Daily Insurance Report - July, 12 2023

Your summary of the Voluntary and Healthcare Industry’s most relevant and breaking news; brought to you by the Voluntary Benefits Association®

The World’s Best Life Insurance Companies 2023

By Rachel Rankin Peachman - Over the past few years, obtaining life insurance has gotten easier and faster. Many companies now offer a digital-first approach that enables consumers to get life insurance policies online and without an in-person medical exam, according to a recent report from Policygenius, an online insurance marketplace, But that doesn’t mean settling on a life insurance policy is always simple. Read Full Article…

VBA Article Summary

  1. Long-term nature of insurance: Insurance policies are designed to fulfill promises made in the future, often spanning several decades. According to Burke A. Christensen, an insurance professor, the longevity of insurance policies makes it challenging to predict future conditions accurately. Factors like interest rates, which are difficult to forecast even in the short term, become even more uncertain over extended periods. The extended time frame of insurance commitments adds complexity to choosing the right policy.

  2. Forbes and Statista collaboration: Forbes partnered with market research firm Statista to create a comprehensive list of the World's Best Life Insurance Companies. The collaboration involved surveying over 30,000 individuals across 15 countries. These participants, who had held a life insurance policy within the past three years, were asked to recommend their insurance company and rate it based on various criteria, such as employee advice, customer service, price performance, transparency, and damage service. The survey aimed to provide insights into customer satisfaction and assist individuals in making informed decisions about their insurance providers.

  3. International coverage: The final list compiled by Forbes and Statista comprises 110 companies from 15 different countries. These countries include Australia, Belgium, Brazil, Canada, France, Germany, India, Italy, Japan, Netherlands, South Africa, South Korea, Spain, the United Kingdom, and the United States. The number of companies listed per country and insurance category varied based on the number of evaluations collected and the final scores. This diverse range of companies and countries demonstrates the global scope of the survey and the effort to encompass a wide range of perspectives in determining the best life insurance providers.

Join us in Chicago on July 13th at 5 PM. Click for More Information

Rare link between coronavirus vaccines and Long Covid–like illness starts to gain acceptance

By Gretchen Vogel and Jennifer Couzin-Frankel - COVID-19 vaccines have saved millions of lives, and the world is gearing up for a new round of boosters. But like all vaccines, those targeting the coronavirus can cause side effects in some people, including rare cases of abnormal blood clotting and heart inflammation. Another apparent complication, a debilitating suite of symptoms that resembles Long Covid, has been more elusive, its link to vaccination unclear and its diagnostic features ill-defined. But in recent months, what some call Long Vax has gained wider acceptance among doctors and scientists, and some are now working to better understand and treat its symptoms. Read Full Article… 

VBA Article Summary

  1. Increasing Reports of Postvaccination Symptoms: Medical professionals and researchers are noticing a growing number of individuals experiencing postvaccination symptoms, such as persistent headaches, severe fatigue, abnormal heart rate, and blood pressure. These symptoms can occur hours, days, or weeks after receiving a COVID-19 vaccine. Although considered rare compared to Long Covid, the accumulation of cases raises concerns.

  2. Overlapping Medical Conditions: Researchers have found some alignment between postvaccination symptoms and known medical conditions. One such condition is small fiber neuropathy, which can cause tingling sensations, burning pain, and blood circulation problems due to nerve damage. Another condition is postural orthostatic tachycardia syndrome (POTS), which can involve muscle weakness, heart rate fluctuations, fatigue, and cognitive difficulties. Some postvaccination patients exhibit features of one or both of these conditions, similar to individuals with Long Covid.

  3. The Need for Further Research: Despite reports of postvaccination symptoms, regulatory bodies in the United States and Europe have not established a direct connection between COVID-19 vaccines and small fiber neuropathy or POTS. Researchers express concerns about the potential impact on vaccine trust while emphasizing the significant benefits of vaccination. Limited studies have been conducted to investigate these complications, and researchers are striving to gather more evidence and understand the underlying mechanisms. Funding for studies is being organized, and ongoing research projects aim to correlate symptoms with immune cell patterns in blood samples and explore potential treatment options.

VBA Poll Question of the Week - Please share your insights

What type of B2B event are you MOST interested in attending post-pandemic?

Login or Subscribe to participate in polls.

Express Scripts joins Optum in adding more Humira biosimilars to its formulary

By Paige Minemyer - Pharmacy benefit management giant Express Scripts said it will continue to conduct reviews of emerging products for potential formulary placement and that the company supports a market shift to biosimilars while maintaining patient choice. On the heels of a similar announcement from Optum Rx, pharmacy benefit management giant Express Scripts said Monday that it will add three biosimilars to its formulary to compete with Humira. Read Full Article…

VBA Article Summary

  1. The pharmacy benefit manager (PBM) Express Scripts announced the inclusion of Boehringer Ingelheim's Cyltezo and two biosimilars produced by Novartis' Sandoz in its National Preferred Formulary. These biosimilars will serve as alternatives to Humira, the top-selling pharmaceutical product in the world, and are expected to drive greater affordability for individuals with chronic and complex conditions who require these drugs.

