Tag Archives: blue shield

5 Insurance Apps to Download Today

Forward-thinking insurance companies are leveraging technology to improve customer experience and differentiate themselves from the competition. Here are the top five insurance apps you should download today, to help with tasks ranging from creating a home inventory to improving your driving skills.

  1. Home Gallery App
    Cost:
    Free
    Benefit: Helps you create a home inventory

A home inventory makes filing an insurance claim easier should your things be stolen or damaged. It also gives you an estimate of how much your possessions are worth, which is helpful when you shop for homeowners insurance. Fortunately, the Home Gallery app from Liberty Mutual makes cataloging your possessions a cinch. The app allows you to take photos of your items, note important information such as purchase price and date and share your inventory with family members or your insurer. Best yet, you can use the Home Gallery app whether or not you’re a Liberty Mutual customer.

  1. Driver Feedback App
    Cost:
    Free
    Benefit: Gives you information to become a better driver

State Farm’s Driver Feedback app helps you become aware of driving habits that increase your chance of being involved in an accident, which could raise your auto insurance premium. The app uses your smartphone’s accelerometer and GPS locator to collect data about how you brake, corner and accelerate. Once you arrive at your destination, the app gives you a score for your trip and offers tips about how to improve your driving.

Using the Driver Feedback app, you can also compare data from one trip with another and share the results via email or text. These features can help new drivers form good driving habits and allow parents to monitor their teen’s performance behind the wheel. Plus, using a driving app is one way your teen might reduce her auto insurance premium. You don’t need to be insured with State Farm to use the app, and your driving data isn’t shared with your insurance company.

  1. Text4Baby App
    Cost:
    Free
    Benefit:
    Provides tips to help expectant moms stay healthy during pregnancy

The Text4Baby app provides pregnant women with a wealth of information to help them have a healthy pregnancy and avoid preventable complications. When a mom signs up, she receives a “starter pack” of messages. Then, every week, she receives three text messages about prenatal care, ranging from doctor appointment reminders to information about symptoms that could warrant concern.

Major insurance providers, like Aetna, CIGNA and Blue Cross and Blue Shield, are Text4Baby “outreach partners.” This means the companies encourage expectant moms to use the app to stay healthy, which can reduce the chance of complications that can make pregnancy-related costs skyrocket.

  1. Infinity App
    Cost:
    Free
    Benefit:
    Allows you to create a secure digital inventory

The MetLife Infinity app gives you the power to create a digital inventory of photos, videos and audio files, plus important documents like wills and insurance policies. The app stores as much as five GB of data in the cloud, and it’s password-protected and permanently backed up. You can organize your information in collections and securely share the information with anyone, from a family member to your insurance agent. You can take advantage of the app even if you’re not a MetLife policyholder.

  1. Defend Your Income
    Cost:
    Free
    Benefit: Explains how a disability can affect your life

Defend Your Income is an online game produced by the Council for Disability Awareness. Its goal is to help you understand how a disability may affect your life. Throughout the game you defend yourself from health-related issues like pregnancy complications, cancer, and respiratory disease. After you complete each round, you answer trivia questions and learn miscellaneous facts about the disability.

By the end of the game, you’re more aware of your disability likelihood and have an idea of how much income you could lose if you become disabled. This information is useful when you’re calculating the amount of disability insurance you need.

These apps are transforming the insurance industry by elevating customer service to a new level. Download one or more of them and then share your experience. We’d love to hear your thoughts.

Big Disruption That Just Hit Healthcare

The event drew little fanfare and scant attention last week, but it still rocked the healthcare world.

The headline I wrote for Forbes was an attempt to capture the full effect, but headlines are tough that way. On the one hand, you have to grab a reader quickly. On the other, headlines have to be accurate and truthful. In this day and age — where everyone has a keyboard and a WordPress (or LinkedIn) account — it can be hard to separate the wheat from the chaff and too easy to discount headlines that scream “disruption.” I elected to run with the popular technique of using a question as the headline:

Could This Pricing Tool for Consumers Disrupt Healthcare?

The fact is — this particular pricing tool is very disruptive — and not for the reasons that are readily apparent. The first reaction by many was, so what? There are tons of consumer pricing tools already on the market. I highlighted three that are “consumer facing.”

