state-run "health" plan made Barbara Wagner "an offer she couldn't refuse:"
So what can happen when your medical records fall into the wrong hands?
It could affect your ability to get a job, a promotion or even a loan. There is also the possibility you could be a victim of medical identity theft.
So what happens when your carrier sends information on your medical health, complete with your Social Security number, to 202,000 people who are not you and have no right to your information?
The error occurred statewide and affected both employer and individual health benefit plans. The company has many state employees and schoolteachers as members, as well as large and small corporate customers. Blue Cross declined to identify large employers that it serves.
This may not be the only breach.
A thick stack of paperwork from Blue Cross of Georgia arrived at the Portland home of a KOIN News 6 employee. Many national and international corporations are based in Georgia, some of which have branches in Oregon, but provide insurance from Georgia-based insurance companies.
It is possible the two are related, but we cannot tell at this point.
Oxendine said he ordered the company to provide free credit monitoring for affected patients for one year. Blue Cross also must give written notice to policyholders whose names were on the EOBs and compile a list of names of those who erroneously received the forms.
While a noble gesture, I am not sure the credit bureau's track medical identity theft.
Monday, July 28, 2008
The 47,000,000 who are uninsured.
The upcoming election has once again focused a light on the uninsured, and the prospective candidate's plans for fixing what is wrong with America.
So how will "universal coverage" affect the uninsured?
Well according to the Phoenix Business Journal it won't include illegals.
Obama's plan to save us will not include 8.3 million illegals.
Thirteen percent of American citizens do not have health insurance compared to 69 percent of illegal immigrants in Arizona
There goes the Hispanic vote . . .
Sunday, July 27, 2008
Saturday, July 26, 2008
So, would I do it for free?
If I could, I would, but the folks I owe money to might not feel the same way.
I got a renewal letter on a small employer that has been a group health insurance client for almost 2 years. This employer was a bit of a pain at first, and I almost walked away from it.
Their prior agent had lied, or was simply mistaken, and had promised that certain medical conditions would be paid by the carrier.
As it turned out, that simply was not the case.
The result was, it cost the owner of the company over $10,000 to pay a claim he felt should have been the carrier responsibility. The agent who made these promises was a long time friend and I was a total stranger to the owner.
Still, I made my presentation which received (to put it mildly) a cool reception. The owner put me through the ringer, asking for financial information on the carrier, a copy of the policy and other things that are out of the ordinary.
After reviewing the information he asked what Blue Cross would charge for a similar plan. He was comfortable with the "brand" and felt he would be better served by a big company vs. the one I suggested.
I gave him a copy of the Blue proposal and pointed out their rates were about 40% higher for essentially the same benefit, but if he insisted, I had no problem using Blue.
He finally agreed to apply for coverage with the carrier I recommended.
Last years renewal went well but there was some resistance.
This year is a different story.
They are facing a 34% rate increase.
I received an advance copy of the renewal letter. A summary of the financial's follows.
Total premiums paid to date, $25,114.
Total claims paid to date, $83,546 (including $22,818 in Rx claims).
Total claims denied, $0.
This is what insurance is all about.
This is what drives me.
Finding ways to make coverage more affordable and delivering on a promise to pay.
It would seem that way, as the Senate "is investigating whether insurance companies are forcing able-bodied people to apply for Social Security disability benefits, worsening a severe backlog in the government program while increasing their own profits."
Forcing able-bodied folks to apply.
I suppose that is one way to say it.
Of course if they are able-bodied, why are they currently collecting disability? Carriers are not benevolent organizations that freely dole out monies to folks who are able to work.
Sick and injured people must often wait more than a year before their claims can be decided by one of Social Security’s administrative law judges, a delay Mr. Grassley called “abominable.”
“The last thing those who rely on Social Security need is for insurance companies to be clogging up the system by forcing ineligible applicants to apply,” he said.
Waiting a year before being awarded the benefit. Many times SSDI applicants must hire an attorney to appeal earlier denials.
