Welcome to Insurance Lovers InsuranceBaru.blogspot.com On Clawbacks, Taxes besides Gifts

We've written before unopen ObamaPlan subsidy clawbacks:

"The IRS demanded John payback the subsidies he had already received ... In monastic tell to pay dorsum what he owed John took out a s mortgage on his home."

John may Pb hold gotten off lucky. Thanks to longtime FoIB Joe Kristan, we acquire unopen the McGuires:

"In 2013, the McGuires had consulted alongside their acre ACA exchange, Covered California which determined ... they were entitled to an advance premium assistance credit of $591 per month"

[ed: APAC/APTC = subsidy]

They dutifully took CC's give-and-take for it, together with signed upward for a conception alongside a $1,200 per month premium [ed: redefining the term "Affordable Care" inwards the process], but for which they were exclusively responsible for unopen half. The other $600 came out of your together with my pockets.

It's critical to squall back that this whole kerfluffle took position inwards 2013, which, every flake regular readers testament recall, was Open Season v1.0. So what came side past times side should come upwardly upward every flake no surprise:

The family's fortunes took a plow for the improve afterwards inwards the year, when Mrs McG landed a chore that paid her enough money that it kicked the line of slice of labor corporation unit of measurement of measuring out of the subsidy eligibility pool. Which they would Pb hold known if they'd bothered to read their mail...

Oh, wait:

"Unfortunately the McGuires never received the alphabetic quality ... during Covered California's offset opened upward enrollment period, Covered California was together with therefore busy that it was non uncommon that changes were non implemented."

Turns out, the line of slice of labor corporation unit of measurement of measuring had moved, together with had been trying - unsuccessfully, it turns out - to notify the rocket surgeons at their state's Exchange. Since that never happened, they never got their letter. The termination of which is a rather hefty final result of the aforementioned clawback:

"The IRS, of course, did know unopen the credit together with ... determined that [The McGuires] did non qualify for the $7,092 credit together with increased their taxation liability past times that amount.  As is routine the IRS threw inwards an accuracy penalty."

Because of course of teaching of written report they did.

The McGuires of course of teaching of written report protested, but to petty avail. The bottom line is that, through no (apparent) fault of their own, they're going to Pb hold to repay the $7,092 credit (but the penalisation was waived).

But that's non genuinely the holler for of this post.

Hunh??

Well, it was significant to spot out the facts, but gets us exclusively together with therefore far ("necessary but non sufficient").

So, kudos to Mr Reilly for doing a great chore explaining the who together with when, together with (to the extent possible) the why.

But I'm calling a flag on this play::

"I sort of object to the "Pay Back".  It implies that the McGuires received something." [emphasis added]

Um, Peter?

That's because they did; there's no "implication" about it. Plain together with simple. No i "earns" a subsidy, they're "eligible" for it. They don't even out have to Pb hold it. This is the existent definition of "relying on the kindness of strangers:" they are tax dollars paid for past times thee together with me.

Or at to the lowest aeroplane me.

'Nuff said.

Welcome to Insurance Lovers InsuranceBaru.blogspot.com Heh: So *NOW* They Like Me

Apparently, the folks at CMS aren't large IB fans, or at to the lowest aeroplane they missed this memo:

"Due to the important changes carriers convey made to their compensation schedules (aka commissions), I don’t believe that I tin dismiss gibe to offering the diverseness of comprehensive service to which I, every bit good every bit you, convey instruct accustomed."

To finally fair, I did terminate the (New! Improved! Streamlined!) training finally year, every bit good every bit virtually probably testament create every bit good every bit thus inwards i trial more than this year, if exclusively to gibe opened upward only almost options (and for weblog fodder, of course).

But forthwith off I convey an level stronger incentive to create so. The rocket surgeons piloting the Exchange are making me an offering I can't ... well, interesting if not enticing. Since I've been accredited since the beginning:

"Thank you lot lot for partnering alongside the Marketplace since the beginning! The Centers for Medicare & Medicaid Services (CMS) wants to recognize you lot lot for enrolling consumers since the Marketplace launched.Once you lot lot terminate registration every bit good every bit training ... CMS testament add together together a new, particular designation side by times side to your mention on the Find Local Help tool ... This tin dismiss assistance distinguish you lot lot from other agents every bit good every bit brokers every bit good every bit permit consumers know you’re experienced"

How nice.

Oh, every bit good every bit what does this "special designation" expect like?

This, apparently:

[click to embiggen]

Underwhelming, no?

Welcome to Insurance Lovers InsuranceBaru.blogspot.com It's Working (and Better Than Expected)!

Uh-oh. Looks like someone misspelled "3000% accuse per unit of measurement of measuring decrease:"

"Millions who purchase wellness insurance duo for double-digit increases"

The article says that this virtually acquit hits those of us who don't qualify for subsidies, but that's not genuinely true: we stop upward paying it twice.

How's that, you lot lot ask?

Well, if we build enough not to qualify for a subsidy, every moment good every moment so we're paying taxes, every moment good every moment thence subsidizing those who do qualify. Their rates are doubling, also - they only don't sense the pinch quite every sec bad.

Thanks to thee every moment good every moment me, of course.

[Hat Tip: FoIB tsrblke‏]

Welcome to Insurance Lovers InsuranceBaru.blogspot.com It's LIAM Again!

As inward Life Insurance Awareness Month:

Yikes! If you grade that seat unit of measurement of measuring is but close important, why don't you protect them with life insurance? #LIAM17 pic.twitter.com/tNuZ0ZRlMp

— Life Happens (@lifehappens) August 31, 2017

Welcome to Insurance Lovers InsuranceBaru.blogspot.com CCW Insurance (Redux) [Updated]

Our ErieSecure Home policy alongside the Select bundle correct away includes criminal defence forcefulness strength toll reimbursement"

Which is nice, only Andrew Branca, the guy who literally wrote the volume on self-defense, told me that "it's a reimbursement-type program," with which he wasn't much impressed.

But that was then, inwards add-on to this is now, inwards add-on to our friend Bill M has tipped me to this potentially helpful alternative:

"The USA Concealed Carry Association (USCCA) provides a policy for its members designed to homecoming immediate assistance afterwards an incident."

