Hair Transplant Insurance

I have long resolved that there is nothing I can do to stop the loss of hair follicles, but some folks are willing to invest thousands of dollars in an attempt to look youthful. They pay someone to transplant hair from the back of their head to the front & top.

For sure, this is not medically necessary. I mean, you don't really NEED hair. It is just something to tease, style, color, cut and maintain.

Perhaps that is why hair transplants are not covered by health insurance.

But some folks think, and I know I will catch heat over this, that insurance should pay for testing and even treatment, just because you want to have a baby.

I am not one of those in favor of covering any fertility testing under an insurance policy but there are some in the Show Me state who want to make it a law.

one Missouri legislator is proposing a bill that would require health insurance companies to pay for infertility diagnosis and treatments.

"We spend millions upon millions of dollars trying to assist people, even in terminal situations with cancer, with a lot of different things," said the bill's sponsor, Rep. Steve Hodges, D-East Prairie.

So the logic behind this is, we spend all this money on terminal cancer patients, why not spend a few more to make babies.

OK, why not make it a zero sum game?

You can have fertility testing covered but we no longer cover treatment for terminal cancer patients. Anyone want to buy into that deal?

Seriously, there are only so many dollars to go around. For certain, you can pass laws requiring carriers to cover everything from removing splinters to brain transplants. The question is, do you really want that?

Every time something new is added the cost goes up for everyone.

But what about this bill?

This is not a proposal to cover the cost of IVF (in vitro fertilization), but rather a bill requiring carriers to cover testing of males to see if the reason why they cannot impregnate someone is because of low sperm count.

I am dead serious.

"Men that have concerns about their fertility don't always know where to turn," said Erma Drobnis, an andrologist at Columbia Regional Hospital. "And actually having a semen analysis at a fertility clinic is very simple, very noninvasive and not terribly expensive."

I have been out of the game for some time, and never had a problem siring children. But if the cost of a "semen analysis" is reasonably low, why do we need insurance to cover the cost?

So what causes a low sperm count?

Obesity, smoking and alcohol use can lower sperm counts. Researchers suspect the quality of drinking water as well.

"There was no relationship determined between (sperm counts) and actual pesticides in the water they were drinking because there was no study of even where they drank the water," Carlson said. "It was just a general statement that certain areas of the country, the Midwest, where there was more agricultural work going on, that there was more pesticides used, and therefore, it would be logical that some of that pesticide could be getting into drinking water."

So now for some good news.

No bills have been prefiled that deal with water quality in general or water as a root cause of infertility.

Now, about those hair transplants . . .

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Insurance by the Mile?

On a consumer-oriented online forum at which Bob and I frequently post [full disclosure: we've both received golf shirts for our "services" there], a poster recently brought up the idea of auto insurance based strictly on the number of miles driven. Neither Bob nor I are P&C agents, but we have enough knowledge of insurance principles to know that, when something sounds too good to be true, it often (usually?) is.

Another frequent poster, who happens to be a state insurance regulator, also weighed in with his opinion of the phenom. The three of us concurred that the scheme, while unique and interesting, had a number of flaws.

Briefly put, "insurance by the mile" is designed so that one signs up, and pre-pays for insurance based on the number of miles one anticipates driving for the next six months. These miles are audited, of course, lest one be tempted to "lowball" the company. There is apparently no other underwriting.

I probably wouldn't even blog on this had not alert IB reader Holly R sent me this link this morning:

"Bordoff and Noel have some common-sense proposals for encouraging pay-as-you-go insurance—most notably a tax credit to cover the initial cost to insurance companies of installing remote mileage-monitoring devices in customer's cars or setting up a network of odometer-inspection stations."

In other words, they like the idea, but implicitly question drivers' honesty as regards miles driven.

Hunh.

The TNR article contains another even more serious, if less obvious, error:

"This process, better known as adverse selection, is what causes individually-purchased health insurance to cost a lot more than a comparable employer-provided plan."

Nope.

As we've repeatedly pointed out here at IB, the only advantages to employer-based coverage are guaranteed issue and the "convenience" of payroll deduction. Individually underwritten plans for health folks are always less expensive than group (this may not seem obvious, until one recalls that the employer "subsidizes" the group premium).

Now, I have no horse in this particular race, but I would be very concerned about sharing the road with someone who didn't understand basic risk management, and how carriers determine risk and premium.

Methinks that there's a very good reason that there's only one carrier even testing these waters.

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Top 100: Again!

Back in September, we reported that IB had been selected by RN Central as one of their top 100 health care policy blogs.

Quite an honor, and we were grateful for that recognition.

This morning, we received word from the Radiology Technician Schools site that we'd been selected by them as a top 100 Best Health Care Policy blog.

And we're quite honored by that, as well.

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Swag Gone?

In a trend I'd like to see emulated by other industries (e.g. insurance), "the pharmaceutical industry has agreed to a voluntary moratorium on the kind of branded goodies — Viagra pens, Zoloft soap dispensers, Lipitor mugs — that were meant to foster good will and, some would say, encourage doctors to prescribe more of the drugs."

