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Last Week Tonight with John Oliver: Retirement Plans

Anyone annoyed or worried by the relentless TV and print ads implying that your best hope for a”brilliant” financial future rests upon hiring a corporate financial advisor, this episode is for you. Advertisers can’t promise specific results because that’s against the law, but they sure know how to use fear and greed to their advantage. John Oliver shows how saving for retirement means navigating a potential minefield of high fees and bad advice.

Watch on youtube: https://www.youtube.com/watch?v=gvZSpET11ZY
Show date: Jun 12, 2016 (HBO)

Judge Overturns IRS on Artist Tax Deductions

Posted by Mostafa Heddaya on October 7, 2014 at http://hyperallergic.com/153951/judge-overturns-irs-on-artist-tax-deductions/

A ruling by the United States Tax Court last week held that an artist employed as a professor could still claim tax deductions on her independent output, the New York Times reported. The case, which centered around Hunter College professor Susan Crile, affirmed that the right to claim an Internal Revenue Service (IRS) income tax deduction on expenses related to your status as a professional artist is not jeopardized by low sales or other full time employment (in this case, teaching). The IRS had argued that Crile’s claim to be both an artist and a teacher was an “artificial” distinction, since her work was produced as a corollary of her full-time job, not as an independent avocation, and could therefore not be grounds for deductions.

Though the ruling ultimately only affects a small number of artists — artists who teach or have another form of primary employment whose duties involve making art, while at the same time producing and selling art independently — Crile’s success in claiming the deduction cements, by some accounts, the tax security of artists. Yale School of Art dean Robert Storr told the Times that the right to claim deductions on such expenses was “one of the last remaining areas where the federal government cuts artists any slack to allow them to do what they do.”

Though a good deal of successful artists are also full-time academics, including some who earn much larger sums than Crile, it would appear that the Hunter College professor’s case was unique. And although she made relatively little off her politically-inclined prints and paintings on an annualized basis (just under $16,000 per year from 1971 to 2013), her career earnings of $667,902 still place her at the top of the financial echelon of working artists. That the IRS initially refused to allow her to claim deductions on this work, which has been collected at the Guggenheim and Metropolitan Museums, among others, seems ever the more strange, and the success of her defense all the more justified.

How to File a Complaint, Grievance, Appeal, or Request for Independent Medical Review

If you do not agree with a coverage decision by your insurance plan, the first step is to file a grievance/appeal with your health plan by phone, mail, fax. You may also be able to file on your plan’s website. If you don’t get traction with your appeal, review your next steps in the letter the insurance company sent, which is to file your next appeal/complaint with California Department of Managed Health Care (regulates most HMO plans), or California Department of Insurance (regulates most PPO plans).

Health plans are required by law to have a grievance process in place to resolve member complaints within 30 days. In most circumstances, you are required to file a grievance regarding each issue/request with your health plan and participate in the process for 30 days before submitting a complaint to the Department. Exceptions to this requirement include when there is an immediate threat to your health or the request was denied as experimental/investigational in either instance, you may seek DMHC’s help immediately.

California Department of Managed Health Care (DMHC)
The DMHC regulates most HMO plans

  • Phone: 888-466-2219
  • Web: http://www.dmhc.ca.gov/
  • Click “File a Complaint” or call 1-888-466-2219
  • Call if you have an immediate need for health services and a delay could seriously jeopardize your health.
  • Email inquiries: please use the DMHC website Contact Form.

California Department of Insurance (DOI)
The DOI regulates most PPO plans

Covered California

  • If you do not agree with an enrollment decision by Covered CA, call them at 800-300-1506 and ask for an appeal form. It is called Request for a State Fair Hearing to Appeal a Covered CA Eligibility Determination.
  • If you do not agree with a coverage decision made by your insurance plan, do not call Covered CA, but instead file a grievance/appeal with your health plan by phone or by mail. You may also be able to file on your plan’s website.

Medi-Cal

Health plans are required by law to have a grievance process in place to resolve member complaints within 30 days. In most circumstances, you are required to file a grievance regarding each issue/request with your health plan and participate in the process for 30 days before submitting a complaint to the Department. Exceptions to this requirement include when there is an immediate threat to your health or the request was denied as experimental/investigational in either instance, you may seek DMHC’s help immediately.

Health Insurance Billing Issues

Lisa Zamosky’s excellent L.A. Times article on 09/18/2015 was about people being illegally billed for charges not paid by Medi-Cal.  Below are some contacts that may be of assistance in resolving billing and other healthcare issues for not just Medi-Cal.

