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THCB: Comments on Mr HSA’s comments

Greetings from Europe where I’ve been engaged in the mother of all consulting projects.  Thanks to Mr JiB for keeping THCB going in my absence.  Meanwhile I’ve been having some emails complaining about Ron Grenier using the comments as advertising for his HSA business.  Do you feel Ron does that? And what do you think THCB can or should do about it?  The thread is all yours and I’d love to hear any other views about the comments (including whether anyone apart from the "regulars" ever reads them!)

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  1. His name is Eric not Greg. Secondly, don’t ever contact me for insurance because I’m probably not licensed in your state. All that will happen is I’ll spend a whole bunch of time discussing what are your best options and then tell you where to go locally.
    Lucky that nobody has ever contacted me because of this blog. But I do advertise on 50,000 Watt radio stations and get calls that I have to do exactly what I have discribed above.
    Eric took his link off of here? If he did I’m still going to listen to his interview with Greg Scanlen. I will also call the show and try and get a question to Greg. I know Greg. I have stood up in his lectures before and I’m sure he will remember me. I got him to say that HRAs are “exactly” like MSAs. He won’t make that mistake again.

  2. I think that the sum of this is that Ron keeps posting if we can persuade him to remove the personal attacks (e.g. on Greg’s capabilities as a surgeon). He’s already removed his web link, and I don’t mind him giving himself a bit of publicity. THCB readers can tell the propaganda from the intersting stuff, and if Ron thinks that appearing here so often is really going to spice up his buiness, well I’d be surprised!

  3. H.R. 1872
    1. Premium deductibility for HSA insurance for all Americans. — So HSA insurance would be the only game in town with individual health insurance.
    2. Small business tax credit. — Here we have discrimination against HSA individual health insurance. Business owners (100 employees or less) would get a tax credit up to $500 for employer HSA deposits into an employees’ family HSAs. But, employees must be on a group employee insurance plan. An employer who has employees with HSAs and individual insurance doesn’t get the tax credit with employer deposits. I have never heard President Bush ask for this HSA discrimination.
    3. Low-income tax credit for the purchase of health insurance. The credit will be refundable, advanceable, and assignable, meaning the money could go directly to the insurance company chosen by the low income insured. — More HSA discrimination. The money can only go for insurance and not the HSA as president Bush had suggested. Rep Ryan (R-WI) uses an example of a father making $25,000 a year, with a stay at home wife and 2 children. They find insurance for $3,300 a year where the parents pay $300 and the feds pay the insurer $3,000. People here know that if this couple is 30 years old, HSA premiums will cost much less than $3,300 per year in many cities in America. So now the only goal for agents is to raise the cost to $3,300 to maximise the federal funds. This can easily be done by adding “permitted insurance” as a rider to the HSA policy. President Bush never asked for this either.
    If everybody wants to call this President Bush’s agenda what can we do as mere individuals? First of all, very little can be done because the media won’t touch this legislation with a 10 foot pole. I personally would have preferred to give the tax credits to the individual and then they get the lowest cost HSA insurance and the remaining balance went into the HSA, tax free. That would have been better for the citizen and we would have no HSA discrimination.

  4. Eric, I did listen to your show with the MICA CEO today. It was a good show. Carland said they paid more in claims than collected premiums. That’s a very bad sign.
    I want to thank you for all that you are doing for HSAs. You beat the media in displaying current HSA legislation. I expect the media to censor all HSA information. The media suggests that they care about the level of uninsured Americans but when legislation is introduced in the House and the Senate to help the uninsured, they refuse to report. You on the other hand posted the Heartland Institute report on “President Bush’s” agenda.
    You have an AZ Representative that authored that legislation along with a WI Rep. I suspect that WI Rep has some of his locals that are very smart on HSAs.
    Keep up your good work and ask Greg Scanlen some real questions when you have him cornered.

  5. Generally, one only resorts to ad hominem attacks when one’s reasoned arguments are failing. Thank you for the constructive criticism about the show and keep listening!

  6. eric,
    OK, I just listened to your interview with Newt Gingrich. I took notes on every question you asked and every answer Newt gave you. Newt and Scanlen are from the same school. I’ll say it again, they combine HSAs and HRAs together and call them “Consumer Driven” health care then eliminate the HSA, because of federal regulation, and suggest everybody get an HRA. I will make this very simple for you: THEY ARE HRA SALESPEOPLE.
    Eric you asked Newt: Is health insurance from your employer better or individual insurance better? Newt answers you with: “It’s going to come from the employer. I tell every employer to get an HRA or HSA plan. HSAs are “risky” and complicated. I tell all employers to start with an HRA. blah, blah blah …then Newt continues…I just talked to 2 people with $5,000 in their HSA.”
    Sorry Eric, but that was a meaningless interview. Newt is lucky I didn’t feed you the questions. I do see that Greg Scanlen is going to be interviewed by you in a couple of weeks. I suggest that I give you some questions and we will blow Scanlen’s mind. I notice you also interview important politicians. You could start asking everybody real questions and we could listen to it over the net.
    When Greg Scanlen, you call him an HSA expert, and galen.org said that Herzlinger wrote the “Bible” on “Consumer Driven Health Care”, I knew she had to be confused. I spent some time reseaching her. Matthew Holt said it best with: “Somewhere in here there are some interesting ideas trying to get out. I just don’t think “Reggie” is going to be the one to explain them. That of course won’t stop her going on the lecture circuit and making a packet.
    My final thoughs? Well as we’re dealing with “Reggie”, true to her style they’re just random anecdotes. First, when I saw her talk in 1998 she gave her presentation, made all these bold assertions and left without taking a single question. That was symbolic to me.”
    Eric you are a doctor and I have enrolled thousands of people into HSAs. I have been enrolling MSAs and HSAs for longer than anybody else in America. I work with a team of people that our “Outline Of Coverage” use to say, “The 43 largest company in the world.” Our stats are on the Heartland Institute article, “Bush Health Care Agenda Introduced in Congress”, that you have just posted to your website. Just go to the bottom paragraph and look at the company’s name.
    I live in Tampa Bay. But I did check and see if you were on my own PPO network. A Dr. Eric N. Novack is in Glendale and in Sun City. Is this you? If it is you, you are on my PPO network. I have to tell you that if you are not any better being a surgeon than you are at explaining HSAs and asking real questions as a radio host; I know exactly who “not” to see if I do need surgery — YOU.