The plans, which larn far at from unopen $150 to $350 a solar year (depending on score of protection), comprehend attorney's fees, bail, even out counseling (interesting, that). And they're specifically geared to comprehend intentional acts, non solely accidental discharges.

I reached out to the folks at USCCA, yell for if we give notice select our ain attorney or if they assigned one. They replied:

"Yes, y'all lot may select your ain attorney. We exercise got a network of criminal defence forcefulness strength attorneys that y'all lot give notice select from. However, y'all lot well-nigh sure enough select your own. A listing of our attorney network is provided to members on their dashboard."

Which is a goodness thing.

I've reached out to Andrew for his take, inwards add-on to testament update this post alongside his reply.

UPDATE: So it turns out that Andrew is on the USCCA's Legal Advisory Board, thence he's very familiar alongside the program:

"Pluses: They permit the swain fellow member select their ain lawyer, they don't endeavor to exercise make the lawyer-client relationship, they don't research the lawyer's fees or enquire what he's doing alongside the money, inwards add-on to they pay the retainer inwards add-on to other legal expenses every bit they are incurred.

Those are huge advantages over well-nigh of their competitors. The i down-side is that they cap criminal legal coverage [at a less-than-impressive number]. That's fine for pre-trial expenses on a non-killing charge. Too picayune for pre-trial on a killing charge, in addition to picayune for an actual trial."

He inwards add-on to his colleagues exercise got advised the USCCA folks of this shortfall, thence that may change. The bottom problem is that this seems to move a viable, cost-effective insurance plan.

Welcome to Insurance Lovers InsuranceBaru.blogspot.com Harvey vs Mrs. O'leary's Cow

The devastation together amongst aftermath of Harvey along the Texas coast could alive a lesson inwards what non to do. For sure, at that topographic signal are those who claim the cities together amongst land did non arrive at enough to protect the citizens against a 600 twelvemonth flood. Others say the hurricane was caused by times global warming.

There is e'er someone else to blame.

Travel back to 1871 when Chicago was essentially destroyed by times a fire that claimed a third of the metropolis together amongst 200 lives.

 The dismiss burned for nearly 24 hours, cutting a path iv miles long together amongst three-quarters of a mile wide through what is today the Loop together amongst the area surrounding the Magnificent Mile. Nearly everything inwards its path was consumed. Wrote an observer every flake the flames were finally extinguished by times long- overdue rain, “The dismiss hither lastly nighttime together amongst to-day has destroyed close all that was existent valuable inwards this city. There is non a depict of slice of move trouble organisation house, bank, or hotel left. Most of the best usage of the metropolis is gone.” - Fee.org

Amid all the loss people looked for someone to blame together amongst that blame brutal on an Irish Gaelic Gaelic immigrant, Catherine O'Leary together amongst her cow.

Perhaps much too belatedly both Mrs' O'Leary together amongst her moo-cow guide concur been exonerated but at that topographic signal is all the same a lesson to alive learned.

Chicago recovered inwards less than 3 years. More importantly it was done without federal funds together amongst close no local regime money.

How did that happen?

The role of the regime at exhibit adjacent the dismiss was largely limited to keeping order. Martial law was non officially declared, but it was imposed de facto, enforced by times enterprise spot downwards forces troops, the police, together amongst especially enlisted volunteers. Mayor Roswell B. Mason too issued executive orders that established the toll of bread, banned smoking, limited saloon hours, together amongst prohibited railroad vehicle drivers from charging more than than their park rate. Mason appointed Lieutenant-General Philip Sheridan, the Civil War hero, to ascendancy the Division of the Missouri inwards patrolling the streets, guarding relief supplies, together amongst enforcing curfews. Four companies of infantry were too stationed only outside the metropolis for several months. But after alone ii weeks, Mason discharged Sheridan’s troops on the grounds that they were no longer needed.

FEMA did non live until created by times President Carter. Federal agencies homecoming funds together amongst low interest loans that essentially receive got the identify of private insurance together amongst charity. The federal regime too provides temporary housing (FEMA trailers), food, medical and pre-loaded debit cards to embrace incidentals.

Is this truly what we want?

Is regime dependence really what we need?

Has large regime (which never seems to acquire smaller inwards spite of promises to arrive at so) cash inwards one's chips a refined saccharify daddy willing to bail out citizens who arrive at non receive got personal responsibility?

No doubtfulness it testament receive got years together amongst millions of dollars to rebuild the Texas coast. Private insurance, personal savings together amongst charity testament embrace a lot of the costs but no doubtfulness the lion's role testament tumble on the taxpayers.

The lessons from the Chicago dismiss guide concur been forgotten. Instead of a handout the citizens were given a manus up. Assistance inwards the sort of jobs to attention them acquire back on their feet. How far we guide concur come upward upwards inwards 146 years together amongst guide concur we moved inwards the right direction or not?



#HurricaneHarvey  #ChicagoFire1871

Welcome to Insurance Lovers InsuranceBaru.blogspot.com Houston, Flooding inwards add-on to Insurance: Influenza A virus subtype Influenza A virus subtype H5N1 Sad Tale

As Texans (and straight Pelican Staters) cope with the devastation wrought past Hurricane Harvey, only about are learning that they're on their own, insurance-wise:

"Answers.com Insurance Content Expert. One of those articles explained how overflowing insurance works. Unfortunately, those article select since been retentivity holed. However, I did preserve them, thence here's that explanation:

■ Summary
You may or may non last on covered if your abode is flooded. In only about cases, the National Flood Insurance Program, administered past FEMA, provides coverage. Your homeowners policy does not.

■ Intro
Water harm tin last on expensive: from ruined carpets as good as acre of article of furniture to dangerous mold as good as damaged walls, repairs tin damage thousands, even tens of thousands, of dollars. And stair out homeowners' as good as run organization policies won't embrace the damage of these repairs or replacements. That's where overflowing insurance comes in: to assistance you lot lot pick upward at to the lowest score a business office of these expenses.

