Opinion: A Health Insurance Detective Story





I’VE had a long career as a business journalist, beginning at Forbes and including eight years as the editor of Money, a personal finance magazine. But I’ve never faced a more confounding reporting challenge than the one I’m engaged in now: What will I pay next year for the pill that controls my blood cancer?




After making more than 70 phone calls to 16 organizations over the past few weeks, I’m still not totally sure what I will owe for my Revlimid, a derivative of thalidomide that is keeping my multiple myeloma in check. The drug is extremely expensive — about $11,000 retail for a four-week supply, $132,000 a year, $524 a pill. Time Warner, my former employer, has covered me for years under its Supplementary Medicare Program, a plan for retirees that included a special Writers Guild benefit capping my out-of-pocket prescription costs at $1,000 a year. That out-of-pocket limit is scheduled to expire on Jan. 1. So what will my Revlimid cost me next year?


The answers I got ranged from $20 a month to $17,000 a year. One of the first people I phoned said that no matter what I heard, I wouldn’t know the cost until I filed a claim in January. Seventy phone calls later, that may still be the most reliable thing anyone has told me.


Like around 47 million other Medicare beneficiaries, I have until this Friday, Dec. 7, when open enrollment ends, to choose my 2013 Medicare coverage, either through traditional Medicare or a private insurer, as well as my drug coverage — or I will risk all sorts of complications and potential late penalties.


But if a seasoned personal-finance journalist can’t get a straight answer to a simple question, what chance do most people have of picking the right health insurance option?


A study published in the journal Health Affairs in October estimated that a mere 5.2 percent of Medicare Part D beneficiaries chose the cheapest coverage that met their needs. All in all, consumers appear to be wasting roughly $11 billion a year on their Part D coverage, partly, I think, because they don’t get reliable answers to straightforward questions.


Here’s a snapshot of my surreal experience:


NOV. 7 A packet from Time Warner informs me that the company’s new 2013 Retiree Health Care Plan has “no out-of-pocket limit on your expenses.” But Erin, the person who answers at the company’s Benefits Service Center, tells me that the new plan will have “no practical effect” on me. What about the $1,000-a-year cap on drug costs? Is that really being eliminated? “Yes,” she says, “there’s no limit on out-of-pocket expenses in 2013.” I tell her I think that could have a major effect on me.


Next I talk to David at CVS/Caremark, Time Warner’s new drug insurance provider. He thinks my out-of-pocket cost for Revlimid next year will be $6,900. He says, “I know I’m scaring you.”


I call back Erin at Time Warner. She mentions something about $10,000 and says she’ll get an estimate for me in two business days.


NOV. 8 I phone Medicare. Jay says that if I switch to Medicare’s Part D prescription coverage, with a new provider, Revlimid’s cost will drive me into Medicare’s “catastrophic coverage.” I’d pay $2,819 the first month, and 5 percent of the cost of the drug thereafter — $563 a month or maybe $561. Anyway, roughly $9,000 for the year. Jay says AARP’s Part D plan may be a good option.


NOV. 9 Erin at Time Warner tells me that the company’s policy bundles United Healthcare medical coverage with CVS/Caremark’s drug coverage. I can’t accept the medical plan and cherry-pick prescription coverage elsewhere. It’s take it or leave it. Then she puts CVS’s Michele on the line to get me a Revlimid quote. Michele says Time Warner hasn’t transferred my insurance information. She can’t give me a quote without it. Erin says she will not call me with an update. I’ll have to call her.


My oncologist’s assistant steers me to Celgene, Revlimid’s manufacturer. Jennifer in “patient support” says premium assistance grants can cut the cost of Revlimid to $20 or $30 a month. She says, “You’re going to be O.K.” If my income is low enough to qualify for assistance.


NOV. 12 I try CVS again. Christine says my insurance records still have not been transferred, but she thinks my Revlimid might cost $17,000 a year.


Adriana at Medicare warns me that AARP and other Part D providers will require “prior authorization” to cover my Revlimid, so it’s probably best to stick with Time Warner no matter what the cost.


But Brooke at AARP insists that I don’t need prior authorization for my Revlimid, and so does her supervisor Brian — until he spots a footnote. Then he assures me that it will be easy to get prior authorization. All I need is a doctor’s note. My out-of-pocket cost for 2013: roughly $7,000.


NOV. 13 Linda at CVS says her company still doesn’t have my file, but from what she can see about Time Warner’s insurance plans my cost will be $60 a month — $720 for the year.


