You say STOLI, I say STOA

Earlier this year, we posted on a fairly sophisticated scheme that seems to have cost at least one insurer a pretty penny:"For example, one participant (it's really difficult to call her a "victim," since she profited, as well) was dying from stomach cancer when she "saw a flier from what appeared to be a Catholic charity, says her husband, Dan. Mr. Bulpitt says the family of four was on food stamps...

ACO's Revisited: Connecting the Dots, Part 1

And so the end-game is revealed:■ Data Point 1:"A new survey demonstrates that very few doctors believe that government reform plans for the health care system will improve patient care .... 500 general practitioners and 500 hospital doctors ... found that only 22% believed the health service will be able to keep improving efficiency while implementing the planned changes ... only a quarter of those...

Cavalcade of Risk #117: Call for Submissions

Ironman hosts next week's Cavalcade of Risk. Submissions are due this Monday (the 18th). Please remember to include:■ Your blog's url■ Your post's url■ The post's trackback URL (if available)■ A (brief) summary of the postAnd PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).You can submit your post via Blog Carnival or ema...

ObamaCare© vs Health Care (Costs, that is)

In our Medicare Shanda post yesterday, we explored how ObamaCare© really doesn't do much to actually rein in costs, focusing on how little transparency there is in allocating Medicare funding. But there's another facet we've previously explored, that of whether or not regulating insurance rates would actually help rein in the cost of health care.As we suspected, not so much:"Consumers, by and large,...

Health Wonk Review: Ghosts and Goblins edition

The New Health Dialog blog presents this week's roundup of scary-smart posts, including Skittles and Zombies.Check it out - if you da...

More on "Free Advice"

As we noted earlier this year, the actual administration of a Health Savings Account can pose some interesting challenges. That's why we recommend a local expert to our own clients, and why I'm a proponent of the "you get what you pay for" school of thought.A recent personal experience has only underscored the importance of that advice. For many years, we were covered under my spouse's group insurance,...

Medicare Shanda

"Shanda" is a Yiddish word meaning "scandal" (it also implies shame and embarrassment). And it's an entirely appropriate description of how the AMA should feel. Although it purports to represent all physicians, its membership comprises fewer than 1 in 5 of them. Yet it wields power completely out of proportion to its membership:"Three times a year, 29 doctors gather around a table in a hotel meeting...

(Low) CLASS Act

One of the stated reasons for John Hancock's recent rate hike on some of its Long Term Care (LTCi) business was its large book of government-employee business. No surprise, but apparently gummint workers generated far more claims than anticipated.So what, you ask?So this: we've mentioned the so-called CLASS Act (part of ObamaCare©) before, but missed an important point. As Avik Roy points out:"Another...

Obamacare Taking on Water

The SS Obamacare is barely out of the harbor and is already taking on water. Last month HHS was forced to grant Obamacare waivers to 30 companies including McDonald's restaurants. The waivers will allow those companies to bypass some of the mandates in Obamacrap and continue to offer limited benefit health insurance plans to thousands of their employees.Now it appears HHS it poised to cave on other...

Grand Rounds: Lesson Learned edition

The Spice Island blog hosts this week's roundup of touching and intructional medblog pos...

$2000 and out...

It shouldn't take a sitting Democrat Governor to make this obvious connection, but maybe it's for the best:"For a person starting a business in 2014, it will be logical and responsible simply to plan from the outset never to offer health benefits ... the eventual penalty for not providing coverage, of $2,000 per employee, is still far less than the cost of insurance it replaces."We've made this same...

LTCi: Another reason to buy

Many folks reason that Long Term Care insurance is an unnecessary expense because they have family members who will care for them. And it's true that for non-critical, maintenance-level care, this is an obvious choice (assuming one's children or sibling's are amenable to the idea). What's not so obvious, though, is the cost to the caregiver:"About 73% of the primary caregivers – and 40% of the secondary...

From the mailbag: Retirees and Dependents

From a reader:"My spouse is a retiree of [a well-known financial institution]. We are both in our late 50's and on [the former employer's] group health insurance. Our daughter turned 24 last Spring, and "aged off" our insurance due to that event. We were told by the [former employer] in August that she could be added back during open enrollment for coverage effective 1/1/2011 under the new provision...

