Judge Tells Aetna to Pay for Cancer Treatment

Judge Tells Aetna to Pay for Cancer TreatmentHEALTH INSURANCE
Judge Tells Aetna to Pay for Cancer Treatment
A Texas judge granted a restraining order preventing Aetna from denying cancer treatment to a man with advanced prostate cancer. Bobby Allen Bean’s doctors recommended proton radiation therapy. His doctors said that the only other options to treat the cancer are too risky because he has insulin-dependent Type 2 diabetes.

Aetna refused to cover the treatment, calling it experimental. However, the patient’s medical facility has been using proton radiation therapy for nearly 10 years. “This is not some unknown experimental treatment. It works. And my client should be given the opportunity to have the treatment to save his life,” said his attorney, Robert Hilliard of Hilliard Munoz Gonzales LLP. For more information, visit hmglawfirm.com.

CMS Issues Hospice Payment Reform
The Centers for Medicare and Medicaid Services released the FY 2016 Hospice Wage Index Final Rule on July 31. It features payment reform, including a two-tiered routine home care rate and a service intensity add-on payment. These are the first significant changes to hospice payment since the Medicare hospice benefit went into effect in 1983.

The two-tiered payment model for routine home care will be implemented on January 1, 2016. Hospices will be paid a higher rate for the first 60 days of hospice care and a lower rate for subsequent days in hospice care.  The National Hospice and Palliative Care Organization supports the two-tiered payment model. The payment applies to any hospice patient in the last seven days of life, regardless of length of stay. “For patients with a short length of stay in hospice, the payment will help to mitigate the marginally higher costs associated with short lengths of stay,” said senior vice president of Health Policy, Jonathan Keyserling. For more information, visit MomentsofLife.org.

Amputees Face Losing Coverage for Their Prostheses
Because of a policy change proposed by The Centers for Medicare and Medicaid Services, Amputees who use prostheses face losing their Medicare, Veterans Administration, and private-insurer coverage for artificial limbs. A coalition of amputee advocacy organizations and industry groups developed SaveProsthetics.org. They are asking people to visit the site now to sign a petition protesting the changes and share their opinion about the proposed changes with CMS.

CMS recently issued a proposed Local Coverage Determination (LCD) for Lower Limb Prosthetics that would lower Medicare beneficiaries’ and eventually all amputees’ care to a level last seen in the 1970s. J. Douglas Call, CP, President and CEO of Prosthetics & Orthotics said, “While there are numerous issues with the LCD that threaten patients’ access to prostheses and medically necessary care, the most egregious issues–and the ones I find particularly offensive for patients–discriminate against specific amputees.  Amputees who don’t walk with what CMS subjectively describes as ‘a normal gait’ or those amputees who use a cane or crutches instead of putting on their prostheses when they get up in the middle of the night are defined by CMS as having a prosthesis that’s not medically necessary, and therefore the costs…aren’t covered.”

While the LCD would initially affect only amputees receiving Medicare benefits, the changes would grow to affect all amputees, he said. That’s because many of the proposed policies involve major changes to the Uniform Code Set which all insurers, including the Veterans Health Administration, use to cover and pay prosthetic limb claims. For more information, visit SaveProsthetics.org.

New Law Aims to Reduce Insurance Company Insolvencies
Governor Brown signed Assembly Bill 553 into law. It establishes new oversight tools that are designed to reduce the number of insurance company insolvencies. It aligns state law with standards developed by the National Association of Insurance Commissioners (NAIC). New disclosures and filings will help the Commissioner determine the financial and corporate capacity of companies to conduct business in California, and identify troubled companies quickly enough to avoid insolvencies. It clarifies the role of state insurance departments as group-wide supervisors over multi-national insurance groups, as part of the Insurance Holding Company System Regulator Act. The bill takes effect immediately.

State Offers Employees a Handy Benefit Calculator
The California Department of Human Resources launched a benefit calculator to help employees determine their out-of-pocket costs for their health, dental, and vision benefits. For more information, visit eservices.dpa.ca.gov/BenefitsCalculatorExternal.

