Personal Injury and Social Security Disability Blog

Workers' Health Insurance Costs Soar

Yesterday's Los Angeles Times had a good article on the outrageous cost of health insurance, especially relative to inflation. As a small-business owner, I struggle with this issue every year. Each time we come up for renewal, I am forced to increase our deductibles or reduce our benefits in order to keep the costs of premiums at a manageable level. I blame both the health insurance carriers for these increases and the health providers for increasing their fees at a much greater rate than inflation in general. Here are excerpts:

          

If gas and milk price hikes seem steep, check out health insurance premiums. They have increased 10 times faster than incomes in recent years, a study shows.

Workers with job-based coverage for their families saw earnings rise 3% from 2001 to 2005, while their health insurance premium contribution increased 30%, according to the study by researchers at the State Health Access Data Assistance Center at the University of Minnesota.

The average cost nationally of family coverage during the period increased nearly $2,500, to $10,728 from $8,281. The average cost for job-based family coverage in California increased more than $2,650, to $10,551 from $7,898.

Between 2001 and 2005, more than 30,000 of the 3.6 million private-sector employers offering health insurance as a benefit to workers dropped it.

As a result, the number of people in private-sector jobs that offered health insurance benefits declined by more than 4 million, and the number of people with private insurance fell by 2.4 million, or 6%, the study found.

   

Featured Link - FoodSafety.gov

There have been so many food recalls lately that some of us are losing weight just worrying about the safety of what we eat. The federal government has a site filled with information about food safety. There's lots of good stuff here. Here's the description from the site:

FoodSafety.gov is a gateway website that provides links to selected government food safety-related information. Not every government web site is listed. When more than one government web site provides similar information, links will be provided to only one or two of those sites. Individuals with different backgrounds review all potential sites for inclusion on the FoodSafety.gov web site. This web site is part of the National Food Safety Information Network. It is maintained by FDA's Center for Food Safety and Applied Nutrition.

Reminder - Texas Auto Liability Minimum Limits Raised

I've written before about the woefully low minimum automobile liability insurance limits in Texas, and how they were going to changed in April 2008. Well, the time has finally come, and as of April 1, the minimum insurance requirements were increased under the Texas Motor Vehicle Safety Responsibility Act. This applies to policies purchased or renewed on or after that date.

Now, the minimum limits are no longer 20,000/40,000/15.000. The new state-mandated limits are 25,000/50,000/25,000. That means $25,000 for bodily injury to or death of one person in one accident; $50,000 for bodily injury to or death of two or more persons in one accident; and $25,000 for damage to or destruction of the property of others in one accident. These limits are still far too low, both for injury and property damage, but at least it's a small step in the right direction.

We advise all our clients to purchase more than the minimum limits if possible, and please pay the few extra dollars to add Personal Injury Protection and Uninsured Motorist coverage to your policy. Statistics show that 25% or more of all Texas motorists have no auto insurance coverage. If you get hit by one of those drivers and you don't have Uninsured Motorist coverage, you'll probably be out of luck. Talk to your insurance agent now about adding this coverage.

Co-Payments For Expensive Drugs Soar

Today's New York Times carries a story about the rising costs of prescription drugs — even for people who have health insurance. The gist of it is that insurance carriers are raising the co-pay amount for the most expensive and popular drugs. Here are excerpts:

Health insurance companies are rapidly adopting a new pricing system for very expensive drugs, asking patients to pay hundreds and even thousands of dollars for prescriptions for medications that may save their lives or slow the progress of serious diseases.

With the new pricing system, insurers abandoned the traditional arrangement that has patients pay a fixed amount, like $10, $20 or $30 for a prescription, no matter what the drug’s actual cost. Instead, they are charging patients a percentage of the cost of certain high-priced drugs, usually 20 to 33 percent, which can amount to thousands of dollars a month.

The system means that the burden of expensive health care can now affect insured people, too.

No one knows how many patients are affected, but hundreds of drugs are priced this new way. They are used to treat diseases that may be fairly common, including multiple sclerosis, rheumatoid arthritis, hemophilia, hepatitis C and some cancers. There are no cheaper equivalents for these drugs, so patients are forced to pay the price or do without.

