The Survive and Thrive Boomer Guide

FTC fails halt the merger of two giant pharmacy benefit management companies

By Rita R. Robison

It’s troubling that the Federal Trade Commission didn’t stop the merger of the two largest pharmacy benefit managers, Medco and Express Scripts Inc.

A pharmacy benefit manager is a third party administrator of prescription drug programs. They’re mainly responsible for processing and paying prescription drug claims. They also are responsible for developing and maintaining the “formulary,” contracting with pharmacies and negotiating discounts and rebates with drug manufacturers.

Medco and ESI announced a $29 billion merger agreement in July 2011. The combined company would have more than 155 million American customers – creating a virtual monopoly that could lead to fewer independent community pharmacies, reduced access to generics and specialized treatments, and fewer options for consumers.

“I am deeply disappointed by the FTC’s decision to allow this $29 billion merger to proceed, creating a monolithic PBM with near monopolistic control of the prescription drug sale marketplace,” Representative G.K. Butterfield (D-NC) said in a statement. 

“For many months I have warned the FTC to carefully consider this merger’s negative impact on the industry and consumers alike. The FTC’s decision puts community pharmacies, seniors, and sensitive populations at risk of having less access and choice for purchasing needed prescription drugs.”

The merger was subject to review by the FTC, which decided on a 3-1 vote not to oppose the merger. FTC Commissioner Julie Brill issued a dissenting statement opposing the decision and expressing concern that the merged company would hurt consumers and the industry. 

The merger has been challenged in federal court. Several states may bring legal action to prevent it.

Copyright 2012, Rita R. Robison, Consumer Specialist

How to be successful when filing insurance claims

Companies that insure homes paid about $35 billion in loss claims last year, and auto insurers say they’re alarmed about higher claims costs.

So consumers need to be extra careful to get their due from auto, home, and life policies.

If you have to file a claim on your auto or home policy, or on a loved one’s life insurance, it pays to know the right procedures and how to resolve problems, according to Consumer Reports Money Adviser. Here’s what you need to do:

Auto

When an accident occurs. When a crash involves another person or vehicle, call the police to officially document the incident. If you can, take your own notes at the scene. At a minimum, get the other vehicle’s license-plate information.

You should also get the other driver’s name, address, driver’s license number, insurer’s name and policy number, and vehicle-registration details. Use your cell-phone camera to take photos of the scene from all angles.

When filing the claim. Always call your own insurer right away if a crash involves another person or vehicle. Never agree to skip reporting a crash out of sympathy for an at-fault motorist who promises to pay you out-of-pocket.

If you’re at fault, you might not want to file a report with your insurer if damage is limited to your own vehicle and you expect costs to be within your deductible or slightly more.

You might be pressured to take your car to a shop in the insurer’s direct-repair program or to use cheaper replacement parts instead of original equipment manufacturer parts. You’re under no obligation to accept either.

Home

When the loss occurs. First, make sure your family is safe and that emergency personnel have been called to protect your home. As soon as practical, take pictures of the damage. Then take steps to prevent further damage, such as covering a hole in the roof with a tarp.

Keep receipts for any money you spend to prevent further losses. But don’t repair anything or dispose of ruined property until an adjuster has examined everything.

If you were burglarized, call the police first and your insurance agent later.  If someone trips and falls on your front stairs, see to their medical care first. Again, take detailed notes about what happened and get photos of the scene.

Make sure the adjuster sees everything. Ask for a copy of his or her report and scrutinize it for mistakes. You’re also entitled to a copy of your entire claims file.

Copy everything you give the adjuster and ask for a receipt. If he or she advises you to start repairs, get that in writing so promises and permissions can be accurately passed on if your case is transferred to another person. 

Life

When the loss occurs. An insurer might delay or deny payment to beneficiaries if the policyholder died within two years after buying the policy. No matter how long a policy was held, however, if no one files a claim, insurers historically haven’t done much to find the beneficiaries. 

When filing a claim. Send the insurer a claim form for each beneficiary and a certified copy of the policyholder’s death certificate.

To find out if a deceased family member had a life-insurance policy, check his or her files for the policy itself or billing statements; search bank statements for canceled checks to a life insurer; or contact the employee-benefits office of previous employers or unions.

Copyright 2012, Rita R. Robison, Consumer Specialist

What were your best and worst consumer experiences this week?

By Rita R. Robison

Which consumer happenings cheered you this week and which ones made you want to scream or weep? 