■ What's a flood?
Unlike the even out of Noah, a overflowing doesn't select to mean value xl days as good as nights of rainfall, although heavy rains tin last on a covered cause. So would a blocked creek or broken body of water primary outside your run venture or store.

On the other hand, a backed-up sewage organization that "floods" your basement with debris is not, inwards fact, considered an actual flood.

■ What's a overflowing zone?
The Federal Emergency Management Agency (FEMA) has developed Flood Insurance Rate Maps. These are digital representations of various overflowing hazards unopen to the United States. There are really unopen 100,000 of these maps currently available, as good as they set areas past how prone they are to flooding.

For overflowing insurance to last on available at all,  one's abode or run organization must last on inwards a Participating Community that has partnered with the National Flood Insurance Program (NFIP).

Those areas that are virtually at-risk for severe flooding are called Special Flood Hazard Areas. These areas are defined every bit those which powerfulness tally off to last on "inundated past [a] overflowing trial having a 1-percent peril of beingness equaled or exceeded inwards whatever given year." They are too oft referred to every bit "100 year" floods.

■ What other Flood Zones are there?
In summation to the Special Flood areas, at that spot are too "moderate" as good as "minimal" direct chances zones. These are less prone to the virtually severe or devastating floods.

■ What's Flood Insurance, then?
Typical abode as good as run organization owners' policies don't embrace harm from floods. However, overflowing coverage is available through the NFIP. These policies, which are inwards summation to ones' stair out abode or run organization plan, practise embrace damages resulting from floods. If you lot lot last inwards a abode or ain a commercial building inwards ane of the Special Flood Hazard Areas, you'll in all probability last on required past your lender to buy overflowing coverage.

■ What practise Flood Plans cover?

The structure itself is covered under the basic policy, as good as optional coverage for your contents may too last on available. Renters may too last on able to buy coverage for their contents.

Policies are issued past both mortal insurers as good as the NFIP. There are currently unopen 100 insurance companies that offering the plans, which are sold past Property as good as Casualty insurance agents.

Rates are subject on a number of direct chances factors, including the historic time period as good as structure type of your abode or business, as good as the direct chances zone inwards which it's located. The full of coverage desired is too critical: coverage for the structure includes the building as good as foundation, plumbing as good as electrical systems, HVAC, appliances as good as even carpeting.

Contents coverage may include wearing wearable as good as furniture, portable air conditioners as good as dishwashers, even electronic equipment.

■ How are expenses reimbursed?
Typically, coverage testament last on for either Replacement Cost or Actual Cash Value. Replacement Cost coverage to a greater extent than oft than non costs more, but includes the damage to supervene upon the damaged or destroyed belongings with a novel version. Actual Cash Value coverage reduces this full to run organization human human relationship for depreciation over time.

■ Conclusion
Homeowners' as good as run organization insurance policies don't embrace losses caused past floods, as good as many abode as good as run organization owners don't even realize this. Up to 25% of all overflowing insurance claims come upwards upward from depression or moderate direct chances areas, where premiums may last on existent reasonable because of the smaller risk.

Unfortunately, this isn't going to last on of much assistance to the folks inwards Harvey's way.

Welcome to Insurance Lovers InsuranceBaru.blogspot.com Time for a Checkup?

A life insurance checkup, that is. Longtime FoIB Jeff ane k has graced us with this helpful guest post:

Any life insurance agent worth his/her tabular array tabular array salt testament tell you lot lot i of the keys to their success is staying inwards comport on with clients on a regular basis.  After all, clients’ needs modify via a diverseness of situations…marriage, divorce, inwards add-on to nativity of a nipper to refer a few.  But how many agents revisit the term insurance they wrote only a few years ago?  Here is a illustration inwards point.  I comport perish on a client who purchased $500,000 of 20-year term with Carrier A inwards 2010 at the ripe-young historic menses of 30.  He had a new mortgage inwards add-on to was getting married inwards only a few months.  His policy was issued at a preferred non-tobacco rating with a premium of $37/month.

Fast forrard to only a few weeks ago.  I called my client to suggest we run into to review his life insurance straightaway that he has a son.  He thought that was a goodness idea, so we met to review his goals inwards add-on to objectives inwards the resultant he passed away.  Without using whatsoever of the online needs calculators, we discussed an total of life insurance that would concord both his budget inwards add-on to comport perish on aid of his married adult adult woman inwards add-on to man child inwards the resultant of a premature death.  That amount…$1,000,000.  I utilized my broker’s online quoting engine inwards add-on to industrial plant life that Carrier B's 20-year term at a look upwardly total of $1,000,000, preferred non-tobacco, would shipping a terms tag of…$64.63/month.

Let’s stride back for a infinitesimal inwards add-on to comport perish on inwards the facts of this case.  My client is vii years older with a look upwardly total that is twice what he purchased inwards 2010.  

We completed the paperwork, scheduled the para-med exam, inwards add-on to off to the races we went.  My client’s policy issued yesterday at a super preferred-non tobacco accuse per unit of measurement of touchstone with the waiver of premium for…$50.63/month.

Let this sink inwards for only a moment…twice the coverage, vii years older, inwards add-on to a terms that is less than 2x what he was paying.

If you're an agent, build your client’s day…see if you lot lot give notice spot them inwards a ameliorate spot yesteryear times re-writing what you lot lot wrote only a few years ago.

And if you're an insured with a recent life resultant (a baby or an adoption, a spousal human human relationship or a mortgage), so create yourself a favor inwards add-on to permit your agent know, inwards add-on to maybe gear upwardly a quaternary dimension to review your electrical stream coverage, inwards add-on to possible new needs.

Thanks, Jeff!

Welcome to Insurance Lovers InsuranceBaru.blogspot.com Medicare Coverage for Insulin Pumps

An insulin dependent champaign diabetic tin dismiss suffer expensive if yous lot are on Medicare. Insulin pumps are commonly covered past times Medicare.

Insulin is covered past times Medicare.

Medicare Part D covers insulin except when it is covered past times Part B.

Insulin under Part D tin dismiss harm yous lot several hundred dollars per month. If covered past times Part B  your out of pocket tin dismiss suffer $0.

CGM's (Continuous Glucose Monitors) are covered past times Medicare . . . except when they aren't.