  7. Perhaps we are not completely understanding each other. I realize that currently HSAs are essentially always “attached” to provider networks- either “owned” or “leased”.
    The broader issue I am addressing is what consumer-driven healthcare advocates are trying to achieve– increasing patient choice/ responsibility for healthcare as a means to both improve healthcare outcomes/ overall health as well as reduce costs of the healthcare system as a whole.
    One of the problems with the healthcare system is the number of “middlemen” that come between the consumer (patient) and provider (doctor). As this number has grown (administrators, etc.), costs have increased. HSAs are a vehicle to provide consumers more control and responsibility, not the goal.
    I would refer you to Regina Herzlinger’s book (Consumer-Driven Health Care: Implications for Providers, Players, and Policy-Makers). In her concepts about consumer driven care, there are no provider networks.
    Additionally, I am certainly not “insisting” on no provider networks for HSAs. The current system is an incremental step toward a system that puts patients in greater control. Also anyone who has ever tried to read and understand an EOB would know that they do not simplify healthcare delivery or reduce overall costs to the system. Patients would benefit if they received a service and paid a bill. If a more significant injury/ illness occurs, the bill ought to be submitted to the insurer.

  8. Eric, without a PPO clients would not be assured of no balance billing like current insurance contracts provide.
    You also write: “If referral to an orthopedic surgeon is felt to be indicated by the primary care doctor, then an orthopedic surgeon from the approved list for his insurance must be chosen. When he finally arrives at the orthopedist, there is likely a copay, followed by a coinsurance bill. An inefficient system to say the least.”
    This is not HSA insurance. First, we for example, have no primary care doctors. A referral to see a specialist is not required. Second, an orthopedic surgeon from within the PPO network is not a “must”. HSA PPO clients may use the surgeon of their choice. With us there is a 20% penalty capped at $1,000 for non-PPO providers. HSA insurance would have no co-pays to see the surgeon. My clients don’t have co-insurance either. After the HSA deductible, HSA insurance pays 100% of covered charges.
    Also, HSA clients usually don’t pay at time of service. Clients wait till their Explaination Of Benefits (EOB) arrives with proper pricing from their insurance carrier. You could ask your doctor but like you say he has so many prices his staff probably would be wrong.
    Did you think all this stuff up or did you get this from someone else? I don’t know of anybody, besides you, that insists on no PPOs with HSAs. There are some little insurance companies that offer HSA Qualified insurance that have no PPOs. But of course then there are no PPO discounts before you hit the HSA deductible and clients are subject to balance billing.
    If you actually enrolled people into HSAs you wouldn’t say this stuff. Unless, you didn’t have a PPO available then you probably would. However, without informing clients of balance billing I would think you are not giving full and proper disclosure which is required if you are licensed.
    Also, charges for procedures could be listed on the internet. Granted there might be several charges listed for a service or supply, depending on which discount or PPO is available. Our HSA is exploring this very topic for our clients. It’s called “HSA Tools”. We give our HSA clients a choice of PPOs in most service areas.
    One more thing. We have non-PPO HSA plans available but the premiums will be about 20% more.

  9. “Balance billing” is the charging of the patient for the rest of the billed charges after copays, coinsurance and insurance payment. The current system is a lot like buying airine tickets, to borrow from your analogy. The person in the next room may be paying much more or much less, depending upon their insurance status and which insurance plan.
    A physician mayu have contracts with 15-20 different insurance plans. Each plan has several products (PPO, HMO, Medicare Advantage…). The “contracted rate” for the physician could be different for each of these. So to say “It would be too easy to list provider charges on the internet for procedures so consumers could become better informed” is, currently, not true.
    HSAs ought to be the first step in the “cutting out” of the middleman in health insurance. Without provider networks, when someone wants to see a physician, they can get recommendations from friends, family, family doctor or even the yellow pages. Then, they can do research on their own via the telephone, the internet, or any other means possible. One of the factors the person might use to make a decision will be the price. It perhaps ought not be the only one- accessibility, reputation, location, quality- all may play a larger or smaller role for a given person.
    Let me run through a real example. Let’s say a 40 year old man has knee pain after playing with his kids on the weekend. He continues to have some pain and swelling for 2 weeks and decides he wants to see a doctor. In the current system, he may or may not need to see his assigned family physician or internist to get permission to see a specialist. In many cases, he will have never met his primary care doctor before. If referral to an orthopedic surgeon is felt to be indicated by the primary care doctor, then an orthopedic surgeon from the approved list for his insurance must be chosen. When he finally arrives at the orthopedist, there is likely a copay, followed by a coinsurance bill. An inefficient system to say the least.
    With a HSA system without provider networks, the same patient would call the family physician or orthopedic surgeon of his choice (same as if he wanted his car fixed or air conditioning fixed), find out an estimate of cost and then make an appointment. The bill would be paid at the time of service. Done. The physician charges would be much less as there would not be on average 1 billing employee or more per doctor in the office. Decisions about MRIs or other tests would be made the same way: discuss with your doctor why it is indicated and then make an informed choice about where and whether to go ahead.