  1. Health Care Blue Book
  2. Fair Health
  3. ClearHealthCosts

These are all great examples in their own right, of course (and there are many others), but they are all attempts to circumvent the mechanism that keeps true “in-network” provider pricing from becoming transparent. They’re mostly designed with the fervent prayer that consumers will influence pricing by shopping with their feet.

But that’s not the full effect of the new pricing tool — by a long shot. One of the key pricing targets is the providers that Blue Cross Blue Shield of North Carolina (BCBSNC) negotiates with. In the course of one short week (since launch), one provider has already called BCBSNC to ask that its prices be lowered.

In. One. Week.

Full credit goes to BCBSNC for its bold vision. This cannot have been easy. For decades, in-network pricing (hotly negotiated between payers like BCBSNC and their various networks of providers) has been a closely guarded secret. Prices were considered proprietary — and serious legal effort was expended to ensure their secrecy — often including non-disclosure agreements, with serious penalties for breach.

That changed this month, and I posit it will have a profound impact on the healthcare system as a whole. Why? Because it’s a Blue Cross Blue Shield organization (one of 37 around the country), and because the footprint for the Association of Blues is enormous. Not just in North Carolina (lives covered by BCBSNC equal about 40% of the population in North Carolina): The association either administers or provides health coverage for about 1/3 of the entire U.S. population (roughly 105 million Americans).

It will be hard for other Blue Cross Blue Shield plans to ignore this precedent-setting move by BCBSNC.

Will this be the impetus that forces payers to disclose in-network contract pricing more broadly? That’s a big unknown, of course, but the pressure is enormous and growing. BCBSNC was the first, but I doubt it will be the last.

I ended the article on Forbes this way: “Some said this could never happen. Others said it never would. The fact is — it just did. I’m betting other payers (every color stripe) will follow.”

At the very least, the pressure of true, in-network contract pricing transparency is clearly evident… and mounting. The whole healthcare industry needs as much disruption as everyone can create. The surprise here was the source. Way to go, Big Blue!

Data Breaches: Who Has Legal Liability?

Untold millions of people provide personal and private information on the Internet every day to pay their bills, to purchase a product, to post a picture and so on, even though data breaches have become practically a daily occurrence. The problem has focused attention on the lack of security by the companies that use the data, but consumers also need to take some responsibility.

The hacking of Target at the end of 2013 is the best-known of recent data breaches, but hackers know no bounds. Virtually every individual who uses the Internet—no matter who he is or what she does professionally—is at risk for a data breach.

For instance: In May 2014, three desktop computers were stolen from the California office of Bay Area Pain Medical Associates. About 2,780 patients were notified that their personal information was in a spreadsheet that could have been accessed by the thieves.

In March 2014, about 1,700 people in the employee wellness program for Virginia-based Dominion Resources had their personal records accessed by a hacker who gained entry to the systems of a subcontractor, Onsite Health Diagnostics. The personal information of their spouses and domestic partners was also hacked, if they had scheduled a health-screening appointment online.

In Encinitas, a California Public Employees’ Retirement System (CalPERS) payment document containing 615 current and former employees’ personal information—including Social Security numbers—was inadvertently made public on the city’s website from May 18, 2014, to July 3, 2014, and was accessed by 16 unauthorized individuals before the data breach was discovered.

In July 2014, Orangeburg-Calhoun Technical College in South Carolina had to notify 20,000 current and former students and faculty that their personal information—including Social Security numbers—was on a laptop that was stolen on July 7, 2014, from a staffer’s office.

In Texas, from Dec. 28, 2013, until June 20, 2014, the Houstonian Hotel Club & Spa’s payment processing systems were compromised when they were infected with malware. More than 10,000 customers had their payment card data exposed.

In April 2014, Park Hill School District in Missouri learned that before leaving the district an employee downloaded 10,210 current and former staffers’ and students’ personnel and student files that contained their personal information. The former employee made the files accessible to untold numbers on the Internet.

The Department of Managed Health Care (DMHC) discovered on May 16, 2014, that Blue Shield of California inadvertently made public the names, business addresses, business telephone numbers, medical groups, practice areas and Social Security numbers of about 18,000 doctors.

The list could go on and on, but you get the message. Data breaches can occur on any computer system, anywhere and any time.

