Stupid Provider Tricks (Coast to Coast)

[Welcome Industry Radar readers!]

Over the past three and a half years, we've chronicled the "exploits" of agents, carriers and patients. It seems, though, that providers are not exactly immune to outrageous games, either.

First up, we learn that the UCLA Medical Center has been bumping legitimate, deserving, long-suffering American organ transplant candidates in favor of yakuza, members of Japanese organized crime groups. The surgeries, conducted between 2000 and 2004, took place while there was a distinct shortage of qualified organs, exacerbating an already-critical problem.

Although the physicians claim not to have known of the, er, character of their erstwhile patients, they also aver that "they do not make moral judgments about patients and treat them based on their medical need."

Riiiight.

On the other side of flyover country, the Washington Post reports that "surgeons across the country receive trips, meals and consulting deals from artificial-hip and -knee makers." Isn't that the textbook definition of "conflict of interest?"

Turns out, the suppliers of various joint-replacement gizmo's [ed: must you use technical medical industry jargon?] allegedly paid certain surgeons to use their equipment. Manufacturers advocates counter that "the arrangement allows doctors and medical-supply companies to collaborate, paving the way for important technology advances in hip and knee replacements."

In the event, a federal investigation was launched to look into this kickback scheme. A settlement has apparently been reached, and the facts are beginning to come to light. In what may be a happy ending (of sorts), "(f)our of the world's top companies last year agreed to pay a combined $311 million to settle a federal probe into whether the manufacturers paid kickbacks to doctors to get them to recommend their products."

Sheesh!

Read More

Stupid Provider Tricks (Coast to Coast)

[Welcome Industry Radar readers!]

Over the past three and a half years, we've chronicled the "exploits" of agents, carriers and patients. It seems, though, that providers are not exactly immune to outrageous games, either.

First up, we learn that the UCLA Medical Center has been bumping legitimate, deserving, long-suffering American organ transplant candidates in favor of yakuza, members of Japanese organized crime groups. The surgeries, conducted between 2000 and 2004, took place while there was a distinct shortage of qualified organs, exacerbating an already-critical problem.

Although the physicians claim not to have known of the, er, character of their erstwhile patients, they also aver that "they do not make moral judgments about patients and treat them based on their medical need."

Riiiight.

On the other side of flyover country, the Washington Post reports that "surgeons across the country receive trips, meals and consulting deals from artificial-hip and -knee makers." Isn't that the textbook definition of "conflict of interest?"

Turns out, the suppliers of various joint-replacement gizmo's [ed: must you use technical medical industry jargon?] allegedly paid certain surgeons to use their equipment. Manufacturers advocates counter that "the arrangement allows doctors and medical-supply companies to collaborate, paving the way for important technology advances in hip and knee replacements."

In the event, a federal investigation was launched to look into this kickback scheme. A settlement has apparently been reached, and the facts are beginning to come to light. In what may be a happy ending (of sorts), "(f)our of the world's top companies last year agreed to pay a combined $311 million to settle a federal probe into whether the manufacturers paid kickbacks to doctors to get them to recommend their products."

Sheesh!

Read More

Cavalcade of Risk #53: 2nd Anniversary Edition - Submissions Due

Next week's edition marks our 2nd Anniversay, so we'd like to try something a little different: please send in your favorite risk-related post from the past 12 months. Don't forget to include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

You can submit them via Blog Carnival or email.

We have hosting opportunities available for late summer and early fall, so please drop us a line to reserve yours.

Read More

Cavalcade of Risk #53: 2nd Anniversary Edition - Submissions Due

Next week's edition marks our 2nd Anniversay, so we'd like to try something a little different: please send in your favorite risk-related post from the past 12 months. Don't forget to include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

You can submit them via Blog Carnival or email.

We have hosting opportunities available for late summer and early fall, so please drop us a line to reserve yours.

Read More

Health Wonk Review: Post-Memorial Day Edition

[Welcome Kaiser Network readers!]

Welcome to this week's edition of all that's wonky in the healthcare world. As a 4-timer, I was tempted to out-shtick myself, but decided to play it straight (for once). And so, without further ado...

Paul Hsieh poses an interesting question at We Stand Firm: What would health insurance look like in a truly free market? I really liked the Q&A format of this post.

The Health Business Blog's David Williams has a chilling post on identity theft, specifically crooks who take advantage of the fact that stolen health information is likely to be useful for much longer than stolen financial data.

Sam Solomon, blogging at Canadian Medicine, draws a connection between global warming and mortality rates.

Brian T. Schwartz, writing at Patient Power, has a real issue with the concept of mandatory health insurance.

Dr Deb Serani reports on a VA facility in Texas, whose cost-conscious administrator has apparently put the kibosh on any more PTSD diagnoses.

HWR's Julie Ferguson is out of the country, but her Workers Comp Insider partner, Jon Coppelman, has his own take on that VA administrator.

Alvaro Fernandez, blogging at Brain Health Business, explores how people can use emerging technologies to keep their brains healthy and productive as long as possible.

Here at IB, we're big fans of transparency in health care (and health insurance). Over at his New America blog, Tom Emswiler talks about the newest HHS program, which lets consumers compare cost data at nearby hospitals.

Vince Kuraitis, principal of e-CareManagement, tells us about the newest delivery and financing model to rescue primary care, the Patient Centered Medical Home (PCMH).

Shaheen Lakhan, the Brain Blogger, presents a Patient Manifesto. He points out that each of us may also be a patient and so many blog posts are about medical topics and issues, but not about the patients.

Over at Health Populi, blogger Jane Sarasohn-Kahn discusses the rising cost of health insurance, especially from the employers' standpoint, and wonders if we'll see more employers dropping cover, or requiring a bigger bite out of the employees' paycheck [ed: Yes].

At the Disease Management Care Blog, Jaan Sidorov discusses the cost/benefit dilemna when looking at med's that treat brain cancers, and how making the decision on whether or not to even use them can cause more stress.

Anthony Wright, of the Health Access California blog, asks what, exactly, constitutes insurance coverage? He posits that, at the very least, coverage should protect a consumer against unlimited financial liability.

