Tag Archives: insurance

The Great “Out-0f-Network” Scam Is Eating Patients Alive. And It’s Supposed To.

by BrandonWWN Posted on September 22, 2014

Mother Jones

Over the weekend, Elizabeth Rosenthal gave us the latest installment in her series of rage-inducing stories about the American health care system. Like all the others in the series, it was all but ignored by the rest of the world. I guess everyone was too busy panicking over the White House fence jumper or figuring out ways to one-up each other in their withering scorn for Roger Goodell.

Or, like me, they’ve just given up even hoping that anyone will ever do anything about it. Saturday’s installment was about a medical practice that infuriates me more than almost any other: the routine practice of creating artificial and insanely high “list prices” for procedures that bear no relation to reality and exist for only one reason: to occasionally take advantage of the people who are most vulnerable to abusive pricing. That includes the uninsured, who can least afford it, and those who are already on the gurney going into surgery, who are barely in any condition to fight back.

Rosenthal’s latest piece is about the increasingly common practice of calling in “assistants” during surgical procedures who aren’t covered by the patient’s insurance and are therefore not subject to rates negotiated with the insurance company. This allows them to charge as much as they feel like, and then to harass patients with bill collectors forever unless they pay up. Here’s a graphic that accompanied the article:

The stomach-turning part of this is that it’s so obvious what’s going on. Clearly, the muscle and skin graft in the first example can be done for about $2,000, which produces a decent income for the doctor. So what’s the reason for list price topping $150,000? There isn’t one. It’s solely so doctors can scam the occasional patient and make a fast buck. As long as it’s not a Medicare or Medicaid procedure, and it’s out-of-network, there are no rules. So why not?

Are these assistants pals of the primary surgeon who get called in occasionally as a wink-wink-nudge-nudge buck-raking favor for a friend? Does it happen more randomly than that? Who knows. But there’s a limit to what patients can do. They’re in prep for surgery, there are tubes in their arms, and they get handed a bunch of papers to sign. Who knows what they say? Are they going to check? Are they going to read all the fine print? No and no, even if they’re aware that this kind of stuff can happen. Which most patients aren’t. A few weeks later they get the bill and their jaw drops to the floor. It’s the same thing that happens to uninsured patients who don’t have the benefit of insurer-negotiated rates when they land in the ER.

And there’s virtually no way to negotiate anyway. Have you ever tried to mark up a consent form? Have you ever tried to get a hospital to agree to an out-of-pocket max before an operation? Are you laughing hard enough yet? Insurance companies can do this, but ordinary schlubs like you and me can’t.

This is a scam, plain and simple. So why does it continue? Let’s allow James J. Donelon, the Republican insurance commissioner of Louisiana, to explain:

This has gotten really bad, and it’s wrong. But when you try to address it as a policy maker, you run into a hornet’s nest of financial interests.

And there you have it. It’s a great racket that allows doctors to extort loads of money from those in the most pain and with the least ability to fight back. None of them want the gravy train to end, and that’s your “financial interests” right there. It’s shameless and venal and there’s no excuse for it. And that’s America’s health care system.

In good conscience, I’m not even sure I can recommend that you read the whole piece. It will probably send your blood pressure skyrocketing and possibly send you to the ER, where you’ll be pauperized by the very practice the article is about. You have been warned.

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The Great “Out-0f-Network” Scam Is Eating Patients Alive. And It’s Supposed To.

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How to Discriminate Against Pre-Existing Conditions in Two Easy Tiers

by MaryannHickey Posted on September 18, 2014

Mother Jones

Via ProPublica, here’s an editorial published yesterday in the American Journal of Managed Care:

For many years, most insurers had formularies that consisted of only 3 tiers: Tier 1 was for generic drugs (lowest co-pay), Tier 2 was for branded drugs that were designated “preferred” (higher co- pay), and Tier 3 was for “nonpreferred” branded drugs (highest co-pay)….Now, however, a number of insurers have split their all-generics tier into a bottom tier consisting of “preferred” generics, and a second tier consisting of “non-preferred” generics.

Hmmm. What’s going on here? In some cases, this new non-preferred tier is reserved for higher-priced medicines. That’s pretty easy to understand: insurers are trying to motivate their patients to choose cheaper drugs when they’re available. That’s the same reason copays are lower for generics compared to brand name drugs.

But it turns out that sometimes all the generic drugs for a particular disease are non-preferred and therefore have high copays. What are insurance companies trying to motivate in these cases? Charles Ornstein takes a guess:

The editorial comes several months after two advocacy groups filed a complaint with the Office of Civil Rights of the United States Department of Health and Human Services claiming that several Florida health plans sold in the Affordable Care Act marketplace discriminated against H.I.V. patients by charging them more for drugs.

