What was at stake in the ruling for Washington state

Earlier this month, we put out a report detailing what was at stake for Washington state -- down to the county level -- if the Affordable Care Act was thrown out by the Supreme Court.

The upshot was that more than 800,000 Washingtonians stand to get coverage through the Medicaid expansion OR to get subsidies to help them and their families pay for private insurance.

In addition, the report details the reforms, most of them largely unnoticed by the average person, that have already taken effect. Among these: Young adults can now stay on their parents' health coverage up to age 26, kids can't be denied insurance because they're sick, small businesses get tax rebates if they provide health coverage for workers, no caps on lifetime benefits, etc.

The most significant reforms will take place in 2014, including the state's new health care exchange, an online marketplace to shop for and compare insurance -- as well as a way for lower- and middle-income families to get substantial help paying for it.

The full report is at http://www.insurance.wa.gov/legislative/reports/Whats-at-stake.pdf.

Kreidler reaction to Supreme Court upholding health care reform law

OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler expressed great relief with the U.S. Supreme Court’s decision upholding the Affordable Care Act and said Washington state is now well ahead of most states in reforming its health care system.

 

Many reforms are currently in place, but key benefits and programs take effect in 2014, including Washington’s new Health Exchange, federal subsidies to help 477,000 people afford health insurance, an expansion of Medicaid for 328,000 poor childless adults and the ban on insurance companies from denying people coverage if they’re sick.

 

“I’m very pleased the Supreme Court chose to uphold the Affordable Care Act,” said Kreidler. “We’ve been busy for two years now implementing the reforms and have made great progress, but there’s a lot left to do before 2014. With the court decision out of the way, we can continue our focus on where it should be – bringing relief to families struggling to find quality, affordable health insurance.”

 

The millions of Washington state consumers benefitting from the Affordable Care Act’s early reforms include:

 

• More than 2.4 million people who no longer face lifetime caps on their health benefits.
• More than 52,000 young adults up to age 26 who have stayed on their parents’ health plans.
• More than 1.2 million people who now have coverage for preventive care with no co-pays or deductibles.
• More than 60,000 people in Medicare who have saved hundreds on their prescription drugs.

 

Washington state also leveraged millions in federal funds available under the Affordable Care Act to create:

 

• Public access to health insurance rate requests. 
• A new marketplace in Washington state for health insurance in 2014 – called an exchange – where people can shop for health plans, compare their options and apply for subsidies.
• A temporary health insurance program (PCIP-WA) for people with pre-existing health conditions.

 

“The Affordable Care Act is not perfect, but it moves us in the right direction and is the only meaningful reform that’s passed in decades,” said Kreidler. “The debate was clearly contentious, and I’m grateful to have it behind us. But, now it’s time to focus on the work ahead – more than a million uninsured people in our state are counting on us.”

Reminder: Next Kölner R User Meeting 6 July 2012

This post is a quick reminder that the next Cologne R user group meeting is only one week away. We will meet on 6 July 2012. The meeting will kick off at 18:00 with three short talks at the Institute of Sociology and will continue, even more informal, from 20:00 in a pub (LUX) nearby.

All details are available on the KölnRUG Meetup site. Please sign up if you would like to come along. Notes from the first Cologne R user group meeting are available here.

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Cease and desist order issued against Lenovo

Insurance Commissioner Mike Kreidler has issued a cease-and-desist order against computer maker Lenovo, barring the company from continuing to sell illegal service contracts in Washington state.

From May 2008 to May 2012, Lenovo (United States) Inc. is believed to have sold $153,415 worth of service contracts in the state. The plans, which covered repair or replacement of damaged Lenovo products, can only be sold to Washington residents by a licensed insurer or a registered service contract provider. Lenovo is neither.

Kreidler also ordered the company to mail a copy of the cease-and-desist order to all its Washington customers within 10 days.

Nothing in the order prevents the company from fulfilling the terms of the service contracts or from issuing a refund, if requested.

The company’s unauthorized sale of service contracts was initially disclosed by Lenovo itself when it applied for registration as a service contract provider in April 2011. At that point, the company said, it had already sold 855 contracts for $90,630.

When Kreidler’s staff reviewing the application sought more information, the company failed to respond, and later withdrew its application (December 2011). Lenovo later said it had sold a total of 1,327 contracts worth $153,415 to Washingtonians (May 2012).

The company has a right to demand a hearing. The order takes effect immediately.

Hodgkin-Huxley model in R

One of the great research papers of the 20th century celebrates its 60th anniversary in a few weeks time: A quantitative description of membrane current and its application to conduction and excitation in nerve by Alan Hodgkin and Andrew Huxley. Only a shortly after Andrew Huxley died, 30th May 2012, aged 94.

