Georgia Health Insurance 411

Archive for September, 2009

If you have BCBSGA, I have good news and bad news.

The good news is, you no longer have to put up with limited or non-existent customer service. The Georgia Blue’s now allow you to appoint an agent to act as your liason to guide you through the pitfalls of coverage, claims, billing and renewals. A simple form puts an experienced agent in between you and Blue who is available seven days a week.

This beats the heck out of holding on the line and dealing with people who don’t really care about your problem. The Blue customer service hours are 7 – 7 Monday through Friday.

What happens if you have a question on a weekend or holiday?

You are out of luck.

More good news!

BCBSGA will pay the agent to service your account, advise and help on renewals and it costs you nothing. Your premiums will not change one bit.

The bad news?

Blue will still hammer you on renewal and give you the run around on claims. The difference is, you now have someone who is sympathetic to your cause and is paid to specifically help you.

Here comes the shameless plug.

I want to be your agent.

There, I said it. The form is available on request.

Now for other news.

And another shameless plug.

I have a reputation for taking on seemingly impossible challenges when it comes to finding health insurance. If you have had difficulty finding health insurance, even if you have been turned down by other Atlanta Georgia health insurance companies, give me a call.

When I agree to take up your cause I have better than a 90% chance of success. In the last 3 months I have found coverage for 5 people who had been rejected for health insurance in Georgia in prior attempts.

We are talking real health insurance, not some limited benefit plan. True major medical.

Some situations are impossible, and if that is the case I will tell you so up front. But if you have a chance I will give it all I have and stay with it to the end.

Just in case, you need to know I can handle the easy ones as well.

So when looking for affordable Atlanta health insurance, keep us in mind.

“I’m Chevy Chase and you’re not”, the SNL Weekend Update on line  seemed appropriate for this bit of gallows humor from the New Yorker.

Getting sick is no fun, but think about the impact your illness will have on stimulating the economy.

Human illness adds two trillion dollars annually to America’s gross domestic product. Are you contributing your fair share?

Sentences set in small type make a handy eye test. If you can read this without difficulty, your eyes may be too strong and you will need the prescription drug Corneac R (dollarmycin-B) to return your vision to normal. Consult your pastor about the choice between sightlessness and personal bankruptcy.

Personally, I have weak eyes.

According to my mother it has to do with a common teenage practice.

Policy Updates

—All of you “Far Horizons” Fifteenth Tier Plan subscribers may now choose any doctor you like, who will then refer you to the list of approved cheap doctors, ex-doctors, doctors-in-training, and veterinarians.

—“Near Horizons” Sharing & Caring Plan members: Some misunderstandings about this plan have arisen lately. Sharing your hospital bed does not reduce the per-day costs of your hospital stay, and you will be legally liable if your bedmate contracts a communicable disease.

—Be sure to ask about the new “Invisible Horizons” Plan, providing discounts and a free ballpoint pen on hospital bills of more than a million dollars per week for any fifty-two-week period when you cannot get out of bed.

—The new “Artificial Horizons” Plan for prosthetics will no longer provide separate prosthetic toes. See Pamphlet 567-A-2099 for a limited-time-only “Five-Pak” prosthetic-toe kit. (One foot per subscriber.)

—Feeling poorly? Ask about our new “Eternal Horizons” Plan option, which includes an afterlife provision covering basic medical care for eternity. Have your executor call 1-800-RIV-STYX for details. Cryogenic “Eternal Horizons” subscribers, or their survivors, must provide a matching body and head.

Explanation of Benefits

Skip this section. No benefits are currently available.

Q. & A. of the Month

Q: My current statement lists two hundred and thirty-one charges for “brain surgery,” even though I have had no brain surgery. How can I rectify this?

A: Invalid question. Brain surgery is not covered under your plan.

And there you have it.

Aren’t you glad you asked?

Thanks to Jeff Silver for this tip . . .

A Mississippi woman can watch TV or read a book through her tooth.

The WSJ Health Blog reports:

The procedure was developed in Italy in 1963 and has been used successfully in Europe and Japan, according to the Miami Herald. It’s a last-ditch procedure for people with problems with their cornea — where the lens would normally sit — because of trauma, corneal disease or scarring, but whose optic nerve and structures beneath the cornea are still healthy.

