Georgia Health Insurance 411

Archive for 2010

The Associated Press is reporting that Washington has agreed to let health insurance companies utilize and open enrollment period for children applying for health insurance under Obamacare.

Insurers were concerned the new health care law would allow parents to sign their kids up in emergency rooms while the child is in the middle of a health crisis.

The administration now says insurers can limit the sign-up to an "open enrollment" period, for example, December 1 to December 31 for plans that start January 1.

No word on how this may impact children's health insurance rates (which were expected to rise two-fold at a minimum) or if any carriers will modify their position in rejecting "child only" health insurance applications.

Details to follow . . .

Washington is excited about their consumer health insurance portal and are perhaps having visions of providing "direct to consumer" choices for health insurance. Healthcare.gov is an expanding and changing site with quite a bit of information, some of it actually useful.

The latest addition is an "Explore Your Options" button that allows consumers to share personal information with the government in exchange for ideas on how to find health insurance coverage. You start by selecting your state then proceed through different pages based on your response.

Don't want to answer a question?

Too bad. Just like Seinfeld's Soup Nazi, "no information for you!".

The site will not let you progress until you answer every question.

At first the questions seem non-threatening but gradually become more personal.

You start by telling the government where you live by selecting on of the 57 states in a drop down box.  Next you must pick one of the following that best describes your situation. Are you:

Family, healthy individual or sick individual (you must decide which), pregnant woman (can males get pregnant?), someone with a disability, senior, young adult, small employer or self employed.

Assuming you pick something that best describes your situation you can progress to the next page. If you are under age 26 and a pregnant female you must pick one since the government does not allow you to be both.

Before you go on you might want to read their privacy policy. Of course they would not collect any information that is not pertinent to helping you find the best health plan for your needs.

Or would they?

We automatically collect and temporarily store the following information about your visit:

the name of the domain you use to access the Internet (for example, aol.com, if you are using an American Online account, or stanford.edu, if you are connecting from Stanford University's domain);
the date and time of your visit;
the pages you visited; and
the address of the web site you came from when you came to visit.

I will let you decide if you really want to share this much information with big brother.

Back to the health insurance info . . .

I opted to pick a category that best described me and chose healthy individual. I admit I was lured in by the "Just two quick steps" at the top of the page. After all, if this is all they need, no big deal, right?

On the next page they tell you "Just a few more questions . . ."

Why does this seem like a visit to the dental office where he says you might feel a slight prick?

On this page you need to make some decisions again, including how much more you want to share with the government. Are you losing coverage through your employer or do you need health insurance?

Apparently if you are not losing your employer plan or if you do not have any pressing medical needs they feel there is no reason for you to even be at this site. Healthy people need go no further.

If for some crazy reason you decide you want to explore your options, even if you are healthy, you must decide which age bracket fits your situation. If you are a family and one individual is over 25 and the other is under age 26 you are again faced with a dilemma. Pick one if you want to progress.

The next category let's you make more than one selection so you can be a pregnant military veteran (presumably a woman) as well as an American Indian or Alaskan Native and still qualify for something.

The last question before leaving this page wants to know if you have trouble affording health insurance. I don't imagine they will have many "no" answers but since I like to be as helpful as I can since the government is taking such an interest in my personal life I decide to answer this as "no".

Based on the answers I have provided so far I am offered four choices. The options include finding a job with health insurance (good luck on that one), buying health insurance in the open market, exploring the PCIP plan, and finding local free health care clinics.

Already they have lured me in but I don't want to leave without finding out what is behind door number 2, so I tell the government I want to explore insurance in the private market.

Now they want to know just a bit more information before letting me proceed.

They want my zip code.

Why do I feel like there is a government drone or spy satellite watching my every move?

The next page gives me the option of going to the Georgia Department of Insurance website or picking a link to any one of 14 health insurance company websites. They currently offer 45 plans to pick spread over the 14 carriers. Some have only 1 plan while others have 13.

When you click on a carrier link you are offered a very brief description of plans that are readily available in the market either direct from health insurance companies or through an insurance broker. The difference here is, if you want rates you have to come back in October. There are no rates available at this time on the government site.

So you have given the government all this personal information only to find there are no answers.

I don't know about you but this just makes me feel used.

For what it is worth, I have offered visitors a health insurance quote engine on my site for years. Anyone looking for affordable health insurance in Georgia is free to visit my site, run quotes and apply for health insurance. They can do this on their own or solicit my advice.

Either way, I do not collect information and send it to the government.

