Archive for the ‘Insurance’ Category

Service of Insurance: What it Pays For, Making Coverage Easier and When a Company Should Consider Ducking Coverage

Monday, October 28th, 2019

Photo: aiche.org

If I had back all the premiums I’ve paid for everything from renter’s and owner’s to car, life and health–even Social Security–insurance I’d be a wealthy woman as many would be. I admit that when I’ve needed it, I was grateful for the coverage.

For humanitarian reasons I question how insurance companies can get away with not covering a sick person for lifesaving medication and related legitimate health expenses. Drugs that aren’t on approved lists aren’t covered nor is unlimited home health care which is cheaper and in most cases far better than carting off a person to a nursing home. In this post I write about a pharmaceutical company that’s addressing how to help insurance companies pay for a pricey drug.

I also question whether an insurance company should have to pay an organization’s settlement and legal expenses in cases of abuse. The exception would be legal expenses. They should pay them if the accusations prove false.

Medical

Here’s a creative way that pharmaceutical company Novartis is helping insurance companies pay for Zolgensma, the most expensive drug in the world. I first read about it this summer in a Wall Street Journal [WSJ] article by Denise Roland, “Insurers Limit Access to $2 Million Drug.” One dose of the innovative gene therapy helps prevent a rare condition in young children from getting worse.

They are born without a gene that controls the muscles that allow them to sit up and later, stand on their own. When this article was written, insurance companies were reluctant to spring for the money to pay for the one injection because they weren’t sure it would work. It is meant to halt the progression of the disease, it doesn’t reverse or cure it. It is most effective when given in infancy, before symptoms appear.

Photo: zolbensma.com

Things have changed since summer. Recently Novartis made concessions to help patients acquire the drug. Denise Roland and  Carlo Martuscelli explained the company’s compromises in the WSJ article “Novartis Lauds Launch of World’s Most Expensive Drug.”

Novartis agreed to refund some of the cost to the insurance company if the drug didn’t work. It also offered to divide the cost evenly over five years [though few insurers have opted for this choice]. Sales of $160,000 in the first three months have exceeded analyst expectations. CEO Vas Narasimhan “said on a call with reporters that 99 percent of patients who were eligible for Zolgensma were receiving it, although some must go through an appeal process to do so.” Regardless, Narasimhan said patients “on average” received the drug within 30 days of requesting it.

Insuring Abuse

On the other hand I wonder how some insurance customers think that they should collect and why a company should pay them.

The title of a recent WSJ article by Nicole Friedman and Ian Lovett was: “Insurers Face Wave of Costly Child Sex-Abuse Claims–As 22 states move to ease victims’ pursuit of damages against alleged abusers, disputes over decades-old policies loom.” In New York, the Child Victims Act gives victims a year to report abuse with no time limits.

Photo: correllfirm.com

The reporters wrote: “Most of these institutions, such as churches or schools, are expected to try to use liability insurance to cover some of the cost of defending against these lawsuits and paying potential damages.” They continued ” The legal disputes underscore the complexity of litigating decades-old claims and the uncertainty about how much money will ultimately be available to compensate victims.” It could be $billions they estimated.

According to them insurance companies have already paid 20 to 80 percent of settlements for victims against churches. [The New York Archdiocese has been compensated in one or another way since 1954.]

Photo: businessinsurance.com

As the statute of limitations kicked in, insurers calculated what their exposure would be. Now that it has been lifted for a year, those calculations are out the window and exposure to compensation has increased, but not without complications. “Many institutions and insurers don’t hold on to decades-old policy documents, and it can be difficult to track down details. Sometimes ‘insurance archaeologists’ are hired to hunt down evidence of old policies,” Friedman and Lovett reported.

They identified additional reasons to derail compensation: Did the policyholder know about the alleged abuse? “Liability insurance policies typically cover negligent acts but not intentional ones.” And should a claim cover one alleged abuser or each of his victims?

Do you agree that health insurers/Rx plans should cover costs for medicine, generic if necessary–even expensive experimental drugs?

What about an institution with a sexual predator among its employees?  Should court or settlement costs be eligible for insurance coverage if the person is proved guilty? Wouldn’t this be like my buying insurance to cover my legal and bond costs were I to be accused of robbing a bank?

Photo: witc.edu

Service of Celebrating the Worst of the Past: What’s with Lloyd’s of London?

Monday, March 25th, 2019

 

Lloyd’s of London Photo: en.wikipedia.com

I was surprised that this behavior survives in a civilized country.