If carriers acted in the same manner they would be strung up by their Gucci heels.
The Social Security Administration defines “disabled” much more narrowly than insurance policies typically do, so many people who qualify for insurance benefits do not qualify for Social Security.
It is true that the SSDI definition of disability is much more stringent than carrier language. It is also true that if carriers tried using the same language in their contracts would be tarred and feathered for denying claims to folks who were not "disabled enough" to qualify.
Senator's calling carriers on the carpet for trying to legally manage their business while ignoring their own shortcoming.
This must be an election year.
Friday, July 25, 2008
Most of his "family" are still in jail, including Susan Atkins.
Her story has taken a different twist of late. Seems she has brain cancer which has paralyzed her right side and led to the amputation of a limb.
So how much has her treatment cost so far?
About $1.4 million.
That's $1.4 million in taxpayer dollars.
"I dare say that apart from the president and the members of Congress, the people with the best health care in this country are inmates," said Dr. Joshua Atiba, the medical director and CEO of Newport Oncology and Healthcare, which delivers cancer treatment to inmates in prisons in California.
I can't say if that is a subjective comment or not. Regardless, this situation is eye opening.
Atiba said that much of the cost can be attributed to the $10,000 daily cost of a bed in the intensive care unit, along with the money needed for guards. According to Thornton, two guards are with Atkins at all time to prevent family members from helping her escape and to keep her from being harmed by members of the public.
The woman is paralyzed and missing a leg. She is 60 years old. How much of a threat is she if she does escape?
No, I am not minimizing her crime. But rather I am simply stating a fact based on the economics of the situation.
Now here is an oddity.
While all of Atkins' health-care costs are paid for by the state, she cannot receive any experimental treatments while in custody, says Atiba. As a prisoner, she cannot give consent.
"They have no autonomy," he said.
Brain cancer patients in the general public, on the other hand, may have the option to receive such experimental treatments.
Probably some kind of prisoner's rights thing.
But there is a positive.
According to the UCLA Hospital System, the total medical bill for a person in the general population who had a diagnosis of brain cancer would be $2.2 million over the same time period.
I'm sure the California taxpayers are relieved to hear that.
Caplan also noted that while many speculate that some people will commit crimes to get better health care, he hasn't seen any evidence that this is the case.
"People are interested in health care, but they're not interested in getting it as a prisoner," he said.
They are not interested in becoming a prisoner to receive health care, but they are willing to become a prisoner of a government run, universal health care system.
What is wrong with this picture?
Caplan predicts the problems we now confront about prisoners may eventually become discussed more widely as health care costs rise.
"We have a hard time saying no, even with prisoners," he said, noting that the questions applied to them will become more widespread with time.
"Why are we doing things that are basically hopeless when they cost a lot of money? We don't spend much on prevention, but boy, do we spend money to rescue people."
And so it goes . . .
There is a new drug in the fight against liver cancer. Most drugs do not work on liver cancer so this is a breakthrough.
The bad news.
Nexavar runs $5,400 per month.
So who pays?
All of us.
So what does the patient gain by using this new drug?
Average life expectancy without the drug . . . 7.9 months.
Average life expectancy for those using the drug . . . 10.7 months.
Is trading $15,000 for 3 months worth it?
This is a question all of us will have to ask.
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Thursday, July 24, 2008
Thank goodness for the Tampa Tribune, which brought Aetna to its (proverbial) knees.
Wednesday, July 23, 2008
Tuesday, July 22, 2008
Now we are back.
Consider Gladys Lester who battled cancer for 19 years only to discover she had exhausted her $1,000,000 plan limit.
Or Australia Montoya who hit her plans' $150,000 per illness limit in less than 2 years.
Patients with advanced breast cancer can ring up $160,000 annually just for chemotherapy. One of Montoya's hospital stays was billed at more than $200,000.
The time to find out about plan limits is BEFORE you need the benefits, not after.
Caps come in many forms: lifetime caps, annual caps, prescription caps, caps per illness. Most people don't realize their policies are limited until they find out the hard way.