  10. Eric, you wrote: “The concept of HSAs and “consumer-driven healthcare” has, as one of its central goals, the elimination of “provider networks”. This would then allow a patient to truly demand “transparency” in pricing. You ought to be able to “shop” around for medical opinions and make your own best decision.”
    I have never heard that HSAs central goal is the elimination of “provider networks”. Provider networks provide no “balance billing” which is an important consideration for those who require medical care.
    People may choose HSA insurance with or without provider networks today and I recommend a program with a “provider network” and I can offer both.
    Your “transparency” suggestion is correct in my opinion. If people in Miami need an procedure and their Miami “provider network” charges $4,000 and the same procedure only costs $2,200 in Tampa, some might prefer to spend the day going to Tampa to save $1,800. Heck, you could fly into Tampa, stay at the Hilton and take a limo and still save over $1,000. After all, with an HSA it is your money that is being spent before you hit the HSA deductible.
    It would be too easy to list provider charges on the internet for procedures so consumers could become better informed. Of course more than just pricing should be compared by health care consumers.

  11. The concept of HSAs and “consumer-driven healthcare” has, as one of its central goals, the elimination of “provider networks”. This would then allow a patient to truly demand “transparency” in pricing. You ought to be able to “shop” around for medical opinions and make your own best decision.
    HSAs as passed in the Medicare Modernization Act are but the first step in a move toward “consumer-driven healthcare”. Beware the critics of HSAs- many are really advocates for a government controlled system and anything that moves away from that goal is inherently bad.
    The Cardinal’s quote above inherently means that physicians have fewer “rights” because they must provide care, presumably with terms dictated to them.

  12. Medical care is a human right, and the “morass we have today” is the result of this kind of uniquely American I’ve-got-mine-so-screw-you attitude. So much for the greatest nation in the world.
    To quote Cardinal Joseph Bernardin, Chicago Archiocese:
    “Health care is an essential safeguard of human life and dignity and there is an obligation for society to ensure that every person be able to realize this right.”

  13. I’m amazed at the number of people on here that unfairly criticize Ron’s posts. I find his discussions very informative and educational on HSA’s of which I’m admittedly ignorant. I also appreciate his link to his site which allowed me to read up more on HSA’s.
    I’m surprised Ron kept his restraint as long as he did after the repeated personal attacks by KPHawaii and Sue. Most on here act like health insurance coverage is a constitutional right! It isn’t. Life is not fair and it never will be. The federal government beginning in the 1930’s has taken personal responsibility out of the equation thus creating the morass we have today. What a mess.

  14. As far as Ron’s comments are concerned, I have found some of them to contain usefull information that matches my experience in dealing with COBRA and individual insurance. I have also seen some questionable comments that make me wince.
    As far as a free market in health care, I don’t think we know what a free market in health care would result in. I don’t think we currently have one. The system is rigged and the tax code provides incentives for certain activities and not others.
    I think one of the most important points that Ron has made has been the effect of COBRA. Plans without pre-existing conditions are great. But what happens if you are no longer an employee? You can try to get another job and get on another group plan. Or your group coverage will disappear. What happens if you have an in force individual policy and become diagnosed with an expensive condition? According to Ron, as long as you pay the premium and the deductible, the insurance will pay the rest. I don’t have any experience with this, but if it is true, people win with the HSA. Why? Because the premium and deductible of an HSA is less in total than just the premiums of a group plan.
    I think taking some real world examples is helpfull. I don’t mind Ron quoting numbers from his company. I use it as a source of comparison. Its like getting a rate quote without having to call the insurance company. I have recently called several insurers to get a rate quote. When trying to shop around for insurance, this is time consuming.

  15. Dear Abby,
    //let’s say you open HSA insurance for your kid at birth. Can he take over the HSA and the policy when he is 18, 21 or 24?//
    Children as Primary Insureds.
    Insurance purchased on a “child only” almost has to be individual insurance today. As long as the parent or guardian purchases “Individual Medical” (IM) (their only choice) the child won’t lose the insurance because of reaching a majority age, with any company. The big exception is that millions of poor children are on the State’s Children Health Insurance Program or S-CHIP. “Parents pay” (usually about $20 a month) for this government insurance along with the tax payer (well over 3 digits per month). S-CHIP is over-priced and only a few “special insurance companies” get all the money. S-CHIP can be terminated for a bunch of reasons. S-CHIP will be terminated on the 19th birthday no matter what the child as been diagnosed with. In my opinion the government’s S-CHIP is very dangerous if your child becomes sick or hurt. It is politically incorrect to even suggest of better ways than S-CHIP and subjecting America’s children to such danger. So I’m the only one I know that feels this way. Senator John Kerry (D-MA) ran for President wanting to put millions of additional children on dangerous over-priced S-CHIP and no one even dicussed if that was an “improper risk assessment”.
    President Bush suggests to give government funds directly to the poor parents and let them purchase insurance on the child so the child will be safe.
    With that said, a minor who is claimed as a dependent by another person is not eligible to establish an HSA – with us. The child may have HSA insurance but can not establish an HSA. My son was diagnosed with Crohn’s Disease as a minor so thank goodness he was not on S-CHIP because he is uninsurable and those government people would have terminated his insurance. He has HSA insurance that I pay for because I don’t trust him making the payments. He is employed now but he has not established his HSA yet. Anytime he wants to open an HSA he could and we probably will do so by 4/15/06. He could of made a small prorated deposit for last year but we didn’t. In the future when employers make HSA deposits he is prepared with qualifying coverage. I would tell you how inexpensive HSA qualifying insurance is on a child but some say that is improper for me to discuss the cost.
    Iowa just passed HSAs in Medicaid as a new choice for citizens. Iowa is the first state to do so. So things will have to change on HSAs so minors will be able to accept HSA funds from the state, tax free. The maximum the state may give the child is $2,600 a year in their HSA, only if the child has a $2,600 HSA deductible. Poor children who are not sick, like most children, could reach their 19th birthday with a large financial estate dedicated to future medical, vision and dental expenses. I submit that’s a good thing for poor children. I suspect however that the program will be the very same “special insurance companies” getting most of the money instead of the poor children because these companies have lobbists up the wazoo at your state’s capitol. No one (politicians) really cares about the poor children and what would be best for them. The most important thing, they think, is to funnel untold billions of dollars into these “special insurance companies” in the name of poor children.
    So parents can’t purchase Individual Medical on a child, as a primary insured, that will be terminated at a majority age unless they get it from the government.
    Good questions Abby. I’ll get back to you on the rest of your questions.

