New Database to Help Coloradans Shop for Best Priced and Effective Medical Procedures
In my opinion, the single most important factor in the ever increasing cost of medical care is clients’ inability to obtain competitive pricing for medical treatments and their lack of knowledge/confidence in choosing the best option. Is the knee MRI offered by one provider for $297 really as good as the same test offered by someone else at $1261?
According to an article published November 2, 2012 in the Denver Post, the new Colorado All Payer Claims Database will shine a harsh spotlight on health price differences that can not be justified.
Organizers claim the database will be Colorado’s most accurate reflection ever of costs actually paid by consumers, insurance companies and government plans. Many other listings have focused on “charges” — the retail prices for health care rarely paid by large insurers or the very poor.
By late next year, another leap in data will allow consumers and analysts to compare actual costs for various services on a hospital-by-hospital or doctor-by-doctor level, with the provider named and open to questioning.
Cost experts estimate $750 billion, or about 25 percent, of U.S. health care spending is unnecessary and driven by waste, misuse or overuse. That waste won’t be cut until consumers can shop accurately for health care, and providers can see how others deliver care more efficiently, database promoters said.
By late 2013 or early 2014, consumers should be able to use an interface showing, for example, their share of cost and the insurer’s share for a colonoscopy at specific hospitals within a 20-mile radius. A side-by-side column would also show a quality rating for each facility, taking into account factors like how many post-surgery infections occurred at that hospital.
I believe that if this new database can live up to these projections, it will have a huge impact on lowering medical cost.
- Published in Colorado State Initiatives
Autism- What is Covered by Health Insurance in Colorado?
Broadly speaking, the Colorado Autism Insurance reform Law(C.R.S. 10-16-104), which went into effect July 1, 2010, applies to all children under the age of 19.
Plans must provide at least $34,000 of coverage per year for applied behavior analysis from birth to age nine. Plans must provide at least $12,000 of coverage per year for applied behavior analysis a child nine years of age or older until the child is 19.
- Published in Colorado State Initiatives, Individual Health Insurance
Driving a Taxi in Honolulu
The summer of 1969 I went over to Hawaii to drive a taxi. I still had a year left to graduate from college and this seemed like a romantic way to spend my vacation as well as to make a little money. I had read James Michener’s book Hawaii and found the opportunity to visit the islands enticing.
My friend Dannie Jaich had graduated the year before and had gone to Honolulu to find a teaching job. For some reason this never panned out for him and he ended up driving a cab. He invited me to join him there and promised to guide me through the process of qualifying as a driver myself. So, with my one-way airfare paid for, and about $50 in my wallet, I flew over.
Dannie was living in a run-down rental house in downtown Honolulu on Liliuokalani Street, not too far from Waikiki and the beach. Oahu then was just as you might imagine; colorful, warm, humid and covered with palm trees and tropical plants. There was also an exotic mix of ethnic groups; businessmen descended from indentured Japanese laborers, Polynesian “Primo Warriors” (named for the local beer), mixed race “Portugees”, American soldiers on leave from the war in Viet Nam, lily-white mainland secretaries seeking romance, handsome, brown-skinned “real Hawaiian” surfing instructors and a few college kids looking for adventure.
Dannie soon put me to studying a map of the city because, in order to obtain a taxi driver’s license, you had to pass a test based upon your knowledge of the city streets and pertinent rules and regulations. The one part of the exam that I remember now was that you were verbally given a hypothetical location where you picked up an ill client and you had to give the examiner the quickest route to the nearest hospital. The test was not easy, especially when you consider all the streets had Hawaiian names that I could neither pronounce nor easily distinguish, one from the other.
Our vehicles were rented from a fellow who charged $15/day for their use. We worked out of the Ilakai Hotel at the far northwest end of the Honolulu tourist area. This meant we waited in an off-site parking lot until they needed to replenish the 3-4 cabs that were stationed in front of the hotel. A good fare for us, where we could make a few bucks, would be to the airport, but too many times, after waiting for hours, we would get a client who just wanted to go to the International Market Place on Waikiki, a two dollar fare. As summer was the low tourist season, many days we would have to work 8 hours in order to make the funds to pay for the use of the cab. After that we would have to come up with the money to pay for gas and, yes, food. In many ways, this was some of the hardest work I have done.
