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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After a billion, what next for Facebook?

MENLO PARK — In just eight years, Facebook signed up more than half the world's Internet population.

Now it's going after the rest.

Facebook wants to reach every single person on the Internet whether they are logging on from a laptop in Santa Monica, an iPhone in Tokyo or a low-tech phone with a tiny screen in Nairobi.

It's parachuting into market after market to take on homegrown social networks by currying favor with the locals and venturing where many people have spotty — if any — access to the Internet.

In Japan, it lets users list their blood types, which the Japanese believe — like astrological signs in the Western world — give insight into personality and temperament. In Africa, Facebook markets a stripped-down, text-only version of its service that works on low-tech mobile phones.

International growth is crucial to maintain its dominance as the world's largest social network. The company's scorching pace of growth has cooled especially in the United States. Facebook must coax users to sign up — and make sure it remains popular with the users it already has — or risk being knocked from its lofty perch.

"We're not a company that is just trying to add more people," said Chris Cox, Facebook's vice president of product. "What we are trying to do is build a service that everyone in the world can use."

But overseas growth that once seemed to come so easily is slower now. Facebook has already saturated most major markets around the globe. Eight out of 10 Facebook users are outside of the U.S.

"I don't think that Facebook has a chance of attracting another billion users," Wedbush Securities analyst Michael Pachter said.

Inside Facebook's Menlo Park, Calif., headquarters is a small army out to prove naysayers wrong. Above their desks they have hung flags from around the world that represent their nationalities. They obsessively scan screens that track user growth around the world.

They cheered and popped open champagne in September when the number of active Facebook users crossed 1 billion. But the moment of jubilation quickly passed as they redoubled their efforts to spread Facebook around the globe.

Naomi Gleit is the soft-spoken, headstrong 29-year-old product manager in charge of growth at Facebook. She says Facebook's future is on mobile devices, the medium by which most people will experience the Web in coming years. Facebook now works on more than 2,500 different phones, helping it gain a foothold in emerging markets. And it is forging relationships with mobile phone operators around the world.

Gleit's 150-member team has boots on the ground in far-flung places armed with low-tech phones and cheap data plans. Even team members here carry Nokia phones alongside their iPhones to update their status or check their News Feed.

"We originally built a product for ourselves," Gleit said. "This is different. Now we need to understand the experience of users who are not like us."

Analysts say Facebook already has established an impressive track record of uprooting entrenched competitors. In Britain, it displaced the dominant social network Bebo, forcing AOL to sell it at a huge loss. In Germany, Facebook overtook the homegrown StudiVZ. Facebook even broke Google social network Orkut's stranglehold on Brazil and India.

In 2009, it launched a clever tool to help Facebook users find their Orkut friends on Facebook and instantly send them friend requests. Two years later it swiped Google's top executive in Latin America, Alexandre Hohagen. Facebook sprinted ahead of Orkut one year ago, and now has 61 million active users in Latin America's largest country.

Facebook is treating India as a test lab for how it can spread in other emerging markets such as Indonesia. Facebook, which has offices in Hyderabad, India, has grown from 8 million users in 2010 to 65 million users today. It is aggressively targeting India's youth. A few hundred young Indian programmers recently jammed a Facebook hackathon at a Bangalore convention center to chug chai and brainstorm new apps that would appeal to their friends.

But Facebook has its eyes on a much bigger prize beyond the country's 100 million Internet users: the 900 million-plus Indians on mobile phones. Some analysts predict India will have more Facebook users than any other country including the United States by 2015.

The company also faces significant challenges in India. It must make the service captivating on low-tech mobile phones with unreliable Internet connections and it must gingerly navigate demands from the Indian government to remove objectionable content without alienating users.

Facebook is making some of its biggest moves in Russia, South Korea and Japan, the only major markets where it operates but has penetration of less than 50%, according to research firm ComScore.

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6 dead, 10 wounded across city overnight

Six people were shot on the South Side of Chicago. Police investigate one of the crime scenes in the 4200 block of S. Wells St. (Chris Sweda/Chicago Tribune)

Staff report

3:05 a.m. CST, December 1, 2012

Four people were shot and killed Friday night and Saturday morning, and a fifth person who may have been dead for weeks was found with gunshot wounds.

At least ten others were wounded by gunfire in shootings from the Uptown neighborhood south to the Chatham neighborhood, police said.  

In addition to the shootings a man was stabbed to death on the Southwest Side about 12:45 a.m. Saturday.