  2. Express Scripts' trend data revealed that anti-inflammatory drugs accounted for almost 25% of total drug spending for its commercial business in the previous year. An analysis conducted by its parent company, Evernorth, estimated that increased competition from biosimilars could result in cost savings of $225 billion to $375 billion over the next decade.

  3. The president of Express Scripts, Adam Kautzner, stated that the inclusion of biosimilars in the formulary reflects the company's commitment to embrace competition and enhance affordability, particularly for patients with chronic and complex conditions. By introducing clinically-equivalent and cost-effective biosimilars to their offerings, Express Scripts aims to leverage competition to generate greater savings for their clients and the millions of Americans they serve. Express Scripts also expressed support for a market shift to biosimilars while maintaining patient choice, emphasizing the importance of clinical effectiveness and cost savings in their formulary decision process.

Employers are increasingly suing their health plan for claims data

By Jakob Emerson - Lawsuits from large companies and employers are increasingly being filed against third-party health plan administrators in an effort to access complete employee medical claims data. Through lawsuits recently filed against Aetna, Elevance Health and BCBS Massachusetts, employers claim payers have breached their fiduciary duties by not allowing complete access to claims data and how claims are processed. Read Full Article… 

VBA Article Summary

  1. Allegations of undisclosed fees and unreviewed claims: Kraft Heinz lodged a complaint on June 30, accusing Aetna, its third-party administrator (TPA), of exploiting its position to benefit itself while harming Kraft Heinz. The complaint states that Aetna charged undisclosed fees and processed medical and dental claims without human review, negatively impacting Kraft Heinz.

  2. Access to claims data and inflated rates: In separate lawsuits, bricklayer and metal worker unions sued Elevance Health, claiming that the payer denies self-insured plans access to their own claims data and charges them higher rates than negotiated with hospitals. Similarly, a labor union in Massachusetts sued BCBS Massachusetts in April for similar reasons. These cases highlight the alleged lack of transparency and fairness in the pricing and data access practices of health payers.

  3. Legal implications of Consolidated Appropriations Act and hospital price transparency rule: The Consolidated Appropriations Act and the hospital price transparency rule, which became effective in 2021, have played a significant role in driving these lawsuits. These legislative measures have granted self-insured employers greater access to medical costs, thereby increasing pressure on them to fulfill their fiduciary duty to employees. Experts suggest that these lawsuits may be the first in a wave of legal actions by employers and employer plan sponsors seeking to hold health payers accountable for potential breaches of fiduciary duty.

Bonus point: Growing interest in employee plaintiffs: The article mentions that a law firm is actively seeking employees of Target, State Farm, and PetSmart through social media channels to explore the possibility of becoming plaintiffs in health plan-related matters. This indicates a rising trend of employees potentially taking legal action against their employers or health payers regarding their health plans.

How employees can avoid medical debt: A look at hospital care charity programs

By Deanna Cuadra - Americans have nearly $200 billion worth of medical debt, and as healthcare prices continue to rise, that number isn't likely to shrink — still, many Americans may not realize that they are eligible for financial assistance after receiving their hospital bill. Read Full Article…

VBA Article Summary

  1. Non-profit hospitals in the U.S. are required by the Internal Revenue Service to offer charity care programs, providing free or discounted services to eligible patients in exchange for tax-exempt status. Despite this requirement, charity care costs represented 1.4% or less of operating expenses at half of all hospitals in 2020, according to Kaiser Family Foundation.

  2. Lack of education and transparency surrounding hospital financial assistance programs contributes to underutilization. Many hospitals avoid mentioning their charity care programs, and patients are often unaware of the available options. In Oregon, where Dollar For conducted research, it was found that hospitals were not properly screening patients for financial aid eligibility, even though state laws mandated it.

  3. Oregon implemented a law in 2019 to improve the situation by requiring non-profit hospitals to screen patients falling within 200% of the federal poverty level for financial aid eligibility. Hospitals must apply aid before patients receive their bills, offer refunds to those who mistakenly paid, and make financial aid applications easily accessible online. Despite relatively generous eligibility requirements, Dollar For discovered that 70% of Oregon's hospitals were providing less charity care after the law was passed. There is no correlation between financial assistance granted and hospital profitability, as seen in the case of Oregon Health and Science University, which increased financial assistance grants by 298% while experiencing an increase in net patient revenue.