The Internet Marketing Blog's D. Singh takes a close look at the new, improved Google Health, and comes away concerned about whether or not we should trust the search-engine behemoth with our private medical data.

Speaking of Google Health, Health Care Industry blogger David Hamilton is quite concerned that Google has hedged its exposure in the event a privacy breach occurs. In fact, it appears that the company actually requires users to defend against or settle any suit brought against Google.

Finally, you might think that insurance agents would welcome presidential wannabe John McCain's market-based solutions. Not so fast: Our own Bob Vineyard takes the good senator to the woodshed, instead.

That's all for this week's edition. Please make sure to stop by the Health Affairs Blog on June 12th for the next exciting episode.

Read More

Health Wonk Review: Post-Memorial Day Edition

[Welcome Kaiser Network readers!]

Welcome to this week's edition of all that's wonky in the healthcare world. As a 4-timer, I was tempted to out-shtick myself, but decided to play it straight (for once). And so, without further ado...

Paul Hsieh poses an interesting question at We Stand Firm: What would health insurance look like in a truly free market? I really liked the Q&A format of this post.

The Health Business Blog's David Williams has a chilling post on identity theft, specifically crooks who take advantage of the fact that stolen health information is likely to be useful for much longer than stolen financial data.

Sam Solomon, blogging at Canadian Medicine, draws a connection between global warming and mortality rates.

Brian T. Schwartz, writing at Patient Power, has a real issue with the concept of mandatory health insurance.

Dr Deb Serani reports on a VA facility in Texas, whose cost-conscious administrator has apparently put the kibosh on any more PTSD diagnoses.

HWR's Julie Ferguson is out of the country, but her Workers Comp Insider partner, Jon Coppelman, has his own take on that VA administrator.

Alvaro Fernandez, blogging at Brain Health Business, explores how people can use emerging technologies to keep their brains healthy and productive as long as possible.

Here at IB, we're big fans of transparency in health care (and health insurance). Over at his New America blog, Tom Emswiler talks about the newest HHS program, which lets consumers compare cost data at nearby hospitals.

Vince Kuraitis, principal of e-CareManagement, tells us about the newest delivery and financing model to rescue primary care, the Patient Centered Medical Home (PCMH).

Shaheen Lakhan, the Brain Blogger, presents a Patient Manifesto. He points out that each of us may also be a patient and so many blog posts are about medical topics and issues, but not about the patients.

Over at Health Populi, blogger Jane Sarasohn-Kahn discusses the rising cost of health insurance, especially from the employers' standpoint, and wonders if we'll see more employers dropping cover, or requiring a bigger bite out of the employees' paycheck [ed: Yes].

At the Disease Management Care Blog, Jaan Sidorov discusses the cost/benefit dilemna when looking at med's that treat brain cancers, and how making the decision on whether or not to even use them can cause more stress.

Anthony Wright, of the Health Access California blog, asks what, exactly, constitutes insurance coverage? He posits that, at the very least, coverage should protect a consumer against unlimited financial liability.

The Internet Marketing Blog's D. Singh takes a close look at the new, improved Google Health, and comes away concerned about whether or not we should trust the search-engine behemoth with our private medical data.

Speaking of Google Health, Health Care Industry blogger David Hamilton is quite concerned that Google has hedged its exposure in the event a privacy breach occurs. In fact, it appears that the company actually requires users to defend against or settle any suit brought against Google.

Finally, you might think that insurance agents would welcome presidential wannabe John McCain's market-based solutions. Not so fast: Our own Bob Vineyard takes the good senator to the woodshed, instead.

That's all for this week's edition. Please make sure to stop by the Health Affairs Blog on June 12th for the next exciting episode.

Read More

Tiered Doc Copays

Here is a novel idea.

Create a system where price AND quality is evaluated. Those who perform at a higher level are paid more, while those who perform at a lower level are penalized.

Then take it a step further.

Inform the provider's clientèle who measures up and who doesn't.

If your clients want to use a practitioner who does not make the grade, they must be willing to pay more out of pocket to use that provider.

This is precisely what the Massachusetts Group Insurance Commission has done.

And is seems the docs are not happy.

In a lawsuit filed in Suffolk Superior Court, the (Massachusetts Medical Society) - which represents the state's doctors - alleges the commission's plan hurts physicians and patients.

The suit claims doctors capriciously ranked lower have been defamed, and that patients who have to pay higher copayments based on their doctor's ranking have been defrauded.

The patients are defrauded.

That's a gutsy claim.

Tiering has become a widespread technique for controlling healthcare costs. For example, many insurers have adopted tiered pharmacy benefits, with higher copayments for name-brand drugs serving as an inducement for patients to choose generics. Such structuring is credited with controlling spiraling drug costs.

But the tiering of physicians has proceeded more slowly. Doctors have fought the cost-control methods, particularly tiering plans that seek to rank individual doctors, as opposed to physician practices.

So, carriers and patients should pay the same price, regardless of the ability of the medical practitioner to treat medical conditions?

In other words, you should pay just as much for top level care as you would for a lower level of care.

Right.

Read More

Tiered Doc Copays

Here is a novel idea.

Create a system where price AND quality is evaluated. Those who perform at a higher level are paid more, while those who perform at a lower level are penalized.

Then take it a step further.

Inform the provider's clientèle who measures up and who doesn't.

If your clients want to use a practitioner who does not make the grade, they must be willing to pay more out of pocket to use that provider.

This is precisely what the Massachusetts Group Insurance Commission has done.

And is seems the docs are not happy.

In a lawsuit filed in Suffolk Superior Court, the (Massachusetts Medical Society) - which represents the state's doctors - alleges the commission's plan hurts physicians and patients.

The suit claims doctors capriciously ranked lower have been defamed, and that patients who have to pay higher copayments based on their doctor's ranking have been defrauded.

The patients are defrauded.

That's a gutsy claim.

Tiering has become a widespread technique for controlling healthcare costs. For example, many insurers have adopted tiered pharmacy benefits, with higher copayments for name-brand drugs serving as an inducement for patients to choose generics. Such structuring is credited with controlling spiraling drug costs.

