Georgia Health Insurance 411

Archive for 2009

All of the rhetoric about health insurance reform seems to eventually come down to an argument about  . . . PROFIT. I seriously doubt those who say a profit motive is what is driving up the cost of health care, and health insurance premiums, have any real understanding of the economics of profit. If they have a college degree at all it is most likely in liberal arts. To them, profit is a four letter word, but if they have a job, or run a business, then they owe their livelihood to someone making a profit.

But let’s clear the air on one thing. Even not for profit organizations make profits. Rather than paying out those profits to stockholders they reinvest those profits directly in the business.

Churches, hospitals, schools, charities that fall under the umbrella of not for profit status all have a goal of bringing in more income than they pay out in expenses. If they fail to accomplish this they close their doors.

A fellow I know is constantly railing against the current health insurance system because he can’t afford health insurance for his wife. She has a minor heart condition that, if not for the medication, she could easily find coverage. Since her doctor chose to write a prescription as a “precaution” finding coverage is almost impossible. I did find a plan in the $350/month range but he could not afford it so she has nothing. He constantly blames the “for profit” big insurance companies when in fact there is no one to blame but himself. If she were to go off the medication (subject to doctors approval) for 12 months there would be more plans available and at lower premiums.

But it is easier to complain and blame the system.

He provided me with a link to “prove” his argument against for profit health insurance companies.

Supporters envision the public option as a nonprofit insurance company that would offer lower-cost health coverage.

If that sounds vaguely familiar, there’s a good reason: For decades, most Americans got health benefits through just such a company. It enrolled everyone who applied, something it considered part of its social mission.

It used what’s called “community rating” to set reasonable rates for all. And it offered the same standard benefit package across the country.

For those not familiar with this concept and the company, the article describes the original Blue Cross model.

All of the original Blue plans were not for profit organizations that did indeed charge the same rate for everyone in the “community” regardless of age or health. You were a member, not a policyholder. The plan operated much like a co-op.

According to the article, things changed as evil, for profit insurance companies came in to the picture.

When commercial insurance companies got into the market after World War II, they used a different system based on actuarial tables, like life and casualty insurance. They tried to identify who was most likely to get sick and charged them higher rates.

While nonprofit Blues made money by enrolling more people, for-profit companies found they could make more by excluding people who were more likely to become sick. That left someone else – relatives, hospitals and eventually the federal Medicaid program – to cover the sick and the poor.

Market segmentation eventually spelled trouble for Blue Cross. Unless it also segmented markets and excluded the sick, it couldn’t match prices charged by other insurance companies.

For profit insurance companies were able to deliver a better value by charging rates based on risk vs. a one-size-fits-all approach and this is considered . . . bad.

Community rating of individual health insurance policies still exists by mandate in states like NY, ME & VT. Each of those states have only a handful of health insurance companies offering individual major medical and the premiums are astronomical. It really begs the question, why is Congress hellbent on moving the entire country toward a business model of higher premiums when we have real world examples of how one-price-for-all doesn’t work?

And if profits are so bad, why is that for profit health insurance companies are able to deliver a better product at a lower price than their not for profit counterparts?

This is a true story, as told by a professional Santa Claus of a real Christmas miracle which he experienced. A story that I think will cause YOU to believe …

Three years ago, a little boy and his grandmother came to see my Santa at Mayfair Mall in Wisconsin. The child climbed up on his lap, holding a picture of a little girl.

“Who is this?” asked Santa, smiling. “Your friend? Your sister?”

“Yes, Santa,” he replied. “My sister, Sarah, who is very sick,” he said sadly. Santa glanced over at the grandmother who was waiting nearby, and saw her dabbing her eyes with a tissue.

“She wanted to come with me to see you, oh, so very much, Santa!” the child exclaimed. “She misses you,” he added softly.

Santa tried to be cheerful and encouraged a smile to the boy’s face, asking him what he wanted Santa to bring him for Christmas. When they finished their visit, the Grandmother came over to help the child off his lap, and started to say something to Santa, but halted.

“What is it?” Santa asked warmly.