In 1952 Hodgkin and Huxley published a series of papers, describing the basic processes underlying the nervous mechanisms of control and the communication between nerve cells, for which they received the Nobel prize in physiology and medicine, together with John Eccles in 1963.

Their research was based on electrophysiological experiments carried out in the late 1940s and early 1950 on a giant squid axon to understand how action potentials in neurons are initiated and propagated.

Read more »

And Now, A Word From Our Sponsor

My favorite, my absolute all time favorite, involved a spaceship hovering over a farm house. As a tractor beam guided bottles of Stroh’s Beer from the refrigerator to the vehicle above, the farmer deadpans, “Don’t surprise me none.”

What are some of your favorite television commercials? Do you like the new La Quinta spots that parody tired sales clichés? Are you a fan of locally produced ads? The Cleveland market has several ads of young girls asking you to love your floor or Chevy as much as they love their daddies.

Which ads are you going to miss?

It all ends today. Local commercials were already being crowded out of the market by ads for and against President Obama, for and against Governor Romney. The candidates and their super PAC’s have an almost endless supply of money to run ads in a swing state like Ohio. But the Supreme Court decision is due today, June 25, 2012. The Court’s decision on the constitutionality of the Patient Protection and Affordable Care Act (PPACA) will dominate the airwaves for the rest of this year.

The Verdict? I have no idea. You will have that answer by the time you read this. The Court’s decision is just one piece of the puzzle. It is what the President, the Congress, the individual states and the American people do over the next eight months that will give us the entire picture.

The first actions will be the most meaningless. Unless the decision is completely, totally on one extreme or the other, both sides will declare victory. Both sides will treat that part of the ruling that favors the other side as an insignificant set-back that can be easily remedied. In the unlikely event, in my opinion, that one side or the other completely wins; the losing side will vow revenge and cry politics.

In any case, the ads start tomorrow. Both the Democrats and the Republicans will use the Supreme Court’s decision as the main reason to vote for their guy and the rest of the ticket.

The first victim of the Supreme Court’s ruling won‘t be any section of the PPACA. The first casualty will be the Truth. Black will become white. Day will become night. If you become confused, so much the better. And, if you are undecided and choose to stay home on Election Day, then they will have won. The hard-core of both parties, the people who are so sure, will always turn out. It’s you, the people who are up for grabs, that can’t be trusted to vote for the right guy.

So there will be ads, non-stop, till Election Day. And you will hear claims and counterclaims. You will be bombarded with meaningless statistics and weepy old people. What you won’t get is any nuance or a whole lot of truth. What will be missing are young girls that love their daddies and wall to wall carpet.

And now, a word from our sponsor.

DAVE

http://www.bcandb.com/

Theft charges for medical worker who submitted $4 million in bogus bills, sometimes claiming to be a doc

We're going to post a news release soon about this case:


A medical worker submitted at least $4.1 million in bogus bills to insurers, sometimes while falsely claiming to be a doctor or physician’s assistant, has pleaded guilty to theft.

Kenneth R. Welling, 45, of Lake Forest Park, pleaded guilty Thursday in King County Superior Court. The charges -- all of which are felonies -- include one count of first-degree theft and six counts of second-degree theft.

“This was a pretty audacious scam,” said state Insurance Commissioner Mike Kreidler. “We were tipped off to it when a patient contacted us, saying that Welling billed her insurer $89,000 for six surgeries that never happened.”

Welling is a registered surgical technologist and sole proprietor of Shoreline, Wash.-based Alpine Surgical Services. His license allows him to perform tasks like preparing supplies and instruments, passing them to the surgeon and preparing basic sterile packs and trays. But after patients had procedures done, he would often submit large bills with codes listing himself as a doctor or physician’s assistant. He is neither.

Kreidler’s investigators also found numerous instances in which Welling billed for surgeries that never happened. Sometimes he would include post-operative reports, listing himself as the surgeon.

No evidence was found to indicate that Welling was playing an improper role in actual medical care. The fraud involved billing.

“As far as we could tell, the only time he pretended to be a doctor was when he submitted bills,” said Kreidler.

In one woman’s case, Welling billed $140,323 as assisting surgeon for nine surgeries that never took place. Over a five-year period, he billed another woman’s insurer 107 times for 51 different surgeries, listing himself as the primary doctor. Hospital records show she’d only had surgery twice.

From 2004 through 2011, according to medical records obtained by Kreidler’s Special Investigations Unit, Welling billed five insurance companies at least $4.1 million for services he did not provide. He was paid $461,000.

