Comprehensive Insurance

Tuesday, 9 January 2018

Companion Life takes a hit

From co-blogger Bob V:

"When Beau Heimer crashed his dirt bike while drunk, incurring nearly $200,000 in medical costs, his insurance company denied benefits ... U.S. District Judge Janet Neff said those key words - "illegal use of alcohol" - didn't absolve Companion Life Insurance Co. of responsibility for the medical bills."

Read the whole thing (it's pretty short and to the point), and then I have a question:

Related: About 20 or so years ago I had a similar situation with a client. Small group health plan with $15,000 life and AD&D "Accidental Death and Dismemberment;" the idea was that the death benefit doubled if one died from an accident (as opposed to illness). One of the employees, a young man (of course), decided to play chicken with a Ford Explorer (he was riding a motorcycle).

To my surprise, they actually care-flighted him to the hospital (to no avail, of course).

We submitted the death claim, which was approved for the underlying amount, but the AD&D portion were denied because the wording (more explicitly than was the case here) said no "double indemnity" if alcohol was involved.

I had a few questions about that wording, too, but never had the opportunity to raise them.

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Top 30, Baby!

The folks at Feedspot have graciously named us as one of the Top 30 Health Insurance blogs.

Blogs are ranked based on:

• Google reputation and Google search ranking

• Influence and popularity on Facebook, twitter and other social media sites

• Quality and consistency of posts.

• Feedspot’s editorial team and expert review

We're in pretty august company, too, including 404Care.gov's blog, Blue Cross and Aetna blogs, and our friend David Fluker's, too.

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Monday, 8 January 2018

Another day, another MVNHS© shanda

The Much Vaunted National Health System© strikes again:

I have unwell patients begging me not to send them into hospital. This is what ‘we’have become. The state of the NHS is shameful. My condolences - feel so upset for you and very angry on your behalf that this could have been avoided.
— universalhealthcare (@Protectthenhs) January 6, 2018

[Hat Tip: FoIB Holly R]

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Thursday, 4 January 2018

Compare & Contrast: CanuckCare vs MVNHS©

Wednesday, 3 January 2018

Two steps forward, one back

So in December, we began moving several small groups to Anthem (mostly from United Healthcare)(Heh). But we weren't alone, and they are severely backlogged.

How backlogged? Well, my rep told me that groups approved on December 21st are still not all keyed in. Which is a problem for groups approved late last month or even earlier this week.

Here's why that can be an issue: in the early morning hours of January 1st, one of my client's daughters suffered severe frostbite (long story). In fact, she had to spend time in the burn ward, and we're still not sure whether they'll be able to save her feet. As one can imagine, there's a heck of an ER and burn unit bill, and surgery is likely.

I've been on the phone with the hospital about this numerous times over the past few days; she'll be covered, but the billing situation is a mess (fortunately, this just happened so nothing's actually been billed yet).

She also mentioned that there seemed to be (at least) two factors involved here: first, of course, is the aforementioned desertion from UHC. But a close second is, interestingly, the implosion of the individual market, especially here in southwest Ohio: a lot of smaller employers who had been on the fence about installing a group plan took the plunge as a result of that implosion.

So, not a bad problem to be sure (hey, lots of new business means lots of new premium dollars), but a service mess for at least a while.

[Hat Tip: FoIB Liz M]

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Tuesday, 2 January 2018

Breaking: UHC and Premier Kiss, Make up

After spending most of the year on the outs, health insurance behemoth United Healthcare and big-time medical care provider Premier Health have reached "a new, multi-year relationship ... the agreement ensures access to Premier Health’s physicians and facilities for Medicare Advantage plans and restores access for commercial plans effective Jan. 1, 2018."

This was a major stumbling block for most of 2017, and one wonders just how badly the disagreement hit UHC's bottom line (I know of more than a few groups who bailed solely because of this issue).

Will be interesting to see who's next....

[Hat Tip: FoIB Amanda A]

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