  16. Oh I never got to ask Ron my question. I guess it got deleted. Let’s say you open HSA insurance for your kid at brith. Can he take over the HSA and the policy when he is 18, 21 or 24?
    What happens if he gets schizophrenia and they want to hospitalize him. Will your insurance cover him at 100% after the deductible is met? What happens if he needs to stay longer than 30 days?

  17. Bill,
    //The law is quite explicit in saying that an employee working in a company that uses a separate pharmacy benefits manager (PBM) like Medco or Caremark is not eligible to open an HSA. This takes effect on 1/1/06. Can anyone tell me what may be the effect of this? Will employers dump their PBMs and revert to providing pharmacy benefits through their health plans? Will employers value more highly the savings associated with a PBM and offer HRAs which are not inconsistent with the use of a PBM? Or stay with their PBM and offer neither an HSA nor HRA?//
    No one has a crystal ball but here is my opinion. HRAs will see a great rise in participation and then turn right around and deminish. Employers would prefer not to pay 100% after a maximum out-of-pocket (OOP), chosen by the insured, which is required with HSA qualifying insurance. Today, its bait and switch. Lump HSAs and HRAs together as “consumer driven” health care. Then HRA “salespeople” eliminate the HSA, because of all the federal requirements, and employees end up with an HRA with cheap inferior coverage. Over time the public will discover that HSAs and HRAs are very different. If you have a $100,000 HSA balance at 65 years of age and then retire, you keep the HSA funds for retirement health care expenses. HRAs are different than HSAs. So, would you prefer to keep your $100,000 balance when you retire with an HSA or give it back to your employer with an HRA? Of course employers would prefer the latter, hence the great rise of HRAs.
    HRAs could never be considered part of President Bush’s Ownership Society. Whereas the HSA is a cornerstone.
    Of the first 1 million HSAs over 50% are paired with individual insurance. Group health plans are not on the HSA bandwagon yet. Americans will focus on retirement security in the future and then HSAs will dominate.
    We use Medco Health for Rx administration on our HSA plans so obviously it’s already done.
    Note: For best advise on HRA bait and switch and so-called “Consumer Driven” healthcare visit galen.org

  18. matt
    //If I knew that his only souce of income was a certain kind of surgery… and that’s what he seemed to be advocating for every person, then absolutely yes I would question his credibility.//
    I have a very good friend, who is a 50 year old doctor, who was diagnosed with bone cancer a couple of months ago. He is praying that his doctors are wrong. I’m told he will be in a bubble for 6 weeks, twice.
    It would be great if we could trust our doctors, newspapers, politicians and consultants. I was talking with a consultant who is helping a large financial institution start their HSA program. I think his client is a bank. I could tell he didn’t have much of a clue. I would suggest that bank question his credibility. It’s like the blind leading the blind. His name is David and he is from Manhatten. I told him to come to this blog so he is probably going to see this post. Remembwer David to say, “The HSA is the doorway to the 21st Century financial service sector.” He can trust me because he isn’t paying me a dime.

  19. The law is quite explicit in saying that an employee working in a company that uses a separate pharmacy benefits manager (PBM) like Medco or Caremark is not eligible to open an HSA. This takes effect on 1/1/06. Can anyone tell me what may be the effect of this? Will employers dump their PBMs and revert to providing pharmacy benefits through their health plans? Will employers value more highly the savings associated with a PBM and offer HRAs which are not inconsistent with the use of a PBM? Or stay with their PBM and offer neither an HSA nor HRA? Will PBMs figure out a way to add a deductible to PBM coverage (the lack of which appears to be the legal stumbling block)? Am I missing something? Opinions would be welcomed. Thanks!

  20. The law is quite explicit in saying that an employee working in a company that uses a separate pharmacy benefits manager (PBM) like Medco or Caremark is not eligible to open an HSA. This takes effect on 1/1/06. Can anyone tell me what may be the effect of this? Will employers dump their PBMs and revert to providing pharmacy benefits through their health plans? Will employers value more highly the savings associated with a PBM and offer HRAs which are not inconsistent with the use of a PBM? Or stay with their PBM and offer neither an HSA nor HRA? Will PBMs figure out a way to add a deductible to PBM coverage (the lack of which appears to be the legal stumbling block)? Am I missing something? Opinions would be welcomed. Thanks!