So, who is ultimately responsible for data breaches? The company holding the data, because of its system’s vulnerability? Or the user/consumer, because we are responsible, through our passwords and PINs, for the security of all data we post? (If you read the privacy policies of the sites you use, the user is responsible.)

The answer is not an easy one.

If your information was hacked through an entity’s online systems, your answer most likely would be the entity, and you might participate in a class action. at least two dozen federal class actions have been filed against Target, alleging it did not adequately protect customer privacy. A class action has been filed against P.F. Chang’s China Bistro for a security breach that involved, according to the complaint, 7 million customers’ credit and debit card payment data stolen from its restaurants’ systems between March and May 2014. (It has been reported that the breach came to light only when a batch of card data was alleged to be up for sale at Rescator, an underground store best-known for selling customer data stolen in the Target breach.)

But is it that simple, that the sole responsibility lies with the entity that was hacked?

What about us, the consumers? Do we need to be part of the answer by accepting that we willingly create those passwords and PIN numbers and that we provide our personal and private information so we can shop on eBay (which just notified 145 million of us that a cyber attack may have compromised customers’ login information and other personal and private information) or pay bills online?

Should it be our responsibility to understand that online systems, or the strips on the back of our credit and debit cards, that store the data we provide are moving targets (no pun intended) for theft?

Saying “yes” would be the first step in the right direction. Everyone, user and organizations alike, is vulnerable, so the responsibility to protect our information lies with us all.

The second step is for each of us to do whatever we can to manage our vulnerability. Such as:

  • Making sure our anti-virus software is current, to prevent scammers from installing viruses on our computers that allow hackers to steal our personal and financial information. When the popular online ticket marketplace Stub Hub suffered a data breach, the hackers did not break directly into Stub Hub’s system; instead, they stole account information directly from the customer by downloading viruses onto each customer’s personal computer, or by collecting the information from data breaches of other websites.
  • Monitoring our bank and credit card accounts every day. If you see charges or withdrawals you did not authorize, contact the bank or credit card company immediately. (The liability is still yours until you report that your information has been compromised.)
  • Make sure your homeowner’s or renter’s insurance policy covers losses because of fraud, because, even if a class action is settled, there may be strings attached to how you can collect your share. For example: Vendini, another company that offers ticketing services to theaters and event venues, settled a class action in 2014 about compromised data. The settlement requires Vendini to pay as much as $3,000 a customer for identify theft losses. But here is the catch—you have to prove that the information used to make you a victim of identity theft actually came from Vendini’s systems.

Here is the bottom line:

The landscape on cybersecurity is shifting rapidly as data breaches are spiking. Congress, regulators and state attorneys general are taking a hard look at how companies, universities and governmental agencies are protecting consumer information from unauthorized access. Hearings have been held and new laws pushed. As a result, organizations are facing critical questions about what their responsibilities are to ensure consumers’ private and personal information is secure and in compliance with old as well as new laws.

But it is also imperative that you, the consumer, understand that you cannot depend on organizations to protect the information you provide to them. Rather, you need to take matters into your own hands and pose critical questions to yourself about how you use your own information online. You need to decide what information you are willing to turn over to be able to pay bills, make purchases or register for social media online.

It is after all, your information and your life. Think about it.

The information contained in this article is provided only as general information and may or may not reflect the most current developments legal or otherwise pertaining to the subject matter thereof. Accordingly, this information is not promised or guaranteed to be correct or complete and is not intended to create or constitute formation of an attorney-client relationship. The author expressly disclaims all liability in law or otherwise with respect to actions taken or not taken based on any or all of the content of this article.

Implementing International Medical Providers Into The U.S. Workers' Compensation System, Part 3

This is Part 3 of a multi-part series on legal barriers to implementing international providers into Medical Provider Networks for workers’ compensation. Previous articles in the series can be found here: Part 1 and Part 2. Subsequent articles in the series will be forthcoming soon.