But the new system sticks seriously ill people with huge bills, said James Robinson, a health economist at the University of California, Berkeley. “It is very unfortunate social policy,” Dr. Robinson said. “The more the sick person pays, the less the healthy person pays.”

Traditionally, the idea of insurance was to spread the costs of paying for the sick.

Drug Makers Near Old Goal: A Legal Shield

I wrote recently about the legal doctrine of pre-emption that is threatening to steal legal rights from American consumers. Now the New York Times has published a lengthy but excellent article on the subject of the legal shield sought by drug manufacturers. Here are excerpts, but I encourage you to read the article.

The Supreme Court appears to be on the verge of endorsing a doctrine that the F.D.A. should not be second-guessed by courts.

For years, Johnson & Johnson obscured evidence that its popular Ortho Evra birth control patch delivered much more estrogen than standard birth control pills, potentially increasing the risk of blood clots and strokes, according to internal company documents.

But because the Food and Drug Administration approved the patch, the company is arguing in court that it cannot be sued by women who claim that they were injured by the product — even though its old label inaccurately described the amount of estrogen it released.

This legal argument is called pre-emption. After decades of being dismissed by courts, the tactic now appears to be on the verge of success, lawyers for plaintiffs and drug companies say.

The Bush administration has argued strongly in favor of the doctrine, which holds that the F.D.A. is the only agency with enough expertise to regulate drug makers and that its decisions should not be second-guessed by courts. The Supreme Court is to rule on a case next term that could make pre-emption a legal standard for drug cases. The court already ruled in February that many suits against the makers of medical devices like pacemakers are pre-empted.

A series of independent assessments have concluded that the agency is poorly organized, scientifically deficient and short of money. In February, its commissioner, Andrew C. von Eschenbach, acknowledged that the agency faces a crisis and may not be “adequate to regulate the food and drugs of the 21st century.”

The F.D.A. does not test experimental medicines but relies on drug makers to report the results of their own tests completely and honestly. Even when companies fail to follow agency rules, officials rarely seek to penalize them. “These are scientists, not cops,” said David Vladeck, a professor at Georgetown Law School.

The Ortho case, however, suggests that Johnson & Johnson, like other drug makers, is not always quick to tell the F.D.A. about potential problems with its medicines.

Telemarketers Losing Access To Texas Crash Victims' Phone Numbers

The Dallas Morning News reports today that the state is taking at least one small step toward protecting auto accident victims from unauthorized and sometimes illegal solicitation from medical clinics, body shops, and lawyers.

As is, anyone who is involved in a collision in Dallas is exposed to literally dozens of phone calls offering free X-rays, free property damage estimates, and worst of all, legal representation. Telemarketers or representatives for doctors and lawyers line up at the police department every day and buy accident reports. Then they call the innocent parties in the collision, if the police report verifies there is insurance available. Various bills to protect consumers from these solicitation calls have either not passed the Texas House or Senate, or in one case, was vetoed by Governor Perry.

The calls are frequently made on behalf of medical clinics, and offer to come to the accident victim's house and drive them to the doctor for a free consultation. In many cases, once the person arrives at the doctor's office he or she is told that before the examination can begin, a contract must be signed with a lawyer who has representative at the clinic. It is not only unethical, but also illegal, for a lawyer to solicit business in this manner. Unfortunately, neither the State Bar nor the District Attorney's office seems to take any interest in these violations. As a result, accident victims are essentially tricked into hiring unethical lawyers (who probably are not among the best lawyers in town).

Now, by agreement between the Texas Department of Public Safety and the Texas Department of Transportation, accident victims will no longer have to give their phone numbers after a collision. Of course, it won't take much work to find numbers on the Internet, and some hard-core solicitors will just drive to the homes of the victims. Still, it's a step in the right direction. The new rule takes effect Monday, April 7, 2008. Here are excerpts from the story:

"It is getting to the point where every person involved in a reported traffic accident is being solicited," said Mark Hanna, a spokesman for the Texas Committee on Insurance Fraud, a panel created by the insurance industry and the Texas Department of Insurance.      

"The telemarketers say whatever it takes to get crash victims into the doctor's office. They are today's lazy ambulance chasers, doing it all by phone. We are trying to put a stop to these calls or at least slow them down."