  21. lin,
    //Please make it clear that HSAs of course have in network and out-of-network providers//
    Yes most HSAs are PPOs. When clients go out of network on a PPO there is always a penalty. Usually its a 20% penalty. But I have seen a lot of higher penalties. And you are correct that 40% of a $400,000 bill is a lot. Many plans cap the penalty today at say, $10,000. My software will pull up a variety of PPOs in each zip code. Many times we choose the network that they are currently on because all their doctors are on that network. No matter which network they choose the penalty on our HSA plan is a 20% penalty capped at $1,000. I have never seen a smaller penalty for going out of network.
    //You make it sound so simple – it is not// We have a special feature on our HSA where the claims department forwards the claim to the HSA department and the bill is paid. Totally paperless except the EOB is generated and sent to the client on every charge so the can keep track if they want to. A lot of people just keep our HSA because it is free, there are no fees.
    //The CDHP only pays 100% for in-network providers, and up to the covered maximum//This is true of course. Usually our clients have $8 million lifetime max per person. I tell them that all people with children should get the $8 million max because how much will it cost to treat cancer in 30 years when your 16 year old is 46 years old? Our VP is quoted all over the place saying to look at the lifetime max. However, a young family can save about $10 a month with only a $3 million max per person which is probably higher than what they have now. We keep adding on more options all the time. Maybe in the future clients can choose an out of network penalty of $5,000, $10,000 or $20,000 instead of just the $1,000 penalty we have now. Of course the amount of the penalty will alter the premium. That way if one of our agents is competing with another product with a $20,000 penalty we can match that penalty and drop the premium and then we could be more competitive.
    //I’ve got a plan in front of me with a $10,000 OOP max//Of course you do. All plans should have the $10,000 max for families. For singles the max is $5,000. Of course Newt Gingrich’s website says the maximums are about half that. They call the HSA the “information rich HSA”. I have called them and emailed them to correct this but they haven’t the last time I looked. Most of our clients get the $5,200 deductible for families and $2,600 for singles. Then the HSA plan pays 100% of covered expenses. If they go with a lower deductible that restricts the amount that may be placed in the HSA and also produces a higher premium. No one pays extra just to limit the size of their HSA balance. With the $10,000 HSA deductible the maximum HSA deposit is still only $5,200 but that would make the premium smaller. One consideration on the deductible for someone getting HSA insurance in June. The $5,200 family deductible would produce a prorated amount that may be placed into the HSA this year. The maximum HSA deposit for 2005 would be $3,000. But with the $10,000 family deductible started in June would still be able to put the maximum into their HSA of $5,200. When couples turn 55 years of age they may place an additional $2,000 annually into their HSA for larger balances at 65 years of age. So then for the last years a couple can place $7,200 a year in their HSA. That’s a catch up clause. These deductibles can go up through time but no faster than the Consumer Price Index (CPI). In 1997 the family maximum was $4,500 a year and today it’s $5,200 a year (of course when the MSA was renamed the highest deductible was increased to $10,000). The clients enrolled in 1997 are still on the $4,500 deductible unless they raised it so they can make larger HSA deposits. Some companies just automatically raise their clients deductibles each year, we don’t.
    With the MSA maximum deposits were 75% of the family deductible. When the MSA became the HSA it was enhanced and now 100% of the deductible may go into the HSA each year.

  22. “I could say the credibility of your doctor’s comments need to be taken in the context of his direct financial connection to your open heart surgery.”
    If I knew that his only source of income was a certain kind of surgery… and that’s what he seemed to be advocating for every person, then absolutely yes I would question his credibility.
    As another example, I have long been an advocate of removing the profit motive that oncologists have for infusion chemo (which is part of the MMA) and using some (more profitable) drugs instead of others.

  23. Please – Make it clear that HSAs of course have in network and out-of-network provider panels, and all sorts of managed care internal financial “incentives” (ie controls) the patient never knows about. You make it sound so simple – it is not. And the paperwork is worse that M/C, or any supplimental plan I’ve worked with. The “customer representatives” complain about the inadequacy of the software used for claim processing.
    The CDHP only pays 100% for in-network providers, and only up to the covered maximum if you are in-network, have reached your deductible AND your out-of-pocket maximums(OOP). I’ve got a plan sitting in front of me with a family $10,000 OOP max, which would not be enought to cover a short hospitalization at UCR rates even in my high priced city.
    Don’t forget to tell your clients that if they go out of network, which the PPO structure positively encourages, they can be balanced billed for whatever the provider wants, and those extra charges don’t count towards the OOP or the deductible.
    Lots of surgeries and other proceedures are done at hospitals but on an OP(out patient) basis, opening them up to the 90% error rate. The 46% error rate on a $200,000 bill OON (out of netwoork)(actual client)makes it pretty clear that if you are paying any percentage of the total charge, you best be a half-way decent medical coder with a lot of time on your hands.

  24. KP,
    You should train our claims department. We are in 43 states and if you can get huge discounts by not paying on time that might work out pretty good for us and save us few hundred million dollars or more.
    But the clients would get pretty mad at all those collection notices.

  25. lin,
    I should also point out that most of our HSA clients today have what we call “Suite Solutions” which drops the deductible to only $100 on accidents, then the insurance pays 100%. This way the HSA funds are not deminished.
    Suite Solution also pays disability benefits for accidents for up to 52 weeks. Remember this is our 9th year so we are probably a bit ahead of the competition.
    So if its a billing error on an accident the clients don’t care because the insurance company is paying everything over $100.