CVS assigns my case to Rebecca. She says she’s “sure all will be fine.” Well, “pretty sure.” She’s excited. She’s been with the company only a few months. This will be her first quote.


NOV. 14 Giddens at Time Warner puts in an “emergency update request” to get my files transferred to CVS.


Frank Lalli is an editorial consultant on retirement issues and a former senior executive editor at Time Warner’s Time Inc.



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Designer made herself into a manufacturer

Shoemaker Annie Mohaupt nearly closed down a year ago after her move to make sandals in China proved a bust. In the year that followed, she started her own factory in Chicago, producing and selling her luxury wooden shoes. (Posted Dec. 1st, 2012)









Shoemaker Annie Mohaupt nearly closed down a year ago after her move to make sandals in China proved a bust. The sandals could easily be pulled apart.

She looked into what it would cost to make her sandals in another country but returned production to Chicago. The decision, she said, allows her to tap into growing demand for U.S.-made products and to utilize manufacturing technology that makes her company, Mohop Inc., a global competitor.






"I have a factory," Mohaupt said, her statement reflecting her evolution from thinking of herself solely as a designer. As a manufacturer she understands she has control over the quality of her products — a key to sales and growth. "I'm happy but it's also intimidating. There is a lot to manage and wrap my head around."

Mohaupt's tale is illustrative of what manufacturing experts and politicians have been saying for quite some time: American manufacturers can be successful and create jobs by using the latest technology in producing and developing products.

So far this year, Mohaupt has sold about 1,500 pairs of sandals for about $158,000, she said. Mohaupt credits Facebook fans and word-of-mouth recommendations for a 500 percent increase in sales this fall over a year ago, and she expects to sell about 5,000 pairs of sandals in 2013. When she reaches annual sales of 10,000 pairs, Mohaupt said she'll need to invest in more equipment, like a new wood-cutting machine.

"I want for her to be making her shoes in the U.S.," said Greg Kaleel, owner of American Male & Co. a family-owned retail shop in Oswego, adding that his customers will pay more for shoes made here. "That's how important the 'made in America' is."

On a recent evening, the sweet smell of burned walnut filled Mohaupt's basement shop in a three-story building in Chicago's River West neighborhood. The smell emanated from a computerized machine about the size of a pingpong table cutting walnut blocks into triangles with concave curves and arches. Those curves support the heel and arch of a woman's foot and create a sleek, sophisticated look.

An architect by training, Mohaupt, 37, feeds her three-dimensional designs into a program that converts it into letters and numbers and tells the machine where to cut. That was the easy part for her to learn. To operate the machine, Mohaupt relied on a tutorial from the machine-maker and learned the rest via the Internet.

The soft-spoken woman employs three people, including an office manager and a young designer. If sandals sell as planned, she would hire four to six temporary workers in the spring. That's when sales typically ramp up after the winter lull. Mohaupt wants to expand her product line to lessen her dependence on sandal sales. One idea is a moccasin she can sell in the cold months.

Mohaupt has come a long way since 2005, when she cut and glued layers of plywood by hand to make her sandals. Her early versions featured a cylindrical wooden heel and elastic loops on each side of the sole that acted as guides for ties or ribbons that customers could change at will — her signature design.

She sold her first sandals for $70 at a craft fair and appeared to be off and running. The bliss of her success crumbled the following morning when customers complained that the shoes easily came apart. The heels broke off and the loops snapped. In effect, the stumble marked the beginning of her apprenticeship as a manufacturer.

Mohaupt spent the next year quizzing seasoned shoemakers and shoe repairers about how she could improve the quality of her shoes. Ultimately, she decided that her sandals should be able to withstand 100 miles of use. To test her designs, she wore her sandals while taking her dog on five-mile treks.

"I lost some weight," she said. She also test-marketed the evolving sandals by mailing samples to her first customers. Some got up to five pairs as Mohaupt developed — and later patented — a system to keep the elastic loops in place. One problem licked, she then focused on the labor involved.

Cutting the plywood by hand was grueling work in its own right. And then she had to glue together the layers. "I would end up covered in glue," she said.

So Mohaupt began experimenting with wooden blocks, which she'd sculpt with a saw into wedges. That eliminated having to glue together layers of plywood but still was physically draining.

That's when she made a decision that would forever change her business. In 2009 she bought on credit a $70,000 computer-driven machine that could read her 3-D designs and cut heels in minutes, saving hours of labor. The machine also allowed Mohaupt to experiment with new designs. For example, she could for the first time produce curved heel bases and make shoes with added arch support.