But the tiering of physicians has proceeded more slowly. Doctors have fought the cost-control methods, particularly tiering plans that seek to rank individual doctors, as opposed to physician practices.

So, carriers and patients should pay the same price, regardless of the ability of the medical practitioner to treat medical conditions?

In other words, you should pay just as much for top level care as you would for a lower level of care.

Right.

Read More

Incredibly Stupid Carrier Tricks

Stupid carrier tricks has been a recurring theme at InsureBlog, proving that we are not shills for the industry that has provided us a way to make a living for a number of years. There are no perfect carriers, nor perfect industries for that matter. For the most part, the carriers get it right . . . except in areas of customer service.

And some times they do the right thing from a contractual perspective but forget that they could have made a better decision from a perspective of goodwill.

Customer service is virtually non-existent in the carrier world.

So far this year I have encountered more issues on relatively simple things that have frustrated my clients and taken up more of my time than is necessary. Here are some examples.

Carrier notifies client they have a dependent who appears to be aging off the plan. Client calls carrier asking when coverage will terminate and if their premium will change. Carrier promptly cancels coverage on ALL family members dropping the premium to $0. Client calls carrier who says "Oops!" and reinstates all family members . . . including the over-age dependent.

At this point the client calls me for assistance. I get involved and send an email followed by a call to the carrier. They (eventually) send me a form for the client to complete. It is a clean application that is to be completed (sans medical information) and the client is instructed to check the appropriate box to delete the over-age dependent.

The following month the dependent is dropped, retroactive by two months but the premium is not adjusted. We wait another month for premium accounting to catch up to the dropped dependent.

Nothing happens.

I start calling and emailing (again) the local manager about the issue.

No response.

I call and email, this time copying my client (so she knows I am working on the problem).

No response.

I call again, this time getting the manager instead of her voice mail. She apologizes and tells me I will be called within an hour with a response.

4 days pass and no word.

I call again. This time the manager sends me a terse email telling me that I am not to reveal her name to clients as a contact point for service issues.

This escalates the issue and I am finally told the problem will be resolved at the next billing cycle. If so, this means my client has overpaid some $65 per month for 4 months.

We are still waiting to see what will happen.

I am not holding my breath.

Situation number two involves a different carrier. My client (who is pregnant) wants to spin her husband and son off the current plan to a less expensive plan with the same carrier. She has been trying to accomplish this for 4 months on her own with no success.

She was not originally my client, but contacted me because I came recommended by another client. She names me her agent of record and I start to work on her problem. The carrier assures me this can be handled with a letter, requesting the dependent change.

Of course, they were only kidding.

Seems there is also a form for the client to sign, plus a form for their PCP to sign, before the change can be effected.

The change was finally effected . . . after 2 months with me working on it. Fast forward another month. The baby is born and is taken to the doc at 3 weeks of age for an initial visit.

Only problem, the baby is not on the plan. A call to the carrier from the doc's office and an hour later here is the result.

The carrier will only agree to add the baby to the plan if she signs a letter and faxes it to the carrier (from the doc's office) naming the carrier as agent of record (essentially firing me) and she gives them a credit card for $520 to cover adding the baby on for April and May.

All this for a $100 office visit.

She signs the letter and gives them a credit card.

Her next call is to me.

She wants to change to another carrier and this cannot be done quickly enough.

One more situation (even though I have quite a few I could relate).

Client applies for coverage with a high deductible ($5700). He takes Lexapro for anxiety.

The medication runs $83 per month.

They surcharged his premium by $96 per month.

Three months later, they came back and said they were only kidding. They are going to refund his $96 overcharge and lower the premium in future months.

At least, that is their story for now and they are sticking to it.

Read More

Incredibly Stupid Carrier Tricks

Stupid carrier tricks has been a recurring theme at InsureBlog, proving that we are not shills for the industry that has provided us a way to make a living for a number of years. There are no perfect carriers, nor perfect industries for that matter. For the most part, the carriers get it right . . . except in areas of customer service.

And some times they do the right thing from a contractual perspective but forget that they could have made a better decision from a perspective of goodwill.

Customer service is virtually non-existent in the carrier world.

So far this year I have encountered more issues on relatively simple things that have frustrated my clients and taken up more of my time than is necessary. Here are some examples.

Carrier notifies client they have a dependent who appears to be aging off the plan. Client calls carrier asking when coverage will terminate and if their premium will change. Carrier promptly cancels coverage on ALL family members dropping the premium to $0. Client calls carrier who says "Oops!" and reinstates all family members . . . including the over-age dependent.

At this point the client calls me for assistance. I get involved and send an email followed by a call to the carrier. They (eventually) send me a form for the client to complete. It is a clean application that is to be completed (sans medical information) and the client is instructed to check the appropriate box to delete the over-age dependent.

The following month the dependent is dropped, retroactive by two months but the premium is not adjusted. We wait another month for premium accounting to catch up to the dropped dependent.

Nothing happens.

I start calling and emailing (again) the local manager about the issue.

No response.

I call and email, this time copying my client (so she knows I am working on the problem).

No response.

I call again, this time getting the manager instead of her voice mail. She apologizes and tells me I will be called within an hour with a response.

4 days pass and no word.

I call again. This time the manager sends me a terse email telling me that I am not to reveal her name to clients as a contact point for service issues.

This escalates the issue and I am finally told the problem will be resolved at the next billing cycle. If so, this means my client has overpaid some $65 per month for 4 months.

We are still waiting to see what will happen.

I am not holding my breath.

Situation number two involves a different carrier. My client (who is pregnant) wants to spin her husband and son off the current plan to a less expensive plan with the same carrier. She has been trying to accomplish this for 4 months on her own with no success.

She was not originally my client, but contacted me because I came recommended by another client. She names me her agent of record and I start to work on her problem. The carrier assures me this can be handled with a letter, requesting the dependent change.

Of course, they were only kidding.

Seems there is also a form for the client to sign, plus a form for their PCP to sign, before the change can be effected.

