Georgia Health Insurance 411

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Want to see a Georgia doctor?

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This is especially so if you are a new patient, do not have health insurance, have Medicare, Medicaid or PeachCare. So if we are having problems now, what happens when it is free?

Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the number of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president.

You can’t just push a button and “poof” you have new doctors. It takes years to “grow” a new crop of docs.

One proposal — to increase Medicare payments to general practitioners, at the expense of high-paid specialists — has touched off a lobbying fight.

This is called squeezing the balloon.

Cut reimbursement to one sector to cover the cost of services for another sector. It is also known as robbing Peter to pay Paul.

That has never worked. Why would Obama-man think it will work now? Read the rest of this entry »

With unemployment in Georgia topping 9%, and at least one county over 20%, many are finding themselves without employer sponsored health insurance. Even with the employer COBRA subsidy, paying for group insurance without a paycheck can be a challenge. If the employer drops the group insurance plan, COBRA goes away as well.

This is not just a Georgia problem. Individuals and families everywhere who have had health insurance that is tied to their jobs fall into a trap of believing they can’t afford health care unless they have health insurance.

For most, nothing could be further from the truth.

Routine health care usually is affordable for most, it is the catastrophic care that is a problem. But some medical providers in Kansas City think they have a solution. The Briarcliff Medical Associates have started what they call a “No Insurance Club”.

For one person to join the No Insurance Club, it cost $480 for the year.

After you sign the contract, you get 12 doctor visits a year that include services like physicals, blood work and flu shots.

For a family, no matter the size, it will cost you $680 for the year. It includes everything that an individual plan does, but ups the number of doctor visits to 16.

Sounds great, right?

But it has drawbacks and can convey a false sense of security. Read the rest of this entry »

What is a MERP and what does it have to do with Georgia health insurance?

A long time client called the other day with the same question. He has a high deductible health plan with an HSA, but needed a way to extend his tax breaks beyond the limit of the HSA. A family member needed to have inpatient psychiatric care and the $5,000 monthly bill would stretch the limit of his HSA.

Someone had suggested a MERP so he called me for advice.

Frankly, MERP’s are something I have not used, or even thought about, for some time. The Medical Expense Reimbursement Plan (MERP) is allowed under Section 105 of the Internal Revenue Code. We helped clients set up quite a few MERP’s long before HSA’s and HRA’s came along.

So what is a MERP and how does it work with health insurance?

The MERP is a specialized bank account that is established by an employer for the purpose of reimbursing employees (and their dependents) for certain eligible medical expenses. We found several sites that provide information on MERP’s including the one here. We also located a sample MERP document as well as a MERP explanatory PDF.

If you are looking for Georgia health insurance rates and information on MERP’s you have found the right place.

Washington’s idea of a stimulus package seems to be springing leaks. They want to spend taxpayer money to create jobs and stimulate the economy.

So why are they buying condoms from China?

the U.S. Agency for International Development, which has distributed an estimated 10 billion U.S.-made AIDS-preventing condoms in poor countries around the world.

But not anymore.

They will still be handing out condoms, just not ones made in the United States.

In a move expected to cost 300 American jobs, the government is switching to cheaper off-shore condoms, including some made in China.

Outsourcing condoms. What is the world coming to?

“Of course, we considered how many U.S. jobs would be affected by this move,” said a USAID official who spoke on the condition that he would not be named. But he said the reasons for the change included lower prices (2 cents versus more than 5 cents for U.S.-made condoms) and the fact that Congress dropped “buy American language” in a recent appropriations bill.

Makes you wonder how effective is a 2 cent condom?

Or a nickel one for that matter.

Besides, he said, the sole U.S. supplier — an Alabama company called Alatech — had previous delivery problems under the program.

Delivery problems. Probably a joke in there somewhere but this is serious business.

It’s clear that Alatech’s problems over the years, which apparently have been resolved, may have driven U.S. officials to seek much less expensive foreign-made condoms in the first place.

But that’s cold comfort to Fannie Thomas, who has been making AIDS-preventing condoms in southeastern Alabama for nearly 40 years in the small town of Eufaula.

When the company loses this contract the plant will have no choice but to shut down, putting some 300 people, including Fannie Thomas, out of work.

Many residents in Georgia are losing their job and their health insurance. Sometimes COBRA is an option, sometimes not. There are many low cost alternatives available including short term medical, high deductible catastrophic health insurance as well as traditional health insurance plans.

So what the heck is post issue underwriting?

Glad you asked.

That’s when you apply for coverage, the policy is issued. Then at some point in the future, usually following a claim, you get a letter from the health insurance carrier. They want to know all doctors you have seen in the last 5 years and all medications you have taken.

The envelope has a form you are to sign, allowing them to contact the doctors and obtain medical records.

Welcome to post issue underwriting.

You submitted an application. Probably went through a recorded telephone interview. They pulled your medical records (such as they are) from MIB and may have checked your prescription drug history with someone like Milliman Intelliscript.

You passed with flying colors.

Or did you?

Your claim may have been for a persistent cough or a nagging pain in your back. Or it may have been something as simple as your annual exam.

The next thing you know, they’re baaacckk . . .

