Express Scripts

Normally, I’m pretty easy going. It really takes a lot to really get me mad. Express Scripts, Anthem's pharmacy benefit manager, has succeeded royally.Background: Untreated, I have fairly high cholesterol levels. Over a couple of years my doctor and I have worked out a regimen consisting of 10mg of Zetia and 40mg of Lipitor. Lipitor is a statin, a HMG-CoA reductase inhibitor that blocks the formation...

Laudable Carrier Trick (#4 or 5)

Once in a while, carriers do really great things. This is one of those times, and we want to acknowledge it.First, check out this touching and inspirational story:"A legally blind 16-year-old runner, Sami is traversing cross-country courses this season with her new guide dog, Chloe, and is believed to be the first high school...

Halloween Tricks

When the ghouls and goblins come around to terrorize you tonight you might want to screen your candy bin for licorice.If you are going to hand out the gooey black or red chewy candy, you might need to include a warning label.According to Consumer Reports, The U.S. Food and Drug Administration warns the tangy-tasting morsel...

MassImmigration

If you'd like to see the potential impact that caring for illegal immigrants is likely to have on ObamneyCare©, one has only to look at its progenitor:"A dogged freshman lawmaker who refused to budge from the House chambers ... until the Patrick administration came clean on how much taxpayers coughed up last year for free health care to illegal aliens finally got his answer..."Care to guess?No, higher.Higher.Bingo:...

Walgreen's commits Seppuku

Last week, we reported on the little tug-o-war between Walgreen's and Express Scripts.Guess who won?Yesterday, I received snail-mail from Walgreen's:"[W}e are not planning to be part of Express Script's pharmacy provider network as of Jan. 1, 2012 ... The following health plans in your area use Express Scripts and cannot ensure continued in-network access to Walgreen's in 2012: Anthem Blue Cross and...

Bug, or Feature?

You be the judge:"[Medicaid], funded jointly by the feds and the states, was devised to cover the poor. But if a provision in [ObamneyCare©] isn't changed that could be the case for people with pretty healthy incomes."Ooopsie's.Turns out, even folks in their early 60's making as much as $60,000 a year could be eligible for Medicaid; that's because the bulk of Social Security benefits aren't taxed,...

Take 2 and skip the Oncologist?

For a while now, folks have been taking low doses of aspirin to lower the risk of heart disease, but who knew that the little pills might be a strong defense against cancer?Well, some scientists Across the Pond© may have the answer:"Taking aspirin regularly can cut the long-term risk of cancer ... British researchers found it can reduce the risk by 60 per cent in people with a family history of the...

You're doing it wrong: Life Insurance and Murder

One of the first things one learns in Insurance 101 is that you're not allowed to profit from illegal acts. So, for instance, you're not going to have a lot of success collecting on your home-owner's insurance if you burn down your house (apocryphal cigars notwithstanding).And murdering your kids for their life insurance?Fuggedaboutit!"A South Carolina mother who told police her son killed three family...

Cavalcade of Risk #143: Call for submissions

Julie Ferguson hosts next week's CavRisk, and wants your risk-related post. Entries are due by Monday (the 31st).NB: We're now using this submission tool: The BC WorkAroundOnce there, you'll be asked to provide:■ Your post's url and title■ Your blog's url and name■ Your name and email■ A (brief) summary of the post ("Remarks")At the bottom of the form, you'll see a drop-down menu; simply select...

Health Wonk Review - Superhero edition now online

HWR co-founder (and all-around mensch) Joe Paduda hosts this week's outstanding round-up of healthcare wonkery.You won't be disappoint...

Death Panels slog on

There has never been any real dispute that ObamneyCare© will, in fact, reduce health care choices. When the power to decide who's treated (and lives) is granted to the state, personal choice goes away. We've seen this under the MVNHS©, and now we're seeing even more evidence that this is the goal of ObamneyCare©:"MPAC [Medicare Payment Advisory Commission], whose decisions have the force of law, has...

SOA, ASAP

Got this in email from Anthem, but it is actually pretty industry-standard verbiage.Which is to say, unfathomable:"When submitting Anthem Medicare Advantage business, please make sure you are using the correct version of the scope of appointment. The standard template which contains “CMS Approved 09/27/2011” on the bottom of the first page is what you need to use. If this is not used, Anthem will...

