Georgia Health Insurance 411

Archive for June, 2009

If you need health care in Georgia it doesn’t matter if you live in Atlanta, Smyrna, Lawrenceville or Savannah. You need a resource for health care information and health insurance and we offer both at Georgia Insurance Shop.

Georgia Insurance Shop is a leading resource for information on health insurance for individuals and businesses. We have access to over 3500 health insurance plans that will fit almost ever budget and need.

Georgia insurance shop also has some of the best supplemental plans for those who cannot afford, or qualify for health insurance. Our Georgia Core Med is a value oriented plan of health insurance that does not ask any health questions or require a physical exam.

But we offer much more than just health insurance. We have links to more resources on health care than any other site we have encountered. Our Patient Charity page is one of the more popular ones on the web as a “one stop” place for information.

If you are looking for information on Georgia PeachCare for Kids, Medicaid or the Georgia assignment system for HIPAA eligible individuals, you will find information at Patient Charity.

Looking for affordable prescription drugs? There are plenty of resources including patient assistance programs and sources of low cost prescription drugs by mail.

Our Georgia Health Insurance Resource section has over 30 links to information on health care in Georgia and more are being added every day.

Today we will be adding a new resource for everyone, not just those in Georgia. My Medical Reports is one of the most extensive, yet easy to follow sites I have seen. If you are looking for information on specific medical conditions, or those affecting women’s health, pediatrics or sports Medicine, My Medical Reports should be researched.

Health care is important, but so is access to health care and a way to pay for the care you need. When looking for affordable health insurance in Georgia, we hope you will keep Georgia Insurance Shop in mind.

Unless you are allergic to strawberries, they are an excellent source of Vitamin C and fiber. But in picking strawberries, does size matter?

According to the California Strawberry Commission and reported by Consumer Reports, you should look for medium sized strawberries and darker reds.

choose shiny, firm ones with a bright red color and fresh, green, and intact caps. And stay away from the green-ish yellow berries

So now you know . . .

If PresBO get’s his way, and we get a public health insurance plan in Georgia similar to Medicaid, how will it work?

There are no assurances at this time that a public health insurance option will materialize. Or how it will work. Or most importantly, how it will be funded.

But we do know this much.

If and when it happens, we can probably get a good idea of how we will be affected by looking at how well (or not) current public health insurance plans work (or don’t work).

For instance, consider how Medicaid works. According to at least one source, 40% of doctors will not treat Medicaid patients. In some states, like California, it is more like half of all doctors refuse to treat Medicaid patients.

In Georgia, Rep. Alan Powell tried to introduce a bill (HB 89) earlier this year.

so as to require physicians who participate in the state employees’ or board of regents’ health insurance plan to also participate in the Medicaid program

In other words, if you want to treat state employees you must also treat Medicaid patients.

Bills such as this, requiring doctors to treat Medicaid patients have failed in the past. HB 89 was withdrawn the end of April without coming to a vote.

How is this working for you so far?

U.S. Congressman Phil Gingrey who is also a physician, has these thoughts on a public health insurance plan as reported by U.S. News and World Report.

DNC Chairman Howard Dean, former candidate for president, is a staunch supporter of Obama’s push for a public health insurance option. Governor Dean is also married to a physician, Dr. Judith Steinberg.

Dr. Steinberg does not treat Medicaid patients.

As Vermont’s governor, Dean aggressively pursued expansions of government-run health insurance—and bragged that doing so “was very cheap to do.” Unfortunately for beneficiaries on state-run Medicaid and children’s health insurance, that “cheap” coverage often came at a very steep price. Low reimbursement rates mean that few doctors actually participate in the government-run plan, so patients can’t see their personal physician—and may not be able to see any physician when they need one.