The sixth homicide of the night - a 29-year-old man found dead inside his car with a gunshot wound to the head - drew a crowd from the neighboring Wentworth Gardens apartment complex at 37th and Wells streets, two blocks south of U.S. Cellular Field. 

At one point, cars from the Englewood police district came north to assist with crime scene security. At least 14 cars, most marked, sat near the scrime scene early Saturday morning. 

The dead man lived nearby, and his family lingered at the scene. 

Another man was found shot to death in the 6100 block of South Morgan Street in the Englewood neighborhood. 

The violence began Friday night with a pair of shootings that left five people wounded and one dead. At least two of the five survivors are still in critical condition, police said. 

Check back for more information. 

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JLo tones down concert in Indonesia

JAKARTA, Indonesia (AP) — Jennifer Lopez wowed thousands of fans in Indonesia, but they didn’t see as much of her as concertgoers in other countries — the American pop star toned down both her sexy outfits and her dance moves during her show in the world’s most populous Muslim country, promoters said Saturday.

Lopez’s “Dance Again World Tour” was performed in the country’s capital, Jakarta, on Friday in line with promises Lopez made to make her show more appropriate for the audience, said Chairi Ibrahim from Dyandra Entertainment, the concert promoter.

“JLo was very cooperative … she respected our culture,” Ibrahim said, adding that Lopez’s managers also asked whether she could perform her usual sexy dance moves, but were told that “making love” moves were not appropriate for Indonesia.

“Yes, she dressed modestly … she’s still sexy, attractive and tantalizing, though,” said Ira Wibowo, an Indonesian actress who was among more than 7,000 fans at the concert.

Another fan, Doddy Adityawarman, was a bit disappointed with the changes.

“She should appear just the way she is,” he said, “Many local artists dress even much sexy, much worse.”

Lopez changed several times during her 90-minute concert along with several dancers, who also dressed modestly without revealing their chests or cleavage.

Most Muslims in Indonesia, a secular country of 240 million people, are moderate. But a small extremist fringe has become more vocal in recent years.

They have pushed through controversial laws — including an anti-pornography bill — and have been known to attack anything perceived as blasphemous, from transvestites and bars to “deviant” religious sects.

Lady Gaga was forced to cancel her sold-out show in Indonesia in May following threats by Islamic hard-liners, who called her a “devil worshipper.”

Lopez will also perform in Muslim-majority Malaysia on Sunday.

“Thank you Jakarta for an amazing night,” the 43-year-old diva tweeted to her 13 million followers Saturday.

Entertainment 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)

By Emily Bryson York




Chicago Tribune reporter

6:51 a.m. CST, November 30, 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.

SVU data by YCharts

SVU data by YCharts

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Male shot by police on South Side

An off-duty Chicago police officer who witnessed a crash during a police chase shot the driver of a stolen SUV after it struck a woman crossing the street late Thursday night, authorities said.

The SUV's drivert sustaine a non-life-threatening wound to his hand or arm, Fraternal Order of Police Spokesman Patrick Camden said.

The crash and subsequent shooting happened about 10 p.m. at the intersection of 37th Street and Dr. Martin Luther King Jr. Drive, two blocks south and three blocks east of the police department headquarters, in the city’s Bronzeville neighborhood, police said. 

A gray SUV was fleeing Wentworth District police northbound on King Drive when it made a left turn through a red light trying to head west on 37th Street, hit a light pole, hit a female pedestrian, and then hit a concrete wall that surrounds the massive three-story brick home on the corner, authorities said. 

An off-duty officer, on his way home from work with his girlfriend and his dinner, was stopped at the light facing south and saw the chase coming north up King Drive. His girlfriend was getting out of the passenger side about this time, Camden and police said. 

As the off-duty officer approached the stolen SUV, its driver tried to reverse back toward the officer, who fired twice, fearing that the SUV would hit his girlfriend. The SUV hit the officer’s black Yukon, Camden said, and its driver put the SUV into gear and tried to escape again. 

The officer fired two more times, hitting the man in the hand, who gave up and was taken to Mercy Hospital and Medical Center. 

The female pedestrian’s age wasn’t available, and she was taken to the University of Chicago Hospitals. The officer’s girlfriend, whose age wasn’t available, was also taken to Mercy Hospital and Medical Center. 