Demand grew steadily, which should have been a good problem. But even with the machine she couldn't keep pace with orders. Mohaupt tried training people to make the sandals but found that she couldn't train them and make shoes at the same time.

That's when she first considered outsourcing production. She tested a Canadian shoemaker but severed the relationship after it sent her a shipment of poorly made shoes. Mohaupt also was unsuccessful in lining up production in Argentina.

Then, suddenly, a competitor emerged that jolted her into making a decision that ultimately would nearly bring down her company. The competitor was selling sandals almost identical to hers and nudging her sandals out of local shops she had supplied for years. Its prices also were lower because it was producing its sandals in China. She faced being driven out of business, she said.

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Kansas City Chiefs linebacker Jovan Belcher kills girlfriend, self


















Police say a 25-year-old Kansas City Chiefs player was involved in two shootings Saturday, one of which occurred in the parking lot near Arrowhead Stadium. (Dec. 1)














































KANSAS CITY, Mo. -- Kansas City Chiefs linebacker Jovan Belcher this morning shot and killed his girlfriend before going to Arrowhead Stadium and fatally shooting himself as team personnel tried to stop him, police said.

Police Capt. David Lindaman said Belcher, 25, and his girlfriend, 22, got into an argument around 7 a.m. at their home in the 5400 block of Crysler Avenue in Kansas City. Around 7:50 a.m., Lindaman said, Belcher shot his girlfriend multiple times. She was taken to a hospital, where she was pronounced dead.






The Star is not naming the victim at this time pending assurances that her family has been notified.

Lindaman said Belcher’s mother, who was visiting the couple and their 3-month-old daughter, witnessed the shooting and was being interviewed by police.

Belcher left the scene on Crysler and went to the Chiefs practice facility at Arrowhead, police said.

Police were called to the stadium around 8:10 a.m. When Belcher arrived there he encountered General Manager Scott Pioli, Coach Romeo Crennel and other team personnel. Police said Chiefs staff attempted to keep Belcher from committing additional acts of violence. When police arrived, they heard a gunshot and found that Belcher had shot himself in the head.

The Chiefs released the following statement: “We can confirm that there was an incident at Arrowhead earlier this morning. We are cooperating with authorites in their investigation.”

Outside the home on Crysler, Jennifer Ashley, who said she was a friend of Belcher’s girlfriend, said the woman was a student at Blue River Community College in Independence and had started dating Belcher after being introduced to him by the girlfriend of another Chiefs player.

Belcher, originally from Long Island, N.Y., had been with the Chiefs for four years. He joined the team as an undrafted free agent out of the University of Maine.


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The Kids Are All Right: How Social Media Created a Generation of Activists












This week marked the nation’s inaugural  “Giving Tuesday,” a UN sponsored initiative, which utilized social media to encourage businesses, schools, and community members to give back. The effort resulted in $ 10 million worth of donations made in a single day, a 53 percent increase over the same day last year.


Conceived as a means to promote activism and charity, the campaign’s use of social media to spread its message is most likely a large part of the initiative’s success. 












Certainly people from every age group use Twitter and Facebook, but social media activism is especially resonant with young adults. According to TBWA, people between the ages of 18-29 strongly identify as activists and count social media as their first point of engagement when they learn about a new cause.


MORE: ‘Tis Always the Season to Give: Creating a Corporate Culture That Gives Back


In fact, about half believe that activism is important to their personal identity and about a third look to it as a means of socializing and relating to one another.


But more than identifying with activism, this younger generation’s aptitude for social media can effect real change. Look at the Susan G. Komen Foundation. Earlier this year, when the organization announced it would pull its funding for breast cancer screenings from Planned Parenthood, cutting off medical access for millions of women, Twitter and Facebook lit up with vitriolic statements, claiming the organization had become a puppet of the religious right. The ensuing bad press proved to be too much and within days, the organization reversed its decision and issued a public apology.


Similarly, when Florida law enforcement officials refused to arrest George Zimmerman after he fatally shot Trayvon Martin, the case lay dormant for almost a month. But an online petition started by Martin’s parents went viral and galvanized a nation demanding justice for the boy’s death. Zimmerman was arrested and charged as a result.


For all we hear about “kids these days” and their irresponsible use of social media−posting questionable pictures of themselves doing kegstands or letting Twitter corrode their ability to hold a thought for more than a nanosecond−it turns out that most are using it to express a genuine passion for changing the world around them. And they’re succeeding.


And these trends extend well beyond the U.S. That same age group in other countries shows similar interests in contributing to larger causes. China’s young adults for instance, lead the world in online political discussions and offline they donate the most money to charities. India’s younger generation ranks the first in the world when it comes to staying informed, and they’re the most optimistic about the impact their activism has on the world around them.