In Vermont, one of those physicians whom Medicaid beneficiaries couldn’t visit was Judith Steinberg—Howard Dean’s wife. In 1998, low reimbursement rates—coupled with the impact of additional regulations her husband signed into law—prompted Dr. Steinberg to end participation in the state’s largest Medicaid-managed care program. As a result, the residents of Shelburne in Vermont’s largest Medicaid plan lost access to the only primary care provider in town who would accept their insurance.

Oops!

Rep. Gingrey continues:

I don’t fault Dr. Steinberg for her decision—it may well have been the only rational business decision for her to make. But for Governor Dean to claim that a government-run plan won’t be “inferior” is to ignore his wife’s experience, and that of the many beneficiaries who lost access to their physician due to Medicaid bureaucracy and poor coverage.

So health care is a business decision. As in, “for profit”.

Supposedly having a government run plan would eliminate the for profit motive.

Apparently not . . .

President Obama promised during his campaign that, “If you like the plan you have, you can keep it.” But most individuals don’t really have their own health coverage—they get it from their employers. And if the coverage provided in the government-run plan is cheaper than what employers are paying now, logic suggests that employers will drop their current plans and place their workers in the government plan.

Estimates from independent actuaries at the Lewin Group suggest that well over half of all Americans currently with employer-sponsored health coverage—nearly 120 million individuals—would lose their current coverage due to the creation of a government-run health plan. And the change in coverage would not be a “choice”—according to Lewin studies, employers would drop their plan options, dumping employees into the government-run health plan to save money.

Well of course. Free is always better, isn’t it?

If you want a choice of affordable health insurance plans rather than waiting on something that might go over as well as the Fiat did, then check us out at Georgia Insurance Shop.

If you are looking to buy health insurance in Georgia, there is one place you should never go.

Direct to the carrier.

Seriously.

Here’s why.

When you buy direct you deal with a carrier CSR (customer service rep).

Carrier CSR’s are not a good source for answers to your questions. You would be better off in most cases with a weak agent vs a CSR.

CSR’s are hourly workers with little training . . . usually a week or even less. They sit in a booth all day wearing a headset and looking at a computer monitor.

Conversations are recorded and timed. If they spend too much time on the phone they are notified it is time to kill the call and move on to the next one. Too many warnings and they lose their job.

The only answers they have are based on an FAQ system. You ask a question, they key it in, then read the answer.

Want to talk to a supervisor?

Good luck.

It won’t happen until you have a problem that is escalated and that will only occur after several phone calls by you to the carrier.

I can’t imagine why anyone would want to deal direct with a carrier. I have been working with them for over 30 years. I know the answers to most questions but also know where to go and what questions to ask to get the answers I need. Even then, it frustrates me from time to time.

As long as you deal direct with carriers you will almost always pay more than you need and never get real value for your money.

And you will continue to be frustrated.

The choice is yours. Deal direct with a carrier CSR or buy through an agent who can give real advice without reading from a computer screen.

Do you have questions? We have answers.

If you have a question about health insurance, or are looking to buy affordable health insurance in Georgia, give us a call.

The Oracle of Washington, who knows all, see’s all, is poised to pronounce what is good for us in the way of health care.

This is the same group that thought it was a great idea to make housing available to everyone regardless of their ability to repay their mortgage.

The same group that thinks spending more than you earn is a great idea.

First they loaned money they didn’t have to folks in Detroit who make our cars. Then they decided to assume control of an industry they know nothing about. Their solution is to sell one company to the Italian’s so that company can now import cars that no one bought 20 years ago.

Apparently Washington thinks America is ready for the “Fix It Again Tony” (Fiat). The car that voluntarily withdrew from the U.S. market rather than meet (what was then) tough emission standards.

The other car company has either sold, or is in the process of selling off the Hummer. They will also cut back on other big cars with high profit margins in favor of smaller cars with little or no profit margin.

And let’s not forget the guy (Brian Deese) in Washington who is the “brains” behind the bailout, no wait, bankruptcy of the automakers is a 31 year old law school dropout.

But wait, there’s more!