Border Control

Immigration policy is a hot topic thanks in part to the political landscape, Herman Cain's electric fence and Rick Perry's educate them at taxpayer expense proclamations.Of course Obamneycrap is also front and center thanks to the upcoming election and pending Supreme Court docket.So this is a two-fer.The back story is an illegal immigrant is seriously injured in a workplace accident.And he does not...

When is a pill not a pill?

Well, according to Walgreen's, "[o]ur product is not a pill; our product is a health outcome."How nice for you.To understand what's happened, let's revisit the Pharmacy Benefits Manager (PBM) model:"PBM's are (allegedly) a cost-efficient way for carriers to offload the administrative functions of filling prescriptions ... The stated reason for this business model is that it helps carriers to rein...

Employer Mandate Under the Radar

And under the gun.The (Evil) Individual Mandate continues to garner the lion's share of press, but the (also Evil) Employer Mandate is beginning to get some (dis)respect:"Whereas other suits hinged mostly on a challenge to the law's "individual mandate" ... the Liberty University case also challenged similar requirements on employers to extend coverage to workers."Currently, employers are under no...

Grand Rounds: Hush! It's the library edition

Dr Jacqueline (PhD) hosts this week's literary-themed edition of Grand Rounds, presenting a beautiful and eclectic collection of interesting medblog posts.Do check (it) o...

Romney on ObamneyCare©

Courtesy of the Galen Institute, we have expert analysis explaining just how the President's signature legislation mirrors the Bay State's version:[Hat Tip: PowerLi...

Rationed Health Care

Folks who rely on Medicaid are about to get short-sheeted. With states running out of money (and the federal government running out of folks willing to lend them money) the time has come for Medicaid patients to get well or die.The taxpayers can't continue funding your health care.In some states Medicaid patients will max out...

ACO's: Regulations Cometh

The government came out with its final regulations for ACO’s, or Accountable Care Organizations, all 696 pages of information. As a medical practice manager, my main concern is still “How do I get paid?” The original scheme was a capitation plan, similar to the HMO’s of the 1980’s. In this plan a physician receives a set amount of money to care for the patient, medical care, labs, imaging, etc. If...

Caution: Falling Prices, er, Benefits

Even big-box mega-retailers are feeling the ObamneyCare© pinch:"Wal-Mart is substantially rolling back coverage for part-time workers and significantly raising premiums for many full-time staff ... Citing rising costs ... any new employees who average 24 hours to 33 hours a week will no longer be able to include a spouse as part of their health care plan."What was that phrase we kept hearing?Oh, yeah:"If...

Obamneycare Continues to Take a Toll

As Obamneycare continues an assault on the U S health care finance system another health insurance carrier bites the dust.American Republic insurance carrier will withdraw from the market.The move means 110 employees will lose their jobs over the next three years — 40 in Des Moines and 70 in Omaha — and signals the widespread...

Remember: I'll Drink to That!

As we've noted before, a little tipple may be enough to offset the risk of developing dementia. And now, there's even more evidence to support this theory:"Researchers analyzed 143 studies that looked at the association between moderate alcohol consumption and mental abilities ... most showed that drinking moderate levels of alcohol showed no effect or a decreased risk of dementia and cognitive impairment"The...

RomneyCare© Floundering

"After three years of study, the state’s legislative leaders appear close to producing bills that would make Massachusetts the first state — again — to radically revamp the way doctors, hospitals and other health providers are paid." [emphasis added]Not the brightest lights in the (Boston) harbor, are they?As we've long noted, one of the biggest problems with RomneyCare© is that increasing the number...

Humana Exit

The Utah Health Insurance Exchange has lost a player. For one of the few existing exchanges that seems to have a future, losing Humana could be a lone wolf or it could be the start of a domino effect.Humana’s departure comes at a time of great uncertainty for Utah’s experimental insurance marketplace, which was slow to catch...

Cavalcade of Risk #142 - Expert edition, now online

Van Mayhall makes his CavRisk debut with an outstanding collection of risk-related posts. Each entry is highlighted and annotated with a deft touch.Great job, Van, and welcome to the (hosting) cl...