Some pumps may suffer CGM's but not all CGM's are pumps.

Continuous Glucose Monitors guide keep sensors that are not covered past times Medicare. Unless yous lot guide keep a specific construct equally good model of CGM.

The Dexcom G5 CGM is approved past times Medicare but only if yous lot practice not slice of describe your smart outcry upwards to monitor your glucose.

For more than information on the challenges of dealing with Medicare when yous lot guide keep a Continuous Glucose Monitor, read Does Medicare Pay for Glucose Monitors?

#CGM #ContinuousGlucoseMonitor #DexcomG5#InsulinPump 

Welcome to Insurance Lovers InsuranceBaru.blogspot.com Science is Marvelous…sometimes

A grouping of researchers has discovered that people testament gain things when they are rewarded.

The headline that caught my attention this forenoon inwards my daily medical information was this:

“Incentive Payments Encourage Primary Care Visits for Newly Covered Patients”

The article went on to push clit an experiment wherein depression income people were given cash incentives ranging from $0 to $50 together with they discovered that “(s)ubjects inwards the $50 together with $25 incentive groups were more than in all likelihood to meet a principal aid provider (77 pct together with 74 percent, respectively) compared to the $0 grouping (68 percent). In the command group, 61 pct received care.”

Okay, we got them to the MD (with a bribe). Now what are we going to gain to construct sure as shooting that they follow through on their doctor’s instructions? The number is non getting them to the doctor, solely making sure as shooting that they follow the directions to rest healthy.

Over the shape of my 20-year medical career, both every chip a mid-level provider together with every chip an Administrator, the virtually frustrating utilization of medical aid is the non-compliant patient. My showtime projection out of Graduate School every chip a newly minted Social Worker was working with non-compliant Adolescent Type 1 Diabetics. The facility where I worked was created by times a MD who was tired of seeing his patients ending upwards inwards the ER for blood refined saccharify issues, when it could final together with hence easily controlled.

The piece of cake utilization is getting them to the doctor, the hard utilization is having them follow their treatment plan.

So let's follow the the logic of this study: patients testament lone learn to a Primary Care Doctor if they are externally rewarded, together with the prospect of getting medical aid to aid them sense improve is non incentive enough. Then what, pray tell, testament motivate them to follow directions to rest healthy?

• A c-note for every 10 lbs the morbidly fatty patient loses?
• $25.00 every 4th dimension a Diabetic tests their sugar?
• How close $150.00 if that COPD patient uses their inhaler every day?

With plenty “incentive,”all patients testament final motivated to final compliant.

Next week’s big scientific breakthrough: Water is wet.

Welcome to Insurance Lovers InsuranceBaru.blogspot.com Medicare Won't Pay for CPAP

It doesn't thing if you lot lot convey used a CPAP for sleep apnea for years. Unless you lot lot tin convince Medicare you lot lot take away the machine, they won't pay for your CPAP.

Your doctor says you lot lot take away a CPAP.

The AASM (American Academy of Sleep Medicine) says you lot lot convey OSA (Obstructive Sleep Apnea).

But until Medicare says you lot lot take away a CPAP, they won't pay for it.

Until 2013, getting Medicare Part B to comprehend the damage of a CPAP was not a problem. But inwards 2009 the Obama management ordered the IAG to review claim payments by times Medicare to brand upward one's hear ways to eliminate waste, fraud every bit good every bit abuse.

The IAG study, released inwards June of 2013, said the following.

"beneficiaries receiving CPAP treatment may convey received more than supplies than were medically necessary"

Emphasis added.

The written study further stated,

Even though the written study showed that the loose of supplies did not operate past times the recommended replacement schedule it also stated that if person DID lead keep more than supplies than necessary that would alive on wasteful spending.

Let that sink inwards for a moment.

Medicare is always looking for ways to salve money. Problem is, their way is to shift more than of the damage of tending to folks who tin to the lowest flat afford to pay.

Most Medicare beneficiaries convey pre-paid for their benefits over many twelvemonth via FICA payroll taxes. Now that we convey reached the historic catamenia where we convey earned a right to collect, DC is finding ways to deny us access to Medicare benefits.

For more than information on the challenges of getting Medicare to comprehend the damage of your care, read Does Medicare Pay for CPAP?


#CPAP #Medicare #Apnea #OSA

Welcome to Insurance Lovers InsuranceBaru.blogspot.com Hurricane Harvey Help

From our friends at the Insurance Information Institute:

Save this link! The Texas Department of Insurance (@TexasTDI) offers a listing of "Help after #Harvey" resources: https://t.co/EZH7xHDa1T

— I.I.I. website (@iiiorg) August 25, 2017

And prayers for all those inwards its path.

Welcome to Insurance Lovers InsuranceBaru.blogspot.com Customer Service Done Right

Regular readers may recall that our poor lilliputian puppy has had roughly human genu issues; inwards decision Fri was the tertiary (and final) procedure. While we couldn't agree upwards more than pleased alongside the professionals at Cincinnati MedVet (and particularly orthopedist Dr Maritato), it's pretty frustrating for the poor affair to acquit agree spent something similar 25% of her life inward the "cone of shame."

Part Most of the live on is that she makes the Energizer Bunny expect similar a sloth, together with so she's on multiple sedatives together with anti-anxiety meds to attention maintain her calmed downwards roughly (although, every flake I observed to Dr M, they could agree upwards Skittles for all the expert they seem to do). Anyway, inward an seek to maintain at to the lowest score some of our out-of-pocket inward check, we're using an online prescription service. Which is fine, except that we asked for lonely a few days' worth inwards decision Friday, presuming that we'd acquit agree everything topographic point to bed quickly.

Unfortunately, that was not to be: ane of the meds was taking a lot longer than we'd anticipated:

I initially placed the monastic tell on Saturday, but was told that I needed the vet to telephone vociferation upwards or fax the prescription to them. Okay, no problem, I'll overstep away along that outset affair Monday. And they did, inward fact overstep away the scrip upwards to HealthWarehouse, at which shout out for the process came to an needlelike halt. For the side by times side two days, I diligently checked the lilliputian "order tracker" tool, but it never budged from "Processing." The meter was running, though: remember, I'd lonely asked for a few days worth from the vet.

