Be th’ insurance company takin’ me doubloons?

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Enter a capion

Be off in fer me #ACA Wellness exam (covered 100% No Deductible) Kaiser Permanente sends me a bill fer it. Blimey!

pirate-img_1631Today is Talk Like a Pirate Day and what’s going on here is pure Hornswaggle. I had the same issue last year with John Muir Health and Blue Shield of California, to be fair. The intent of having Preventative is for catching and treating a health problem before symptoms start. Health insurance plans must cover preventive services without charging you a co-payment or coinsurance. Insurance company actuary’s price for this in their plan pricing.

The Affordable Care Act has been around for three years nowobamacare-cartoon-2-a, so the excuse that, oops we coded it wrong is kind of a cop out. So I wonder why does this still happen. Are they “double dipping”, collecting the premium for a 100% benefit and billing insureds for these services as well?

I posted this on Linked In and Twitter and this morning Kaiser’s social media team called me. I didn’t have to call them. In the middle of the call I has an epiphany that I shared with the Kaiser representative.  It’s 12 or 18 months from now and I’m watching a late movie on the couch when all of a sudden a commercial with a stern looking spokesperson comes on and exhorts, “Have you had your wellness exam with your insurance company and been charged for services that should have been covered at 100%? Be part of a class action lawsuit to collect damages for the time, pain and suffering (have you heard their hold music?) your insurance company has caused you.

This preventative care charge could be the new asbestos! I mean Mesothelioma, who had ever heard of that before the lawyers got involved?

The ACA does mandate coverage for the annual wellness visit, but the blood work (which is the draw and two panels) may or may not be covered, depending on your insurance plan. When you go in for your wellness exam they draw two vials of your blood for testing. You should have the expectation that this testing is part of the wellness exam protocol that’s designed to make sure you’re healthy.

So if you’re an insurance company like Kaiser which has built it’s business model on “Thrive” I would think you would want to motivate and give the incentive to insureds to take care of themselves and catch health issues early when treatment is less costly and the outcomes are better.

No matter how this turns out I’ll still go in every year to see how my body is  doing, or more importantly, what changes in my diet or lifestyle I can make that will ensure good health.

For an Old Salt, the preventative exam is the Crows Nest view to longevity. Because Dead Men Tell No Tails!

 

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California SB 810 ‘Medicare for all’ bill could be named ‘Mediocre for all’

The news out of the State Capitol in Sacramento only gets more surreal considering how close we are coming to allowing the State Government takeover of the current healthcare system. The obvious argument against SB 810 is the cost. The financing detail is in the State Senate’s own evaluationthat SB 810 would cost the state $210 billion in the first year and would grow to $250 billion by 2015-16.  The state’s entire general fund budget this year is only $86 billion. So math wizards, $210B – $86B = $124B. Huh, I get it.

This new Government plan would outlaw private health insurance plans: “This bill would prohibit the existence of a health care service plan contract or health insurance policy, except for the California Healthcare System (SB 810), that would be sold in the state that provided for the same services as the system.” You would not be allowed, by law, to upgrade to “first Class”. Kaiser lover’s would also see their plan would go “bye, bye”. Your coverage will now become a function of revenue in the state budget and the political whims of lawmakers.

This coming on the heels that last year, our Golden State suffered what only can be seen as a butt whipping by the Lone Star state.  The Texas Public Policy Foundation compared Texas to California showing that Texas economically outperformed California in job creation with 129,000 new jobs in 2010 while California lost 112,000. Shouldn’t we be looking for better performance from our lawmakers in Sacramento? We have 2.2 million unemployed in California right now, excuse me, wake up and smell the coffee.

If there is a crystal ball as to this may turn out we only need to look north of the border to Canada. Their federal government recently disclosed a plan to cut the rates of Canada Health Transfer payments, saying it wouldn’t be enough money to do the job. In hockey terms, that’s a cross check to the stability of their government run care.

Which brings us back to the falacy that eliminating the mddleman will save the state money. Ask anyone who works in the health insurance industry, are they working harder and more leaner than before? Would a state created job have the same level of effort? Adding a huge new state run program is just madness.

 

 

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