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■ What if you could add collision coverage to your car after hitting that tree? Well, thanks to FoIB Holly R, we learn that health insurance startup Bind offers pretty much that for its self-insured corporate clients:

"Technology has made on-demand services a reality for everything from food deliveries to gym classes and car-sharing. What if you could have on-demand health coverage for big-ticket procedures like knee surgery?"

It does sound kind of 'too good to be true,' but it's apparently a legit service available to companies willing to take the leap. Bind in't actually an insurance company, but a third party administrator for some of UHC's self-funded groups.

Interesting.

■ Thanks to the folks at United Healthcare, we're privy to next year's new IRS limits for group and HSA-compliant plans:

"Maximum out-of-pocket limit for 2019 group plans:

•$7,900 for self-only coverage ($7,350 in 2018)

•$15,800 for family coverage ($14,700 in 2018)"

That's an increase of almost 10%, and of course the premiums will also be headed north, although we don't yet know by how much. There's a term for this: "unsustainable." And it makes alternatives like sharing ministries and Direct Primary Care (not to mention Short Term plans) more and more attractive.

On the other hand, maximum HSA contributions are increasing almost $50 a year for individuals. WooHoo!

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It can be difficult to pay for healthcare services not covered by insurance. #OnJuly1inTN a new law allows physicians to accept a barter of goods and services in exchange for healthcare services.

— TN Senate GOP Caucus (@tnsenategop) June 26, 2018

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■ First up, the joys of Government-run health "care," wherein the VA continues its #Winning ways:

"Secret data: Most VA nursing homes have more residents with bed sores, pain, than private facilities"

Sad and frustrating:

"More than 100 VA nursing homes scored worse than private nursing homes on a majority of key quality indicators."

Shanda.

[Hat Tip: ginny j]

■ Second, a report on one of the 58-state laboratory models (the concept of which I'm a big fan):

"Instead of starting with the hospital’s list price and negotiating down for discounts, [Montana] began telling these facilities how much it was willing to pay — a “reference price” — for each type of hospitalization."

In a kind of "reverse transparency," the state is using Medicare pricing as its benchmark, and so far it seems to be working:

"Two years in, the state calls the effort a success, saving $15.6 million this year over the estimate of what it would have paid without the change."

Will other states follow? That remains to be seen, but one wonders if the demographics here (Montana ranks in the bottom 15% in population) play a big part.

[Hat Tip: Elisabeth Rosenthal]

■ And finally, "Is The Cash Price The Best Price?" well, that certainly seems to be the argument put forth by DPC proponents (and others, of course). The idea is that paying cash for medical services actually results in lower out of pocket costs (although for those with insurance, there's additional paperwork to get those payments to count towards one's out-of-pocket).

The folks at Green Imaging think this is the way to go, though:

"[W]hile the idea of big health insurance companies negotiating lower prices with the hospitals sounds excellent on paper, the reality is that negotiated prices may be more expensive, sometimes much more expensive, than if patients simply had no insurance to begin with."

Or choose to skip using it.

There are, of course, downsides, including doing that negotiating oneself (which many folks are loathe to do).

Unfortunately, Dr Dickerson has missed one excellent reason to go this route: "paying cash" can also mean using one's HSA (or HRA/FSA) funds for an additional economic boost.

Too bad, really.

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I get this question a lot. "Does Medicare pay for routine physical exams? I hear they are not covered".

I don't know who started this rumor but I wish they would stop.

Original Medicare includes a "Welcome to Medicare" physical exam. As long as you have the exam within the first 12 months of going on Medicare Part B there should be no charge.

Thereafter you are entitled to what Medicare calls the Annual Wellness Visit. At this time your doctor will update your records, check your blood pressure, height and weight. There may also be a cognitive impairment test and / or a balance and mobility test.

Rather than making you read all this, sit back and watch this 3 minute video.

Additional reading here.

https://ift.tt/2MOOchJ

Medicare. 

You have questions. We have answers.

Never any charge.

#WelcomeToMedicareExam #MedicareRoutinePhysical #AnnualWellnessVisit

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Px as in pre-ex, as in Pre-existing conditions. We generally define these as health issues for which we are currently being treated, or have been in the recent past. As we know, ObamaCare requires health insurance plans to cover these immediately (subject to one's eligibility to buy a plan), and also forbids carriers from charging those with these conditions a different (ie higher) premium for the privilege.

