April 28, 2006 by bob.

So tell me, are you still beating your wife?

This not so funny line surfaced many years ago as an example of asking a question that makes you look bad no matter how you answer.

If you say “no”, that implies you did beat your wife but are no longer.

If you say “yes”, well, you know . . .

Now you can ask the big drug companies the same question, just phrased differently. “So tell me Pharma, are you still telling people they are sick just to sell your drugs?”

A lot of money can be made from healthy people who believe they are sick. Pharmaceutical companies sponsor diseases and promote them to prescribers and consumers

This particular practice of “inventing” disease has been a burr in my saddle for some time now. At one time we had heartburn. The treatment was to take an antacid and refrain from eating the food that caused the discomfort. Now we have medicines that allow us to eat freely of anything without experiencing the repercussions.

I am not a doctor, but something tells me if my body reacts negatively to a substance, perhaps I should listen to my body rather than some advertiser. It’s like the first puff on a cigarette; your body is trying to tell you this may not be good for you.

Some forms of medicalising ordinary life may now be better described as disease mongering: widening the boundaries of treatable illness in order to expand markets for those who sell and deliver treatments

It seems to me the author of this article is taking some liberties by creating words like “prescribers” and “medicalising” but I am not going to take issue with that because I do believe the underlying message needs to get out.

Within many disease categories informal alliances have emerged, comprising drug company staff, doctors, and consumer groups. Ostensibly engaged in raising public awareness about underdiagnosed and undertreated problems, these alliances tend to promote a view of their particular condition as widespread, serious, and treatable

No argument there. There is definitely a benefit to getting information about symptoms into the hands and minds of the public. This is good when you talk about early warning signs for cancer or heart condition. I have to question the purpose when the condition is a hair loss, an irritable bowel or yellow nails.

Around the time that Merck’s hair growth drug finasteride (Propecia) was first approved in Australia, leading newspapers featured new information about the emotional trauma associated with hair loss.

Emotional trauma? Give me a break. You would think this is a male form of post-partum depression.

Irritable bowel syndrome has long been considered a common functional disorder . . . . . . What for many people is a mild functional disorder requiring little more than reassurance about its benign natural course is currently being reframed as a serious disease attracting a label and a drug, with all the associated harms and costs.

No doubt, DTC (direct to consumer) advertising has its’ place and it does produce positive results when a patient is encouraged to discuss symptoms of a REAL disease with their doctor. But some of the information is just going way too far.

And in case you are wondering, now that my hair is not falling out I am no longer beating my wife.

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April 27, 2006 by bob.

In only 10 minutes, my patient had come to hate me, and who could blame her? I had frowned at her blood pressure, rolled my eyes at her weight, clucked at her blood sugar readings, asked some pointed questions about her drinking habits and pointed out the possible relationship between her chronic stomachaches and her tourniquet-tight jeans.

This must be why I don’t go to doctors.

First she just looked miserable and guilty, but by the time I got around to asking exactly what she had eaten for dinner the night before, she had become downright hostile. “Cheesecake,” she spat out, with venom.

I am guessing there is a problem with this response. Cheesecake, being a dairy product, does not last forever even with good refrigeration. It’s either eat it or throw it out.

Under the circumstances, there was only one thing to say, and I didn’t hesitate for a second. “By the way,” I said, “I’ve been meaning to tell you, I love what you’ve done with your hair.”

Somehow this approach doesn’t work with my wife. She still insists on returning to the insulting remark that got me in hot water to start.

We were taught to call them lubricating comments: little morsels of oleaginous verbiage tucked into the usual miserable catechism to ease it along a little.

Lubricating comments, huh? No, don’t think I will go there . . .

When does it all stop? I like your tie. You like my sense of humor. I appreciate your punctuality. You love my pen. Look, I’m sorry but I have run out of things to like about you, and I hate your cholesterol. Can we get back to work?

So much for the verbal foreplay, now it’s down to business.

Next!!

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April 25, 2006 by bob.

I have never owned a hippo. Would not have any idea how to go about buying one. The only hippo’s I have seen are in the zoo, or on a TV show and I have no idea what the steps are for finding a good hippo, buying it, and caring for it.