As mentioned before, many of the streets had Hawaiian names and were difficult to distinguish between. I often had problems finding destinations. One memory that still makes me cringe is when I picked up an obviously in-a-hurry businessman at the Ilakai Hotel. He had an appointment in a few minutes at a hotel I had only heard of, but never had been to, although I felt I could find it. After wandering around for way too long, with a very agitated passenger in the back seat, I finally took him back to the nearest standing taxi I could find and admitted to him I could not find the hotel where his meeting was to be. The look on his face still haunts me.
One evening I remember was when the cab owner took Dannie and me, as well as several others of his drivers, out for drinks and a late breakfast on Waikiki (my first Eggs Benedict). We got pretty looped and he ended up racing his car at 120 mph (as I write this 120 mph seems impossible, but that is what I remember) down the main tourist thoroughfare at 2:00 am with a car full of quickly sobering passengers.
Sometimes I was really hungry. I remember one time at an all-you-can-eat buffet when I stuffed a pocket with scrambled eggs for later consumption. It doesn’t make sense now, as there must have been other more portable foods to carry out, but that’s what I did. And I remember eating them later.
Dannie, who was more bold than most, would propose a personalized Oahu Island tour to many of his passengers. For a set fee he would drive them around to the Northshore and back, showing them all the tourist spots and naming the flora and fauna that they saw. Now Dannie did not know their real names any more than I did, so he would just make up names like, Monkey Tree or Island Blue Birds. He encouraged me to offer these tours as well, but I was hesitant, not only did I not know any flowers’ names; I really did not know where the tourist spots were either. But I did propose it to one couple and when they did not readily accept, I was relieved. They said however, that they would think about it and asked for a telephone number where they could contact me. Much to my dismay a few days later they called to accept. I don’t remember much about the trip, but as uncomfortable as I was, I was able to fake my way through it. We did get up to the north side of the island and maybe saw some tourist sites, perhaps I named a few trees and birds. I did receive my fare and a tip but I didn’t try it again.
Other snap shot type memories that endure are:
– This was the year that Neil Armstrong was the first person to walk on the moon. It was a big event in Hawaii, as the return capsule was picked up in the waters just off shore. The triumphant astronauts came to Honolulu to be greeted by large and enthusiastic crowds. I did not see them in person, but remember watching the landing and return on a flickering, black and white TV in the dorm room of Carlyn Hanson, a student at the University of Hawaii that I was dating at the time.
– George Pena was a friend of Dannie’s and mine from high school. He had signed on with the Los Angeles Angels baseball organization and was with their triple A team in, I think, Palm Springs. His team came over to play the Hawaiian franchise and we of course went to see him. I don’t remember much about the game except for my introduction to Saimen which I really liked. This is typical Hawaiian baseball fare and is similar to Ramen noodles.
– Dropping someone off at a house where they had the 1969 College All Star Football team playing the previous year’s Super Bowl Champions (as they used to do) NY Jets on the television. I only saw a moment of the game, but the Joe Namath led pros won in a close one 26-24.
– Cutting Sam Rosseli’s hair, the first and only time I have done this. Sam was another friend from college, who had come over to join us to drive a cab that summer. Sam was a laid-back guy notable for having dated a well-known model, Cheryl Tiggs, before she became famous.
– I remember that black people were always conscientious about tipping.
– The local, year-round, full-time taxi drivers were understandably resentful of we “haoles” who had come over from the mainland to pick up the scant fares.
– I started reading Catch 22 and finished it only recently, close to 40 years later.
– And, I remember thinking that the ocean water was as warm as a bath.
So, after a full summer, exhausted, with an airline ticket in my hand, $15 dollars in my pocket and all debts paid (except for that traffic ticket for driving at dusk on Waikiki Blvd without my lights on that I did not believe I deserved) I headed home.
Thanks Dannie for inviting me. It was great fun.
