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Today's Long Term Care insurance (LTCi) plans generally max out at 5 or fewer years of claims, and at a certain dollar limit ("bucket of money" concept). But back in the day, one could buy a policy with no such limits; these were called "unlimited" plans.

We actually still have a couple of those on the books.

It's been a while since carriers have offered these, and one can imagine why.

But if you can't, then I recommend this item by FoIB Allison Bell over at ThinkAdvisor:

"[O]ne male policyholder who has received about $1.6 million in LTCI benefits, over a period of 9 years and 10 months."

This gentleman paid in about $56,000, and has (thus far) received almost 30 times that in benefits.

Heckuva deal.

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The days of unknown pricing when it comes hospitals may soon be a thing of the past if the Trump administration and CMS have their way.

CMS Proposed Rule 1694-P reveals the following.

requires hospitals to post their pricing lists online, accessible to patients in a "consumer-friendly" way, so that "patients understand what their potential financial liability might be for the services they obtain at the hospital, and to enable patients to compare charges for similar services across hospitals." - HKLaw

Hooray! Price transparency may soon become law. No longer will patients wonder about how much a procedure costs. One day soon, patients may be able to go online and see a price list like this.

Let's hope they don't have a weak heart!

Couple of observations.

• Price estimates for many medical procedures are already posted online, but few people bother to check. Why? Because in most cases, patients have very little skin in the game. Insurance carriers pay the lions share of medical bills, typically around 85% of the cost.
• Retail pricing is meaningless because no one pays list price. If you have insurance, and use par providers, your net (discounted) out of pocket is a fraction of list price. Those who have no insurance and no money pay almost nothing for their care.
• The proposed law assumes patients are looking for the cheapest care. In 40+ years in the health insurance business I have never had anyone ask where they can find the cheapest cancer treatment or the best deal on a used heart or kidney.

Rule 1694, if implemented, will initiall apply to Medicare and Medicaid patients only. This population is typically less computer savvy than younger people and those with more disposable income.

In much the same way that Obamacare was destined to bend the cost curve, increase access to health care and bring down health insurance premiums, it appears to me Rule 1694 could be dubbed Son of Obamacare.

#HealthCarePriceTransparency #Obamacare

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The Much Vaunted National Health Service© wins again.

For certain values of "win."

Alfie Evans dies after long-running legal battle as parents left 'heartbroken'

 

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When you want/need customer service, don't curse at the agent.

One would think that this is obvious, but yesterday a former customer called asking/yelling/complaining about an older long term care policy. But he didn't make that clear to the receptionist, who transferred the "gentleman" to an auto/home CSR, whom he began to berate and curse. She tried valiantly to ascertain what he needed, and finally understood that it was about his LTCi plan. She told him that he needed to talk to me, but that she wouldn't transfer him until he'd calmed down.

He continued to curse at her, so she hung up, and then buzzed me with a heads' up.

Sure enough, this rocket surgeon called back, and demanded to talk with me. I had already decided how to handle him. He immediately started in, insulting the CSR. I told him that I didn't appreciate his cursing my colleague, and that I would give him the phone number he needed and then I expected never to hear from him again.

At which point he very deliberately said "f*ck you" and hung up.

Without getting the information he needed.

Genius!

I have decided that if he calls back, he will be subject to my (just made up and completely arbitrary) $100 consulting fee, payable in cash, in advance.

Hope he calls.....

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Last year, we reported on a Wellmark insured who was running through $1,000,000 a month in claims. In that case, the patient was a hemophiliac, and his treatment was obviously quite expensive.

It never occurred to me to consider the third party in that scenario: the drug company that made and sold the med(s) used in that treatment.

Flash forward (almost) a year, and FoIB Holly R alerts us to another, similar case:

"Olive-McCoy, 44, has hereditary angioedema (HAE), a life-threatening disease so rare that many doctors have only read about it ... the price of just one of Olive-McCoy’s drugs will be about $600,000 this year ... she has received hospital bills for more than $1 million"

Oy.

So first, we certainly wish Mrs Olive-McCoy well, and hope that her continuing treatments prove successful. But this post isn't really about her: it's about how "Big Pharma" actually engages in a win-win strategy with cases like this.

And yes, there certainly are other such cases:

"Pharmaceutical companies donate to independent charities that cover drug co-pays and, in some cases, health insurance premiums so that financially needy patients such as Olive-McCoy can afford the best health-care plans and get the treatment they need to survive."

Very generous of them, but one wonders "why?" Companies are in business to make money, and are accountable to their stakeholders. So why all this charity?

Well, one reason would be good will: folks like and admire companies that engage in this sort of behavior.