Kind of like how auto insurers can't decline someone with 4 DUI's and 3 at-fault accidents, or charge them more than someone with a pristine driving record.

But what if the ObamaTax was itself a pre-existing condition?

That's the premise of this article in The Hill, tipped to us by a regular reader:

"As a physician whose career in medicine was dedicated to preserving and improving my patients’ health, I know firsthand how important it is for everyone to have access to care ... Before the ACA, having pre-existing conditions did raise the cost of health insurance — sometimes to unaffordable levels — for some Americans, and the key word here is “some.”

As we've pointed out over the years, the actual number of folks that were adversely affected by the ability of insurers to actually assess and rate risk was negligible. Dr Hayworth quantifies this for us:

"Their numbers were very few relative to our population of over 300 million, and we can make a rough estimate of less than 120,000 — that is, well under 4 people per 10,000 nationwide."

Now, for those few, the results were daunting, and expensive. But there were already plans in place (PCIP comes to mind). And these could be quickly re-implemented if, as Dr Hayworth urges, we let the market provide the cure. She offers 3 very specific steps to get that rolling, starting with eliminating all the fluff that plans are required to include, but which really don't neet the definition of insurance. And she also endorses a tried-and-true strategy of assessing carriers to fund risk-pools for those who need that coverage.

There's more, and I especially like the way Doc H presents her case in a straightforward way, without relying on scare tactics or sob stories.

Recommended.

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Allison Bell is one of my very favorite insurance journalists, and we've quoted her work quite often. Her work is typically first-rate: understandable, accurate and complete.

You just knew there'd be a "but" here, didn't you?

Recently, she posted an article on the cost of nursing home care depending on whether one was self-pay (including long term care insurance), Medicare and Medicaid:

"If nursing home owners had a choice, they might prefer to see Medicare patients come through the door."

That;'s because (apparently) Medicare pays nursing home about 60% more for nursing home care than private payers (including the aforementioned LTCi policyowners).

Which makes sense,, actually, since Medicare doesn't actually pay for long term care, which is where the nursing homes would then make up any shortfalls. And for short term, Medicare-elgible stays, it's unlikely that very many LTCi plans would pay a nickel, since most will have a 20 or 90 (or longer) day waiting period. It's also important to note that the criteria for Medicare reimbursement is quite different than what would trigger an LTCi claim, further reducing the number of those actually paid for such short term stays.

Now what would be interesting would be to include those newfangled short term care plans in this mix.

One wonders how they might fare.

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■ What's it all about, Alfie?

The Much Vaunted Naitonal Health System© is famous for its enthusiasm for infanticide, the most recent example of which would be the Baby Alfie Evans case. We noted at the time that, as usual, this wasn't really about health care dollars (pounds?) or delivery, it was about control, period:

"[I]n this case it's actually cost the MVNHS© more money to fight his being flown elsewhere for treatment at his parents' expense."

Ah, but how much more, you ask?

This much more:

NHS spent almost a quarter of a million dollars asserting its right to let this child die instead of allowing his family to take him to Italy at no cost to the British taxpayer

When they say it's time to die they mean it https://t.co/ypUW4jSkBa

— DaveinTexas (@DaveinTexas) June 17, 2018

Indeed they do.

■ O say can you see?

We've long been aware of the horrendous wait lists to which British *victims "patient's are subject, and now we have a picture-perfect metric of just how tragic that can be:

"Hundreds of people are going blind every year because of long waits for NHS treatment, medics have warned." https://t.co/Pas6vhg1pX via @TelegraphNews pic.twitter.com/KwoK4gmi6k

— Sally Pipes (@sallypipes) June 17, 2018

Spectacular.

■ Food Fight!

And now for something completely different: (alleged) insurance fraud and travel insurance. Seems that Brit's have found a veritable pot of gold across the channel:

"The number of bogus food-poisoning and gastric illness claims filed by Britons traveling abroad is reported to have reached epidemic proportions"

Turns out, it's been amazingly easy to file a claim on the travel insurance available with vacation packages, often just needing a copy of a receipt for a bottle of Imodium. The practice has swelled of late, to the tune of over 100 of these claims a day. Some of this has been due to the fact that it's often cheaper to settle than to fight .... up to a point.

That point, apparently, is now:

"Between 2013 and 2016, the number of allegations skyrocketed 500 percent  ... spurring some hoteliers in Spain and Turkey to threaten that they would suspend vacation deals from the UK market entirely."

I have a suggestion.

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