Baruch Atah Adonai Eloheinu Melech Ha-Olam Shehehchiyahnu vekiyamanu vehegianu lazman ha-zeh.
Blessed are You, Lord our God, Ruler of the universe, for giving us life, for sustaining us, and for enabling us to reach this season. Amen.
Saturday, July 3, 2010
A Wonderful Independence Day...
Baruch Atah Adonai Eloheinu Melech Ha-Olam Shehehchiyahnu vekiyamanu vehegianu lazman ha-zeh.
Blessed are You, Lord our God, Ruler of the universe, for giving us life, for sustaining us, and for enabling us to reach this season. Amen.
Friday, July 2, 2010
Would You Buy Health Insurance From This Man? [UPDATED]
Would you buy health insurance from this man?Here's the deal:
The long awaited Pre-existing Condition Insurance Plan (P-crap) has arrived. Well, almost . . .
You do not know what your benefits will be.
Obama says, no problem. Trust me.
You do not know what the rates will be.
No problem, trust me.
You do not know when or if you will be accepted.
No problem, trust me.
You do not know how long before the $5 billion allocated to this program will last and if more money will be made available or it will end like Cash 4 Clunkers.
No problem, trust me.
Taxpayer money has already been allocated by state. Once the money runs out new entrants will be put on a waiting list.
No problem, trust me.
If you are lucky enough to be granted admission to the pool, and can afford to pay the subsidized premium, there is no guarantee your doctor will be willing to treat you.*
No problem, trust me.
So if you apply in time, and if you are accepted into a plan where benefits and premiums are not disclosed, and if you can afford the premiums you could end up paying for coverage that is not worth the paper on which it is printed.
*Few details have emerged but in the planning stages consideration was given to reimbursement rates for providers. The consensus at the time was to follow Medicare DRG billing practices. In many cases, Medicare reimburses physicians and hospitals at a rate that is 20-30% less than what health insurance companies pay. While it is true that well over 90% of hospitals and docs accept Medicare assignment, most limit the number of Medicare patients they are willing to treat.
Medicare patients already face challenges finding a doctor that is willing to accept them as a new patient. One can only imagine the same will be true when newly covered participants flood the market with their PCIP cards in hand.
With an estimated 32 million uninsured individuals that could qualify for PCIP, if even 5% of those are accepted into the plan not only will this break the $5 billion bank but will lead to queues for medical services.
UPATE [HGS]: Piling on, as it were, to Bob's excellent take-down of "P-crap," this just in:
"Emergency rooms, the only choice for patients who can't find care elsewhere, may grow even more crowded with longer wait times under the nation's new health law ... That might come as a surprise to those who thought getting 32 million more people covered by health insurance would ease ER crowding."
But - as Bob's already pointed out - this is unlikely to be the case. So what's the real bottleneck? Regular readers won't be the least bit surprised:
"The biggest users of emergency rooms by far are Medicaid recipients. And the new health insurance law will increase their ranks by about 16 million."
Ah, that darned ol' Law of Un(?)intended Consequences. Try not to break it.
Friday Updates: Privacy and Solvency
FoIB Rick B tipped us that Anthem's recent security breach may have been a bigger deal than originally thought. Now comes word from California insurance blogger David Fluker that "more than 200,000 affected so far by the security breach of the Anthem Blue Cross Online Application Tracker."
Indeed, he points us to an article in the Orange County (CA) Register that reports "the confidential information was briefly accessed, primarily by attorneys seeking information for a class action lawsuit against the insurer." Ironically, these erstwhile "officers of the court" apparently jiggered the system in support of their own lawsuit against Anthem's (WellPoint's) online privacy standards.
Meanwhile, Mr Fluker (who's also an agent), tells us (and his clients) that, while "this security breach does not impact HIPAA applications (nor small group) ... This PDF file contains the full application information including PHI and financial information." Kinda scary. Interested parties should plan to check for updates at David's blog.
On the other side of the continent. FoIB Jeff M reports that Virginia's Department of Insurance has been hammering out a "negotiating agreement ... for the potential purchase of Shenandoah Life Insurance Company ... The 90-day exclusivity agreement with Prosperity Life Insurance Group, LLC, which may be extended, will afford the parties the opportunity to negotiate a definitive purchase agreement."
This is potentially a great outcome, because it puts the interests of the policyholders first (unlike some others).
The sale, and subsequent recapitalization, isn't yet a "done deal," but the sign are encouraging.