For another, it's good business:

"Patients such as Olive-McCoy are extremely valuable to drug companies. Costs of treating rare diseases averaged $140,000 a year in 2016 ... a pharmaceutical company’s $1 million donation to a charity for patients with rare diseases can generate up to a $21 million return in drug reimbursements."

That's a heck of an ROI, no?

But so what? If the patient gets the treatment they need, at little or no cost, then what difference does it make if the company that provides that treatment makes out, too?

Well, that's a pretty picture, but leaves out a critical detail: none of this is "free;" that is, someone pays that $21 million.

Care to guess whom?

Not saying that's necessarily "a bad thing," but it is something to consider.

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I'm beginning to see why Direct Primary Care continues to remain a blip on the health care radar (comprising 3% of practices, it's basically a rounding error):

And when they realize that they could have gotten that MRI for $300 instead of $2500, along with their $7500 deductible (which they have never met because we encourage people to stay healthy) then you begin to see why price transparency is important and why insurance fights it. https://t.co/4GPXVsmBca

— John Chamberlain (@misterchambo) April 25, 2018

This is just silly: why would an insurance care how much that hypothetical MRI cost in this example? It's not like they're the ones paying for it. And if the insured has already met their deductible, the carrier has a vested interest in encouraging its insureds to find the lowest price.

I'm becoming less and less enamored of this health care delivery model every day.

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■ Shot:

Our friend Dr Emer Jose tips us to this breaking news:

"Drunk People Are Better at Creative Problem Solving"

That headline is, perhaps, a bit misleading, since the study sampled men exclusively. Still, interesting analysis.

■ Chaser:

From the "Where there's a will, there's a way" Department comes this heartwarming story of a vet whose male bits, which had been blown off by a roadside bomb while he was deployed in Afghanistan:

"Veteran receives penis and scrotum transplant in surgery doctors say is a medical first"

To be fair, this was the first surgery of its kind here in the US; nevertheless it's nice that, at least in this instance, our servicemembers are receiving decent care.

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Well, patient, anyway:

Recently, I've had two occasions to partake of the services of Dr Nava at Medix Urgent Care here in Warm & Cheerful Centerville (Ohio).

The first, a few months ago, was flu-related; that is, I had it, I finally gave in to The Better Half's "suggestions" and headed over. I had never been there before (to the best of my recollection, I've never been treated at any urgent care before) so I didn't know what to expect. After signing in, filling out the intake form and a scan of my ID and insurance card (I could have opted for cash, but chose not to), I had a short (maybe half-hour?) wait until I was seen. Dr Nava was warm and caring, and when I explained that my wife's Primary Care had diagnosed her with the flu less than 24 hours earlier, she knew the score. I collected up my Tammiflu scrip, and headed off to the pharmacy.

All-in, maybe an hour-and-a-half's time and I was back at home, in bed and recovering.

Last week, I developed a rather ugly stye on my eyelid. I really didn't want to seek medical attention for such a trifle, so I tried the warm compress thing. And the warm teabag thing. And the antibiotic ointment thing. When I found myself reaching for the x-acto knife I knew the time had come to return to Dr Nava (yes, we have a Primary care, but I really wanted to just get this done and over with as quickly as possible). She recognized me from my flu adventure, and took a look at the stye. When she learned that I'd been with the hot/warm compresses for at least 4 days with no noticeable results, she suggested we try brute force, and then a prescription anti-biotic.

A few seconds later, stye is mostly gone, and I have the ointment, and instructions to continue the compresses for a little while to make sure it's truly all cleared up.

I really can't say enough good things about Medix Urgent Care or Dr Nava. Great care, great folks.

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Identity theft has become an ever growing problem; most folks think it pertains primarily to credit cards and the like. But your Visa info isn't the only valuable item in your wallet: in an effort to stem the tide of health care fraud, the folks in DC have (finally) followed their own rules and changed the face of Medicare ID cards:

"Millions of people 65 or older will soon get new Medicare cards to prevent identity theft ... Social Security numbers aren’t being printed on the new cards. Instead, they will contain 11-digit personal identifiers with numbers and letters"

Which makes sense: previously, one's social security number doubles as one's Medicare ID (which became a big issue, too). As co-blogger Kelley poijnted out several years ago:

"According to the article, doctors do not need your social security number to bill. That is correct; however, we do need your social security number if you choose not to pay your bill and we have to turn you over to collections."

Yeah, those pesky doctors and wanting to get paid for services rendered. The point, though, was that folks were concerned about identity theft being helped along by having one's social security number on their Medicare card.

So here, at least, the government is addressing the issue, however late to the game it may be.

That's the good news.