Medi-Cal

  • If you get a bill, contact your doctor’s office to confirm they have all of your insurance information. Billing Medi-Cal patients for any balance not covered by insurance is a violation of the law.
  • Don’t ignore bills. Providers regularly send outstanding bills to collections, which can wreak havoc on your credit. Don’t ignore notices.
  • The Medi-Cal Ombudsman can help members with billing matters. Call (888) 452-8609 or send email to MMCDOmbudsmanOffice@dhcs.ca.gov

Health Plan Issues

  • The California Department of Managed Health Care Help Center offers assistance at (888) 466-2219 or online at www.HealthHelp.ca.gov.
  • Neighborhood Legal Services of Los Angeles County’s Health Consumer Center provides L.A. County residents with free advice and legal services. Attorneys can be reached at (800) 896-3202.
  • Outside of L.A. County, call the Health Consumer Alliance statewide line at (888) 804-3536 or visit Healthconsumer.org.

Patient advocate and medical bill specialist services

  • Many large and mid-size companies offer medical advocate services. Check with your human resources department.
  • Claims Assistance Professionals: http://www.claims.org/refer.php
  • Alliance of Professional Health Advocates directory: http://www.advoconnection.com/
  • Medical Billing Advocates of America: http://billadvocates.com/dispute-medical-bill/
  • Health Proponent offers “access to expert, personalized help to resolve a full range of healthcare and insurance-related problems, and can save you time, money and worry.” If they are able to negotiate a lower bill from your healthcare provider, for example, they take 25% of the savings for their fee. You must enroll in their basic program for $59.95/mo (as of this writing) in order to use their bill saver program. For details send an email to info@haihealthproponent.com or call 1-866-939-3435.

How to File a Complaint, Grievance, Appeal, or Request for Independent Medical Review.

If you do not agree with a coverage decision by your insurance plan, the first step is to file a grievance/appeal with your health plan by phone, mail, fax. You may also be able to file on your plan’s website. If you don’t get traction with your appeal, review your next steps in the letter the insurance company sent, which is to file your next appeal/complaint with California Department of Managed Health Care (regulates most HMO plans), or California Department of Insurance (regulates most PPO plans).

Health plans are required by law to have a grievance process in place to resolve member complaints within 30 days. In most circumstances, you are required to file a grievance regarding each issue/request with your health plan and participate in the process for 30 days before submitting a complaint to the Department. Exceptions to this requirement include when there is an immediate threat to your health or the request was denied as experimental/investigational in either instance, you may seek DMHC’s help immediately.

California Department of Managed Health Care (DMHC)
The DMHC regulates most HMO plans

  • Phone: 888-466-2219
  • Web: http://www.dmhc.ca.gov/
  • Click “File a Complaint” or call 1-888-466-2219
  • Call if you have an immediate need for health services and a delay could seriously jeopardize your health.
  • Email inquiries: please use the DMHC website Contact Form.

California Department of Insurance (DOI)
The DOI regulates most PPO plans

Covered California

  • If you do not agree with an enrollment decision by Covered CA, call them at 800-300-1506 and ask for an appeal form. It is called Request for a State Fair Hearing to Appeal a Covered CA Eligibility Determination.
  • If you do not agree with a coverage decision made by your insurance plan, do not call Covered CA, but instead file a grievance/appeal with your health plan by phone or by mail. You may also be able to file on your plan’s website.

Medi-Cal

Health plans are required by law to have a grievance process in place to resolve member complaints within 30 days. In most circumstances, you are required to file a grievance regarding each issue/request with your health plan and participate in the process for 30 days before submitting a complaint to the Department. Exceptions to this requirement include when there is an immediate threat to your health or the request was denied as experimental/investigational in either instance, you may seek DMHC’s help immediately.

Health Net poised to exit individual PPO marketplace in LA County

Yours truly (Michael Grodsky) was trying to dig up the scoop on 2016 rates for individual Health Net PPO plans. Open enrollment doesn’t begin until November 1, and there weren’t any rate books I could download.  So I looked up Health Net’s rate filings submitted to the CA Dept of Insurance. (See for yourself at http://bit.ly/1gyNPpR, but weeding through the documents is not for the faint of heart).

To my surprise, there were no rates listed for Region 16! Region 16 is most of Los Angeles County, except zip codes beginning 906, 907, 908, 909, 910, 911, 912, 915, 917, 918 and 935, which belong to Region 15.

I got on the horn with Health Net producer support, and asked if it was true that Health Net was bailing out of LA County. After a few beats, Tamara told me there have been whispers, and she’d check to see if she was allowed to say anything about it. She came back on the line and, nope, it’s under wraps until publicly released.

It’s possible Health Net could change its mind, but that seems unlikely to since it would require another rate filing and it’s pretty late in the day for that to happen. If you already have a HealthNet PPO plan and you live in Region 16, it remains to be seen whether or not you can keep your plan.