“Well, I know it’s really too much to ask you, Santa, but ….” the old woman began, shooing her grandson over to one of Santa’s elves to collect the little gift which Santa gave all his young visitors. “The girl in the photograph … my granddaughter … well, you see … she has leukemia and isn’t expected to make it even through the holidays,” she said through tear-filled eyes. “Is there any way, Santa … any possible way that you could come see Sarah? That’s all she’s asked for, for Christmas, is to see Santa.”

Santa blinked and swallowed hard and told the woman to leave information with his elves as to where Sarah was, and he would see what he could do.

Santa thought of little else the rest of that afternoon. He knew what he had to do. “What if it were MY child lying in that hospital bed, dying,” he thought with a sinking heart, “this is the least I can do.”

When Santa finished visiting with all the boys and girls that evening, he retrieved from his helper the name of the hospital where Sarah was staying. He asked the assistant location manager how to get to Children’s Hospital. “Why?” Rick asked, with a puzzled look on his face. Santa relayed to him the conversation with Sarah’s grandmother earlier that day. “C’mon …. I’ll take you there,” Rick said softly.

Rick drove them to the hospital and came inside with Santa. They found out which room Sarah was in. A pale Rick said he would wait out in the hall.

Santa quietly peeked into the room through the half-closed door and saw little Sarah on the bed. The room was full of what appeared to be her family; there was the Grandmother and the girl’s brother he had met earlier that day. A woman whom he guessed was Sarah’s mother stood by the bed, gently pushing Sarah’s thin hair off her forehead. And another woman who he discovered later was Sarah’s aunt, sat in a chair near the bed with a weary, sad look on her face. They were talking quietly, and Santa could sense the warmth and closeness of the family, and their love and concern for Sarah.

Taking a deep breath, and forcing a smile on his face, Santa entered the room, bellowing a hearty, “Ho, ho, ho!”

“Santa!” shrieked little Sarah weakly, as she tried to escape her bed to run to him, IV tubes intact.

Santa rushed to her side and gave her a warm hug. A child the tender age of his own son — 9 years old — gazed up at him with wonder and excitement. Her skin was pale and her short tresses bore telltale bald patches from the effects of chemotherapy. But all he saw when he looked at her was a pair of huge, blue eyes.

His heart melted, and he had to force himself to choke back tears. Though his eyes were riveted upon Sarah’s face, he could hear the gasps and quiet sobbing of the women in the room. As he and Sarah began talking, the family crept quietly to the bedside one by one, squeezing Santa’s shoulder or his hand gratefully, whispering “thank you” as they gazed sincerely at him with shining eyes.

Santa and Sarah talked and talked, and she told him excitedly all the toys she wanted for Christmas, assuring him she’d been a very good girl that year. As their time together dwindled, Santa felt led in his spirit to pray for Sarah, and asked for permission from the girl’s mother. She nodded in agreement and the entire family circled around Sarah’s bed, holding hands.

Santa looked intensely at Sarah and asked her if she believed in angels. “Oh, yes, Santa … I do!” she exclaimed.

“Well, I’m going to ask that angels watch over you,” he said.

Laying one hand on the child’s head, Santa closed his eyes and prayed. He asked that God touch little Sarah, and heal her body from this disease. He asked that angels minister to her, watch and keep her. And when he finished praying, still with eyes closed, he started singing softly, “Silent Night, Holy Night … all is calm, all is bright.” The family joined in, still holding hands, smiling at Sarah, and crying tears of hope, tears of joy for this moment, as Sarah beamed at them all.

When the song ended, Santa sat on the side of the bed again and held Sarah’s frail, small hands in his own. “Now, Sarah,” he said authoritatively, “you have a job to do, and that is to concentrate on getting well. I want you to have fun playing with your friends this summer, and I expect to see you at my house at Mayfair Mall this time next year!”

He knew it was risky proclaiming that, to this little girl who had terminal cancer, but he had to. He had to give her the greatest gift he could — not dolls or games or toys — but the gift of HOPE.

“Yes, Santa!” Sarah exclaimed, her eyes bright. He leaned down and kissed her on the forehead and left the room.