Police blocked King Drive in both directions between the 3500 block and 39th Street, and 37th Street was also blocked. The CTA rerouted buses in the area. 

pnickeas@tribune.com
Twitter: @peternickeas

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Apple overcomes last hurdle, iPhone 5 cleared for sale in China as Android continues to dominate

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France’s Depardieu detained for drunken driving

PARIS (Reuters) – French actor Gerard Depardieu was detained for driving his scooter while drunk on Thursday after he had a minor accident in Paris, prosecutors said.

The 63-year-old star of films such as “Jean de Florette” and “Green Card” was held for questioning after he fell from his scooter mid-afternoon, slightly injuring his elbow.

No-one else was hurt in the accident.

One of France’s best-known actors for roles in more than a hundred films, Depardieu has recently grabbed headlines for the wrong reasons.

The incident came just months after a car driver filed a legal complaint for assault and battery against Depardieu in August following an altercation in Paris.

Last year, Depardieu outraged fellow passengers by urinating in the aisle of an Air France flight as it prepared to take off, forcing the plane to turn back to its parking spot.

A passenger on the flight said Depardieu appeared to be drunk and insisted he be allowed to use the bathroom during takeoff, when passengers must remain seated.

(Reporting by Gerard Bon; Writing by Leigh Thomas; Editing by Jon Hemming)

Movies News Headlines – Yahoo! News

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The New Old Age Blog: Forced to Choose: Nursing Home vs. Hospice

An older person, someone who will die within six months, leaves a hospital. Where does she go?

Almost a third of the time, according to a recent study from the University of California, San Francisco, records show she takes advantage of Medicare’s skilled-nursing facility benefit and enters a nursing home. But is that the best place for end-of-life care?

In terms of monitoring her vital signs and handling IVs — the round-the-clock nursing care the skilled-nursing facility benefit is designed to provide — maybe so. But for treating end-of-life symptoms like pain and shortness of breath, for providing spiritual support for her and her family, for palliative care that helps her through the ultimate transition – hospice is the acknowledged expert.

She could receive hospice care, also covered by Medicare, while in the nursing home. But since Medicare only rarely reimburses for both hospice and the skilled-nursing facility benefit at the same time, this hypothetical patient and her family face a financial bind. If she opts for the hospice benefit, which does not include room and board at the nursing home, then she will be on the hook for hundreds of dollars a day to remain in the facility.

She could use the hospice benefit at home, of course. But, “we know these patients are medically complex,” said Katherine Aragon, lead author of the study in The Archives of Internal Medicine, and now a palliative care specialist at Lawrence General Hospital in Massachusetts. “And we know that taking care of someone near the end of life can be very demanding, hard for families to manage at home.” And that assumes the patient has a family or a home.

For some patients, a nursing home, though possibly dreaded, is the only place that can provide 24/7 care.

But if she uses the skilled-nursing facility benefit to pay for room and board in a facility, she probably has to forgo hospice. (The exception: if she was hospitalized for something unrelated to her hospice diagnosis. If she has cancer, then trips and breaks a hip, she can have both nursing home coverage and hospice. If cancer itself caused the bone to fracture, no dice.)

Let’s acknowledge that these are lousy choices.

The study, using data from the National Health and Retirement Study from 1994 through 2007, looked at more than 5,000 people who initially lived in the community – that is, not in a facility. About 30 percent used the skilled-nursing facility benefit during the final six months of life; those people were likely to be over 85 and family members said, after their deaths, that they had expected them to die soon. (The benefit is commonly referred to as S.N.F., which people in the field pronounce as “sniff”).

The choice to use S.N.F. had ongoing repercussions. Almost 43 percent of those who used it died in a nursing home and almost 40 percent in a hospital. Just 11 percent died at home, though that is where most people prefer to die, studies repeatedly show.

Among those who didn’t use the S.N.F. benefit, more than 40 percent died at home.

In effect, nursing homes were providing end-of-life care, expensively and probably not so well, for almost a third of the elderly population.

The skilled-nursing facility benefit, Dr. Aragon pointed out in an interview, is meant to provide rehabilitation. “The hope is that someone will get stronger and go home,” she said.

Sometimes, of course, that is what happens.

“What we may be missing is that this patient is on an end-of-life trajectory,” she continued. “Maybe they can’t get stronger.”

Moreover, Dr. Aragon pointed out, nursing homes often have financial incentives to keep re-hospitalizing patients. After three days in a hospital, the skilled-nursing facility benefit starts anew, and it reimburses at a higher level than Medicaid, which pays for most nursing home care.

