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

Chiefs Player Involved in Murder-Suicide (Posted Dec. 1st, 2012)

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, Kasandra Perkins, 22, got into an argument at their home in the 5400 block of Crysler Avenue in Kansas City. Around 7:50 a.m., Lindaman said, Belcher shot Perkins 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 from New York, witnessed the shooting and had been 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.

“He had a conversation with Scott Pioli,” Lindaman said. “There was no threat and it was quite friendly, from what I understand. The Chiefs organization had been very supportive of him and he was expressing that.”

When police arrived, they heard a gunshot and found that Belcher had shot himself in the head.

The Chiefs announced Saturday afternoon that their game Sunday against the Carolina Panthers at Arrowhead Stadium will be played as scheduled, with kickoff set for noon CST.

Chiefs owner Clark Hunt released the following statement: “The entire Chiefs family is deeply saddened by today’s events, and our collective hearts are heavy with sympathy, thoughts and prayers for the families and friends affected by this unthinkable tragedy. We sincerely appreciate the expressions of sympathy and support we have received from so many in the Kansas City and NFL communities, and ask for continued prayers for the loved ones of those impacted. We will continue to fully cooperate with the authorities and work to ensure that the approporiate counseling resources are available to all members of the organization.”

In a video titled “Belcher’s drive to succeed helps team and self” posted on the Chiefs website Nov. 21, Belcher commented on what he was most thankful for leading into the Thanksgiving holiday: “First and foremost, God. Family and friends just keeping me focused, coaches and just everyone.”

The video was removed this afternoon.

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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Sony’s radical PlayStation 4 controller concept: A motion-control device you can split in half

While Nintendo (NTDOY) has been busy innovating with unique controllers on the Wii and Wii U, Sony’s (SNE) DualShock controller for its PlayStation, PlayStation 2 and PlayStation 3 has remained virtually the same since 1997. A newly discovered patent reveals Sony might be planning on a radical overhaul of the DualShock for the PlayStation 4 that’s rumored to arrive next year. U.S. patent 20120302347A1 details a “hybrid separable motion controller” that resembles a DualShock controller with two PlayStation Move sensor balls attached to it. Much like how the Wii Remote and Nunchuk controller combo separated the left and right hand input, the Sony controller patent goes one step further by allowing the two halves to be split and combined at any time – all without reducing the amount of buttons available.

The patent also highlights the inclusion of a “connection sensor for determining whether the controller is in a connected configuration or a disconnected configuration.”

One of the PlayStation Move’s biggest disadvantages is that it’s a separate controller and not the default one. As a result, most developers either saw it as merely a Wii Remote clone or as a niche controller with a limited install base not worth programming special controls for. If Sony were to include proper 1:1 motion controls within the default PS4 controller without turning its back on the “core” controller, it could greatly appeal to casual and core gamers.

Such a controller can be considered a natural evolution of the current DualShock 3 controller that sports limited motion controls using its three-axis accelerometer and gyroscope.

Of course, the controller is only a patent that may never make it to market, so don’t get your hopes up if it doesn’t happen.

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Show sheds light on Handel’s hidden “Messiah” helper

LONDON (Reuters) – Anyone dusting off their copy of George Frederic Handel‘s “Messiah” in the run-up to Christmas this year might spare a thought for the unsung hero of the piece.

Without Charles Jennens, experts argue that the 18th century oratorio would never have been created, robbing Western choral music of one of its greatest works.

Handel House Museum, located in the cozy London home where the German-born composer spent much of his life, is seeking to put the record straight about a man who, for many reasons, has been passed over by history.

“The Messiah would not have been written without him,” said the museum’s director Sarah Bardwell of Jennens, who lived from 1700 to 1773.

For landowner and patron of the arts Jennens, the words to the Messiah were an expression of deeply held Protestant beliefs, and he was determined that Handel, a composer he had long championed, set it to music.

The words, famously opening with “Comfort ye”, are not Jennens’ own but carefully selected verses from the Bible as well as a small number of psalms from the Book of Common Prayer.

“If you listen to the words it’s all to do with your relationship with God as in the individual, there’s none of the big theological questions,” Bardwell told Reuters.

“Everyone can relate to the Messiah, even beyond Christianity on some level,” she added. “I think that’s why Jennens is so instrumental.”

FRIEND AND BENEFACTOR

Jennens, whose family fortune came from iron, was a friend of Handel and a major backer, subscribing to his music and providing the texts for “Saul”, “Belshazzar”, “L’Allegro, il Penseroso ed il Moderato” and probably “Israel in Egypt”.

So important did Handel consider Jennens that he referred to “your oratorio Messiah” in a letter to the librettist and made a detour on his way home from its premiere in Dublin to visit Jennens and tell him of its success with audiences.

The exhibition, “The Man Behind Messiah”, includes Handel’s autographed score of Saul which Jennens also annotated, suggesting changes to the composer’s work including a different entry point for the words “impious wretch”.

Yet Jennens’ name never appeared on scores, helping to explain why his contribution is largely unknown. An intensely private man, Jennens had reasons for remaining anonymous.

