Best insurance law

State’s plan to assess 50Gs more will force many to close practices, Island opponents say
Staten Island doctors fear a proposal being floated to hit them with a $50,000 surcharge to solve the state’s medical malpractice insurance funding woes could drive droves of physicians, from internists to high-risk specialists, out of medicine.
Even worse, they say, it will adversely impact patients.
“There’s going to be practices going out of business and the higher-tech specialties [such as obstetricians, neurosurgeons and orthopedists] are going to be harder to find. Everybody’s nervous about what’s going to happen, ” warned Dr. Ralph K. Messo, president of the Richmond County Medical Society, who practices internal medicine and pediatrics in Eltingville. “It’s going to affect patient care.”
Dr. John Maese, a past president of the medical society, paints an even gloomier picture.
“It will just be the death knell of primary care,” said Maese, who practices internal medicine and geriatrics in Eltingville and is on the board of governors of the American College of Physicians.
“There’s no way you have a spare $50,000 to cover that on top of your regular $30,000 [in annual medical malpractice insurance a Staten Island general practitioner typically pays]. Primary care practices run on a very tight [profit] margin.”
“I think private practice as we understand it will be gone,” predicted Dr. Maese, adding doctors likely will join hospital staffs.
And internists are on the low-end of the premium spectrum.
The typical Island obstetrician-gynecologist pays an eye-popping $160,000 to $225,000 in annual malpractice premiums, doctors say. A neurosurgeon on Long Island pays more than $300,000 a year, according to the state Medical Society.
The Medical Malpractice Insurance Plan, the state-regulated, high-risk pool for doctors declined coverage by commercial carriers, is $500 million in debt.
In July, Gov. Eliot Spitzer created a task force to probe the state’s soaring medical malpractice costs. The group was formed on the heels of a 14-percent medical malpractice insurance premium spike — the largest increase in 14 years.
The committee, headed by state Insurance Superintendent Eric R. Dinallo and Dr. Richard F. Daines, the state health commissioner, was charged to consider all possible solutions to control medical malpractice costs, including risk management, legal reform and regulatory changes. It seeks both short-term and long-term options.
Its report, originally slated to be completed Dec. 31, isn’t finished and a new date has not been set, officials said.
SUB: INITIAL WORRY
At the time the committee was formed, Daines said in a statement, he feared increasing malpractice insurance costs “will drive some physicians out of the field and will discourage young people from entering the medical profession.”
Meanwhile, Dinallo said insurers’ financial states were “rapidly eroding.”
Dinallo said the prior administration in Albany had kept malpractice insurance premiums “artificially low” for years. In addition, it had appropriated $691 million of medical malpractice insurance reserve funds for general state expenses, which ultimately helped create the current crisis for doctors and insurers, he said.

