Tag: Insurance

My Young Invincible, His Lost and Found Toe, and University Health Insurance That ‘Technically Isn’t’

IMG_1225 - Version 2Last fall I wrote about my 26-year-old son who lost his right big toe in a freakish university gym accident a day after his student health insurance officially took effect. (See my blog post Young Invincible Health Insurance Saga 10-5-13). He had aged out of my university job-based health insurance three months before and, much to my consternation, had ‘gone bare,’ unable to afford any of the health insurance plans available to him at that time. He signed up for the University of Washington’s School Health Insurance Plan (SHIP) as soon as he started in a graduate program there. As I drove him to the (University-affiliated) emergency department with his (found) toe, and then as a wonderful physician cheerfully sewed it back on, I breathed a huge sigh of relief that his SHIP would at least cover most of the cost.

Although, on second thought, as I wrote then:

“Even though he officially has health insurance to cover his expensive ED visit (X-rays, sutures, IV Vancomycin, physician quips) and ortho follow-up, I do not trust it. There are pages upon pages of exclusions to his health insurance plan, including bungee-jumping and intercollegiate sports–neither of which would seem to apply to losing a toe in ballet/karate. But I know how crafty and devious health insurance companies can be in trying to deny medical claims. I would hope that the university where I am employed and teach (and where my son is now a student) would have a decent health insurance plan option for its students. I guess I’m about to find out.”

And now, almost seven months later, I have discovered a very surprising answer: his university health insurance ‘technically isn’t health insurance.’ Silly us for assuming that something called a ‘Student Health Insurance Plan’ offered through a major U.S. public university was really health insurance!

This was explained to me today by a nice young representative who answered the phone at LifeWise, the insurance company that underwrites and administers University of Washington’s SHIP. I called to ask (nicely) how it was that they could still legally include a pre-existing condition exclusion since ACA/Obamacare requires insurance companies to cover people with pre-existing conditions (including the ‘pre-exisiting condition’ of being a woman, for which insurance companies charged more). I had done my homework on this, reading the user-friendly Healthcare.gov website to find that there was one exception to this rule: the benignly named ‘grandfathered individual health insurance plans.’ I wanted to know how SHIP could possibly qualify for this ‘grandfatherly’ exception category, and if they did, why they didn’t include that statement clearly in their information brochure as mandated by the ACA. LifeWise has hassled my son to prove that his torn off toe wasn’t a pre-existing condition and has refused to pay for some of his other healthcare claims.

The LifeWise representative’s answer was that they weren’t a grandfathered plan, but that they didn’t have to follow many of the ACA mandates because ‘technically this isn’t a health insurance plan, it is a disability plan.’ Huh? She went on to explain that the fine-print ‘Note’ clause on the front page of their consumer brochure ‘clearly states this.’ I had the brochure on the screen in front of me and sure enough, right under the large purple banner/title “University of Washington/ Seattle ‘SHIP’ Student Health Insurance Plan” it has a teeny tiny “Note:This coverage is blanket disability insurance. Coverage provided is “excess” only and does not contain a “coordination of benefits” provision.” 

That is so (not) clear and transparent for any self-respecting university-attending Young Invinsible, not to mention their University Professor parent who, oh I don’t know, perhaps has a doctorate in health policy? Now I happen to have both ‘real’ health insurance and ‘real’ disability insurance through my university job and I know the difference between them.When I asked the LifeWise representative to please explain how SHIP was really S-DIP I suppose, she replied that she really couldn’t explain it: “of the hundreds of different insurance plans I deal with, this is a unique policy.”

Unique indeed. How can a university (‘my’ university no less) offer what it clearly labels ‘student health insurance’ when it isn’t really health insurance and therefore doesn’t have to comply with current ACA mandates? What will it take for our country to get a saner health care system?

 

Toe Saga Enters Health Insurance Maze

toes
toes (Photo credit: ribarnica)

The first bill of sorts came today for my young not-so-invincible son for his recent torn off big toe (previous post). The letter is in reference to a $17 radiology charge from the emergency department of the university-affiliated hospital where he was seen. I assume this charge was for flipping the switch to warm up the X-ray machine, but it doesn’t specify what it was for.

The letter came from his student health insurance company. They are requesting documentation that my son’s missing toe was not a preexisting condition. Their specific wording: “Has (dearest son of mine) received any medical care or medicine for diagnosis code 729.5–pain in limb (for the three months preceding the X-ray)?”  Like what, he’s been running around for the past three months with his
toe in the refrigerator just waiting for his health insurance to kick in
so he can have his toe reattached?

Do U.S. health insurance companies purposefully hire stupid people so they can spend even more on administrative overhead and pass those charges on to us, the mostly overwhelmed and confused health care consumers? At least 15% of our country’s total healthcare expenditures is spent on this sort of inept health insurance administration. That’s over $360 billion annually just for paper pushing. Medicare’s administrative costs are less than 2% of total Medicare expenditures. Meaning: that paper pushing can be done a lot more efficiently.

As Jeffrey Pfeffer wrote in his Bloomberg Business Week News article (4-10-13), “Because insurers are paid a fixed percentage of the claims they administer, they have no incentive to hold down costs. Worse than that, they have no incentives to do their jobs with even a modicum of competence.”

A good overview of the obstacles to reducing administrative costs within our healthcare system is included in this brief NEJM article. The authors point out that Obamacare/ACA has some provisions to address these problems. Here’s hoping.