Many plans are starting to limit how much they will cover for Rx benefits. The people who buy these plans never believe they will require expensive medication.
In tight spots like this, patients figure out ingenious ways to work the system. Lester has used Local 1262's unlimited prescription plan to order chemotherapy drugs through her drugstore. By purchasing a drug like Herceptin — a $6,499 anti-cancer medicine that costs her a $30 copay under her prescription benefit — she keeps the charge off her hospital bill.
Gaming the system in your favor is a common occurrence.
Rather that resorting to playing games, why not just buy a plan without limits from the start?
HealthMarket sells mostly to the self employed via the NASE (National Association for the Self Employed). Their marketing arm includes UGA and Cornerstone.
Following a 36 state investigation, HealthMarket has been fined $20,000,000.
The investigation, prompted by numerous complaints, found that insurer HealthMarkets failed to properly train its sales agents, who didn't always fully disclose the limits of its health policies to consumers and sometimes did not pay for medical services promptly.
HealthMarket carriers offer limited benefit plans that often fail to pay the majority of bills for a major claim.
If HealthMarkets does not resolve its problems, it could face up to $10 million in additional fines. Last year, it took in $1.6 billion and posted net income of $70.2 million, according to Securities and Exchange Commission documents.
The fines are a mere slap on the wrist compared to the financial loss incurred by those who have purchased their plans.
Monday, July 21, 2008
Sunday, July 20, 2008
According to Bloomberg, Allianz SE is going to join Axa in offering health insurance to animals.
Health insurance for dogs costs between 27 euros ($43) and 42 euros a month depending on the extent of the coverage, race and age, while cats cost between 18 euros and 28 euros, the newspaper said.
Guess their government run health care plan doesn't cover pets.
At least, not yet . . .
"Will you love her, comfort and keep her, and forsaking all other remain true to her and continue to provide health insurance as long as you both shall live?"
a poll conducted by the Kaiser Family Foundation, a leading health policy research group, found that in the past year 7 percent of U.S. adults married so one or the other could get on a partner's health insurance plan.
That is an astounding percentage.
Jeff Heisler didn't have $6,000 to cover much needed dental work. His solution?
Get married for dental insurance.
Says a lot about the basis of that marriage, huh?
"I married to obtain health insurance in retirement," said a 63-year-old Massachusetts woman who asked to remain anonymous.
Though the former hospital worker's relationship with her "best friend," a retired state corrections officer, is strictly platonic, the two tied the knot three years ago so she could get on his generous employer-funded health policy.
Insurance for retirement. Something wrong with Medicare?
But it goes both ways.
Earlier this year, a 50-something Indiana couple who'd been married 11 years got divorced so that the recently laid off, uninsured husband would be eligible for Medicaid, which he needed to help pay for $80,000 worth of cancer treatments (because of his wife's $38,000 annual salary, he didn't qualify for a government-subsidized health plan).
Seems there is always a way to game the system.
"I have not gotten married because of health care," said a 39-year-old Web designer from Vancouver, Wash., who didn't want to give her name. "I have had my daughter on Washington state health care since she was born. If I were to get married to the guy that I have been with for the past 10 years, then our combined income would disqualify my daughter for her coverage."
Sure. Why pay for it when you can get it for free?
Marriage, and divorce, is a wonderful thing.
Especially if you are in Massachusetts where you are required to have health insurance.
Since the law was passed, requiring residents to have health insurance, a little over half of the previously uninsured have gained coverage.
But at what price?
As the Cato institute reported, the state tax budget for health insurance subsidies overshot the mark by 33%.
But the cost of mandated care extends beyond dollars and "sense".
Want to see a doc?
Get in line.
Dr. Kate Atkinson is taking on new patients . . . who can wait until May 2009 before they are seen.
There are many reasons for this overcrowded access to primary care. One is there are fewer med school grads opting for the relatively low pay of primary care vs. a specialty.