Out in the hall, the minute Santa’s eyes met Rick’s, a look passed between them and they wept unashamed. Sarah’s mother and grandmother slipped out of the room quickly and rushed to Santa’s side to thank him. “My only child is the same age as Sarah,” he explained quietly. “This is the least I could do.” They nodded with understanding and hugged him.

One year later, Santa Mark was again back on the set in Milwaukee for his six-week, seasonal job which he so loves to do. Several weeks went by and then one day a child came up to sit on his lap. “Hi, Santa! Remember me?!”

“Of course, I do,” Santa proclaimed (as he always does), smiling down at her. After all, the secret to being a *good* Santa is to always make each child feel as if they are the only child in the world at that moment.

“You came to see me in the hospital last year!”

Santa’s jaw dropped. Tears immediately sprang in his eyes, and he grabbed this little miracle and held her to his chest. “Sarah!” he exclaimed. He scarcely recognized her, for her hair was long and silky and her cheeks were rosy — much different from the little girl he had visited just a year before.

He looked over and saw Sarah’s mother and grandmother in the sidelines smiling and waving and wiping their eyes.

That was the best Christmas ever for Santa Claus. He had witnessed — and been blessed to be instrumental in bringing about — this miracle of hope.

This precious little child was healed. Cancer-free. Alive and well. He silently looked up to Heaven and humbly whispered,

“Thank you, Father. ‘Tis a very, merry Christmas!”

The story was told by Mark R. Leonard, a professional Santa Claus and written by his wife, Susan Leonard, a.k.a “Mrs. Claus:”

While Congress wants you to believe you are getting a Christmas present in the form of health insurance reform it is beginning to look more like a lump of coal. The reckless spending and political vote buying (with our money) is one thing, but the Senate bill is beginning to look like a “cram everything you can into this law because we may never have a chance like this again” piece of . . . legislation.

Some parts of the bill make no sense whatsoever, including (but not limited to) the part that discusses “Wellness and Prevention Programs” on page 5 under the heading “Protection of  Second Amendment Gun Rights”

Will someone tell me how wellness programs are tied to gun rights?

The folks at Reuters found this jewel. The CLASS Act will add a long term care insurance benefit to the already gargantuan health insurance reform bill.

A new government insurance program that would help the elderly and disabled stay in their homes is headed for passage in the U.S. Senate’s sweeping healthcare revamp despite doubts about its viability and cost.

The measure has not received the intense scrutiny focused on a proposed government-run medical coverage plan, which has been jettisoned from the the Senate’s healthcare bill and is unlikely to be restored in final legislation.

But the Community Living Assistance Services and Supports (CLASS) Act, which was championed by the late Senator Edward Kennedy, is a significant program that supporters say is long overdue and critics say could add to the federal treasury’s long-term debt problems.

As with anything else coming out of Washington, it always sounds much better than it really is.

We never did find those WMD’s, did we?

Obamacare, Pelosicare, whatever you want to call it seems dead this year. It never made much sense, at least not the way Congress was approaching it. There was no true health CARE reform, but rather insurance reform. Some would argue that CHANGE is needed, and no doubt the current system is not perfect, but the change that was proposed was ill-conceived.

Here is a summary of what would have happened if reform, as envisioned by Washington, had become reality.

Reform was directed solely at the constantly debated figure of 47 million who are without health insurance. Not health care, but health insurance. At least one flaw in the number is the estimated 10 – 18 million counted in that figure that are in the United States illegally.

For chuckles and grins, let’s just round it off to 35 million without health insurance.

The projected annual cost varies, depending on which version of the bill you want to use and whose numbers you want to believe, but the range was $80 billion to $130 billion. To keep it simple, let’s split the difference and use $100 billion. That’s about $2800 per year per uninsured man, woman and child.

That doesn’t seem like much when you break it down like that and with good reason. It is woefully underestimated, especially when one adds in the NEW benefits mandated by health “care” reform including prohibiting health insurance companies from medically underwriting new applicants.