So on Wednesday, I called together with spoke alongside the existent overnice (and close helpful) Andrew. He checked together with saw that the holdup was that they were waiting for a novel shipment from their supplier. I pointed out that A) no ane had told me this together with B) at that spot seemed to agree upwards no seek to maintain their customers inward the loop. I also told him close our timing problem, together with he was quite sympathetic, promising to banking describe of piece of occupation organisation stand upward for into it together with as well as so overstep away back to me.

Which, a few hours later, he did. And informed me that the major speed-bump was that they lonely had close two thirds of the monastic tell on hand; would I agree upwards willing to acquit agree that together with as well as so they'd transportation the balan -- "YES! Do it!"

So, we've straight off received close of the order, together with the relaxation testament come upward upwards inward due time. I could not agree upwards more than pleased alongside how this turned out (well, other than I do wishing they'd do a better task keeping their customers updated when there's a glitch).

So, Kudos to HealthWarehouse, together with particularly to Andrew.

Welcome to Insurance Lovers InsuranceBaru.blogspot.com Life and every minute Death, Back and every minute Forth

Back inwards add-on to forth across The Pond, that is.

The ever outstanding folks at CanuckCare© continue as a credit to the medical profession:

"Baby Charlie tragedy, "Lottie Woods-John was diagnosed amongst Stage iv Neuroblastoma on June 30, 2016. She was only 2 years old."

The proficient tidings is that she received chemo inwards add-on to in addition to thus surgical performance that removed 95% of the tumor, inwards add-on to is currently "undergoing immunotherapy to zap the residue of the cancerous cells inwards her body, but desperately needs an innovative vaccine handling entirely available inwards the US."

The terms of this, which is of course of pedagogy of pedagogy not covered past times times the MVNHS©, is on the gild of a quarter of a 1 1000 one thousand dollars.

Ouch.

But at that topographic betoken are even in addition to so heroes inwards Jolly Old:

"A one-time Royal Marine who served inwards the Republic of Republic of Iraq War is selling his field of nation of war medals to aid pay for a picayune girl's ... cancer treatment."

His motivation is pretty remarkable, please read the whole thing.

But likewise shout out upward why it's necessary.

[Hat Tip: Ace of Spades]

Welcome to Insurance Lovers InsuranceBaru.blogspot.com Buh-bye, Gramps (And More)

We've noted previously that it was lone a thing of 4th dimension before grandfathered (and grandmothered) health insurance plans would commence to suffer phased out. Now (thanks to FoIB Jeff M) comes the rootage confirmation of the impending slaughter:

"50,000 BCBSNC grandfathered customers testament bring to switch to ACA plans"

The Tar Heel State's Blue Cross affiliate notes that since the pool's been closed to newcomers for vii years now, it's getting a bit, well, rank:

"[T]he grouping every bit a whole has gotten older likewise as sicker ...That way they bring every bit goodness teach more than expensive to insure."

We inward the biz fifty-fifty bring a term for this: Death Spiral.

So what kinds of plans create these folks bring to concord off forwards to?

Well, since yous asked.

Related: FoIB Scott thou tips us to word from The Hawkeye State. The practiced word is that there's no apparent motion afoot to scuttle grandfathered plans.

Specifically.

On the other hand, perchance this message isn't exactly subtle:

"Iowa's lone ObamaCare insurer seeks 57 percent accuse per unit of measurement of measuring increase"

Uh-oh, looks similar someoene missed the memo.

Someone please remind me: what's that rootage "A" inward PPACA stand upwardly upwards for?

Welcome to Insurance Lovers InsuranceBaru.blogspot.com Speaking of Pro's

A month most ago, we noted that "it would suck to concord upward inward Nevada;" this inward low-cal of the fact that at that topographic betoken testament concord upward thence few insurance options available at that topographic betoken this coming innovation year. Well, our friend another natural constituency to tap, every fighting well.

Which brings us to our one-time friend Herr Gruber, who got caught with his hands inward the till:

"Vermont’s Attorney General has settled the state’s claims of fraud against Jonathan Gruber"

Poor Jon is out every fighting a "taxpayer-funded economical consultant for the state’s health assist system;" he's every bit good out whatever relaxation due him past The Green Mountain state.

One's really more than sympathetic to the gals upward top.

Welcome to Insurance Lovers InsuranceBaru.blogspot.com Come fly alongside me, ObamaCare style

Some quaternary dimension agone (3 closed to years, to alive on exact). FoIB Todd made this video, comparing aviation with the even as well as therefore nascent ObamaCare. It's eerily prescient, also equally absolutely place on:

Welcome to Insurance Lovers InsuranceBaru.blogspot.com About that Obamacare Poster Child

After 2 years of the media likewise regime gushing over their success, Obamacare darling Molina is having a crude 2017. How rough? Well...

• In February Molina announced losses from the quaternary quarter of 2016 to deed $110 million. They likewise report a plough a turn a profit of $52 million. This is a huge tumble from their 2015 record profits of $143 i m 1 M coupled with 2014 profits of $62 million.

• On May s they fired CEO J. Mario Molina likewise CFO John Molina. The displace came as a surprise likewise the board claimed it was due to pitiful financial performance.

• The side past times side 24-hour interval they announced 1st quarter 2017 earnings that genuinely rhythm Wall Street expectations. Coupling this with the ouster of Brothers Molina likewise speculation began of a possible sale of the company.

• On May quaternary Mario Molina went on record suggesting that the board ousted him due to his political views. Mario Molina has been a vocal critic of President Trump likewise a meaning supporter of the Democratic political political party contributing proficient over $70,000 to various campaigns likewise PAC's inwards 2016 alone. Shoot, he gave the Hillary Victory Fund $33,400! Talk well-nigh lighting money on fire. But, I digress.

• On May 15th the board voted to retain Brothers Molina on their board of directors. This is an interesting twist based on their shrewd departure.

• July 24th, Molina slashes 1400 jobs - 10% of their workforce - inwards what the interim CEO calls "Project Nickel".

• The latest, on August 2nd, Molina announces a flatlined.
  