Health Insurance
According to published reports, doctors in the high-risk pool that is deeply in debt, whose premiums are substantially more than their colleagues, could also be the specific targets of a surcharge.
David Neustadt, an Insurance Department spokesman declined to speculate last week on any conclusions the task force might have reached. But he said current state law provides that doctors can be surcharged to make up deficits to pay medical malpractice claims.
“That’s not saying that’s going to happen,” stressed Neustadt, adding that any surcharge would not be tacked on to doctors’ current annual premiums, and would be paid over time.
A surcharge is especially problematic, doctors contend, because they can’t pass costs on to patients, as say, supermarkets can to customers, if the price of tomatoes sky-rockets. Nor do they want to.
“Our rates are essentially fixed by the insurance industry,” said Dr. Jack D’Angelo, who practices physical medicine in New Dorp and is a past president of the county medical society.
Despite public perception, many doctors don’t live on easy street, he said.
The typical Staten Island general practitioner earns between $130,000 and $150,000 a year. Expenses and overhead are rising, but medical reimbursements aren’t keeping pace, so a $50,000 surcharge would really hurt.
“It’ll be a huge burden,” said Dr. D’Angelo. “As physicians, we believe strongly we can’t absorb it.” Вђ
SUB: IMPACT ON CARE
Those who can’t take on the added costs may have to leave the field — or join a hospital.
Many have already done so.
From 2000 to 2004, the Island lost 19 percent of its full-time primary care physicians per capita — a greater loss of doctors per capita than in any other borough, according to a survey by the State University of New York at Albany, the Advance has reported.
While Manhattan had an average of 181 primary care doctors per 100,000 residents, Staten Island had a little more than 75 doctors for the same population.
“Patients won’t be able to get the proper care,” warns Dr. Joseph Motta, president of the medical staff at Richmond University Medical Center, West Brighton, and the immediate past president of the county medical society. “The potential problems will take on a global significance.”
Specialty practices also have been hard-hit.
Dr. Mitchell Maiman, chairman of obstetrics and gynecology at Staten Island University Hospital, recently estimated that 12 or 13 OB-GYNs — or about half those associated with the hospital — have limited their practice or left it in the past seven to eight years due to soaring medical malpractice premiums or fear of litigation.
“The last thing we want is for physicians to decide if they have to go out of business,” said Rep. Vito Fossella (R-Staten Island/Brooklyn), who, along with state Sen. Andrew Lanza (R-Staten Island) last week urged Gov. Spitzer to take the surcharge proposal off the table. “Patients will ultimately suffer. One of the suggested cures [by the task force] could be worse than the illness.”
Doctors D’Angelo, Maese, Messo and Motta advocate tort reform — capping limits on pain and suffering awards — and perhaps even establishing medical malpractice courts where a panel of medical experts decides malpractice claims. Fossella also is a tort-reform proponent.
Dr. D’Angelo further suggests that profitable insurance carriers help assume some of the premium burdens.
Critics, however, contend the court system works fine. Instead of griping about it, they say doctors and the state need to do a better job of weeding out the small number of bad physicians.
According to a 2003 study by Public Citizen, a national non-profit consumer watchdog, 7 percent of the state’s 80,000 doctors account for 68 percent of medical malpractice payouts.
Dr. Messo said finding an equitable solution is crucial, and everyone from politicians to insurance carriers, must pitch in.
“Right now, it’s the physicians’ problem,” he said. “Tomorrow it will be the public’s problem.”

Frank Donnelly is a news reporter for the Advance. He may be reached at fdonnelly@siadvance.com.

Island Insurance Co. is giving its homeowner policyholders access to Life Stages, an identity theft management program.

The Honolulu-based insurance carrier and Identity Theft 911, a provider of identity theft management, education and resolution services, offer support through fraud specialists and other services that help prevent or resolve identity theft.

The new program is available free to policyholders and immediate household members, the company said Tuesday. Policyholders are also given educational resources to help prevent identity theft.

Island Insurance said it is the first insurance carrier in the nation to provide the Life Stages program.

Acknowledging the concerns of hundreds of freelance workers, MTV Networks on Wednesday reversed some of the cuts it had intended to make to benefits packages.

Some workers said they would continue to challenge the remaining proposed changes, and nearly 100 of them protested for a third day outside the headquarters in Times Square of Viacom, MTV’s parent, amid throngs of holiday tourists.

MTV Networks relies heavily on freelancers to produce content for MTV, VH1, Nickelodeon, and other cable channels and Web sites. Last week, it told freelancers that the changes it was making to the company’s benefits plans would substantially reduce their health care and dental coverage.

Most freelancers receive no benefits from the companies that hire them, but Viacom maintains a stable of permanent freelancers who work like full-time employees and do receive benefits packages, albeit less generous ones than those given to permanent, full-time staff members.

On Wednesday, the company said freelancers would be permitted to keep their current health care plans, and it extended by two months the deadline for freelancers to choose plans. The company also said it would evaluate whether some freelance positions should be converted to staff jobs.

Despite the changes, some of the freelancers walked out of work again Wednesday to chant “Shame on Viacom” and “We’re being Punk’d,” a reference to an MTV reality series.

Brian, a two-year freelancer at Nickelodeon who would give only his first name for fear of retaliation, said the protests would continue despite the changes.

Cancer insurance

“It’s better, but it’s not great,” he said. “It’s certainly not what we had before.”

Protesters said they were seeking the restoration of paid time off, tuition reimbursement and company matching for 401(k) contributions. A company spokeswoman said she anticipated no further changes to the proposed benefits package.