Heather T. Williams agrees with critics, that medical tourism is a trade-off for consumers, allowing them to opt-out of increased regulation in favor of fewer restrictions and greater cost savings. Factors unique to the medical tourism industry will help preserve the quality of patient care and insulate patients from the regulatory pitfalls critics fear. Williams points to the benefits of medical tourism as providing patients with substantial cost savings, due in part to lower labor costs overseas.43

The cost savings in the context of inflated health care costs in the U.S. indicates why patients are driven abroad to seek medical care. How much of a cost savings medical tourism offers patients can be seen in how much hospitals charge for major surgical procedures such as cardiac surgery, partial hip replacement, knee replacement, and rhinoplasty. A hospital in India charges $4,000 for cardiac surgery, compared to $30,000 in the U.S. Hospitals in Argentina, Singapore or Thailand charge $8,000 to $12,000 for a partial hip replacement that would otherwise cost twice that much here. Singapore and Indian hospitals charge $18,000 and $12,000 respectively for knee replacement that normally cost $30,000 in the U.S. Finally rhinoplasty that costs $4,500 in the U.S. costs only $850 in India.44

Though all patients can benefit, medical tourism’s cost savings are more likely to benefit those with inadequate health insurance coverage.45 Lower-middle-class individuals, who typically have sufficient means to pay for reduced-price care out-of pocket, will benefit most from medical tourism.46 This is a point to bear in mind with regard to workers’ compensation, as many claimants are generally lower-middle-class.47

Medical tourism disproportionately benefits uninsured or underinsured individuals,48 but they are not the only ones benefitting from cost savings from medical tourism.49 Self-insured employers and private insurance companies have begun integrating medical tourism into their policies. It is attractive to small businesses as well.50 Medical tourism is expanding as self-insured employers and insurance companies have integrated medical tourism into their policies.51 For instance, Blue Ridge Paper Products of Canton, North Carolina sought to send an employee overseas for gallbladder and shoulder surgery.52 They offered him 25% of the savings, but the United Steelworkers prevented them from doing so and union workers were removed from the pilot program.53 54

State governments, looking to save money anyway they can may accept medical tourism for their state employees. A bill introduced into the state legislature in West Virginia in 2006, (H.B. 4359), would have encouraged state employees covered by the Public Employees Insurance Agency (PEIA) to utilize Joint Commission International accredited foreign hospitals, receive travel reimbursements for themselves and a companion, and participate in the savings with a cash rebate.55 56 The bill is still pending in the House Banking and Insurance committee.57

Large HMOs and health insurance companies have established plans to allow patients to obtain low-cost services overseas.58 BlueShield and Health Net of California, United Group Programs of Boca Raton, and BlueCross and BlueShield of South Carolina have offered such plans for travel to Mexico and Thailand for treatment.59 The effect of financial incentives on American’s willingness to travel for medical care is evident in a 2007 nationwide telephone survey of a representative sample of 1,003 Americans in which 38% of uninsured and one-quarter of those with insurance would travel abroad for care if the savings exceeded $10,000. One-quarter of uninsured, but only 10% of those with insurance would travel if savings were between $1,000 and $2,400. Fewer than 10% would travel to save $500 to $1,000, and no one would do so to save $200 or less. This represented a potential market share of 20-40 percent for non-urgent major surgery.60 61

Medical tourism is fast becoming a feature of American health care. In the next few years, more and more Americans will be going overseas for medical care. It is only a matter of time before medical tourism’s mark is felt on another arena of American health care — workers’ compensation.

43 Williams, 611.

44 Herrick, 8.

45 Williams, 614.

46 Ibid, 614.

47 Juan Du and J. Paul Leigh, “Incidence of Workers Compensation Indemnity Claims Across Socio-Demographic and Job Characteristics,” American Journal of Industrial Medicine, 54 (2011): 758-770. The study suggests that low socioeconomic status was a predictor of reporting workers compensation claims, but did not include income levels; although it is possible to extrapolate from the data presented that the subjects were generally lower middle class or working class.

48 Williams, 614.

49 Ibid, 615.

50 Ibid, 615.

51 Ibid, 615.

52 Boyle, 43.

53 Ibid, 43.

54 Williams, 616.

55 Ibid, 44.

56 Nicolas P. Terry, “Under-Regulated Health Care Phenomena in a Flat World: Medical Tourism and Outsourcing,” Western New England Law Review, 29, no. 29 (2007) 427.

57 West Virginia Legislature website, (2006).

58 Williams, 616.

59 Boyle, 44.

60 Herrick, 2.

61 Arnold Milstein and Mark Smith, “Will the Surgical World Become Flat?,” Health Affairs, 26, no. 1 (2007): 138.