Posts
When is selling not selling? Where is the line between helping your customer and primarily helping yourself? Determining that becomes harder each day.
One of my clients needed to talk. She had received a disturbing phone call at her home and wanted to know if she had handled it correctly and if I knew the back story. Mary (not her real name) was contacted by a national pharmacy. We’ll call the pharmacy chain Mega Rx. Mary was advised that her insurer would no longer cover medications for her and her family from their local Mega Rx. Since they knew that Mary would hate to loose access to Mega Rx, they would be happy to connect her to someone who could help her find an insurance policy that would allow her to retain them. All she had to do was stay on the line. Mary thanked them but said that she already had an agent and hung up.
Think about this for a second. The national drug store chain had fought and lost a battle with a national insurer. They were mining their records for anyone who had that insurer and had had a prescription filled in the last year or so. And if Mary was gullible and not paying attention, she might have somehow been talked into different insurance that would have definitely covered Mega Rx, but might not have covered her doctor, or given her and her family the same level of coverage.
The appointment to change individual health insurance policies usually takes an hour in my office and involves a lot more than whether or not Mega Rx is in the network. This silliness is taking place under our current set of rules. The states and the federal government are still writing the new rules. Some people don’t think we really need licensed agents. Why not let anyone sell insurance?
I just spent twenty minutes completing my application to renew my license to sell life and health insurance. I had to prove that I had completed 21 hours of continuing education and 3 additional hours of ethics training in the last two years. I actually had a total of 42. That does not include the 7 to 9 hours per year for Medicare products or the mandatory additional training for long term care coverage. I then attested that I haven’t been convicted of any crimes, haven’t had my insurance license suspended or revoked, and that I don’t owe back child support. This is true. You can not sell insurance in the State of Ohio if you owe back child support. I paid my $5 and I should get an approval notice some time next week.
All states have seen a value in licensing insurance agents. It is obvious that one value of the requirements is to weed out the part-timers. The public is better served by committed professionals who are willing to take the time and effort to stay current. And though insurance agents (me included) will never be confused with rocket scientist, we do serve an important function in the market as we help the insured public acquire coverage and navigate the process to get the most from their contracts. The insurers long ago (begrudgingly) accepted our value.
This brings us to the Patient Protection and Affordable Care Act (PPACA). The authors of this legislation did not believe that the public is capable of calling an insurance agent or company or shopping online to purchase health insurance. Since finding health insurance was so difficult, insurance exchanges, a marketplace, would be created in each state. As you can see from the Obama administration’s website, the exchanges, an additional layer of bureaucracy, is going to save you money. And how will you get to the exchange and who is going to help you choose the right type of policy for you? That would be the Navigators.
The PPACA is pretty sure that almost anyone that can fog a mirror is capable of doing my job. Any employee of trade association or union can walk you through the process. In fact, the PPACA spends more time on the notion that the Navigators can not be compensated by the insurers than it does on training or qualifications.
A well publicized letter from David M. Casey, Senior Vice President of MAXIMUS, a company that specializes in Medicaid enrollment, details the Patient Protection and Affordable Care Act’s aversion to professional insurance agents.
John Doak, the Oklahoma Insurance Commissioner, is succinct in his judgment. He has consistently challenged the federal government’s intrusion into insurance regulation and health insurance. He has asked what kind of training the Navigators will have in insurance products, health information privacy regulations (HIPAA), or ethics. And of course we already knew the answer, none.
The other question is “Who will be paying the Navigators”? You have two choices. Either the Navigators eventually become employees of an endlessly growing government program, or they are employees of organizations who have something to gain by you and I being steered into one policy versus another. And that brings us back to Mega Rx. The major pharmacy chains are currently exploring ways to have employees become Navigators under the future exchange program. Will they be impartial? Will they be looking out for your best interest? Will the sun rise from the west tomorrow morning?
This is too easy and way too transparent a case of conflict of interest. What if a major insurer is donating money to your local trade group? The employee of that trade group would work to navigate people to that company’s policy. There is a lot of money involved. This won’t be subtle. And it won’t be easily traced.
So when you get that phone call from the drug store, or the doctor’s office, or the Chamber of Commerce, and you will one day, ask yourself why. Slow the process down and try to determine who is getting paid and for what.
In the interest of creating transparency and simplicity, we have failed at both.
DAVE
www.bcandb.com
Friday, December 30, 2011
Thursday, December 15, 2011
The Day After The House Burned Down
This is a post about someone with cancer. I have not met Ms. Ward, nor do I think that I ever will, but I wish her a successful recovery. This post may take issue with some of her choices and many of her conclusions. These differences should not be interpreted as personal. They are not. Too many of our discussions have devolved into the personal as they abandon fact and reason. This blog champions a polite discussion of the facts.
