Georgia Health Insurance 411

Archive for January, 2010

There is a change you can believe in when it comes to underwriting Georgia health insurance plans and it is not what you had hoped for. More people who apply for health insurance in Georgia are being declined for coverage. More are having coverage denied for certain pre-existing medical conditions. More are getting offers from health insurance companies at much higher premiums than originally quoted.

The reason?

The biggest reason is, most people do not know how to properly fill out a health insurance application. They give too much information, or not enough.

Even if you do all the right things the next obstacle is the application itself. All health insurance companies now offer online, electronic applications. Some companies will ONLY accept electronic applications.

This may seem like a good thing but in fact it can be a hornet’s nest.

The electronic applications are designed to have almost no human intervention. Give the wrong answer to any one question and you will find your application rejected. Many health insurance companies are routinely rejecting 40 – 50% of applications due to medical reasons.

These automated, or as I like to call them, robo-underwriters, are creating havoc. I can’t tell you how often I hear from people who have applied to 2 or 3 health insurance companies only to be denied coverage. Once I hear the details the only thing that is apparent is that they did not know how to fill out an application that would satisfy robo-underwriter.

Most of the time I am able to find a health insurance company that WILL issue coverage. Sometimes I can even get a policy issued by a company that has previously rejected them (although this is becoming increasingly difficult and time consuming).

My best advice is to avoid the robo-underwriter if at all possible by allowing an experienced agent to review and advise the best way to construct and submit an application. A knowledgeable agent will also review possible outcomes from each health insurance company based on your health history and will provide a detailed, written evaluation of offers that may be forthcoming.

So you can take your chances with robo-underwriter and risk getting rejected or rated up for a condition that another health insurance company will consider standard, or you can use an agent to assist.

Georgia Insurance Shop is a leading resource for information, benefits and rates on affordable health insurance plans in Georgia.

Many times people will buy a Georgia Short Term Medical (STM) plan as a stop-gap or bridge between coverage. Most of the time things work out. You have purchased a plan, “just in case something happens”, and you never have to use the plan.

But sometimes you actually need your short term health insurance plan to do more than originally planned.

As indicated, short term medical insurance plans are designed to fill a gap in coverage when transitioning from one health insurance plan to another. Many times you will purchase the coverage for a specific time period, such as 3 months. Others may have an undetermined need and purchase their STM on a month to month basis.

In either case, coverage expires at the end of the term, usually 6 months or in some cases 12 months. If you need health insurance after the term expires you apply for a new plan.

Unlike traditional major medical insurance, short term medical plans do not renew. With each application you start a new waiting period on pre-existing conditions.

Short term medical plans usually have very loose (by traditional standards) underwriting qualifications. As such, many who cannot qualify for a traditional health insurance plan may be accepted by a short term medical plan.

STM plans have a very unique characteristic that allows this “flex underwriting” and at the same time keeps the rates low. Short term health insurance plans do not cover anything for which you have been diagnosed or treated for in the 5 years immediately prior to the effective date of coverage.

This is true if you are a new applicant, or re-applying for a new term with the same health insurance company.

Therein lies the rub.

I got a call a short while ago from a client. Last year we looked at health insurance plans that would meet her needs and budget. Money was tight and since she was getting married in a few months she decided to pick a short term medical plan with a lower price.

She applied. Coverage was issued. Her wedding date was postponed.

Coverage expired at the end of 6 months so she applied for a new health insurance plan and was approved.

Three weeks after the new short term medical plan went into effect she was involved in an auto accident. Injuries were serious and to make matters worse, the other driver only had minimal auto insurance coverage.

The good news is, her short term plan did what it was supposed to do and has paid out over $100,000 in benefits to cover 4 surgery’s as well as medication, doctor visits and so forth.

The bad news is, she will need at least 3 more surgery’s and her 6 month policy is coming to an end in a month.

She called, looking for a permanent major medical plan that will pick up where this one leaves off and pay for future surgery, rehab, etc..

I had to break the bad news to her. She can’t get a new major medical plan with anyone until she is released from a doctor’s care for her existing conditions. Any new STM plan will not cover treatment for this injury since it is a pre-existing condition.

This was not good news.

I am not the type to beat up my clients and make them take one plan over another. Rather, I outline their options, give them advice, and let them pick. If they are leaning toward a plan that has pitfalls, I encourage them to avoid that plan but in the end I say the same thing.

“This is your plan and your money. Pick the one that satisfies your needs and budget”.

That is what my client did. She picked a plan that fit what she felt like were her needs at the time. The few dollars saved will do nothing to make up for the emotional and financial impact of future treatment without the benefit of health insurance to pay the bills.

Georgia Insurance Shop is a leading resource for health insurance information. We offer a wide range of affordable Georgia health insurance plans to fit any need or budget and we do not charge extra for expert advice.

Most people who have high blood pressure and want to buy health insurance in Georgia will not have any problem finding coverage. As long as your pressure is within normal range, whether controlled by diet and exercise or medication, usually will not prevent or hinder you from getting major medical insurance.