Hippo’s in the zoo are bought by someone else who I presume knows where to look for a good selection of hippo’s. I must also assume they know what is a good price on a hippo, what isn’t.

So how much do hippo’s cost any way?

Is $1500 too much or is $10,000 not enough?

How do you know you are getting a good hippo? I suppose if nothing goes wrong in the first few weeks you got a healthy hippo. Or maybe you have to wait a year or more to find out if the hippo really was healthy.

I suppose all of these are good questions, but then I have never talked to a hippo buyer so I don’t know what questions to ask in negotiating for a hippo.

So what has buying a hippo have to do with health insurance?

Most of the folks I know have never bought health insurance before. They usually worked for a place and someone at their company was the hippo, I mean health insurance buyer. They have no idea how much the health insurance costs, at least not until they get their COBRA bill. Most of the time they don’t even know what the plan covers and what it doesn’t. They usually know what the doc & Rx copay is but nothing beyond that. They think they have a $500 deductible but it could be $1500. They just assume everything over the deductible is covered in full, but they really don’t know.

So why are these folks, who have never bought health insurance before, suddenly experts in buying health insurance? What questions do they ask? What is a good price? How do they know they got a good plan or a bad one?

They would be just as effective trying to buy a hippo.

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April 20, 2006 by bob.

From the “why didn’t I think of that?” department comes this newsy tidbit.

Fake ‘Doctor’ Offers Door-To-Door Breast Exams

Certainly is creative.

People are often annoyed at door-to-door sales people, but they were downright offended at what one man was offering to women who answered his knock. Police say the man went door-to-door carrying a doctor’s bag and offering free breast examinations, and actually got two women to take him up on his offer.

Fell for the old “let me see you naked” line, huh?

OK, so you’re thinking, this must be a young stud pulling this off (no pun intended of course).

Not exactly . . .

WFOR-TV is reporting that 76 year old William Winikoff of Coconut Creek, Florida has been arrested for his free breast exams

OK, more the Marcus Welby type. So the women must have been old & senile, right?

Guess again.

two women, both in their 30’s, agreed to allow him to examine their breasts in their apartments, after representing himself as a doctor making a house call.

That should have been a tip off. What doctors make house calls?

As bizarre as the Winikoff’s story is, investigators believe the two women assaulted today may not be the first to fall for the phony breast exam scheme, and they are asking anyone who may have taken advantage of Winnikoff’s ‘examinations’ to contact the Broward Sheriffs’ Office.

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April 19, 2006 by bob.

Most insurance buyers are not perfect. Not even close. They start out on a trek into uncharted (to them at least) waters without a clue about how to navigate from A to B. Along the way they will be distracted, not only by the overwhelming amount of data to parse and digest, but other things in life that come their way.

Things like . . .

Work at home that need attention.

Work at work that need attention.

Work on the care that need attention.

Work on the kids that need attention.

Then of course there is play time. Everyone needs time to decompress so there are movies, sports and shopping to do. All important, but not as important as protecting your financial future.

Usually what happens is this. Something comes along to rock their world. The wage earner loses their job and the health insurance that was previously taken for granted suddenly becomes an item to budget in the midst of a lost paycheck. Or they may have been notified of an increase in their monthly outlay for health insurance. Either their employer decided to pass more of the cost of coverage along, or the private coverage has just sent them a renewal rate increase.

Sometimes the change is brought about by a health crisis and one who is without health insurance suddenly decides to seek cover.

These are usually the most vulnerable buyers and the ones open to major frustration and disappointment.

They are sucked in by promises of no health questions, no deductible, no annual or lifetime maximum benefit. All of these plans are not insurance and the tip off should be the come-on sales pitch and the fact the price is half of the cost for real health insurance.

And there are those who do shun the cheesy pitch but settle for something with a bit more substance but still buy on price or settle with a “name” carrier.

These are the people who, more often than not, are destined to complain. They will complain when their claim is not paid the way they think it should be, or even worse, when the claim is inexplicably (to them at least) denied. They will complain about renewal rate increases. They will complain when they discover a procedure is not a covered item.