Even if you want to accept their fantasy figure, where would the money come from to fund this . . . change?

Eliminating fraud and abuse in Medicare and Medicaid. No one ever answered why we need a  new $100 billion entitlement program to eliminate fraud and abuse in existing entitlement programs.

Taxes. New ones. It was a constantly moving target but some of the ideas tossed out included taxes on tobacco, alcohol (the drinking kind), snack foods, taxes on individuals who do not buy health insurance, taxes on those who have too much insurance, taxes on business owners that do not provide health insurance for their employees. The list was constantly changing.

Personally, I am glad this “change” appears to be dead. Many, including me, asked why we should allow the government to take take over and manage health care (by way of controlling health insurance) for 100% of the population when they can’t even manage the programs they already have for 30% of the population.

It seems obvious to me that more pressing issues would be things like reducing taxes, not increasing them, to stimulate the economy. Put more money in the hands of American’s who actually drive the economy and create jobs rather than spending money we don’t have on bailouts and pretend job creation programs through failed stimulus plans and cash for clunkers.

So while some will bemoan the death of health care reform, my guess is the 11 million plus that are unemployed would rather have a job than a new entitlement program. Just imagine, if the billions spent on bailing out banks, insurance companies and auto companies had been redirected to the citizens in the form of tax cuts, how many would now be back at work or better yet, would never have lost their job (and home) from the start?

Think about it.

Saving money on Atlanta Georgia health insurance is synonymous with saving money on health care. Each affects the other both when purchasing health insurance and going forward after the purchase.

When you apply for health insurance in Georgia, underwriters look at any and all medications you are taking, or have taken during the last 3 years. More expensive medications translate into higher premiums for health insurance. Being pro-active in working with your doc to lower your cost of medication will help you save money.

The folks at Consumer Reports have provided us with a list of ways to save on the cost of medication. Some are obvious, such as switching to (or starting out with) generics. Others may not be so obvious such as the tip to avoid doctor samples. Worthwhile reading.

Yesterday I talked with a lady that was taking two different medications for migraines. Her employer group health insurance plan was changing in January and she would no longer be able to get these medications for a $30 copay. Until she satisfies her deductible she will be paying almost $600 per month for medication.

Generic alternatives will run $20 per month. That is a major savings.

Ask your doctor about generics and lower priced alternatives.

If she were applying for major medical health insurance carriers that are unable to offer exclusion riders for medical conditions would decline her application for coverage. The few that still offer riders would issue a policy, but would not include coverage for her migraine medications. A simple switch to generics saves her premium dollars but also cuts her monthly out of pocket down to almost nothing.

When looking for Atlanta Georgia health insurance be aware that the medication you take can have a major impact on your ability to find affordable health insurance.

Today at sundown begins the Festival of Lights, also known as Hanukkah.  This is (so I am told) considered a “low” holiday when compared to Rosh Hashanah or Yom Kippur. Often times Christians try to equate it to our own holiday of Christmas which is celebrated around the same time as Hanukkah, but Hanukkah is anything but “Jewish Christmas”.

This 8 day holiday commemorates the rededication of the Temple in Jerusalem following the Maccabean revolt.

To all my friends who celebrate their Jewish heritage I extend my best wishes.

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Health care reform is supposed to guarantee health insurance to roughly 36 million Americans over the next 10 years at a cost of $1 trillion or more.

In simple terms, that is $100 billion per year for 10 years. That averages out to just under $2800 per individual per year . . . IF you believe their numbers.

So how does Professor Obama score on his math abilities so far?

According to Reuters, the Obama administration has spent (or invested, depending on your perspective) $158 billion to create or save 640,329 jobs.

Ignore for the moment that not all of those were real jobs created or saved. Some were only temporary jobs that lasted a few weeks. Some were not jobs at all but rather the money was spent to give raises to people who already had jobs. And it was recently reported that Columbus schools spent $145,000 to rent banquet halls and conference rooms in “high end” hotels to train existing teachers on how to teach.

This in spite of the fact they own 120 buildings that are designed for . . . teaching.

They are also spending $1.4 million to pay speakers for this 3 day session.

