Georgia Health Insurance 411

Archive for February, 2009

It seems Obamaman will push ahead with a desire to revamp health care in America as part of his budget proposals. According to the Washington Post, the President wants to start with Medicare and Medicaid.

Making policy changes in those programs — such as rewarding physicians who computerize their medical records or paying doctors for results rather than procedures–could improve care while generating long-term savings, expert say.

Computerization, or converting to EHR (electronic health records) is something that has been discussed for 20 years or so. There are numerous problems, not the least of which is compatibility in software and database programs.

And as we know, the internet is not secure making PHI (personal health records) a potential nightmare.

Paying doctors for results instead of procedures is nice in theory but has no practical application in our society. Much of the testing is redundant as a precaution against future litigation. If the government tells a doc you will not be paid unless your service generates a positive result then the doctor is torn between getting paid and protecting against future suits.

And just who decides if the care is effective?

If the government decides the treatment did nothing favorable is the patient then given a clear path to sue the doctor?

This is a slippery slope from which there may be no good answers.

And what happens if, as we have seen with PeachCare, the number of providers willing to see Medicare/Medicaid patients erodes even further? If you are covered by either of these programs and cannot find a doctor willing to treat you, then what?

This is a real can of worms.

If the FDA approves it, you would think it must be safe.

Not so.

If new legislation passes, consumers will be permitted to sue the manufacturer of medical devices and possibly drug manufacturers as well.

A year ago today, the Supreme Court ruled that federal law bars lawsuits “challenging the safety or effectiveness of a medical device,” as long as the device is marketed in a form approved by the FDA.

The ruling, in a case called Riegel v. Medtronic, relied heavily on a federal law that regulates medical devices; now, some key congressional players are looking to change the law, this morning’sNew York Times reports.

Democrats Henry Waxman and Frank Pallone plan to introduce a House bill that would allow injured patients to sue device makers. In the Senate, Democrats Ted Kennedy and and Patrick Leahy plan to reintroduce a similar bill they rolled out last year.

So if a medical device doesn’t work (even if FDA approved), or you have an adverse reaction, the company that manufactured the device is fair game.

If this law passes look for the cost of medical devices to go up, fewer new devices will come on the market, and (of course) health insurance premiums will rise.

Having fun?

It’s Oscar weekend, so the WSJ Blog wonders who is your favorite movie doc?

Some of their suggestions . . .

Hawkeye Pierce, M*A*S*H
BLAKE: Headquarters … says you stole a jeep.
HAWKEYE: No sir, no. I didn’t steal it. No, it’s right outside.

Gotta love Hawkeye. There are other lines from the movie I could quote but in the interest of keeping this a family place, I won’t.

They also offered up a line from Young Frankenstein, but a more memorable one to me is the following exchange

But this is another memorable line from The Hospital.

Herbert Bock, The Hospital
BOCK: We’ve established the most enormous medical entity ever conceived… and people are sicker than ever. We cure nothing! We heal nothing!

Enjoy!

The Comprehensive Reapportionment and Assistance Package (CRAP) otherwise known as the Spendulus Bill contains COBRA enhancements we have already posted.

We are still researching for additional information and found this at USA Today.

Employees who left voluntarily or retired are still eligible for COBRA, but not the subsidy, says Kathryn Bakich, senior vice president and head of the health care compliance practice at Segal Co.

Another comment of interest is this.

Laid-off employees who didn’t sign up for COBRA when they lost their jobs will have 60 days to enroll. Those who signed up and have been paying full premiums won’t get a rebate, but their payments will drop in March.

We also found this summary from Marketwire.

Clearly there are more questions than answers. Any time you deal with the government that is pretty much par for the course.

This has nothing to do with insurance, but heck. It’s Friday, might as well take a break.

Apparently this is the latest in fashion. Somehow I don’t think my wife will find any of these at Nordstrom.

But something about #6 is a turn on . . .

The Atlanta Braves think Hartford Insurance is trying to stiff them on a disability claim. Who can blame them?

Mike Hampton who, at one time, was one of the most dominating lefties in the league spent the better part of 6 years on the Braves payroll . . . most of that time on the DL.

Mr. Hampton was injured in 2005 and missed all of the 2006 and 2007 seasons after two elbow surgeries. During those two seasons, Hartford, Conn.-based Hartford Life made “daily benefit” payments under the policy.

So what’s the beef?

According to court documents, a provision within the policy states that if Mr. Hampton was “totally disabled” before the expiration date, the policy would remain in effect. Further, the policy states that “benefits will remain in effect after the expiration date of coverage if (Mr. Hampton’s) total disability commenced during the coverage period.”

This guy was a walking disaster. I used to love watching him pitch for the Astro’s . . . except when he was pitching against us. His arrival in Atlanta was supposed to beef up our rotation. Instead, he spent most of the days on the bench, watching teammates earn their salary.