- Published in Personal Interests
Who are the Health Uninsured In Colorado?
Well, according to Westley Mori, Research Analyst for the Colorado Health Institute, they are low income adults. Here are some of the findings from his work:
About one in five Colorado adults between the ages of 19 and 64 did not have health insurance in 2010. Adults represent the vast majority—about 83 percent—of Colorado’s uninsured.
Digging deeper, CHI finds wide variation within that group of uninsured adults. Findings in “Health Insurance Status of Colorado Adults” include:
•About 640,000 adults were uninsured in 2010, up from about 623,000 in 2008.
•The uninsured rate for adults varies dramatically by region – from a low of seven percent in Douglas County to a high of 27 percent in Adams County.
•Forty percent of the uninsured adults have annual incomes below 133 percent of the federal poverty level (FPL), or about $29,000 for a family of four.
•Sixty-three percent of uninsured adults are employed.
Adults without dependent children (AwDCs) with incomes at or below the FPL, about $11,000 for an individual, have an uninsured rate of 41 percent, twice that of the average adult in the state. Within this group, CHI estimates that:
•Six in 10 (about 94,000) are male. In comparison, about 50 percent of Colorado’s adult population is male.
•The vast majority are single.
•More than a third are employed, either full- or part-time.
In my opinion, the Affordable Care Act requirement that all citizens have health insurance, that goes into effect January 1, 2014, will do little to change these numbers. Coverage will still be expensive, rebates using the tax system will be complicated and not timely and the penalties for non-compliance will be low in the begining.
We will see what we will see.
- Published in Individual Health Insurance, Personal Observation
Essential Health Benefits-What Do You Want vs. What Are You Willing To Pay?
The Affordable Care Act requires Americans have access to quality, affordable health insurance. To achieve this goal, the law requires health plans offered in the individual and small group markets, both inside and outside of the Affordable Insurance Exchanges (Exchanges), offer a comprehensive package of items and services, known as “essential health benefits.” Essential health benefits must include items and services within at least the following 10 categories:
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management, and
- Pediatric services, including oral and vision care
The challenge now facing the Colorado Department of Insurance is what additional, if any, benefits they will require the new policies to contain. Each state is empowered to devise their own list.
Here is a partial run down of additional requirements being consider in other states and of course, each benefit has a very active advacacy group pushing for inclusion:
Acupuncture (now a requirement in California)
Pre-vacation visits to travel clinics (whatever this is, apparently it will be required in Colorado)
Bariatric Surgery (stomach reduction)
Each of these services is, of course, very dear to a segment of the population. The question before the Department of Insurance is “is it reasonable to require all health insurance policy holders to pay higher premiums for these benefits, when they may or may not be “”essential””?
Here is an excellent article written by the Washington Post on this subject.
Child-Only Health Insurance Policy
One of the most impactful regulations of the Affordable Care Act (Obamacare) that has already gone into effect is the requirement that no child under 19 may be turned down for health coverage. For the family with a child with a significant ”pre-existing condition” this is a godsend. For the insurance companies it is a headache.
The reason that this is difficult for the insurance companies, is that although they can “rate-up” the child’s portion of the premium up to 200%, some of these kids have conditions that may cost $100,000′s to treat
Another concern is that parents, knowing the insurance companies must cover their child, will not be willing to purchase and pay for coverage until the child is “literally in the ambulance on the way to the hospital.”
While a parent and child may apply anytime for insurance, to ameliorate this situation somewhat, the feds have allowed the insurance companies to only offer child-only policies during ”open enrollment” periods, except in the case of a “qualifying event.” In Colorado those open enrollment periods are January 1-31 and July 1-31 with coverage starting 30 days after the enrollment period.
Outside these periods, the only other times insurance companies are required to offer child-only coverage is in the case of a qualifying event. A qualifying event is defined in the new Colorado law as within 30 days of birth, adoption, marriage, dissolution of marriage, loss of employer-sponsored coverage, loss of eligibility for Medicaid or Child Health Plan Plus (CHP+), entry of a valid court or administrative order mandating the child have coverage, or involuntary loss of existing coverage other than because of fraud, misrepresentation or failure to pay premium.