Indeed, he points us to an article in the Orange County (CA) Register that reports "the confidential information was briefly accessed, primarily by attorneys seeking information for a class action lawsuit against the insurer." Ironically, these erstwhile "officers of the court" apparently jiggered the system in support of their own lawsuit against Anthem's (WellPoint's) online privacy standards.
Meanwhile, Mr Fluker (who's also an agent), tells us (and his clients) that, while "this security breach does not impact HIPAA applications (nor small group) ... This PDF file contains the full application information including PHI and financial information." Kinda scary. Interested parties should plan to check for updates at David's blog.
On the other side of the continent. FoIB Jeff M reports that Virginia's Department of Insurance has been hammering out a "negotiating agreement ... for the potential purchase of Shenandoah Life Insurance Company ... The 90-day exclusivity agreement with Prosperity Life Insurance Group, LLC, which may be extended, will afford the parties the opportunity to negotiate a definitive purchase agreement."
This is potentially a great outcome, because it puts the interests of the policyholders first (unlike some others).
The sale, and subsequent recapitalization, isn't yet a "done deal," but the sign are encouraging.
Thursday, July 1, 2010
Stupid Carrier Tricks: Dental Edition
This morning's mail brought this gem from Companion Life (which markets non-medical products like dental and disability insurance):
"Companion Life ... is pleased to announce (that) it will accommodate young adults ... by allowing (them), up to age 26, to stay on their parent's group dental and vision plans in accordance with the [Un]Affordable Care Act ." [emphasis added]
The PP[U]ACA does no such thing:
"Generally, the "insurance market reform" provisions of PPACA, such as the ... requirement to cover dependent children to age 26 ...apply to "group health plans," which are defined as employee welfare benefit plans providing medical benefits."[emphasis added]
So what kinds of plans are specifically excluded from this definition?
How about:
"Benefits that are not an integral part of a group health plan. Examples of these benefits include limited-scope dental and vision benefits ..."
Full Disclosure: I have (happily) represented Companion Life for many years. But I also believe that this alone does not exempt them from being "called out," especially when they intentionally and proactively cave in on requirements which don't apply to them.
So why would a carrier willingly, indeed proactively, seek to labor under ObamaCare© rules? What do you think?
"Companion Life ... is pleased to announce (that) it will accommodate young adults ... by allowing (them), up to age 26, to stay on their parent's group dental and vision plans in accordance with the [Un]Affordable Care Act ." [emphasis added]
The PP[U]ACA does no such thing:
"Generally, the "insurance market reform" provisions of PPACA, such as the ... requirement to cover dependent children to age 26 ...apply to "group health plans," which are defined as employee welfare benefit plans providing medical benefits."[emphasis added]
So what kinds of plans are specifically excluded from this definition?
How about:
"Benefits that are not an integral part of a group health plan. Examples of these benefits include limited-scope dental and vision benefits ..."
Full Disclosure: I have (happily) represented Companion Life for many years. But I also believe that this alone does not exempt them from being "called out," especially when they intentionally and proactively cave in on requirements which don't apply to them.
So why would a carrier willingly, indeed proactively, seek to labor under ObamaCare© rules? What do you think?
Obamacare for Pre-Existing Conditions
The long awaited and much touted national risk pool for those with pre-existing medical conditions apparently is up and running. The folks in DC have even provided a website to learn about this Obamacrap provision.
When you go to PCIP.gov the site is well laid out. You can even switch from English to Spanish. Don't bother to click on the Spanish version unless you are a US citizen, or a naturalized citizen, or a non-citizen with a US Passport or a documented alien.
So what are the benefits of P-crap?
That just gives me warm and fuzzy's knowing it covers a broad range of health benefits. Don't you just know health insurance companies would have a field day by promising a plan that covers a broad range of benefits but doesn't really tell you what you get?
But of course the government can write their own rules and it doesn't have to apply to anyone else.
So how much does this broad range of benefits cost?
Are you following this?
You can apply for a plan with indeterminable benefits and an unknown premium. How many are ready to jump on that puppy?
Ready to sign up? Here is the link to the application.
To medically qualify for coverage you must have been uninsured for 6 months and have proof you have been denied coverage by an insurance company.
You may also qualify if you have coverage but your pre-existing medical coverage was excluded by a rider.
The folks in DC have allocated $5 billion to this fund. Even given you don't know what kind of coverage you will get or how much it will cost, $5 billion could fall short just like Cars 4 Clunkers.