Mr. Hampton injured his pectoral muscle while warming up for his first game back from injury in April 2008, forcing him to miss 117 days of the season. The Braves claim that they are owed $41,208.79 per day from Hartford Life for those days.

At $41k per day that’s a nice paycheck. Can’t blame the Braves for trying to collect.

Police in Kansas City, Mo., said a woman’s tight hair weave stopped a bullet, rescuing her from injury and likely saving her life.Officers said they arrived at the Country View Market at about 11:30 p.m. Wednesday to find the woman’s boyfriend had allegedly shot out the back window of a car, KSHB-TV, Kansas City, reported Thursday.

Investigators said the woman wasn’t injured after her hair weave stopped the bullet and her boyfriend was taken into custody.

For the rest of us, health insurance is a good idea . . .

PeachCare is the Georgia version of SCHIP . . . the State Children’s Health Insurance Plan. PeachCare is funded through taxpayer dollars, with roughly a third coming from federal taxes.

In addition to medical care, the PeachCare plan cover’s dental benefits for qualified children up to age 18. In addition to funding issues, Peachare (and any other taxpayer funded health care plans) face major hurdles for accessability.

Many providers are refusing to service PeachCare/Medicaid patients due to the low reimbursement rates. In 1999 roughly 260 dentists accepted PeachCare/Medicaid as a form of payment. The state agreed to increase reimbursement rates which led to an increase to 1800 dental providers over the next few years.

That number is now down to less than 600 participating dental providers.

Every time a PeachCare/Medicaid patient is treated, the dental provider loses money unless they are running some kind of scam. Georgia is not the only state with disappearing providers. Here is a letter to the editor from a dentist in California. Read the rest of this entry »

Washington works in strange ways, if you can say it works at all. One part of the recent legislation, which no one read before voting on, provides subsidies for COBRA.

Or does it?

We found several resources that have their take on the subsidy. Of course, like anything else having to do with new rules, the devil is in the details.

Problem is, we don’t have any details yet.

But here goes.

The folks at Fox Rothchild, Attorney’s at law, offered this perspective.

the American Recovery and Reinvestment Act signed into law today. It is going to create some change to COBRA administration that require some attention very soon. It provides for a 65% employer paid subsidy for COBRA premiums for 9 months.

An employer paid subsidy. That’s an interesting wrinkle, especially since the ex-employee normally makes the election and is responsible for paying the premium.

The subsidy applies to those who suffered an involuntary loss of coverage between September 1, 2008, through December 31, 2009. But the Act does not specify what it will consider an involuntary loss, and it also provides that all qualified beneficiaries, regardless of the reason for their qualifying event, must get the notice. Employers and plan sponsors should go back to September 1, 2008, and review records to determine everyone (including dependents) who had a qualifying event and confirm that these individuals will get notice. This can be for voluntary or involuntary termination or reduction of hours, but it also applies to those made eligible as a result of divorce, death or aging out of coverage. They may not get the subsidy, but you must be prepared to send them the notice.

This is like watching sausage being made.

You not only don’t know what is going in, but what is coming out either.

The Act includes a retroactive provision that allows those who were eligible for COBRA and did not elect. It creates a window for them to now elect continuation coverage retroactive back to the first date of the qualifying event subsequent to September 1, 2008.

So what if someone bought coverage other than COBRA? Can they drop it and pick up COBRA going forward?

Or say they did nothing, but had a major claim in the interim. Can they elect COBRA retroactively and expect COBRA (and the taxpayer subsidy of course) to cover the claim?

Recognizing that now there is an added cost to reductions in force that equates to paying 65% of COBRA premiums, employers must consider this added expense when considering the cost benefit of a reduction in payroll. Not all eligible employees will elect COBRA because of the subsidy, but it can reasonably be anticipated that more will than would without the subsidy. If you are in the process of reducing the workforce, affected employees should be advised that the subsidy is available, but application of the subsidy will not be finalized until the close of the transition period.

OK, so the employer is laying off employees to save money. After the RIF, say half decide to opt for COBRA. Since this is an employer subsidy, the employer must pay their share, collect the balance from the ex-employee, and then ask the government for a refund of their share.

Or something like that.

Regardless of the mechanics, the RIF was to save money, but the COBRA SNAFU might create cash flow issues for the employer, leading to more lay offs, creating more COBRA elections, which creates more cash flow issues, leading to more . . . .

Confused?

I know I am.

The cost of life insurance may be going up.

A lot.

In some cases as much as 40%!

And very soon.

Some carriers are pulling existing products with long term guarantees off the market. These plans (20 & 30 yr term, life expectancy term, ROP term and well as UL and whole life) will soon be replaced with much higher rates.

Run life quotes now. Apply soon.

Here is a link.