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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Report: Kansas City Chiefs' Jovan Belcher shoots girlfriend, himself

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)

A 25-year-old Kansas City Chiefs player fatally shot his girlfriend early Saturday, then drove to Arrowhead Stadium and turned the gun on himself as two team officials were confronting him, police said.

The Kansas City Star identified the player as linebacker Jovan Belcher, citing police.

According to the Star, Police Capt. David Lindaman said Belcher 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.

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.

Kansas City police Supervisor Andrea Khan would not release the name of the player involved and the condition of the two parties was not immediately known. A team source told CBSSports.com that Belcher was involved in a shooting. 

Police spokesman Darin Snapp said authorities received a call Saturday morning from a woman who said her daughter had been shot multiple times at a residence about five miles away from the Arrowhead complex. Snapp said a call was then received from the Chiefs' practice facility.

Upon arriving, Snapp said that police witnessed a black male in a car with a handgun to his head talking to two Chiefs officials. That's when police heard a gunshot.

Before turning the gun on himself, the player thanked Chiefs general manager Scott Pioli and Romeo Crennel for all they had done for him, Snapp said.

Arrowhead Stadium has been lockdown since about 8 a.m.

"We can confirm that there was an incident at Arrowhead earlier this morning," the Chiefs said in a statement. "We are cooperating with authorities in their investigation."

The Chiefs host the Carolina Panthers on Sunday at Arrowhead Stadium. The Charlotte Observer reported that the NFL informed the Panthers to leave on its team charter plane as scheduled Saturday.

The Observer reported that NFL officials have not decided if the game will still be played but told the Panthers to travel as scheduled. The team's flight was scheduled to leave Charlotte at 1:15 p.m. ET.

Chiefs players were asked to meet at the team facility, according to Fox Sports.

Belcher started 10 of 11 games at inside linebacker for the Chiefs this season and was in his third season as a fulltime starter, fourth overall in the NFL.

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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

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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)

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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Staged plane crash makes the morning news

As its helicopter hovered above the scene, WGN-Channel 9 broke in with the news this morning that an airplane had crashed onto Martin Luther King Drive on the South Side, breaking off a wing that had skidded down the road and hit a car.

But three minutes later, the station reported back that the crash was actually a scene being shot for the TV series "Chicago Fire."

"We are just getting word that this is being shot as part of a TV show," anchor Larry Potash told viewers.

"Are you kidding me?" said anchor Robin Baumgarten. "They might want to tell the news folks that they're doing this and shutting down King Drive. Are you kidding me? Are you kidding me? 29th and King Drive, it's OK. It's all for a TV show, even though you see that plane in the road."

Police and fire officials report that other stations also called them about what looked like a major story unfolding at King and 29th Street, though Channel 9 apparently was the only one to go with the story around 8 a.m.

Jennifer Graves, vice president and news director of ABC-Channel 7, said the station's assignment desk heard about the "crash" between 7:30 a.m. and 8 a.m. She said the station’s helicopter arrived on the scene a few minutes before 8 a.m.

“Within five minutes of getting our helicopter there, we confirmed with the fire department that it wasn’t a real crash scene,” she said.

The Fire Department tweeted this alert after Channel 9 aired the story: "Chicago TV News is reporting a plane down at. . .King Drive this is a filming for the NBC show Chicago Fire and is a simulation disregard"

Larry Langford, a spokesman for the Chicago Fire Department, said information about the staged plane accident was not widely distributed. "It looks like it didn't get filtered down to everybody." Even some patrol officers could be heard on scanners this morning asking their supervisors about a plane crash.

Rich Moskal, director of the Chicago Film Office, said the local community was notified of the fake crash.

"To be honest, 'Chicago Fire' is out on the street filming nearly every day and we didn’t see this any differently than the standard filming," he said. "The local community was notified so there weren’t any surprises there. We notify residents by knocking on doors, leaflets, talking to people directly in the community who live within the close proximity to the filming area.”