“Part of the reason he got away with this for so long is that he’d rarely challenge an insurer who paid little or nothing,” said Kreidler. “He’d just send them the bills and hope they’d pay.”

The investigation also showed that some patients were complaining to their insurers.

“I am angry!” one woman wrote to her insurance company in 2011. “Here is yet another fraudulent claim. Can’t you people help me to stop this? I never had surgery on Aug. 27, 2009. I never met or had anything to do with Ken Welling.”

A sentencing date is expected to be scheduled soon.

Kreidler statement on Regence's proposed 14.7 percent rate hike

Regence BlueShield, one of Washington state's largest health insurers, is proposing an average 14.7 percent hike in premiums for its customers who buy coverage on their own.

Even with that increase, the company says it would also face a loss of $4.5 million from its surplus, which currently exceeds $1 billion.

Here's state Insurance Commissioner Mike Kreidler's statement on the proposal:

“We’ve just received this request. It will undergo a rigorous review by our actuaries.

“Regence contends that even with this increase, it would lose $4.5 million from the company’s surplus. To put that in perspective, that’s less than half of 1 percent of the company’s $1 billion surplus.

“In fact, Regence could continue to lose $4.5 million annually for the next 220 years and it would still have a surplus.

“A similar request by a sister company, Regence BlueCross BlueShield of Oregon, sought a 6.4 percent increase, starting August 1, 2012. But after our review and objections, it withdrew the request today. Any future rate request will face the same thorough scrutiny.”

Dynamical systems in R with simecol

This evening I will talk about Dynamical systems in R with simecol at the LondonR meeting.

Thanks to the work by Thomas Petzoldt, Karsten Rinke, Karline Soetaert and R. Woodrow Setzer it is really straight forward to model and analyse dynamical systems in R with their deSolve and simecol packages.

I will give a brief overview of the functionality using a predator-prey model as an example.

This is of course a repeat of my presentation given at the Köln R user group meeting in March.

For a further example of a dynamical system with simecol see my post about the Hodgkin-Huxley model, which describes the action potential of a giant squid axon.

I shouldn't forget to mention the other talks tonight as well:

• Writing R for Dummies - Andrie De Vries
• News from data.table 1.6, 1.7 and 1.8 - Matthew Dowle
• Converting S Plus Applications into R - Andy Nicholls (postponed to 18 September 2012)
  

For more information about venue and timing see the LondonR web site.

Insurance tips: Credit scores and insurance scores

Many insurers use a credit-based "insurance score" as a factor -- a major factor, often -- in setting your rates. It's a quick way of quoting you a price, and insurers maintain that there's a correlation between these credit-based scores and a person's claims history.

Washington state limits how insurers can use these scores, and Commissioner Kreidler has repeatedly pushed for legislation to ban their use completely.

In Washington, insurers cannot hold the following things against you:

• The number of credit inquiries
• Collection accounts identified as medical bills
• A loan if it's the initial purchase or finance of a vehicle or home.

In Washington, insurers must also tell you if you didn't get the best rate due to your score. If this happens, you're entitled to a free copy of your credit report from the credit agency that your insurer used.

What goes into an insurance score? Here's the breakdown of a score from FICO, one of the biggest companies generating these scores for insurers:

• Payment History (40%) – How well you have made payments on your outstanding debt in the past

• Outstanding Debt (30%) – How much debt you currently have

• Credit History Length (15%) – How long you have had a line of credit

• Pursuit of New Credit (10%) – If you have applied for new lines of credit recently

• Credit Mix (5%) – The types of credit you have (credit card, mortgage, auto loans, etc.)

How can you improve your score? The same way you'd improve your credit score: make payments (bills, taxes, fines, etc.) on time. Keep credit card balances as low as possible. Think carefully before opening new lines of credit, such as a department store charge card, just to get a discount.
 
You can check your credit reports from the three nationwide consumer credit reporting companies annually at http://www.annualcreditreport.com/. If you find errors, contact the credit reporting company to have them corrected.
 

Transforming subsets of data in R with by, ddply and data.table

Transforming data sets with R is usually the starting point of my data analysis work. Here is a scenario which comes up from time to time: transform subsets of a data frame, based on context given in one or a combination of columns.

As an example I use a data set which shows sales figures by product for a number of years:

df <- data.frame(Product=gl(3,10,labels=c("A","B", "C")), 
                 Year=factor(rep(2002:2011,3)), 
                 Sales=1:30)
head(df)
##   Product Year Sales
## 1       A 2002     1
## 2       A 2003     2
## 3       A 2004     3
## 4       A 2005     4
## 5       A 2006     5
## 6       A 2007     6

I am interested in absolute and relative sales developments by product over time. Hence, I would like to add a column to my data frame that shows the sales figures divided by the total sum of sales in each year, so I can create a chart which looks like this:

There are lots of ways of doing this transformation in R. Here are three approaches using: Read more »

Insurance and vintage or antique cars

Q: I'm rebuilding my antique car and my grandfather's one-seater vintage biplane in my garage. Will my homeowners policy cover all the parts if they are stolen?