Qualifying for Medigap

Applying for Medigap in Georgia? If you are not "guaranteed issue" as defined by Medicare you will be required to answer a few health questions. Every Medigap carrier is different but most use a 5 year look back and want to know if any of the following are true.In the last 5 years have you been diagnosed with, or treated for...

MVNHS©: Deadly for Seniors

Speaking of Death Panels:"Elderly patients are being condemned to an early death by hospitals making secret use of "do not resuscitate" orders"Here in the 'States, Do Not Resuscitate (DNR) orders are "affirmative;" that is, one must pro-actively sign a special form indicating that this is indeed one's desire. Absent such permission, it's generally difficult to legally force a health care provider...

Grand Rounds (with a hint of Garam Masala)

Dr Sumer Sethi hosts this week's tasty collection of interesting medblog posts, sprinkled with beautiful photograp...

Anatomy CLASS

Now that HHS Secretary Shecantbeserious has subjected the CLASS Act to a very real Death Panel, a postmortem is appropriate.Let's note first that we called this some time ago (not that this was any great feat of prognostication). The fact is, this program was never fiscally sound or sustainable in the first place. Then, too, Long Term Care insurance is one of the two most complicated products in the...

Remember, "The Andromeda Strain" was only a novel

The New York Times reports that scientists researching the Black Death have solved its genetic code and hope to recreate the microbe itself.Good luck with that. Serious...

For the record: ObamneyCare©

Regular readers may be puzzling over the lack of coverage here regarding the "news" that various RomneyCare designers were brought in by the White House to advise the Obamastration on implementing its signature legislation.Here's why:D'u...

Cavalcade of Risk #142: Call for submissions

Van Mayhall makes his CavRisk hosting debut next week. Entries are due by Monday (the 17th).NB: We're now using this submission tool: The BC WorkAroundOnce there, you'll be asked to provide:■ Your post's url and title■ Your blog's url and name■ Your name and email■ A (brief) summary of the post ("Remarks")At the bottom of the form, you'll see a drop-down menu; simply select "Cavalcade of Risk"...

Obamacare White Person Tax Falls Short

Funding Obamneycrap would come from many sources, including a tax on white people. The tanning bed tax was estimated to bring in $200 million per year.The first 9 months of 2011 has generated only $54 million which means the expected revenue will be less than half what was expected.I guess white folks (other than John Boehner)...

More ObamaTardiness©

Regardless of one's stance on the overall benefits of ObamaCare©, it is the law, and insurers and providers are having to live with it.HHS Secretary Shecantbeserious?Not so much:"[HHS Secretary Shecantbeserious] has yet to write rules — mandated as part of [ObamaCare©] — that would force drug and medical-device companies to disclose their gifts, fees and payments to doctors."We've discussed such swag...

Plainspeakin' Health Wonk Review

Chris Fleming hosts this week's no-nonsense round-up of health care policy and polity. There may be no fluff, but Chris obviously took the time to read each post, adding helpful conte...

LTCi News: GW follows JH

Sorry, couldn't resist the power of the acronym.Last year about this time, John Hancock announced a pretty hefty rate increase for many of its existing clients, as well as some new products. As we noted at the time, this was a pretty hefty jump:"Obviously these plans were under-priced at the time.....so it is likely that a 40% rate hike would probably not even bring these plans up to today's level...

Medicare Annual Election Period (AEP)

(Almost) Everything you need to know about Medicare Annual Election Period in Georgia. A simple path to finding affordable coverage in the Medicare maze.Medicare AEP - It's Not for EveryoneThe biggest misconception about Medicare AEP is that it applies to everyone. Not so.If you already have a Medicare Advantage plan, or you...

Commercial Hypocrites

Remember these guys?"Three times a year, 29 doctors gather around a table in a hotel meeting room. Their job is an unusual one: divvying up billions of Medicare dollars ... convened by the American Medical Association, has no official government standing." Well, they have a new Mediscare ad out with this dire warning:"Medicare payments to doctors are scheduled to be cut by 30% in January. It means...

This Sceptered Isle - Part CLXXI

Today I happened on a statistic published by UK's National Health Service about a year ago: the NHS is the largest employer in Europe, with more than 1,300,000 employees.Are you curious how a bureaucracy of that magnitude might relate to the US?Well of course, I was.The 2010 populations were about 62 million in the UK and about 307 million in the US. A rough ratio based on populations suggests an...