There are some things that are constant based on my experience. Over half of those who run a health insurance quote don't want anyone to know who they are or how to contact them. On average, about a fourth are willing to seek advice about which plan to pick and how to apply.

Roughly 5% of those who run a health insurance quote will also start an application for coverage. Well over 90% of those never complete the application and about half that do are turned down mostly because they did not know how to respond to the questions on the application.

I don't know what the government is expecting, but if they think they are going to provide a service that will result in thousands or millions obtaining health insurance they will probably be disappointed.

You may be able to build a ballpark and they will come, but not so for a health insurance website.

From the “What did you think would happen?” division of the land of Obamington comes this report from The Hill.

The rule barring insurance plans from turning away sick children or denying coverage for specific illnesses for children who are already covered was one of the most popular parts of the new law.

But the new rules are leading some health plans across the country to stop issuing new child-only coverage, the state officials said. That could force parents to buy costly family coverage where in the past they could have saved money by buying separate policies for themselves and their children.

Let’s look at this logically, something that completely escapes the clowns in Washington.

Beginning in September, health insurance companies will not be able to refuse coverage to any child (under age 18) REGARDLESS of their medical condition(s) and must cover any all necessary treatment for those conditions. If your child is healthy or sick, you are not required to purchase coverage. There are no penalties for failing to provide health insurance for your children. You may buy health insurance on your child once their health changes and the health insurance company is required to cover them.

In whose world is this considered insurance?

This is not insurance. This is asking someone else, in this case an insurance company, to pay for your expenses AFTER you know you are sick and can’t afford to pay for your health care.

If you could buy auto insurance AFTER your car was stolen, or after the wreck, I doubt anyone would consider that a good business model. But try to apply this kind of logic to health insurance and suddenly a lot of people think that buying health insurance AFTER you get sick should be allowed if not required.

The state commissioners, who are helping write the regulations governing the overhaul of the nation’s health insurance system, said they expect to see more insurers ceasing to offer new child-only coverage. They said middle-class families with healthy children, who don’t have access to state public programs, will be the hardest hit.

Anyone with half a brain would have seen this coming.

Obviously the folks who designed Obamacrap are either like Dorothy’s Scarecrow or they got Abby Normal’s brain.

This would certainly qualify for our Stupid Government Tricks award.

Nothing lasts forever, even in the LaLa world of Washington. The land where money seemingly grows on tree's has at least for now seen a halt in reckless spending. 

U.S. workers who lost their jobs as of June 1 won’t be eligible for a 65 percent federal subsidy to help pay for health insurance under an unemployment bill Congress will send to President Barack Obama for signing.

Eligibility for the financial help expired May 31, meaning workers who lost their jobs after that date don’t qualify. Those already receiving the benefit may continue to pay reduced premiums for up to 15 months, according to the Department of Labor.

Had Washington spent their resources on encouraging the private sector to create jobs instead of pissing money away on welfare programs there might not be a need for continued assistance.

Workers who lose their job and are no longer eligible for the health-insurance subsidy should check if they or their children may be eligible for other public aid such as Medicaid and the Children’s Health Insurance Program, said Kaiser’s Schwartz.

Most folks would rather have a job than rely on public assistance. Given the anti-capitalist mood of the White House it doesn't appear the economy and the jobs that come with it will turn around any time soon.

The next shoe to drop in Obamacare involves providing health insurance for children from birth to age 18. As we have indicated in prior posts, some Georgia health insurance companies are no longer offering "child only" health insurance and at least one will no longer accept child only applications after 8/15/2010.

Now word comes that Blue Cross plans in two different states are taking a different approach. The Blues in Texas and Illinois have announced filing for approval of a new child only health insurance policy.

No details on rates or benefits but the announcement to insurance agents in those states includes this comment.

Blue Cross and Blue Shield of Illinois (BCBSIL) is committed to offering the broadest possible range of products for our members, as well as to maintaining its strong financial position. Thus, on Friday, July 16, 2010, it filed a new policy called Blue Pathway to provide coverage for children age 1 through 18 when the child is the primary insured (commonly called “child-only” policy) with the Illinois Department of Insurance (DOI).

This new coverage option responds to an Interim Final Rule that was issued by the Department of Health and Human Services (HHS) to implement several provisions of the Patient Protection and Affordability Act of 2010 (PPACA). In this Rule, HHS has determined that provisions limiting the application of pre-existing condition exclusions for children under 19 means that all children under 19 who apply for insurance for which they are eligible on or after Sept. 23, 2010, cannot be denied coverage—this is commonly known as “guaranteed issue.”