Protests by freelance workers are uncommon because the workers have little job security.

Robert D. Lipman, an employment lawyer based in Jericho, N.Y., said companies often classify full-time employees as freelancers or independent contractors to avoid certain tax and benefit laws. “There’s a lot of abuse in this area,” he said.

Six months ago, Gov. Eliot Spitzer of New York said his administration would try to crack down on companies that took advantage of the freelance or contractor designations.

Canada’s insurers face an uphill battle selling long-term-care insurance, and they’ll have to try harder to persuade me.

We all know there’s a chance we will eventually need help to perform normal activities of daily living.

But the cost of insurance to pay for someone to help us bathe, eat, dress, use the washroom or move from bed to a chair is high.

We would have to be incapable of doing two of those things for more than three months before we would collect a cent from one of these insurance policies.

And I have yet to see a private insurer provide the detailed analysis it would take to persuade me that my wife and I should fork out nearly $5,500 a year from our pension income to maintain such coverage.

Manulife Financial has recently announced what it says is a unique shared-coverage option with the company’s LivingCare policy that would save couples money compared with two separate policies, but only about 10 per cent.

A couple would pay $3,376 a year at age 50, or $7,551 from age 65, to buy a benefit that would pay the equivalent of $1,500 a month for care in the home or $3,000 for care in a facility, up to a maximum of $300,000 per person.

All benefit amounts would be adjusted by 2 per cent a year to deal with inflation.

But premiums would be payable to age 100, and could be adjusted upward if Manulife had underestimated the cost of the program.

Other policy options are available, but few consumers have been drawn to this type of insurance.

One marketing research firm has estimated reporting insurers have sold only about 60,000 individual long-term-care policies to Canadians after several years of trying.

A poll conducted for Manulife Financial suggests most us are worried about eventually needing long-term care.

But most of us expect to use our savings, government programs and the equity in our homes to pay for the cost of care, should we need to.

Paul Smith, Manulife’s vice-president of marketing and product development, pointed out in a recent news release that government programs are likely to come under strain.

“By 2021, there will be nearly seven million seniors for the health-care systems to support, representing 19 per cent of Canada’s total population.”

But the cost of long-term care is not a major portion of the total health-care budget, and the expense is shared by the working population, by retirees and by the residents of nursing homes themselves.

Only about 4 per cent of Ontario residents over the age of 65 are now in some form of long-term-care facility, according to a spokesperson for the Ministry of Health and Long-Term Care.

They are paying from their own pockets up to $1,543.95 a month for basic accommodation and $2,091.45 for a private room, plus other fees for hairdressing, cable TV and telephone services.

A subsidy is available only to those in need, and only for basic care.

The background material with Manulife’s latest news release has eight graphs to illustrate the results of the consumer survey, but doesn’t contain a single mention of prices, or the impact the new shared-coverage option will have on prices for couples.

We had to ask three times before we got an answer to our question about prices.

That would seem a fundamental piece of information for persuading consumers that such an insurance policy is a smart choice.

Here’s a topic that inspires fear, loathing — and boredom.

Yes, we’re talking travel insurance. We fear illness and accidents, loathe thinking about them when we plan a trip and are too bored to plow through 20 pages of fine print on an insurance certificate.

“Nine times out of 10, they don’t read it,” Angela Norton, spokeswoman for CSA Travel Protection in San Diego, said of travelers who buy packaged policies for trip cancellation and interruption, medical costs and evacuation, luggage loss and other mishaps.

Now, some heavy-hitting critics are asking, “Why bother?”

First, Consumer Reports magazine in May ran an article titled, “Travel Insurance: Why You Rarely Need It.”

One of the experts quoted, Bob Hunter, director of insurance for the Consumer Federation of America in Washington, D.C., told me that the typical traveler can afford to forfeit trip deposits and is covered by medical insurance homeowners’ policies or credit cards for most other losses.

In emergencies, he added, airlines and other suppliers may offer refunds or waive penalties.

“I never buy travel insurance,” said Hunter, a former federal insurance administrator under presidents Ford and Carter.