The bad news is that nogoodniks have already begun to find ways to exploit this new development:

"But now con artists are cold calling seniors around the U.S. about the new cards ... trying to steal seniors’ Social Security numbers, bank account numbers and credit card information."

So what's the best way to fight these crooks?

Well, Indiana’s Senior Medicare Patrol program director Nancy Moore says "People need to know Medicare won't call you. They only operate via U.S. mail, but the scammers are very persistent."

Looks like "Just hang up" is the new "Just say no."

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A few weeks ago, we reported that the Much Vaunted National Health Service© had granted not-quite-two-years-old Alfie Evans a (temporary) reprieve:

"Alfie Evans’ Life Support Won’t be Switched Off, Delayed After Pope Francis Intervenes on His Behalf"

And it's critical to remember that his parents were willing to foot the entire health care bill themselves (likely with a little help from their friends).

Well, it seems that the poor toddler's time has, in fact, now run out:

"UK Supreme Court declines appeal from parents of ill toddler"

And so the plug will be pulled, and little Alfie will be gone (but certainly not forgotten by anyone with a heart).

Here's the thing: while reasonable folks could disagree about the utility of further treatment (he's "in a "semi-vegetative state" as the result of a degenerative neurological condition"), and it could further be argued that public health care dollars pounds would be wasted, in this case it's actually cost the MVNHS© more money to fight his being flown elsewhere for treatment at his parents' expense.

But hey: Free health "care."

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So, working on an interesting case for a long-time client. Doris is in her early 60's, has an existing Universal Life policy but is looking at replacing it with a new plan that would include both life and long term care coverage (please don't ask why she's replacing a perfectly good UL plan; she apparently has her reasons).

After some discussion, we've narrowed things down to 2 (well, technically 3) options. All include $250,000 of life insurance and $5,000/month of long term care benefits:

Option 1: Term life + Stand-alone Long Term Care (LTCi) plan

15 Year term + LTCi = $4,551/year, or
20 Year term + LTCi = $5,189/year

The stand-alone LTCi plan offers 3% inflation protection and is Partnership-compliant; benefits payable for up to 48 months.

Option 2: Hybrid Guaranteed Universal Life/LTCi has a 50 month benefit period, and is built on an indemnity chassis (no receipts or invoices to submit past the initial claim form). On the other hand, it has no inflation protection and is not Partnership-compliant. On the gripping hand, the life insurance pays someone if there's no long term care claim (to her age 120!).

There are a few other details, of course, but that's the gist.

So which option will she pick? I have no idea, but would be interested in our readers' prognostications (and feel free to explain why in the comments section below):

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And so has this month's Health Wonk Review, with a wonderfully fresh variety of posts on health care wonkery.

Louise Norris hosts, offering items ranging from "rumblings at CMS" (yay Silver plans) to the horrendous opioid crisis, not to mention the state of Medicaid (oops, mentioned!).

Do head on over for a great buffet of interesting topics.

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As previously noted, government-run health care schemes like the Much Vaunted National Health System©  have never really managed to rein in health care costs:

"It's kind of funny that their data actually shows real socialized medicine (UK NHS) has annualized cost growth higher than that in the US."

But co-blogger Mike tells us that they're at least trying (for certain values of "try"):

"Health leaders have written to Justice Secretary David Gauke urging him to reform the payout system for negligence claims against the NHS."

Seems that all those (costly) mistakes (such as leaving patients "dying prematurely in corridors") have begun to add up. A pound here, a pound there, and pretty soon you're talking real money:

[click to embiggen]

Yikes!

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Via email from our friends at Cornerstone regarding next year's individual health insurance market:

The Bureauweenies in DC© have published their "Notice of Benefit and Payment Parameters for 2019, " which includes another reprieve for Transitional ("Grandmothered") plans for another year, as well as info on:

• Qualified Health Plan (QHP) Certification Standards
• Exemptions
• Risk Adjustment
• Advance Premium Tax Credit (APTC) Program Integrity
• Special Enrollment Periods (SEPs)
• Medical Loss Ratio

Among other items. There's also additional guidance on those underwhelming SHOP plans (oh, goody).

Interested (or insomnia-stricken) readers may click here for the not-so-gory details.

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It was the best of times, it was the worst of times.

Benjamin Hynden had an abdominal pain and made an appointment to see his doctor. During the examination his doctor suggested a CT scan to look for abnormalities.

The radiologist didn’t see anything wrong on the images, and Ardesia didn’t recommend any treatment.
A few weeks later, Hynden, who has a high-deductible health insurance policy with Cigna, got a bill for $268. He paid it and moved on. - KHN

Three months later the pain returned. This time Dr Ardesia wasn't available so he saw a nurse practitioner. The NP, fearing possible appendicitis, told Benjamin to have a CT scan at the hospital.