Blues Cross MFN

In the insurance world, MFN (no, that's not an acronym for something dirty) means "Most Favored Nation," a term usually reserved for international trade agreements. In this case, it's an agreement between an insurer and a provider (or many providers) which grants the insurer exclusive and substantial discounts on medical services. These are generally perfectly legal, but - as Blue Cross of Michigan...

BREAKING: Blue Cross gets greedy, slapped

My father used to have a saying about the stock market: bulls make money, and bears make money, but pigs go to market. Meaning, "don't be greedy." But that's apparently just what's happened with Michigan Blue Cross Blue Shield:"The Justice Department alleged Monday in a lawsuit that [the carrier] is discouraging competition by engaging in practices that raise hospital prices ... The suit targets "most...

ACO's: Accountable Care Organizations and Keeping Your Doc

Once again, we're delighted to present our favorite Medical Office Manager Kelley Beloff. Regular readers know that she brings to the table a unique perspective, and is willing to share with us some of the "backroom dealings" of health care. This time out, she reports on the devastation that looms ahead due to ObamaCare©'s new rules on Accountable Care Organizations:Several months ago, Hank and I...

Cavalcade of Risk #116 now online

LexisNexis Top Workers Comp Blogger Julie Ferguson hosts this week's roundup of risky posts. As usual, Julie does an outstanding job of keeping things simple and interesting. And be sure to check out the commercia...

Agent to Blue Cross: "You're fired!"

A very compelling and well-written post by California insurance agent David Fluker. Here's a sample:"After due and careful consideration I have decided to eliminate offering for sale any Anthem Blue Cross HIPAA or underwritten individual & family coverage plans after today. This was not an easy decision to make ... Anthem Blue Cross of California has demonstrated erratic, inconsistent, irregular...

If you like your (Medicare Advantage) plan, you can keep it. Not:

From email:"Did you know that the 236,000 displaced Private Fee for Service members nationwide are eligible for an SEP (Special Election Period) and can enroll now?"This is an announcement (from Anthem) about the upcoming Special Election Period (no, not that election - although it's relevant); HHS Secretary Shecantbeserious has ordained this unique opportunity for folks being booted from their preferred...

Boeing, Boeing, Gone?

Aircraft manufacturer Boeing announced Obamacare has caused them to cut benefits and increase premium contributions. While Obamacrap is not the only reason, it was given at least partial credit. According to the folks at ABC News:Boeing said deductibles and copayments are going up significantly for some 90,000 nonunion workers.The company cited three major reasons for the cost shift, including untamed...

Constitution State Rate Spike

Once again, HHS Secretary Shecantbeserious has proven herself to be quite fangless in her efforts to cajole insurers into artificially suppressing rates:"[Connecticut]'s largest insurer has been approved to raise health premium rates by 41 percent to 47 percent for some of its policies sold to individual buyers..."The good news is that the bulk of Anthem's business in the state will experience only...

More from the "Real World" files

A very nice young lady called the other day, looking for individual health insurance. She's a student at a local university, on her own at the tender age of 18. Her mother has moved out of state, and for a number of reasons, Karen [ed: not her real name] can't be on mom's plan. She is eligible for the university's health plan, but is (understandably) not enthused. She'd really like to have a real...

Ch-Ch-Changes, ObamaCare© style

As we move further out from September 23rd, the state of the individual health insurance market continues to crystallize. Here's what we know as of this morning (October 18, 2010).Plans that have "grandfathered" status are subject to some (but not all) ObamaCare© provisions. Of course, it's likely that these plans will quickly lose this vaunted status as insureds make changes to keep their plans affordable....

About that Individual Mandate (Video)

As we've long noted, the Individual Mandate is evil. The folks at Amendment63 show us why:[Hat Tip: R...

Obamacare© and Your W-2: An Update

From reliable sources:It appears that the requirement to report -- set to begin next year (2011) -- is voluntary only for that year. It's anticipated that the IRS will provide more guidance in the future, including clarity for 2012 W-2s. It's also anticipated that it will rain unicorns.What this (probably) means:■ If an employee leaves in, say, March 2011, the employer doesn't have to provide the...

Cavalcade of Risk #116: Call for Submissions

Julie Ferguson hosts next week's Cavalcade of Risk. Submissions are due this Monday (the 18th). Please remember to include:■ Your blog's url■ Your post's url■ The post's trackback URL (if available)■ A (brief) summary of the postAnd PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).You can submit your post via Blog Carnival or ema...

