Monday, 10 December 2018

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Courtesy of FoIB Holly R:

Camp Fire kills carrier:

"The local Merced County Insurance Company — whose client base is overwhelmingly located in the wildfire-prone Sacramento Central Valley area — announced this week that it was closing shop because it can’t pay out the expected fire-related insurance claims."

Facing at least $64 million on claims, and with only $23 million of available assets, the company sought - and has received - bankruptcy protection. Fortunately for their clients, the California Insurance Guarantee Association (sort of like FDIC for insurance companies) will step in and cover their losses.

In an interesting twist, Dutch medical authorities have discovered medical ethics. Readers may recall our recent post about a Dutch doc in the dock:

"Dutch doctor faces first euthanasia prosecution"

Well, it seems that another of the country's traditions is about to expire:

"Two major Dutch hospitals say they will stop importing human body parts from American firms, which they have been doing without any regulation for a decade."

Parts is parts, as the saying goes, but apparently this practice was a bridge too far for even the Dutch:

"The move comes amid investigations by U.S. law enforcement into some so-called body brokers - companies that obtain the dead, often through donation, dissect them and sell the parts for profit. "

More details at the link.

  The Much Vaunted National Health Service© is also in the news for coming clean on their own little shanda:

"The family of a former soldier who took his own life have won a six-figure payout after NHS chiefs admitted a catalogue of failings in his care."

The 29 year old paratrooper, Aidan Knight, had served in Iraq for half a decade. He finally bailed, having "seen too much death." He'd been trying to get professional counseling for two months, unsuccessfully. In a case of "too little, too late," the MVNHS© has apologized and cut a cheque.

Better than nothing, one supposes.


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Friday, 7 December 2018

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77 years ago today:



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Thursday, 6 December 2018

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We're big fans of Health Savings Accounts and, more specifically, of true catastrophic major medical plans, which would be ideally suited for "wrapping around" Direct Primary Care subscriptions. Currently, DPC fees are not eligible for HSA reimbursement, and there are a lot of folks (myself included) who would like to see that corrected.

On the other hand, it turns out that what seems like a simple idea may not, in fact, be such a slam-dunk:

"A quick analysis of this bill by DPC docs was startling. This “simple fix” was suddenly no longer simple, and it wasn’t really a fix at all."

This was in response to new legislation, called the Primary Care Enhancement Act (PCEA), that has been bandied about the hallowed halls of Congress for a little while. Once it finally got through that meat-grinder, what came out was a stripped down, essentially useless bit of fluff without real-world application or benefit:

"DPC agreements could only include services represented by codes for “evaluation and management” office visits (CPT 99211-5). That means that Pap tests, wellness exams, simple in-office testing, strep tests, urinalysis, EKGs or any office-based procedures would need to be excluded."

Ooops. Again, the goal was to make more widely available a model that took obviously non-insurance services (pap smears, physicals, etc) out of the bloated (and unnecessarily expensive) ObamaPlans and put them back where they belonged: with the patient. By then allowing these fees to be run through one's HSA (just like contact lens solution and baby sunscreen) one's net cost is then reduced, making this an even more affordable option.

Alas and alack, it appears that this is not to be:

"The bill fixes the wrong Internal Revenue Code ... it makes DPC an exempted health plan ... [which] creates conflict in the 25 states that passed legislation declaring DPC is not a health."

/sigh

And that just scratches the surface of what's wrong with this ill-advised effort. Do click through for more gory details.

[Hat Tip: Dr Lee Gross]


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Wednesday, 5 December 2018

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From our friend Michael Bertau:

[click to embiggen]

This in response to a request for a comparison of Medicare reimbursement levels to commercial (private sector) carriers.

It's a very useful way to visualize what would happen under even the most rosy of M4A scenarios; that is, what physician in their right mind would agree to take that kind of financial haircut?

As Michael goes on to explain, "[i]t's more of a local question anyway. We've got quite a few safety net hospitals in our networks, for example, who are spending 70%+ of their bed/days on Medicaid/Medicare. That's quite a big hole in their finances to fill with private pay."

In layman's terms, it means that the current (imperfect at best) system is currently bailing out the gummint-run one. What happens when that "safety net" goes away?

And as long as we're piling on, there's this. According to the gentleman who actually did the study that's received the most attention:

"It is likely that the actual cost of M4A would be substantially greater than these estimates, which assume significant administrative and drug cost savings under the plan, and also assume that health care providers operating under M4A will be reimbursed at rates more than 40 percent lower than those currently paid by private health insurance.”

Oh.

[Hat Tip for Meratus link: Leo Perez]


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Tuesday, 4 December 2018

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■ Just a thought in clarification of Justice Roberts' ObamaTax observation:

[click to embiggen]



I'd never seen it explained that way before, but that is, in fact, pitch perfect.

■ Harv Randecker (of the National Association of Alternative Benefits Consultants) alerts us to some interesting HSA news:

"Disenrollment from HSA-Eligible Health Plans Increases Employer Health Benefit Costs"

That is, deleting these types of plans actually increases ESI (Employer Sponsored Insurance) costs:

"There is evidence that individuals who disenrolled from HSA-eligible health plans were more likely to have certain health conditions than those who remained enrolled in HSA-eligible health plans"

But is the cart pulling the horse?

"Individuals with multiple conditions were even more likely to disenroll"

It's certainly a possibility.

■ This is interesting: you know all those GoFundMe campaigns to help raise money for folks facing catastrophic medical bills? Well, FoIB Rob M warns the folks behind them to tread carefully:

"[M]any people on ACA exchange policies likely also utilize GoFundMe and other "Crowdsourcing" tools to raise money for their medical expenses even if they also receive ACA subsidies ...  some funds raised via GoFundMe accounts counted as taxable income*, that means they also may* count against your ACA subsidy eligibility." [emphasis in original]

That is, if you're worried about clawback (and you should be), then you need to be aware of this potential money trap.

And by the way, great catch there by our friend Charles Gaba.


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Monday, 3 December 2018

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Insurance Tips and trik auto insurance, auto insurance quotes, auto insurance companies, auto insurance florida, auto insurance quotes online, auto insurance america

So, working on an interesting, perhaps one-of-a-kind case:

Sally, 62 years young, has a very limited income, a few meds, and a need for health insurance. Fortunately, she qualifies for a substantial subsidy: so substantial, in fact, that one of the plans would cost her $0 in premiums [ed: Hi, Jeff!]. On the other hand, that plan has a substantial out-of-pocket liability of its own, to the tune of $7900, which represents a rather significant portion of her income were she to encounter a major, catastrophic expense.

And speaking of catastrophic expenses, one of the problems with the Direct Primary Care model has been the lack of plans to provide coverage for major claims (eg heart attacks and cancer treatment). On the other hand, it does offer affordable primary care (of course), and often includes deeply discounted prescription drug costs.

Well, it turns out that we may have our first legitimate "you got my DPC in my ACA" case:

We checked DPC Frontiers, and it turns out there are a couple of practices located near Sally, and with affordable rates (about $100/month). Coupled with that "free" ACA plan to act as the DPC "wrap," it looks like we have a winner:

Catastrophic coverage in case she gets hit by a bus, or cancer
Not defined by or limited to in-network doc's (other than, perhaps, specialists), and so not deterred by narrow networks
Perhaps my biggest DPC bugaboo is unnecessary (and costly) duplication of coverage, which this basically resolves
From what I have gathered, DPC doc's also have access to low(er) cost prescription meds, which obviates the need to ACA-plan rx coverage
Seems like a win-win to me.

Unfortunately, of course, this will continue to be the exception, rather than the rule, until we get true catastrophic plans back.




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