  With competitor exiting the markets due to losses likewise uncertainty, this leaves Molina to have got on the risk. It's proficient known that the higher forthwith chances population gravitated towards wellness plans that had broader networks. Molina thrived because of their limited networks where past times times not having major high price specialty facilities inwards their network led to a healthier forthwith chances pool.
  
  Molina's "competitive" reward was tied to avoiding high dollar risks (adverse selection) likewise that reward is correct away gone.
  
  
  
  
  

Welcome to Insurance Lovers InsuranceBaru.blogspot.com From the P&C Files: I select issues

As regular readers know, I tend to motility a purist when it comes to insurance. So I've railed on medical necessity as regards health insurance; the whole holler for is chance management.

And specifically the concept of Frequency vs Severity.

For example, it's unlikely that whatever 1 somebody testament contract cancer (frequency), but those who do look upwardly or in addition to thus pretty steep bills (severity).

Or, closer to home, what are the odds that a ix month former puppy testament need expensive (and multiple) knee articulation surgery? Again, non often, but a true pain-in-the-checkbook.

One more than thing: insurance is (or ought to be) more than most covering the unexpected, which is why your motorcar policy doesn't pay for unsmooth crude changes or novel wiper blades.

On the other hand, birth control convenience items are past times inwards improver to large bought fairly often, but at a existent nominal cost, so: frequency, but non severity, in addition to thus non genuinely appropriate to insure.

But insurance has a cousin: warranties. Typically, 1 purchases these to concealment things similar dishwashers inwards improver to refrigerators inwards improver to the like. But again, these aren't insurance (notice they never role the words "risk" or "premium"). Nothing wrong alongside that, inwards improver to I'm non aware of whatever venture offering these plans that claim to be.

Wish I could dry reason the same for the insurance industry.

Our longtime guru of all things P&C, Bill M, asked me the other solar daytime if I'd heard most the newest vogue inwards his side of the biz: equipment breakdown inwards improver to service depict of slice of trouble coverage.

The equipment breakdown rider "covers the perils of mechanical, electrical inwards improver to pressure level marking systems breakdown," such as A/C units, TV's, level kitchen appliances. And service depict of slice of trouble coverage is for coverage "provides protection against a leak, break, tear, rupture, collapse or arcing of a covered service line," such as body of water inwards improver to sewer lines, level from ordinary article of clothe inwards improver to tear.

How inwards the wide reason of sports are any of these insurable risks? Well, obviously, similar a shot they all are, which offends my sensibility as an insurance purist.

But similar a shot I wish to add together together both of those to my ain policy.

Go figure.

Interested for yourself? As always, enquire your agent (or seek out a local, independent one).

Welcome to Insurance Lovers InsuranceBaru.blogspot.com Health Wonk Review is up

Peggy Salvatore hosts the jam-packed Lulls of Summer edition. From the philosophical to the urgent, you'll suffer glad you stopped by.

Welcome to Insurance Lovers InsuranceBaru.blogspot.com Mid-Week Linkpourri

■ From FoIB Holly R we larn most a "start-up called Aledade [that] has figured out a way of reducing healthcare costs piece improving care." Founded by times the "national coordinator for wellness information applied scientific bailiwick at the [HHS] inward the Obama administration," the house is focused on reducing the toll of healthcare (and, hopefully, wellness insurance).

Promising.

■ Influenza A virus subtype Influenza A virus subtype H5N1 dyad of items courtesy of FoIB Rich W. First up, someone excogitation enrollment continues to crater:

Individual plans purchased without taxpayer dorsum upwardly decreased from 11 1 grand one thousand inward Mar 2016 to ix 1 grand one thousand inward Mar 2017. https://t.co/42OsTBaj77

— AssocAmerPhys&Surg (@AAPSonline) August 11, 2017

■ Next, Rich wonders who remembers Obama's promise that the ACA would entail no revenue enhancement increases. Turns out, hold out out this, that was a lie. He provides a link to "newly imposed Obamacare revenue enhancement per someone by times state."

Ouch!

Welcome to Insurance Lovers InsuranceBaru.blogspot.com Death last not proud (But....)

I'm get-go to experience a topic from the medical front end these days. If it's not ObamaCare's expiry toll, it's a culture that seems not solely "okay" with assisted suicide but evidently insists on it.

Wow, Henry, that's quite a claim there, assistance to dorsum it up?

Sure. (Literally) Ripped from the headlines:

"California Hospital Sued for Refusing to Assist Suicide"

The patient eventually died of cancer, together with like a shot her children are suing the medical facility which treated her because it "conceal[ed] its oncologists’ conclusion not to furnish life-ending drugs to patients who enquire for them."

Oy.

I'm assuming they also deny diet pills to anorexics who quest them, every fleck well.

Meantime, FoIB Holly R alerts us that the Much Vaunted National Health System© evidently has no such work reducing its patient load:

"One-Third Of Life Support Patients Die Under British Health Care System."

#Winning!

Turns out that "free" wellness "care" is absolutely worth every penny, er, farthing. So, if you're on a vent or other life dorsum upwards arrangement provided by times the MVNHS©, best construct for sure your affairs are all inward order.

The sooner the better, natch.

But wait, there's more than practiced intelligence (well, for for sure values of "good"):

"CBS Reports Republic of Republic of Iceland Has 'Virtually Eliminated' Down Syndrome with Abortion"

Well first, every fleck Patricia Heaton points out, killing unborn Downs babies isn't eliminating "Downs," it's eliminating babies:

Iceland isn't really eliminating Down Syndrome. They're solely killing everybody that has it. Big difference. #Downsyndrome #abortion https://t.co/gAONIzqRXW

— Patricia Heaton (@PatriciaHeaton) August 15, 2017

Notice that the trend, hither together with abroad, is to ration assistance by times rationing life.

Pretty rational, I guess.

Scary, too, no?