Spike Dolomite Ward has cancer. Ms. Ward is a forty-nine year old married mother of two. She lives in California. This past Sunday’s Plain Dealer included an article she wrote that initially appeared in the Los Angeles Times. Ms. Ward explained why she hasn’t had health insurance for over two years. Trust her, it is not her fault.
The key element, the point that requires ten paragraphs to justify, is that she has been saved by President Obama and the Patient Protection and Affordable Care Act (PPACA). How you ask? Will the President be administering the Chemo? No, but close. As we have discussed before, the PPACA included the creation of guaranteed issue policies that cover pre-existing conditions for people who have been uninsured for over six months.
I completely understand the need to purchase homeowners insurance now that my house has burned to the ground.
Please read Ms. Ward’s article. It is entirely possible that the laws in California are very different from those here in Ohio. It is also possible that there is a touch of exaggeration and hyperbole in those first ten paragraphs. Don’t get lost in the details. They aren’t relevant. This post is about the uninsured and the individual mandate.
We are, or at least should be, responsible for our choices. Ms. Ward is not alone. There are millions of uninsured Americans. The poor have Medicaid, a program that should have received a lot more attention in the last two years. It is the working poor that are falling through our system’s cracks. There is also a large segment of the population who simply choose to spend the money on other stuff. I refuse to speculate as to Ms. Ward and her family’s status.
Ms. Ward is correct. Her life choices, her insurance choices, her and her husband’s job choices could have had devastating consequences. Instead, someone else, you, will pay the bills. Any solution that includes guaranteed issue and the complete coverage of preexisting conditions must include a mandate that requires everyone to have insurance.
The individual mandate has been both championed and disparaged by everyone from Newt Gingrich to Barack Obama. One day they embrace it. The next day they flee from the concept. As an agent, as someone in the system for thirty-three years, I am convinced that requiring people to participate is the only way a guaranteed issue plan would work. This is not limited to private insurance programs. A government plan is just as dependent on universal participation. That is why Medicare Part B and Part D penalize late enrollees.
All of the candidates expressed their hatred of the individual mandate at last week’s Republican debate. I understand. They are running for president. But the time has come to stop telling us that you hate “Obamacare” and to instead offer a realistic alternative. Better yet, there are lots of serious people waiting to hear any viable option that doesn’t include an individual mandate.
Whether or not an alternative is ever proposed and passed, we wish a full and speedy recovery to Ms. Ward. And we wonder how in the world we can afford all of the other Spike Dolomite Wards we are going to be supporting.
Spike Dolomite Ward has cancer. Ms. Ward is a forty-nine year old married mother of two. She lives in California. This past Sunday’s Plain Dealer included an article she wrote that initially appeared in the Los Angeles Times. Ms. Ward explained why she hasn’t had health insurance for over two years. Trust her, it is not her fault.
The key element, the point that requires ten paragraphs to justify, is that she has been saved by President Obama and the Patient Protection and Affordable Care Act (PPACA). How you ask? Will the President be administering the Chemo? No, but close. As we have discussed before, the PPACA included the creation of guaranteed issue policies that cover pre-existing conditions for people who have been uninsured for over six months.
- Significant medical condition like cancer? Check.
- About to have lots of expensive treatments? Check.
- Uninsured for over six months? Check.
- Insurance now seems like a really, really good idea? CHECK.
I completely understand the need to purchase homeowners insurance now that my house has burned to the ground.
Please read Ms. Ward’s article. It is entirely possible that the laws in California are very different from those here in Ohio. It is also possible that there is a touch of exaggeration and hyperbole in those first ten paragraphs. Don’t get lost in the details. They aren’t relevant. This post is about the uninsured and the individual mandate.
We are, or at least should be, responsible for our choices. Ms. Ward is not alone. There are millions of uninsured Americans. The poor have Medicaid, a program that should have received a lot more attention in the last two years. It is the working poor that are falling through our system’s cracks. There is also a large segment of the population who simply choose to spend the money on other stuff. I refuse to speculate as to Ms. Ward and her family’s status.
Ms. Ward is correct. Her life choices, her insurance choices, her and her husband’s job choices could have had devastating consequences. Instead, someone else, you, will pay the bills. Any solution that includes guaranteed issue and the complete coverage of preexisting conditions must include a mandate that requires everyone to have insurance.
The individual mandate has been both championed and disparaged by everyone from Newt Gingrich to Barack Obama. One day they embrace it. The next day they flee from the concept. As an agent, as someone in the system for thirty-three years, I am convinced that requiring people to participate is the only way a guaranteed issue plan would work. This is not limited to private insurance programs. A government plan is just as dependent on universal participation. That is why Medicare Part B and Part D penalize late enrollees.
All of the candidates expressed their hatred of the individual mandate at last week’s Republican debate. I understand. They are running for president. But the time has come to stop telling us that you hate “Obamacare” and to instead offer a realistic alternative. Better yet, there are lots of serious people waiting to hear any viable option that doesn’t include an individual mandate.
