Georgia Health Insurance 411

Posts Tagged ‘health insurance’

“Old timers” will remember that phrase from a copier commercial years ago when Xerox dominated the copier market. The pitch had a sleazy salesman trying to peddle his no-name copier to a business owner and his assurance that their copier was “just as good as a Xerox”, only cheaper.

The American public has been sold on a health insurance plan that is “just as good as RomneyCare” (the Massachusetts Experience and venture into universal health care).

Obamacare is RomneyCare on steroids.

So how well is this model for the future working?

Barely 4 years after approving RomneyCare the plan is coming apart at the seams.

While 97 percent of Massachusetts residents now have health insurance, actually getting in to see a doctor is a challenge. ABC News reports that patients wait an average of 50 days to see a doctor in Boston, nearly double the next-longest wait time — 27 days in Philadelphia. Some patients are traveling outside the state to avoid the long waits.

The access problem won’t be resolved any time soon.

Sounds like one of those good news, bad news jokes, except without the good news. I guess Obamacare folks will have to travel outside the U.S.to see a doctor.

How does Mexico sound?

A recent study by the Robert Wood Johnson Foundation found that 75 percent of non-crisis emergency room visits occurred because a regular physician was not available after hours, and half of these visits occurred because patients couldn’t get a timely appointment with their doctor.

Why doesn’t Gov. Patrick simply require docs to work longer hours? That would solve the problem.

Dr. Lorraine M. Schratz, a pediatric cardiologist in Massachusetts, writes that more than half of all the doctors trained in Massachusetts are leaving the state, and one out of four doctors is considering a career change.

Rather than curb cost increases, post-reform health-care costs in Massachusetts have risen faster than the rest of the nation.

Harvard physicians Rachel Nardin, David Himmelstein and Steffie Woolhandler say the reform has been more expensive than expected, costing $1.1 billion in fiscal 2008 and $1.3 billion in fiscal 2009.

I know the folks in D.C. are currently using all that brain power to stop the flow of oil in the Gulf, but is anyone paying attention to what is happening in Massachusetts? Sounds like Massachusetts needs to borrow Rahm Emanuel to capitalize on this crisis.

So why is RomneyCare falling apart? One is taxpayer subsidies for people earning up to 300% of the Federal Poverty Level. For those of you playing along at home, this is one of the key foundations of Obamacare as well.

Another reason is that some people are gaming the system, buying insurance only when they need it, then dropping coverage.

Gosh, who would have anticipated that? Massachusetts should impose fines on those who fail to comply with the law and don’t buy health insurance.

Oh wait, they do have fines for non-compliance.

So how is RomneyCare any different than Obamacare?

It isn’t.

If a state of 6.5 million people can’t manage a universal health care program why should we expect offering the same kind of plan to 340 million people will work any better?

Just another stupid government trick.

Smaller cars, bigger health care problems, Poppa Washington.

If you are looking for a job, especially one that provides group health insurance, don’t be surprised if you come up empty. The intent of Obamacare (Patient Protection and Unaffordable Health Care Act) was to  make health insurance more accessible and more affordable.

In fact, it does neither.

Many large companies have already crunched the numbers and figured out it will be cheaper to drop health insurance and pay a fine than it is to continue the much coveted employee benefit.

Now smaller companies are coming to a similar conclusion.

The Heritage Foundation reports:

Thanks to Obamacare, low-skilled job seekers will find it even harder to find work.  And low-income areas will find it even more difficult to attract new businesses.  That’s the lesson drawn from a new analysis by White Castle, the iconic hamburger chain.

Numbers crunchers there looked at how Obamacare provisions would affect the company’s bottom line.  Of particular interest were provisions that hit employers with a $3,000 per employee penalty—even if they offer health insurance—for workers whose household income is low enough and they get subsidized health coverage through a government-run insurance exchange.

Curiously, the penalty for hiring and offering coverage to a low-income worker is 50% higher than the Obamacare penalty ($2,000 per employee) for NOT offering coverage.

What kind of idiot thought that one up? Assess a larger fine for compliance than for non-compliance.

“The net result would be higher unemployment for low- and moderate-income families and higher health insurance costs for their co-workers—the exact opposite of what the bill’s proponents claim is their goal.”

As the White Castle report shows, Obamacare is more likely to hurt than help low-income workers. Additionally, employer penalties create incentives to drop coverage altogether, making a mockery of President Obama’s promise that “if you like it, you can keep it.”

This is what happens when you put someone in charge who lacks real world experience.

Most headaches, including migraines, are covered by most Georgia health insurance plans. Each carrier has their own set of underwriting rules and guidelines, particularly when it comes to migraines.

How do you know if you have migraine headaches or not?

The folks at Real Age have a simple quiz to help you determine what kind of headaches you have and suggestions on how to treat them. Follow the link to take their headache assessment quiz.