Hospitals' latest "innovation": "patient-centric payment capabilities

By Chris Deacon - As America’s health insurers keep increasing the amount of money their customers must pay out of pocket before their coverage kicks in, more and more patients are unable to pay their hospital bills. As Chris Deacons writes below, hospital administrators are taking a range of actions to collect as much from those patients as possible, often before admitting them. Read Full Article… 

VBA Article Summary

  1. Increase in Self-Pay-After-Insurance Accounts: In 2018, only 11.1% of hospital bad debt was attributed to self-pay-after-insurance accounts. However, by 2021, this number had surged to 57.6%. The increase can be partly attributed to job losses during the pandemic but largely due to the rise of high-deductible health plans.

  2. Hospital Emphasis on Patient-Centric Financial Engagement: Hospitals are prioritizing "patient-centric financial engagement" alongside patient care to ensure long-term financial sustainability. They leverage various strategies such as requesting payment in advance, using electronic health records and voice response systems to remind patients to pay, and initiating financial conversations at the point of service. These practices focus on increasing cash payments and educating patients about their financial responsibilities.

  3. Shift from Patient Care to Revenue Generation: The pursuit of revenue from patients appears to be on par with the commitment to patient care in many hospitals. Financial conversations and practices often take precedence, overshadowing the provision of care. This shift not only undermines trust in the healthcare system but also creates barriers for patients seeking access to financial assistance programs that hospitals are required to provide. The requirements for financial assistance, such as tax returns, Medicaid denials, and Social Security Numbers, further burden patients in need.

Join our LinkedIn Community!

New Vulnerabilities Accompany Growing Reliance on AI, Machine Learning

By Captive.com - Artificial intelligence and its potential applications have become an inescapable topic recently. But, as reliance on artificial intelligence (AI) and machine learning (ML) systems grows, so too do new vulnerabilities, according to a new report from Swiss Re. Meanwhile, insufficient risk awareness and governance expose greater numbers of AI services to new attacks, the reinsurer suggests. Read Full Article…

VBA Article Summary

  1. Emerging Risk Themes: The 2023 Swiss Re Sonar report identifies two high-potential impact emerging risk themes. The first theme is the risk of AI getting hacked and the systemic vulnerabilities associated with the technology. The report highlights concerns about adversarial machine learning, which could lead to the accumulation of risks or losses. It also mentions the potential for model evasion, fraud targeting machine learning systems, and reputational damage from public reports of hacks or adversarial attacks.

  2. Exclusive Markets and Geopolitical Alliances: The second high-impact emerging risk theme identified in the Sonar report is the existence of exclusive markets where polarization of geopolitical alliances hampers global (re)insurance businesses. This theme focuses on the challenges faced by the insurance industry due to the polarized geopolitical landscape, which can impede the operations of (re)insurance companies in certain markets.

  3. Risk Mitigation Strategies: The Sonar report suggests several steps to reduce exposure to vulnerabilities associated with artificial intelligence and machine learning. These steps include implementing strict access management, setting suitable usage limits, and ensuring effective data governance. The report emphasizes the importance of integrating security and data governance as core features of the development and deployment of machine learning systems. It also highlights the need to balance usability with privacy and intellectual property protection to build resilient machine learning applications for the future.

The DEA Relaxed Online Prescribing Rules During Covid. Now It Wants to Rein Them In.

By Arielle Zionts - Federal regulators want most patients to see a health care provider in person before receiving prescriptions for potentially addictive medicines through telehealth — something that hasn’t been required in more than three years. Read Full Article…

VBA Article Summary

  1. DEA's temporary allowance for telehealth prescription: During the COVID-19 public health emergency, the Drug Enforcement Administration (DEA) permitted healthcare providers to prescribe controlled medications during telehealth appointments without an in-person examination. This measure aimed to increase access to healthcare and facilitate remote consultations.

  2. Proposed rules requiring in-person appointments: In February, the DEA proposed new regulations that would mandate providers to conduct at least one in-person appointment before prescribing certain controlled drugs during telehealth visits. These proposed changes received a significant number of public comments, leading to an extension of the current regulations until November 11. Patients receiving controlled medications without in-person appointments have until November 11, 2024, to comply with the future rules.

  3. Debates and concerns surrounding the proposed rules: The proposed rules sparked a variety of responses from the public. Opponents argued that the decision of whether in-person appointments are necessary should be left to healthcare providers rather than a law enforcement agency. They expressed concerns about limited access to care, especially for rural patients. Some commenters called for exemptions for specific medications and conditions. On the other hand, supporters believed the proposed rules would strike a balance between increasing healthcare access and preventing medication misuse. Various stakeholders, including physicians, telehealth providers, and patients, voiced their opinions on the potential impact of the rules.