We Will Have to Watch Congress like Hawks to Keep Them from Repealing ObamaCare

by LAS

While the current political situation (i.e. – factional infighting) keeps any one party from being able to repeal the Affordable Care Act outright – that will not stop them from attempting the “death by a thousand cuts.” In other words, according to the National Association of Underwriters (an arm of the insurance industry), lobbyists will attempt to get individual provisions of the act repealed by inserting lines into other bills.

The insurance industry will be working with friendly members of Congress to insert language repealing just one given provision of the Affordable Care Act into bills that may about entirely unrelated matters. And they will do this for each provision of ObamaCare until it looks like Swiss cheese and totally useless for providing healthcare to those who need it. 

Supreme Court decisions on DOMA rules will affect gays' insurance, pensions, and more

by LAS

The recent Supreme Court decisions on the Defense of Marriage Act (DOMA) solidifies gays' rights in the 12 states that recognize same-sex marriage, but still leaves unclear areas in the other states. However, in those 12 states, gay couples will see personal benefits in healthcare coverage, pensions, annuities, 401(k)'s, and might possibly extend to COBRA and the Family Medical Leave Act.

It is pretty clear now that gay couples who live in those 12 states, who have for example, a pension plan in effect, will be able to draw survivors annuities rights. If the plan provides for a maximum benefit of $1500 per month, then the survivor could apply for a benefit check of at least $750 per month. Also, if a surviving spouse had already been receiving such survivor benefit checks, and those were taxed by the federal government, the survivor can now apply for a refund of that tax now that the benefit is not taxable.

Persons affected by these changes will still have to wait while employers prepare updated materials and forms related to these medical and pensions plans. So please, be patient, because this is not going to happen overnight – and typically employers have until the end of the year after such a ruling to get things in order. Again, be patient, because the employers have to make sure all the i's are dotted and t's crossed, and there are a lot of legal and tax implications to be thought through.

Still unclear are all the implications and applications when the couple was married in a state that recognizes gay marriage but no longer reside in a state that recognizes gay marriage. That could easily happen if a couple worked in New York, which does, and retires to Florida, which does not. Companies are still unclear on how a change in residence would affect coverage. Another area that needs clarification is in the case of companies that operate in several states – are they only bound by the laws in states where they have offices, or only the state where they are incorporated? In any case, it will be a tangled mess to prepare paperwork for employees in the several states where they have employees.

It is always a tangled mess that the courts weave, and employers and insurance companies will need some time to untangle it. 

set this one for 9 pm Sat., July 6

by LAS

California recently crowed that premiums for the new insurance exchange plans would be lower than current plans offered. However, that is because some of the most expensive doctors and hospitals were cut out of the provider networks covered by the exchange plans. Also, copays and other out-of-pocket charges will cost more for the patients.

With less than 90 days now remaining until the Oct. 1 target date for getting the states' exchanges up and running, it seems likely that even if they do get activated, consumers will likely find glitchy websites and application processes, and rather high premiums.

Still, coverage will be a relief for people who previously could not get a healthcare plan at any price, or at a prohibitive price. 

Buying All Your Health Insurances From Same Company May Not Be Best Strategy

by LAS

Unlike with casualty insurance, where the consumer is usually entice with some very nice discounts for buying both Home (or Renter's) insurance from the same company as your Auto insurance, bundling all your health insurances usually does not offer the same savings.

Buying both Health and Dental, or Physician and Hospital, insurances through the same carrier may be more convenient for you to pay the premiums every month, but they offer no savings otherwise.

In fact, because you automatically assumed that there was a discount offered and given, you may have failed to even shop around for a better deal or better coverage.

I recommend the following strategy---

IF you are carrying a High-Deductible, High-Copay policy, then by all means get yourself a voluntary policy that will cover Hospitalization. By this I mean a policy through a company other than one that serves your employer -- a fully portable plan that will go with you wherever you work.

My reasoning is this. Your current plan is leaving you vulnerable to mounting bills for high copays on hospitalization, the most expensive type of medical bill there is. To help close that gap, a voluntary policy will cover whatever costs are not paid by your primary carrier.

The second benefit to having this type of voluntary policy, is that the Hospitalization plan will cover you no matter what the reason for your inpatient stay. You may face cancer treatment, wind up in the hospital as a result of a non-workplace accident, or even go in for elective surgery. (Some policies will even cover elective medical care, so check around.)

No matter what the reason is for your stay, that policy will help cover the costs of your medical treatment. And isn't that nice to know?  

And where will all those doctors come from when ObamaCare kicks in, to treat all the new patients?

 By LAS

By now you know that I have been a supporter of the so-called Obama-Care plan, formally known as PAACA, for a long time now. I like the closing of the donut hole, the coverage of all children even those with pre-existing conditions, clamping down on Medicare fraud, and a lot more.

But there are the practical considerations of implementing this broad expansion of coverage to people who have rarely seen a doctor. Where will all the doctors come from to fill the increased demand for healthcare, for face time with a doc?

This is the silent, un-discussed question. It is NOT only Medicare patients who have problems finding a doc who will accept assignment. I refer to finding ANY physician who can fit you into his crowded schedule, once formerly uncovered people become potential or actual patients who need medical attention.

Are we just sending a whole new batch of people to the emergency rooms?

More Options Than Ever Before in Pet Insurance

 by LAS

In 2011, it was estimated that only 1.5 million pets in America (out of at least 100 million) are currently covered by pet insurance. Or to look at pet numbers in another way, 70 million households are graced by the presence of either a dog or a cat – and to judge from the animal lovers here on Newsvine, many of those households have multiple fur babies.