I first heard this story on Bloomberg Radio over the weekend during a review of Bloomberg Businessweek stories. For more I linked to Gavin Finch’s story, “The Old Daytime-Drinking, Sexual-Harassing Ways Are Thriving at Lloyd’s.”

During the radio interview he emphasized the rampant drinking during business hours even more than in the article. It seems that after each insurance deal those involved retire to the local pub to celebrate, often many times a day. Sounded like “Mad Men” and the advertising industry in the 1960s though drinking in the latter took place at lunch while in London the practice seems to happen 9 to 5.

Appalling behavior outweighs the old world traditions that Finch described. He covered the unchecked “deep-seated culture of sexual harassment” for the majority of the article. The drinking makes it a dangerous place for women to work, he wrote.

For almost five years Inga Beale, as CEO, did her best to address “modernization of technology, attitudes, and behaviors—and met resistance at every step.” Currently, women in the industry “fear that Lloyd’s, already a deeply backward-looking institution, might actually be on the verge of regressing.” Finch added: “When she took over, everything was being done on paper, much as it had been for the past three centuries. By the time she stepped down, about 16.5 percent of the market’s business was being placed online.”

Lloyd’s coffee house Photo: en.wikipedia.com

The drinking isn’t the only thing that harkens to the past and some is charming if anachronistic. Finch wrote: “Beyond the quaint nature of the trading, other rites date to the first exchange Edward Lloyd opened in a 1680s London coffee shop. When a ship is lost at sea, the event is recorded with a quill pen in a leather-bound ledger kept near the center of the main trading floor, which Lloyd’s calls the underwriting room. To mark major disasters that yield billions of dollars in claims, such as the terrorist attacks of Sept. 11 and the Indian Ocean tsunami of 2004, a man in a red tunic and white gloves rings a golden bell.”

And According to Finch “the underwriters and brokers of Lloyd’s mostly do business the old-fashioned way: face-to-face, using rubber stamps, pens, and sheaves of paper. Well-tailored dark blue and gray suits are the norm, often with bold chalk stripes. One does not wear brown shoes. A code mandating suits was lifted last year, but it was clear on several recent tours of the trading floors that almost everyone still adheres to it. Some of the older underwriters wear brightly colored suspenders, or braces. Even by the standards of London’s financial district, the vibe is sartorially conservative.”

Was this news to you as it was for me? How come such behavior is accepted in the global marketplace? Isn’t the contemporary look of the Lloyd’s building in striking contrast to the culture of this company and what goes on inside? Do you think working under the influence impacts the insurance industry?

Lloyd’s lost ship ledger. Photo: reddit.com

Service of Family: No Marriage, No Children=No Family & Unfit to Serve?

Thursday, May 3rd, 2018

Photo: motivationpt.com

I was at an auto dealership in upstate New York last weekend speaking with an insurance company customer service rep. Our salesman was arranging for the transfer of our insurance to a new car and when done, he passed me the phone.

After “Hello”—I’d expected a quick “confirming that you’re Jeanne Byington leasing a car,”–but instead the rep bombarded me with questions starting with “What’s your PIN number?” I panicked, looked at my husband and we spat out a few options. The rep interrupted me and then asked, “What is the name of your child?” I answered: “I don’t have one.” He said, “You have to call back. I’ve been logged out.” Click.

Photo: datagenetics.com

So we called back, this time logging in with a PIN number, which worked thank goodness, and we reached a pleasant woman who took the information she needed from the salesman and she then asked me: “What’s your child’s birthday and year of birth?” I told her I don’t have children, but decided to share the birth info of my stepdaughter to move things along. That was the right answer. The company, its staff or computer had assumed that everyone has a kid and that my husband’s daughter–he uses the same company for a range of services—was also mine.

I immediately thought of a comment I read on Twitter by author Father James Martin, @JamesMartinSJ,  regarding the replacement of the fired House of Representatives Chaplain Father Patrick J. Conroy: “The idea that a priest can’t be House chaplain because he’s not a ‘family man’ is absurd and borderline anti-Catholic. Priests have families: mothers and fathers, sisters and brothers, nieces and nephews. Also, by that yardstick, Jesus Christ wouldn’t qualify.”

Father James Martin. Photo: ncregister.com

He was responding to a remark by Mark Walker, a Republican representative from North Carolina who is on a committee to find a new chaplain. According to The Hill, Walker said: “I’m looking for somebody who has a little age, that has adult children, that kind of can connect with the bulk of the body here, Republicans and Democrats who are going through, back home the wife, the family—that has some counseling experience…”

I take Walker’s comment a step beyond religion: Is Supreme Court Judge Sonia Sotomayor unable to do her job appropriately because she never married nor had children yet her judgments impact citizens?