In Memorium: Bye, Papa

[ed: This post is in loving memory of Robert (Bob) Keller, who passed away yesterday, 10/13/10]I suspect that most readers will wince when I mention "The Brady Bunch;" the theme song is an almost tribal memory for most of us. In "real life," of course, blended families don't always (or frequently) actually "blend." Because of his indomitable spirit and bottomless heart, my step-dad, Bob Keller, managed...

The People v ObamaCare©: This just in...

A Florida judge has ruled that the 20 of the 57 states may, in fact, continue pressing their lawsuit against ObamaCare©:"U.S. District Judge Roger Vinson ... said the case would continue as scheduled. He had previously set a hearing for Dec. 16."Not much more than that right now; interested readers may peruse the decision he...

Health Wonk Review: Rescue Me Edition

Our favorite health care economist, Jason Shafrin, hosts this week's wonky round-up. Jason asks (and answers) the question "What do the Chilean miners have to do with health policy blog...

ObamaCare© and Your W-2: In the news

This is how the IRS characterizes the health care/W-2 kerfluffle:"The Internal Revenue Service (IRS), an arm of the U.S. Treasury Department, has decided to include health expense codes that employers can use, but do not have to use, in the draft version of the 2011 W-2 wage tax withholding form." [emphasis added]Gee, thanks fellas.I find that ironic because of this:"The IRS on Tuesday announced it...

Stupid Government Trick: Hit a cop, Sell a Policy

We had to go back all the way to our very first year (2005!) to find an idea this reprehensible:"On at least six occasions, state Chief Financial Officer Alex Sink approved felons’ applications to sell insurance in Florida."Ms Sink, currently running for Governor of the Sunshine State, presently serves as the state's Chief Financial Officer. It's not just that her office thought this was a good idea,...

Old Dog, New Trick: Apologia

Years ago, Saturday Night Live featured a funny sketch called "Common Knowledge," the point of which was to show that a lot of what we think we know is, in fact, wrong. This past summer, in one of my posts about Ohio's new ObamaPool©, I inadvertently mis-characterized how renewal rates are calculated in the individual market. I said:"by law, carriers can't single out individual insureds for rate increases"Turns...

A spoonful of sugar...

Perhaps it's all in one's perspective:"Growing numbers of Americans with health insurance are walking away from their prescriptions at the pharmacy counter, the latest indication that efforts to contain costs may be curbing health-care consumption."The Journal's thesis is that, because folks have higher co-pays and/or deductibles, they can't afford to pay as much for their meds.I think it's something...

How Will the Insurance Company Find Out?

"If I don't tell the health insurance company about (name any illness), how will they find out?". I always cringe when this question comes up. Got a call like this today from a former client.I say former because he bought health insurance from me a few years ago, including maternity with no waiting period, so his wife could get pregnant.She did, she delivered, he dropped the coverage.Then last week...

ObamaCare© Travelin': Medical Tourism under PPACA

Steven Lash, President of Satori World Medical, thinks that there's a silver lining in ObamaCare©: it's his belief that it will continue to fuel, and in fact increase the demand for, medical tourism. He bases this belief, in part, on the fact that this train-wreck has already begun to show the stress fractures in our system as a result of increased demand without adequate supply.With Steven's permission,...

Retro Risk Reduction

It's tempting to think that the long, heavy "big metal" cars of bygone eras were safer than today's smaller versions. Take, for example, the venerable '59 Chevy Bel Air, its 211 inches weighing in at an impressive 3225 pounds. At the other end of the spectrum, last year's Chevrolet Malibu which, while actually a bit heavier (by about 200 pounds), is about 20 inches shorter. In a head-to-head (literally!)...

ObamaCare© Dreamin': I've got some questions

Currently, and since the advent of HIPAA, I can go from a group plan to another group plan, or an individual plan to a group plan, on a guaranteed issue basis, and any pre-existing conditions will be covered immediately.[ed: Yes, there are a variety of hoops through which to jump, but assume those for sake of discussion]In order to accomplish this, I need but a simple piece of paper, called a Certificate...

Friday LinkFest

■ At Frontpage, Tait Trussell makes the case that ObamaCare© constitutes "Medicare Malpractice" by essentially shafting "millions of low-income folks, minorities, and Hispanics." As we've noted, a lot of seniors covered by Medicare Advantage plans have been thrown under the bus.■ David Hogberg offers his fisking of the New Republic's Jonathon Cohn's take on efforts at repealing ObamaCare©. He notes...

