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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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