Young Invincible Health Insurance Saga

IMG_1227Last night I had to take my ‘young invincible’ son to a local emergency department to have his toe sewn back onto his body. He had heeded my advice to get back to the gym to exercise, and somehow combined ballet with karate and lost a big toe in the process. His ED physician said he’d never seen anything like it in his 33 years of practice. Oh so reassuring. Also unsettling was this physician mug shot on the vending machine in the ED waiting room. He glared at me all night as I tried in vain to figure out what he was doing there, what his message was. Don’t you dare drink these sugary drinks? You’d better have good health insurance if you want to be seen here? I have some bad news: we somehow lost your son’s toe?

Fortuitously (or so I hope), my son listened to me and signed up for student health insurance–the day before his ballet/karate accident. As a mom and a nurse it was taking years off my life to have him ‘going bare’/uninsured. I now know some of what it feels like to live in fear of an accident, injury, or illness that could ruin my son (and by extension, me) financially. Even though he officially has health insurance to cover his expensive ED visit (X-rays, sutures, IV Vancomycin, physician quips) and ortho follow-up, I do not trust it. There are pages upon pages of exclusions to his health insurance plan, including bungee-jumping and intercollegiate sports–neither of which would seem to apply to losing a toe in ballet/karate. But I know how crafty and devious health insurance companies can be in trying to deny medical claims. I would hope that the university where I am employed and teach (and where my son is now a student) would have a decent health insurance plan option for its students. I guess I’m about to find out.

Health Insurance: Good Luck

Insurance
Insurance (Photo credit: Christopher S. Penn)

If anyone ever questioned whether or not US healthcare is political, they should now be convinced that it is. What with the drama of Obamacare, that Texan Tea Partier/Green Eggs and Ham reading/White Castle hamburger loving/Obamacare hating Senator Cruz, and then the looming shutdown of the federal government.  Not to mention Vanderbilt Medical Center’s recent creative administrators’ cost-cutting move to require nursing staff to take over housekeeping duties, for which they invoked the ghost of Nightingale (yes, HER again!) as the rationale behind their decision. Oh Nightingale! Rise up and smite them with a mop!

And then there is the desperate, mostly behind-the-scenes scramble for state health exchanges to be up and working by this coming Tuesday, October 1, when they are all slated to open for business. As described in today’s NYT article, many state exchanges will most likely be delayed. I especially like the article’s photograph of a roomful of intensely-working computer programmers trying to fix things for Oregon’s health exchange. I wonder how many of those workers have health insurance, and if not, how many of them now understand how to shop for and purchase health insurance once the system they’re working on is functional. Many of them do not look healthy.

My son, age 26, recently aged out of my health insurance plan. He was able to stay on my plan thanks to that provision of Obamacare. For the past few months he has been one of the many ‘young invincibles‘ (or ‘young invisibles’ perhaps?) who has no health insurance. Of course, I bug him constantly about this and want him to be insured. He’s now in graduate school at the University of Washington and is now eligible to purchase their student health insurance plan. The annual fee for one student (including 2014 ACA fees/whatever that means) is $2,748. School started this week, the earliest he would qualify for the insurance. I just checked their website and it has a statement marked urgent: “due to a system error some students who registered for Autumn quarter have had their coverage cancelled.”

This is complex stuff. I have a doctorate in health policy, teach, live and breathe health policy, and I can’t figure it out. Our healthcare system, especially the health insurance scene, has always been complicated, but I’m convinced that this specific part of Obamacare is creating more problems than it solves. It adds layers of administrative complexity and a huge burden (time and frustration–heart attacks anyone?) on consumers to ‘shop and pick a plan.’ These add up to a substantial increase of costs and inefficiencies in our already overly costly, inefficient, ineffectual healthcare system.

The best (mostly fully functional that I’ve seen) interactive tool for consumers ‘explaining’ ACA/Obamacare in more or less vernacular (English and Spanish), is Consumer Report’s Healthlaw Helper. Good luck.

‘Obamacare’ Working for Young Adults

English: Barack Obama signing the Patient Prot...
English: Barack Obama signing the Patient Protection and Affordable Care Act at the White House (Photo credit: Wikipedia)

One of the provisions of the Affordable Care Act (ACA) that took effect in September 2010 allowed children/young adults to stay on their parent’s health insurance policies until their 26th birthday. The reason for this provision was that young adults ages 19-25 had the highest rates of being uninsured of any age group in the U.S.

For the past two springs in my health policy course I’ve asked students to raise their hands if they were now receiving health insurance under the ACA provision. This past spring about half of the students in this age range raised their hands. My own son who is in graduate school has been able to continue on my health insurance because of the ACA. Highly unscientific evidence for this part of the ACA working, but evidence nonetheless.

Now there is more objective evidence that the ACA is working for young adults. A NYT article today by Sabrina Tavernise “More Young Adults Have Health Insurance After Health Care Law, Study Says,” reports on data from a recent CDC/National Health Interview Survey. Lack of health insurance among young adults 19-25 fell from 33.9 percent in 2010 to 27.9 percent in 2011, translating into about 1.6 million fewer uninsured young adults. There was a corresponding increase in young adults having private insurance over the same time period, from 49.3 percent in the third quarter 2010 to 58.8 percent in the fourth quarter 2011. These positive changes for young adults were seen across different racial groups. Additional evidence that the ACA is working for young adults is that lack of insurance grew for adults ages 26-34.

As most everyone knows by now, young adults have been the hardest hit by the Great Recession. It is good to hear that something is going in their favor.