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At The California Medicine Man � which, BTW, is a terrific new blog, written by a physician, but in no way overly technical or condescending � there�s a disturbing bit of information: �(F)or an FDA advisory committee member evaluating the COX-2 inhibitors, affiliation with Pfizer or Merck appears to constitute a clear conflict of interest. Consider these numbers I extracted from the vote breakdown in one report . If you were one of 10 committee members taking money from Pfizer or Merck, You had a 100% probability of supporting Bextra compared with a 35% if you had no such tie. You had a 90% probability of supporting Vioxx compared to 36% if you had no such tie. If these 10 committee members had abstained from the vote, neither drug would have been approved for marketing. To suggest that this breakdown occurred by mere chance and had nothing to do with drug company affiliation strains credulity to say the least!" If verifiable, this represents an incredibly egregious abuse of regu...

Okay, not really, but I couldn�t resist the headline. What did happen, tho, is that the much-ballyhooed arbitration has come to an abrupt � and fruitless � halt . Apparently, after they had met for a grueling day and a half (not counting coffee- or potty-breaks), the two sides �broke off their mediated negotiations without a contract.� Where does this leave those Anthem insureds whose providers are in the Premier system? Think creek, missing paddle. For most, non-emergency access to Premier services will come with a much higher price tag. For some, there may be no non-emergency coverage at all (this depends on which plan design a given insured has chosen). As always, there are (at least) two sides to this story. Anthem maintains, and Premier has so far not disputed, that Premier�s costs are significantly higher than other, comparable area provider networks. In essence, Anthem insureds who choose non-Premier providers are subsidizing those who do utilize Premier. OTOH, physicians and ho...

Recently, I had occasion to speak with a client who was unhappy with his coverage [ ed: nooo! really?! ]. This gentleman owns his own business, and has had a policy with Company F for a number of years. The plan has a high deductible, and no frills. It covers this gentleman and his family for a little over $900 per quarter. He called me a few months ago to see if there was anything we could do to lower his premium without lowering his benefits. I looked around, and found nothing that would do accomplish his stated goal. He was not happy with this report, but there was nothing I could do about that. The quotes are the quotes. Last week, he called me back to complain that he had been declined for health insurance. Excuse me? It seems that he had contacted (or been contacted by) another agent, not affiliated with our agency, but who also represented Company F. This agent told the client that Company F offered a plan with benefits he did not currently have, at a lower premium. The client a...

Got an interesting flyer from Humana today. Effective May 1, they�re changing how they cover certain medications. Based on previous experience, I expect other carriers to follow suit shortly. The letter starts out auspiciously enough: �Humana is launching a new program designed to help employees who take certain high-cost drugs save money each month on their prescriptions. And when employees choose less expensive drugs, overall pharmacy costs should decrease.� The program targets specific medications that have �lower-cost alternatives,� presumably generic equivalents. For now, Humana is focusing on meds for heartburn, pain, allergy and high cholesterol. Left unsaid, but certainly easily inferred, look for blood pressure and anti-depressant meds to follow. The program is set up so that, at the next refill (or, for first-time use, the initial scrip), insured�s will need to talk with their doc about their new options: - Switch to lower-cost alternative (i.e. generic), - Stay on current me...

This article caught my eye. I�m a fan of Jeff Foxworthy, and I immediately thought of his humor when I read: No federal charges in theft of boyfriend's remains, and beer SHEBOYGAN, Wis. - A woman accused of digging up and taking her boyfriend's cremated remains more than a decade ago - and drinking the beer that had been buried with them - won't face federal charges, a prosecutor says. Sheboygan County District Attorney Joe De Cecco said Karen Stolzmann, 44, faces only a misdemeanor charge of possession of stolen property, punishable by up to nine months in jail and a $10,000 fine. Stolzmann has been accused of digging up the remains of Michael Hendrickson from the Cambria Cemetery in Columbia County and drinking the beer that also had been buried, possibly out of spite for his family� An exhumation discovered that Hendrickson's cremated remains were missing from the cemetery. Beer and cigarettes that were buried with him were also missing. One wonders if the late Mr He...

Recently, my friend Bob (be sure to check out his blog, Health Insurance 411 ) sent me an article about a new product: The Social Security Death Index Database . Briefly, the company makes available �a database of all reported deaths of reported Social Security number holders.� That is, if you�re in the Social Security system (and who isn�t?), and you die, you �make the list.� So Bob and I had a brief email conversation about WHY someone (or some company) might need this information, and under what circumstances that need would be so great as to justify paying over $600 a year for this information. We speculated that perhaps funeral directors would find it helpful, or even insurance agents (�Pardon me, Mrs Thompson, but I see that your husband has passed away. Did he have enough life insurance? Do you?�). But neither of us could figure out exactly who would pay for this kind of information, or to what purpose(s) it would/could be put. So I moseyed on over to the site (which is easily n...