The triage nurse told him the problem wasn’t his appendix, but she suggested he stick around for some additional tests — including another CT scan — just to be safe.

 “It was the exact same machine. It was the exact same test,” Hynden said.

The results were also the same as the October scan: Hynden was sent home without a definitive diagnosis.

But what happened next was a complete shock.

Total Bill: $10,174.75, including $8,897 for a CT scan of the abdomen

Things such as this happen every day. So how can you protect yourself?

Follow this link for the rest of the story.

It was the age of wisdom . . . .

#CTScan #MedicalPriceGouging  #Medicare  #ProviderNetworks

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What kind of dental coverage is included with original Medicare? Does Medicare pay for routine care like exams, cleaning and X-rays? Or crowns and bridges.

The answer is no.

No basic dental coverage. No routine exams. No cleanings or X-rays.

The next question is . . . why not?

Auto insurance doesn't cover routine items like tires, brakes and oil changes. Why do people THINK they need dental insurance to see a dentist?

I have no idea.

But maybe this will help.

The retail cost of dental and oral health care services varies widely, from practice to practice and from one geographic region to another. But according to one consumer website, a standard cleaning typically costs between $70 and $200. Dental X-rays can cost $250 or more. - Insurance News Net

Split the difference in $70 vs $200 and call it $185 for a routine exam and cleaning. With twice a year cleaning that works out to a little more than $30/month, stuffed in your mattress, to cover the cost of routine dental care.

Why does someone need insurance to "help pay for" something you could pay from petty cash?

Most individual dental insurance plan premiums run $25 - $45 per month. Almost all require you to use participating network dentists. They have annual limits of $1,000 - $1500. Major work like crowns, bridges and root canals are not covered until you have had the plan 6 to 12 months.

Does it make sense to pay $500 - $600 per year for a dental insurance plan you can only use with maybe 15% of the dentists in your area? When you finally do get to use it for major work it may only pay 30% of what the dentist bills.

You decide.

#Medicare #DentalCare #DentalInsurance

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So, underscoring once again that ("free") coverage ≠ care, the Brits' Much Vaunted National Health System©, FoIB Sally Pipes tips us to this item:

"Megan flew to Istanbul for private surgery late last year, having been told she faced long delays for an operation to fix the deformation of her spine, which was causing her problems breathing."

As we know, the bureauweenies who run the MVNHS© aren't too keen on the next generation, so I was actually surprised that the young lady was allowed to travel elsewhere for potentially life-saving treatment. Perhaps this was due more to the fact that she's Irish, not English.

And adding insult to injury, we learn that these kinds of national health care schemes don't actually rein in costs:

It's kind of funny that their data actually shows real socialized medicine (UK NHS) has annualized cost growth higher than that in the US. This is not something they much advertise, though (see Exhibit 5): https://t.co/YWWJtW3L0h

— Rob McMillin (@scareduck) April 10, 2018

Ooops.

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Back in late '16, we pointed out that "going bare" had begun to make sense since health insurance had become too expensive to use:

"It might be a ticket to get you into certain medical facilities, but in these days of narrow networks, it will keep you out of others."

Believe it or not, it's gotten worse:

"Obamacare is now so expensive it keeps patients away from their doctors"

And, I would add, their hospitals and specialists, as well.

As Heartland Institute's Justin Haskins points out:

"In a recent survey ... 47 percent of those surveyed said they chose within the past 12 months not to see a doctor or dentist for a routine checkup ... because of the high costs associated with healthcare."

But how could that be; after all, annual physicals are "free."

Well, except for that whole pesky thousands-of-premium-dollars-later thing.

And then there are the non-routine costs, with additional out-of-pockets in the thousands (often tens of thousands) of dollars.

The point, of course, is that the ultimate end-goal of ObamaCare has always been  Single Payer; by that metric, these unworldly prices are features, not bugs.

Definitely click through to read the whole thing.

[Hat Tip: FoIB David Fluker]

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Back in Aught Nine, we noted that "[a] group in British Columbia has offered medical waiting-list insurance to members whose government treatment is on hold."

Well, turns out that the folks in charge of Canadian health "care" haven't taken too keenly to these kinds of work-arounds:

"The B.C. government has moved against doctors who engage in illegal extra billing, enacting a law that aims to end queue-jumping by patients who pay to fast-track access to publicly funded medical care."

What makes this so funny ironic is that the province leads the country in these types of practices.

For now.

Which may be good news for American providers, no?

