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You Don’t Want To Come Out Ahead With Health Insurance

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Browsing around Reddit this morning, we came across this thread (there is profanity). The initial sentiment in the title is no doubt one that has been expressed by a lot of people over the last few years, and the thousands of comments are testament to the fact that healthcare debate tends to get people fired up […] Another way to think about it: Health insurance is designed to spread risk. We all pay in (ideally, anyway) and then the carriers pay out when someone has a claim. The premiums from those of us who have been fortunate enough to not have health problems are used to cover the healthcare costs of people who have serious illnesses or injuries. And we never know when we might find ourselves in that second category. If you’re complaining because you’ve paid $13,000 in premiums over six years and have have very little paid out in claims, would you take a similar position if you suddenly had a $500,000 claim? Would you want the carrier to say that you have to pay in what you get out? Reversing the scenario like that highlights the lack of logic on the part of people who get annoyed because they haven’t gotten as much out of their health insurance as they’ve paid in. And yet that sentiment is one that is constantly tossed around when people talk about their health insurance.

To summarize: It will be a very bad day if and when you actually come out ahead financially with your health insurance. Please don’t wish for that day. Remind yourself that your health insurance is in place to protect you in the event of a medical catastrophe. Don’t buy a mini-med or a discount plan or any other type of coverage that won’t actually be there for you if you have a major health crisis. Get a policy that you’re confident will protect you if you have a major claim, and then be grateful if you’re one of the people who remains healthy enough to get less back in benefits than you pay in premiums.

Being A Savvy Healthcare Consumer Is Tougher Than It Sounds

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[…] I’ve long been a fan of high deductible, HSA qualified health insurance policies (our family had one until very recently when we switched to a high deductible plan that isn’t HSA qualified but has much lower premiums). But I’ve also always been aware that we’re fortunate to be able to utilize a high deductible health insurance policy – both in terms of being healthy and not needing much in the way of healthcare, and also in our ability to make contributions to our HSA to cover the cost of care we might need in the future. People who have serious health conditions and/or those with very limited funds […] When it comes to actually being a savvy consumer of healthcare, the vast majority of us wouldn’t even know where to begin. Google? Asking friends? Maybe, but chances are, we’re going to go to a doctor and follow (at least roughly) the recommendations the doctor makes. Most of the time, providers are the ones who control how much care a patient receives ie, it’s the supply that’s driving things, rather than the demand. We might know that something’s not right and take the initial step of going to the doctor. But what happens next (surgery? PT? wait and see? Medication? etc.) is generally up to the doctor. As Michelle pointed out, the patient’s number one priority is going to be getting better, especially if the problem being treated is a serious one. Shopping around for the best price and poring over comparative effectiveness research data probably isn’t going to be high on most patients’ lists.

Comparing Wall Street And Healthcare

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[…] Should hospital, insurance, and pharmaceutical executives be earning millions of dollars while millions of Americans have no health insurance and no realistic access to healthcare? Should those executives earn their millions regardless of how their company has performed? Or regardless of the overall state of healthcare in this country? Should decision-making at healthcare companies (hospitals, pharmaceutical companies, insurance carriers, device makers, etc.) be based more on the best interests of shareholders and executives, or on what is best for the health of Americans? Do healthcare companies need to be held to a different standard than other corporations, simply because of the importance of the product they provide? […]

More Flexibility With An Individual Health Insurance Plan

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[…] For the average person who has had an individual policy for a decade and is late 50s-ish, keeping that individual policy (even though a group plan may become available) might be the ticket to being able to have some flexibility in terms of when to retire. The group plan is guaranteed issue – health conditions won’t be a barrier to getting coverage. But the group plan is also tied to the current employer, and the policy will only be available for a maximum of 18 months after you leave that job (via COBRA). […] Linda’s article is an excellent reminder about the importance of looking at the specifics of your own situation – including long term issues that might outweigh short-term benefits – rather than following conventional wisdom or doing what everyone else is doing.

Colorado’s Average 2012 Premium Increase Is The Smallest Since 2000

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[…] I’m sure there will still be people who falsely claim that Colorado’s maternity mandate and federal reform are the reason for any increase. But when we place the 2012 increase in context with the increases we’ve seen over the past decade, it becomes harder to blame recent reform laws for the 2012 premium increases. I’m glad to see that after a year of having guaranteed issue coverage for children, no lifetime maximums, more comprehensive preventive care, and maternity benefits on all new and renewed individual policies, we are seeing the lowest average rate increase in over a decade.