  26. //CMS says 90% of all hospital bills have errors, and because of the way hospital billing is organized, the error is almost always in the hospital’s favor. If you have an HSA that comes out of YOUR pocket.//
    Hi Lin,
    After all was said and done with the medical bills I discussed with you last fall, I found various errors in 100% of the bills from every doctor, lab, radiology and hospital…every facility I went to! It wasn’t impossible to have them corrected, but that is only because I knew what to look for and what I like to call my, uh, persistent nature. I had to scream like a lunatic at one hospital’s patient account monster, oops manager, and threaten to go down there and rearrange her computer for her =)
    On top of worrying about a possibly life-threatening illness I had to deal repeatedly with the functional illiterates they hire to work in these billing departments. A person facing a potentially major health problem and financial ruin doesn’t need the stress.
    The most interesting and bizarre thing I learned from my experience is *Never Pay Your Bills On Time*! I received 15-20% discounts for paying in full on the date of service, then when the incorrect bills started rolling in (they weren’t used to receiving cash payments and didn’t know what to do with them I guess) I received settlement offers (read: collection notices) for 40% off. Once they were informed I had already paid, do you think they offered me the 20-25% difference? No way. Does this make sense to anyone…pay fast, pay in full, pay more?!

  27. lin,
    //CMS says 90% of all hospital bills have errors, and because of the way hospital billing is organized, the error is almost always in the hospital’s favor. If you have an HSA that comes out of YOUR pocket. But you will never know.//
    Trust me, the insurance company is adding every charge against the deductible. They try and catch all errors because they are paying the bill for all charges above $2,600 (Single). Everything is the same regardless if its a $500 deductible plan (with 80/20 to $5,000 – total $1,500 Out-Of-Pocket) that does not qualify for an HSA or a $1,500 deductible HSA qualifying plan.
    Besides, if it’s a hospitalization the bill is going way over the deductible and the insurance company is paying 100% of all claims. The insured will have to pay the HSA deductible of the $1,500 regardless if there are billing errors. It’s the insurance company that is going to be responsible for these billing errors and not the HSA client.
    You really do have good questions.

  28. spike,
    //Ron, that was my polite way of saying you come off sounding like a huckster, haha.//
    Lets see, you are a thinker and I am a lowly salesman. It was completely obvious to me what you meant, haha.
    You can google your heart away and come up with a reasonable arguement against the HSA and post it here. I suggest Paul Krugman or John Edwards or any Democratic Congressman. Don’t use Howard Dean though or Senator Nelson (D-FL) because they are confusing the HSA with something called the HSSA which was taken out of the Medicare Rx Bill. I was surprised about Howard Dean when he was running for President not knowing what was just enacted in health care reform.
    Good luck.

  29. lin,
    //I think calling the HSA a medical IRA is pretty apt – were you offended that the CDHP wasn’t mentioned as part of the package?//
    Jan was interviewing the President on Social Security having Personal Savings Accounts (PSA) and Jan said, “How come we can’t get poor people involved in the Ownership Society by the federal government putting money in a Medical IRA. The President said (I don’t have the exact words) something like – I have proposed tax credits for the purchase of HSA insurance and to also make a deposit into a Health Savings Account (HSA).
    The President should have said in my opinion — Excellant point Jan. I have proposed refundable tax credits for the purchase of HSA insurance for the poor. Here in Des Moines a 30 year old couple and 2 children can get HSA insurance for just $150 a month and the federal government will pay 100% of the premium PLUS, the federal government will deposit $1,000 in their HSA, tax free. I’m hoping that the Des Moines Register will write about this proposal, but I’m still waiting.
    You probably already know that HSAs were just passed as a new option in Medicaid in Iowa. Iowa is the first state to do so.
    You have some more good questions lin.

  30. Spike,
    are these guys big thinkers
    You should call it socialized medicine and then convince people its a good idea. Its a rare chance to put socialism in a very positive light.
    One question, if people in Brittain and France aren’t dying from heart disease and cancer, what can kill them?
    I like the idea of less infant mortality and less heroic measures to save the very old and very sick. Since so many people seem to be terrified of death though, wouldn’t a middle-aged selfish white guy want more heroic measures and be less concerned with infant mortality? Not officially of course, just in reality. It would be nice to br able to sell single payer to middle-aged white guys. They run the world afterall.
    Posted by: Neil Paul | May 27, 2005 11:58 AM
    Over last weekend, my doctor friend and I were talking about end-of-life care, and the ridiculous amounts of money sons and daughters will throw at a hospital to “save the life” of their 80-something parent with preexisting conditions. Infection? Give them those $5,000-a-day antibiotics, STAT!
    His thought was that if you could have people look at death differently than they do now (that it can be “cured” somehow), then much of our health-care dollars can be better spent.
    Posted by: verplanck colvin | May 27, 2005 12:10 PM

  31. lin,
    //The operative phrase here is “until he learned too much.” He learned they were rotten health policy.//
    That’s not true. Representative Ganske was a MSA supporter before he wasn’t. “Doctor” Ganske wrote a brilliant piece on MSAs in Medicare way before they were enacted into law with “The Original Pilot Test”. Here is the deal, a very large insurance company in Iowa also came out with an MSA product at the very beginning of the test. It was odd though. A 25 year old couple with a $500 deductible was cheaper than the MSA $4,500 deductible. I contacted Ganske’s office and informed him that this insurer was undermining federal MSA legislation. Ganske was all over it and wrote the CEO, John, a letter and asked for an explaination. The CEO had his head actuary write a really confusing letter that Ganske asked me to decifer. It was all a bunch of goofy stuff that basically said that $500 is actually larger than $4,500. So Ganske returned my conclusion to this unnamed insurer and asked them to try again. Basically Ganske had this insurer by the short hairs. The guy I was dealing with at Ganske’s office was also named John. John faxed me the second response from this very large insurance company to me with a note that said, “The next chapter – Good Luck.” Then I found out that the staff was fired at Ganske’s office and John is gone.
    The large insurance company closed down their MSA program. They had 472 MSAs. Some Iowa farmers would pay extra to raise their deductible just to get the Tax Free MSA, funny. Ganske could really roll in some big campaign bucks after that.
    As far as all your other questions, you have some good ones, but it will have to wait a bit.