It seems that our youngest generation of adults are the ones leading the charge when it comes to effectively making a difference.


Do you consider yourself an activist? Let us know in the Comments what social causes inspire you to get involved.


Related Stories on TakePart:


• Secret Santas: Profiles in Anonymous Holiday Generosity


• Rwanda Genocide Survivor Wins Grant for Giving Back


• 40 U.S. Billionaires Pledge Half of Fortunes to Charity



A Bay Area native, Andri Antoniades previously worked as a fashion industry journalist and medical writer.  In addition to reporting the weekend news on TakePart, she volunteers as a webeditor for locally-based nonprofits and works as a freelance feature writer for TimeOutLA.com. Email Andri | @andritweets | TakePart.com


Social Media News Headlines – Yahoo! News


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“Honey Boo Boo” star arrested for going ape on Georgia Freeway












LOS ANGELES (TheWrap.com) – If you tend to believe that the cast members of TLC reality series “Here Comes Honey Boo Boo” are less than totally evolved, rejoice; this story might just confirm your suspicions.


“Crazy” Tony Lindsey – the cousin of “Honey Boo Boo”‘s titular star Alana Thompson” – was arrested in Georgia earlier this week following a goofy, but dangerous, stunt involving a gorilla suit, TMZ reports.












A police report says that Lindsey was among a group of men arrested for reckless behavior after one of them, dressed in a gorilla suit, prepared to jump into a lane along Highway 20 at approximately 11 p.m. Unfortunately for the band of wrongheaded pranksters, Deputy Joe Rozier happened to be driving by as he was about to take the leap from the side of the road.


“I observed a white male dressed in a gorilla suit acting as if he was going to jump into my lane of travel. I swerved into the left lane to avoid an accident with the person,” Rozier said in a police report.


Rozier took pursuit, and “observed several white males run up the embankment and into the woods,” the report notes. After threatening to release his police dog, he heard a voice yell back, “You don’t have to do that, we’re coming back.”


A group of five adults and two minors emerged – but with no gorilla suit. After a while, however, they admitted to hiding the suit in the woods.


It’s not known if Lindsey was the one in gorilla suit, or if the stunt will be incorporated into an upcoming episode of “Here Comes Honey Boo Boo.”


A spokesperson for the show has not yet responded to TheWrap’s request for comment.


TV News Headlines – Yahoo! News


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Jewel parent says sale talks proceeding













 


Exterior of Jewel-Osco's first "Green Store" located at 370 N. Desplaines in Chicago.
(Antonio Perez / November 29, 2012)





















































Supervalu, the Minneapolis-based parent of Jewel-Osco said sale talks are proceeding after stock closed down more than 18 percent Thursday, to $2.28.

The beleaguered grocery chain was likely moving to combat reports that sale talks with suitor Cerberus Capital Management had stalled over funding.

"The company continues to be in active discussion with several parties," according to the statement. "There can be no assurance that this process will result in any transaction or any change in the Company's overall structure or its business model."

Supervalu, the third-largest U.S. grocery chain, has acknowledged sale talks since the spring. The company has been closing stores and cutting jobs as it has underperformed competitors like Dominick's parent Safeway and Kroger.

If Supervalu does not sell to Cerberus, it may have to restructure on its own or sell off individual assets, which could have big tax consequences, Bloomberg said.

Reuters reported last month that buyout firm Cerberus was preparing a takeover bid for Supervalu, the third-largest U.S. supermarket chain.

Cerberus officials could not be reached immediately for comment.

-- Reuters contributed to this report

In addition to Jewel, Supervalu owns Albertsons, Cub and other regional grocery chains.

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Missouri Powerball jackpot winner: 'It's surreal'












Cindy Hill, a laid-off office manager who lives in a small town in Missouri, called her husband Thursday with urgent news that would change everything: "We won the lottery."


"What?" he asked.











"We won the lottery," she repeated. But Mark Hill, a 52-year-old mechanic who works at a meat processing plant, is the kind of person who carefully checks the prices for everything he buys, and he needed proof.


He drove to his mother's house, where his wife was waiting with their quick-pick ticket, and confirmed for himself that the numbers matched those drawn for a record $588 million Powerball jackpot that they'll share with an unknown winner who bought a ticket in Arizona.


Missouri lottery officials officially introduced the Hills as winners Friday in front of reporters and townspeople gathered at the high school in Dearborn, which is about 40 miles north of Kansas City. The announcement was not a surprise. The Hills' name began circulating Thursday, soon after lottery officials said a winning ticket had been sold at a Trex Mart gas station and convenience store on the edge of town.