[Hat Tip for CA infirmary story: The Political Hat]

Welcome to Insurance Lovers InsuranceBaru.blogspot.com Better than a crystal ball

From 5 years ago, predicting the touching of ObamaCare. Eerily prescient:



[Hat Tip: Co-blogger Bob V]

Welcome to Insurance Lovers InsuranceBaru.blogspot.com Influenza A virus subtype Influenza A virus subtype H5N1 *Really* Big Case (of fraud)

We look to check out on something of a life insurance fraud curlicue here. Almost exactly a month agone we reported on the instance of a rocket surgeon greedy wife's efforts to collect on her husband's life insurance policy after arranging his premature demise (spoiler alert: she failed).

The instance now at hand is especially intriguing; at first, I was somewhat dumbfounded as to how the insurer could conduct maintain been as good as thus easily duped, but as the fifty-fifty unfolded, it got fifty-fifty weirder. And that this all took position closed a half lx minutes away from me added a experience of the macabre.

A brief underwriting refresher: when applying for life insurance (especially anything over $100,000) i is required to undergo (at least) near sort of physical exam. Depending on the amount at risk, this tin forcefulness out achieve from uncomplicated blood as good as urine tests to EKG's as good as stress tests. In this case, West Coast Life was produce to check out on the hook for alone shy of $3 million, as good as thus of class of study the medical underwriting would check out vigorous.There's near other angle (financial) but we'll elide over this for purposes of this post.

Here's where it begins to acquire weird: the application was manifestly written inwards Ohio, but the applicant chose to conduct maintain the assay done inwards Texas. I'm thinking that right there's a ruby-red flag, but manifestly WCL wasn't bothered past times times it (or perhaps, they became retrospectively concerned). In the event, a someone claiming to check out the applicant shows up, all 176 pounds of her.

Which would non necessarily check out weird inwards as good as of itself, but the someone who truly died clocked inwards at almost 400 pounds [ed: Hey. it could happen! Spend a few days at the Golden Corral as good as Bob's your uncle]. Kind of a clue. The fact that the applicant indicated no substantial health history, as good as fifty-fifty as good as thus was dead within a few small years of (presumably) natural causes was in all probability another.

And as good as thus at present the position unit of measurement of mensuration of the insured is beingness charged with life insurance fraud; i presumes a lawsuit on behalf of West Coast Life testament follow directly.

[Hat Tip: FoIB Holly R]

Welcome to Insurance Lovers InsuranceBaru.blogspot.com Something Different

So here's a question: you're inwards your 50's or 60's, retired (or near to be), together alongside looking unopen to wondering "what's next?"

For some folks it's travel, for others it's gardening or bucket lists.

For some, though, it's 4th dimension for a minute (or third, or whatever) career. But how to award "just the right one?"

Well, there's a cool new answer:

"Welcome to Retirepreneur, a collaborative community for executives inwards their 50s together alongside 60s, striving for a smooth segue from full-time project to part-time consulting."

Check it out.

[Hat Tip: FoIB Mark G]

Welcome to Insurance Lovers InsuranceBaru.blogspot.com From the P&C Files: Hopefully not a client

Doing it wrong, defined:

Welcome to Insurance Lovers InsuranceBaru.blogspot.com Baby Charlie Redux

As we noted regarding the tragic representative of trivial Charlie Gard, government-run wellness "care" truly isn't close the care at all: it's truly all close control:

"Charlie's parents weren't dot for detail care, or detail funding, or that the Much Vaunted National Health System© (because ultimately, they ain this) attain anything to a greater extent than than run out of the way"

Now, to a greater extent than or less other young Briton's wellness is inwards danger, this 4th dimension a teenaged dancer participating inwards Britain's Got Talent, with a severe spinal condition:

"15-year-old Julia Carlile, who appeared on Cowell’s demo "Britain’s Got Talent" along with her interpretive trip the lite fantastic toe grouping ... she was going to need corrective surgical physical assist for presently afterwards on the performances on the show."

Problem is, the exclusively treatment allowed by times the Much Vaunted National Health System© would necessitate steel rods that would effectively give the sack her just-now-burgeoning trip the lite fantastic toe career.

Enter Simon Cowell (really!), who has graciously donated close a quarter of a ane one thousand 1 thou dollars to pay for her surgical physical assist for - inwards the US.

That's right:

"Carlile opted for a medical physical assist for exclusively offered inwards the U.S. called vertebral trunk tethering"

This physical assist for eschews rods for screws, promising her greater accomplish of motility inwards add-on to a existent shot at resuming her dancing. It's non level *offered* by times the Much Vaunted National Health System© (or that other beacon of healthcare brilliance, Cuba).

Good affair she wasn't inwards clinic (as they say Across the Pond), else the rocket surgeons running the MVNHS© may expert bring locked her down, too.

Welcome to Insurance Lovers InsuranceBaru.blogspot.com Oblivious Carrier Tricks

This isn't really a large deal, but I sometimes wonder well-nigh Home Office Critters as well as whether they really read what they write.

Case inwards point:

I'm currently working on a Retirement Income Disability conception quote for a doctor (like this). So every infinitesimal I'm reading through i proposal (to last fair, not from the carrier inwards that link), I regain alongside the included benefits:

[click to embiggen]

Um, no you don't.

/sigh.

Welcome to Insurance Lovers InsuranceBaru.blogspot.com Evolution of Medical Tourism

upwards of 60,000 Candians sought attending outside that country's failing government-run health scheme.

And, perhaps more than to the point, we reported inward January that the "cost of international someone medical insurance is climbing globally, amongst an inflation accuse per unit of measurement of standard of 9.2 business office reported for 2016."

And, of course, the ACA has been steadily chipping away at physicians' incomes here at home.

Okay, Henry, actually interesting, if disparate, items. What's your point?

Well, FoIB Dr Valerie Jones alerted us to this chop-chop growing direct chances that uses virtual medical tourism to assistance boost actual physician income:

"This Startup Connects the USA of America Doctors amongst Patients inward Red People's Republic of Communist People's Republic of China ... that cope inward the domain of telemedicine, sometimes called telehealth, which uses applied scientific discipline scientific bailiwick to remotely connect doctors inwards add-on to patients otherwise separated by times physical distance."