Mr. Steinwald urged the overhaul of a fee-for-service reimbursement system that he said undervalued primary care while rewarding expensive procedure-based medicine. His report noted that the Medicare reimbursement for a half-hour primary care visit in Boston is $103.42; for a colonoscopy requiring roughly the same time, a gastroenterologist would receive $449.44.
The Medicare reimbursement rate.
As in, taxpayer funded plan.
And keep in mind that Medicare reimbursement rates are typically much lower, sometimes by as much as 30 - 40%, than reimbursement by private insurance carriers.
“It is a fundamental truth — which we are learning the hard way in Massachusetts — that comprehensive health care reform cannot work without appropriate access to primary care physicians and providers,” Dr. Bruce Auerbach, the president-elect of the Massachusetts Medical Society, told Congress in February.
Is this the same congress that wants to provide free health care for all as part of their election campaign promise?
Apparently they have selective listening skills.
The share who accept new patients has dropped, to barely half in the case of internists, and the average wait by a new patient for an appointment with an internist rose to 52 days in 2007 from 33 days in 2006.
You could be well by then.
Or much sicker.
The need to pay off medical school debt, which averages $120,000 at public schools and $160,000 at private schools, is cited as a major reason that graduates gravitate to higher-paying specialties and hospitalist jobs.
Primary care doctors typically fall at the bottom of the medical income scale, with average salaries in the range of $160,000 to $175,000 (compared with $410,000 for orthopedic surgeons and $380,000 for radiologists). In rural Massachusetts, where reimbursement rates are relatively low, some physicians are earning as little as $70,000 after 20 years of practice.
If your goal as a new doc is to pay off med school loans quicker, opt for the higher paying job.
You know, like rocket surgery.
But let's get back to those folks on taxpayer funded plans. How do the docs react when a Medicaid patient shows up?
Dr. Atkinson, 45, said she paid herself a salary of $110,000 last year. Her insurance reimbursements often do not cover her costs, she said.
“I calculated that every time I have a Medicaid patient, it’s like handing them a $20 bill when they leave,”
Gosh, she says that like it's a bad thing.
Saturday, July 19, 2008
Hank’s recent article about the Caitlin Jackson case mentioned Nataline Sarkisyan. Which raises a question: whatever happened to the lawsuit that celebrity attorney Mark Geragos vowed to file against CIGNA in the Nataline Sarkisyan case? I have been unable to find any current news of it on the internet, either under “Nataline Sarkisyan” or at Geragos’ own website. The news articles seem to have stopped in January 2008. Why? Anyone know?
Geragos’ website is here
The only reference to Nataline Sarkisyan (scroll down) is a copy of a newspaper article dated December 21, 2007. No updates on the Sarkisyan case have been posted to Geragos’ website since that time.
And here is a link to an editorial published January 11 in the Wall Street Journal that contains a summary of the case as it was only then beginning to be understood.
But even this editorial is now almost 7 months old. Does anyone know whether the threatened lawsuit against CIGNA is, or will be, proceeding?
Thursday, July 17, 2008
While some of the reports are true, most are exaggerated at best while some are totally misleading.
Take the case of 5 year old Logan Swaim.
According to the report, Logan was determined to be "short for his age". AFTER receiving this "diagnosis" (more like an observation than a diagnosis) his mom tried to buy health insurance.
(Comment. Insurance is something that is bought before the need, not after).
Two insurers accepted the Swaims and three of their children for new coverage, but they rejected Logan, fearing his height — 40½ inches — might indicate a glandular problem that could be expensive to treat.
Out of how many?
Might have a glandular problem.
For two years, the Swaims paid all of Logan's medical bills themselves, about $4,300. Eventually they got test results showing there was nothing wrong with him.
Why did it take them 2 years to have the tests done?
Even so, the insurers wouldn't cover him, Theresa Swaim says, because the time to appeal the denial of coverage had expired.
So what's wrong with trying a new carrier? Or even a new application on the boy?
Something smells here.