Georgia Health Insurance 411

Archive for September, 2009

Begin by standing on a comfortable surface, where you have plenty of room at each side.

With a 5-lb. potato sack in each hand, extend your arms straight out from your sides, and hold them there as long as you can. Try to reach a full minute, then relax.

Each day, you’ll find that you can hold this position for just a bit longer.

After a couple of weeks, move up to 10-lb. potato sacks.

Then 50-lb. potato sacks, and eventually try to get to where you can lift a 100-lb. potato sack in each hand and hold your arms straight for more than a full minute.

After you feel confident at that level, put a potato in each of the sacks; but be careful.

If you are applying for a Georgia health insurance plan and have depression, or anxiety, you need to know there is a BIG difference in the way health insurance companies will rate their offer.

Here is the situation.

Male, age 24, good health except  . . . he has anxiety. (Anxiety and depression are underwritten in the same manner)

The condition is controlled with generic Paxil (paroxetine HCL). The medication is $4 at Wal-Mart.

The plans he was considering had Rx deductibles of $300 to $4,000.

Health insurance company A wants a 40% rate increase.

Health insurance company B wants 50% more.

Health insurance company C is willing to offer a standard rate.

This is one of those stupid carrier tricks we try to avoid with our clients.

At Georgia Insurance Shop we pre-screen almost every application to make sure there are no surprises like this.

Is health care reform about satisfying politician’s ego’s or making health care affordable as they claim? The Washington Post‘s op-ed columnist Robert  Samuelson has his own perspective on Obamacare.

“My colleagues, this is our opportunity to make history,” Chairman Max Baucus implored last week as the Senate Finance Committee opened consideration of his bill. Politicians, in their most self-important moments, see themselves as instruments of national destiny. They yearn to be remembered as the architects and agents of great social and economic transformations. They want to be at the signing ceremony; they want a pen.

One can almost envision Sen. Baucus in a powdered wig, white stockings and buckle shoes signing on in large fashion as John Hancock did with the Declaration of Independence.

One study “found that every year in America, lack of health coverage leads to 45,000 deaths,” he told the committee. “No one should die because they cannot afford health care. This bill would fix that.”

Oh really?

But wait, there’s more!

“These reforms would give Americans real savings,” Baucus said. The Congressional Budget Office “tells us that the [insurance] rating reforms and exchanges in our proposal would significantly lower premiums in the individual market.” As well, the bill wouldn’t increase the budget deficit and “starts reducing the deficit within 10 years.”

How could anyone be against that?

Unfortunately, just having insurance doesn’t automatically improve people’s health. Sometimes more medical care doesn’t really help. Sometimes people don’t go to doctors when they should or follow instructions (take medicine, alter lifestyles).

Say it ain’t so!

Indeed, many people don’t even sign up for insurance to which they’re entitled. An Urban Institute study estimated that 10.9 million people eligible for Medicaid or the Children’s Health Insurance Program in 2007 didn’t enroll.

Why would someone refuse FREE health insurance? Inquiring minds want to know.

And how about those 45,000 who died because they didn’t have health insurance?

The 45,000 figure cited by Baucus is itself an unreliable statistical construct built on many assumptions. It’s based on a study of 9,004 people ages 17 to 64 who were examined between 1988 and 1994. By 2000, 351 had died; of these, 60 were uninsured. The crude death rates among the insured (3 percent of whom died) and uninsured (3.3 percent) were within the statistical margin of error. After adjustments for age, income and other factors, the authors concluded that being uninsured raises the risk of death by 40 percent. They then extrapolated this to the entire population by two techniques, one producing an estimate of 35,327 premature deaths and another of 44,789.

Oops!

OK, but we will still have lower health insurance premiums, right?

Here is what the CBO had to say about that.

“Premiums in the new insurance exchanges would tend to be higher than the average premiums in the current-law individual market – again with other factors held equal — because the new policies would have to cover pre-existing medical conditions and could not deny coverage to people with high expected costs for health care.”

“Higher than average premiums” because the NEW policies will have to cover pre-existing conditions and cannot deny coverage. Somehow this information has never passed the lips of the politicians who are promising lower, more affordable health care and health insurance.

Wonder why?

So how many want to pay higher taxes to cover people who won’t take advantage of “free” health insurance, higher health insurance premiums to cover pre-existing conditions and “no refusal” policies, and questionable improvement in health outcomes . . . just to satisfy the ego of their favorite politician?

Health care reform is a sham.

Smaller cars, bigger (more expensive) health insurance, Poppa Washington.

Consumer Reports gives us 7 ways to have fewer wrinkles. Here is their list.

Use a facial moisturizer with an SPF of at least 30 to limit the sun’s damage every day, not just when you’re at the beach.

Shield your face with a hat and sunglasses when you’re outdoors, particularly on sunny days.

Avoid tanning beds. Those ultraviolet rays can be even more intense than the sun’s and can increase your risk of skin cancer.

Don’t smoke. Tobacco ranks second only to sunlight in its dire effects on skin.