The Sad (Real) Faces of ObamaCare©

Yesterday, I had to turn away two prospective insureds. That's happened before ObamaCare© was a gleam in Ol' Nancy's eyes, but it was particularly troublesome because there are fewer choices now on which these folks can "land."Let me explain:Steve is a 45 year old gentleman who was laid off from his job last month. He's eligible for COBRA, but his means are (obviously) more limited, and the cost is...

Irony, Thy name is Cliff Clavin

Let me get this straight: Postal Workers' union elections are on hold because ballots have been lost in the mail?Yep:"But the union announced that only about 39,000 ballots were turned in -- and that "a large number of union members had not received their ballots."You're kidding, right?Um, no:"The American Postal Workers Union has extended its internal election after thousands of ballots appeared...

Shecantbeserious Waivering: You want fries with that?

On the heels of the recent McDonad's/Mini-med kerfluffle, we now learn that over 2 dozen companies have been granted temporary ObamaCare© exemptions. This of course raises a number of -- shall we say uncomfortable? -- questions:First, under what criteria were these waivers granted? What, if any, quid pro quo was extracted from the corporate coffers of those which benefitted?Second, what happens next...

Obamacare - Is The Public Option Dead?

Is the so-called public option in Obamacare dead? Some don't think so. Left wing blogger Huffington is sporting a post today suggesting there is still hope for those who want a public health insurance option. According to Dr. Abrams who it appears has never practiced medicine nor run a health insurance company, Democrats can still exploit a little publicized provision in Obamacrap to sweep them...

The Commish (An InsureBlog Exclusive!)

Although the Whitman-Brown (or is that Brown-Whitman?) race seems to be sucking up all the air in the room, there's another electoral competition going on in the Golden State. In California, the Commisioner of Insurance is an elected position. It's a tough race, but independent insurance agent Rick Bronstein aims to give it all he's got. Rick graciously agreed to an (Exclusive!) email interview with...

Movin' on up... (An IB Exclusive)

In the Wikio Health Blog rankings. The new numbers are out, and we've moved up quite a bit, all the way to the (lucky) 13 spot (pretty good for an insurance blog!).Thanks to Wikio's Oliver Orlik for the heads' up, and for the (exclusive!) opportunity to post this before the official publishing date: 1Well2Respectful Insolence3Science-Based Medicine4Kevin, M.D. - Medical Weblog5Dr. Wes6Health Beat7The...

Foreign Serendipity

My better half has long cautioned me that "there are no coincidences," but what am I to make of this?First, my office email brings word from Golden Rule (Health) Insurance outlining "3 Reasons You Should Add International Health Insurance to Your Portfolio."Among these are the opportunity to provide "an additional service to your current clients, and attract new ones, when you offer international...

AIG Update: Good news?

Yeah, sorta:"The Treasury Department says it expects the total cost of Troubled Asset Relief Program (TARP) aid to American International Group Inc. (AIG) and other federal aid to AIG to be about $30 billion."I know, how's that good news?Wait for it...."The Treasury Department invested about $40 billion in helping AIG ... and the Federal Reserve System invested about $182 billion"So according to Washingtonian-style...

Cavalcade of Risk #115 now online

Wenchy outdoes herself with this week's outstanding roundup of risky posts. Come for the Open Enrollment, stay for the RTFM (if you have to ask...).Still looking for a host for the November 17th edition - take a risk and sign ...

Timing is everything...

Remember the health care "crisis" that necessitated that we had to quickly "pass the bill to learn what's in it."Remember that?If you do, then you're a few steps ahead of HHS Secretary Shecantbeserious and her minions of bureauweenies:"A new report from the non-partisan Congressional Research Service ... finds astounding proof of the total administrative failure of the administration in implementing...

Ahoy, mateys! (From the P&C Files)

When Somali pirates [ed: did they actually swash their buckles?] forcibly captured Captain Richard Phillips and his crew last year, the primary concern was, of course, for their safety. But what of the ship's cargo? About a third of the 17 thousand metric tons was "relief supplies bound for Somalia, Uganda, and Kenya."The other two-thirds, one supposes, were commercial; one further supposes that most,...