The patient’s eyetooth (as a canine tooth from the upper jaw is called) was selected because it had a decent amount of jawbone and ligament attached, which are essential for the tooth to heal into the eye after implantation, notes the Herald.

My question is, if this has been used in Europe and Japan for over 40 years, why is it just now coming to the U.S.?

Medicare will pay for a kidney transplant then expects you to die in 3 years. Bet you didn’t know that.

According to the WSJ Health Blog, Medicare could save lives and money by making beneficial changes to the way they approve treatment but they choose not to.

Medicare’s three-year limit on payment for anti-organ-rejection drugs led to a woman needing a second kidney transplant, because she couldn’t afford to the medicine that would have allowed her to keep her first transplanted kidney in healthy, working condition.

The cost of anti-rejection drugs for the patient? $1,000 to $3,000 a month. Cost of the second transplant? $125,000. The average Medicare expenditure per kidney transplant patient care is $17,000 yearly, while it’s $71,000 a year for dialysis patients and $106,000 for a transplant, according to the Times.

According to the NY Times, Melissa Whitaker found herself in a Medicare conundrum.

Ms. Whitaker, 31, who describes herself as “kind of a nerd,” has Alport syndrome, a genetic disorder that caused kidney failure and significant hearing loss by the time she was 14. In 1997, after undergoing daily dialysis for five years, she received her first transplant. Most of the cost of the dialysis and the transplant, totaling hundreds of thousands of dollars, was absorbed by the federal Medicare program, which provides broad coverage for those with end-stage renal disease.

By late 2003, her transplanted kidney had failed, and she returned to dialysis, covered by the government at $9,300 a month, more than three times the cost of the pills. Then 15 months ago, Medicare paid for her second transplant — total charges, $125,000 — and the 36-month clock began ticking again.

“If they had just paid for the pills, I’d still have my kidney,” said Ms. Whitaker

So rather than paying $1000 – $3000 per month for anti-rejection meds beyond the arbitrary 36 month limit, Medicare in their infinite wisdom put her back on dialysis, approved a second transplant, and started her on a new 36 month plan.

The most recent report from the United States Renal Data System found that Medicare spends an average of $17,000 a year on care for kidney transplant recipients, most of it for anti-rejection drugs. That compares with $71,000 a year for dialysis patients and $106,000 for a transplant (including the first year of monitoring).

This reminds me of Jay Leno’s question to Hugh Grant following Hugh’s incident with a transvestite hooker.

“What were they thinking?”

No reason to get sidetracked by the truth. PresBO has declared war on health care.

According to POTUS, the insurance industry is using  WMD’s (weapons of mass disintegration), also known as health insurance policies, that self destruct when you need them most.

In his speech to Congress he alleged

“More and more Americans pay their premiums, only to discover that their insurance company has dropped their coverage when they get sick, or won’t pay the full cost of care. It happens every day.”

Those bastards!

To highlight abusive practices, Mr. Obama referred to an Illinois man who “lost his coverage in the middle of chemotherapy because his insurer found he hadn’t reported gallstones that he didn’t even know about.” The president continued: “They delayed his treatment, and he died because of it.”

Actually, the carrier is not in a position to administer, advise or delay treatment. That is clearly a patient-doctor decision.

The deceased’s sister testified that the insurer reinstated her brother’s coverage following intervention by the Illinois Attorney General’s Office. She testified that her brother received a prescribed stem-cell transplant within the desired three- to four-week “window of opportunity” from “one of the most renowned doctors in the whole world on the specific routine,” that the procedure “was extremely successful,” and that “it extended his life nearly three and a half years.”

Well yeah, but he still died so PresBO did get that right at least.

The president’s second example was a Texas woman “about to get a double mastectomy when her insurance company canceled her policy because she forgot to declare a case of acne.” He said that “By the time she had her insurance reinstated, her breast cancer more than doubled in size.”

Canceled because of failure to disclose acne? Give me a break, Barry.

The woman’s testimony at the June 16 hearing confirms that her surgery was delayed several months. It also suggests that the dermatologist’s chart may have described her skin condition as precancerous, that the insurer also took issue with an apparent failure to disclose an earlier problem with an irregular heartbeat, and that she knowingly underreported her weight on the application.

Irregular heartbeat, depending on the nature and treatment, can be an automatic decline on the front end. Missing your weight by a few pounds is common. We don’t know how much her weight was understated, but it seems to be enough to make it an issue to the carrier.