Pen-Cal Joins Lion Street
Executive benefit firm, Pen-Cal, has become a Lion Street owner-firm. Based in Pleasanton, Calif., Pen-Cal serves large and mid-size employers. It is ranked among the top five U.S. executive benefit consulting firms by Plansponsor. Lion Street is a privately held financial services distribution company based in Austin, Texas.  Kirk Penland, Pen-Cal’s CEO said, “Pen-Cal has aspirations to serve more businesses and employees, and we believe Lion Street offers us outstanding leverage opportunities.” For more information, visit lionstreet.com.

Pregnant Women to Get Full Medi-Cal Coverage
The Centers for Medicare & Medicaid Services has approved California’s waiver to extend full Medi-Cal coverage to pregnant women. The amendment authorizes the state to provide full-scope Medi-Cal benefits to low-income pregnant women with incomes above 109% to 138% of the federal poverty level. The amendment also authorizes California to require pregnant women with incomes up to 138% of the federal poverty level to enroll in a Medi-Cal managed care health plan in counties in which such plans are available.

Medicare Product Comparison Database
Mark Farrah Associates is offering a database for Medicare product comparisons and competitive analysis. The goal is to make it easier for Medicare Advantage and PDP companies to compare their products’ with competitors’ products down to county market levels. For more information, visit markfarrah.com.

Marketing Agency for Baby Boomers
Influent50, a new, full-service marketing agency, is helping businesses connect to Baby Boomers. A survey by Influent50 finds that 47% of Baby Boomers say that advertisers use false stereotypes of their age group. And this group is spending, but their purchase behavior has changed. Eighty-four percent are more likely to consider quality and features, and not just price when considering a purchase. Fifty-two percent are more willing to splurge on purchases than they were when they were younger. For more information, visit influent50.com.

Longevity Annuity
The Guardian introduced its first qualifying longevity annuity contract for The Guardian SecureFuture Income Annuity.  Now individuals can designate a portion of their IRA assets for use later in retirement so that these funds will not be subject to required minimum distributions beginning at age 70½. For more information, visit guardianlife.com/my-retirement.

College Financing Guide
Prudential Financial  is offering the white paper, “Paying for College – A Practical Guide for Families.” It provides tips on how to complete the free application for federal student aid (FAFSA) and sheds light on the various factors that come into play when deciding how to pay for college. For more information, visit research.prudential.com.

IRA Assets Expected to Approach $12 Trillion by the End of the Decade
Total IRA assets are expected to reach $11.7 trillion by 2020, according to research from Cerulli Associates. Research analyst, Shaan Duggal said, “We expect IRA asset growth to remain steady through the end of the decade. Even with heightened FINRA rollover scrutiny, individuals, especially Baby Boomers, will continue to roll over their defined contribution (DC) assets.”

Cerulli examined retirement decisions by individual investors throughout their retirement planning lifecycle, with particular emphasis on 401(k) plan participants, IRAs and rollovers, and retirement income. “As the Baby Boomer generation ages, much of this rollover activity will be due to account consolidation as these individuals plan for their retirement income needs,” Duggal explains. Cerulli recommends using participants’ defined contribution data points to send targeted communications. “Creating a positive relationship early and building on it as the individual progresses towards retirement is the ideal situation for many providers.  Personalized communication during opportune life moments will help ensure customer loyalty when an individual eventually decides to roll over their account,” he said.

Life Insurance Sales Continue to Climb
U.S. applications for individually underwritten life insurance grew 4 % in July, year-over-year for all ages according to the MIB Life Index. July’s strength comes on the heels of progressive quarterly growth in 2015. The first quarter was up 1.5%, and the second quarter was up 2.6%. Year-to-date, the MIB Life Index was up 2.3%, compared to the same seven month period last year. July’s activity was off 2.6% from that of June, as we entered the summer doldrums. In July, application activity was up for the following age groups: 6.5% for birth to 44, 0.9% for 45 to 59, and 1.8% for 60 and over. For more information, visit mibgroup.com.

Wealthier Consumers Are Less Likely to Have LTC Insurance
The wealthier you are, the less likely you are to own long-term care insurance, according to a white paper from Spectrem Group.  The majority of affluent investors are not purchasing long-term care insurance at all. Thirty seven percent of consumers with a household net worth of $100,000 to $999,999 say it’s too expensive. Thirty-six percent of millionaire households and 52% of ultra-high net worth households are saving for long-term care though other vehicles. For more information, visit spectrem.com.

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