Langford said steps will be taken to improve communications. "In the future, I'm asking my people to let me know so I can let the media know. News desks need to know," Langford said. "I'm sure from the helicopter it looked like it was real."

Footage from Channel 9's helicopter showed a white single-engine plane buckled in the middle of King Drive, its left wing hundreds of yards away at the side of the road. It was surrounded by police cars and an ambulance. Several cars appeared to have been hit by the plane.

The station had been alerted by dozens of callers and quickly swung its helicopter over the scene as it made repeated calls to fire officials. Potash and Baumgarten reported what they could see from the helicopter's skycam, at one point noting the lack of ambulances and urgency.

Within a few minutes, the anchors reported that the crash was not real and used the episode as a running joke during the rest of the show.

"So really, it's a good news story, which is what the people are always looking for," Potash said. At another point, he observed, "It's for a show that nobody watches on NBC."

Later, when Baumgarten switched to traffic reporter Erin McElroy, she added: "Erin, King Drive might be blocked near 29th, but it's OK."

WGN-TV is owned by Tribune Co., which is also parent company of the Chicago Tribune.

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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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Hockey Coaches Defy Doctors on Concussions, Study Finds

Despite several years of intensive research, coverage and discussion about the dangers of concussions, the idea of playing through head injuries is so deeply rooted in hockey culture that two university teams kept concussed players on the ice even though they were taking part in a major concussion study.

The study, which will be published Friday in a series of articles in the journal Neurosurgical Focus, was conducted during the 2011-12 hockey season by researchers from the University of Western Ontario, the University of Montreal, Harvard and other institutions.

“This culture is entrenched at all levels of hockey, from peewee to university,” said Dr. Paul S. Echlin, a concussion specialist and researcher in Burlington, Ontario, and the lead author of the study. “Concussion is a significant public health issue that requires a generational shift. As with smoking or seat belts, it doesn’t just happen overnight — it takes a massive effort and collective movement.”

The study is believed to be among the most comprehensive analyses of concussions in hockey, which has a rate of head trauma approaching that of football. Researchers followed two Canadian university teams — a men’s team and a women’s team — and scanned every player’s brain before and after the season. Players who sustained head injuries also received scans at three intervals after the injuries, with researchers using advanced magnetic resonance imaging techniques.

The teams were not named in the study, in which an independent specialist physician was present at each game and was empowered to pull any player off the ice for examination if a potential concussion was observed.

The men’s team, with 25 players and an average age of 22, played a 28-game regular season and a 3-game postseason. The women’s team, with 20 players and an average age of 20, played 24 regular-season games and no playoff games. Over the course of the season, there were five observed or self-reported concussions on the men’s team and six on the women’s team.

Researchers noted several instances of coaches, trainers and players avoiding examinations, ignoring medical advice or otherwise obstructing the study, even though the players had signed consent forms to participate and university ethics officials had given institutional consent.

“Unless something is broken, I want them out playing,” one coach said, according to the study.

In one incident, a neurologist observing the men’s team pulled a defenseman during the first period of a game after the player took two hits and was skating slowly. During the intermission the player reported dizziness and was advised to sit out, but the coach suggested he play the second period and “skate it off.” The defenseman stumbled through the rest of the game.

“At the end of the third period, I spoke with the player and the trainer and said that he should not play until he was formally evaluated and underwent the formal return-to-play protocol,” the neurologist said, as reported in the study. “I was dismayed to see that he played the next evening.”

After the team returned from its trip, the neurologist questioned the trainer about overruling his advice and placing the defenseman at risk.

“The trainer responded that he and the player did not understand the decision and that most of the team did not trust the neurologist,” according to the study. “He requested that the physician no longer be used to cover any more games.”

In another episode, a physician observer assessed a minor concussion in a female player and recommended that she miss the next night’s game. Even though the coach’s own playing career had ended because of concussions, she overrode the medical advice and inserted the player the next evening.

According to the report, the coach refused to speak to another physician observer on the second evening. The trainer was reluctant to press the issue with the coach because, the trainer said, the coach did not want the study to interfere with the team.

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