There are exceptions of course.

If you use tobacco, are overweight (BMI in excess of 30) or have high cholesterol,  finding coverage becomes more challenging.

Diet and exercise will work most of the time for most people, but you might need a little help. Sometimes controlling your blood pressure can come from some unlikely sources.

Like chocolate.

Specifically, dark chocolate.

Dark chocolate is also rich in antioxidants called flavonoids (milk chocolate contains far less), which help your body fend off cancers and heart disease. And, in a study of 44 adults with high blood pressure, eating dark chocolate daily for several months resulted in lowered systolic and diastolic blood pressure levels.

It also lowers stress.

And can stimulate the libido.

Valentines Day is around the corner. Lower blood pressure, reduce stress and get lucky.

Lowering blood pressure can also reduce the stress of buying Atlanta health insurance.

Seems there is a hole in the pocket of our trusted Congress critters. A hole big enough to do a lot of things, including paying for a good portion of Obamacare. But no one wants to do anything about it.

If Obamacare becomes law, the IRS will be put in charge of compliance. Their job will be to make sure everyone who is supposed to buy health insurance has done so, and make sure that policy meets federal guidelines. If you qualify for a subsidy, the IRS will be responsible for doling out those funds.

Gives you a warm, fuzzy feeling doesn’t it?

“It’s hard to see how the IRS could take on the huge responsibility it would be given under pending health care legislation without some real glitches, or worse,” said Sen. Chuck Grassley of Iowa, the top Republican on the Senate Finance Committee.

According to  USA Today, by their own estimates, the IRS fails to collect $290 billion every year.

That’s some serious coin . . . except in Washington of course.

Now comes NBC reporting as part of their Fleecing of America report that Medicare fraud alone is another $60 billion hole.

Visit msnbc.com for breaking news, world news, and news about the economy

Will someone tell me why we should trust these folks with health care when they can’t even run programs already entrusted to them?

A few weeks ago I signed up for a Facebook account, not really knowing what to expect. In a very short time I found a world that was, and still is, somewhat foreign to me.

I have a Twitter account but so far have not seen the value in reading about what someone had for breakfast or knowing that their dog pooped on the carpet.

I thought Facebook would be pretty much the same except with pictures and I really didn’t want to go there. But on a lark I signed on and connected not only with current friends and business clients but also with folks I have not seen or communicated with in 40 years. Hard to believe it has been that long since high school.

Some of the stories are fun, some are interesting, and some are quite touching. I found out through a good friend I have known since elementary school that several of our mutual friends had died in the last few years. That was quite a shock.

But I have also connected with someone that was always a friend but in a sisterly kind of way. She reached out to me in a way that was totally unexpected.

In reviewing my profile she decided to click through to my business website and read a bit about my work. Her first correspondence was very intriguing to me. She revealed she has two daughters who are now adult’s living with Gaucher’s disease.

I was only casually familiar with the illness but something in her note raised my awareness even more. She said the medication required to keep her daughter’s stable runs $250,000 per year for each of them.

That is astounding even to me. I have clients with various types of cancer and a few with RA and MS. Their medication runs anywhere from $2,000 to $5,000 per month. Certainly expensive but not even close to $250,000 per year.

When clients want to purchase major medical coverage the only thing I really push is full Rx coverage. Sadly, there are quite a few plans out there with no Rx coverage or annual limits as low as $2,000.

Most folks feel like they will never get sick and need expensive medication. As a whole, we are really out of touch with how much medical treatment can cost. That is caused by having plans with a copay for practically everything.

The line I hear most often is, “I don’t plan on getting sick”.

How silly is that? No one PLANS on getting sick any more than planning an accident.

In the case of Gaucher’s, it is an inherited disease. For children to contract Gaucher’s both parents must be carriers. Due to the rarity of the illness (1 in 40,000 births) it is not something normally tested for unless there is a history somewhere in the family line.

One of the meds used to treat Gaucher’s is Cerezyme. Not only is the drug expensive but there have been recalls of the drug due to contamination. After a 6 month void the girls were finally able to get a new dosage this week. Without the drug, symptoms of the disease start to manifest. The drug does not cure but will alleviate some of the effects of the illness.

Illnesses that only affect a small percentage of the population are sometimes classified as orphan illnesses. The research that goes into finding a treatment is time consuming and expensive, often running in the billions of dollars and taking years.

Some will argue that Genzyme, the company that developed and manufactures Cerezyme, is becoming wealthy on the backs of those who are desperate due to health. The profit margin on Cerezyme is reported to be 30% which some view as excessive.

To a Gaucher’s patient, having access to the medication is a difference in quality of life.

The Orphan Drug Act was signed into law in 1983 under Ronald Reagan. Under the law, companies that develop drugs for orphan diseases are granted special tax incentives and exclusive marketing rights for several years. It should be noted that not all research pans out and some of the drugs developed never hit the market.