The change was finally effected . . . after 2 months with me working on it. Fast forward another month. The baby is born and is taken to the doc at 3 weeks of age for an initial visit.

Only problem, the baby is not on the plan. A call to the carrier from the doc's office and an hour later here is the result.

The carrier will only agree to add the baby to the plan if she signs a letter and faxes it to the carrier (from the doc's office) naming the carrier as agent of record (essentially firing me) and she gives them a credit card for $520 to cover adding the baby on for April and May.

All this for a $100 office visit.

She signs the letter and gives them a credit card.

Her next call is to me.

She wants to change to another carrier and this cannot be done quickly enough.

One more situation (even though I have quite a few I could relate).

Client applies for coverage with a high deductible ($5700). He takes Lexapro for anxiety.

The medication runs $83 per month.

They surcharged his premium by $96 per month.

Three months later, they came back and said they were only kidding. They are going to refund his $96 overcharge and lower the premium in future months.

At least, that is their story for now and they are sticking to it.

Read More

(Extremely) Stupid Agent Tricks

[Welcome Industry Radar readers!]

We all do stupid things from time to time, but this one takes the proverbial cake:

"The insurance agency owner charged in the death of a state examiner initially consented to a search of his office and car but withdrew after police found areas on carpet and a computer cord that tested positive for blood."

Seems that the owner of Dilworth Insurance in Charlotte, NC was being investigated based on an "administrative complaint;" Sallie Rohrbach, the DOI investigator, went missing while conducting her investigation. At one point, "(e)ight armed law-enforcement investigators with the North Carolina Department of Insurance [joined] the search." Never heard of armed insurance investigators before (maybe that's a good thing).

Ms Rohrbach's funeral was this past Sunday. The 40-year-old agent, Michael Howell, has been charged with first-degree murder. The authorities believe that "her death is connected to her duties as an auditor."

Rest in Peace, Sallie.

[Hat Tip: IB reader Jeff Milne]

Read More

(Extremely) Stupid Agent Tricks

[Welcome Industry Radar readers!]

We all do stupid things from time to time, but this one takes the proverbial cake:

"The insurance agency owner charged in the death of a state examiner initially consented to a search of his office and car but withdrew after police found areas on carpet and a computer cord that tested positive for blood."

Seems that the owner of Dilworth Insurance in Charlotte, NC was being investigated based on an "administrative complaint;" Sallie Rohrbach, the DOI investigator, went missing while conducting her investigation. At one point, "(e)ight armed law-enforcement investigators with the North Carolina Department of Insurance [joined] the search." Never heard of armed insurance investigators before (maybe that's a good thing).

Ms Rohrbach's funeral was this past Sunday. The 40-year-old agent, Michael Howell, has been charged with first-degree murder. The authorities believe that "her death is connected to her duties as an auditor."

Rest in Peace, Sallie.

[Hat Tip: IB reader Jeff Milne]

Read More

The Graduate

No, not Benjamin Braddock & Mrs. Robinson.

Your graduate.

The one who just finished high school, or college.

Yes, that one.

Have you considered medical insurance?

Probably not.

That isn't high on the list of requests by the grad.

But here is a heads up.

Your college freshman has a few options, most of them are not good.

One option is to continue on the parents plan. Usually this is the most expensive option. Depending on how your health insurance is structured, you could be paying $300/month or so to cover your child.

There are less expensive options.

But the student health plan through college is one you probably want to bypass. Most of these plans are relatively inexpensive, but also lacking in benefits.

At least one carrier (Time) is promoting student health plans but this one also falls short.

The Time plan limits coverage to $100,000 for any single illness or accident and $1M overall. There is no coverage for outpatient Rx and pre-existing conditions are not covered for 12 months.

Actually, there is nothing wrong with any of these plans . . . until you actually need them.

Your college grad will run into the same situation, except coverage through the university is not an option.

They may also "age off" your family plan but with a COBRA option . . . usually in the $300+ range.

Your grad, high school or college, should have their own major medical plan. Not a student plan, or even an extenuation of the family plan.

Many times they can pick up exactly what they need for less than $100 per month. I have quite a few students as clients. The savings is significant and, unlike most student plans, they are not subject to arbitrary limits in coverage.

Read More

The Graduate

No, not Benjamin Braddock & Mrs. Robinson.

Your graduate.

The one who just finished high school, or college.

Yes, that one.

Have you considered medical insurance?

Probably not.

That isn't high on the list of requests by the grad.

But here is a heads up.

Your college freshman has a few options, most of them are not good.

One option is to continue on the parents plan. Usually this is the most expensive option. Depending on how your health insurance is structured, you could be paying $300/month or so to cover your child.

There are less expensive options.

But the student health plan through college is one you probably want to bypass. Most of these plans are relatively inexpensive, but also lacking in benefits.

At least one carrier (Time) is promoting student health plans but this one also falls short.

The Time plan limits coverage to $100,000 for any single illness or accident and $1M overall. There is no coverage for outpatient Rx and pre-existing conditions are not covered for 12 months.

Actually, there is nothing wrong with any of these plans . . . until you actually need them.

Your college grad will run into the same situation, except coverage through the university is not an option.

They may also "age off" your family plan but with a COBRA option . . . usually in the $300+ range.

Your grad, high school or college, should have their own major medical plan. Not a student plan, or even an extenuation of the family plan.

Many times they can pick up exactly what they need for less than $100 per month. I have quite a few students as clients. The savings is significant and, unlike most student plans, they are not subject to arbitrary limits in coverage.

Read More

And the Answer is: 42!

Well, that was Douglas Adams' answer, anyway. The question was: what's the answer to life, the universe and everything? A better question might be: how come so many people think nationalized health care is such a good idea? A common answer is that we'd do away with those eeeevil insurance companies, and that everyone would have access to affordable, competent health care.

Oh, yeah?

Better tell that to our Neighbors to the North©:

"Mark Degasperis was furious his mother spent five days on a stretcher at Toronto Western Hospital waiting for a room with 25 patients ahead of her ... Heather Degasperis, 60, has a dangerous bacterial condition and was sent by her doctor to Toronto Western because it has the experts for her condition."

