Burning Data

We've been writing about who owns our medical data for a long time. For example:

"Hugo Campos has [an ICD] buried in his chest to help keep him alive. But he has no idea what it says about his faulty heart ... what if Mr Campos wants to see that data for himself?"

An interesting question, no?

Here's another: what if that information was relevant to a crime?

Think that's far-fetched?

Well, thanks to FoIB Holly R, we have the case of Ross Compton:

"A judge says data from the pacemaker of a man accused of setting his Ohio house on fire in 2016 can be presented as evidence at his trial."

His attorney had argued that use of the data "violated Compton's constitutional rights."

Maybe, but the judge didn't agree, saying that "the individual data is no more private than other things."

What "other things" isn't clear, but the message certainly is.

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Tuesday LinkFest

■ First up, courtesy of FoIB Holly R:

Just released USA Today poll on Obamacare:
11% keep it
42% fix it with major changes
44% repeal

— Ben Ferguson (@benfergusonshow) July 10, 2017

■ Next, our friend Allison B at ThinkAdvisor piles on:

"Individual Health Enrollment Falls 11% ... Plan withdrawals and rising premiums led to a sharp drop in individual and family major medical plan use in the first quarter" of the year.

But hey, if you like your plan....

■ And finally, FoIB Ʀєfùsєηíκ tips us that "The number of U.S. adults without health insurance has grown by some 2 million this year."

Which seems unpossible, since the entire point of ObamaCare was to eradicate this plague.

Hunh.

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SEP News (Sorta)

As we've previously noted, the qualification process for triggering a Special Open Enrollment have gotten tougher as carriers have been hot with ever higher claims:

"Perhaps the most egregious is the fact that no one in government seems to care about the massive fraud being perpetrated right under their noses during this time."

Our friends at Medical Mutual emailed us a slideshow of the new, tougher Special Open Enrollment process, available here.

One that immediately jumped out was this:

"Beginning in Summer 2017, new applicants ... who attest to certain types of SEP qualifying events will be subject to the SEPV process of pre-enrollment verification. Eligible consumers must submit documents that confirm their SEP eligibility before they can enroll and start using their Marketplace coverage."

Quite different than before, where one was given a certain period of time after enrolling in (and, perhaps, using) a new plan. Under the new system, no policy is issued until the verification paperwork is submitted and approved.

Which would seem to be a challenge for carriers, but fret not:

"When submitting business ON Exchange please submit verification documents directly to the exchange.  Medical Mutual cannot process/accept anything that is submitted directly to us."

Can't say as I blame them. 

NB: I reached out to our rep wbho confirmed that MMO would continue to process this info for off-HIX plans.

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Stupid "Beneficiary" Trick

A few years ago, we reported on a "widow" who tried to collect on her husband's life insurance policy. The challenge? He wasn't dead, and the woman was charged with fraud.

But at least the perp had her paperwork in order.

Not so with this rocket surgeon wannabe:

"A newlywed accused of soliciting her firefighter husband's killing to collect $100,000 in insurance money has been convicted of aggravated murder in a scheme that was flawed from the start: His ex-wife was still the beneficiary of his policy."

Ooops.

Oh, and it gets better (for certain values of "better"): she'd recruited her teenaged daughter and her boyfriend to do find a someone to actually do the deed.

But wait, there's more:

The boyfriend thought it'd be a good idea to "keep it in the family," and reached out to his cousin to pull the trigger. Be sure to click on over for even more twists.

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Breaking: A Reprieve for Baby Charlie?

Via RedState:

"In an abrupt shift, a London hospital said on Friday that it would reconsider its decision to turn off life support for Charlie Gard, a brain-damaged and terminally ill British infant, in light of “fresh evidence” about a potential treatment."

More as (if?) this develops.

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From the Mailbag: CTE or no CTE?

Interesting query from a reader:

"My sister went to the doctor because of some symptoms she's been having (memory loss, moodiness and headaches). She's a cyclist, and used to race competitively, and suffered concussions in the past. The doctor thinks she could possibly have CTE. She hasn't done any testing because from what she knows there's no treatment for it.

She does have health insurance through her spouse's employer, but wants to know if she gets this testing and it's in her records that she has CTE could that hurt her in the future for insurance purposes? Like if she has to switch insurance companies etc.

I know right now it wouldn't matter because of ACA. But what if things change if/when they repeal it? The way I always understood pre-existing conditions before ACA was that you could not have a gap in coverage. So if you have insurance and you're diagnosed with a condition you are covered. If you switch insurance and there is no gap in coverage it can't be considered a pre-existing condition. But if you do have a gap in coverage it could fall under pre-existing conditions. Is that how it worked before? Who knows how insurance is going to change in the future. She's just trying to figure out if she should just not do it and wait and see."

First, Thank You for a really outstanding, well thought out query. There's a lot to unpack, so I'll try to be as thorough as possible.

Here's the thing: we really don't know what's going to happen (or when, or even if) ACA-wise. If we go back to something that looks like pre-ACA, then yes, this is a legitimate concern. But the cat's already out of that bag:

"went to the doctor because of some symptoms she's been having"

Assuming new applications look like pre-ACA, then she's going to have to answer yes to at least one of the questions ("have you consulted a physician"). It may not be explicitly CTE, but it's likely going to be an issue, although I have no idea how much of one. But: this presumes a new app. Again, assuming something that looks like 2009, as long as she keeps continuous coverage group-to-group (or COBRA), no problem. However: that only really worked individual-to-group, or group-to-group, not group-to-individual (or individual-to-individual).

From what I've read, CTE is kinda like Alzheimer's in that it's only truly diagnosable at autopsy. While alive we're only able to infer its presence. So test or not? I don't know, but I would suggest taking the insurance element out of the equation, and look only at pro's/con's of "knowing."

Hope this helps, and best of luck to your sister-in-law and her family.

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Thursday Afternoon Potpourri

■ Our friends at Cornerstone have an update and explanation of the Social Security Number removal initiative (SSNRI), part of 2015's "“Medicare Access and CHIP Reauthorization” (MACRA).

The bottom line is that CMS will begin issuing new kinds of ID for Medicare beneficiaries, in an effort to hold down identity theft.

Also known as: major headache for providers.

■ As co-blogger Patrick reported this past Spring, the Small Business Health Options Program (SHOP) has been a resounding .... flop:

"Turns out SHOP enrollment is extremely cumbersome, there are less plan options compared to the off exchange market, and that tax credit, well it hasn't been worthwhile for most employers"

Ooops.

Well, the folks at Medical Mutual just emailed us to say "adios,muchachos:"

"Beginning January 1, 2018, Medical Mutual will no longer offer plans through the Small Business Health Options Program (SHOP) marketplace. Coverage will terminate for affected groups on their renewal date."

But hey, if you like your group health plan...

■ From the "You Don't See This Every Day" Department:

"Zurich American Life Insurance Company is offering to buy back some of its annuity contracts ...  it is making the offer partly because it believes some annuity holders' needs may have changed over time, and partly because it wants to exit this segment of the variable annuity business"

To sweeten the deal, they're offering an "enhancement amount."

Hunh.

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