In the 10 years prior to 1983 less than 10 drugs for orphan illnesses hit the market. Since passage of the ODA, almost 2,000 drugs have been given orphan status and of those roughly 340 actually reached the market under exclusive arrangements.

No doubt, without this law many illnesses would go untreated and many would die.

If you want to argue against protectionism and profits then you must accept the reality that many, perhaps even someone you know, could be adversely affected without proper treatment. In the case of Cerezyme, if the manufacturer was prohibited from making a profit you need to consider the cost would still exceed $150,000 per year per patient.

Of course without the profit incentive and tax breaks, the drug most likely would never have been developed.

You can’t have it both ways.

Just because you have health insurance in Atlanta, Georgia does not mean you have access to health care. A lot depends on the kind of health insurance you have in determining which doctors, if any, are willing to treat you.

Traditional health insurance plans from companies like Aetna, Cigna, Blue Cross, United and Humana will get you in the door with any doc or hospital in greater Atlanta. But if you have a government insurance plan, like Medicare, Medicaid or Peachcare you may run into a problem. Hard figures are difficult to come by but national averages turn out numbers like this.

Roughly one out of five doctors do not treat any Medicare patients and 25% are not accepting new Medicare patients. Primary care has the biggest squeeze on new and existing patients. Most docs try to limit their total Medicare patient load to less than 20%.

If you are on Medicaid or Peachcare the numbers are even more bleak.

Think about this if you are in support of a government run “public option”.

The Baltimore Sun recognizes there is a doctor shortage, and especially for those covered by government insurance.

That 30 million Americans may soon be able to obtain health care insurance is at the core of the Senate and House health care bills. But let’s be clear: “insurance” doesn’t guarantee “care.” Indeed, a recurrent theme on the Senate floor last week was that the legislation is giving “bus tickets” – that is, health insurance – to uninsured Americans. But there are no buses running on those routes.

Define soon . . .

Bear in mind that if legislation passes, overhauling the way health care is funded, most of the provisions will not come into play until 2013 – 2014. If you need health care now, get in line.

And what happens when there’s a sudden increase in the number of insured, with no consequent increase in physicians? There’s already a model for the disconnect between “insurance” and “care”: Health reform in Massachusetts, begun in 2006. In that state, 97 percent of residents have insurance. But nearly a quarter of residents had difficulty getting care in 2008.

Read that again.

Almost everyone has health insurance but one in four have difficulty getting health care.

The Sun goes on to say the solution is to create more primary care doctors.

If only it were that easy.

Doctors are not created overnight. Start with 4 years of college, 3 years of medical school, residency and internship and you are looking at almost 10 years to even begin to “fix” the problem. By then the boomers will already be soaking up as many Social Security and Medicare dollars as possible and the “T” (for tax) generation will be trying to figure out a way to pay for all those promises and campaign slogans from 2008 and later.

Right now you can still find health care and affordable health insurance in Georgia, but for how much longer is anyone’s guess.

Mayo Clinics are one of the premier treatment centers in the U.S. and have been praised by Obama as a “national model for efficient health care”, but there is a problem. As of today, January 1, 2010, the Glendale Arizona Mayo clinic will no longer treat Medicare patients.

Why?

Because the government pays too little . . .

The Mayo organization had 3,700 staff physicians and scientists and treated 526,000 patients in 2008. It lost $840 million last year on Medicare, the government’s health program for the disabled and those 65 and older, Mayo spokeswoman Lynn Closway said.

This doesn’t bode well for those who are, and hope to be, part of any government run health care plan.

At the present time, the Glendale clinic is the only one withdrawing from Medicare but this decision could have a ripple effect to other clinics. And it doesn’t stop there.

Mayo’s move to drop Medicare patients may be copied by family doctors, some of whom have stopped accepting new patients from the program, said Lori Heim, president of the American Academy of Family Physicians, in a telephone interview yesterday.

“Many physicians have said, ‘I simply cannot afford to keep taking care of Medicare patients,’” said Heim, a family doctor who practices in Laurinburg, North Carolina. “If you truly know your business costs and you are losing money, it doesn’t make sense to do more of it.”

Family physicians and other primary care docs are on the low end of the pay scale and are squeezed more than any other medical providers. Typical reimbursement for an insured primary care visit in the Atlanta area can run as low as $42 with most running no higher than $60. In other words, a trip to the doc is about the same price as a lube & premium oil change with tire rotation.

And Medicare pays even less than traditional health insurance carriers.

Mayo’s hospital and four clinics in Arizona, including the Glendale facility, lost $120 million on Medicare patients last year, Yardley said. The program’s payments cover about 50 percent of the cost of treating elderly primary-care patients at the Glendale clinic, he said.

The folks in Washington love to get health care on the cheap and the proposals considered in Congress will cut funding for Medicare below current levels.

It doesn’t take a rocket surgeon to figure out this is not going to work.