Specifically, the complaint contended that the plans placed all of their H.I.V. medications, including generics, in their highest of five cost tiers, meaning that patients had to pay 40 percent of the cost after paying a deductible. The complaint is pending.

“It seems that the plans are trying to find this wiggle room to design their benefits to prevent people who have high health needs from enrolling,” said Wayne Turner, a staff lawyer at the National Health Law Program, which filed the complaint alongside the AIDS Institute of Tampa, Fla.

If all your HIV drugs are expensive, then people with HIV will look for another plan. Technically, you’re not discriminating against anyone with a pre-existing condition, but you’re sure giving them a reason to shop around someplace else, aren’t you?

At the moment, this practice appears to be confined to just a few insurers and a few classes of drugs. But if it catches on, it will prompt everyone to follow suit. After all, you can hardly afford to be the insurance company of choice for chronically sick people, can you? This is worth keeping an eye on.

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How to Discriminate Against Pre-Existing Conditions in Two Easy Tiers

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The Paperless Office Has Beaten Out the Paperless Bathroom After All

by BritneyGurley Posted on August 13, 2014

Mother Jones

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Back when I was in the document imaging business, we joked that the paperless office would become a reality about the same time as the paperless bathroom. In other words, even those of us in the biz didn’t really believe in the hype of the paperless office.

I haven’t paid much attention to any of this for well over a decade, but today John Quiggin comes forward to tell me that, in fact, the paperless office is finally starting to come true:

Paper consumption peaked in the late 1990s and has fallen sharply since 2005….The annual rate of decline (-0.9 per cent) is unimpressive in itself, but striking when compared to the growth rate of 5.7 per cent observed from 1985 to 1999, at a time when talk of the paperless office was particularly prevalent. Compared to the ‘Business as Usual’ extrapolation of the previous growth rate, office paper consumption has declined by around 40 per cent.

….Of course, the “paperless office” myth wasn’t just a prediction that digital communications would replace paper one day. It was a sales pitch for a top-down redesign of work processes, which, for the reasons given by Sellen and Harper, was never going to work.

That’s interesting, though not too surprising. It takes a long time for habits to change, and sometimes you just have to wait for old generations to retire and allow new ones to take their place. I imagine that 20- and 30-somethings are way more comfortable with a purely digital information flow than folks in their 40s and 50s, and that’s probably responsible for much of the decline in office paper use since 2005.

As an aside, I should add that top-down redesign of work processes sometimes gets a bad rap that it doesn’t deserve. For casual work processes it doesn’t work that well, and the hype of the 90s really was overdone. But there are also lots of clerical production processes that are highly rule-bound and can be redesigned just fine. Insurance claims agents these days almost never see a piece of paper, for example. It’s all scanned and indexed so that everything—both paper and digital documents—can be viewed on screen instantly.

And I wouldn’t be surprised if even casual work processes become far more digital in the fairly near future, especially as software gets better, cloud storage becomes commonplace, and high-speed connectivity becomes all but universal. If you can look up movie times on your phone, you can keep track of schedules and due dates on your phone too. That sounds like something of a pain to me, but I’m 55. I’ll bet if I were 25 it would sound a whole lot more attractive than being forced to work with messy bundles of paper that can’t be searched and have to be carried around everywhere to be useful.

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The Paperless Office Has Beaten Out the Paperless Bathroom After All

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Quote of the Day: Honda Is Keeping Car Thievery Alive

by LeiaKrieger Posted on August 13, 2014

Mother Jones

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From Josh Barro:

One of the factors that keeps car theft going in the United States is the reliability of old Hondas.

Think about the advertising possibilities! Hondas are built so tough that thieves want them no matter how old they are. If you’re wondering what this is all about, Barro is explaining why car thefts in New York City have declined by 96 percent over the past couple of decades. In a nutshell, the answer lies in high-tech ignitions:

The most important factor is a technological advance: engine immobilizer systems, adopted by manufacturers in the late 1990s and early 2000s. These make it essentially impossible to start a car without the ignition key, which contains a microchip uniquely programmed by the dealer to match the car.

Criminals generally have not been able to circumvent the technology or make counterfeit keys….Instead, criminals have stuck to stealing older cars. You can see this in the pattern of thefts of America’s most stolen car, the Honda Accord. About 54,000 Accords were stolen in 2013, 84 percent of them from model years 1997 or earlier, according to data from the National Insurance Crime Bureau.

