Category: Health plans

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?


Don’t worry, be happy with your health plan!

published date
November 21st, 2019 by
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The Likes have it

Joe Biden said in a recent debate, “one hundred sixty million people like their private insurance.” I agree with Biden’s assessment that it’s foolish to advocate scrapping insurance companies as his rivals Elizabeth Warren and Bernie Sanders want. It’s stupid politically to take such an extreme view and it’s also worth noting that other countries with nationalized health insurance (like the UK and Germany) have private insurers, too.

Still, what does it mean to say people like their private health insurance? I suppose I would be counted in that number. And, by and large I would say I do “like” my insurance, which is with Blue Cross Blue Shield of Massachusetts. They cover the doctors and hospitals I want to use and the drugs my family takes. Their customer service is good. Their website is ok. They’re flexible in their approach to enforcing policies.

The problem is the cost, which soared to about $2800 per month for family coverage, even for a high-deductible plan. At a colleague’s suggestion, I switched to an even higher deductible plan –which is also one where you have to pay for your own prescription drugs within that deductible instead of the first-dollar coverage I had previously. So while the premium dropped by several hundred dollars a month, I ended up with a co-pay on a generic drug of over $1000 –which would have been $100 before.

And did I mention that since it’s an HMO I needed to buy separate insurance for a dependent who’s at school out of state? And that the out-of-state insurance doesn’t cover expenses arising from participation in college sports? So I had to buy a third policy.

I don’t really blame my health insurer for the high and rising premiums. The main driver is the price of healthcare procedures, which continue to go up. I’ve been healthy, but still routinely see bills for my care in the thousands of dollars that would cost hundreds at most in other places. Some of that cost is attributable to the paperwork burdens imposed by the plans.

Warren and Sanders have a point about problems with health insurers and the lack of universal coverage. But in my view, the real way to address problems in the US healthcare system is to build on Obamacare, focusing not just on coverage (which Obamacare provides, especially if Medicaid expansion is fully implemented), but also on the cost, efficiency, and appropriateness of the care provided.

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

 

 

The healthcare cost revolution will not be televised either

published date
November 6th, 2019 by
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Coming to a TV near you

The quote at the end of yesterday’s Boston Globe article (Consumers struggle to find information on health care costs, poll shows) made me laugh.

“We’re seeing more and more consumer awareness every year,” [an insurance executive] told the Globe. “It’s a revolution that’s occurring, but it occurs over time.”

When I read about this ‘revolution’ it brought to mind an expression/poem/song from long ago: The Revolution Will Not Be Televised! The timeframe for the healthcare cost ‘revolution’ is on the order of decades, and I don’t think anyone will be able to sit still for a TV show of that length!

Not surprisingly, the Pioneer Institute’s survey demonstrated that while people with commercial insurance are interested in obtaining  price information before receiving a healthcare service, they don’t often get it. Only 2 to 7 percent of people check costs on insurers’ websites, according to the Attorney General.

Although that number seems crazily low, it’s actually easy to understand once you consider the multitude of the barriers:

  1. Patients don’t know what services they’re going to need
  2. Choice of provider often trumps cost as a factor
  3. Their health plans may not reward or punish them for saving or spending more money
  4. Next year’s insurance premiums are unaffected by what they do this year
  5. Those with a high deductible plan are likely to blow through the deductible anyway if they have serious medical expenses
  6. Insurers’ cost estimators aren’t easy to use
  7. The estimates may not be accurate anyway
  8. People haven’t heard about the available tools

I’m an educated consumer with a high deductible plan but I don’t try to check the costs ahead of time.

So there’s no need to be glued to your TV (or other device) watching this ‘revolution.’


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

Blockbuster Medicare Innovations: AHIP panel recap

published date
September 27th, 2019 by

I enjoyed moderating the Blockbuster Medicare Innovations panel at the AHIP conference on Medicare, Medicaid and Dual Eligibles. In this video recap, I summarize the panelists’ key takeaways on supplemental benefits, home dialysis, and telemedicine.

Thanks to Dr. Michael Cantor of CareCentrix, Bruce Greenstein of LHC Group and Mary Hsieh PharmD MPH of Health Management Associates for doing a great job with it.


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

Harvard Pilgrim and Tufts are merging. Here’s why it doesn’t really matter

published date
August 15th, 2019 by
Hail to the Chief! Tom Croswell is slated to lead the combined Tufts/Harvard health plan

Harvard Pilgrim and Tufts –the second and third largest health plans in Massachusetts–  are merging.  It deserves the front page treatment it’s receiving today (check out the comprehensive coverage in the Boston Globe) –and will have an impact on employees and members– but I predict that the long term impact on Massachusetts healthcare overall will be modest at best.

To boil it down, despite being ranked by NCQA as the top two health plans in the whole country for many years (here’s 2014 for example), it’s been a long time since either Harvard or Tufts had a major influence in the local market. That’s harsh but I don’t think I’m overstating things.

In 2001 when I was setting up my business and looking for health insurance, I asked around about which insurer to use. My doctors said they were indifferent, but a friend at Partners Health Care told me Blue Cross was the only plan they paid attention to.

The last time Tufts tried to seriously impact the market was about 20 years ago, when Partners HealthCare manhandled them in rate negotiations.  And former Harvard Pilgrim CEO, Charlie Baker admitted publicly around the early aughts that when Harvard Pilgrim tried innovative reimbursement structures, hospitals just ignored them and converted everything into Medicare equivalents. And clearly the attempt to channel volume to community hospitals and away from Partners was a bust.

At least in Baker’s current job as Governor he has some influence.

I don’t mean to be cynical at all. I’ve followed both of these mission-driven companies for many years and would love the new combined entity to be an influential innovator –not just in holding down costs but in radically improving experience and quality as well.

But after so many years of banging their heads against the wall, will they give it another go? I kind of doubt it. As the number 2 player in an insurance market led by Blue Cross Blue Shield, and a healthcare market dominated at the Massachusetts level by Partners and BI/Lahey and overall by the federal and state governments, I see their role mainly around the margins. I’m not sure their leadership is ready to go all out to change the system either.

In the last several years, under CEO Andrew Dreyfus, Blue Cross has actually passed Harvard Pilgrim and Tufts in the NCQA ratings. It’s been more innovative as well, with the Alternative Quality Contract (AQC) in particular.

I looked back this morning at my blog coverage of these companies over the years and picked out some highlights.

I’ve interviewed the CEOs of all three:

  • Tom Croswell, who will head the combined entity and is currently CEO of Tufts (2018)
  • Eric Schultz, then CEO of Harvard Pilgrim in a four-part video series in 2011 and again in a podcast in 2013
  • Charlie Baker, when he was running for Governor in 2014. (I interviewed every candidate that year)
  • Andrew Dreyfus, CEO of Blue Cross Blue Shield in 2012

In my coverage (which is by no means comprehensive) I found a few examples of Harvard Pilgrim and Tufts trying to make waves in the market.

There’s much more to say, of course, but I do wish the new entity luck! Massachusetts can use all the help it can get.


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