Yet she spent almost a week without treatment, and was seen by a doc only after the newspaper called and raised a fuss. Still, dangerous waits and provider shortages are rare in the medical utopia, right?

Not so much:

"This is a terrible environment. I suggested taking her to another hospital, but we were told there are long waits across the region and the doctors we need are here."

Ooops!

Too bad Mrs Degasperis didn't know about CoverMe, the health insurance supplement for our Canadian friends:

"Concerned about the many medical expenses you’ll have to start paying for out-of-pocket because of the increasing gaps in your provincial health insurance coverage? ... With four different levels of affordable health insurance coverage to choose from, you’re certain to find the plan that meets your specific needs and budget."

That's right, folks Up North can buy insurance for their, um, insurance. Which begs the question: if nationalized health care is so good (not to mention "free"), how come they still need medical insurance supplements?

Oy Canada!

Read More

And the Answer is: 42!

Well, that was Douglas Adams' answer, anyway. The question was: what's the answer to life, the universe and everything? A better question might be: how come so many people think nationalized health care is such a good idea? A common answer is that we'd do away with those eeeevil insurance companies, and that everyone would have access to affordable, competent health care.

Oh, yeah?

Better tell that to our Neighbors to the North©:

"Mark Degasperis was furious his mother spent five days on a stretcher at Toronto Western Hospital waiting for a room with 25 patients ahead of her ... Heather Degasperis, 60, has a dangerous bacterial condition and was sent by her doctor to Toronto Western because it has the experts for her condition."

Yet she spent almost a week without treatment, and was seen by a doc only after the newspaper called and raised a fuss. Still, dangerous waits and provider shortages are rare in the medical utopia, right?

Not so much:

"This is a terrible environment. I suggested taking her to another hospital, but we were told there are long waits across the region and the doctors we need are here."

Ooops!

Too bad Mrs Degasperis didn't know about CoverMe, the health insurance supplement for our Canadian friends:

"Concerned about the many medical expenses you’ll have to start paying for out-of-pocket because of the increasing gaps in your provincial health insurance coverage? ... With four different levels of affordable health insurance coverage to choose from, you’re certain to find the plan that meets your specific needs and budget."

That's right, folks Up North can buy insurance for their, um, insurance. Which begs the question: if nationalized health care is so good (not to mention "free"), how come they still need medical insurance supplements?

Oy Canada!

Read More

Grand Rounds now available

Parallel Universes hosts this week's roundup of medblog posts. Dr Emer presents a "Top 5," followed by two dozen other interesting (and often provocative) entries.

Our friends at the Colorado Health Insurance Insider blog take a look at how some insurance carriers are pushing healthy lifestyle programs.

Read More

Grand Rounds now available

Parallel Universes hosts this week's roundup of medblog posts. Dr Emer presents a "Top 5," followed by two dozen other interesting (and often provocative) entries.

Our friends at the Colorado Health Insurance Insider blog take a look at how some insurance carriers are pushing healthy lifestyle programs.

Read More

Life Insurance Shenanigans

When does a life insurance policy pay?

When the insured dies.

Unless of course the insurer decides the policy holder bought too much insurance.

U.S. District court judge William Acker ruled that Mega life must pay $960,832 in death benefits plus interest.

Kellie Pieniozek, 23, of Calera, died Dec. 14, 2004, in a one-car accident in Shelby County. The Pieniozeks were driving home when a deer ran onto the road and Kellie Pieniozek lost control of the vehicle and struck a culvert. She died at Shelby Baptist Medical Center.

Donald Pieniozek's attorney, Roland Gamble, said Pieniozek attempted to claim a life insurance policy the couple took out in September 2004, but the company denied it because the insurance form listed Kellie Pieniozek's yearly income as $35,000.

Mega Life contended she made far less, as she was employed in a series of temporary jobs. The company would never have issued a policy with a high death benefit for someone with a smaller income, it stated in court documents. Mega Life's underwriting guidelines called for a death benefit 15 times the insured person's yearly income.

Nothing in the article confirms Mega's contention that Mrs. Pieniozek earned less than $35,000. Trying to fight a claim on a vague claim that the insured earned "far less" is shallow at best.

"That figure and the method it was arrived at were never questioned by Mega Life's underwriters until after the insured's accidental death," Acker wrote. "Mega Life perhaps, in its own interests, should have been more careful in establishing and enforcing underwriting guidelines."

More careful indeed.

Read More

Life Insurance Shenanigans

When does a life insurance policy pay?

When the insured dies.

Unless of course the insurer decides the policy holder bought too much insurance.

U.S. District court judge William Acker ruled that Mega life must pay $960,832 in death benefits plus interest.

Kellie Pieniozek, 23, of Calera, died Dec. 14, 2004, in a one-car accident in Shelby County. The Pieniozeks were driving home when a deer ran onto the road and Kellie Pieniozek lost control of the vehicle and struck a culvert. She died at Shelby Baptist Medical Center.

Donald Pieniozek's attorney, Roland Gamble, said Pieniozek attempted to claim a life insurance policy the couple took out in September 2004, but the company denied it because the insurance form listed Kellie Pieniozek's yearly income as $35,000.

Mega Life contended she made far less, as she was employed in a series of temporary jobs. The company would never have issued a policy with a high death benefit for someone with a smaller income, it stated in court documents. Mega Life's underwriting guidelines called for a death benefit 15 times the insured person's yearly income.

Nothing in the article confirms Mega's contention that Mrs. Pieniozek earned less than $35,000. Trying to fight a claim on a vague claim that the insured earned "far less" is shallow at best.

"That figure and the method it was arrived at were never questioned by Mega Life's underwriters until after the insured's accidental death," Acker wrote. "Mega Life perhaps, in its own interests, should have been more careful in establishing and enforcing underwriting guidelines."

More careful indeed.

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Memorial Day Carnival of Personal Finance

Canadian Dream hosts this week's edition of the Carnival of Personal Finance. There are a lot of posts, each one with a brief explanation.

For those of us who wonder (and worry) about what Social Security will look like a few years hence, Bob McDonald tells us that it may not be as bad as we think.