Then, in September, Jeffrey Miller, a travel attorney and consultant in Columbia, Md., wrote a piece in the trade magazine Travel Weekly titled “Losing Faith in Travel Insurance.”

After 15 years of encouraging travel agents to sell such policies, which can pay commissions of 25% or more, he wrote, “I no longer believe travel insurance to be a vacation staple.”

Miller said that in the last year, many friends and clients had complained about insurers denying apparently legitimate claims and that confusion reigned over what policies cover.

After his article ran, he said he “got a lot of grief from the industry.”

In separate letters, Brad Finkle, president of the U.S. Travel Insurance Assn. in Richmond, Va., criticized the Consumer Reports and Miller’s articles.

Finkle wrote that the “vast majority” of travel-insurance claims were paid and that consumers needed to take responsibility for reading their policies. Only travel insurance, he added, covers most losses from trip interruptions and cancellations, the most common claims.

Neither the insurance organization nor several insurers I contacted would say how much companies paid in claims. (Organization officials said they didn’t know, and insurers cited competitive reasons for not disclosing figures.) But it is, without a doubt, a big industry.

Americans spent more than $1.3 billion on travel insurance in 2006, the association said. About half of U.S. travelers who take a cruise, a tour or fly internationally buy policies, the association estimates, up from 10% or less before Sept. 11, 2001. My take? Most packaged policies I’ve seen are difficult to read and interpret. But because they cover you for many mishaps and premiums are modest — typically 4% to 8% of the trip cost — they can be worth buying if you’re spending thousands on your getaway.

Sometimes, insurance can really pay off.

Tully Seymour, a retired judge from Newport Beach, figures he collected more than $20,000 on a travel policy that cost him a few hundred dollars after he broke his shoulder two years ago skiing in Austria.

Seymour estimated that his insurer paid $2,500 for his evacuation from the mountain, $8,000 for medical treatment and $12,000 for first-class air tickets to get him and his wife, Janette, home. “I was just treated royally,” he said.

And although policy exclusions can be mind-boggling, so can the range of coverage, as some Southern Californians learned during the recent wildfires.

The good news: If a natural disaster makes your home uninhabitable before your scheduled departure, many policies will pay for trip cancellation.

The bad news: Insurers don’t agree on what “uninhabitable” means.

At M.H. Ross Travel Insurance Services in Northridge, “uninhabitable” includes mandatory evacuations, even if your home is undamaged, a spokeswoman said.

At CSA and Access America, evacuations usually don’t qualify a home as uninhabitable, but company representatives said they were making exceptions for policyholders in some of the fire-hit areas.

How can you inhabit your home if you can’t get to it?

That’s a riddle only an insurer could answer.

Most Colorado employers think everyone should be required to have health insurance, according to a recent survey from the Business Health Forum.

The survey, conducted among members of the business community in six cities, was designed to tap employers’ perspectives in the debate over health care reform.

According to the survey, 62 percent of the respondents agree that health insurance should be mandatory.

Four out of five of the proposals being studied by the state’s Blue Ribbon Commission for Health Care Reform call for individual mandates as one way to provide coverage to Colorado’s roughly 800,000 uninsured residents.

Health care experts say the uninsured create higher health care costs because providers like hospitals pass uncompensated costs to health insurers — resulting in double-digit premium increases for employers.

The commission is preparing a report to state legislators that will outline policies that could retify the problem.

The survey showed that 67 percent of respondents said employees should be protected from having to spend more than a certain percentage of their family income on insurance.

But the survey also showed that only 42 percent of the participants believe employers should be required to provide insurance or pay into a purchasing pool that will help uninsured employees obtain some kind of coverage. Eighty-five percent of the respondents said government subsidies should allow people to buy into the private market.

Ninety-one percent said portability or continuity of health coverage ought to be assured for indiviuals and families.

When a wall of fire rushed toward Patty Thompson’s house last week, all she thought of was getting her husband and two sons out safely.

As embers the size of Coke cans rained down, the family took refuge at a relative’s house. That’s when Thompson’s thoughts turned to rebuilding. Her insurance agent told her years ago that she had enough coverage to replace her house if disaster struck. She’ll soon find out if that’s true.