Here are my best and worst consumer experiences this week:

My best: 8 x 10 inch prints at Ritz Camera

Last Sunday, Ritz Camera offered a free 8 x 10 print if you went to one of its stores and placed an order. I copied one of my favorite photos on a disk and headed over to the store.

When I was there, the manager of the store pointed out that Ritz was having a sale the next day: 8 x 10 inch prints for a $1 each. There was no limit on the number of prints.

I was excited. I’ve been waiting for months for this sale. I put 45 of my best photos on a disk.

When I arrived at the store, the manager told me that Ritz had pulled the sale that morning. They offered a larger size instead, he said, because they had just had the one 8 x 10 deal for free and wanted to offer a different size. However, the manager said he’d honor the $1 price for me because he had pointed out the sale to me.

The photos are wonderful. I’ve already given some of them for Christmas gifts.

My worse: Renting a medical device gone awry

At the recommendation of my physical therapist, I rented a medical device. It didn’t do the job it was supposed to do. I followed the directions for sending it back.

The company charged my first insurance company $695 for the device I’d returned. I complained loudly.

Now the company has charged my second insurance company $695. The amount of this that I’m supposed to pay is $231. I’m incensed. This is fraud, in my opinion.

I’ve spent so much time trying to get this straightened out. I hope I can get this second outrageous charge canceled, too.

Copyright 2011, Rita R. Robison, Consumer Specialist

What were your best and worst consumer experiences this week?

Which consumer happenings cheered you this week and which ones made you want to scream or weep?

Here are my best and worst consumer experiences this week:

My best: Good customer service at Starbucks

When I went to Starbucks for coffee with a friend, he ordered my tea for me. The barista put it in a real cup.

I asked if she remembered that it was what I usually asked for. She said no, one of her co-workers told her that’s what I liked.

I really appreciated the good customer service.

My worst: Having a failed roof that requires arbitration

My attorney is helping me get ready for the arbitration early next month for my failed metal shingle roof. It’s stressful.

The good news is I received a settlement from the manufacturer. Now, I need to prevail in the arbitration against the contractor and his bond company. Then I’ll have a new roof.

Copyright 2010, Rita R. Robison, Consumer Specialist

MetLife stops the sale long-term care insurance

In a few years, baby boomers will begin swelling the ranks of older consumers needing a variety of health-related services.

Governments, including Washington state where I live, want them to buy long-term care insurance.

This insurance – designed to cover costs that Medicare and Medigap policies won’t pay for such as assisted living and nursing home care – will help cut the costs governments have to pay for older consumers who don’t have money or have run out of money.

However, four companies have stopped selling the insurance.

The latest is MetLife. Because it’s paying out significantly more in claims than it expected, the insurance company is discontinuing the sale of long-term care insurance, reports ConsumerAffairs.com.

You’ll still be able to buy long-term care insurance, but it will cost you more.

Copyright 2010, Rita R. Robison, Consumer Specialist

Watch out for BP oil spill scams

 

Consumers and businesses need to be on the lookout for frauds related to the BP Deepwater Horizon oil spill and to report scam artists to federal and state authorities.

It’s likely that scammers will use e-mails, websites, door-to-door collections, flyers, mailings, and telephone calls to solicit money, warns the Federal Trade Commission. Do some homework before making a donation or entering into an agreement for services.

Here are tips from the commission on how to avoid being ripped off:

Claims

• Expect some scam artists to pose as authorized adjusters and ask for fees to expedite services. ESIS, BP’s authorized claims administrator, isn’t charging individuals or companies any fee to process claims. If you make a claim, you’re assigned a claims number through the BP hotline at 800-440-0858. An authorized ESIS adjuster will contact you to verify and process the claim. If you aren’t satisfied with the resolution, you can call the U.S. Coast Guard’s National Pollution Funds Center at 800-280-7118, or visit the center’s website for more information at www.uscg.mil/npfc/Claims/default.asp.

• Expect other scam artists to pretend to be government officials – and then require a bogus processing fee to provide services.

Insurance

• Verify that you are dealing with authorized representatives of BP, and don’t sign waivers of liability too quickly without getting adequate legal and financial advice.

• Report anyone who is making false or exaggerated insurance claims to your state insurance commissioner.

• Report anyone who is making insurance claims but lives outside the disaster zone.

Contractors

• Don’t do business with contractors who require up-front payment for services: You’ll be out the money if they fail to perform the work or finish the job to your specifications or satisfaction.

• Require any contractors you use to describe the services they’ll perform on a written contract.

• Use only licensed contractors.