P-crap is just another well intentioned but ill conceived idea from the folks who have steered the Social Security and Medicare ships into an iceberg.
Just another stupid government trick.
When you go to PCIP.gov the site is well laid out. You can even switch from English to Spanish. Don't bother to click on the Spanish version unless you are a US citizen, or a naturalized citizen, or a non-citizen with a US Passport or a documented alien.
So what are the benefits of P-crap?
The Program:
Will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available to you, even to treat a pre-existing condition.
Won’t charge you a higher premium just because of your medical condition.
Doesn’t base eligibility on income.
That just gives me warm and fuzzy's knowing it covers a broad range of health benefits. Don't you just know health insurance companies would have a field day by promising a plan that covers a broad range of benefits but doesn't really tell you what you get?
But of course the government can write their own rules and it doesn't have to apply to anyone else.
So how much does this broad range of benefits cost?
Premiums will vary depending on the state you live in. (But as an example, if you live in a state where the U.S. Department of Health and Human Services provides coverage, the premium for an age 50 year old enrollee may range between $320 and $570.
Are you following this?
You can apply for a plan with indeterminable benefits and an unknown premium. How many are ready to jump on that puppy?
Ready to sign up? Here is the link to the application.
To medically qualify for coverage you must have been uninsured for 6 months and have proof you have been denied coverage by an insurance company.
You may also qualify if you have coverage but your pre-existing medical coverage was excluded by a rider.
The folks in DC have allocated $5 billion to this fund. Even given you don't know what kind of coverage you will get or how much it will cost, $5 billion could fall short just like Cars 4 Clunkers.
P-crap is just another well intentioned but ill conceived idea from the folks who have steered the Social Security and Medicare ships into an iceberg.
Just another stupid government trick.
Buying Insurance PRN
Why pay for insurance when you don't need it? Apparently the folks in Massachusetts have discovered something interesting.
There is something to be learned here, but no doubt the rocket surgeons in DC are not paying attention.
Here is another clue.
In other words, since there is no real penalty (other than the nominal, slap your wrist tax) for delaying the purchase of health insurance until you need it, many do just that.
Buy coverage when they need it, drop it when they are healthy.
This is not gaming the system. Rather, they are simply playing by the rules set up by idiots who designed this system.
What if auto insurance worked this way? Suppose you were required to buy auto insurance and if you didn't you only had to pay a nominal tax.
Simultaneously, you were allowed to purchase auto insurance without penalty, at any time you needed it. If this were the case I see no reason to buy auto insurance on days when I am not driving my car. Even then, I would only buy it AFTER I had a wreck or my car was stolen.
Imagine how much money I could save.
Buying insurance PRN (only when needed) is a wonderful idea brought to you by those brain dead idiots we elected to manage the government.
Massachusetts requires carriers to use the same pre-existing condition limitations and waiting period rules in the individual market that they use in the small group market.
“Although health carriers always applied waiting periods or pre-existing limitations for individuals, they did not generally apply them for small employers, due to the administrative burden of doing so,” Welch and Giesa write in their Massachusetts individual health insurance market analysis. “Consequently, when the markets were merged, health carriers stopped applying waiting periods or preexisting condition limitations to individuals. Now individuals become covered from the effective date of purchase for all services.”
There is something to be learned here, but no doubt the rocket surgeons in DC are not paying attention.
Here is another clue.
The analysts found that the average number of covered individuals increased to about 107,000 in 2008, from about 46,000 in 2006.
The total number of “high-cost individual subscribers” – plan members with claims costs of $1,000 or more per month – increased to 7,185 in 2008, from 3,932 in 2006.
The percentage of individuals terminating coverage within their first year increased to 24% in 2008, from 14% in 2006.
In other words, since there is no real penalty (other than the nominal, slap your wrist tax) for delaying the purchase of health insurance until you need it, many do just that.
Buy coverage when they need it, drop it when they are healthy.
This is not gaming the system. Rather, they are simply playing by the rules set up by idiots who designed this system.
What if auto insurance worked this way? Suppose you were required to buy auto insurance and if you didn't you only had to pay a nominal tax.
Simultaneously, you were allowed to purchase auto insurance without penalty, at any time you needed it. If this were the case I see no reason to buy auto insurance on days when I am not driving my car. Even then, I would only buy it AFTER I had a wreck or my car was stolen.
Imagine how much money I could save.
Buying insurance PRN (only when needed) is a wonderful idea brought to you by those brain dead idiots we elected to manage the government.