Whether or not an alternative is ever proposed and passed, we wish a full and speedy recovery to Ms. Ward. And we wonder how in the world we can afford all of the other Spike Dolomite Wards we are going to be supporting.
Monday, December 5, 2011
Discipline
We all know people who have invested in $2,500 clothing racks. OK, the store called the equipment an exercise bike or a treadmill. But sitting idly in the bedroom with clothing draped over it, the apparatus is obviously a clothing rack. What a waste of money! If only these people had the discipline to take full advantage of their investment.
Recent studies performed by researchers at Duke University have proven that the above problem may not be shared by physicians. If a doctor purchases equipment, such as expensive heart-testing or imaging equipment, they use it. In fact, it appears that these doctors may be using their equipment regardless of whether the patient needs the testing or not.
That’s what I call discipline.
USA Today reported this past week about a Duke University study of 500 MRI scans that had been performed on patients with lower back pain. The researchers were trying to determine whether doctors who own the equipment order more tests than those who don’t. You bet they did. Almost twice as many normal results (106 vs. 57) were found on scans ordered by doctors with an economic incentive than by those who didn’t.
The article notes that MRI scanning equipment carries a price tag of over $1,000,000 and that the patient or insurer is charged about $2,000 per test. Once you’ve got the equipment, you might as well use it, just to be safe.
Consumer Reports carried a similar story in early November. Duke University researchers reviewed the health insurance records of 18,000 health patients. The original study was published in the Journal of the American Medical Association.
A July 25th article in Washington Post notes that unnecessary tests don’t just waste money. There are also the risks of false positives that lead to further unneeded procedures including surgery.
Whether we are discussing lower back pain or heart problems, the patient is always his/her best advocate. But when you are in pain or when you have been diagnosed with a heart problem and coming to terms with your own mortality, are you going to ask the doctor if a test is really necessary? Or, are you going to do what you are told, especially if the test is being paid by your insurance?
This is part of cost containment. It doesn’t matter whether insurers or the government is paying the bill. An aging population is going to have more conditions, not less. And doctors, unchecked, are going to order more tests, not less.
There are doctors that will point to the risk of lawsuits as for their motivation to order so many tests. Yes, tort reform is also an important part of cost containment.
As of today, December 5, 2011, there has been precious little done to control costs. The authors of the Patient Protection and Affordable Care Act may not understand why the price of health care continues to rise. But then again, there are lots of suburbanites who don’t understand why they haven’t lost any weight. They bought the StairMaster. It is in their bedroom. Under the towels.
DAVE
www.bcandb.oom
Recent studies performed by researchers at Duke University have proven that the above problem may not be shared by physicians. If a doctor purchases equipment, such as expensive heart-testing or imaging equipment, they use it. In fact, it appears that these doctors may be using their equipment regardless of whether the patient needs the testing or not.
That’s what I call discipline.
USA Today reported this past week about a Duke University study of 500 MRI scans that had been performed on patients with lower back pain. The researchers were trying to determine whether doctors who own the equipment order more tests than those who don’t. You bet they did. Almost twice as many normal results (106 vs. 57) were found on scans ordered by doctors with an economic incentive than by those who didn’t.
The article notes that MRI scanning equipment carries a price tag of over $1,000,000 and that the patient or insurer is charged about $2,000 per test. Once you’ve got the equipment, you might as well use it, just to be safe.
Consumer Reports carried a similar story in early November. Duke University researchers reviewed the health insurance records of 18,000 health patients. The original study was published in the Journal of the American Medical Association.
“…the researchers found that patients of doctors who billed for both technical and professional fees – an indication that the doctors owned the medical equipment themselves – were more than twice as likely to undergo a nuclear stress test and more than seven times as likely to undergo stress echocardiography than patients of doctors who did not bill for those fees.”
A July 25th article in Washington Post notes that unnecessary tests don’t just waste money. There are also the risks of false positives that lead to further unneeded procedures including surgery.
Whether we are discussing lower back pain or heart problems, the patient is always his/her best advocate. But when you are in pain or when you have been diagnosed with a heart problem and coming to terms with your own mortality, are you going to ask the doctor if a test is really necessary? Or, are you going to do what you are told, especially if the test is being paid by your insurance?
This is part of cost containment. It doesn’t matter whether insurers or the government is paying the bill. An aging population is going to have more conditions, not less. And doctors, unchecked, are going to order more tests, not less.
There are doctors that will point to the risk of lawsuits as for their motivation to order so many tests. Yes, tort reform is also an important part of cost containment.
As of today, December 5, 2011, there has been precious little done to control costs. The authors of the Patient Protection and Affordable Care Act may not understand why the price of health care continues to rise. But then again, there are lots of suburbanites who don’t understand why they haven’t lost any weight. They bought the StairMaster. It is in their bedroom. Under the towels.
DAVE
www.bcandb.oom
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