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Memorial Day Carnival of Personal Finance

Canadian Dream hosts this week's edition of the Carnival of Personal Finance. There are a lot of posts, each one with a brief explanation.

For those of us who wonder (and worry) about what Social Security will look like a few years hence, Bob McDonald tells us that it may not be as bad as we think.

Read More

Health Wonk Review at InsureBlog

We're delighted to host this week's edition of the Health Wonk Review.

To submit your post on "(h)ealth policy, funding, insurance, managed care, infrastructure, IT, the uninsured, economics and trends," click on over to Blog Carnival or drop us a line.

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Health Wonk Review at InsureBlog

We're delighted to host this week's edition of the Health Wonk Review.

To submit your post on "(h)ealth policy, funding, insurance, managed care, infrastructure, IT, the uninsured, economics and trends," click on over to Blog Carnival or drop us a line.

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Memorial Day Miracle...

Although Memorial Day is really about those who have served our country, I was quite intrigued by this story of a woman's near-death experience:

"A West Virginia woman is at the Cleveland Clinic after walking the line between life and death...[she] suffered two heart attacks and had no brain waves for more than 17 hours. At about 1:30 a.m. Saturday, her heart stopped and she had no pulse. A respiratory machine kept her breathing and rigor mortis had set in..."

By all accounts, and by current medical definition, Val Thomas was dead. But as her family met with doctors to discuss organ transplant harvesting, she "woke up and started talking."

There's video, as well:

[Video courtesy of NewsNet5]

She's currently at the Cleveland Clinic for observation.

Wow.

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Memorial Day Miracle...

Although Memorial Day is really about those who have served our country, I was quite intrigued by this story of a woman's near-death experience:

"A West Virginia woman is at the Cleveland Clinic after walking the line between life and death...[she] suffered two heart attacks and had no brain waves for more than 17 hours. At about 1:30 a.m. Saturday, her heart stopped and she had no pulse. A respiratory machine kept her breathing and rigor mortis had set in..."

By all accounts, and by current medical definition, Val Thomas was dead. But as her family met with doctors to discuss organ transplant harvesting, she "woke up and started talking."

There's video, as well:

[Video courtesy of NewsNet5]

She's currently at the Cleveland Clinic for observation.

Wow.

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Whose Insurance Does What during "DELAYED POSSESSION"?

Got this great question from Jennifer Allan, author of Sell With Soul today and thought the answer might be helpful.

Hey Dennis...

What's the deal when a home sells and closes, but there's a delayed possession - that is - the seller retains possession of the property for a few days past closing to move out?

If there's damage... which homeowners policy pays? The buyer's (who owns the property, but hasn't yet taken possession) or the seller's (who no longer owns the property)?

J

WOW! Great questions, Jennifer.

Homeowners insurance for the buyer goes into force to close escrow. After the closing, the BUYER owns and insures the house. Should there be damage to the home, it would fall on the BUYER'S insurance to cover the loss. The new owner would be responsible to pay the deductible. (there could be some stipulations in the RENT BACK AGREEMENT about that, but without some agreement to the contrary, that's how it would likely settle out.)

Loss to any contents of the SELLER (those items remaining while they move out) could be covered one of two ways.

1. Using the homeowners insurance for THEIR (the sellers) new home
2. Using Renters Insurance if they're moving to a rental

Most insurance companies offer at least 30 days of "EITHER PLACE" coverage. In other words, their stuff can be covered by their existing policy for up to 30 days in the old OR the new location. So if they're moving to another home, they will have homeowners insurance in place on that new home. If they're moving to a rental, they need to roll their old homeowners insurance over to RENTERS INSURANCE for the new residence at the close of escrow, In either case, the EITHER PLACE coverage still applies using the new insurance policies to cover their contents during moving.

If you have any questions, please call, write, email, signal flags, or smoke signals.... :)

p.s. My insurance company, which is available nationwide, offers additional location coverage without a time limit. In other words, your stuff is covered anywhere in the world -- PERIOD. Doesn't matter if you're moving, storing, vacationing, or stocking your Ski Chalet in Switzerland.

Point here being that not all insurance companies handle this situation exactly the same. Check with your local insurance professional to be sure.

It's a Good Life !

Dennis Volz Insurance Agency
10783 Jamacha Bl, Suite 1, Spring Valley, CA 91978
OFFICE: (619) 670-1000 - FAX: (619) 670-1121

eMail:mailto:Dennis@DennisVolz.com

Websites: Company Site: DennisVolzInsurance.com

Client Convenience Site: 6701000.com

My 'Other Blogs'
Working by Referral
Musings from California

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Healthcare Transparency: More Good News

It's not just commercial insurers and providers who've jumped enthusiastically onto the transparency bandwagon:

"The Bush administration [has launched] a $1.9 million advertising campaign touting its effort to rate hospitals and urging patients to check a government website before choosing one. "

Notice that these measures include not just price, but some two and a half dozen metrics. According to the Department of Health and Human Services:

"CMS [Center for Medicare & Medicaid Services] is adding information about the number of certain elective hospital procedures provided to those patients and what Medicare pays for those services. For the first time, consumers have the three critical elements -- quality information, patient satisfaction survey information, and pricing information for specific procedures -- they need to make effective decisions about the quality and value of the health care available to them through local hospitals."

Cool beans!

The site itself is pretty basic and easily navigable. It looks and works much like an insurer's "Find A Provider" page: you can choose to look by a procedure or condition, or by hospitals in your area. Kudos to the CMS folks!

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Healthcare Transparency: More Good News

It's not just commercial insurers and providers who've jumped enthusiastically onto the transparency bandwagon:

"The Bush administration [has launched] a $1.9 million advertising campaign touting its effort to rate hospitals and urging patients to check a government website before choosing one. "

Notice that these measures include not just price, but some two and a half dozen metrics. According to the Department of Health and Human Services:

"CMS [Center for Medicare & Medicaid Services] is adding information about the number of certain elective hospital procedures provided to those patients and what Medicare pays for those services. For the first time, consumers have the three critical elements -- quality information, patient satisfaction survey information, and pricing information for specific procedures -- they need to make effective decisions about the quality and value of the health care available to them through local hospitals."