Employer Reimbursement Of Premiums Causing Applicants To Be Declined

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[…] I know that the law was written with good intentions, but we’re noticing that it’s the employees – the applicants who are trying to get individual health insurance policies – who get the short end of the stick. It’s the employees who end up getting their health insurance application declined. It’s the employees who end up having to pay for their own premiums in order to obtain coverage, even if they thought that they were going to be able to rely on some level of reimbursement from their employer.

Millions Of Uninsured Children Are Eligible For Public Health Insurance

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[…] The first sentence of Jason’s article is the most striking: The fact that there are 4.3 million uninsured children in the US who are eligible for Medicaid or CHIP (Children’s Health Insurance Program). Obviously, not all states are pushing hard to enroll all (or even most) Medicaid/CHIP eligible children in those programs. And although Colorado received a $13.7 million grant last year thanks to the increased enrollment in the state’s Medicaid program, the expansion of public health insurance programs in Colorado has not been without criticism. Especially in the current economic climate, it’s hard to see how government health insurance programs could afford to insure an additional 4.3 million children. […]

Kaiser Permanente Colorado Gets Top NCOA Ranking

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Kaiser Permanente Colorado is the highest-rated private health insurance plan in Colorado and one of the top-ranked private health plans (#6) in the nation for clinical performance and effectiveness, as well as member satisfaction, according to new rankings by the independent, non-profit National Committee for Quality Assurance (NCQA).
Kaiser is one of the top 10 plans in the nation in 36 of the 40 health outcome measures, recognizing high quality clinical care

Walgreens Leaving Express Scripts Network

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If you’re insured through Anthem Blue Cross Blue Shield or another carrier using the Express Scripts network, Walgreens will be leaving the network on January 1, 2012. Express Scripts just posted on their website:
“At Express Scripts, we’re committed to keeping your prescription drugs affordable and accessible. That’s why we negotiate cost-competitive agreements […]”
Express Scripts is sorry that Walgreens did what they did and has expressed sincere regret about the situation:
“We regret any inconvenience that Walgreens’ actions have caused you. If you have any questions, please call us at 1.877.885.3409.”

Comparative Effectiveness Research Fee To Be Added To Premiums In 2012

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[…] This fee is similar to the one that is assessed to pay for CoverColorado (except that it’s a much smaller amount). Basically, carriers will collect the fee from members and then pass the money on to the Patient-Centered Outcomes Research Institute, much the way carriers pass on the CoverColorado fee. The fee will not be counted as premiums for the purpose of calculating medical loss ratio numbers, and should not be confused as being part of the premium that we pay for our health insurance.

Possible Solutions For Long Term Care Funding Problems

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[…] As long as we’re looking at a fragmented public/private hodge podge of long term care funding that includes Medicaid, private long term care insurance, private assets, and help from family and friends, I think it’s important that we look for ways to make things as fair as possible and also keep Medicaid financially afloat. The CLASS Act got nixed from the ACA, but the problem of funding long term care isn’t going away, and is only going to grow as the baby boomer generation ages. John’s article is a good one to read if you’re interested in possible solutions.

World Insurance And American Republic Leaving Individual Market

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[…] The rep I spoke with at World Insurance said that it wasn’t clear yet which states will be in the November round of notifications, so we aren’t sure when World/American Republic policyholders in Colorado will be officially notified that their carrier is leaving the market. But I confirmed with both World Insurance and Celtic that the change is happening and that the initial stage of it will begin next month. Colorado residents who are currently covered by either World Insurance or American Republic would be wise to begin looking for other health insurance options. […]

Real-Time Tracking Of Healthcare Costs

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[…] Obviously we have to avoid cutting corners just for the sake of lowering costs at the expense of patient outcomes (again, including patient outcomes when we compare the cost data would help to prevent this problem). But I have no doubt that there are other healthcare expenses that could be eliminated without compromising patient outcomes. In many cases, the providers might just be unaware of the actual costs that are being incurred – Dr. Fogelson’s idea for a real-time digital tracker would help to keep cost in the front of everyone’s mind.

Health Insurance Exchange Payroll and Admin Expenses

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[…] One of the comments on the post was from Dede de Percin, the Executive Director of the Colorado Consumer Health Initiative (CCHI). […] Dede’s comment on my article referenced the point I made about consumers not having to pay additional fees to have a broker. Basically, health insurance is priced the same whether you go directly through a health insurance carrier (calling Anthem Blue Cross Blue Shield directly, for example) or through a broker (who will compare options from multiple carriers for you). Dede made this point:
“While a consumer or business doesn’t not pay a health insurance broker directly, broker fees and commissions are paid by the insurance companies – and rolled into […]”

Why People Don’t Buy Life, Disability, and LTC Insurance

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[…] Insurance just isn’t that much fun to buy, period. It’s a product that we purchase while hoping we never have to use it, and if we ever do have to use it, things aren’t going so great. Having insurance does contribute to our peace of mind though, and that’s valuable in and of itself.

