Public Health Emergency (Still)

This week, U.S. Department of Health and Human Services Secretary Xavier Becerra signed a renewal of the determination that the COVID-19 public health emergency exists. This latest renewal means the public health emergency will be extended for at least 90 more days, unless other action is taken.


KHN Reports on Crazy Trauma Alert Billing

Looks like Sutter Health is getting some bad PR for wacky billing. Here’s how the story on Kaiser Health News starts:

The care was ordinary. A hospital in Modesto, California, treated a 30-year-old man for shoulder and back pain after a car accident. He went home in less than three hours.

The bill was extraordinary. Sutter Health Memorial Medical Center charged $44,914 including an $8,928 “trauma alert” fee, billed for summoning the hospital’s top surgical specialists and usually  associated with the most severely injured patients.

Read the entire story here. Guess they thought nobody would notice a nearly $9,000 add-on?! Maybe nobody usually does notice??


Survey Suggest Billing Errors a Problem

This week, AdminaHealth, an insurtech offering a premium billing SaaS platform for the healthcare, employee benefits, and insurance industries, released the findings of their 2021 Premium Billing Survey: Being Exceptional in the New Way of Work.  Responses were collected between April and May and encompassed the market segments for member employer plans from small (under 50) to enterprise (over 10,000+).  AdminaHealth says more than 300 industry executives involved in sales of employer plans, billing operations, benefits consulting, HR operations, enrollment, and benefits administration participated—representing a diverse group of agents, brokers, carriers, TPAs, captive managers, associations and technology firms. Here are a few findings you might find interesting:

  • Billing issues dominate concerns and significantly contribute to the loss of revenue for brokers, TPAs, and carriers—which can be manifest in the inability to renew plans or generate new business.
  • Over three-quarters of respondents still rely on spreadsheets and error-prone manual processes for premium billing.
  • Three of the most pervasive operational errors are associated with inaccurate and manual processing.

If you’d like to access results from the whole survey, you can do so here.


Lexis/Nexis Teams Up with Quest to Deliver Risk Data to Insurers

LexisNexis® Risk Solutions unveiled a new life insurance risk assessment product called LexisNexis® Risk Classifier with Medical Data. The company says this is the first solution to combine up to six sources of behavioral and medical data to provide life insurers with a predictive mortality model. LexisNexis Risk Classifier with Medical Data aggregates info from public records, credit attributes and driving behavior data with prescription history, medical diagnosis and clinical lab attributes. The data is made possible by a strategic relationship with ExamOne®, a Quest Diagnostics company. Of course the applicant has to authorize the data collection. The data scientists at LexisNexis say the model provides more mortality separation across risk classifications and more accurate underwriting. The aim, they say, is to help life insurers get more information upfront, which may allow them to avoid the paramedical process altogether and accelerate underwriting. From Lexis/Nexis:

As a result, consumers applying for life insurance appreciate the faster, more streamlined and less invasive life insurance underwriting process.

Okay then.


AI-Delivered PA for AscellaHealth

Banjo Health announced the signing of a multi-year partnership with AscellaHealth, a global specialty pharmacy and healthcare solutions company. Banjo will provide AscellaHealth its package of AI-powered prior authorization solutions.


Aflac Puts $ into Sustainable

Aflac Global Investments announced a $2 billion commitment to Denham Sustainable Infrastructure to launch a new debt platform that will invest primarily in the senior debt of sustainable infrastructure projects. Aflac has committed $100 million toward Denham’s second dedicated equity fund to support the acquisition, enhancement and development of sustainable infrastructure assets. Aflac Global Investments will also hold a non-controlling 24.9% minority equity interest in Denham Sustainable Infrastructure. Here’s what Aflac says:

The transaction with Denham Capital is part of Aflac’s long-term growth strategy…[t]he agreement positions Denham Sustainable Infrastructure to become a leader in bringing both debt and equity investment capital to help satisfy the global demand for assets that support economic growth while protecting the environment.


Must-do Medicare Events

In person —

  • 9th Annual Senior Summit: Chart Your Course and Navigate Into the Future, in person at Pechanga Resort & Casino in Temecula, August 31-September 2. Online registration is open through August 19. Register here. Cal Broker will be toasting its 40th anniversary here! Please join us!

Virtual —

  • California State Medicare Expo: Unmasking Medicare – August 26-27. Register here.


SIIA Announces Keynote

The Self Insurance Institute of America announced it’ll have futurist Mike Walsh speak at their next conference in October.  Walsh is a futurist focused on the questions leaders need to ask themselves as we move forward in a post-COVID world. Click here to view a video of Walsh. You can go here for more info on the conference, which will be held in Austin.


WLS Announces ‘Save the Date’

Have you heard the good news? Organizers for the CAHU Women’s Leadership Summit announced there will be a WLS 2022! Save the dates of March 14-16 for the summit at Green Valley Ranch Resort & Spa in Las Vegas! Stay tuned for more details and follow WLS on Instagram @cahuwls. If you have questions, or would like to get involved, reach out to


Preliminary Settlement in Class Action Lawsuit Against CalPERS Long Term Care Announced

A preliminary settlement agreement has been reached in a class action lawsuit against the CalPERS Long Term Care program involving 117,000 policyholders. Part of the agreement includes options that will be offered to policyholders, some of which may involve cash payments in return for giving up their policy.

“There may be multiple variations of options offered that will depend on whether a policyholder died or lapsed their policy following the premium increase that triggered the lawsuit, or made or didn’t make changes to their benefits as a result of the premium increase,” said Bonnie Burns, long-time long-term care advocate and expert with California Health Advocates. “Included in the lawsuit is a potential for the development of replacement coverage, but as of yet, there are no details about how that would work, what it would cost, or what company might be willing to offer such coverage.”

Policyholders who receive notices about their options can contact their local Health Insurance and Counseling Program (HICAP) or call (800) 434-0222. HICAP is a state and federally funded program that is free to older Californians and is available in each county. It has trained volunteer counselors to help policyholders and their families.


  • LIMRA, LOMA and the Society of Actuaries (SOA) Supplemental Health, DI & LTC conference, virtual, Aug 4-6, info here.
  • BenefitsPro Broker Expo, in person in San Diego, August 16-18. Save 15% with promo code RIGHTPLAN. Agenda here, register here.
  • 9th Annual Senior Summit: Chart Your Course and Navigate Into the Future, in person at Pechanga Resort & Casino in Temecula, August 31-September 2. Online registration is open through August 19. Register here.
  • California State Medicare Expo: Unmasking Medicare, virtual, August 26-27. Register here.
  • American Association for Medicare Supplement Insurance, National Medicare Supplement Insurance Industry Summit, Sept 8-10, in person at Schaumburg Convention Center, Chicago area. Info here.
  • SIIA 41st Annual National Educational Conference & Expo, In-Person & Virtual, October 3 – 5, JW Marriott, Austin, TX. Info here.


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