The new "regs" took effect on the 1st, and have met with both skepticism ("[s]ome skeptics deride the voluntary ban as a superficial measure") and optimism ("proponents welcome it as a step toward ending the barrage of drug brands and logos that surround, and may subliminally influence, doctors and patients").

It seems obvious to me that both positions have merit; that is, it's not likely to directly reduce health care costs all that much, but it's certainly a step in the right direction. The giveways themselves likely cost very little, but if doc's are more inclined to prescribe products whose manufacturers "bribe" them with pretty trinkets than perhaps equally effective generics, there's obviously going to be a drop in the overall cost of health care.

Of course, there are other "freebies" available to physicians; last summer, we noted that the AMA has an issue with vendor-sponsored Continuing Medical Education (CME). I'm still unconvinced that this is a major problem, but perhaps the new ban on tangible freebies will affect the intangible ones, as well.

As we've noted many, many times here, the cost of health care drives the cost of health insurance, and any reduction in either one is likely to be "a good thing."

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Blessed Event or Lucky Break: A New Year's Conundrum

[Editor's note: this post is not about abortion, per se, so please refrain from comments pro and con re: abortion rights]

First, Mazel Tov to British couple Gaynor and Lee Purdy on the birth of their son, Kai.

This was not necessarily a certainty:

"Gaynor Purdy was warned her first child could have a fatal chromosome defect and a life threatening heart condition...

Four months into the pregnancy doctors told them that part of their unborn child's heart was narrow and underdeveloped and would mean open heart surgery if the baby was born...

Further tests conducted a few days later on New Year's Eve suggested the baby could also have Edwards Syndrome - the presence of an 18th chromosome - with a life expectancy of only up to four months if birth is survived."

As the parent of two beautiful and healthy daughters, I can only guess at the fear and trepidation felt by the Purdy's as they faced this potentially disastrous outcome. Their doctors repeatedly urged them to abort the baby, which wasn't expected to survive more than a few months anyway.

And yet.

Kai was born a month and a half prematurely, and one side of his heart is somewhat enlarged (corrective surgery is anticipated). Still, he was discharged "from hospital" six weeks after birth, or about the time he would have been "discharged" naturally.

Now, we have the luxury of playing Monday morning quarterback, but I'm curious: in this incredible roll of the dice, and not knowing the outcome as we do now, did the Purdy's make the right choice?

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Grady's New Year Resolutions

One of the New Year resolutions for Grady Hospital in Atlanta is similar to what many of us pledge. The difference is, while we resolve to lose weight, Grady resolves to lose less money in 2009.

Not an easy task for a hospital that ended 2007 $67 million in debt plus owing another $63 million in debts, mostly to Emory University & Morehouse University who provide staffing via their medical schools.

Grady has already done quite a few things to stem the flow of red ink. They have eliminated non-emergency clinics that provided things like eye exams. They have cut back over 400 non-essential personnel.

What more can they do?

Well, they could start charging for services.

As the designated "charity" hospital, Grady delivers free or nearly free services to 250,000 individuals every year.

Most of these live in Dekalb or Fulton county.

The total population of Dekalb & Fulton combined is roughly 1.5 million residents. You don't have to be a math major to figure out that 1 in 6 residents in greater Atlanta are receiving services at little or no charge, courtesy of the taxpayer.

But how many of those are truly deserving of financial assistance?

We don't know for sure, but we do know that Grady recently notified 1400 people that they no longer qualify for free or reduced fee services.

Some of those who were "cut off" include . . .

One person receiving discounted care was found to have a $750,000 house, he said. Some students have been receiving free care by only submitting their county address, when they should be the responsibility of their parents, he said. Other people hide the fact that they have insurance.

The article does not say where this $750,000 home is but you can bet it is not Section 8 housing.

Right now, Fulton and DeKalb county patients who earn less than 250 percent of the federal poverty guidelines —- or $26,000 for one person annually —- can receive free medical care.

That seems rather generous to me. Apparently the board feel likewise because they are proposing changes to the qualificiations.

Under the plan, Fulton and DeKalb patients who earn between 126 percent and 200 percent of the federal poverty guidelines can receive a 60 percent discount on their bill.

Even if these proposals go through, they will still provide free or reduced care to those who are truly in need.

But of course these changes are not without opposition.

State Sen. Vincent Fort (D-Atlanta), a leader of the Grady Coalition, said the proposed changes would hurt uninsured working-class people already struggling to make ends meet. He said the changes will dissuade many from seeking care at Grady.

“If I know there’s going to be a big bill hanging over me, I may not go,” he said.
“People will die for lack of care.”

Vincent Fort has a panache for over-stating the situation.

None the less, Grady is resolving to change the way health care is paid for in Atlanta and it is about time. Heck, my home isn't worth $750,000 so why can't I get free health care?

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