And another one bites the dust

Well that didn't take long. Monday it was movie ticket-takers, today it's pulse takers:

"The parent company of Reading Hospital, Reading Health System, laid off 210 employees today as part of a cost-cutting plan that also will eliminate an additional 181 jobs ... Hospital officials said the cuts are in response to changes in the national health care system, including cuts in Medicare and Medicaid reimbursements to hospitals."

The ObamaTax: the gift that keeps on giving taking.

Cavalcade of Risk #181: "What if" edition on-line

Jason Shafrin hosts this week's very timely Cavalcade of Risk. Timely? Yup: Jason deftly weaves this week's Cav around the horrible tragedy in Boston, presenting each post under the rubric of "What if?"

Well done, and quite thought-provoking.

Movie Time

2014 is in countdown mode and Obamacare claims another victim. Regal Entertainment Group (movie theater's) issued this terse but to the point memo to their employees.

“To comply with the Affordable Care Act, Regal had to increase our health care budget to cover those newly deemed eligible based on the law's definition of a full-time employee.”

Breitbart

In case you were wondering how this news was received.

as a result of cutting employees' work hours (which is, of course, the same as a pay cut), full-time Regal managers have resigned in "a wave" after their hours and pay checks were slashed by as much as twenty-five percent.  

DC isn't the only place with sequester's.

“Mandating businesses to offer health care under threat of debilitating fines does not fix a problem, it creates one," he said. "It fosters a new business culture where 30 hours is now considered the maximum in order to avoid paying the high costs associated with this law.

“In a time where 40 hours is just getting us by, putting these kind of financial pressures on employers is a big step in a direction far beyond the reach of feasibility for not only the businesses, but for the employees who rely on their success," he said.

This Obamacare job cut nonsense is playing out like a Saturday movie serial.

Cold Shoulder

According to the NYT,  Obama issued a decree for a command performance in DC to discuss the Obamacare roll out.

Problem is, it was sparsely attended.

Among attendees from the industry, which stands to get millions more customers, were Karen M. Ignagni, the head of a trade association for the insurance industry; Chet Burrell of CareFirst BlueCross BlueShield; David M. Cordani of the Cigna Corporation; Scott P. Serota of the BlueCross BlueShield Association, a federation of local Blue Cross and Blue Shield companies; and Joseph R. Swedish of WellPoint.

New York Times

Notably absent (or at least failed to make honorable mention) were Aetna, Assurant, Humana, United Healthcare, Kaiser and a few others.

Did they send regrets or snub PresBO?

Is there a message here?

The purpose of the meeting seemed to be to remind everyone we hang together or we shall hang separately.

“We’re all in this together,” Mr. Obama told the executives, 

Government and industry, which battled while forging the law, are now “joined at the hip,” the president said at one point. “We’re going to make it work.”

Wasn't this health care reform all HIS idea? But now we are in this together?

For weeks, news reports have conveyed industry warnings that the new law could lead to higher premiums for many people, because the policies to be sold under the law’s requirements will be more comprehensive than those many Americans have now. Republicans in Congress, who remain united in opposition three years after the law’s enactment, have held hearings to underscore such warnings.

But the administration says such talk is overblown. 

As Jack Nicholson said, "You can't handle the truth!"

And now we (they) are calling the exchanges . . . "marketplaces". 

The marketplaces would intensify competition, she said, adding, “When plans have to compete side by side and it’s very transparent, that in and of itself drives prices down.”

Marketplace has such a pleasant ring to it vs. exchange.

Makes it sound like walking through an open air fruit and vegetable market where you can pick the best produce at a price you are willing to pay.

Yeah, this is going to be fun to watch.

Limitations

This seems to be a very strange case:

"Julie Heimeshoff ... worked in public relations at Wal-Mart. In August 2005, she filed a group long-term disability (LTD) insurance claim, saying that she was unable to work due to lupus and due to pain from fibromyalgia."

Now, fibromyalgia is not to be taken lightly: it's "a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues."

The challenge is that, unlike (say) a broken leg, there may be no obvious cause or way to verify the extent of a person's condition. So these can be tricky claims to adjudicate. In this case, Hartford Life (the LTD carrier) seems to have taken over a year to deny the claim. One presumes that there was a flurry of medical records flying back and forth between Hartford and Ms Heimeshoff's health care provider(s).

About a year after the initial denial, Ms H appealed the denial; Hartford re-confirmed it a few months later.

Fast forward to 2010 (remember, the claim was initially filed in 2005 and denied in 2006) and she sues Walmart and Hartford. Hartford argues that that she'd run out the clock because she'd failed to "[begin] any legal actions within three years after the date when she was supposed to give the company proof of her loss, rather than three after the date when the claim accrued."

That part's important, because it's where I had to call in some expert help - more on this in a moment.

In the event, Ms H countered that the statute of limitations didn't apply because they were talking about two different time periods, and Hartford's was incorrect. She lost that round in 2012 (some 7 years after the initial claim), and proceeded up the food legal chain where the 2nd U.S. Circuit Court of Appeals upheld the the lower court's decision.

But that's not the end of it: the case has been appealed to the Supreme Court, which has agreed to "take up only first question presented -- about when a statute of limitations should accrue for judicial review of an ERISA disability adverse benefit determination."

What I was having (and am still having) so much trouble with is the whole timing issue. Or, rather, issues: there's a time lapse of a year between the initial claim and the original denial, then another year before the appeal, and then three more years until she filed suit.

So I turned to a good friend who is also an experienced hand in the non-medical benefits field (and specifically, group short and long term disability cover). Over the course of several emails, he helped me come to understand the basic issue (and kudos for his patience with me!):

"Walmart has deep pockets, and as her employer prior to disability her attorney is certainly going to include them, along with the insurance company in the suit.  My guess is that they were simply hoping for some nice settlement check at that point, but alas, they'd missed the statute of limitations.   I have to feel for the lady on some level if she's hurting, but if so, why did she wait so long?

Her first filing was in 2005, so if she were ultimately going to file suit, then it would've had to be done within 3 years of when she first provided proof of loss, which would be no later than 2008"

That was the sticking point. And it helped to finally understand what SCOTUS is looking at: When does the clock actually start?

If it's the first denial (2006), then three years is up in 2009, but she waited to file her suit until 2010. That seems open-and-shut. But it's apparently not that simple (else why would they agree to take it up?). If it started with the confirmation of denial in 2007, though, she seems to have sneaked in under the wire.

I think the lesson to take from this is that if your claim is denied, and then denied again, maybe it's time to see a lawyer, and not wait until the last minute to do so.

Something new under the sun

Say what you will about the ethics of this, it's refreshing that even today folks are clever enough to come up with new insurance products:

Pirate Party launches file-sharer fine insurance"

The idea is that folks who share potentially illicit files over the internet and are caught doing so can turn to this new venture to pay any actual fines that are levied.

From what little I've been able to learn, this seems more analogous to those "sharing" plans set up by some churches:

"The plans share similarities in that the members pay monthly dues to cover some of the administrative fees associated with these plans. Above the dues comes the sharing of others burdens ... They are not insurance. This alone can create issues when the chips are down so to speak. If your claim is not paid, where do you turn?"

Aye, cap'n, thar's the rub.

Still, an innovative solution to a potentially pesky problem.

Thoughts and Prayers...

To the victims and their families in Boston.