According to the Dayton Business Journal , �Anthem expects to save $40 million to $50 million this year as a result of dropping Premier from its network,� and �plans to funnel some of that savings back to businesses through quarterly premium credits.� Leaving aside the plausibility of ANY insurer promising to �reduce rates,� nowhere in the article does the company representative [ ed: Chris is an okay guy. This isn�t a slam on him, per se ] explicate exactly how Anthem determined that it would save this amount of money by deleting Premier from its network. But it gets better: these �premium credits� would only be available to groups of greater than 50 employees. The major problem here is that most employers fall into that �small group� (under 50 lives) category, and so will never see a penny in �savings.� Notice the other �gotcha,� as well: those employers which ARE eligible will see that any savings will be offset (reduced) �based on how often their employees had used Premier services...

Health Savings Accounts (HSA�s) are not really new; they�re an evolution of the MSA�s that (sort of) took off in the 1990�s. Briefly, the premise behind HSA�s is that most people, in most years, pay far more in health insurance premiums than they get back in benefits. The other major complaint I get (aside from premiums) is that people resent �bean counter medicine,� where whether or not a given procedure will be covered by insurance is determined by an anonymous voice on the phone, not the physician (or hospital, etc). With HSA�s, one purchases a high deductible health plan (HDHP), which is generally less expensive than the typical, generic co-pay plan, and then puts the savings into a tax-deductible account. Money in the account is available to pay for medical expenses not covered by the insurance (e.g. expenses below the deductible, braces for the kids, bifocals for Dad, etc). Whatever money is left in the account at the end of the year is credited to my personal checking account. N...

Well, I have my answer [ see Update below ]. Okay, actually, the client has indicated his preference, and I agree with his conclusion. We have decided to go with individual medical plans. We can write them on a list-bill basis, which means that the employer will receive one bill which includes all 5 policies. The way this works is that he will deduct the appropriate amount from each employee's paycheck, and forward this as a lump sum to the insurer each month. The benefits here are: 1) Simplicity: We won't have to worry that a carrier will either enforce or change their participation requirements, triggering the kind of frustration we've just experienced. 2) Each employee will have some choices regarding their coverage; that is, if Employee A wants a $500 deductible, he can have it, and if Employee B wants the $1,000 deductible, he can choose that, and save some shekels. 3) Individual plans are portable, which means that, if an employee leaves, he doesn't automatically ...

In the study of logic, one learns of the �Straw Man Fallacy.� Briefly, this method consists of arguing that since a=b, then of course f=g. Allow me to illustrate: In a recent Letter to the Editor of The Free Lance-Star ( link ), Dr Peter Kamilakis writes: "Anthem made $295 million profit in the first quarter of 2004. This is $100 million more than the year before. Compare Anthem CEO Larry Glasscock's "performance bonus" of $42.5 million in 2002 (working no nights or weekends) to what your family doctor earns working 90 hours per week under Anthem's miserable payment schedule, and you can see why doctors arrive and then depart the Fredericksburg area constantly.� He goes on to ask: �In this age of concern about health care and health insurance costs, who on earth would side with a monster like Anthem, which demonstrates such colossal greed?� He concludes that: "Only when Anthem loses their monopoly on health insurance in Virginia will the playing field be lev...

To my clients, I've added a few product links to the sidebar. The most interesting of these, in my opinion, is the Special Risk Medical plan. It's not for everyone, but it seems to offer the best (or maybe just least bad) alternative for those folks who are uninsurable. Most folks, even with various medical conditions, are NOT uninsurable. Generally, once I spend some time digging out the medical info, and checking with the carriers, some offer will be made. But for those folks who truly can't get past underwriting, there are precious few options: 1) HMO Open Enrollment. By law, HMO's are required to periodically "open the doors" to anyone who wishes to obtain coverage. Generally, these are folks who can't obtain coverage elsewhere, so these enrollment periods are somewhat like Russian Roulette for the carriers. As a result, the premiums for these plans can be pretty hefty. 2) Medical Service Discount Programs (e.g. Care Entree, et al). It's important...

The point is to blog every day. Or, more precisely, to post something of interest every day. But what if there�s really nothing that fits the bill? Posting for the sake of posting isn�t blogging: it�s cyber-babbling. I still have no definitive answer from Carrier S regarding my �problem group.� (�An interesting challenge�) I have had no luck in re-connecting with the young lady who may or may not be able to obtain health insurance. (�Right answer�) There is a bit of bright news regarding the ongoing battle between Premier and Anthem: they�ve both agreed to arbitration, and chosen an arbitrator. She is a nationally-recognized authority in these types of cases, so perhaps we�ll see a satisfactory resolution soon. So, I�ll wish y�all a great weekend, and attempt to have something worthwhile come Monday.