  32. I’m very new to the site so I don’t know if my opinion carries much weight, but it seems to me like most people here are policy thinkers and Ron is a salesman and most of the struggle is coming from that. It’s difficult for me to understand the perspective of a salesman, but Ron is just thinking about people who are getting ripped off by group insurance and he either can’t discuss the larger policy implications because he has a different mindset or won’t because he has different objectives. That’s the source of my frustration, anyway.

  33. gadfly,
    //You use jingles like “Bush say get an HSA.”//
    I never said that.
    I do use jingles because I write the radio spots. I don’t here though, come on.
    Example:
    Senator Salier would say, tax free MSA
    President Bush supports MSAs for all Americans
    Representative Greg Ganske doesn’t
    Iowa Republicans opposing the President is WRONG
    Representative Ganske, taxing every dollar saved for retirement is wrong
    Trickle down saved by citizens in tax free MSAs is right.
    blah blah blah (spots are 59 1/2 seconds long)
    We have used President Bush’s name in every commercial since before he was elected. The White House has never complained yet. I’m sure they probably have every one on file. I have them too.
    Grassley used a commercial kinda like the one above in his last election. The Des Moines Register went crazy an did an opinion piece on it. Talk about propaganda and just plain lies. I called the editor and told her that we have the highest population of MSAs in America right here in Des Moines. You can’t lie about the MSA to thousands of our clients and make them feel bad. The editor said, “Oh, that article is over 72 hours old so its to late to do a correction.”
    I did say here, //President Bush says, “Become empowered with a tax free HSA.”// But that’s ok isn’t it?

  34. Great start Joe! Let’s keep going: how about the problems of the HSA as national policy rather than a great plan for a working mother with two kids in Lansing Michgan?
    How about when you gat a bill for $375 for a 99253? Did you get a 99253? How do you know? (Just send it to Joe’s wife -she fixes everything!)
    CMS says 90% of all hospital bills have errors, and because of the way hospital billing is organized, the error is almost always in the hospital’s favor. If you have an HSA that comes out of YOUR pocket. But you will never know.
    How about a discussion of the HSA as a contract of adhesion?
    What happens when HSA’s have gained enough market share that insurers feel they can “adjust” the pricing, so the deductible rises?
    15% of the GDP is health care – do HSA’s do anything to reduce this? How? Or doesn’t it matter? How about their impact on GME? Or choice of residency and the subsequent fallout in lowering health outcomes? Is that even in his consciousness?
    I think calling the HSA a medical IRA is pretty apt – were you offended that the CDHP wasn’t mentioned as part of the package?
    “I used to help Ganske with the MSA back in 1997 until he learned too much and then he fired his staff and joined the opposition and authored the Ganske-Dingle Bill called the Patient Bill of Rights. That legislation would have eliminated the MSA forever.” The operative phrase here is “until he learned too much.” He learned that they were rotten health policy.
    And yeah, patient protections sure are nasty. You sure don’t want to mandate ER coverage, or hosptalizations following mastectomies or childbirth. Or screening tests; or solvency requirements. Quicker and Sicker is part of the marketing plan.
    Ron is eager to encourage the free market, since it’s been doing SUCH a great job of keeping expenditures in check and giving us fabulous health outcomes. I think our newborn mortality rate has just fallen below Bolivia’s.
    The problem with Ron is not that he is an HSA salesman, but that he thinks diatribes and commercials are part of a discussion of health policy, when he is in reality just a zealot. You cannot dialog with a zealot.

  35. //I took my website off so Sue, gadfly and KP will be happy.//
    I don’t know what you’re talking about here, Ron.
    But in regard to your posts, it’s not just the personal attacks that bother me. You use jingles like “Bush say get an HSA!” This makes it sound like you are setting yourself up as an HSA evangelist – perhaps to get gigs as a public speaker or a consultant. It seems like you are using Matt’s blog for PR, spamming blogs to get name recognition.
    I’m interested in learning about HSAs, though.

  36. matt,
    //The credibility of Ron’s comments need to be taken in the context of his direct financial connection to the success of HSAs.//
    I could say the credibility of your doctor’s comments need to be taken in the context of his direct financial connection to your open heart surgery.
    Who are you going to trust?

  37. joe,
    //What about a $50,000 annual income family of four without a major health event?//
    They don’t have to put anything in their HSA. Then they can keep their receipts on medical, vision and dental expenses throughout the year. If they have $1,000 in receipts on December 31st they can deposit $1,000 in their HSA and get their income tax reduction, then take their $1,000 right back out. Using the HSA this way lets medical, vision and dental expenses be paid with pre-taxed dollars.
    //Will doctors up their prices to attract certain customer classes?//
    Most HSA health insurance is a PPO today but it is not manditory. When you see the Doc he bills the PPO and the PPO reprices the charge to the predetermined cost and forwards that to the insurance company. The insurance company sends you an Explaination of Benefits (EOB) that tells you how much you owe. At that time you can decide to pay your bill with your HSA or from your ordinary checkbook. Of course now HSAs are being combined with debit cards. So if the Doc wants paid on the spot he will have to know what his own rates are so he can inform the client. If he charges $50 and then the EOB confirms the predetermined amount is only $48.62 then the Doc will have to give a credit to the client. I don’t think the Doctors care which checkbook they get paid from.
    //Who will be worse off?//
    Evolution can be mean and that’s a pretty big subject. I first thought of the new HSA plans coming online and some are not as good as current products. I am not going to discuss that subject because I don’t want to give anybody ideas on how to hoodwink the consumer.
    I think some major insurance companies are going to be real losers as the HSA reform takes off.

