27 November 2013


This story first appeared in The Detroit News

All of Priority Health’s insurance plans will continue in 2014, whether or not they comply with the federal Affordable Care Act, the company announced Monday.

New customers have until Dec. 31 to sign up for a non-compliant plan, one that doesn’t include all of the 10 “essential benefits” policies required under the federal Affordable Care Act (ACA). Existing customers will be able to decide after Jan. 1 whether they want to sign up for a non-compliant plan or a policy that includes all the services required under Obamacare, such as preventive care, hospitalization, mental health and maternity care.

Grand Rapids-based Priority Health had 22,000 individual plan subscribers in 2013.

The Michigan Department of Financial and Insurance Services announced Friday it would allow insurance companies to reinstate policies that would otherwise be canceled on Jan. 1 for not meeting standards under the Affordable Care Act. President Barack Obama proposed reinstating the policies to satisfy consumers who are upset that their policies are to be canceled on Jan. 1 despite the president’s pledge that Americans could keep health plans that they like.

The state's largest insurer, Blue Cross Blue Shield of Michigan, said Friday it would not revive any of the 26 individual plans shelved for not complying with the health care law, saying they’d have to raise rates on the reinstated policies. About 140,000 Blues customers originally had plans canceled. Detroit-based Health Alliance Plan also also said they won’t bring back policies for about 1,000 customers who received cancellation notices. Both companies said members can get better plans — and federal subsidies — by purchasing policies that conform with the health care law.

Priority Health didn’t have to cancel any policies. Earlier this year, Priority sought and received approval from the Department of Financial and Insurance Services to make all of their plans renewable in 2013. Plans that are renewed on Dec. 31, 2013 remain in effect through Dec. 31, 2014, meaning even Priority’s non-ACA compliant plans could remain in effect through 2014.

Blue Cross Blue Shield of Michigan has just one non-ACA compliant plan that renews in 2013, the “Keep Fit” plan. The Blues Friday said they will move any of 140,000 members who received cancellation notices into the Keep Fit plan if they want to stay in a policy that doesn’t meet the requirement of the Affordable Care Act.

“We anticipated there would be a lot of confusion,” said Amy Miller, manager of public relations for Priority Health. “We wanted to give people more time to consider their options, so we’re giving them almost one more year to consider what will best meet their needs.”

Ann Flood, director of the Michigan Department of Insurance and Financial Services, said Michigan has about 800,000 residents with health insurance policies that have been canceled or will be soon.

Michigan is among 11 states where the insurance commissioner has agreed to allow companies to reinstate policies, while 11 other state have declined to implement Obama’s fix, according to the industry group America’s Health Insurance Plans.

08 November 2013

Pop Warner sued for 'head-first' tackling technique

Story originally appeared on USA Today.

A California youth was left paralyzed after a head-first tackle, a technique coaches taught

The family of a Pop Warner youth football player, paralyzed making a tackle during a 2011 game, filed suit in California this week alleging he was taught an unsafe "head-first" technique by his coaches and that the Pop Warner organization and others failed to ensure the coaches complied with rules banning such tackling.

Donnovan Hill was 13 at the time of his injury as a member of the Lakewood (Calif.) Black Lancers, a Pop Warner group about 20 miles south of Los Angeles.

"As Donnovan approached contact with his opponent, he dropped his head down, kept his arms at his side and initiated the tackle head-first," as stated in the lawsuit filed in Superior Court of California. "Upon contact with the opposing player, Donnovan immediately went limp and dropped to the field unmoving."

The suit says Hill sustained a "catastrophic spinal cord injury" and that he has minimal use of his arms and no movement from the chest down, because of tackling as he was taught -- head first.

"It's an unbelievable story about how not to run a football program," says Rob Carey, a Phoenix attorney representing the plaintiffs. "And the really sad part is when you look at Pop Warner, they market themselves as safety, safety, safety."

Jon Butler, executive director of Pop Warner, declined comment, which he said is the organization's stance on all litigation.

In August, Pop Warner announced it is joining the Heads Up Football program being rolled out nationally this year by USA Football, a national youth football governing body which receives NFL funding. Pop Warner said the plan is for all of its 1,300 associations to go through Heads Up certification before the start of next season.

In Heads Up, players are taught to hit with their heads to the side.

Hill was injured in a Nov. 6, 2011, game in Laguna Hills, Calif., about 45 miles southeast of Los Angeles.

"Their coach wasn't certified. He didn't follow their own procedures and get certified on safety at regular intervals," Carey said of Salvador Hernandez, head coach of Hill's team in 2011. "They (Pop Warner) didn't supervise him to make sure he is teaching proper tackling techniques. And the consequence is ... that Donnovan Hill is now quadriplegic."

The lawsuit says the 2011 Pop Warner rules prohibited "face tackling" or "spearing" techniques and that any coaches teaching such techniques should be dismissed following a hearing.