Without phone numbers on official crash reports, telemarketers will have to rely on phone books or the Internet to get numbers to contact accident victims, Mr. Hanna said. They won't have access to unlisted numbers, cellphones and business numbers – which officials estimate will cut the number of unsolicited calls by at least half. Fred Lohmann, Dallas-area director of the nonprofit National Insurance Crime Bureau, said telemarketers line up every day at police departments and central records offices across the state to purchase crash reports from the previous day. Although state law requires them to know the date and location of the accident to buy each report, telemarketers simply purchase police department dispatch logs beforehand and get the information they need to purchase the crash reports. "The accident reports are the fuel that allows the solicitation process to work," Mr. Lohmann said. "Oftentimes they will give the appearance of being a representative of the victim's insurance company, and they tell the person to go to a clinic for treatment or risk not getting their insurance claim paid." 

A bill was introduced in the Legislature last year to impose a 30-day hold on all crash reports, except for crash victims, law enforcement officers, insurers and the news media. But the measure was killed under heavy opposition from telemarketing firms.

"We're up against a group that has made a lot of money through these harassing phone calls, and they'll do whatever it takes to stop us," Mr. Hanna said, noting that another effort will be made to pass the bill in the 2009 legislative session.

The Texas Trial Lawyers Association and the Texas Chiropractic Association supported the legislation as well as another bill to make telemarketing of traffic victims illegal. That bill also failed.      

The solicitation of business using information contained in a police dispatch log is a Class B misdemeanor in Texas, but most prosecutors say they can't justify the resources to go after telemarketers who violate the law.

Insurance industry representatives said the additional medical and legal expenses created by telemarketers generate unnecessary costs that are in the end paid for by insured drivers across the state in the form of higher premiums.

 

Roadside Assistance On Texas Highways

Have you received an e-mail saying that the Texas Department of Public Safety offers free roadside assistance and that the phone number is on the back of your Texas driver license?

That's sort of true, but not exactly. If you have a roadside problem (NOT an emergency like  a major car wreck), you can call that number on the driver license and DPS will pass along your information to the nearest local authorities, who may or may not offer roadside assistance. Any any rate, the motorist will be responsible for any charges for towing or repairing a flat tire, etc.

Here is the information from the DPS Web site:

The public needs to be aware that an erroneous e-mail is being circulated about the Texas Department of Public Safety Roadside Assistance Hotline.

The toll-free line has been operated by DPS since 1989 for motorists to use when reporting non-life-threatening situations on Texas roads and highways.  DPS then passes the information along to the appropriate local police agency or DPS office.

If a tow truck is ultimately dispatched, the motorist is responsible for any costs incurred. Some cities and agencies do have courtesy patrols and roadside trucks to provide non-towing services and they may be dispatched by the local agencies when appropriate. These two points are misrepresented in the widely-circulated e-mail that has led to an increase in inquiries to the Roadside Assistance Hotline.

The number, 1-800-525-5555, is printed on the back of virtually all Texas driver licenses and identification cards. Customers of participating wireless companies - ALLTEL, Nextel, Cingular Wireless, Houston Cellular and Verizon Wireless - can dial *DPS (*377) free of airtime charges anywhere in Texas.

Examples of when a motorist should call the Roadside Assistance Hotline include: stranded with car problems, hazardous road conditions, debris in the roadway, suspicious activity at a rest area, and obviously intoxicated or dangerous drivers.

The Roadside Assistance Hotline is not intended to replace 911 as an emergency number; 911 should still be the first option for emergency situations.

To better assist our communications operators please have the following information ready:

• Your name, cell phone number (and vehicle description if applicable);
• Highway location (mile marker would be helpful); and
• County location, or city location if inside city limits.

Health Insurance Companies Cut Back On Medical Tests - Does This Help Or Hurt Patients?

The Associated Press is running a story today in papers across the country, documenting cutbacks health insurance companies are making in the number of medical tests they approve. Actually, the carriers are requiring pre-approval for more and more tests, which has the effect of cutting back on the total number. The insurance companies say this is for the protection of the patients (to reduce unnecessary exposure to radiation), but doctors say patients are endangered because they're not getting sufficient testing before diagnoses are made. Here are excerpts from the story:

Insurance companies are taking a harder look at advanced medical scans like CT scans, citing spiraling costs and safety concerns. And some doctors agree that there’s emerging evidence that these scans are being over-prescribed.