This has created a virtuous circle. Only old cars are vulnerable, and they aren’t worth much. That makes it less lucrative to run illegal chop shops, which makes it harder for thieves to sell their cars. This in turn allows police forces to concentrate more resources on the small number of thefts (and chop shops) remaining.

In any case, it turns out that Hondas remain the most stolen cars in America because they’re still worth something even if they were built before 1997. Looked at a certain way, that’s a badge of pride. In another decade, though, even Hondas from the Seinfeld era won’t be worth stealing. And that will put car thieves almost entirely out of business.

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Quote of the Day: Honda Is Keeping Car Thievery Alive

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Obamacare is Working, and It Will Probably Continue to Work

by MarcyHamblin Posted on July 14, 2014

Mother Jones

Tyler Cowen isn’t satisfied with current answers to the question of how well Obamacare is working. But although no one has firm answers to the questions he asks, I think we know more than he implies we do—especially when you widen your scope beyond just the details of the Obamacare transition over the next few years. Here are a few quick responses to his questions:

1. Five to ten years from now, how much do we think employment will have gone down as a result of ACA?

Take a look at Europe. The answer almost certainly is (a) perhaps a little, but not much, and (b) it’s going to be swamped by other factors anyway. In fact, if Obamacare eventually leads to the end of employers being responsible for health insurance, it could end up helping employment. More generally, though, if you’re worried about employment trends, then health care taxes and mandates should be the least of your concerns. They’re just a blip by comparison to everything else going on.

1b. How will the effort to introduce greater equality of health care consumption fare if wage and income inequality continue to rise? Will this attempt at consumption near-equalization require massively distorting incentives?

No. Even if we move to full universal health care, it will likely raise marginal tax rates by something in the neighborhood of 6-7 points. That’s nothing to sneeze at, but the bulk of it will replace current spending by employers and will do little to distort anything. The remainder is simply too little to introduce more than a modest amount of distortion in a $15 trillion economy.

2. Will ACA even have improved overall health in America?

Probably a little bit, but not a lot—though it depends on how you measure it. Especially in the under-65 age group, for example, it will do little to reduce mortality. However—and this is something I can’t repeat often enough—this is not the main point of universal care anyway. The main point is to improve quality of life and reduce the life-shattering financial consequences of serious medical emergencies.

3. Given that prices in the individual insurance market already seem to have gone up 14-28 percent, and may go up more once political scrutiny of insurance companies lessens, what is the overall individual welfare calculation from this policy change?

Actually, prices will probably go up less in future years. The initial increase was a one-time response to the new requirements of the law, especially the addition of lots of sicker people to the insurance pool. In the future, given the competition between insurance companies, increases are likely to roughly match the rate of health care inflation.

4. Given supply side constraints, how much did ACA increase the consumption of health services in the United States?

We don’t know yet. But obviously the answer is that, yes, any kind of universal health care entitlement will increase consumption. Once again, though, look at Europe. We have decades of experience in lots of different countries with a wide array of different forms of universal health care, and in every case health consumption is lower than in the US. There may well be birthing pains associated with Obamacare, but in the longer run there’s simply no reason to think that it inevitably has to lead to a significant increase in consumption.

5. How much of the apparent slowdown of health care cost inflation is a) permanent, b) not just due to the slow economy, and c) due to ACA? Or how about d) the result of trends which have been operating slowly for the last 10-20 years?

Obviously historical evidence is never conclusive, but the historical evidence we have points very, very strongly to a permanent slowdown. There’s a lot of variability in medical inflation, but one of the most underreported trends in health care reporting has been our steady, 30-year-long decline in medical inflation. There’s no special reason to think this is suddenly going to change.

If I were allowed only one answer to all these questions, it would be this: Just look at the rest of the world. Health care is not an area where we’re confined to econometric studies and CBO models. There are dozens of countries that have implemented national health care in dozens of different ways, and we can look at how they’ve actually done in the real world. Almost universally, the answer is that they’ve done better than us on virtually every metric. Unless you really, truly believe that the United States is a unique outlier to the laws of economics, there’s very little reason to believe that national health care in America would fare any worse.

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Obamacare is Working, and It Will Probably Continue to Work

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About Half of Obamacare Exchange Enrollees Were Previously Uninsured

by AntoniaHUW Posted on June 19, 2014

Mother Jones

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A new Kaiser survey shows that 57 percent of those who bought health insurance on Obamacare exchanges were previously uninsured. That’s about 4.5 million people who gained private insurance via the exchanges, and the vast majority of them say they would have remained uninsured if not for Obamacare. If this number is correct, it suggests that the number of newly insured by the end of the year will be a little higher than I’ve projected before—perhaps around 11-13 million.