Cool beans!

The site itself is pretty basic and easily navigable. It looks and works much like an insurer's "Find A Provider" page: you can choose to look by a procedure or condition, or by hospitals in your area. Kudos to the CMS folks!

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Questionable Healthcare Advertising...

We've seen some pretty, um, interesting advertising in the past, but this one takes the cake:

HealthPartners, a Minnesota-based healthcare provider, is a non-profit operation, but that doesn't necessarily mean a "non-humor" one.

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Questionable Healthcare Advertising...

We've seen some pretty, um, interesting advertising in the past, but this one takes the cake:

HealthPartners, a Minnesota-based healthcare provider, is a non-profit operation, but that doesn't necessarily mean a "non-humor" one.

Read More

John McCain's Health Insurance Scam

[Welcome Kaiser Network readers!]

This is not a political blog.

Well, maybe.

Sometimes.

But not really.

However, we received a "heads up" from Michelle Lange about Prez hopeful John McCain and his secret plan to change the way health insurance is bought and sold.

This article seeks to tie the future of McCain Health Insurance to the credit card industry.

Frankly, not only do they make a strong case, but a scary one as well.

Why do most of us send our credit-card bills to South Dakota or Delaware? The answer to that seemingly arcane question illustrates the dangers of replacing state regulation with no regulation at all. It also offers a cautionary tale about a little-understood provision at the center of John McCain's health care plan.

The details about the credit card industry are in the link, so I won't bore you with that portion of their argument. Let's just say the reason why banks prefer to offer credit cards from Delaware or South Dakota is because they can make more money by ripping off anyone with less than perfect credit.

So what does that have to do with health insurance?

Apparently Mr. McCain's proposal includes a provision whereby "families should be able to purchase health insurance nationwide, across state lines."

That is also a proposal put forth by NFIB.

How do I know?

I was contacted by two individuals who are high up in the organization a few months back. They wanted my feedback on their proposal to lower health insurance rates by making it possible for anyone to purchase across state lines.

Let's just say they were not pleased with my response, and decided I would not be a good mouthpiece for their misinformed proposal.

So why is it bad to allow individuals to purchase health insurance from another state, particularly if rates are lower than in their home state?

An insurance company that chose to be regulated under Arizona law could sell policies in New York without following New York rules. Arizona, like most states, lets companies charge what they want to people who are sick—or simply deny them coverage altogether. Under Shadegg's bill, insurers wouldn't even need to pick up and move their operations; it would be enough to file some paperwork with a state insurance commissioner and pay that state's relevant taxes.

New York requires carriers to cover anyone, including their pre-existing medical conditions.

Arizona does not.

The result is, NY residents pay much higher rates for similar coverage than those in AZ.

Why is that bad?

This is a zero sum game.

If all the healthy NY residents buy from AZ then only the sick ones are left in the NY pool. The result would be, fewer carriers in NY and much higher rates than they have now.

How is this a positive?

John McCain may know about the military and his wife knows beer, but that does not make either of them an expert on health insurance.

This is a dumb idea.

Read More

John McCain's Health Insurance Scam

[Welcome Kaiser Network readers!]

This is not a political blog.

Well, maybe.

Sometimes.

But not really.

However, we received a "heads up" from Michelle Lange about Prez hopeful John McCain and his secret plan to change the way health insurance is bought and sold.

This article seeks to tie the future of McCain Health Insurance to the credit card industry.

Frankly, not only do they make a strong case, but a scary one as well.

Why do most of us send our credit-card bills to South Dakota or Delaware? The answer to that seemingly arcane question illustrates the dangers of replacing state regulation with no regulation at all. It also offers a cautionary tale about a little-understood provision at the center of John McCain's health care plan.

The details about the credit card industry are in the link, so I won't bore you with that portion of their argument. Let's just say the reason why banks prefer to offer credit cards from Delaware or South Dakota is because they can make more money by ripping off anyone with less than perfect credit.

So what does that have to do with health insurance?

Apparently Mr. McCain's proposal includes a provision whereby "families should be able to purchase health insurance nationwide, across state lines."

That is also a proposal put forth by NFIB.

How do I know?

I was contacted by two individuals who are high up in the organization a few months back. They wanted my feedback on their proposal to lower health insurance rates by making it possible for anyone to purchase across state lines.

Let's just say they were not pleased with my response, and decided I would not be a good mouthpiece for their misinformed proposal.

So why is it bad to allow individuals to purchase health insurance from another state, particularly if rates are lower than in their home state?

An insurance company that chose to be regulated under Arizona law could sell policies in New York without following New York rules. Arizona, like most states, lets companies charge what they want to people who are sick—or simply deny them coverage altogether. Under Shadegg's bill, insurers wouldn't even need to pick up and move their operations; it would be enough to file some paperwork with a state insurance commissioner and pay that state's relevant taxes.

New York requires carriers to cover anyone, including their pre-existing medical conditions.

Arizona does not.

The result is, NY residents pay much higher rates for similar coverage than those in AZ.

Why is that bad?

This is a zero sum game.

If all the healthy NY residents buy from AZ then only the sick ones are left in the NY pool. The result would be, fewer carriers in NY and much higher rates than they have now.

How is this a positive?

John McCain may know about the military and his wife knows beer, but that does not make either of them an expert on health insurance.

This is a dumb idea.

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Cavalcade of Risk #52 is up and running...

Jason Shafrin, the Healthcare Economist, hosts this week's collection of risky posts. Don't miss the great example of risk mismanagement at the top.

There's very little risk involved in hosting your own Cav, just drop us a line to sign up!

Read More

Cavalcade of Risk #52 is up and running...

Jason Shafrin, the Healthcare Economist, hosts this week's collection of risky posts. Don't miss the great example of risk mismanagement at the top.

There's very little risk involved in hosting your own Cav, just drop us a line to sign up!

Read More

600,000 May Drop Health Insurance

[Welcome Industry Radar readers!]

According to a published report, as many as 600,000 people now covered by private health insurance could drop their coverage.