This specialty insurance field is growing rapidly, however. Pet owners who are interested in learning more about pet insurance will find some new names offering pet insurance, but should probably go with a company that has a longer track record.

Pet owners might not even have to dial a phone to find a carrier. More and more large companies have been offering pet insurance as a voluntary benefit to their employees. Your vet may have insurance literature in his office waiting room.

They may be prompted by a shocker of a vet bill for their beloved Fido or Fluffy the last time that they needed surgery for their pet. Vet bills have risen much faster than inflation, with major surgery bills running to $3000, $4000, or even more. Bills have been known to top out at $10,000 partly due to the fact that more procedures are being offered, including hip replacement and even kidney transplants.

Now that pet insurance has been around for a few years now, some early mistakes in coverage plans have for the most part been wiped out.

Just like with human health insurance, you will have to decide how much of a deductible you can live with. Plan deductibles vary from $50 to $500. Copays, if any, range from zero to 30 percent. Some plans are set up as reimbursement plans only. You pay the vet, and the plan reimburses you.
One of the more offensive practices was if a pet incurred an illness during one policy year, it would be considered a pre-existing condition (and therefore not covered) during subsequent years.

It is ironic that the battleground over pre-existing conditions is still being fought over regarding human patients, but is pretty well settled regarding four-footed patients. There's still some companies that have kept the infuriating practice, but there are many others that pass this particular “smell test.”

Selecting plans can get complicated, though. Some plans will cover all pets in a household, and some require the owners to buy separate policies for each pet. It pays to wade through any fine print.
Many of the companies offer plans for dogs and cats only, but you can also find plans for birds or exotic pets with a bit of hunting. Probably won't need your beagle to track down a health plan for the parrot and the chinchilla.



SOME CARRIERS OF PET INSURANCE:
=========================
24 PetWatch - 1-800-275-PETS or 24PetWatch.com
AKC- 1-866-725-2747 or AKCpetHealthCare.com

If you register your pet with the AKC, you could take advantage of a free 60-day trial.

Quarterly newsletter. Cover diagnostic testing. Covers multiple cases of “foreign body ingestion.”

ASPCA- 1-866-861-9092 or ASPCApetinsurance.com

The ASPCA plan is a reimbursement plan.

Embrace- 1-800-511-9172 or EmbracePetInsurance.com

Policies for dogs and cats. Web site has a blog and a pet health resource.

Use any vet. Offers wellness rewards. Covers ER, rehab, cancer, optional drug coverage.

Does not cover pre-existing conditions, but covers genetic conditions.

Hartville Group- 1-800-799-5852 or HartvillePetInsurance.com

Use any vet; $100 deductible.

Healthy Paws Pet Insurance & Foundation- HealthyPawPetInsurance.com

Unlimited Lifetime benefits. Offers policies for dogs and cats.

PetPlan- 1-866-467-3875 or GoPetPlan.com

Mail or fax claims, etc to their office in Philadelphia.

Pets Best Insurance - 1-877-738-7237 or PetsBest.com

PetsBest is a claim reimbursement plan. Covers medications, physical therapy, etc.

PurinaCare – 1-877-8-PURINA or PurinaCare.com

Web site has a blog and a pet health library.

QuickCare- same as 24PetWatch
Trupanion- 1-800-569-7913 or Trupanion.com
VPI - 1-877-263-6008 or PetInsurance.com

Based in California. Their Canadian office is called PetSecure.

Allows you to use any vet, anywhere in the world.

$21 to $37 per month. Includes policies for dogs, cats, birds, exotic pets.

COMPARISON SITES:
==============
PetInsuranceReviews.org – Offers insurance basics, costs, comparisons, info on health issues.
PetCareCover.com – Has info pages plus a forum where owners can discuss their experiences.
PetInsuranceUniversity.com – Offers a guide to pet insurance, articles, a blog, and research library on the pet insurance carriers.

NY Dept. Fines Insurer Excellus Nearly $1 Million for Denying ER Claims, etc.

by LAS

The New York Department of Financial Services has fined the health insurance carrier Excellus nearly one million dollars for multiple violations of insurance regulations.

Excellus was caught having denied 166 ER claims, and neglected to send Explanation of Benefits (EOB) as required by law, during a market conduct examination from Oct. 10, 2003 to Dec. 31, 2007.
Excellus, based in Rochester, NY, signed a Stipulation order No. 2012-0047-S and paid a fine totaling $995,000.

The insurer had not included EOBs in response to prescription drug claims. (Such EOBs are required by law, even though the insurer paid most of the claims.) It also omitted claims data on required form Schedule H in 2007.

In all, 166 ER claims were denied, and 337,689 cases of failing to explain coverage or benefits or appeal rights. The State has been informed by Excellus that the ER claims have been reimbursed to consumers.

Excellus claims that a systems error denied the ER claims by mistake.

Excellus is a Blue Cross/Blue Shield carrier in New York state. Its website carries no mention of the fine on its News page for the Rochester office nor for the corporate heading. The page does mention a new CEO-elect, “earns highest national accreditation for quality”, and making a grant to improve disaster preparedness.



SOURCES:
New York State Dept. of Financial Services Stipulation order No. 2012-0047-S, http://www.dfs.ny.gov/about/stip/Excellus_stip_2012-0047-S.pdf
and other industry sources.