As a “non-juror”, or someone who did not endorse the Hanoverian royal dynasty that succeeded the House of Stuart, he was effectively barred from holding positions of authority.

And when, late in life, he published groundbreaking single-volume editions of some of Shakespeare’s most famous plays, he was attacked by a rival, Shakespearean commentator George Steevens (Eds: correct), and, thus, once again overlooked.

“It’s another reason he becomes kind of cut out of history,” Bardwell explained. “It’s been a fascinating insight into how people can just be written out of history.”

Ironically, despite his fundamental role in the Messiah and some of Handel’s other great oratorios, Jennens was not the biggest fan of a work that took less than a month to compose.

“He just thought Handel maybe rushed it off too quickly,” said Bardwell. Ruth Smith, the curator of the exhibition, believes Handel had the manuscript for about 18 months before he started work on it.

“For it to be rattled off in three weeks, I think Jennens felt that maybe he hadn’t done himself justice.

“I don’t think he ever quite got over his opinion that it wasn’t as good as he had hoped it was going to be. I think that also doesn’t help his reputation. I’m not sure he ever quite recovered from that.”

The Man Behind Messiah runs until April 14, 2013.

(Reporting by Mike Collett-White)

Music 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.

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Powerball jackpot winner: 'We'll have a good Christmas'

A 52-year-old Missouri mechanic and his wife claimed their share Friday of the record $588 million Powerball jackpot. ( Source: Associated Press)

Dearborn, Mo.—

A Missouri couple who won half of a record $587.5 million Powerball jackpot said on Friday they plan to stay put in their rural community, but know their lives will be changed.

“I think we'll have a good Christmas,” Cindy Hill said at a news conference where she and her husband, Mark Hill, were presented as winners of the jackpot by the Missouri Lottery.

Cindy Hill, 51, is a former office manager who got laid off in 2010. Mark Hill, 52, was a mechanic for Hillshire Brands, a food company, but has now quit his job.

They have three grown sons and a 6-year-old daughter adopted from China who were among about 25 relatives at the news conference, held in the gymnasium of the high school where they were sweethearts in the 1970s.

Cindy Hill first learned of the winning ticket on Thursday when she checked her numbers at the Trex Mart in Dearborn, a community of about 500 people 30 miles (50 km) north of Kansas City. She then called Mark Hill from her car. They had bought five tickets.

“I think I'm going to have a heart attack,” she told him. He told her to meet him at his mother's house so he could check the numbers for himself. “He said this is the ‘Show Me State,' show me.”

When they verified the numbers, they traveled to lottery offices in Jefferson City, Missouri, spent the night in a hotel and tried to comprehend what happened, Cindy Hill said.

“I thought ‘This isn't what I thought it would be like, now I'm really nervous,” she said. “I'm grateful, but there will be some not-so-good stuff to go along with it.” Earlier, she said “You are going to get people coming out of the woodwork and some of them many not be too sane.”

She said she and her husband plan to make the most of the winnings by giving to charity, to relatives for college education and other needs, and to the community.

“We are pretty well-grounded and worked hard all our lives,” Cindy Hill said.

Mark Hill deferred to his wife for most of the news conference, which was observed by about 300 students from grades 7 to 12 in the bleachers.

“It's all just kind of a fuzz,” Mark Hill said.

He said he has not grasped winning the money. On Thursday, for example, he went to buy toothpaste and other items to take to the hotel and found himself checking the price.

A CAMARO AND A HORSE

Cindy Hill said her husband wants a red Chevrolet Camaro car and she wants a horse. Daughter Jaiden wants a pony, Cindy Hill said. They also plan to travel, including a holiday with a lot of relatives in tow, she said.

The Hills won $293,750,000 before taxes. But they will take it in a lump sum of about $193 million rather than the larger amount over 30 years.

The Hills shared the Powerball payout with someone who bought a ticket at a food store in Fountain Hills, Arizona, on the outskirts of Phoenix. The Arizona winner has not yet come forward.

Some states allow lottery winners to remain anonymous but Missouri requires that the winner be publicly identified to claim the prize.

Dearborn reveled in its sudden arrival in the spotlight.

“It was a total surprise,” Don Palmer, a customer at the Trex Mart convenience store, said on Thursday. “Nothing ever happens in Dearborn.”

The winning numbers were 5, 16, 22, 23, 29, and the Powerball number 6.

The odds of winning the jackpot with a $2 ticket is one in more than 175 million.

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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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No charges against Chris Brown in Fla. phone grab

MIAMI (AP) — Grammy-winning singer Chris Brown won’t be charged with a crime after a woman claimed he snatched her cell phone when she tried to take his photo outside a Miami Beach club.

A memo released Friday by the Miami-Dade County State Attorney‘s office concludes there is no evidence that Brown intended to steal the phone in February or that he deleted the photo. One or the other is necessary for him to be charged.

Prosecutors say that Brown tossed the phone from his limo and that it was picked up by security.

A felony charge against the 24-year-old might have triggered a violation of his probation for his 2009 assault on singer Rihanna, who was his girlfriend at the time. The two have recently collaborated on a new duet.

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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.

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