The new head of GM (Ed Whitacre) by his own admission “knows nothing about cars” but why should that stop him?

So now that we will be building and buying (or so they hope) smaller cars in order to save the American auto industry, what is next on the agenda?

Bigger health insurance.

Washington want’s to provide (their term, not mine) “basic, universal” health care (actually coverage, but why split hairs) for everyone.

So what is their idea of basic?

We don’t really know because that is a moving target, but using politicians outside the beltway as a guide, perhaps we can get some insight into what needs to be covered by health insurance.

According to the NCPA (National Center for Policy Analysis) state mandates, benefits that MUST be covered by health insurance, increase the cost of health insurance by 20 – 50%, depending on the state.

Here is a sampling.

Nine states require coverage (no pun intended) for hair prostheses (wigs).

Thirteen states require coverage for IVF (in vitro fertilization), a topic that is near and dear to our hearts.

Four states mandate coverage for massage therapists, three states for naturopaths. Fifteen states require coverage for “bone mass measurement” and thirty have mandates for dental anesthesia.

Now I am to be included in those who do not like pain and will go out of my way to avoid it. But since when is the cost of dental anesthesia so great that it must be an insured item? I would gladly pay for dental anesthesia even it if wasn’t covered and I bet I am not alone. So why do 30 states feel it must be an insurance mandate?

Is this their idea of “basic” coverage? How do residents of the other 27 states get by without having their dental anesthesia covered by insurance?

The list goes on . . .

One reason why health insurance is expensive is because we are insuring things that don’t need to be insured . . . like all of the things listed above.

I constantly remind clients that their auto insurance (mandated in all 50 states) does not cover things like tires, brakes and oil changes. But now that Washington has decided we will build smaller cars (regardless of whether anyone buys them), what if they decided it was for our own good that auto insurer’s cover oil changes?

Your auto insurance premiums would rise proportionate to the number of miles you drive. If you drive 12,000 miles per year that is 4 oil changes at $40 each so your premium needs to increase by $250 to cover the cost of the anticipated oil change plus the administrative handling fee for processing your claim.

I imagine quite a few folks would balk at that but some would cheer because they no longer have to pay for oil changes.

This same mentality seems pervasive among politicians when it comes to health insurance. This is especially true when no one has to pay for health insurance any more, it will be provided for by the government.

Like their free Medicare coverage.

Taking a cue from a pizza company, I can imagine the commercials for the change that is coming from Washington.

“Smaller cars, bigger health insurance, Poppa Washington.”

Are you having trouble buying health insurance in Georgia? If you are to believe the reporting in Sunday’s AJC,

Policies are suddenly canceled. Monthly premiums rival the size of mortgage payments. Huge bills go unpaid because of surprising gaps in coverage.

If it bleeds, it leads. That’s the mantra for news.

Problem is, the reporting falls short in gathering the facts.

With individual plans, carriers can legally charge higher premiums based on age, gender or health. They can refuse to cover conditions that group plans routinely include, or deny coverage outright for people with problems such as arthritis or diabetes.

This is all true. But it is also true in all but a handful of states where carriers are prohibited from underwriting medical conditions. In states like New York, Maine, New Hampshire and Massachusetts carriers are required to issue policies to anyone without regard to their health history.

Someone with terminal cancer can apply for coverage and receive a policy. The terms and price would be the same as someone the same age who is in excellent health.

The result is, premiums in those states are 2x – 3x higher than premiums for similar plans in neighboring states where medical underwriting is allowed.

So providing coverage on everyone regardless of health is not a problem.

Rich Mazurek, 37, of Suwannee, is among thousands of Georgians who can’t get coverage at all.

Mazurek has rheumatoid arthritis and ventured into the individual market because he lost his job and couldn’t afford premiums under COBRA, the law that allows ex-employees to keep their coverage for a while at their own expense: “I was totally naive. I was declined by more than 20 companies.”