Donations

• Some people may misrepresent an affiliation with an environmental organization when they ask for donations via e-mail or social networking sites. If you’re tempted to contribute, check out the charity at the Better Business Bureau, www.bbb.org/us/charity.

• Some sham organizations may use copy-cat names to cash in on the reputations of older, more established charities.

• Rather than clicking on a link to a website you don’t know, do research online to confirm the group’s existence, history, mission, and nonprofit status.

• To ensure your contributions are received and used for what you want, contribute directly to organizations you know rather than relying on others to make a donation on your behalf.

• If you get pressure to make a contribution, look for another charity.

• Avoid donating cash. Pay by debit or credit card, or write a check to the charity.

• If an organization suggests you wire your donation, cross it off your list.

• Most legitimate charities websites end in .org rather than .com. For more information on charity scams, visit www.ftc.gov/charityfraud.

Employment and volunteer opportunities

• Avoid any job or volunteer opportunity that requires you to pay a fee before the job begins.

For more information

For updates on the oil spill, visit usa.gov. Enter "Gulf Oil Spill" in the search field.

Complaints

If you think someone is committing an oil spill fraud, contact the National Center for Disaster Fraud. Call 866-720-5721, e-mail disaster@leo.gov, or fax 225-334-4707.

Copyright 2010, Rita R. Robison, Consumer Specialist

What were you best and worst consumer experiences this week?

Which consumer experiences cheered you recently and which ones made you want to scream or weep?

Here are my best and worst consumer experiences this week:

My best: Getting a new iMac

Saturday I picked up my new 27-inch iMac. The one I’d purchased in 2008 gave me eye strain. The manager of the Tukwila store said I could have a new one.

I’m excited. I’ll let you know how the new computer turns out.

My worst: A big unexpected dentist bill

When I returned home from vacation recently, I found a dentist bill for $192 in my pile of mail.

I had to have an extra cleaning done because I’m experiencing some bone loss in the front part of my lower jaw.

The receptionist assured me that my insurance company would pay for the extra cleaning when my new diagnosis was sent in.

The bill I received said my insurance company had denied the billing and the procedure billed is only paid for once every three years.

When I called and talked to another staff person, she indicated she had billed the insurance company again with a different code. I hope it works.

Copyright 2010, Rita R. Robison, Consumer Specialist

Baby boomers worry about long-term-care insurance, as policies increase in cost and benefits decline

Long-term-care insurance companies are changing the rules after baby boomers, who have opted to buy the insurance, have been paying premiums for years.

The insurance is complicated, and therefore difficult to regulate, according to the Los Angeles Times article "Long-Term-Care Policies: Pouring Money Down a Hole?"

Boomers are seeing their premiums go up.

The most common problem with long-term-care insurance has been mispricing. During the 1990s, insurers set rates low to increase sales, and they failed to keep enough reserves to pay for the care they promised. The companies threw in lifetime benefits and inflation protection to attract consumers, only to discover that these were a problem, because they didn't know how to price the risks, the article reports. Insurance company reserves also are down.

Now companies are asking consumers to pay more in premiums or accept reduce benefits. For consumers who are getting older and have paid for the policies for years, this is a hardship.

About eight million Americans have long-term-care policies, compared with 255 million covered by health insurance.

State governments and the federal government are encouraging consumers to buy long-term-care insurance in an attempt to reduce the amount they pay for nursing home care. About 70 percent of the cost of nursing home care is paid for by Medicaid, a government program for low-income consumers.

The average nursing home stay is 2.4 years, reports the Long-Term Care Link. The average cost of nursing home care is $200 a day, and that doesn’t include additional fees for specialized services like care for patients with Alzheimer’s or dementia, reports The New York Times article "Stressful but Vital: Picking a Nursing Home."

Whether to buy long-term-care insurance is a difficult question. You may die suddenly and never need nursing home care. Or you could spend years in a nursing home after a heart attack or stroke or other debilitating illness and incur cost that wipe you out financially.

See the following resources for information on how to buy long-term-care insurance:

"Long-Term-Care Insurance" – National Clearinghouse for Long-Term Care Information

"Long-Term-Care Insurance" – AARP.org

"Should You Buy Long-Term-Care Insurance?" – The Motley Fool

"The Basics of Long-Term Care [in New York State]" – New York State Department of Insurance

"Long-Term-Care Coverage: How to Decide if This Pricey Insurance Makes Sense for You" – Consumer Reports

"Long-Term-Care Coverage: How to Scrutinize a Policy" – Consumer Reports

"What Health Care Reform Means for Long-Term Care" – Kiplinger

Copyright 2010, Rita R. Robison, Consumer Specialist