Category: Amusements

Coordination of benefits. Which plan is primary?

published date
October 15th, 2020 by
white male 1834094 1280
Get your act together!

I received a couple of ominous looking letters from Boston Children’s hospital, letting me know that my claim has “been suspended” by my insurance carrier, Blue Cross Blue Shield of Massachusetts.

Unlike a couple months ago, when Blue Cross accidentally cancelled my family’s entire policy (oops!) while trying to remove an adult dependent at my request, this time it was due to a “coordination of benefits” issue.

Here’s the situation. Another dependent of mine is a college student in a different state. Our Blue Cross HMO doesn’t work out of state, so we buy an additional insurance plan from the college. (Also one more policy for varsity athletic participation, but that’s another story!)

When this dependent had services at Boston Children’s, we listed the Massachusetts plan as primary. But at least according to the BCBS MA rep I spoke with today, the out-of-state plan should be primary because my dependent is the subscriber, unlike on our family plan where they are listed as a dependent. So even though the out-of-state plan is likely to deny the Massachusetts claim as out-of-network, we need that denial first before submitting to BCBS MA. Make sense?

Oh, and to make things a little more complex, the rep said I need to ask the other plan if they follow the “standard coordination of benefits rules.” Apparently some student plans don’t.

What fun!


By healthcare business consultant David E. Williams, president of Health Business Group

A few quick observations on recent news

published date
July 16th, 2020 by
april 4911984 1280
Not fooling anyone

I haven’t had much of a chance to write lately, but there are so many things that I want to comment on. So here are a few quick thoughts:

  1. The Peter Navarro piece in USA Today about Tony Fauci was a total joke. It reminded me of what a middle school student would have written if forced to take the Con side in a debate where Pro was obviously correct. “Dr. Anthony Fauci has a good bedside manner with the public, but he has been wrong about everything I have interacted with him on.” It’s just nut. USA Today is getting serious grief for running that, as well they should. But Navarro and Trump are the ones who should really take a beating.
  2. COVID-19 is badly increasing disparities. The stock market is rising and high end homes and cars are selling fine. Private school students are being educated and getting specially designed internships. Meanwhile, lower income jobs are getting squeezed, public schools have given up, and summer jobs for teens are hard to come by.
  3. We continue to dig a deeper hole. Massachusetts and neighboring states are doing relatively well –but the South and West are in serious trouble. Eventually they will take us down with them if the fire keeps raging out of control. We can’t even agree on the lowest common denominator –wearing a mask
  4. Speaking of which, looks like Walmart and other retailers have become our new public health department. There’s no national mask policy and some states won’t impose them. So now it’s up to the retailers to step in.
  5. Looks like private companies may have to take over data collection, too as the White House bypasses the CDC for infection reporting

Ok, that’s enough for now…


By healthcare business consultant David E. Williams, president of Health Business Group.

Let the porn industry reopen the economy

published date
April 16th, 2020 by
Anthony S. Fauci M.D. NIAID Director 26759498706
Give the people what they want!

We’ve heard it over and over again. We can’t reopen the economy until we have a robust testing process in place for #coronavirus. Employees need to be tested frequently so they can return to work and stay on the job without infecting others and causing the whole worksite to have to close down and stay shut.

Meanwhile, Donald Trump, the CDC and much of the rest of the federal government have demonstrated sustained incompetence on getting testing going. Countries like Germany and China are organizing testing programs and restarting their economies.

Obviously we aren’t Asia or Europe. We need an American solution! And we need an adult in the room.

The obvious answer is to enlist the adult film industry in returning the economy to normalcy. The industry has operated a testing system successfully for years to stave off threats of infections from HIV and other sexually transmitted diseases.

From Rewire.News

The [Free Speech Coalition] took over managing sexual health protocols for the mainstream, straight porn world in 2011. It has since developed a set of testing guidelines known as the Performer Availability Screening Services (PASS) system. The guidelines have shifted over the years, but as of today, performers in the system test every two weeks for HIV, chlamydia, gonorrhea, syphilis, Hepatitis B and C, and trichomoniasis at a handful of clinics that partner with the FSC. If performers test positive for any non-HIV infection, a central database visible to agents, studios, and other performers automatically flags them as unavailable for work until they test negative. It also flags them if they have gone more than two weeks without being tested…

Unlike old systems of bringing copies of a recent test to a set, this database system protects performers’ real identities and medical information—and prevents test doctoring to hide results, an issue that has led to outbreaks of STIs like syphilis in the past.

Here is some background from the PASS website. Forgot about the titillating nature of the work for a moment. Replace “performer” with employee and there you have it. Why wouldn’t we want the same thing for other workplaces?