Supreme Court Judge Sonia Sotomayor Photo: en.wikipedia.org

Nobody knows for sure why the Chaplain was fired. According to America Magazine’s Michael J. O’Loughlin who wrote “House Republicans rebuff investigation into firing of Jesuit chaplain,” New York Representative Joe Crowley noted that “Mr. Ryan and other Republican members of Congress were unhappy with the chaplain for delivering a prayer in November they viewed as partisan.” Father Conroy reported to The New York Times that after he offered the prayer on taxes, Mr. Ryan told him, “Padre, you just got to stay out of politics.”  While the Republican tax bill was on the table Father Conroy had urged the planners not to create “winners and losers.”

O’Loughlin wrote that “Mr. Ryan told Republican colleagues on Friday that some lawmakers felt Father Conroy was not providing appropriate pastoral care to House members.” I heard Representative Peter King from Long Island, NY disagree on TV news with this allegation.

So why did it take the House seven years to react if this was so? In his work as pastor at numerous churches as well as chaplain at Georgetown and Seattle Universities, for how many people had he provided pastoral care without complaint?

In a subsequent interview with Walker, Scott Wong reported in The Hill in “Conservative leader: Next House chaplain should have a family” that the congressman said “When you walk the journey of having a kid back home that’s struggling or made some bad decisions, or when you have a separation situation or your wife’s not understanding the [congressional] schedule, having somebody who’s walked in those shoes allows you to immediately related a little bit more than others.”

To be effective, must a grade school teacher have children; a female psychiatrist counsel women exclusively, or an obstetrician be female? Is an unmarried man or woman or a couple with no children, regardless of religion, without family? Is a doctor who doesn’t suffer from his/her specialty unqualified to treat that disease? Are there certain jobs unmarried or childless people are ill-equipped to have?

Father Patrick Conroy. Photo: youtube.com

 

Service of Irritating and Charming Commercials: Phony and Legitimate Laughs

Thursday, March 15th, 2018

Photo: tripsavvy.com

It was less than a year ago that I wrote about the commercials that drove me nuts. Clearly I’ve been listening to the radio and watching TV too much as there are two more to add to the “I immediately change stations or channels as soon as I hear them” list.

This time I’ll also share some adverts I like.

Photo: davekraft.org

Fake giggles over unfunny circumstances are the worst. The prize goes to 1-800-I-Got-Junk for radio commercials in which business or homeowners laugh hysterically when the junk crew tosses out a piece of rubbish. My hands can be wet or sticky but off goes the station at the first sign of this shrill irritation and sometimes I don’t return. In looking for a link to it, which I didn’t find you’ll be relieved to know, I noticed a similar reaction to it on a website “Commercials I Hate!

 

DJ Nana. Photo: twitter.com

Speaking of laughter, I can envision the room of 30-something creative types cracking up as they developed and produced the E*Trade commercial to scare people into saving money so they have funds for their retirement. Sung to the tune of “Banana Boat Song” that Harry Belafonte made famous, it consists of 85 year olds still working and looking foolish as they drop packages they’re trying to deliver, are dragged around by a heavy fire hose, are compared to model-perfect lifeguards and “DJ Nana” spinning records while hideously dolled up. Subconsciously, it could be this ad that inspired my post earlier in the week, “Service of Aging Gracefully.” The commercial isn’t aimed at me but at 30-somethings whose Nana’s and grandpas are, I hope, spending their time making money under more appropriate, dignified circumstances.

And I love “Banana Boat Song.”

“Triathlete” Photo: NYU Langone

I also enjoy the catchy tune that NYU Langone, a well-regarded NYC hospital, uses in some of its TV commercials which make me smile. There’s a series of which “Winter” and “Athletes on their Feet” are only two. Kudos NYU Langone! [And please take good care of my friend who has not been well.]

I wish there were more State Farm “Hall of Claims” commercials as this series is clever. My first favorite is the Mer-Mutts scene where the family pooch turns on the water in the kitchen and floods the living room transformed into a swimming pool. The woof and his pals perform a water ballet while their human mom and pop look on horrified. Actor J.K. Simmons is terrific. Some other good ones are The Truck-Cicle; Frightning-bolt and Vengeful Vermin.

My bet is that the ads that aggravate sell their products like crazy and the ones I like don’t—but I’m not in advertising so what do I know? Are there ads that motivate you to change channel or station in an instant and others you don’t mind hearing and even enjoy?