BCBSIL has long supported guaranteed issue as a way to ensure access to affordable, quality health care for all Americans, particularly children and young adults. However, that must be accompanied by an effective mandate for individuals to obtain coverage. PPACA itself recognizes the importance of pairing guaranteed issue with an effective mandate to ensure a sustainable insurance marketplace, with both being required in 2014. However, this Interim Final Rule addresses only guaranteed issue for children under 19, not any current requirements for them to have health insurance.

Without the mandate, it becomes too easy for people to buy insurance only when they feel they need services. This could be compared to allowing drivers to buy auto insurance once they have a fender-bender, and then drop coverage after their car repairs (financed by the insurance company and other insureds) are complete. This leads to what insurers term as “adverse selection,” which ultimately leads to unaffordable coverage for everyone. The Wall Street Journal recently published an article that demonstrates how this happened in Massachusetts, whose mandate has not proven as effective as originally hoped. This is based on a study commissioned by the Massachusetts Division of Insurance by the consulting firm Oliver Wyman.

Translation, the premium rates for this plan will start high and get even higher the longer the plan is on the market.

The lawyers that designed Obamacrap clearly had no idea what they were doing. This is not surprising given that most elected officials have never held a real job in the private sector. 

During the interim period while we are waiting for authorization to sell this new product, BCBSIL will temporarily suspend issuing new policies to children under 19 when the child is the primary insured. BCBSIL will stop quoting its current child-only policies on July 30, and the last assigned effective dates for those policies will be Sept. 15, 2010. Any application that has not been approved by Sept. 1, 2010, will be withdrawn from consideration.

The memo from Texas Blue Cross contains language that is virtually identical to BCBSIL.

So far BCBSGA has not given any indication they will follow suit. We will continue to monitor changes in the market place, particularly as they relate to Obamacrap, and keep our readers advised.

If you are applying for PCIP (Obamapool) you will need a declination letter from an insurance company to submit along with your application. The letter must be dated within the last 6 months.

The quickest way to do this is to apply for STM (short term medical) through a company such as HPA. The application process is quick, takes less than 5 minutes. When you answer "yes" to any of the health questions you get an instant declination letter that can be printed and submitted with your PCIP application.

Certain preventive health care services are now mandated as part of Obamacare. By law, these benefits are "free" to the consumer in that your health insurance plan will not be allowed to charge a copay or deductible.

But they are not free. Doctors and labs have not suddenly decided to deliver health care services at no charge. The cost of these benefits is added to the premium you pay each month.

Premiums will rise by about 3%-5% to cover the additional cost of these benefits. The plan you have recently purchased may already have these benefits and the premium adjusted accordingly.

In addition to your routine annual exam, the new "free" benefits will include screening for alcohol abuse, high blood pressure, sexually transmitted disease, obesity, tobacco use and more. Some of the services are segregated by gender and age while others are universal.

These new benefits are retroactive to the date Obamacrap was signed in to law so you may receive a notice that your premiums are going to be adjusted upward retroactively. If so, not to worry, this is done to bring the plans into compliance with the new, higher benefits.

If you are looking for health insurance now you may encounter plans that have deductibles, copays or waiting periods for preventive care. Again, you should not worry as these plans will eventually be corrected to bring them into compliance once Washington decides to tell the health insurance companies how the benefits are to be administered.

In the interim you can refer to this nifty summary of mandated preventive care benefits as brought to you by the folks who gave us Obamacrap.

More surprises are on the way including children's health insurance under Obamacrap.

Obamacare continues to systematically dismantle the current health insurance market. If you are looking for children's health insurance on a stand alone basis (not part of a parent or family plan) you have one less option.

Two months ago Golden Rule (United HealthCare) announced they would no longer issue "child only" health insurance plans. Children may be covered as part of a parents plan, but they will not issue a policy  on children alone.

Now another health insurance company has followed suit. Any applications for child only coverage that are not submitted by 8/15/2010 will be returned.

This won't be the last carrier joining this parade.

Just like Victor Frankenstein, the folks that designed Obamacare have unleashed a monster on the American public. By tinkering with a system that worked for the vast majority of people they have unleashed a fury of unrest among the great unwashed. Obamacare is finally showing its' true spirit and has morphed into Obamacrap.

In an effort to provide more affordable health insurance to the masses, and still be in compliance with Obamacrap rules, the health insurance companies are designing new plans by digging up body parts from the 90's and piecing them together in ways that will please the monarchy in Washington but will draw the ire of the torch and pitchfork crowd.