Most people with migraines can get health insurance in Georgia as long as they are not on heavy doses of pain medication. At Georgia Insurance Shop we review each situation and pre-screen all applicants with the health insurance companies before submitting your application.

Our success is high in finding an affordable  Georgia health insurance plan to fit your needs and budget, regardless of most pre-existing medical conditions.

Cyberspace is a wonderful thing. You can “meet” people from all over yet still never REALLY meet.

Over the last few years I have met some really great people from all walks of life. Some of their stories will lift your spirits while others will bring a tear to your eye.

This story of “Sandi” will do a little of both. She is a very brave woman who has faced a lot in the last few months. She posts regularly on a public forum and always has such a wonderful outlook on life. She recently took someone to task who was complaining about having to pay insurance premiums and “getting nothing in return”.

Here (with her permission) is Sandi’s story.

For years and years I paid into insurance, never had a claim, beyond just the usual that they cover, checkups, etc.

THEN, one day, I went for a routine test and lo and behold, they discovered lung cancer! 2 rounds of chemo and 35 radiation treatments later, at a conservative and just a running guess in my head, around $300,000 was expended on me. Came back to edit to let you know that ONE chemo treatment for me was around $12,000 and some change.

A few months later, I went in, AGAIN, just routine test and walked out with a recent bilateral mastectomy, two weeks later, lymph node surgery, I’m currently on the “chemo pill” and looking at that for the rest of my life, working towards having myself rebuilt (my ins. company is picking up the tab for my “boob job” with a plastic surgeon that costs in my area, around $7,000, and I’m grateful for my insurance company picking up that tab, because stuffing my bra was an option as a teenager, but now, not so much. So about now, I’m probably up to around $600K, and if my CT on 11/10 confirms that there is some “movement” in my lung cancer, then I will be back in for more chemo and if so, we will hit a million!

So, should I have been “paid back” as you claim for those years of good health, only to then have them spend close to a million or more on me to keep me alive?

You keep the change, folks, I will be happy to have my insurance!! there is NO WAY that I have paid a fraction of what they have expended on my behalf.

And keep in mind, you just may walk in one day and find that you are not so healthy and you won’t be squawking about those few dollars they kept every month when you need them to expend hundreds of thousands to keep you alive and somewhat comfortable.

Disclaimer: I have no issues with paying for insurance, I have seen what it has done for me so you won’t find this old girl bashing any insurance company over a few bucks I didn’t use in the past. And it is PAST, not passed. Just thought you might like to know.

There was some back and forth where the original complainer tried to justify their position that there should be a refund for premiums paid that did not result in a claim. This person also indicated she had canceled her insurance in protest.

Here is Sandi’s retort.

I would strongly ENCOURAGE you to go back to carrying your health insurance.

You said in your post that you have lost family members due to Cancer and that in and of itself makes you more susceptible.

If you think it was tough for your family WITH insurance, can you imagine what it will be like for you WITHOUT insurance?

I am always looking for ways to cut back and cut out out of fear of what my illness may do to me.

I am continuing to talk to you about this because those years of good health can turn on you in a heartbeat. My life turned completely upside down at 10:54 a.m. on 8/18/09 when I learned about the lung cancer, and then it started, those $12,000 chemo treatments, 10 of those, I set it out for you, but not all of the other tests, mediaendoscopy (sp), CTs, PETs, MRIs, Bone Densities and blood work and after chemo shots and on and on it goes. A new chemo pill that I will be on for the rest of my life, $50 a month, doesn’t sound so bad, but that’s forever, and even a frugal person like me had to do some juggling to work it in with everything else. I had a PowerPort implanted in my chest to make my life easier…

Believe me for all of your chagrin, if you walked a day in my shoes, you would be glad to trade that money over the past 5 years for NOT living like I do.

I’m fortunate than most. I don’t have some big paying job, I’m a peon in a big DC lawfirm, but I learned to be careful with the little money I have, so when this hit, I was not then and am not, so far, yet, living hand to mouth. I was debt free then, am now, but for my mortgage and I have money in the bank, and while I’m no millionaire, I made it my business to become a good strong hundredaire and I can make it.

But this is not only about the physical, being “well”, Cancer does other things, I thought after I finished all the lung cancer treatments they could do, well, I fairly skipped to that mammyslammer in June, figured I’d be wowing the boys at the pool no later than 2:30…not to be, they needed another one to compare, then they wanted a sonigram, then they wanted to do three biopsies…my breasts looked like they had been in a bar fight. No pool for me.

It was/is Cancer. On Sept. 8th, my copay to enter the hospital to let them cut off both my breasts was $200 and the ins. picked up the tab…I won’t be wowing anyone, but thank goodness, I only had to pay that $200, the insurance is picking up the other thousands and I still have more down the road.