Grand Rounds: Cheesehead Sports Edition

Regular IB readers will recognize Jason Shafrin as my favorite health care economist, best-known for hosting Cavalcades of Risk and Health Wonk Reviews. This week, he's pushing his own envelope, hosting Grand Rounds for the first time.His debut edition is here, and it's a doozy: from mini-meds to bodily fluids, you're sure to find something interesting.Great debut, Jas...

Teens Avoid Tanning Tax

The tanning bed tax implemented last year to fund Obmaneycrap will have a few less contributors to the fund.Governor Moonbat has decided that teens in California will have to get their tan the old fashioned way.Outdoors.Under legislation signed by Gov. Jerry Brown on Sunday that is now the nation's most restrictive, boys and...

Dealing with Autism

Autistic children can be a challenge in many ways and the cost of caring for them can sink a family from a financial perspective. While acknowledging the high cost of care for autistic children the state of California decided to push through legislation making it illegal for insurance carriers to deny education related claims.(Governor) Brown said Sunday that he had signed the bill despite concerns...

Money Unclaimed

Right upfront, I'll acknowledge that this is a little "inside baseball," but it could be a big deal for some readers, and I think it points out how important accurate record-keeping can be.Many (most?) folks know that when a bank account goes dormant for a long time, the balance is transferred to the state for safe-keeping until such time as the owner or his/her designee steps forward to claim it....

Inigo Montoya meets Kathy Shecantbeserious

In the classic film "The Princess Bride," Mandy Patinkin's character is dubious of another character's understanding of a rather common term ("inconceivable!"). He famously observes: "You keep using that word. I dunna think it means what you think it means."And so it is with the latest efforts to define the brave new world of health insurance, gummint-style:"The federal government is taking on a crucial...

Insuring Value

Sometimes, insurance policies fall outside the obvious categories of life/health and property/casualty. For example, Personal Guarantee coverage seems to fit comfortably into neither one.And so it is with Home Value Protection, which "is insurance that protects you against real estate market volatility." Anyone who's been following the news recently knows that the housing market makes The Beast look...

Fall of the Roman Empire

68 million members of the Roman Catholic Church in the U.S. have come under attack by none other than the Obama administration and the Department of Health and Human Services. In the 2,000 year history of the Church and a long line of successive leaders starting with the Apostle Peter the Church has survived assault from many...

One Last Plea (Lexis-Nexis Top 50)

The nomination and recommendation period for the LexisNexis Top 50 Insurance Law Blogs of 2011 ends tomorrow (Friday the 7th).There is still time left for readers to show support for InsureBlog, by telling the L-N folks us why we should be included in the Top 50, but it's running out.We would REALLY appreciate it if you'd support our blog by writing a comment at the bottom of the nomination post (click...

Gene Test

We last discussed genetic testing this past summer, reporting on a new protocol that could seriously help with better diagnostics and (ultimately) outcomes. Thanks to FoIB Holly R, we learn about a new test that can help determine whether or not one is a "carrier" of a genetic disease.Best of all, it requires only a saliva sample, and can be mailed to the lab (unfortunately, there's no "app for that,"...

The 9% Solution (A Reality Check)

The Gray Lady weighs in on the news that, because of ObamneyCare©, health insurance premiums have skyrocketed.[ed: in fairness, they didn't couch it that way, I did]Here's their take:"Annual premiums for employer-sponsored health coverage soared by 9 percent for families and 8 percent for individuals this year from 2010, far faster than wages or inflation ... So what is driving up insurance premiums?...

Cavalcade of Risk #141: Backyard edition

Fresh off hosting Grand Rounds, Louise Norris bravely tackles this week's Cavalcade of Risk (and, apparently, the backyard). As usual, she cleans up, raking in some terrific posts and mowing down strawmen.Kudos, Loui...

Some Thoughts on Government Healthcare

As the "life and health guy in a P&C shop," I get to hear some interesting anecdotes about home and auto clients, and a recent adventure is quite illuminating:Our client was cited for speeding in her '98 Mercedes. Oh well, these things happen. The state, however, was unsatisfied with her "proof of insurance;" they said they needed such proof for her '99 Jaguar.One little problem: she's never owned...