A carrier may deny coverage if the child has access to other creditable coverage such as a parent’s plan through an employer.
Most health insurance carriers will offer only one of their plans to child-only applicants. These plans are usually bare-boned and are difficult to apply for, i.e. paper applications, no agent involvement, etc. The only company we work with in Colorado that offers their full array of plans, and no additional barriers in applying, is Rocky Mountain Health Plans.
Of course, we expect this will all change on January 1, 2014 with the full implementation of the Affordable Care Act and the exchanges that go with it.
If you’d like to know more about child-only policies, please call me at 303-541-9533.
- Published in Applications, Child-only, Individual Health Insurance
Canceling Your Individual Health Insurance Plan
Clients are often concerned that they will get “locked into” a long-term commitment when they purchase individual health insurance. The truth is that you may cancel your plan whenever you choose, and most companies will reimburse you for any time you have paid for, but not used.
However, your insurance company is required to continue to offer you coverage as long as you continue to pay the premium and have told the truth, to “the best of your knowledge and belief” on the application. Once your health insurance policy is in place, you cannot be singled out for premium increase or termination no matter how many claims you make. You must be treated like everyone else in you age group and Zip Code.
If you would care to know more about this, please give me a call at 303-541-9533.
- Published in Applications, Individual Health Insurance
Colorado Continuation/Conversion is a state law that assures an employee who leaves a company with less than 20 full time employees and has been covered by the firm’s health insurance plan for 6 continuous months, a continuation of their health insurance coverage for up to 18 months, except in cases of “gross misconduct.” For an employee leaving a Colorado based company with more than 20 employees, the federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) applies.
The ex-employee will be responsible for the full premium (the combination of that which the employer and the employee were previously paying) plus a small administrative cost.
Within 10 days of termination, the employer must sent written notice to the employee of the right to continue. The employee then has an “Election Period” of 30 days from termination to notify the employer of acceptance.
If after this period the employee decides they do not want to accept Continuation coverage, they owe nothing. However, if they do decide they want to accept the coverage, they will owe premium back to their last day of employment.
One concern with smaller companies is that if the firm goes out of business and/or cancels their health insurance plan, this whole option disappears for the ex-employee.
Colorado Continuation/Conversion is a form of “group health insurance” and generally cannot exclude coverage for pre-existing conditions. However, because of this, the premiums are much higher than a relatively healthy person or family could obtain with an individual policy.
If you would like to know more about your options, please give me a call at 303-541-9533.
- Published in Colorado State Initiatives, Individual Health Insurance, Misc
Working as an Usher at Dodger Stadium
I was looking for a part-time job while attending East Los Angeles Junior College in 1964. I had a friend who was working as an usher for baseball games at Dodger Stadium in downtown Los Angeles and I asked him if he could help me do the same. He agreed, so I went down and applied and was accepted. I had to join a union and the rules were that the most senior members of that union had first preference in working the games. That meant if I showed up for a game that had a low attendance, I might not have work that day, because only a limited number of ushers would be needed. If not selected, I had the option of either going home or watching the game from the third deck. I worked the 1964 and 1965 baseball seasons.
There were two shifts, one started two hours before the ballgame and the other started an hour later. I always hoped to get on the first shift because your tour ended after four hours. The second shift stayed until the end of the game, even if it went into many extra innings. I think the pay was four dollars and hour and change. We wore company provided grey slacks, maroon double-breasted coats, clip on ties and straw hats. You provided your own white dress shirt.
The Los Angeles Angels Baseball team was formed in 1961 and played in the same stadium which they called Chavez Ravine. They played their home schedule when the Dodgers were on the road and, as their attendance was low most of the time, except when the Yankees were in town, I did not work as much for them. Having teams from both the National and American leagues come into town, I was able to see all the great players of the era; Mickey Mantle, Roger Maris, Al Kaline, Ernie Banks, Warren Spahn, Willie Mays, etc. Of course, there were all the Dodger greats like Don Drysdale and Maury Wills as well.