The new and improved Obamacrap plans will promote health insurance with lower premiums, but at the same time will offer a limited number of choices when it comes to doctors and hospitals.

Insurers and consultants expect that, over time, businesses of all sizes will gravitate toward these plans in an effort to cut costs.

The tradeoff, they say, is that more Americans will be asked to pay higher prices for the privilege of choosing or keeping their own doctors if they are outside the new networks.

What happened to "if you like your doctor you can keep him or her"? 

Well, that went away with the new mandates placed on health insurance companies to deliver plans with lower premiums and higher benefits.

Companies may be able to reduce their premiums by as much as 15 percent, the insurers say, by offering the more limited plans.

“What we’re seeing is a definite uptick in interest because, quite frankly, affordability is the most pressing agenda item,” said Dr. Sam Ho, the chief medical officer for UnitedHealth’s health-care plans.

There you go.

Since one of the chief complaints of health insurance was the cost the carriers have responded with lower premiums. Who wouldn't like that? 

“Back in the H.M.O. days, it was tight networks, and it did save money,” said Ken Goulet, an executive vice president at WellPoint, one of the nation’s largest private health insurers, which is experimenting with re-introducing the idea in California.

The concept was largely abandoned after the consumer backlash persuaded both employers and health plans that Americans were simply not willing to sacrifice choice.

HMO's do save money and deliver quality care. We expect to see more HMO offerings as well as PPO and POS plans with multiple reimbursement tiers. This kind of shift is already taking place in existing health insurance plans as the carriers negotiate more favorable pricing on commonly prescribed medicines. At the same time they are moving higher priced med's into higher tiers which results in a higher out of pocket when the consumer opts for more expensive medication. Many plans are also imposing a penalty when the consumer chooses a higher priced med and there is a lower cost equivalent medication available.

The new health care law offers some protection against plans offering overly restrictive networks, said Nancy-Ann DeParle, head of the office of health reform for the White House. Any plan sold in the exchanges will have to meet standards developed to make sure patients have enough choice of doctors and hospitals, she said.

That most likely will mean plans offered via the Exchange will have significantly higher premiums than those available outside the Exchange. 

So how is this hope and change thing working for you so far?

The government run health insurance plan for seniors continues to lose money every year and fraud continues unabated. The Miami Herald reports that  Florida has become the Medicare fraud capital of the United States.

Florida mental health clinics submitted $421 million in bills to Medicare last year — about four times more than Texas and a whopping 635 times higher than Michigan, both also hotbeds of healthcare rackets, according to government records.

Florida rehabilitation facilities billed $310 million for physical and speech therapy — 140 times more than New York and 10 times higher than California, records show.
 

With all the criticism heaped on health insurance companies I have never heard a single report on fraud that comes anywhere close to this kind of crime. Yet to listen to politicians and the lame stream media you would think a government takeover of health care is the best thing that could ever happen.

Miami Dade has about 250,000  residents. If the government can't control fraud in such a small population how will it ever prevent fraud when they take over health care for 320 million? This is a problem Ray Charles could see from a mile away.

In 2008, Medicare paid $520 million to Miami-Dade home healthcare agencies for treating diabetic patients — more than what the agency spent in the rest of the country combined, according to federal authorities.
 

Why isn't this a red flag? It doesn't take a rocket surgeon to figure out there might be a problem. Even Forrest Gump would realize something is not right.

This tells you something about the level of incompetence in the Medicare system when obvious abuse is allowed to grow to this magnitude unabated.

Overall, Medicare fraud in South Florida costs taxpayers between $3 billion and $4 billion annually, according to experts. Nationwide, Medicare and other healthcare fraud is estimated to cost $68 billion annually — about $18 billion more than the Obama administration plans to spend on education in the next fiscal year.
 

Teachers take note. When the government pisses away more money on fraud than it will spend on education this should be a warning. Where is the torch and pitchfork crowd? Why isn't someone demanding a halt to this kind of incompetence?

There are currently 40 million people on Medicare. Over the next 10 years the baby boomer generation will add 70 million participants. It is common knowledge that Social Security is flat busted and has been for years. This year Medicare will pay out more than it receives in tax collections for the first time ever. This problem will only get worse, not better, and it doesn't help when dollars are leaking out in the form of fraud.

Wasn't Obamacrap supposed to end this kind of fraud? A snowball has a better chance in Hell.