[Hat Tip: Sally Pipes]

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Almost exactly a month ago, we reported on the Much Vaunted National Health Service©'s latest infanticide effort:

"Alfie Evans, a 21-month old Brit, has been fighting hard for his young life. But the Powers That Be at the MVNHS© are (literally) pulling his plug"

Now comes word that thanks (at least in part) to Pope Francis, he's been given a reprieve:

"Alfie Evans’ Life Support Won’t be Switched Off, Delayed After Pope Francis Intervenes on His Behalf"

Keep in mind, of course, that the MVNHS© has ultimate authority in these cases, even when the parents offer to pay for his care outside the system.

Let that sink in, Single Payer advocates.

[Hat Tip: FoIB Moxie Mom]

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We've talked about transparency, Direct Primary Care, and other strategies to try to rein in health care costs. But this item, tipped to us by FoIB Holly R, may just be the most effective method yet:

"Need a medical procedure? Pick the right provider and get cash back"

Most of us are likely familiar with the "Find a Provider" button on our carrier's website, or a referral from one's Primary Care doc, and these can indeed be money savers. But until now, I'd never heard of a plan that actually pays you cash on the barrel-head to choose a specific facility.

Now, there's always the question of quality vs cost, and that's a valid concern. But one would think that negative feedback about any given provider would be taken into consideration buy the insurer (or not).

Nice to see more outside-the-bun thinking.

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■ We've made the case that "going bare" can certainly be a rational choice:

"There are necessities of life, but insurance is not one of them."

But what' s it actually like making (and living with) that choice?

Well, FoIB Bill M points us to this rather interesting (and, I must say, relatively balanced) article on just that:

"While these people are among [those] who remain uncovered ... their stories transcend politics, reflecting tough kitchen-table decisions about health care faced by many families."

Interesting and thought-provoking.

■  Second up, FoIB JefF M (no relation) seems to have problems with the idea that health insurance rates have decreased buy some 3000%:

"States scramble to avert Obamacare sticker shock after Democrats balk at stabilization effort"

And by stabilization, they mean "throwing more money at it."

■  I can see no possible way for this to go wrong:

California Senate Bill would outlaw short-term health insurance 🤔#SB910 #California #STM #HealthInsurancehttps://t.co/I9coXHu8yX

— David Fluker (@FlukerDavid) April 3, 2018

■ BONUS ITEM: Co-blogger Bob V tips us to this interesting story on why folks choose - often at their own peril - whole life plans. What's special about this is that Burt is an industry giant, and knows where of he speaks:

"Why didn’t Burt sell us whole life?”

Spoiler Alert: He tried.

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So, an interesting confluence of seemingly disparate health care financing lawsuits. First, the Golden State is suing an outfit called Sutter Health for a number of issues, including "[g]ag clauses on hospital prices, 'All-or-nothing' contracts, [and] 'Punitively high' out-of-network charges."

I think it's safe to say that other provider networks and hospitals are watching this case very carefully, since it's likely that Sutter isn't a "lone wolf" in this. And of course, with all the mergers and hospital acquisitions the past few years, there are quite a few communities that have only one or two such organizations, and thus little (or no) competition to keep their prices in check.

Speaking of hospitals and pricing, our second story involves a concept called "reference-based pricing." Briefly, this is where an employer enters directly into a contract with a hospital (or other health care provider, one supposes, including DPC). This has some important advantages for the employer (else why would they bother?), but can carry additional risks, as well, namely balance billing. This is where the provider charge the patient/insured the balance between what's billed and the amount the insurance company pays. In a regular PPO-model insurance plan, this is verboten, but since this is a direct relationship  between the employer and the provider, it's perfectly legal (although apparently frowned upon).

And here's where that risk can become a real problem:

"The conventional wisdom is that this is rare ... And if balance billing does occur, it is easily resolved via a little back-and-forth negotiation between the hospital and the third-party administrator or employer. "

And that, your honor, is when the fight started.

[ed: one wonders, also, if that backroom "negotiating" isn't full of potential pitfalls and perils as well, including anti-trust and discrimination issues]

The thinking had been that no provider is going to risk the bad press that would come with suing a patient. But in this case, that thinking is wrong. Now it may have something to do with the size of the (balance) bill: over $80,000. But it also may be related to the phenomenon we noted above: that is, if you're the only game in town, then why would you care about bad PR?

Something to consider, no?

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I'd forgotten this:

sabotage - n. when Republicans make Obama’s 2010 health care plan look like his 2008 health care plan.

HT: RT @greg_fann

https://t.co/NSjCexNrgj

— Michael F. Cannon (@mfcannon) April 2, 2018

Nice.

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