In the end they will wander aimlessly, constantly in search of the perfect plan which is of course, something that does not exist.

Contrast these individuals to the Stepford Clients. These are people who recognize the world of insurance is confusing at best and can be frustrating even to those of us who have toiled in the field for over 30 years.

The Stepford Clients instead provide full details of their medical history so a proper carrier can be matched with their needs. They also have a solid and realistic idea of how much risk they can afford and how much they can transfer to a carrier. The Stepford Clients are also realistic in their budget and are open to suggestion.

The Stepford Clients are mostly satisfied with my recommendations, at least as satisfied as one can be when paying several hundred dollars each month for an item they hope they never have to use. They know which claims will be paid, which ones won’t and discover ways to maximize their coverage. They do get renewal increases just like everyone else but they discover the adjustments are not anywhere close to those of the general population.

The Stepford Clients do complain from time to time but not as often or as loudly as the general population. They tend to stay with the same plan, and the same carrier, year after year.

Most importantly, to me at least, is the Stepford Clients tell their friends about how nice it is to be a Stepford Client and how much more they accomplish now than would be the case if they were lost in the insurance maze.

Stepford Clients are happy clients, and that makes the insurance world a safer place.

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April 18, 2006 by bob.

This has nothing to do with underwriters wearing Madras shirts with pocket protectors. Retrospective underwriting, or retro underwriting, is the practice utilized by some health insurance carriers to cancel coverage and rescind back to the effective date.

This usually occurs following a claim of some significance when an audit of the underwriting file is ordered. Consider this a post-mortem on an underwriting decision made as far back as 2 year ago.

The scenario could go something like this.

You complete an application for health insurance and submit it to a carrier, we will call them Indigo Cross Health Insurance Company. In the litany of questions is one of note.

Have you ever been diagnosed, treated for or consulted with a medical professional for any of the following:

Blah, blah, blah, cancer, blah, blah.

Have you ever experienced any of the following:

Unexplained fever, swollen glands, abdominal, back or pelvic pain, . . . .

Your answer to all of the questions is “no”

The policy is issued.

Three months later you go to the doctor complaining of a pain in your gut that won’t go away.

How long have these symptoms persisted?

Off and on, maybe 4 or 5 months, but they are more painful now.

Tests are performed and the diagnosis comes back. You have colon cancer.

Then you get a letter from your carrier, denying your claim and rescinding coverage back to the effective date.

You have just entered the world of retro underwriting. In addition to dealing with the diagnosis, you now have to wonder how you will pay for your care.

Like it or not, the carrier has not only denied your claim, but cancelled coverage based on what is considered to be a false application. You misrepresented the facts by failing to mention an undiagnosed pain.

This was coupled with the admission, as reflected in the doctors notes, that this pain existed prior to the date of your application.

Is this practice fair? Yes, and no. It can be argued both ways.

Is this something to consider the next time you submit an application for insurance?

Absolutely.

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April 13, 2006 by bob.

Selective listening is a trait not limited to children and teens. Many adults practice this as well. They hear what they want to hear and disregard the rest.

This is one of the more frustrating aspects of my work. People ask for my advice on how to put together a cost efficient health plan then completely ignore my recommendation because it is not something they wanted to hear.

Case in point.

A lady who had been with the same carrier for 5 years and endured significant rate increases was complaining about the cost of her plan. She felt the carrier was unjustly implementing rate increases and wanted to know what legal action she could take against the carrier. In her opinion, the carrier was breaking the law.

I explained that the plan she chose in 2001 was very rich in benefit. I also told her the plan was under-priced at the time and continued to be so for the next 3 years. What she was experiencing now was the carrier catching up for prior foolishness in delivering a product to market with pricing that would not support the benefits.

She had no complaints as long as she was getting a “deal”. Only when it became time to pay for years of below market pricing did she suddenly feel ripped off.

She wants to blame the carrier for this problem. I agreed, up to a point, and told her the carrier was indeed fined last year for failing to properly inform policyholders of the justification for the rate increase.

So who can she complain to and get a legal remedy for her situation?

No one, I told her. The carrier is well within their rights to raise rates to current levels. The punishment inflicted on the carrier was not because of current rate levels but for failing to properly explain their renewal action.