One of my favorite fellow ushers was a boxing instructor. I believe his name was Joe Crosetti or something close to that. He worked with fighters down at Los Angeles’ old Main Street Gym. The friend who got me the job (unfortunately I can’t remember his name) and I went down there and did some training with Joe, including some sparing with real boxers. I soon learned that I was not quick, tough or hungry enough to go much further. But my friend was real good and worked at it for a long time. I lost contact with him when I went into the Peace Corps after the second year of ushering. I wonder what happened to him?I did see Sandy Koufax pitch a perfect game against the Chicago Cubs, September 9, 1965 and worked all home games for the Dodgers when they won the 1965 World Series against the Minnesota Twins.
Many of the other ushers were Pakistanis with advanced college degrees, who were working for the same peanuts I was. One evening it was explained to me; they had come over to the U.S.on student visas and as long as they continued studying, they could stay here. Their visas only allowed them to work at part-time jobs, like ushering. Additionally, all of them had a wife and kids back in Pakistan. Their parents would not let them leave their home country without establishing these ties to assure their return.
There were a few venders that I got to know well. They would work their way up from selling the heavy things like soda and beer to the ultimate, peanuts. One peanut seller who really impressed me was a black law student with a big personality. He was wonderful at playing the crowd and worked really hard. He told me once that he could make $300 on a big three-day weekend! $300 to me was a lot of money in 1965.
Most of the time as an usher, after we helped people find their places, we would walk behind the last row of seats and ask people to “please stand behind the yellow line”. This painted line was about a yard back behind those seats and the reason we were required to do that was so that the seated patron would not have some drunk hanging over his shoulder spilling beer.
Many times I was selected to work the Club Level where I saw many of the baseball writers and celebrities who attended the games, like Angie Dickinson with whom I had a stilted (on my side) conversation with in an elevator one time. I always suspected, but never asked, the reason I worked there so much was that I was a clean-cut looking white kid.
I saw a few folks get hurt by being hit by line drive foul balls and flying bats, but nothing really ugly. Of course there was always the mad scramble for loose balls in the stands. When I go to a baseball game these days I have absolutely no interest in having any foul ball come near me.
One day in sunny Southern California, we had an extremely heavy downpour of rain and the game was called off. There was so much water on the field that one of the batboys decided to swim, not wade, between the dugouts.
Fights, drunks, cursing, bad behavior? Yeah, but not a lot, and that’s what the police were there for. It was Los Angeles, not the East Coast, baseball not soccer.
As a member of the union, I had the opportunity to work other events as well. One year I saw the circus 64 times. With this overdose, I have had little interest in going again.
All in all it was a good job and I’m happy I had the opportunity to do it.
- Published in Personal Interests
On Line Health Insurance Quotes
If your in-box is anything like mine, you are receiving an endless stream of offers for on-line health insurance quotes. If you are perfectly healthy and know enough about health insurance to be able to select a plan that is well suited for your situation, then this system will work well for you.
However, if you are dealing with some, even minor, pre-existing conditions, or you have not been keeping up on all the changes in the health insurance industry, it might behoove you to speak to an experienced health insurance broker like, modestly, me.
Pre-existing conditions? I promise you that different health insurance companies look very differently at certain pre-existing conditions like; depression, asthma, recent operations, gout, build (height vs. weight), DUI’s and many others. An experienced broker can steer you towards the company who will give your application the best chance of being accepted.
The “right” plan? Low priced health insurance plans often have hidden “gotchas.” These might include excessive co-insurance charges, limited or no doctors’ office visits, no “branded” prescription coverage, additional “access fees” for hospital/ER visits, no mental health coverage, etc. Unless you know what you are doing or have someone to point these “holes in coverage” out to you, you may end up buying a policy that excludes the very things you most want covered.
And, best of all, it costs you nothing to work with a broker; the insurance companies pay our commissions. The cost to you is the same either way.
So, give me a call at 303-541-9533, if you want to make sure you are getting the health insurance coverage you are paying for.
- Published in Applications, Individual Health Insurance, Premiums, Underwriting