A: Probably not. Most homeowners policies exclude autos, aircraft, other motorized vehicles and their parts. You might have coverage for, say, a riding lawn mower or golf cart, but you'd be wise to talk to your agent and insurer about separate coverage that may be available for the parts during the rebuild process and after completion. Most antique cars and planes can be covered on specialized policies designed for their generally limited and unique use.



Note: This is one of a series of common -- or in some cases, particularly unusual -- questions received by our consumer advocacy staff, who answer questions from consumers.
Got a question or insurance problem of your own? If you live in Washington, feel free to give us a call, toll-free at 1-800-562-6900. We'll do our best to help. (And if you live in another state or territory, here's a handy map that lists the contact info for your local insurance regulatory office.)

Coming this fall: Agents and brokers in WA can submit fingerprints electronically

In Washington, as in most states, we require insurance agents and brokers to submit their fingerprints for the required background check.

For years, this has been done on paper cards, on which a worker rolls the applicant's inked fingers. It's messy, but more importantly, it's difficult to get good, usable prints. In fact, there's a 30 percent rejection rate by the State Patrol, meaning that the applicant has to go through the whole process again. We know it can be a pain, but we haven't had a good alternative.

So, good news: Starting late this summer or early fall, we will begin accepting electronically submitted fingerprints. We strongly encourage our resident applicants to use the service.

Why?

For one thing, the rejection rate is much lower. Instead of 30 percent, it's less than 3 percent.

It will also cost less. It now costs $42.50 to submit a paper fingerprint card. It will cost $32.50 to do it electronically.

It takes less time. In fact, in some cases, it could mean getting your license issued weeks earlier than with a paper card.

And there's probably a location close to you. More than 30 locations in Washington state can provide the fingerprinting service. Pearson Vue exam centers offer the service when applicants take the insurance exam, and the company also has a third-party vendor, Morpho Trust, that offers fingerprinting at several additional locations. You can find links to both on our new web page about electronic fingerprinting for insurance licensees.

Lastly, a question I know we'll get: Are electronic fingerprints required? No, not at this point. But we intend to require them starting during the first half of 2013.

Open letter from Commissioner Kreidler to Premera and LifeWise policyholders

Our office has denied requests from Premera Blue Cross to strip some of the company's health plans of vital prescription drug coverage.

Premera filed a request with our office in late April, seeking approval to remove all prescription drug coverage from its small employer plans. These are plans sold to employers with 1-50 employees. Premera subsidiary Lifewise filed a request to remove drugs from all of its catastrophic (meaning high-deductible) plans.

Commissioner Kreidler disapproved those requests. Here's an open letter from the commissioner to Premera and Lifewise policyholders. From the letter:

Let me be clear: Contrary to what Premera has implied, your health plan can keep generic drug coverage and even require you to use a generic drug first. Nothing in my recent decision restricts your health plan from covering generic drugs.But if you get sick and a generic drug doesn’t exist for your condition or doesn’t work for you, your health insurer must let you try a brand-name drug that could work.


I understand that generic drugs may work for many people most of the time, but it’s my job to protect all insurance consumers. There are some diseases for which generic drugs may not work, such as certain cancers and mental illnesses, diabetes, MS, certain types of arthritis, and AIDS.

Legally, if a plan has prescription drug coverage it cannot restrict someone’s access to a prescription drug that could be vital to a medical condition that’s otherwise covered by the plan and for which they’ve paid a premium.

New insurance bills take effect tomorrow

Four new insurance-related bills take effect tomorrow. None were insurance commissioner request legislation, but they will impact consumers starting June 7.

Whether you'd like to share your car or get evacuated home from a trip, there's something for everyone. Want to know more? Here's the complete list:

Usage-based insurance

Car sharing

Air rescue

PEBB ombudsman for retired state employees

A Pack Of Wild Dogs

Your ten year old comes crashing through the door with a story of being chased home from school by a pack of wild dogs. Do you

1. Grab a shot gun and your copy of Old Yeller
2. Call 911
3. Pour a glass of milk, hand him a cookie, and return to whatever you were doing.

All of the parents out there smiled and chose option #3.

However, if you child would have burst through the door and said that a dog had chased him home, you would have gone to the door fully expecting to see a neighbor’s German shepherd, collie, or great Dane.