I also told her the best way to deal with this “crisis” was to allow me to help her find a new plan with a different carrier. I told her of a plan, almost identical to the one she has now, that is almost 30% lower in price assuming she can qualify for the coverage.

Most of my clients stay with me for years and many stay with the same carrier. This is achieved by designing a plan that will fit your needs now and into the future. I have one client that has been with the same carrier for 10 years, something that is unheard of in today’s world.

Her response to my suggestions was to dismiss them, still insisting the government (or legal action) was the way to fight the increase.

Selective listening.

She should have grown out of this years ago.

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April 10, 2006 by bob.

I have encountered two people in the last week who have asked about dropping their major medical insurance and setting up some kind of asset protection plan to protect them from creditors. In other words, they don’t want to be responsible for paying their medical bills, they would rather have someone else pay them in the event they have a catastrophic illness or accident.

Moral issues aside, and I am not sure one can look at this without weighing in on the morality of shirking your responsibility; there is the financial cost of taking such drastic action.

These are not low income people, they are middle to upper middle class people who simply feel they no long want to fund health insurance.

The upside to this situation is quite simple. The money they now pay for health insurance can be used in some other fashion besides covering their risk. As long as they only have nominal medical events, they come out ahead.

The downside is a bit more complex.

To protect your assets you most likely need a series of trusts as well as a Family Limited Partnership to hold title to your personal residence. This is something only a handful of attorneys are capable of setting up in such a way as to make one appear penniless. Of course this means relinquishing control of those assets, and your residence. Since you no longer hold title to your home you forfeit the tax deduction for mortgage interest and real estate taxes.

You may very well hide all of your assets but your wages are still subject to seizure by creditors. So while you have protected your home and other assets you could forfeit a significant chunk of your paycheck, all for the sole purpose of escaping health insurance premiums.

By the time all this is accomplished, those who seek to save money by hiding assets may well end up paying much more than they ever would had they simply purchased a cat health insurance plan.

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April 6, 2006 by bob.

Riders are dangerous. I haven’t seen them in a long time, but I used to see stickers on the windshield of delivery trucks stating “NO RIDERS”.

I suppose riders, in the form of hitchhikers could be bad news. But so can riders on your insurance policy.

So why is it most applicants, and very few agents, are concerned about riders? Perhaps they don’t know any better. Maybe they are just ignorant.

Either way, ER’s (exclusion riders) are dangerous.

Most applications for individual health insurance ask about STD’s (sexually transmitted disease). Some people feel that is an intrusion into their privacy. Why is it the carriers business to know who they slept with, how often they did it, or who was tied up?

Not all STD’s are bad. At least that’s what some people would have you believe.

So what if you are issued a policy with an ER for STD’s? No big deal, or is it?

One particular STD has a nasty twist to it. HPV (human papilloma virus) is suspect and has been shown to have a connection to cervical cancer. This doesn’t mean everyone with HPV will develop cervical cancer but some may.

So if you have a policy with an STD ER you have a potential problem should you develop cervical cancer. If the carrier can show a direct link between your HPV and your cervical cancer, that means not only can they deny coverage for STD’s but for the cancer as well.

If you have a policy with an ER, and you are not sure what it means with regard to future liability, you need to take time to learn just what your policy will and will not cover.

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April 4, 2006 by bob.

When I revamped this blog I was determined to make it informative and (hopefully) entertaining. Well, as entertaining as health insurance can be. Certainly much better than trying to make a visit to the dentist entertaining. I mean, who wants to read about drill noises and carrying on conversations with your mouth full of gauze and mechanical leeches?

Most of what I have blogged so far is my own rant with very few links to other sites. But this is an interchange I just could not pass up.

As they say in the commercial, this is priceless . . .

From Kevin, M.D.

Matthew Holt tells doctors to quit their whining and deal with it.

Where it all started . . .

Now given that 30% of activity in health care is waste motion, this shouldn’t be the case, but apparently it is and doctors are in high demand. So the next time you catch one pissing and moaning about their life/income, remind them that they could be a GM employee.

Yes, priceless!

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