RA can be very expensive to treat. Some medications used to treat RA (like Enbrel) can run $1600 per month.

Even though COBRA may have appeared expensive, it is a bargain compared to going without coverage for his condition.

The insurance market did not fail him. He failed to take advantage of coverage that was available.

Sams, the taxidermist, has experienced the gamut of individual policy problems.

He lost his insurance in a dispute over whether he’d disclosed his acid reflux disease. After what he called “two years of anguish” trying to find a new policy, he ended up back with the company that canceled him.

There are only two reasons why a carrier will cancel someone.

Fraud, or failure to pay your premium.

If he committed fraud, I would be very surprised if the same carrier would take him back. There is more to this story than is being reported.

Carriers don’t cancel for failure to disclose GERD (acid reflux). They either back-date an exclusionary rider or charge an extra premium.

It’s always interesting when reporters puff up a story just to sell newspapers.

The biggest mistake the individuals highlighted in this article made was failing to talk to a knowledgeable agent. Had Rich Mazurek called me the day he lost his coverage I would have saved him a lot of time and anguish. There was no need to waste time contacting 20 carriers or even bothering to apply for coverage. Our conversation would have ended in 5 minutes of laying out his options. First COBRA, then either enhanced conversion or a policy throught the Georgia assignment system.

Sam’s the taxidermist was a bit easier. GERD is not that difficult to underwrite as long as there are no other complications. Either he tried to do things by himself or simply failed to talk with a qualified agent.

Looking for health insurance is not a DIY weekend project. With some carriers, half the applications are rejected. Less than 5% of applications submitted through my office are declined. Many times I find coverage for people who have been rejected by carriers in the past. Sometimes I am even able to resubmit applications to carriers who have rejected an applicant and get coverage issued.

I don’t sell newspapers, but I do know how to find coverage for almost everyone who calls.

If you are looking to buy affordable health insurance in Georgia, you know where to find me.

According to the New York Times the House has revealed a plan for sweeping health care reform in the United States.

But there are a few hitches.

They don’t know how much it will cost.

They don’t know how to fund it.

But other than that . . .

The draft bill would require all Americans to carry health insurance. Most employers would have to provide coverage to employees or pay a fee equivalent to 8 percent of their payroll.

Everyone must have health insurance or else what?

Then there is this goody.

The plan would also end many insurance company practices that deny coverage or charge higher premiums to sick people.

This is no problem. A handful of states already prohibit carriers from denying coverage (aka guaranteed issue) and/or charging a higher premium (known as community rating) for those with health problems.

Premiums in those states are 2x to 3x higher than comparable plans in states where carriers are free to medically underwrite coverage.

The 852-page House bill, as expected, is more expansive than the legislation taking shape in the Senate, where work on the issue bogged down this week after early cost estimates came in far higher than expected.

No one read the 1100 page stimulus bill. Wonder if anyone will read this one?

That’s probably expecting too much, don’t you think?

The proposal would expand Medicaid eligibility, increase Medicaid payments to primary care doctors and gradually close a gap in Medicare coverage of prescription drugs known as a doughnut hole.

If this were a car company, the design would look like a gas guzzling Hummer on steroids.

But wait! American car companies are not supposed to produce these kinds of car’s any more. America wants smaller, fuel efficient “green” car’s.

The bill would impose a new “tax on individuals without acceptable health care coverage.”

I can hardly wait to find out how “acceptable coverage is defined.

The tax would be based on a person’s income and could not exceed the average cost of a basic health insurance policy.

Define “basic”.

The House bill shows what Democrats mean when they speak of a “robust” public insurance plan.

Under the bill, the public plan would be run by the Department of Health and Human Services and would offer three or four policies, with different levels of benefits. The plan would initially use Medicare fee schedules, paying most doctors and hospitals at Medicare rates, plus about 5 percent. After three years, the health secretary could negotiate with doctors and hospitals.