My favorite ten year olds are Doctors Arthur Lavin and Michael Devereaux the co-chairmen of a local lobbying group, Doctors for Health Care Solutions. Longtime readers of this blog remember this group as the stage props who show up with their white lab coats whenever a politician endorses the President’s health care plan.

Doctors Lavin and Devereaux, along with their own pack of wild dogs, surfaced again in last Sunday’s Plain Dealer. Appearing, fittingly, on Page 3 of the Forum (opinion) Section, they weaved a fact-less tale of illness, greed and desperation.

It is tempting to disassemble their article one line at a time. Several clients, one a young woman with a serious insurance issue and a far more serious health problem, have already participated in this exercise. I will try to keep this down to only a few of the obvious flaws.

The plot: A forty-five year old healthy female, a middle class Greater Clevelander with a good job and “excellent health insurance”, suddenly comes down with multiple sclerosis. Her insurance company drops her. Without insurance, her doctor the alleged hero of this story, drops her. Bills pile up. Treatments fail to keep her healthy enough to work. She loses her job and ends up on Medicaid. Now the government spends $40,000 a year for the doctors to treat her.

WOW! It is too gruesome to imagine. It’s like a pack of wild dogs chasing a ten year old home from school.

She lost her insurance? How? You can not be cancelled by your insurance company due to a health condition. Was this “excellent health insurance” from her employer? How did she lose the coverage BEFORE she lost her job?

The article is filled with random falsehoods and exaggerations. At one point our creative doctors claim that women pay roughly double the price of men. The key is the word roughly as in at 6’3” I am roughly 10 feet tall. I will be happy to bore you with the specific rates of where women are more expensive than men and where men are more expensive than women upon request.

The truth is stretched beyond recognition when the doctors deal with the number of uninsureds, the difficulty in acquiring insurance, and the benefits of the Patient Protection and Affordable Care Act.

Why does this matter? Even the most casual, neutral observer will see this for what it is, propaganda. And that is the problem. Most of what we are seeing is either hysteria from the left, like this, or hysteria from the right that would lead you to believe that the sick are dying on the streets in Canada. It is all so extreme and so unlikely that we start to ignore everything. It is understandable to scream “A plague upon both houses”, but the health care system affects all of us. We ignore this mess at our own peril.

There are real problems with the status quo. There are people falling through the cracks. Doing nothing solves nothing. Unfortunately, the PPACA does not adequately address many of these issues. But we will never get anything done if we are spending all of time fleeing from packs of wild dogs.

DAVE

www.bcandb.com

UK house prices visualised with googleVis-0.2.16

A new version of googleVis has been released on CRAN and the project site. Version 0.2.16 adds the functionality to plot quarterly and monthly data as a motion chart.

To illustrate the new feature I looked for a quarterly data set and stumbled across the quarterly UK house price data published by Nationwide, a building society. The data is available in a spread sheet format and presents the average house prices and indexed to 100 in Q1 1993 by region in the UK from Q4 1973 to Q1 2012. Unfortunately the data is formated for human eyes rather than for computers, see the screen shot below.

Screen shot of Nationwide's UK house price data in Excel

Never-mind, the XLConnect package by Mirai Solutions does a fabulous job in reading Excel files into R. An advantage of XLConnect, compared to other packages, is that it also works on a Mac, although I had to install the package from source (install.packages("XLConnect", type="source")).

Read more »

Insurance and sleepovers

Q: My daughter's having a friend over for a sleepover. If the friend trips and falls or something, would my homeowners policy cover her medical bills?

A: Generally yes, since most modern homeowners policies have what's known as "guest medical" coverage. This is designed to pay the medical bills -- up to a specified dollar limit per accident -- for accidental injury to guests. But it doesn't cover you or other resident family members.

The coverage is a no-fault type of coverage that is designed to apply to accidents with no determination of fault or negligence on your part. Your insurer will still do an investigation to gather the facts of the accident.

Note: This is one of a series of common -- or in some cases, particularly unusual -- questions received by our consumer advocacy staff, who answer questions from consumers.
Got a question or insurance problem of your own? If you live in Washington, feel free to give us a call, toll-free at 1-800-562-6900. We'll do our best to help. (And if you live in another state or territory, here's a handy map that lists the contact info for your local insurance regulatory office.)

Washington state insurance markets: Our annual report

Each year, we issue an annual report summarizing the insurance markets in Washington state, selected financial statement data, authorized insurers by line of business, top companies, top groups, company changes, etc.

Get 'em before they're sold out. (That's a joke. They're online only, and we have no shortage of pixels.)