Does The Pink Ribbon Trivialize Breast Cancer Deaths?

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[…] I can see how awareness is a good thing if it encourages people (men and women) to be in tune with their health and current on the screening exams that they and their doctor feel they need. And it’s a reminder to all of us to do whatever we can to provide support to those who have cancer. But what about the people who know that their cancer is terminal? What about those with metastatic breast cancer? Or with another form of advanced cancer like my friend? The people who know that there is almost no chance they will beat the disease, and that their life will almost certainly be cut short by it? Do all the pink ribbons trivialize their deaths? […]

Conflicting Data Regarding Medical Costs

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[…] These numbers are much more in line with the rise in health insurance premiums that we’ve seen over the past few years. I have no explanation for why the data from the two sources is so dramatically different in terms of medical trend in 2010, but if the trend was really closer to 7.5% rather than 1.7%, the health insurance premium increases would be a lot easier to understand. […] In addition to the MLR rules, some states (including Colorado) have implemented strict review processes for rate hikes. The ACA now calls for insurers who propose a rate hike of 10% or more […]

The Opposite Of Transparent

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[…] David also points out that the amounts allowed by his Blue Cross Blue Shield carrier don’t seem to have anything to do with the amounts billed by his physical therapies – the lowest allowed amount on his EOB was for the service that was billed with the highest price tag. We’ve also seen little rhyme or reason (that we can detect, anyway) in terms of how billed amounts and allowed amount correlate. […]

Stuck In A Mini-Med

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[…] So he applied for an individual policy with Anthem Blue Cross for his family, and was approved. But then when he tried to cancel his mini-med plan, his employer told him that he couldn’t cancel it until the open enrollment period next April. It would seem that trapping enrollees into a year-long contract with a mini-med plan is not in line with the spirit of the HHS guidelines that call for full disclosure regarding the waivers and directives to steer enrollees towards healthcare dot gov if they are interested in getting a policy that does comply with the ACA rules regarding annual policy limits. […]

Grand Rounds – Colorado Fall Colors Edition

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Henry Stern of InsureBlog brings us an interview with the whistleblower who has brought a lawsuit against LabCorp for allegedly charging a lower price to United HealthCare than to Medicare. The post is particularly interesting because Hank adds his own thoughts after the interview, and he sees things a little differently than Andrew Baker (the whistleblower). Hank agrees that it does look like LabCorp lowered their fees for UHC […]

Increased Medicare Cost Sharing Might Not Be The Best Plan

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[…] The healthcare providers make recommendations, order tests, perform surgeries… and in general, the patient does what the doctor recommends. And really, isn’t that the way it probably ought to be? Most of us have not been to medical school. When something seems amiss with our health, we need to feel that we can rely on our doctors to tell us the best course of action. Increased cost-sharing tends to increase the number of people who skip healthcare in general – including very necessary care like keeping diabetes and blood pressure under control.

Accepting Grand Rounds Submissions

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We’re honored to be hosting the next Medical Grand Rounds on October 4th, our fourth time to host! Grand Rounds is a weekly gathering of the best health and medical articles written by doctors, nurses, students, patients, and others in health care related professions.

Colorado Legislators Delay Health Benefits Exchange Grant Application

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[…] That issue again appears to be a sticking point, with Colorado House Republicans blocking the health insurance exchange board from applying for a $22 million grant because the application mentioned changing Colorado regulations to “conform to federal requirements”. The grant application is due at HHS on Friday, and the exchange board will not be able to meet that deadline. They are hoping, however, to address the legislator’s concerns and be able to get the application submitted by the end of the year, to be considered in the second round of funding. […]

Colorado Health Insurance Exchange Board Hires Attorney General’s Office

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[…] I’m confident that the Colorado Attorney General’s office will be able to provide competent legal advice to the exchange board. In addition, it appears that the board is getting an excellent value, since they’ll be paying less than $79/hour for a lawyer. But I assume that John Suthers is hoping to prevail in the lawsuit challenging the individual mandate, and I am a bit skeptical about whether the rest of the ACA (including the health insurance exchanges) could survive without the individual mandate.

A Great Cavalcade And Some Good Advice About Life Insurance

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[…] a good one for people considering such a product – or really, most any very specific life insurance policy that only covers a particular debt, like your car loan, mortgage, or credit card balance. A regular term life insurance policy will likely be a much better value and can be used by your dependents to pay off whatever debts you may have and cover their own cost of living.