American’s turning 65 have a difficult time finding doc’s willing to accept Medicare patients due to the low reimbursement. Anyone want to wager if folks under the “public plan” will encounter similar obstacles?

But the bill says, “There shall be no administrative or judicial review of a payment rate or methodology” used to pay health care providers in the public plan.

Sounds like no oversight to me. Isn’t this what led to Fannie Mae & Freddie Mac crashing on the rocks?

The bill would limit what doctors could charge patients in the public insurance plan, just as Medicare limits what doctors can charge beneficiaries.

Wonder how the doc’s feel about that?

The bill would require drug companies to finance improvements in the Medicare drug benefit. Drug companies would have to pay rebates to the government on drugs dispensed to low-income Medicare beneficiaries.

Gosh, this sounds an awful lot like cost shifting to the private sector.

The bill would expand Medicaid to cover millions of people with incomes below 133 percent of the poverty level ($14,400 for an individual, $29,330 for a family of four). The cost would be borne by the federal government.

The government would also offer subsidies to make insurance more affordable for people with incomes from 133 percent to 400 percent of the poverty level ($43,300 for an individual, $88,200 for a family of four).

I still have difficulty thinking of a family that earns $88,200 as poor. I guess it is something I will have to get over.

For 135 years insurance has been regulated at the state level. While at the federal level, laws are enacted that will filter down to the state level, all regulation is handled in each state by the DOI (Dept of Insurance).

States have been allowed not only to regulate the insurance industry, but most states rely heavily on the tax collections from premium taxes to support state services. In almost every state, premium taxes are the top 1, 2 or 3 source of revenue.

State premium taxes are usually 2% of collected premium or less yet the funds that fill state coffers usually eclipse collections from state sales or income taxes.

Now the Obamanation want’s to change that.

According to Bloomberg,

Obama called for the creation of a federal Office of National Insurance within the Treasury Department to monitor the industry, represent U.S. interests in international insurance agreements, and look for gaps in state oversight.

A division of the Treasury Department.

Seems to me the head of the U.S. Treasury had some oversight problems of his own. Now he wants to be responsible for finding gaps in state oversight?

Yeah, that’s the ticket.

The justification for this move is the collapse and bailout of AIG.

Of course AIG’s problems were mostly the result of the collapse of the mortgage market.

The mortgage market failed because of a government insistence that poor people and those with bad credit deserve to have a home just like the rest of us. The Pied Piper of the mortgage calamity was led by Fannie Mae and Freddie Mac.

Who was watching them?

Oh yeah.

The federal government.

If you are considering Aetna health insurance in Georgia you may have heard of the contract dispute over reimbursement. If not, here is the article from the AJC.

WellStar Health System may sever its relationship with Aetna insurance company, according to a letter sent out to patients.

The June letter says that the health system has been unable to reach a new contract agreement with Aetna and that the existing contract terminates on Aug. 31.

The letter, a copy of which was obtained by The Atlanta Journal-Constitution, says that WellStar hopes to resolve the contract before August.

The letter includes a listing of major managed care and insurance companies with which WellStar has contractual relationships.

“You may find this information useful if you are making new coverage decisions with your employer over the next few months,” said the letter signed by Barbara Corey, the health care system’s senior vice president of managed care.

This is mostly sabre rattling and positioning.  It is Wellstar’s way of kicking dirt on the umpire’s shoes to make a point. They will go back and forth on this with Wellstar telling the media they can’t continue to treat Aetna patients unless Aetna increases their reimbursement.

Aetna will stall, saying they are looking out for the interest of their policyholders and trying to hold the line on premiums.

A few years ago it was Blue Cross’ turn to be the heavy. Blue dug their heel’s in and actually let the contract expire leaving policyholders holding the bag for a couple of weeks before coming back and saying they were only kidding.

To be honest, no one wins in this kind of playground bully tactic. It makes both sides look bad. I look for it to blow over and be settled by mid August.

But if you are looking for affordable health insurance in Georgia we have plenty of other carriers including Cigna.