Covered CA gets its Medicare facts wrong

Sigh…you’d think Covered CA would ask someone with Medicare experience to proof read before publishing, but on 9/10/2015 an agent briefing announced a new Medicare Fact Sheet. They goofed up about the Part B Late Enrollment Penalty, as described at the top of page 5 of the fact sheet.

“A penalty applies to Part B, as well. The monthly premium for Part B may go up 10% for each full 12-month period that the individual could have had Part B, but did not sign up for it. For example, if someone was eligible for Part B for two years but did not enroll until the third year, the person would have to pay the higher premium for the first two years of enrollment in Part B.”

Nope!  Medicare clearly states You’ll have to pay this penalty for as long as you have Part B. (Not just for the first two years as in the example.)  I called Covered CA agent support to let them know so they could fix it.  Maybe they will.

Now, Part A Late Enrollment Penalty does have a limited time span, but not Part B, or Part D for that matter. However, they smartly wrote a person should contact Medicare regarding the Part D Late Enrollment Penalty. Would that Covered California had had the smarts to follow their own advice.

 

 

 

UCLA now in-network with Blue Shield individual & family plans

Effective July 1, 2015, Blue Shield of California has reached a new three-year HMO/PPO network agreement (group plans) with the University of California providers. In addition, UC Health System providers will participate in Blue Shield’s Individual and Family Plan (IFP) Exclusive PPO Network and IFP EPO Network with Covered California on-Exchange and off-Exchange directly through Blue Shield.

Providers include the following hospitals and IPA/medical groups:

  • UC Davis Medical Group
  • UC Davis Medical Center
  • UCLA Medical Group
  • Ronald Reagan UCLA Medical Center and UCLA Medical Center Santa Monica
  • UC Irvine Medical Center
  • UCSD Medical Group
  • UCSD La Jolla and UCSD Hillcrest
  • UCSF Medical Center (Parnassus, Mt. Zion, Mission Bay) and Langley Porter Psychiatric Institute

Late Medicare Enrollees Pay a Price, by Lisa Zamosky

Kudos to Lisa’s excellent article in today’s Los Angeles Times describing the tricky nuances of Medicare eligibility and enrollment.  While mostly accurate, even policy wonks sometimes get it wrong, as when Lisa writes “You can’t delay enrollment and avoid the [Part B late enrollment] penalty if you work for a firm with fewer than 20 employees.”

The fact is, there is no Part B penalty1 while a Medicare-eligible person has employer-sponsored coverage, regardless of the number of employees.  Lisa may have been thinking about whether Medicare is primary payor or secondary payor for enrollees of group health plans. For employers with fewer than 20 employers, Medicare is almost always primary, and if the employee does not enroll in Part B they will have no primary coverage! Yikes!!!

Therefore, it’s usually not a good idea to delay enrollment in Part B if your company has fewer than 20 EEs–but not because of any penalty.


Sources 

Show 1 footnote

  1. If you don’t sign up for Part B when you’re first eligible or if you drop Part B and then get it later, you may have to pay a late enrollment penalty for as long as you have Medicare. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it.

Medicare Fee Schedules

Medicare Physician Fee Schedules (MPFS)

CPT code (Current Procedural Terminology Code)
American Medical Association CPT code lookup: https://ocm.ama-assn.org/OCM/CPTRelativeValueSearch.do

Medicare Part B pays for physician services based on the Medicare Physician Fee Schedule (MPFS), which lists the more than 7,400 unique covered services and their payment rates. Physicians’ services include the following:

  • Office visits;
  • Surgical procedures;
  • Anesthesia services; and
  • A range of other diagnostic and therapeutic services.

    View the educational CMS MPFS Fact Sheet. This link will take you to an external website. which includes information on physician services, MPFS payment rates and MPFS payment rates formula.

    The CY 2015 MPFSDB fees posted are valid from January 1, 2015 through March 31, 2015.  For counties other than Los Angeles, click here.

Los Angeles County physician fee schedules

Online tools to find cash prices for medical procedures

Read Lisa Zamosky’s article describes online services to price shop for various medical procedures.

Resources listed in her story include

  • MediBid. For $4.95 a month or $25 for a year of unlimited requests, patients can post the medical services they need, and doctors bid for their business.
  • San Francisco-based Pokitdok (pokitdok.com) operates in 44 markets including Los Angeles. You can search the 50 most shopped medical procedures among 40,000 providers who have submitted their cash price.
  • New York-based Clear Health Costs (clearhealthcosts.com) was started in 2010 by former New York Times reporter Jeanne Pinder. Its staff queries individual healthcare providers in eight markets, including Los Angeles, for a cash price on up to 35 common medical procedures.