One of my clients is a small business (13 employees) who we�ve had insured with Carrier P for several years. Their situation is unusual, because only 5 of the 13 employees are actually on the plan. The rest have coverage either through their spouse or MediCare (this business attracts a lot of senior citizens looking to supplement their retirement income). The problem is that carriers have rules requiring that a certain percentage of employees must be covered on the plan. Typically, this ranges from 50%-75%. There are all sorts of games that get played with this, but the bottom line is that, when we wrote the case, Carrier P was the only one who would take it. Now, the rates have become unbearable. Yet I have been unable to find a carrier to which to move. The two major players in this area � Anthem and United � both declined to even quote the case, let alone write it. Two other carriers also have declined. One local carrier has essentially told me �maybe;� I�m awaiting clarification. ;...

Okay, finally figured out how they work. You can post "anonymously" (i.e. without registering): Scroll down to a post's "comments" button, and click it. You'll see a screen with a large button that says "Sign In." BUT, just below that button is one that says: "Or Post Anonymously" Click on that, and you're good to go!

I�ll share something personal: For several years now, I�ve had a little sticker in a place where I can�t miss seeing it. Glued to the phone. It�s a pretty simple little prayer: �May the action that I am about to undertake be worthy of You� So as I said, it�s pretty simple, but sometimes it makes my job rather difficult. Case in point: This afternoon, I received a call from a young single lady who recently had a child. She is experiencing several post-partum symptoms, most especially of the anxiety variety. Her medication currently runs about $120 per month. And of course, she is uninsured. And of further course, she wants to buy insurance so that the medication (and concomitant office visits) will be paid for by a 3rd party. The insurer. (Perhaps tellingly, she made no mention of needing � or even wanting � coverage for her newborn). OK, so here�s the dilemna. On the one hand, I have a fiduciary duty to my carriers not to send them �junk.� (This is NOT a value judgment of the young lad...

An alternative to cruising? Long Term Care insurance (LTCi) is one of those coverages, like disability, that everyone says folks need, that all the financial guru�s says folks need, that all us insurance folk say folks need [ed: getting a little �folksy,� aren�t we?]. But so few people actually DO buy it (or buy into it). Now we learn that one reason that so few folks own LTCi is because they can�t get it: �More than half (57.2%) of individuals who apply for long-term care insurance after their 80th birthday are declined coverage according to Long-Term Care Insurance Sales Strategies magazine. At older ages, the percentage of applications declined was significantly higher...only one in 10 (10.7%) applicants who were between ages 50 and 59 were declined coverage.� Now, granted, anyone who waits until their 80 to start even looking for such coverage is most likely going to be disappointed. But my take on this is that maybe I haven�t really been pushing it that hard with my clients. First...

From John McCaslin (click on the title above for link, 5th item down): Our "Dramamine" column item from earlier this week � that it costs just about the same for an 80-year-old American to live out his or her days on a luxury cruise ship ($230,497) as in an assisted-living facility ($228,075) � generated considerable response. "On our October cruise on Royal Caribbean lines, there was an elderly lady who actually resided on the ship 'Voyager of the Sea,'" writes Becky Jackson-Turner of Acworth, Ga. "Medicare took care of her medical needs, which were few, and whenever the ship would pull in to its main port, she would disembark for a few hours. ... "She told us that it was just more financially feasible to do this than living in an assisted-living home and was much more fun," Mrs. Jackson-Turner recalls. "She got to meet new people all the time, always had great food and always had her bed turned down for her when it was time to sleep � w...

And I know that it shouldn�t, but: why do we (and I guess by �we� I mean health care consumers in general) assume that birth control should be a covered expense? And not just BC pills, but IUD�s, vasectomies, etc? (Warning: I�m about to go off on a rant about individual medical coverage; these issues are dealt with differently in group contracts) Because it�s �preventive care?� On the same level as cholesterol screenings, mammograms, and PSA tests? I don�t think so. And this has nothing to do with sexuality or morality, per se. It has to do with risk management, and the underlying premise of insurance. I don�t think that anyone believes that their auto insurance covers oil changes or tune-ups (or should), but aren�t these �preventive� measures? Our homeowners insurance doesn�t pay for the chimneysweep, but wouldn�t that be a preventive measure? Why do we expect our health insurance to cover so much that is not risk-based? I suppose it could be that we perceive it to be so expensive, ...

Case in point: One of my clients is a small (3 person) high-end carpentry business, made up of three brothers. One is the owner, the other two work for him. The owner asked me to put together a disability income program for them. After reviewing their needs and goals, I proposed that we write 3 individual plans (primarily because each had such different cash flow issues). They agreed, and we completed and submitted applications. So far, so good. Okay, 6 weeks later , the underwriter decided that only one of the three was insurable (medical issues). Great. Back to square one*. Okay, I thought, let�s go with Plan B: a group DI plan. Requested quotes for Short and Long Term Disability from a handful of carriers. Prepared to wait patiently for said quotes. Surprise! Got answers right away. That�s the good news. The bad news is that all but one declined to quote, and that one would only quote STD. Oooookay, what gives? Well, about half the declines were due to the industry: carpentry. Note ...