  38. Ron,
    How about talking about both the pros and the cons of HSAs instead of coming off like a commercial every time. I would think that people reading this blog see that there is no free lunch in healthcare.
    Who will be worse off? How do you deal with cherry-picking? What about a $50,000 annual income family of four without a major health event?
    How does the system shift under HSAs? Will doctors up their prices to attract certain customer classes? Is there an incentive for GPs to raise their prices b/c they know that any downstream catastrophic event will be covered.
    Or, if you want, you can continue with the absolute rightness of HSAs and sounds like a late-night TV commercial to me.

  39. //I took my website off so Sue, gadfly and KP will be happy.//
    Was this really necessary? How about “I took my web site off in order to avoid any future misunderstandings about my motives for posting”?
    You just can’t resist getting a dig in, even in a discussion about the inappropriateness of some of your comments. Try a little self control, Ron. The change’ll do you good.

  40. Jib,
    If you did have a conversation with Rush Limbaugh about HSAs I know what he would say. Something like: If you are a long time listner of this show you know I am a strong supporter of HSAs. They are like school vouchers.
    Then he would change the subject.
    In the middle of January in 2004 Rush was complaining about the Medicare Rx Bill. Rush said, “I have talked with the administration and they said, Rush, MSAs are in there. That may be so but MSAs are only a test.”
    I couldn’t believe it. HSAs had just been passed for all Americans, under the age of 65, and Rush didn’t even know. Rush says he keeps half of his brain tied behind his back just to keep things fair. I think the HSA is in the half of his brain that he can’t get too.
    When I started advertising on Hannity right before our first spot hit Hannity said, “The liberals demonize our agenda and they say MSAs kill old people.” I called my wife, my boss, and said, “Hey, I was right. Hannity just mentioned the MSA.” She said what did he say. I said, “MSAs kill old people.” she said, “Well that doesn’t sound very good.” I said, “Well it’s better than the usual nothing from Rush.” Hannity used that example forever about demonizing.
    I took my website off so Sue, gadfly and KP will be happy.

  41. Ron’s comments are well-informed, sincere, and at times, thought-provoking.
    The only problem I find with his comments is that when you start talking outside of his knowledge base, he responds with some useless personal remark. That needs to stop.
    But I still think he should continue to participate.

  42. You know Ron,
    I’m just trying to picture a conversation between Rush Limbaugh and me …
    Here’s a hint from a guy with foreign service training: you should apologize.

  43. Jib,
    You could do me a favor and call Rush Limbaugh and tell him to please discuss the centerpiece of President Bush’s health care reform, the HSA. I have been advertising the MSA and HSA since the beginning in 1997 on Rush’s show in selective markets. To this very day the people who respond to our spots don’t have a clue what the HSA is, its pathetic. If you can’t get Rush call Hannity or O’Rielly because these guys are just as bad. Jan Mickelson was interviewing the President last month on WHO Radio about Social Security and Jan did change the subject and ask an HSA question. That must of blown the President away. Of course Jan called the HSA a “medical IRA”, sick, but the President corrected Jan and said they are HSAs.
    I had a commercial that WHO jerked off the air because Representative Greg Ganske complained about me telling the truth. Ganske was running for the Senate against Harkin. In Iowa Ganske said he supported the MSA but in DC he voted against it. When Jan was interviewing Ganske Jan played my commercial and asked Ganske to respond. It sounded like Ganske was ready to start crying. Well Ganske is in the private sector now where he belongs. I used to help Ganske with the MSA back in 1997 until he learned too much and then he fired his staff and joined the opposition and authored the Ganske-Dingle Bill called the Patient Bill of Rights. That legislation would have eliminated the MSA forever. Of course it was defeated, thank goodness.
    I do think everybody here is in agreement that group health plans putting sick cancer patients to COBRA for insurance termination is disgusting. It is the ultimate catch-22. If your ovarian cancer stops you from working then you must lose your health insurance because you have to work 30 hours per week to keep your health insurance. As a nation we should protect the citizen instead of insurance companies.
    As far as advertising on this or any blog I can’t see that anytime soon. It just wouldn’t work for us because of bunch of reasons. I do believe that this blog is in a remarkable position to promote a national dialog on health care policy. Keep up your good work even if I do get kicked out of here.

  44. I have been visiting THCB regularly for almost a year. I always read the comments, but I don’t often post.
    I think general (and civil) discussion of HSAs should be encouraged. However, I do not think it is acceptable to quote rates and promote one company or plan, and Ron does include a link to his commercial web site in all of his posts. Not that a link to a for profit site in itself is necessarily wrong if it belongs to the poster, but in conjunction with Ron’s self-promotion it is little more than spam.
    As the recipient of some of Ron’s most despicable comments yesterday, even I wouldn’t go so far as to say he should be kicked off, unless it continues. Flames and ad hominem attacks detract from the quality of the discussion and shouldn’t be tolerated.

  45. The credibility of Ron’s comments need to be taken in the context of his direct financial connection to the success of HSA’s.

  46. Okay, frankly I think the answer to this is really simple. If people become nasty and abusive, they’re gone. I think that’s fair.
    Honestly Ron, I’m a little surprised that you went as far as you did in some of your comments.
    At the same, I think the running debate we’ve had here is a good thing and should be kept going. For now, I don’t think anyone should be kicked off or anything like that.
    Jib

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