Comprehensive Insurance

Thursday, 12 July 2018

Artwork Liability Update

Last month, we reported on the strange case of the child versus the glass sculpture:

"[T]he young lad, attending a wedding reception replete with expensive (and apparently fragile) art work, who (apparently accidentally) knocked over a priceless glass statue."

Well, maybe not "priceless:"

"A Kansas mother says an insurance company wants her family to pay $132,000"

Now, if you're wondering about how that seemingly-arbitrary value was assigned, well, it appears to have been the sales price of said sculpture [ed: notwithstanding that "asking price" isn't necessarily "what someone ultimately pays"]. In the event, there was some dispute about whether or not the child actually touched, let alone knocked over, the piece.

The good news is that this is now settled:

Surveillance video shows the child wrapping his arms around it and then struggling to hold it up as it fell https://t.co/ITQnKZKSat
— New York Post (@nypost) July 10, 2018

So, that's that, and we appreciate the tip from FoIB NARNfan who also asks (one presumes rhetorically) "How much would you get if you stole it and fenced it?"

The world may never know.

from InsureBlog https://ift.tt/2N6Vk8v

From the P&C Files: Heads' up, Campers!

[Hat Tip: SoIB Gail S]

from InsureBlog https://ift.tt/2Na039D

Wednesday, 11 July 2018

New Claims Tech

If you're fortunate enough to (still) have a PPO-type health insurance plan (coverage for both in- and out-of-network expenses), then you probably know the frustration of actually filing those OON claims. What if there was a simple, inexpensive way to get them paid with little or no hassle?

Well, as you might have guessed, there's an app for that:

"Reimbursify’s smart dashboard manages your claims, helping you to make new claims, and keep track of pending reimbursements."

There's even a feature that helps if your claim is denied.

There's also a "Provider Pro" version for doc offices; this waives the $2 per-claim filing fee. And the folks behind the app promise to keep your personal health info as safe as possible.

The app itself is free, and available for both Apple and Android devices.

Oh, and it may be especially useful for folks who choose both insurance and Direct Primary Care (since DPC folks are by definition out-of-network).

Cool.

[Hat Tip: Vatsal G. Thakkar MD]

from InsureBlog https://ift.tt/2NKeZfN

Hot Summer 'Review

Our good friend Peggy Salvatore hosts the July Health Wonk Review. As she notes, it's "short, sweet and HOT!"

Posts include Joe Paduda's take on high deductible plans, and Tom Lynch's on new Medicaid work rules in the Bluegrass State.

Check it out!

from InsureBlog https://ift.tt/2zpVu93

MVNHS© vs Medical Tourism

Heh:

I'm just surprised that the #NHS didn't forcibly tie the kid down and starve him and withhold water from him. https://t.co/u3bXTL6W0Q
— Þe Political Hat with "Ralph" The Wonder Llama (@ThePoliticalHat) July 11, 2018

from InsureBlog https://ift.tt/2N8Kxut

Tuesday, 10 July 2018

On Risk Adjustment

The only permanent "R" of Obamacare's 3R's, Risk Adjustment, was implemented in 2014 with the impression that it would keep insurers from cherry picking the healthy risk versus the unhealthy risk. Using an actuarial formula insurers would predict health care costs based on a variety of factors.

In a nutshell, the program would take money from insurers who had lower risk members and provide funding to insurers who disproportionately attracted higher risk members. There were two goals: minimize adverse selection and stabilize premiums.

So what happened?

A handful of mainly small insurers got clobbered. The most heavily hit were Obamacare's newly created CO-OP's. Many of these start ups underfunded premiums to be competitive. They took in a large portion of good risk and had priced for it. But when Risk Adjustment (RA) was factored in they had to pay huge amounts of their premiums to other insurers who had higher risk scores.

Three CO-OPs - Minuteman, Evergreen, and New Mexico Health Connections, challenged parts of the formula laid out in HHS annual payment and parameter regulations. These lawsuits were filed in the summer of 2016 against the Obama Administration's HHS and CMS. One of the main points of contention was HHS's use of statewide average premiums instead of each plan's premiums when creating its risk adjustment formula. HHS adopted this based on the assumption that the program must be budget neutral.

Evergreen went in to receivership right after it was ordered to pay $24.2 million dollars into the RA fund in August of 2016. If they wouldn't have had to pay the RA funds they would have seen a profit of $2 million for the year. Minuteman saw their lawsuit upheld in early 2018 so no changes were required to the original HHS/CMS guidelines.

New Mexico however, received a somewhat positive outcome. In their case the judge ruled in favor or NMHC on payments being based on plans and not the state's average premium. All other claims in the suit were dismissed and lawsuit was completed at the end of February of 2018.

Which leads us to now. Without clarity the Trump Administration has temporarily suspended all payments and collections of RA until the lawsuit is resolved. Once it is resolved payments and collections will resume. Further, because the Trump Administration issued relevant guidance in the 2018 Notice of Benefit and Payment Parameters this shouldn't happen again in the future.

Trump is not "sabotaging" Obamacare. In fact this is something that could have been avoided and fixed by the prior administration. I'm not sure why they didn't fix it and I haven't seen anyone suggest or explain why Andy Slavitt and Sylvia Burwell lacked a game plan back then.

They could have issued interim rules to circumvent the problem. They could have adjusted the 2017 Notice of Benefit and Payment Parameters that were rushed through in late 2016 to mitigate the problem too.

But they didn't. So now - for at least the next news cycle - we will be stuck hearing about a small but substantial piece of the insurance payment system gone awry. Albeit those complaining are the ones who implemented it but didn't fix it.

from InsureBlog https://ift.tt/2m5NIHL

Medicare Drug Plan Deductible - How Does It Work?

How do Medicare Part D prescription drug plans work? Why do some have a deductible? Am I required to pay the deductible up front before I can have a copay? Does the copay apply to all drugs? Isn’t a plan without a deductible less expensive?

In 2018 Georgia has 24 different prescription drug plans. Some #PartD plans have a deductible, others do not.

In many cases your drugs may have a lower #copay and lower annual out of pocket cost when you choose a plan with a #deductible. Premiums are usually less as well when compared to plans that do not have a deductible.

Roughly 6% of Medicare beneficiaries will ever enter the #donuthole. Many people can actively monitor their drug plan and avoid the donut hole completely.

Every #drugplan has a #formulary. The formulary let’s you know which drugs are covered by the plan, which are not.

The formulary also determines your copay.

Every Part D plan is approved by Medicare and each one is required to cover roughly 600 different drugs.

You have questions. We have answers.

Additional reading
https://ift.tt/1VM7DYT

https://ift.tt/2ueGKUC

https://ift.tt/2p8sCYk

from InsureBlog https://ift.tt/2ug56gA