But back to the jobs created or saved.

640 thousand jobs.

$158 billion.

That’s $246,000 per job created or saved.

Total compensation earned by the average payroll employee during October, on an annualized basis, was $59,867. If the government had simply used the funds awarded so far to pay for a year’s worth of labor, that would have paid for 2.6mn jobs!

So much for government efficiency.

Will someone please tell me how a government that spends that much money to save or create so few jobs will suddenly become an efficient machine at delivering quality health care for all at a lower cost than what we have now?

I see a lot of things on Georgia health insurance applications. Things that will make an underwriter cringe. Underwriters by nature are negative folks with an itchy trigger finger, ready to blow your application away.

The key to getting your health insurance application approved is to know what underwriter’s are looking for, what they need, what they don’t need. It’s all pretty simple really once you understand how the game is played.

One of the keys to smooth underwriting is in picking the right health insurance plan and the right health insurance company. Another is knowing IN ADVANCE which health insurance companies you should NOT apply with for coverage.

That being said, here are some keys to making your health insurance application idiot proof.

1. Submit applications electronically
2. Make sure you are honest about your health. Failing to admit relevant health information will delay your application and can result in a denial.
3. Don’t clutter your application with needless detail. As Joe Friday says, “Just the facts”.
4. Provide enough information to help the underwriter in assessing you as a risk without causing the underwriter to set your application aside for answers to simple questions.
5. Diagnosis, prognosis and treatment plan (if any) are critical to the underwriting process of your health insurance application.
6. Some “yes” answers will bog down the process and should not be answered affirmatively.
7. Some “no” answers are incorrect and should really be answered “yes”.
8. Be aware of time frames. Some questions apply to the last 10 years while others only apply to the last 12 – 24 months.
9. Know in advance which conditions are relevant to the underwriting process and which are not.
10. During the underwriting interview, anticipate the questions and have firm responses for the examiner.

We pre-screen all applications and advise clients of what conditions will create challenges in the underwriting of your health insurance application and which will not. In most cases, we will review your medical conditions with one or more health insurance companies and get their “best estimate” of what to expect in the way of an offer.

We don’t blanket your application to multiple health insurance companies, but rather zero in on one or two that will provide your best shot at a favorable offer.

There is no charge for our services. Fees for agents are built in to every plan, so you pay the same rate regardless if you go direct to a health insurance company, use an online out-of-state insurance broker, or use our services. You get the benefit of our 34+ years in the industry at no additional charge.

Before submitting a Georgia health insurance application, be an informed consumer and make your application idiot proof.

Blue Cross of Georgia (BCBSGA) may try to talk you into a “rollback” of rates on renewal. They make it sound so good.

Just agree to let them implement a new 12 month pre-existing condition limit and you can drop your renewal by 30%, 40%, 50% or more. What could be easier?

Anyone who does this is playing with fire.

If you are currently under treatment for a medication, that condition will not be covered for the next 12 months. Say you are taking blood pressure medication or being treated for high cholesterol. You probably see your doctor twice a year for a check up and get your med’s filled monthly. BP medication is usually inexpensive. Sometimes as little as $4.

Some cholesterol medication’s are also available for $4.

So what’s the risk?

When you agree to allow BCBSGA to rollback your rates and impose a pre-existing limit it affects not only existing specific conditions and treatment but anything RELATED to that condition.

For example, a heart attack or stroke could be related to high blood pressure or high cholesterol. Even if your condition is under control with medication the pre-existing clause allows BCBSGA to investigate any claims that might be related to the excluded condition under rollback. If they determine your heart attack or stroke is related to blood pressure or cholesterol issues they have a right to deny your claims.

Some folks with high blood pressure can become a type II diabetic. If so, any claims related to diabetes are subject to review and can be denied.

The same can happen if you has asthma or allergies. If those conditions become a crisis requiring you to seek emergency care those claims will be denied.

Be very careful when negotiating and accepting renewal terms that include a rollback offer. When evaluating any coverage, it is always a good idea to discuss your situation with a knowledgeable Georgia health insurance agent.