What is the REAL issue driving the “health care crisis”?

It isn’t profit, or greed or government. It is simple economics.

Opinions on how to solve the “health care crisis” are like belly buttons. Everyone has one and no one really cares about yours.

Some want to blame insurance carriers. Others the government. Seems like quite a few blame the “profit motive” in the health care system.

All contribute but like most complex issues, there is no simple solution and there is no single way to fix.

The challenge of how to pay for health care is not just a U.S. problem, it is world wide. Socialistic health care systems to our north and across the pond have the same challenges we have. Their tax coffers are running dry and the response is to cut services.

I studied economics in college and never thought I would ever visit supply and demand curves after graduation. I won’t bore you with college level economics, but if you really want to learn more, consult with Professor Google and enter phrases like “health care economics”.

The economics of goods and services can be reduced to simple demand and supply. Health care is no different. It follows economic theory just like every other consumer good.

Economists look at “price curves” to determine how much a good or service should cost. In other words, how much the market will bear.

At either extreme you have inelastic price curves and elastic curves. Most consumer items track a bell curve but some things are totally elastic or totally inelastic.

Sugar has price elasticity. As the price of sugar rises, demand decreases since there are substitutes for sugar. If sugar suddenly rose to $10 per pound sales would drop to almost zero.

Gasoline is inelastic. As the price moves toward $5 per gallon consumption drops but not proportionately. In parts of Europe gasoline is $10 per gallon but consumers are still buying gasoline and driving gasoline powered cars. At this time, there really is no substitute for gasoline so (at least in theory) the price could rise to $40 per gallon and there would still be demand.

Health care is also inelastic. Consumers want to be healthy and the way most of us deal with it is through medical services. We ignore the fact that 70% of health care services could be eliminated with a healthier lifestyle and instead put demands on health care providers to produce more and more.

Health care providers are limited and since there is no real substitute, the price can increase geometrically and someone will pay.

But unlike food or gasoline, where the consumer pays for the goods, health care is different.

Consumers do not pay (directly) for health care. Over 80% of health care is paid for by insurance carriers and taxpayer funded programs.

In other words, consumers don’t have any skin in the game. As long as someone else is paying for their care there are no incentives to take personal responsibility and improve health, or to look for less costly ways of treating the individual.

What is so disgusting to me about the rhetoric coming from Washington about changing health care is that they either do not have a clue or simply don’t care.

An op-ed piece by Robert Samuelson in the Washington Post addresses this much more eloquently than I can. My only complaint is that he misses the mark too, by blaming the providers.

The central cause of runaway health spending is clear. Hospitals and doctors are paid mostly on a fee-for-service basis and reimbursed by insurance, either private or governmental. The open-ended payment system encourages doctors and hospitals to provide more services — and patients to expect them. It also favors new medical technologies, which are made profitable by heavy use. Unfortunately, what pleases providers and patients individually hurts the nation as a whole.

That’s the crux of the health-care dilemma, and Obama hasn’t confronted it.

The health care problem is demand driven and priced on an inelastic curve. The price of health care continues to rise but demand is not showing a corresponding decrease. As long as consumers, or more specifically, the carriers and government programs are willing to pay for services ad nauseum there will continue to be a crisis.

The only way to reduce demand is for us as individuals and a nation to become healthier.

That is not going to happen.

Until then, consumer demand for health care services will continue unabated and the price will continue to rise. Premium and tax increases do nothing to limit demand for health care and do nothing to solve the problem.

Washington is playing the public like a fool and, sadly, it seems like the consumer is going along. All Washington is doing is rearranging the deck chairs and running up more and more deficits we cannot afford. The unfunded liability for government programs exceeds $100 trillion dollars against a U.S. GDP of $15 trillion and a global GDP of $60 trillion.

This is completely unsustainable. We are walking an economic plank and are mere steps from the end.

Do have a nice day . . .