Discount Plan Crack Down

We have posted on the non-insurance discount plans before but it is one of those topics that too much cannot be said. In an effort to save money, people will buy these plans based on a smooth pitch that makes it sound like the best thing since PB&J.

Some states have outlawed the plans altogether while others are attempting to reign in the plans and provide some form of accountability. The NAIC has addressed the issue of discount plans. Here is a summary.

The Discount Medical Plan Organization Model Act establishes a comprehensive regulatory scheme for discount medical plan organizations, enabling state regulators to track the organizations and ensure that they are legitimate and not fraudulent in their claims.



The model, crafted by the NAIC Health Insurance and Managed Care (B) Committee’s Discount Plan Working Group, introduces uniform disclosure requirements to help eliminate consumer confusion about what they are buying, making it clear to consumers that the coverage is a discount program and not an insurance policy.

As it now stands, most of the attempts to regulate these plans have fallen on the A.G. in each state to prosecute as a criminal act. In some cases, the plans have been forced to make cursory disclosures in sales literature and on web sites. The problem comes more in the pitch, particularly one that is made over the phone by some fast talking salesperson in a boiler room. No waiting period, immediate coverage, no deductibles, no cap on benefits, no health questions, pre-existing conditions are covered. Sign up today before the price goes up tomorrow.

The model act creates uniform marketing and advertising requirements to ensure that consumers are not subjected to high-pressure sales tactics or provided fraudulent or misleading information. Administrative actions and civil and criminal penalties may be imposed by the state against any organization that is involved in such fraudulent or deceptive practices.



In addition, the model act requires the discount plan organization to not only contract with a network of service providers, but also ensure that its network is adequate to meet the needs of consumers enrolled in its plan. The organization also must maintain a Web site with an updated list of providers under contract that accept the discounted payment.

Nice thoughts, but as long as there are gullible people I don't expect things will change much.

EMR = OOPS!

Dr Rob Lamberts, writing at The Medical Blog Network, has some disturbing news about physicians' access to their patients' EMR's (Electronic Medical Records). Apparently, a number of physicians (and, presumably, other providers) electronically offload their patients' medical info to vendors, who then host the files for them.

The benefits of this technique are, presumably, cost- and security-related, which makes it an attractive option for non-geek doc's. If you're not buying, maintaining, and servicing computer hardware, you've got extra money and personnel available for, well, doctoring.

The problem about which the good doctor reports is that some doc's have fallen behind in paying their vendor's bills (or flat-out refuse to do so), and said vendor's are then withholding access to the records. The doc's call that "extortion;" the vendors, presumably, call it good business sense.

Physicians are quite unhappy with this arrangement, but there is precious little they can do about it: it's all perfectly legal. And why not? If I don't pay my insurance premium, I can hardly complain when my claim goes unpaid. Still, this tends to harm the patient as much as (or perhaps more than) the doc; after all, whose health is put at risk?

I suspect that Dr Lambert will be following this story for a while, so we'll keep you posted.

Grand Rounds...

Blogger Amy, over at Diabetes Mine, presents an outstanding and uniquely creative Grand Rounds. In celebration of matriculation, she's fashioned her 'Rounds after a college student's emails home. It's a terrific metaphor, well executed.

I never gave much thought to the role and training of hospital chaplains. I just assumed that one's Minister, or Priest, or Rabbi would drop by to offer spiritual encouragement. But Susan, hostess of Rickety Contrivances of Doing Good blog, reports that there's quite a debate about the subject.

A Quick Blip from the P & C World...

We don't write much about the Property and Casualty side of the insurance business here. But once in a while, it can be pretty interesting (I'm sure there are folks who believe that it's interesting more often than "once in a while," but they can get their own blog).

Special Event insurance is just that: coverage to protect one from a sudden loss during some unusual activity or promotion. Think "$1 million Hole In One Contest." That kind of thing.