Try not to rub your eyes. Treat hay fever so you’re less itchy and not tempted to rub.

Sleep on your back. Mashing your face into a pillow can cause lines to form over time.

Get an annual eye exam. If you can’t see clearly, you’re likely to squint, which can create wrinkles.

That’s a good list, but we think they missed a few.

Facial moisturizers are good, but we prefer a chocolate facial mask. It’s kind of like having your cake and eating it too.

CR suggest using a hat and sunglasses while outside on a sunny day. That is a good idea, but not a great one. We are partial to the middle Eastern approach to protecting your face.

While it is true that smoking can cause wrinkles, not everyone is affected in the same way.

Yes, a pillow over your face can cause wrinkles, sometimes it can lead to something worse.

So there you have it.

Enjoy a wrinkle free day!

If you think you are going to get away misrepresenting your medical history on a health insurance application you are dead wrong. This advice goes for the applicant as well as the agent assisting.

I participate in several online forums, offering advice on health insurance matters for a nickel.

Actually, I don’t charge anything but my avatar is Lucy of Peanuts fame offering psychiatric advice for a nickel. I may not be as wise as Lucy, but I do enjoy the interaction.

One forum had a post from an “outsider” whose COBRA was expiring. He had sought the advice and assistance of an agent who quickly suggested a plan then rushed him through the application. The application was completed and submitted.

Later when the applicant actually reviewed the application he found “15 errors” and decided to post information on a forum in an attempt to find out how to handle this issue. The following items were left off his medical history.

These are all within the last 10 years:

Rhinitis – Allergy immunotherapy (ongoing )

Dry Eye – keratoconjunctivitis sicca (ongoing)

Sjogren’s Syndrome TEST (potential cause of dry eye) LAB RESULTS NORMAL

Prostatitis – pain from enlarged prostate – (released from care)

Metatarsarsalgia (released)

Bulging Discs and/or Disc Joint pain (physical therapy prescribed, no surgery)

Shoulder – partial tear of right rotator cuff (physical therapy prescribed, surgery is by choice)

Recurrent Fibroma on plantar fascia (avoid surgery)

Near Sighted & Astigmatism (Eye glass/ contact lens Rx)

Midcarpal Instability (excersize recmd’)

Knee Pain (released)

Giant Papillia Congitis (released)

Hairloss (Propecia Rx)

Cyst-benign on scalp (one removed on back)

Inguinal Hernia Repair Surgery (2)

Planter Fascia Fibroma Repair Surgery

Receding gums

High Cholesterol check (just modify diet, no rx)

Anxiety and depression (took 3 meds 6 years ago)

Anal Fissure (released)

Flat feet pain (orthotics made)

Ingrown toenail (released)

TMJ- Temporomandibular joint disorder (bite guard made)

Dry Lip problem

Acne

Pneumonia mild case

Deviated septum diagnosed (no treatment)

This is quite a list, and some of the things did not need to be included in the medical history. Hair loss, receding gums, dry lip, flat feet and an ingrown toenail are non-issues unless there is something more sinister to the condition.

The rest of the conditions should not have been omitted from the medical history.

After reviewing the data, several agents (to my surprise) suggested he cancel the application then file a new one with the same carrier or possibly a different carrier. All suggested he get the advice of a competent agent and, justifiably so, condemned the assisting agent for such shoddy work.

I took a different trek.

The short answer is, this person will not qualify for medically underwritten health insurance with any carrier. He is deemed a “basket case” and “repeat offender” who (so it seems) goes to the doc at the drop of a hat. The medication he is taking is rather expensive, running over $300 per month. He has no less than 3 issues that could well require surgery running in the thousands of dollars.

When I suggested he abandon any hope of finding major medical coverage he was incredulous. His view is, there is nothing really wrong with him.

Well, that is a matter of perspective.

He never revealed his home state, so no way to know which options are best. But depending on where he lives there may be a risk pool, a carrier of last resort, open enrollment or HIPAA conversion.

One agent suggested he start a business and hire a second employee so he could set up a group health insurance plan.

I thought that was off the mark since he had not established a business in the 18 months he was on COBRA so what are the chances of doing so now and getting it up an running in less than 30 days to the point of even qualifying for, much less affording a group health plan.

I have never understood why people like to deal direct with home offices rather than using the services of an agent. I interact with carriers daily and can tell you that unless you know the right questions and who to ask you will almost never get a solution to your problem.

And it seems many people don’t take the time to interview agents. If there is any direct involvement at all it is only to get a rate and maybe ask a cursory question.

Your agent can be your best advocate or worst enemy. If you don’t bother to ask questions and interview prospective agents you may never know if you have a good one or not. Having dealt directly with agents for over 20 years as a home office employee I can tell you the “good” agents are hard to find. That is sad, but true.

People who fill out applications by themselves either give too much information or not enough. Either way diminishes your chances of getting a good offer.

There is an art to completing an application in such as way as to give the underwriter everything they need to properly do their job without overwhelming them with extraneous items that cause them to shut down and simply deny your application for coverage.

You offer as much as they need and nothing more. If the underwriter needs additional information they will come back and ask.