Performer Availability Scheduling Services provides guidelines and services for the adult production industry designed to ensure a safe and healthy work environment of performers and adult film professionals. The program includes:

  1. A series of nationwide testing sites providing low cost, high-quality testing in a timely manner

2. Performers have electronic access to testing results directly from labs

3. Variety of medical providers for treatment of performers in need of medical follow-up

4. Consistent standards and guidelines for testing and treatment of adult performers

5. A secure database that ensures performer privacy and protects producer liability

6. Protocol for performer support in the event of a positive HIV test result, including funding for testing of 1st and 2nd generation partners

It’s time for Dr. Fauci to team up with stars of the adult film industry to replace the President’s daily briefing with a more informative, entertaining and productive replacement.

Strange times make for strange bedfellows. So be it!

How to get Noom for free

published date
March 31st, 2020 by

Noom combines an app with human coaching to help people lose weight and keep it off. The company’s typical user loses 7.5% of body weight over the course of a four month program.  Customers are joining like crazy, and revenue quadrupled last year.

After hearing about Noom on NPR late last year I signed up, paying $44.99 per month. To put it in perspective, that’s almost twice what I pay for my gym. Plus, my health insurer, Blue Cross Blue Shield of Massachusetts actually reimburses me for three months of gym membership.

And that got me thinking, if Blue Cross pays for me to stay fit at the gym, maybe they would pay for my weight loss program as well. After all, trimmer people cost insurers less money. So I called Blue Cross and they told me they actually do cover weight loss plans, the same way they cover gym memberships.

Once I found out about the benefit, it was incredibly simple to get reimbursed. I typed in some basic information online, uploaded my Noom receipt –and today I received a check for the full amount of my Noom membership. No co-pays, no deductibles, no negotiated discount!

Screenshot 2020 03 30 23.35.25
Online form

It wasn’t easy to find, though, so I’m writing this post to give others a heads up. Here’s where I had to go on the Blue Cross site to find the benefit:

  • Login> My plans> Plan Details> Plan Benefits> Benefit Details> Routine Adult Physical Exams Covered By Your Plan
Screenshot 2020 03 30 23.45.06
Where’s Weight Loss?

Buried at the bottom of a run-on paragraph with no line breaks, I found the following run-on section with weird punctuation and a typo:

Weight Loss Benefit – you and your covered family members can be reimbursed for up to 3 months of participation fees paid to a weight loss program that is hospital-based; or one that is non-hospital-based program focused on eating and physical activity habits, and behavioral/lifestyle counseling with certified health professionals (in-person, by phone, or online). You can request this reimbursement once each calendar year; requests must be submitted by March 31 of the following year.

Bingo! (Although can someone explain why on earth this would be in the physical exams benefit?)

Noom isn’t specifically mentioned, but when I called Blue Cross they assured me the company was on the list. They also told me my call was being recorded in case I was denied and wanted to complain later! That was comforting.

Anyway, the moral of this story is to check with your health plan to see if they’ll pay for Noom. You might be pleasantly surprised. And who couldn’t use a little break during these tough financial times?

Judgment day at Planet Fitness

published date
February 13th, 2020 by
No judgment

My hotel in NYC has a decent gym, but I was looking for something more. So I visited the Planet Fitness right on the same block. I’d never been to a Planet Fitness before, but right away I noticed something odd. “Judgement free zone,” is plastered all over the place. It’s on the walls and every piece of equipment –pretty much everywhere.

Back in the day (before spell checkers) I was a good speller. I did well in the spelling bee at summer camp as a kid. (I didn’t win, because I got nervous and misspelled the word “recommend,” even though I knew better.) Still, I can usually spot a typo, and I didn’t think the American version needed that extra “e.”

Sure enough, Easy Street blogged about this very topic five years ago.

Misspellings provoke judgment from readers who catch errors. However, as with most misspellers, Planet Fitness had moved on. According to a spokesperson, “Spelling judgement with an ‘e’ started out as a mistake. Back in 1998 we considered changing it to the traditional spelling, but decided to keep it because it fit with our brand personality—we are judgment free on all matters, so what better way to demonstrate this than by keeping the original incorrect spelling.”

Who really cares? No one.

But it did get me thinking about how computerized tools and artificial intelligence can rob us of certain skills and brain function, even a they relieve drudgery and improve quality and consistency. Think about the GPS. On the one hand, it guides me to the optimal route and gives me the confidence to explore unknown areas. On the other hand, I can barely read a map these days or learn new routes on my own.

The same problems apply to healthcare providers, and I first wrote about this issue nine years ago: Are decision support tools turning doctors into idiots? If every answer is a click away or embedded into automated decision support tools, it’s hard to think for oneself.

By healthcare business consultant David E. Williams, president of Health Business Group.