Because this unhappy choice between hospice care and nursing home reimbursement reflects federal policy, there may be little that individual families can do. If physicians are willing to honestly discuss their patients’ prognosis, to assess whether a nursing home stay will lead to rehabilitation or whether it is where a patient will likely die, sooner rather than later, families may have some personal options.

If they knew that death was likely within a few months, they might try to provide care at home with hospice help for that limited time, difficult as that is. Or they might be able to muster enough money to pay for a few months in a nursing home, so that their parent can be a resident and still receive hospice care.

But these are still lousy choices. “Palliative care should be part of nursing home care,” said Alexander K. Smith, the study’s senior author and a palliative care specialist at the University of California, San Francisco. “And that regulation that prevents concurrent use of the S.N.F. benefit and hospice isn’t in the interest of patients and families.”

Coming up in a future post: Experimenting with a concurrent-coverage option.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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U.S., state to fund battery research at Argonne

The U.S. Department of Energy has chosen Argonne National Laboratory, in suburban Lemont, to become America's capital for battery technology.

The announcement, to be made Friday, will include building a research facility to coordinate the clout and brainpower of five Department of Energy national laboratories, five universities and four private companies that independently have been working to advance battery technology.

Funded with $120 million from the DOE and a $35 million commitment from Gov. Pat Quinn, the Joint Center for Energy Storage Research is expected to develop lighter, cheaper batteries for everything from smartphones to electric vehicles that store more power and charge faster.

Chicago would be the fourth so-called Energy Innovation Hub that the DOE has established since 2010. The concept is modeled after research and development programs that spurred breakthroughs in the past, such as the Manhattan Project, which produced the first atomic bomb.

Other hubs have been devoted to modeling and simulating nuclear reactors, developing fuels from sunlight, and improving energy efficiency in buildings.

Like the space race of the 1960s, the U.S. is battling other nations to be at the forefront of a rapidly growing $42 billion worldwide market for rechargeable batteries that's growing 8.6 percent per year. That number comes from research and consulting firm Frost & Sullivan, which predicts the industry's growth rate and revenues to double by 2018.

A breakthrough in battery technology would have major implications for the auto, wind and solar industries. In particular, the wind and solar industries are looking for affordable batteries to store intermittent power so they can provide power even when the wind isn't blowing or the sun isn't shining.

Batteries that store electricity from the electrical grid are also in demand in countries where outages are frequent or in the case of natural disasters that black out cities for days.

"We're going to be the center of the universe when it comes to charging batteries and storing energy," Quinn told the Tribune in an interview Thursday.

Quinn committed the state to giving $5 million to the project through a capital construction budget he controls designed for job creation and said he will work with legislators to garner an additional $30 million in state funding to help with the building's construction.

The DOE will dole out the $120 million over five years. News of the hub was first reported by Crain's Chicago Business.

A successful battery hub in Illinois, Quinn said, would drive companies in the industry to set up shop nearby and encourage scientists and engineers to stay in the Midwest.

"These people would have the opportunity to change the world. It's transformational," Quinn said.

Earlier this week, Smith Electric Vehicles announced it would make battery-powered trucks in Chicago and hire about 200 workers. Wanxiang, a Chinese automotive company with North American headquarters in Chicago, is vying to purchase bankrupt Massachusetts-based battery-maker A123. As of last week Woodridge-based Palladium Energy became the largest independent battery pack-maker in the Americas and Europe after acquiring competitor MicroSun Technologies LLC.

The Chicago-based Clean Energy Trust, a nonprofit dedicated to accelerating the development of clean-energy businesses in the Midwest, will be responsible for ushering technology from Argonne to the marketplace with the help of Dow Chemical Co., Applied Materials Inc. and Johnson Controls Inc., which all have a financial interest in seeing batteries advance. Johnson, based in Milwaukee, also is vying for the A123 battery assets.

In addition to its own scientists, Argonne would be coordinating the research and development from Lawrence Berkeley, Pacific Northwest, Sandia and SLAC National Accelerator as well as students and researchers at Northwestern University, University of Chicago, University of Illinois at Chicago, University of Illinois at Urbana-Champaign and the University of Michigan.

"I think this is probably the greatest opportunity that we have seen in a long time to bring federal funding that's intended to promote the creation of new companies and jobs," said U.S. Rep. Dan Lipinski, D-Ill.

Tribune reporter Ted Gregory contributed.

jwernau@tribune.com

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