Not being much of a football afficianado myself (although all three of my girls were glued to the OSU/Texas game this past weekend), I was unaware that "Da Bears" had shut out the Green Bay Packers in the teams' season opener. As disappointing as this must have been for the "Cheeseheads," it could have been catastrophic for one Chicagoland merchant:

World Furniture Mall "promised that if the Bears shut out the Packers in the season opener at Lambeau Field in Green Bay, Labor Day weekend shoppers would get their furniture free." Which, as mentioned, they did.

Store owner Randy Gonigam stood by his promise, and stood to lose almost $300,000 to boot. Fortunately, he had purchased a Special Events policy "just in case."

Good on him, and Congrats to Da Bears.

Carnival Monday on Tuesday...

Note: Because we chose to honor the victims of 9-11 yesterday, I'm posting this week's financial carnival notices today. Thanks for your understanding.

This week's Carnival of Personal Finance, hosted by No Credit Needed, includes 40 posts. They're all neatly categorized, but - alas! - no helpful 'blurbs.

We've talked about Section 125 plans here at IB; this post, by Daniel at My Money Path, has a consumer-friendly explanation, as well.

BONUS: Although it's not in the Carnival, Joe's post at Roth & Co, on a humorous lesson in time (mis)management, is a must-see.

And the Carnival of the Capitalists is up, as well. Joshua Sharf, blogging at A View From A Height, presents over 50 posts, each with some helpful comments.

I found this post on college tuition to be quite interesting. Boring Made Dull explains what drives the increasing cost of a higher education.

In Memoriam: Jerome Robert Lohez

As regular InsureBlog readers know, my better half has long maintained that “there are no coincidences.” That is, she believes that everything happens for a reason, although we may not be aware just what that reason is.

As for me, I’ve gradually become 90% convinced that she’s right on this (in everything else, of course, she’s 100% right). But one evening, a few weeks ago, that all changed.

I have a confession: My name is Henry, and I’m a news junkie. It is my habit to stay up way too late reading news blogs. Which I was doing several weeks ago, when I came across an item about one man’s extraordinary effort [ed: back online] to harness the power of the blogosphere, in tribute to our fellow Americans who died in The Towers, exactly five years ago today.

The concept was deceptively simple: 2996 victims, 2996 blogs, each one remembering a single person. Bloggers were invited to sign up, and each was assigned – at random – one name.

Stop for a moment, and consider this: one blogger, reading one news item, decides it’s the right thing to do, signs up, and is assigned the name of a person he’s never even heard of, let alone met. We’ll come back to this shortly.

And so I was assigned the name of Jerome Robert Lohez, given a photo of him, and told the briefest of biographical information: age 30, lived in Jersey City, New Jersey.

That was it. A name, a face, a place.

The assignment was simple: On September 11, post his name and picture.

But I’m a news junkie, and that wasn’t good enough. I had to know more about Jerome. So I Googled his name (hey, why not?) and came across a site that CNN put together in December of ’01. It had pictures and names, of course, but I also learned that Jerome, born in France, married Dening Wu some three years before The Towers fell.

One month before The Towers fell, Jerome got his Green Card, and the happy couple flew to Europe to celebrate with his family. When they got back, two days before The Towers fell, Jerome told Dening “Only in New York do we have so much sunshine."

That was Sunday, September 9, 2001.

On Tuesday morning, he left for work. And The Towers fell.

And now we've come full circle: One. Random. Name.

Jerome didn’t just work in The Towers. He worked for Empire Blue Cross and Blue Shield. He worked in the insurance industry.

90% doesn’t cut it anymore.

Thank you, Jerome, for the lives you touched, the joy you brought, your love for New York and America, and for the privilege of paying you tribute.

Au revoir, Monsieur Lohez, au revoir.

Insurance Dispatch

The latest Dispatch is up at The Medical Blog Network. This week, we take a look at two recent surveys - one from Harris/Kronos and the other from Aetna - about how employees view the value (and importance) of their benefits.

Please take a gander.

Programming note: Tomorrow marks the 5th anniversary of 9/11, and we'll have a special post up all day in commemoration.