In the last 90 days I have placed coverage for 5 individuals who were rejected for coverage with one or more health insurance companies. One individual was actually placed with a company that had rejected him a few months earlier. It was simply a matter of cleaning up his application and providing enough information so the underwriter could say yes.

I specialize in hard to place clients and have better than a 90% success rate if I agree to take on your case. It is never easy and sometimes can take weeks from start to finish but the reward is in knowing I have helped someone find the coverage they need at a price they can afford.

Oh yeah, we also take on the easy cases. Every chance we get . . .

CNN reported that 45,000 die each year because they don’t have health insurance and there were 2,426,264 total deaths in the U.S. last year according to the CDC.

Since 45,000 didn’t have health insurance it is logical to assume that 2,381,264 had health insurance but died anyway.

So if you have health insurance be prepared to die.

We now return you to normal programming.

Sen. Baucus’ health care bill taxes a lot of things, but not condoms. Or contact lenses, or tampons but hearing aids and wheel chairs are fair game.

Finance Committee Chairman Max Baucus, D-Mont., left intact a $4 billion-a-year levy on the medical devices industry — keeping the controversy alive. The industry makes some 80,000 different products from heart valves to imaging machines to tongue depressors. The Congressional Budget Office said Tuesday such industry fees could eventually raise insurance premiums by roughly 1 percent.

The tax will pay for the uninsured. How does raising insurance premiums, even if only by 1%, jive with making health insurance more affordable?

Raising insurance premiums is not considered a tax by the folks in Washington. Apparently if they tax companies, who pass that increase on to consumers, whose medical bills are paid (mostly) by insurance, it is not considered a tax.

My guess is George Stephanopoulos would take a different view.

“He’s trying to avoid the perception that the middle class is going to be taxed,” said Dan Mendelson, president of Avalere Health, an information company that serves the health industry and government. “The trick is to get funding for the bill but not to have anything that smacks of a middle-class tax.”

There is quite a bit of this going on.

The cost of issuing coverage without regard for pre-existing conditions means an immediate doubling of health insurance premiums at a minimum, but that is not a tax either.

Scott Mulhauser, a spokesman for Baucus, said it’s only fair. Hospitals and drugmakers have volunteered to take cuts to help pay for the overhaul — and so should device companies.

“Revenues to the device manufacturing industry will go up as insurance coverage expands, and this fee will ensure the industry helps contribute to the reform effort as it benefits,” Mulhauser said.

Let me see if I have this straight.

More people covered by insurance means more people will buy wheelchairs and contact lenses so everyone wins. Using the Mullhauser theory, people who are not now buying these items will do so once they have insurance which means more revenue and more profits.

Right . . .

Joe (I’m always good for a quote) Biden was allowed out of his cage to speak before the NAIC (National Association of Insurance Commissioners). Here are some tidbits.

tighter regulation of the industry is needed to protect consumers and slow the spiraling cost of medical coverage.

OK, so how does more regulation lead to lower insurance premiums? Every time the government get’s involved things get worse and premiums increase, not decrease.

It never fails.

Far from destroying the profitability of health insurance companies, the new regulations envisioned by President Obama would enhance competition and choice for consumers while creating a bounty of new customers, Biden said.

Enhance competition and choice. Everything in HR 3200, and even the Baucus bill, will lead to fewer health insurance companies and fewer plans.

If premiums increase with health care reform, and they will, where will this “bounty” of new customers come from?

Health insurance premiums in states rose between 88 percent and 145 percent in the past decade, far outpacing wages and overall inflation, which increased 38 percent and 28 percent, respectively, over the same period, according to a new Kaiser Family Foundation study cited by the White House.

There is a problem with this kind of study. It fails to explain why health insurance premiums increased.

The answer is simple. Premiums are driven by claims.

More people are submitting more claims at least in part because health care doesn’t cost them very much. A $20 doc copay and a $25 Rx copay is all it takes to cover a $200 or more bill.

Medical care inflation is 5 – 7% but premiums rise by a multiple of that because claims are increasing at double digit rates.

Biden said new rules should prevent insurance companies from declining coverage to people with preexisting conditions, should limit out-of-pocket expenses and should not allow companies to drop coverage for patients who are seriously ill.

Coverage is usually not dropped except for failure to pay the premium or fraud.

The other provisions, declining coverage for pre-ex conditions and limiting out of pocket will make health insurance LESS affordable, not more affordable.

On the other side, even the spokesman for AHIP shows his ignorance.

“Premiums track directly with the underlying cost of medical care,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, a lobbying group that represents nearly 1,300 plans.

Premiums track claims, not the cost of medical care.

This may seem like semantics, but the cost of a doc visit or drug is not the issue. It is the total expenditure on claims that impacts premiums.

What kind of idiots are working there?

Didn’t get your shots? You can be quarantined by the state. No knock warrants anyone?

Is Obamacare a tax increase? It depends on what your definition of a tax increase is, is . . .

Why does this remind me of Clinton saying “it depends on what your definition of is, is . . .