“Costs are soaring in this area, quality concerns are mounting, and safety concerns are mounting,” said Karen Ignagni, the chief executive of the trade group America’s Health Insurance Plan.

Health insurers are requiring more preauthorizations before patients can have these scans, and setting other restrictions including mandating that the imaging equipment and medical staff be credentialed in advance.

Insurers fear that some patients are being exposed to dangerous radiation levels from having repeated CT and PET scans, which use many times the radiation of a regular chest X-ray. Sometimes, scans are repeated because the first ones were not done properly because of outdated equipment or poorly trained technicians.

But doctors say that the bigger problem with medical imaging tests is the insurance red tape needed to get them.

“Is this a preauthorization process, or are these (insurance) companies practicing medicine?” asks Dr. Arl Van Moore, the board chairman at the American College of Radiology, the specialists in medical imaging.

Moore cited another reason for increasing costs: Doctors sometimes order a diagnostic test that doesn’t need preauthorization - even if it provides less-helpful information than the one they prefer - then try to get approval for a more advanced test if the first one shows that it’s needed.

Worse yet, sometimes patients end up getting a riskier, more invasive test than what they really need, Hendel said. For example, cardiologists wanting to assess blood flow and blockages inside a patient’s heart arteries would prefer a nuclear cardiology test. With that, a small amount of a radioactive substance is injected in the blood and tracked using a camera.

Some doctors will instead order a cardiac catheterization, which doesn’t require advance authorization, Hendel said. But that involves threading a catheter through a blood vessel up into the patient’s heart - and carries a 10-times higher risk of complications such as a heart attack or stroke, he said.

Featured Link - NoEthics.net

The Web site NoEthics.net is interesting, to say the least. It reports information on lawyers, judges, and legislators deemed by the site's author to be unethical.

I applaud this effort, and wish there was more public awareness of such ethical lapses as mentioned on this site. My concern with some similar sites is that often people forget that anyone can file an ethics complaint against a lawyer, with or without a valid reason. It's important that we not libel or slander lawyers who have done nothing wrong, simply because a disgruntled client makes up a false complaint.

Here is the mission statement from NoEthics.net:

The Committee continues to focus primarily on exposing attorney and judicial misconduct. The Committee is neither interested in nor engaged in the sport of lawyer bashing. However, the Committee is interested in performing a service for the public that the legal profession is loath to do. Which includes, exposing attorney and judicial misconduct, providing advice on various legal matters, and discussing the numerous faults in our legal system and suggesting improvements.

I formed the Committee in 1993 after realizing the legal profession was not really interested in exposing misconduct or incompetence of it's members. After repeated victimization by several dishonest attorneys from 1980-1991, I discovered that the Toledo Bar Association and Ohio Supreme Court were not interested in disciplining it's own. Therefore, I decided to act in their stead. For any individual to take on the legal profession as I have done and continue to do is tantamount to engaging in sado-masochism.

My Web Page allows the browser the opportunity to review detailed treatments on the following subject matters, some of which are completed and some of which are under construction:

• Advice on the need for and employment of an attorney.
• Advice on settling your own claims without employing an attorney.
• Advice on how to determine your legal rights.
• Advice on determining if your attorney is dishonest or incompetent.
• Your legal rights to no-fault benefits if you reside in a no-fault state.
• Names and locations of dishonest and/or incompetent attorneys which are listed by State and/or Regions.
• Exposing attorney and judicial misconduct.
• Why contingent fee contracts should be declared unlawful.
• Why the jury system should be changed.
• Why losers in civil cases should pay.
• Why election of Judges should be declared unlawful.
• Why the procedures to discipline attorneys should be revamped.
• Anatomy of a Venal, Vindictive and Dishonest Judge.
• Expose on the Misconduct of Chief Justice Thomas A. Moyer of the Ohio Supreme Court.
• Anatomy of a Dishonest Psychologist.

Featured Link - Texas Fights I.D. Theft

The State of Texas, though the Attorney General's office, has put up a good new Web site about how to fight I.D. theft -- the nations's fastest-growing crime. Check out this site. You'll find some good tips and resources there.