Rx for Shanda

Shanda being Yiddish for scandal. And boy, this one appears to be a doozy:

Express Scripts "egregiously charged for services it didn't deliver," that has cost Ohioans millions. " We want our money back," says @OhioAG Dave Yost. https://t.co/AYFF0UnCQn via @healthcaredive

— AssocAmerPhys&Surg (@AAPSonline) July 15, 2020

At the linked story we learn that the vendor (allegedly) overcharged The Buckeye State's Highway Patrol Retirement System. Looks like they're going to be getting quite the ticket.

Express Scripts is a Pharmacy Benefits Manager (PBM); we've written about these before:

"PBM's are (allegedly) a cost-efficient way for carriers to offload the administrative functions of filling prescriptions."

But wait, there's more:

"While the concept seems innocuous enough, it's apparently become a major source of tension in the health care community, and is frequently cited as a major driver of increasing health care costs."

Oh.

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Timing is Everything (Still!)

Working on an interesting case, and thought readers would be, um, interested:

Sally called yesterday about individual medical insurance. He husband had retired and is on medicare, she still has a couple years to go until she's 65. In the meantime, her COBRA pan is due to run out in November, and she's trying to figure out her options.

There are a bunch of issues here, and we discussed them at length (she's my favorite kind of client, interested and engaged, asking really good, helpful questions). I'll cover just a few of them in this post.

First is timing: if she rides out her COBRA until November she's going to end up squarely in "regular" Open Enrollment Season at the very same time that she's eligible for her own Special Enrollment opportunity. Which means she'll be shopping for a 2-month-long 2020 ACA plan (if she goes that route) and a 2021 version. Which also means that she's going to have 3 annual deductibles in about 60 days (2020 COBRA, 2020 ACA, and 2021 ACA). Not a great place to be, but as I explained to her, pretty common when we're looking at plans this late in the year.

It turns out that she's met very little of her 2020 COBRA deductible, so she might be better served cancelling that sooner rather than later; that way, any expenses that crop up would go towards the 2020 ACA (or other) plan. On the other hand, her COBRA plan is pretty decent, and is a PPO, unlike current ACA plans that are built on the HMO model with pretty much in-network coverage only.

Another option we're exploring is a Short Term Medical plan, which offers better coverage and lower rates than ACA plans, but are underwritten and don't cover pre-existing conditions. That latter isn't really a problem, she's in good health now, but some years ago she had a cancer scare, and we're looking to see if that's going to rule out the STM option.

This is the kind of case I most enjoy: challenging issues, an attentive, engaged client, and the opportunity to look at some outside-the-bun options.

Grateful!

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Fighting For the Children

It seems the L.A. Teachers Union has issued a manifesto to create safe schools . . . for the children.

The UTLA has decreed that Los Angeles Unified District schools effectively cannot reopen unless certain conditions are met.

And those conditions are?

• Charter schools should be closed
• Medicare-For-All ("free health care) is legislated
• Tax the rich with a state "wealth" tax
• Fund housing for the homeless
• "Financial support" for illegal aliens

Perhaps I missed it, but which of these mandates will benefit the students?

And here is an interesting tidbit.

Many private schools and charter schools didn’t miss a beat when Gov. Gavin Newsom ordered schools across the state to close down due to coronavirus. Within one week, most were already up and running with online learning programs, while public schools took as long as 6 weeks to even start to prepare online learning. And private and charter schools have been preparing to reopen for in-class teaching once again.

So how does CLOSING private and charter schools BENEFIT students?

All this begs the question.

Is Marxism taught in L.A. public schools?

Asking for a friend . . .

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CV-19 Claims Another

If you've ever bought a life insurance policy, you've probably (although not necessarily) had what we in the biz call a paramed exam. These usually consist of a nurse (or NP, etc) who takes your pulse, height, weight and samples of various bodily fluids, and then transmits these to the carrier. It's not really a big deal, but on any given day thousands (hundreds of thousands?) of folks undergo this process.

One of the more successful such vendors is - was - EMSI. I say 'was' because, well:

"COVID-19 has disrupoted families, communities and businesses ... As a result, all comapny operatins ceased onFriday July 3, 2020."

Yikes.

So what does this mean to the average person? Well, unless you were an employee or recently applied for life insurance, not much. If the latter, then expect to see underwriting delays while the carriers sort this out. I understand that at least one major company expects this to add at least two more weeks to the underwriting process.

Co-blogger Bob wonders if this may lead to more carriers adopting some kind of simplified issue process,and I think that may be correct: one of our carriers recently (well, within the past couple of years) introduced a product, in conjunction with its sister P&C company, to offer auto/home clients plans which require no application, exams or even paperwork. Pretty cool. So, it can be done, will be interesting to see if it will be.

[Hat Tip: Co-blogger Bob V and FoIB Brian D]

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Dodged a Bullet: A Close Call Non-Client Story

Revisiting the MVNHS©

It's been a while since we last looked in on Britain' Much Vaunted National Health Service©:

"A doctor said pressures at a Bangor hospital in January left staff in a "very deep hole"

But that was then, and this is, well:

"NHS must apologise for dismissing pelvic mesh and anti-epilepsy drug patients' suffering."

How's that?

When we as patients raise concern about our treatment with those providing it, it's only right that they at least consider what we're telling them. But apparently that's not how it works in one of the world's pre-eminent government-run health "care" systems:

"Since the review launched in 2018, more than 700 families from across the UK have given "harrowing details of their damaged lives ... fought for decades to "achieve acknowledgement" of their suffering."

Turns out, they've actually lost count of how many.

But hey: Free.

#Medicaid4All

[Hat Tip: Holly R]

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Who Was That (Un)Masked Man?

An un-named insurance agent has been fired after a COVID-related confrontation at Costco. A video of the dust up surfaced on social media and the termination followed shortly thereafter.

 In the video post on Twitter, the man screams an expletive-ridden tirade telling the woman and a man who appears to be defending her to back up and stop harassing him and his family after he was asked to put on a mask and stay 6 feet away.

"You're harassing me?" the man says as he clenches his fists, to which the other man replies, "I'm not harassing you, you're coming close to me."

The man continues to approach the pair, yelling, "I feel threatened, I feel threatened! Back up! Threaten me again! Back the f--- up, put your f---ing phone down." - Yahoo News

Some folks just aren't meant to be in the insurance business.

No word on whether Costco revoked his membership

#COVID19Mask #Costco

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