Vengeful Vermin Photo: Youtube

Service of Cost vs. Benefit in Healthcare: Who Decides?

Monday, July 6th, 2015

Photo rinehartclinic.org

Photo rinehartclinic.org

This New York Times article, “Cancer Doctors Offer Way to Compare Medicines, Including by Cost,” made significant—if terrifying–points in addition to how cost impacts what drugs a patient may get. Given their ineffectiveness, I wondered why those given as examples are prescribed in the first place.

If you or a loved one has a heart condition, don’t click away just yet: Reporter Andrew Pollack noted that cardiology societies are following in oncologists’ footsteps. And I wouldn’t be surprised if this trend soon affects patients with any and all conditions if it effectively cuts costs for insurers. 

Actor Robert Young playing Marcus Welby, MD

Actor Robert Young playing Marcus Welby, MD

Pollack wrote “Roche’s Avastin, when added to chemotherapy, had a net health benefit of 16 out of 130 possible points when used as an initial treatment for advanced lung cancer. Its monthly cost was $11,907.87, compared to $182.09 for the chemotherapy alone.

“Eli Lilly’s Alimta for that same use had a net health benefit of zero with a cost exceeding $9,000 a month compared to about $800 a month for the drugs it was compared to in the clinical trial.”

Later in the article Pollack spelled out the rating system: “Drugs for advanced cancer are given a score from 0 to 130. Up to 80 of the points are based on a drug’s effectiveness in prolonging lives, delaying the worsening of cancer or shrinking tumors. Then up to 20 points can be added or subtracted based on side effects. And up to 30 bonus points can be granted if the drug relieves cancer symptoms or allows a patient to go without treatment for a period of time.” 

Actor Hugh Laurie who plays Dr. House

Actor Hugh Laurie who plays Dr. House

Regardless of cost why would anyone prescribe a drug that benefits a patient from zero to 16 “points” out of 130?

Other news that was unsettling: “The release by the American Society of Clinical Oncology of what it calls its ‘value framework,’ is part of a change in thinking among doctors, who once largely chose drugs based on their medical attributes alone.” [The underline is mine.] Silly me: and I thought doctors still prescribe what they do according to how a drug helps a patient.

According to Pollack the average cost of cancer drugs runs $10,000/month and some as much as $30,000/month. This is information, Dr. Richard Schilsky said at a news conference, that some doctors don’t know nor do patients. Schilsky is chief medical officer of the American Society of Clinical Oncology. [Why is this significant? Even if you’ve been paying for health insurance for eons and have hardly used a cent until you need to, you can reach the ceiling when off goes the insurance spigot.]

Pollack wrote that this value framework considers the cost to the patient and the health system.  I assume “health system” translates to government supported Medicare and Medicaid plans. 

Ingrid Bergman playing Dr. Constance Petersen

Ingrid Bergman playing Dr. Constance Petersen

As a result, Pollack observed, doctors are now put in the role of “being stewards of societal resources.” He continued, “That is somewhat of a controversial role for doctors, since it might conflict with their duty to the patient in front of them. But the oncology society said it did not see those roles as being in conflict.”

Other points Pollack made include:

  • A rep for the Pharmaceutical Research and Manufacturers of America said the cost of drugs represents only 20 percent of treatment.
  • The cost of drugs is unrelated to how “novel it is or whether it prolonged life versus just shrinking tumors.”
  • In Britain, a drug is rated according to its “cost per extra year of life they provide adjusted by side effects and symptoms.”
  • Starting in June United Healthcare requires “oncologists to get prior approval from the insurance company for every cancer drug they administer. The company will then track what happens to patients and eventually provide information to doctors about how well each drug works.”

Summarizing the questions:

  • Why prescribe a drug that does little if anything to better a patient’s health or length of life?
  • Is a doctor who chooses a drug for a patient based solely on its medical attributes old fashioned and out of step and will he/she soon be forced out of work by insurance companies?
  • If a patient can scrape together the co-pay of a super expensive drug, can an insurance company refuse to pay its part? Then what?
  • Will United Healthcare only use its approval to track drug effectiveness, as Pollack suggests, or eventually will it control costs by refusing to pay?
  • Is the American Society of Clinical Oncology correct when it asserts that there is no conflict for doctors who are now made responsible for the country’s medical resources and their responsibility to their patients?
  • Unless people have unlimited incomes, most adults are aware of what they pay for food, beverages, clothing, shelter and only recently have they become aware of the cost of healthcare. Isn’t this a good thing?

  pills 2

Service of Art Theft Recovery

Monday, June 8th, 2015

Isabella G missing art

The empty frames which bordered some of the stolen artworks previously exhibited at the Isabella Stewart Gardner Museum in Boston [photo above], where the pictures used to be,  give a memorable, haunting sensation of loss. They’ve been missing for 25 years. Check out the website and you’ll see posted a $100,000 reward for information leading to the recovery of a finial of a Napoleonic eagle that was also lost in the 1990 burglary.