But is it correct? Sarah Kliff provides the chart on the right showing the wildly different estimates from different sources, and explains that much of the divergence is due to different organizations asking different questions:

McKinsey asked people to identify the insurance they had “most of the year” in 2013….The RAND estimate relies on the research firm’s ongoing American Life Panel….It found that, when it reached out to them mostly in early March, that 36 percent of those who had exchange coverage were, in earlier surveys, uninsured.

….Health and Human Services has estimated 87 percent of certain Obamacare enrollees lacked coverage when they signed up. This figure comes from a question on Healthcare.gov….The Kaiser Family Foundation report….asked survey respondents this question: “Before you began coverage under your current health insurance plan, were you covered by a different plan you purchased yourself, were you covered by an employer, by COBRA, did you have Medicaid or other public coverage, or were you uninsured?”

To a certain extent, there is no right answer. The basic problem is that the pool of uninsured has a lot of churn: people are covered for a while, then lose their jobs, then get another job, etc. So if you had insurance last August, but lost your job and signed up for Obamacare in November, do you count as previously uninsured? According to McKinsey, no. According to Kaiser, yes.

My own guess is that the Kaiser methodology is probably the closest of the four to what we’d normally think of as “uninsured,” and its sample size is big enough to be reliable. In any case, when you combine these surveys with the Gallup results, the most likely number seems to be somewhere around 50 percent. Given the inherent subjectivity of the topic, that’s probably about as good an estimate as we can get. There’s just no reliable way to get precision any higher.

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About Half of Obamacare Exchange Enrollees Were Previously Uninsured

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Economic View: Buying Insurance Against Climate Change

by Myrna Posted on May 24, 2014

Because efforts to stop global warming may fail, one way to handle the financial losses is to share the long-term risks. More: Economic View: Buying Insurance Against Climate Change Related ArticlesExtreme Weather: How El Niño Might Alter the Political ClimateThe Big Melt AcceleratesIn California, Climate Issues Moved to Fore by Governor

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Economic View: Buying Insurance Against Climate Change

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Get ready for a whole new kind of climate change lawsuit

by ElisabeCavenagh Posted on May 19, 2014

adapt or be sued

Get ready for a whole new kind of climate change lawsuit

By

clarkmaxwell

A very wet Chicago-area neighborhood in April 2013. Now Chicago might get soaked in another way.

Leaders of Chicago-area municipalities will have to explain in court why they didn’t do a better job of bracing for the types of floods that climate change is starting to bring down upon us. If they fail to make their case, then taxpayers could be on the hook for flood-related costs that would normally be borne by insurers.

Farmers Insurance recently filed nine class-action lawsuits on behalf of itself, other insurers, and customers in the wake of heavy flooding a year ago. The damaging floods followed the type of climate change–juiced rainstorms that Chicago’s mayoral advisors had concluded would pose growing threats to the city’s unusual flood control system. Reuters explains:

The legal debate may center on whether an uptick in natural disasters is foreseeable or an “act of God.” The cases raise the question of how city governments should manage their budgets before costly emergencies occur.

“We will see more and more cases,” said Michael Gerrard, director of the Center for Climate Change Law at Columbia Law School in New York. “No one is expected to plan for the 500-year storm, but if horrible events are happening with increasing frequency, that may shift the duties.”

Gerrard and other environmental law experts say the suits are the first of their kind.

Lawyers for the localities will argue government immunity protects them from prosecution, said Daniel Jasica of the State’s Attorney’s Office in Lake County, which is named in the Illinois state court suit.

The strategy is a long shot, according to legal experts, but the potential payout is big enough that Farmers is willing to give it a try.

As if climate adaptation weren’t already urgent enough, now insurers are helping to make sure that government leaders get the message.


Source
U.S. insurer class action may signal wave of climate-change suits, Reuters
Climate change: Get ready or get sued, The Washington Post
Who will pay for climate change? Not us, insurer says, Marketplace

John Upton is a science fan and green news boffin who tweets, posts articles to Facebook, and blogs about ecology. He welcomes reader questions, tips, and incoherent rants: johnupton@gmail.com.

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Get ready for a whole new kind of climate change lawsuit

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Surprise! Better Health Insurance Saves Lives.

by TrinidadMcCourt Posted on May 6, 2014

Mother Jones

Does health insurance save lives? Since death is the least frequent outcome of poor medical care, I’ve never believed that mortality is an especially good way of measuring the value of different interventions. Even if an intervention is high value, the odds are good that it will have only a small effect on mortality.