The Hills chose to take their winnings in a lump sum, not annual payments. Lottery officials estimated the cash payment at about $385 million, or about $192.5 million for each ticket.


The oversized novelty check handed to the Hills on Friday was written in the amount of $293,750,000, but Missouri Lottery spokeswoman Susan Goedde said that after taxes, they will receive about $136.5 million.


"We're still stunned by what's happened," said Cindy Hill, 51, who was laid off in June 2010. "It's surreal."


The couple have three grown sons and a 6-year-old daughter they adopted from China five years ago. They said they are now considering a second adoption with their winnings, and they plan to help other relatives, including their grandchildren and nieces and nephews, pay for college. They're planning vacations, and their daughter, Jaiden, wants a pony. Mark Hill has his eye on a red Camaro.


More immediately, they're preparing for "a pretty good Christmas" and anticipating an onslaught of requests for financial help.


"When it's that big of a Powerball, you're going to get people coming out of the woodwork, some of them might not be too sane," Cindy Hill said. "We have to protect our family and grandkids."


The jackpot was the second-largest in U.S. history and set off a nationwide buying frenzy, with tickets at one point selling at nearly 130,000 per minute. The other winning ticket was sold at 4 Sons Food Store in Fountain Hills near Phoenix. No one has come forward with it yet, lottery officials said.


Before Wednesday's drawing, the jackpot had rolled over 16 consecutive times without someone hitting the jackpot.


Myron Anderson, pastor of the Baptist Church in nearby Camden Point, said he heard Thursday that the Hills had won the huge prize. Anderson said he has known Mark Hill since they attended high school together.


"He's a really nice guy, and I know his wife, and they have this nice little adopted daughter that they went out of their way to adopt," Anderson said. Funeral services for Hill's father were at the Baptist church, but the family attends church elsewhere, he said.


"I hope it's good news for them," Anderson said. "I've heard awful horror stories about people who get all that money in their lap and how everybody treats them, and if you don't mind me saying, I mean just the fact that the press is going to be after them."


Kevin Bryan, a lifelong Dearborn resident, said the only other local lottery winner he could remember was a farmer who won about $100,000 in scratch-off game years ago "and bought himself a combine."


In a Mega Millions drawing in March, three ticket buyers shared a $656 million jackpot, the largest lottery payout of all time.





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Study: DVRs now in half of US pay-TV homes












NEW YORK (AP) — A new survey finds that digital video recorders are now in more than half of all U.S. homes that subscribe to cable or satellite TV services.


Leichtman Research Group‘s survey of 1,300 households found that 52 percent of the ones that have pay-TV service also have a DVR. That translates to about 45 percent of all households and is up from 13.5 percent of all households surveyed five years ago by another firm, Nielsen.












The first DVRs came out in 1999, from TiVo Inc. and ReplayTV. Later, they were built into cable set-top boxes. The latest trend is “whole-home” DVRs that can distribute recorded shows to several sets.


Even with the spread of DVRs, live TV rules. Nielsen found last year that DVRs accounted for 8 percent of TV watching.


Gadgets News Headlines – Yahoo! News


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Emmy Awards date announced by CBS












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Jewel parent says sale talks proceeding













 


Exterior of Jewel-Osco's first "Green Store" located at 370 N. Desplaines in Chicago.
(Antonio Perez / November 29, 2012)





















































Supervalu, the Minneapolis-based parent of Jewel-Osco said sale talks are proceeding after stock closed down more than 18 percent Thursday, to $2.28.

The beleaguered grocery chain was likely moving to combat reports that sale talks with suitor Cerberus Capital Management had stalled over funding.

"The company continues to be in active discussion with several parties," according to the statement. "There can be no assurance that this process will result in any transaction or any change in the Company's overall structure or its business model."

Supervalu, the third-largest U.S. grocery chain, has acknowledged sale talks since the spring. The company has been closing stores and cutting jobs as it has underperformed competitors like Dominick's parent Safeway and Kroger.

If Supervalu does not sell to Cerberus, it may have to restructure on its own or sell off individual assets, which could have big tax consequences, Bloomberg said.

Reuters reported last month that buyout firm Cerberus was preparing a takeover bid for Supervalu, the third-largest U.S. supermarket chain.

Cerberus officials could not be reached immediately for comment.

-- Reuters contributed to this report

In addition to Jewel, Supervalu owns Albertsons, Cub and other regional grocery chains.

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