Why you ask?

Because they can get coverage for free, or at a much lower cost, by allowing the taxpayers to provide coverage.

Those most likely to drop health insurance?

The young, healthy individuals.

This will create an imbalance in the private system leading to an increase in premiums for those who keep private insurance. The additional drag on taxpayer funded plans will lead to deficits on that side, creating more cost shifting back to the private sector.

Dr Armitage estimated that even after a $600 million budget injection into surgery waiting lists, public hospitals would be $43 million a year worse off. Premiums would increase for those who stuck with private insurance, he said.

Those leaving private insurance would opt for Medicare instead.

But AMA president Rosanna Capolingua said it could be a signal to Australians that they could drop their private health insurance or not buy it in the first place.

It would lead to longer waits for elective surgery and other treatment.

"Those people who genuinely cannot afford (hospital cover) will actually be pushed further down elective surgery waiting lists," she said.

Oh yeah. I forgot to mention, this is in Australia.

Read More

600,000 May Drop Health Insurance

[Welcome Industry Radar readers!]

According to a published report, as many as 600,000 people now covered by private health insurance could drop their coverage.

Why you ask?

Because they can get coverage for free, or at a much lower cost, by allowing the taxpayers to provide coverage.

Those most likely to drop health insurance?

The young, healthy individuals.

This will create an imbalance in the private system leading to an increase in premiums for those who keep private insurance. The additional drag on taxpayer funded plans will lead to deficits on that side, creating more cost shifting back to the private sector.

Dr Armitage estimated that even after a $600 million budget injection into surgery waiting lists, public hospitals would be $43 million a year worse off. Premiums would increase for those who stuck with private insurance, he said.

Those leaving private insurance would opt for Medicare instead.

But AMA president Rosanna Capolingua said it could be a signal to Australians that they could drop their private health insurance or not buy it in the first place.

It would lead to longer waits for elective surgery and other treatment.

"Those people who genuinely cannot afford (hospital cover) will actually be pushed further down elective surgery waiting lists," she said.

Oh yeah. I forgot to mention, this is in Australia.

Read More

Why you need health insurance, redux

[Welcome Industry Radar readers!]

I was just talking with an employee of one of my clients. A few months back, she spent a day and a half in the hospital, having three vertebrae fused. The contracted price for the services? Almost $48,000. The price for the hospital's services as originally billed? Somewhat over $600,000. Her out-of-pocket cost? $250.

Let's see...

■ No insurance: $600,000

■ With Insurance: $250 (plus her portion of the insurance premium)

On top of that are her physician's charges, which are also not an insignificant amount.

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Why you need health insurance, redux

[Welcome Industry Radar readers!]

I was just talking with an employee of one of my clients. A few months back, she spent a day and a half in the hospital, having three vertebrae fused. The contracted price for the services? Almost $48,000. The price for the hospital's services as originally billed? Somewhat over $600,000. Her out-of-pocket cost? $250.

Let's see...

■ No insurance: $600,000

■ With Insurance: $250 (plus her portion of the insurance premium)

On top of that are her physician's charges, which are also not an insignificant amount.

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Diabetes + E. D. = Heart Disease

So what does diabetes and E.D. (erectile dysfunction) have in common?

A lot according to the Journal of the American College of Cardiology.

E.D among diabetic males is a "strong marker" for early heart disease.

Such men had twice the coronary heart disease incidence as those without erectile dysfunction (19.7 versus 9.5 per 1,000 person-years)

That's pretty significant.

While erectile dysfunction signals cardiovascular problems in the general population as well, the risk is "especially relevant to the diabetic population where erectile dysfunction is common

Diabetics often have circulatory issues, and E.D. is part of the same system.

Among the 291 men in the study, 40.5% reported erectile dysfunction in the year before detection of heart disease.

Good information to know.

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Diabetes + E. D. = Heart Disease

So what does diabetes and E.D. (erectile dysfunction) have in common?

A lot according to the Journal of the American College of Cardiology.

E.D among diabetic males is a "strong marker" for early heart disease.

Such men had twice the coronary heart disease incidence as those without erectile dysfunction (19.7 versus 9.5 per 1,000 person-years)

That's pretty significant.

While erectile dysfunction signals cardiovascular problems in the general population as well, the risk is "especially relevant to the diabetic population where erectile dysfunction is common

Diabetics often have circulatory issues, and E.D. is part of the same system.

Among the 291 men in the study, 40.5% reported erectile dysfunction in the year before detection of heart disease.

Good information to know.

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Googling for (Health) Info

We've all heard that phrase. You know the one, where you just can't believe what you've just been told, and your friend says "Don't believe me? Google it!" Well, those two little words are about to take on a whole new meaning.

Back in February, we reported on the search engine behemoth's plans to join other internet biggies in offering on-line storage of one's medical records:

"Thousands of patients at the Cleveland Clinic will be able to turn to Google to access their medical records online — everything from their prescriptions to diagnoses — in a pilot program announced Thursday..."

Now, that "pilot" has gone live, and national:

"Google Inc on Monday unveiled Google Health, a long-anticipated U.S. health information service that combines the leading Web company's classic search services with a user's personal health records online."

They've partnered with Walgreen's, CVS, even the aforementioned Cleveland Clinic. In addition to hosting your medical records, it's got a directory of local providers.

But the centerpiece of this effort is the actual warehousing of medical data. The EMR (electronic medical record) initially includes one's basic medical history, and is then updated as "things happen." The major difference between this model and ones already "in the wild" is that this record is actually owned by, and under the control of, the patient. This makes the record portable and easily accessible.

If there's a downside, it's the security aspect. As Bob reported a year and a half ago:

"medical identity theft is the last straw; after crooks steal their wallet and max out the credit cards, they turn to the health insurance card for even more freebies. "An insurance card is like a Visa card with a $1 million spending limit," says Byron Hollis, national anti-fraud director of the Blue Cross and Blue Shield Association."

Granted, Google has a major incentive to keep this info secure, but then again, so did the VA. It seems to me that the onus will be on Google to keep a tight rein on these files, and for participants to keep a close watch on their info, as well.

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