This makes the results of a recent study in Massachusetts all the more impressive. Three researchers studied the effect of Mitt Romney’s universal health care plan and concluded that it’s saved a lot of lives so far. Adrianna McIntyre provides the summary:

Benjamin Sommers, Sharon Long, and Katherine Baicker estimate that overall mortality in Massachusetts declined 2.9 percent relative to control counties between 2007 and 2010; mortality amenable to health care declined 4.5 percent. This translates to one death prevented for every 830 people who gain insurance, and the effects were larger in counties with low income and low pre-reform insurance rates—the counties we would expect to be most favorably impacted by reform.

….If you think the study’s primary findings are impressive, consider their implications: “mortality amenable to health care” does not just magically decline. If fewer people are dying, that is almost certainly because diseases are being better treated, managed, or prevented—because of improved health. It’s hard to come by data on objective measures of health at the state level, but the “improved health” story is consistent with other findings in the paper: individuals had better self-reported health, were more likely to have a usual source of care, received more preventive services, and had fewer cost-related delays in care.

What makes this even more impressive is that the elderly in Massachusetts were already covered by Medicare. These results are strictly for those under the age of 65, who don’t die very often to begin with. Within this group, a reduction of 4.5 percent in mortality amenable to health care (the only kind we care about in this context) is a lot.

The implications for Obamacare are obvious since Obamacare was explicitly modeled on the Massachusetts program—though it’s unlikely that it will produce quite such dramatic mortality improvements since its coverage isn’t as universal as the Massachusetts plan. Still, Obamacare has so far shown that it has a lot in common with Romneycare, so there’s good reason to hope that it will demonstrate mortality improvements as well.

But don’t hold your breath for study results. Given the way research like this works, we probably won’t get them until 2020 or so.

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Surprise! Better Health Insurance Saves Lives.

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How Will We Know If Obamacare Is a Success?

by ChandraPrado Posted on April 18, 2014

Mother Jones

Will Obamacare be a success? Ross Douthat thinks we should all lay down some firm guidelines and hold ourselves to them. Here are his:

For my own part, I’ll lay down this marker for the future: If, in 2023, the uninsured rate is where the C.B.O. currently projects or lower, health inflation’s five-year average is running below the post-World War II norm, and the trend in the age-adjusted mortality rate shows a positive alteration starting right about now, I will write a post (or send out a Singularity-wide transmission, maybe) entitled “I Was Wrong About Obamacare” — or, if he prefers, just “Ezra Klein Was Right.”

Let’s take these one by one. I’d say a reduction in the uninsured of 25 million is a pretty good metric. If, by 2023, the number is substantially below that, it would be a big hit to the law’s success. Getting people covered, after all, has always been the law’s primary goal. What’s more, I’d be surprised if more states don’t expand Medicaid and get more aggressive about setting up their own exchanges by 2023. At some point, after all, Republican hysteria about Obamacare just has to burn out. (Doesn’t it?)

On health inflation, I think running below the post-WWII average is a pretty aggressive standard. That would require health care inflation of about 1 percent above overall inflation. If we manage to keep it to around 2 percent, I’d call that a reasonable result.

But my biggest issue is with the age-adjusted mortality rate. I know this is a widely popular metric to point to on both left and right, but I think it’s a terrible one. Obamacare exclusively affects those under 65, and mortality just isn’t that high in this age group. Reduced mortality is a tiny signal buried in a huge amount of noise, and I very much doubt that we’ll see any kind of clear inflection point over the next few years.

So what to replace it with? I’m less sure about that. Maybe the TIE guys would like to weigh in. But this is a longtime hobbyhorse of mine. Medical care does people a ton of good even if it doesn’t save their lives. Being able to afford your asthma inhaler, or getting a hip replacement, or finding an antidepressant that works—these all make a huge difference in people’s lives. And that’s not even accounting for reduced financial strain (and bankruptcies) and lower stress levels that come from the mere knowledge that a doctor is available if you need one—even if you don’t have a life-threatening emergency that requires a trip to the ER.

In addition, I’d probably add a few things. Douthat doesn’t include any negative metrics, but critics have put forward a whole bunch of disaster scenarios they think Obamacare will be responsible for. It will get harder to see doctors. Pharmaceutical companies will stop innovating. Insurance companies will drop out of the exchanges. Premiums will skyrocket. Etc. Without diving into the weeds on all these possible apocalypses, they count as predictions. If, in 2023, we all have to wait months for a routine appointment, or we can’t get the meds we need because drug companies have gone out of business, then Obamacare is a failure regardless of what else it does. I don’t think these things will happen, but they’re surely on my list of metrics for judging the law’s success.

UPDATE: Whoops. It turns out that one of the TIE guys, Austin Frakt, has already weighed in on this. You can read his comments here.

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How Will We Know If Obamacare Is a Success?

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