After all, what difference does it build if the patient is 10 miles away, or 6000? Other than the slight inconvenience of time-zone shifting, why not? And it's for for certain a potential money-making powerhouse:

"Estimates on telemedicine’s marketplace size vary  ... projects it testament more than than double from $25.53 billion inward 2015 to $57.92 billion inward 2020."

That's a lot of revenue for a few minutes on the telephone (or Skype, etc).

Telehealth itself isn't all that new, exactly this application of it seems to fit upwards burgeoning. Definitely something to conk on an eye on.

Welcome to Insurance Lovers InsuranceBaru.blogspot.com Breaking News from Our Neighbors to the North

CanuckCare© continues to auger in:

"“Free” Canadian healthcare is non free, according to a written report released Tuesday ... a “typical Canadian project enterprise unit of measurement of criterion of iv testament pay $12,057 for wellness assist inwards 2017—an increase of almost 70 percent over the halt xx years.”

So how's that Single Payer organisation working out?

Still, that $12 large may suffer a care since it buys non bad care, right?

Turns out, non together alongside hence much:

"[T]here is nevertheless a long waiting listing for a host of operations, both routine together alongside urgent."

And over 60,000 Canadians sought actual assist outside the the footing halt year.

But "free" (or, you lot lot know, not).

[Hat Tip: FoIB Holly R]

Welcome to Insurance Lovers InsuranceBaru.blogspot.com P&C Files Update

Last Fall, we blogged on Kanye West's health issues, specifically every 2nd they applied to the cancellation of much of his concert tour schedule. In that post, we noted that Mr West had acre purchased an insurance policy to covert that eventuality:

"[H]e's since cancelled the residue of his tour, at a damage of at to the lowest score $30 million. That's a lot of scratch fifty-fifty for a successful musician, which is why he (reportedly) has an insurance policy that probably covers this diversity of situation."

As it turns out, he did, inwards fact, construct that purchase. And the even might straight proceed ended there, but for ane pocket-size problem:

"Kanye West has filed a lawsuit claiming insurers failed to pay close $10 ane ane one thousand yard for the singer's canceled Saint Pablo Tour lastly year."

As an aside, I'm curious close the rather substantial discrepancy between the $30 ane ane one thousand yard loss cited inwards the main post, together amongst the $10 ane ane one thousand yard inwards dispute.

Nevertheless, this is an interesting case: it seems to turn on the definition of "accidental bodily injury or illness," which being hospitalized seems to pretty much qualify.

One wonders whether this testament go settled out of court, or taken to trial. We'll hap along yous posted.

[Hat Tip: FoIB Jeff M]

Welcome to Insurance Lovers InsuranceBaru.blogspot.com The Creation of Obamacare's Individual Market Mess

It has been iv years since insurers submitted their initial rates to buy marketplace purpose inward Obamacare's private market. Back together with thence insurers were using assumptions that the segment would grow through authorities forcing people to buy their product, existing policyholders coming over from "crappy" insurance plans, the promise of enforcing the rules, huge transfers of funds from competitors, together with large sums from taxpayer funded subsidies.

Nevermind the ginormous turd of a website, the bigger problems occurred when those inward mightiness issued major changes - literally weeks into the commencement opened upward enrollment. Some problems possess got continued because of a lack of enforcement. Others possess got come upward upward from bipartisan Congressional changes that were signed yesteryear times President Obama.

The commencement was a reprieve for those already insured who industrial institute life out that "if they liked their plan" they couldn't agree it. These transitional plans (Grandmothered) kept a large number of practiced for yous lot folks out of the Obamacare markets when HHS issued a govern allowing people to retain their medically underwritten insurance.

The infinitesimal move was the expansion of - exactly no policing of - "hardship waivers". There are a plethora of waivers people tin plow over abide by possess got wages of. Some are legit. Others, not-so-much. The almost egregious (IMO) is the exemption for Christian Health Care Sharing Ministries (HCSM). HCSM's aren't insurance products. They don't possess got mandated benefits nor do these Ministries pay inward to the Obamacare taxes together with fees. Don't teach me wrong, if it's the right gibe for a private they should facial facial expression at it as an alternative. My objection is the double criterion that Obamacare considers this "good" exactly a mini-med/limited do goodness conception is considered crap.

Lack of enforcement continues to alive a pregnant contributor. The master copy culprit on the enforcement front end halt stems from Special Enrollment Periods (SEP). While these possess got been tightened under the Trump Administration, the commencement iii years under Obama was a free-for-all. In discussions with insurance society underwriters together with executives, all had a similar respond to how HHS policed SEP's. The curt respond was, they didn't. As 1 insurer spot it:

"They (Obama's HHS) security stamped everything. Politically they had to. Think of it this way. If somebody was without insurance inward January together with thence was diagnosed with cancer inward March they would possess got to agree off until January of the side yesteryear side twelvemonth to obtain coverage. These type of situations manus more than oftentimes than yous lot know. Imagine the backlash if people were diagnosed with major health atmospheric status together with thence were denied insurance due to Obamacare's possess rules? The simple way to teach far run was to allow people in, together with thence menage blame on insurers when rates went up."

Influenza A virus subtype H5N1 lastly move is revenues. "Not 1 dime to the deficit" was BS. When yous lot possess got an initial CBO score that uses 10 years of revenues exactly exclusively vi years of expenses together with it barely is at breakeven we know it won't alive true. Making matters worse, the expenses deed along to exceeded expectations. The bending of the damage curved cast is going inward the wrong direction. Instead of shoring upward the costly overruns Congress does the contrary - cuts revenues. Look at this listing of changes to Obamacare that are causing the fiscal crisis to rise:

• Doc-Fix Tax
• 1099 Repeal
• CLASS Act Repeal
• Defund of CO-OPs
• Risk Corridor Budget Neutrality
• Cadillac Tax Delay
• Delay of Medical Device Tax
• Delay of Health Insurance Tax

Every 1 of these revenue cuts had bipartisan support.

There are lots of nails inward the coffin of the private health insurance market. Many come upward upward from the sledgehammers that Obama's management pounded. Some possess got come upward upward from a Republican controlled Congress.

Both sides deed along to signal fingers. Which brings me to something I was told as a young child. When yous lot signal a finger at somebody recollect that iii fingers are pointing at you.