What are they looking for?

Something you purposely, or even carelessly omitted in your medical history. Something so minor to you, it was probably dismissed or forgotten.

They are looking for a reason to deny your claim or even rescind your policy retroactively to the effective date.

Can they do that?

You bet.

If they can prove you withheld material information about your health you are out of luck.

That’s the bad news.

But here is the good news.

If you used an agent who knows the business. Understands how carriers think and what they look for, then (her comes the shameless plug) you are in good hands. I have worked with carriers for over 30 years. Who knows better how they think and what they will do than someone who has actually been on the inside and walked the halls of the home office?

I do a lot of things to diminish the possibility of post issue underwriting. Things like anonymous pre-screening a clients health history with potential carriers before submitting an application. We also do a trial run on every application. Even though all carriers accept (and prefer) electronic apps, we do a practice run on a paper app before ever submitting to the carrier. I review each application with my client, alerting them to potential issues and tell them what to expect during the phone interview.

I don’t like surprises and I assume my clients don’t either. Clients are never alone when I am hired to be their agent and advisor.

If you need your claim paid, would you rather fight the carrier’s on your own or have a professional “hit man” on your side?

The choice is yours.

Georgia health insurance can be tricky. Finding the right plan is only part of the battle. The real challenge comes the first time you file a claim.

A test of a policy is not in the obvious benefits, but rather what it does NOT pay.

Funding for Georgia health care is about to change. Money is tight. Every where. Especially at the state and federal level although you would not know Washington has gone beyond their last dime based on how they have spent money they don’t have over the last 6 months or so.

But that is another story.

Let’s talk about Georgia.

Even with Santa Claus handing out bags full of money from Washington via the Spendulus bill, Georgia is still coming up short on funding for PeachCare. And eventually even the idiots in Washington will realize they can’t keep funding projects when they can’t balance their checkbook. So Georgia is going to have to address funding for all programs, including entitlement’s, on their own. Read the rest of this entry »

Here at Georgia Health Insurance we like to stay on top how the state is spending our tax dollars. Like most states, and the federal government, we are looking at steep budget cuts to keep from going under. All areas are subject to the knife. Roads, schools and even Medicaid are trying to find ways to keep rolling on less money.

When you cut Medicaid, everyone loses, both rich and poor.

Governor Perdue has proposed a 10% cut in Medicaid funding to hospitals. This translates into a loss of almost $81 million.

The proposed Medicaid cut is expected to be magnified since hospitals will lose $2 in federal matching funds for every $1 in state Medicaid money that gets cut, said Kevin Bloye, spokesman for the Georgia Hospital Association.

“When you add the federal matching dollars,” Bloye said, “hospitals could lose an additional $120 million.”

Most hospitals lose money serving Medicaid patients, so this only makes it worse.

The Medicaid cuts could be the “last straw” for some hospitals in the state, industry insiders said.

Hospitals are suffering from rocketing unpaid medical bills, a decline in high margin elective procedures, and the growing rolls of uninsured.

So what happens when hospitals refuse to accept Medicaid patients?

Everyone loses.

“We can see hospital closures, we can see major damage to large hospital systems and we can see individual physicians who are getting out of the business, all because we didn’t take the stimulus package money and use it directly for Medicaid,” hospital lobbyist Jimmy Lewis said.

Oh yeah. About that Spendulus money.

The stimulus money doesn’t come “close” to offsetting the tax revenue hit facing Georgia, Brantley said.

So even Obamaman can’t save us.

Having fun?

Most folks don’t know as much about health insurance as they think they do. It’s amazing how often I talk to people here in Atlanta and other parts of Georgia and hear comments such as these.

I don’t want an HMO plan because they are all bad.

Blue Cross is accepted by all the doctors so it must be the best.

I can’t afford a high deductible plan.

I need a plan with a copay so I can afford to go to the doctor.

I don’t need doctor coverage, just something in case I go to the hospital.

I need a plan with a copay so I can afford my medicine.

I don’t need drug coverage since I don’t take any medication. Read the rest of this entry »

Coventry is a relative newcomer to Georgia. They entered the individual major medical market in Atlanta and a few other metro area’s in the second quarter of 2007.

To staff their offices they hired quite a few folks away from BCBSGA which, in my opinion, proved to be a bad move.

Coventry decided the best way to make a splash was to essentially duplicate popular plans offered by BCBSGA, making a few changes, and coupling the major med with a dental plan from Delta Dental.

In an effort to quickly gain market share they offered rates that were 20 – 30% below market and coupled it with loose underwriting that resulted in almost every application receiving approval.

They quickly got religion and made an abrupt, and almost schizophrenic shift in underwriting Read the rest of this entry »

How does health insurance with Blue Cross Blue Shield of Georgia work?

In today’s market (2/12/2009) BCBSGA offer’s a mixture of old and new plan designs.

About half the plans available have whiskers. The HSA compatible HDHP is mostly overpriced for the Georgia market. The old Blue Value series of copay plans are still available, but not online.

The newer series, SmartSense and Premier, were introduced in the summer of 2008 and are available for review online.

Blue’s underwriting can be Read the rest of this entry »