In other words, there seems to be evidence of fraud on the application. No reason to let that become an issue, right? I mean, we let mortgage fraud go on for years and that wasn’t an issue.

Later in his speech, the president used Alabama to buttress his call for a government insurer to enhance competition in health insurance. He asserted that 90% of the Alabama health-insurance market is controlled by one insurer, and that high market concentration “makes it easier for insurance companies to treat their customers badly—by cherry-picking the healthiest individuals and trying to drop the sickest; by overcharging small businesses who have no leverage; and by jacking up rates.”

This one is a real whopper.

In fact, the Birmingham News reported immediately following the speech that the state’s largest health insurer, the nonprofit Blue Cross and Blue Shield of Alabama, has about a 75% market share. A representative of the company indicated that its “profit” averaged only 0.6% of premiums the past decade, and that its administrative expense ratio is 7% of premiums, the fourth lowest among 39 Blue Cross and Blue Shield plans nationwide.

Similarly, a Dec. 31, 2007, report by the Alabama Department of Insurance indicates that the insurer’s ratio of medical-claim costs to premiums for the year was 92%, with an administrative expense ratio (including claims settlement expenses) of 7.5%. Its net income, including investment income, was equivalent to 2% of premiums in that year.

In addition to these consumer friendly numbers, a survey in Consumer Reports this month reported that Blue Cross and Blue Shield of Alabama ranked second nationally in customer satisfaction among 41 preferred provider organization health plans. The insurer’s apparent efficiency may explain its dominance, as opposed to a lack of competition—especially since there are no obvious barriers to entry or expansion in Alabama faced by large national health insurers such as United Healthcare and Aetna.

Similarly, Wal-Mart dominates many markets where they operate, AND they earn a lot of profit. When is Congress going to address this inequity?

I know, don’t encourage them.

Looks like the folks in Maryland are getting a jump on Obamacare. According to this recently released memo from the Maryland Insurance Administration, CHANGE is coming soon.

Like the end of this month . . .

Effective 10/1/09 health insurance companies in Maryland will be required to adhere to the following.

• Prohibit carriers from asking about pre-existing medical conditions if the individual has not received care or advice during the 5 years preceding the date of the application.
• Prohibit carriers from asking about medical screening, testing or monitoring during the 5 years preceding the application
• Prohibits the carrier from attaching an exclusionary rider without prior written consent of the policyholder. (This is a red herring. Riders and rate surcharges are part of the offer which can either be accepted or rejected by the applicant).
• Allows a carrier to impose a pre-existing exclusion or limitation if that condition was not discovered during the underwriting process only if the condition was treated during the 12 months immediately preceding the application. The limitation can last for 12 months but is reduced by prior creditable coverage.

This is a bit of a conundrum.

If the carrier is prohibited from asking about conditions in the prior 5 years then how will they discover the condition? Even if a condition shows up in MIB (Medical Information Bureau) or Intelliscripts or similar service the carrier can’t ask about the condition. Seems to me this will lead to a lot more declines.

The other way to find out about a condition is when it manifests or is treated after the policy is issued.

You just can’t make this stuff up.

According to sources, none of the carriers operating in Maryland have made any official comments on this CHANGE. It makes me wonder if they have decided internally to simply stop accepting applications for October and later effective dates.

Of course changes like this require carriers to file new applications and policies with the Maryland DOI and wait on approval. New (much higher) rates will also have to be approved.

This effectively closes the door for new, individual health insurance policies in Maryland until further notice.

Looks like Maryland is now officially part of the United States of Obamaland. Wonder if they will change their name to Mary-Obamaland?

Change you can believe in.

Yes you can.

The next time you order pizza you might be in for a surprise . . .

A friend just sent this 9/11 video link. Thought I would pass it along . . .

Never forget!

Seems Sgt. Joe Friday has his own ideas on change you can believe in . . .

We never thought about health care until we actually needed it . . .

I have empathy for this woman, and what she and her family are experiencing. But if this is the way the Obama House wants to sell health care reform, it is lost on me.

Health insurance is no different from any other form of insurance. You must purchase it BEFORE you need it.

The guy in the casket at the front of the church probably needed life insurance, but it is too late to buy it now.

This story is reminiscent of the folks standing in front of the burned out apartment building claiming they lost everything because they failed to buy renters insurance. Why is this supposed to be my problem?