Speaking of burgled art, Mark Fishsteinm, with K2 Intelligence LLC, said: “You can never give up hope because if they are stolen, some people hold them for a predetermined amount of time and then think it’s safe to sell.” The retired New York City Police Department’s art crime division specialist told this to Wall Street Journal reporter Jennifer Smith for her story, “Picasso Recovery in Newark Shines Light on Art Theft.”

La Coiffeuse by PicassoWhile the article focused on the fascinating business of art recovery, clearly the type of work only for the patient, the discovery in NJ didn’t share any how-to clues. Smith wrote about the theft of a cubist Picasso picture [photo at right], “La Coiffeuse,” [1911], from a storeroom in the Centre Pompidou in Paris that was reported in 2001. It was found in February in Newark, N.J. in a package sent from Belgium marked “Art Craft Toy,” with a value of $37. According to her, “It isn’t clear how customs officials at Newark, among the busier ports in the U.S., unearthed a stolen artwork the size of a place mat. A spokesman for U.S. Immigration and Customs Enforcement’s Homeland Security Investigations declined to comment, citing a continuing investigation.”

Smith observed that in general law enforcement—police, FBI and Interpol–doesn’t work alone. Agencies collaborate with insurance companies and a few businesses such as Art Loss Register and Art Recovery Group [both in London]. The former lists stolen antiques as well as art in its database and is adding reports of forged/fake items to its service. The company boasted that last year it had 400,000 paid searches and found some 150 pieces.

Thomas Crown AffairIt doesn’t help the cause in this country that there is no central reference list for the law-enforcement agencies to track art crimes even though they represent a chunk of change. Smith wrote that the FBI can no longer verify a previous estimate of $billions lost from art and cultural crimes. She didn’t explain why but my guess would be that prices are so crazy these days that nobody can keep track or count that high.

What inspires people to pay the prices they do for high profile art when they are simply making targets of themselves? If it can’t be sold, what’s the point of stealing art? Why do you think there isn’t a single registry here for all legitimate interested parties to access?

To Catch a Thief

Service of Penalties For Doing Nothing Wrong

Thursday, March 26th, 2015

pillory

I knew of a fellow whose car insurance company considered him accident prone for which he was penalized. It had nothing to do with his driving record. He’d park his car in town and on three occasions over a few years another vehicle ran into it. His mistake was to report each incident. The first insurance company dropped him and the next Parked Car hit insurer charged him more.

I wonder if a similar thing will happen to my credit rating. I understand that one of the ways to decrease your credit rating is by ordering too many cards. A few months ago I got a new credit card because Home Depot was hacked. It happened to thousands if not millions of others. We had no choice: A new card arrived in the mailbox. [A friend told me that now this store asks to see your driver’s licensee if you buy goods worth more than $50. Good.]

Credit ratingThis week, someone tried to buy food from a ShopRite supermarket in New Jersey using my credit card number. The card’s security office called to confirm that the purchase was mine because, said the security man, the store had questioned and refused the charge. I assured him I was speaking with him from my desk in NYC, my card in hand, and that it wasn’t me buying groceries. I asked how the perpetrator got my credit card number and he said that there are so many ways he couldn’t tell me which it was.

I now have a second black mark to jeopardize my rating, and also the inconvenience of seven to 10 days without a card I use almost daily. I also must notify EZ Pass of the new number, and any other service that automatically charges expenses to my card. Didn’t I just do that after the Home Depot card fix? Grump.

smartphone 3This new card business is costly for banks. No wonder credit card companies want to move 100 percent of the charging process to smartphones: Someone steals the phone and replacement is the owner’s problem. Surely the swindlers are currently figuring out how to outsmart the phones. It will also be inconvenient for those without the newest phones–which in this harsh world will just be tough for them while great for phone sales.

I wonder how ShopRite staff knew that I wasn’t using my card. We swipe cards–they never go near the cashier who might feel the quality of the plastic or notice something strange about the card’s layout. In addition to examples in insurance and credit card worlds, are we potentially penalized for other things we have no control over?

Naughty Child in corner

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