"It's not so much about not being certified," Carey said. "That can happen. ... But what should never happen is you've got an array of coaches, assistant coaches, on the sideline, multiple times, watching Donovan 'face tackle,' and no one stops it. That should never happen. ... They should ensure the rules are being followed."

The suit says game videos show Hill "consistently tackled head-first" throughout the 2011 season. It alleges the coaches observed this repeatedly in practices and games without correcting or reprimanding it. And during one drill, the suit alleges, Hill said he was concerned he might be hurt tackling head first -- and a coach "chastised" him for "whining."

Pop Warner, the Langhorne, Pa.-based group which had about 275,000 youngsters in its football program nationally last season, is a defendant, as is the Orange Empire Conference; Lakewood Pop Warner; Hernandez; four assistant coaches; Roberto Carlos Gonzales, president and athletic director of Lakewood Pop Warner in 2011, and Robert Espinosa, an assistant commissioner of the Orange Empire Conference in 2011. The suit also includes the spouses as defendants.

The suit says Hill does not have transportation to accommodate his injuries and that his life expectancy is diminished. Hill, 15, and his mother, Crystal Dixon, seek unspecified damages, including compensation to care for Hill for the rest of his life.

"I'm sure Donovan himself doesn't really relish the idea of suing his coaches," Carey said. "But it becomes an issue of insurance and compensability and making sure that Donovan is going to be taken care of."

06 November 2013


This story first appeared at CNBC.

The numbers are staggering: In the first 24 hours of open enrollment in Obamacare on HealthCare.gov, just six enrollments managed to make it through the glitch-riddled system, according to the House Oversight and Government Reform Committee. In this third installment of our first-person accounts of trying to sign up, Joan Carrico, a registered nurse and cancer patient, tells her story about scrambling to find insurance after receiving a cancellation notice. Here is her first-person account of what happened.

I'm a 60-year-old registered nurse with an individual Blue Cross Blue Shield of Michigan (BC/BS) PPO policy. I have been battling cancer for 6 years. I recently received a letter from Blue Cross Blue Shield stating that my existing policy is being canceled as of Dec. 31 because it doesn't cover certain benefits required under Obamacare. I was devastated. Next, I was bewildered as I was told repeatedly by President Obama that I COULD KEEP MY POLICY! What happened to that promise? In addition, I've been with the same plan for over 6 years. Why shouldn't I be "grandfathered?"

Next, I repeatedly tried to log on to the government web site, Healthcare.gov, and have never been able to gain access! Now I really was frightened. I tried different sites and quickly learned that I wouldn't be eligible for any subsidies due to my husband's income level. I might even be rated because of my cancer diagnosis. My agent confirmed everything and attempted to be reassuring. What?! How in the world could this be happening to me?! I was in tears and disbelief.
After a sleepless night, I learned that I could choose from a Gold, Silver, or Bronze plan (HMO or PPO) being offered by Blue Cross Blue Shield. As my doctor doesn't accept HMO plans, my best choice would probably be the Bronze or Gold PPO. However, my premiums and out-of-pocket costs are INCREASING $4,500-$6,500 per year. What happened to saving $2,500 per year as purported by the current administration? Also, these rates include a 10-percent federal tax ... so much for "no new taxes!"

My current insurance premium is not cheap ($648.42/month with a $1,500 deductible); but, I have a cap that has kept my rates steady for the last 6 years. The new plans are confusing with deductibles, co-insurances, and out-of-pocket costs ranging from $5,100 to $6,350 per year with NO premium rate caps. My annual bottom line costs will be about $12,500 to $16,500, with no caps and will probably increase the following year(s)...This is insanity!

So, what I am getting under these new policies? Nothing, as far as I'm concerned, unless you count maternity care, pediatric vision, etc. I chose my own plan, which has served me very well. My husband is a saint: He is 72 (on Medicare with a private supplemental) and working full time to make sure I receive the necessary medical care.

I was working full time as a registered nurse when I became seriously ill with cancer. To make matters worse, I'm not eligible to receive any Social Security disability as I was a few work credits short ... so much for government assistance! I keep praying that my health will improve so I can work part time as an RN or find other employment that will help pay for my increased costs.

So, where does this leave me? I'm currently receiving chemo every 3 weeks at a cost of about $27,000 per infusion. Until May 2013, I was receiving chemo about every week for almost 2 years. Needless to say, I'm happy to be alive and fortunate to have BC/BS of MI and my incredible University of Michigan doctors, who refer to me as their "miracle patient!"

What exactly does this mean for me? I probably won't receive an "acceptance letter" from Blue Cross Blue Shield. My agent has inferred that I won't know until after I get my labs, see my doctor, and get my chemo infusion (all approaching $27,000) on Jan. 1, 2014, whether or not I have insurance that will actually pay for this...YIKES! How and why is this happening to me?! I'm still devastated, confused and petrified.