Not only does Cancer do a number physically that ins. pays for, there is a lot of mental things going on…I was so distraught that a vain woman like me losing her breasts I went on drugs to keep me from crying every day. Insurance pays, but I thought, it’s done now, I should be OK, I let the scripts run out…bad idea, this morning I have been sitting her with tears in my eyes because I’m having a meltdown, I’m tired, MENTALLY and Physically. But thank goodness, tonight when I get off work I will take a few bucks and pick up my scripts again and no more crying jags.

I just fear that you and folks like you have no idea what an illness can do to you, and be ever so grateful that you went those years without any claims. Walk a day in my shoes and you would say “keep the change” and thank God in His Heaven it is not you, but someone else.

In response to this: Ask yourself -if i wanted “my money” back -don’t you think i would have found a way to get it back by now?

No, I don’t think you could! Not in a billion years will you get that money back.

In response to this: Once again I did not mean to offend anybody and hope nobody takes it personal

I am not offended, I would have to give you the Power to do that and I don’t grant you that permission, and I’m not, the word is “offended”, I am just worried about you and everyone who doesn’t understand that 5 years/10 years/20 years means nothing when an illness hits.

I am talking to you because you are being very foolish and I don’t want anyone to go through what I’m going through, and despite your 5 years of good health, you are NOT immune.

I hope you will think about what I have said and be happy to pay your premium and stay in good health, and if you don’t, then have them to help you along the way…

As I said, she is a brave woman. Throughout her ordeal, she has retained her wit and positive outlook on life. I am truly blessed for having met her, and now, so are you.

Do you wonder how Obamacare will handle uninsurable individuals? The Baucus plan will establish a high risk pool to

(A) provide to all eligible individuals health insurance coverage (or comparable coverage) that does not impose any preexisting condition exclusion with respect to such coverage for all eligible individuals;

This can be found on page 38 of the Baucus bill. Over the next few pages are a few surprises . . .

INSUFFICIENT FUNDS.—If the Secretary estimates for any fiscal year that the aggregate amounts available for payment of expenses of the high risk pool will be less than the amount of the expenses, the Secretary shall make such adjustments as are necessary to eliminate such deficit, including reducing benefits, increasing premiums, or establishing waiting lists.

That little tidbit appears on pages 39 – 40.

So if the Secretary, the one who administers your high risk health insurance, runs out of money it is his/her responsibility to correct the problem by reducing your benefits, increasing your premiums or establishing waiting periods (presumably for new entrants although this is not clear).

Change you can believe in.

Mr. Rogers comments on Obamacare. Today’s lesson is brought to you by the letters Y and S. (You’re screwed).

To fund Obamacare, the government pledges to “save or create” at least $100 billion each year by eliminating fraud and abuse in the Medicare system. Some estimates put the savings as high as 35%.

And these are the same folks who want to control ALL health care funding for EVERYONE.

Fascinating.

The same folks who ran out of money in 2 weeks under the Cars for Clunkers program are now admitting the Cash for New Home Buyers tax credit may have sprung a few leaks.

To spur home sales, Congress decided to provide a tax credit of $8,000 for first time home buyers. Like Cars for Clunkers, the program has performed as promised by spurring home sales over the last few months. This is good news for realtor’s, lenders and of course the folks who now are proud owners of a new home courtesy of the American taxpayer.

But Houston, we have a problem.

According to USA Today there are a few folks who applied for the tax credit that were not entitled to the credit.

Treasury Inspector General for Tax Administration J. Russell George told a House panel that more than 19,000 people filed 2008 tax returns claiming the credit for homes they had not yet purchased. George said his office had identified another $500 million in claims, by some 74,000 taxpayers, where there were indications of prior home ownership.

He told a House Ways and Means oversight subcommittee that they also found 580 taxpayers under the age of 18 who claimed $4 million in first-time home buyer credit. One was 4 years old.

That’s 93,580 people who applied for the credit but weren’t entitled to it. At $8,000 each that’s more than $700 million in bogus tax credits.

Sounds like fraud and abuse to me.

About 1.4 million tax returns have been filed to take advantage of the credit at a cost to the government of about $10 billion.

My calculator indicates roughly 1 out of every 14 returns were fraudulent.

Our friends in Washington are not making a good case for extending the public trust.

Medicare fraud and abuse is 10 – 35% of the total amount spent. The housing tax credit is in its’ infancy and they have already identified at least 7% of returns are fraudulent.

What’s wrong with this picture?

Of all the finger wagging and charges levied against the health insurance industry, I don’t recall one politician charging the industry suffers from waste due to fraud and abuse.

Wonder why?

There is criticism about profits which average 3 – 4% of total premiums and about carriers refusing to issue coverage to people with serious medical problems, but nothing about fraud.

Change you can believe in.

Back from the dead, Obamacare now seems like it will come to a vote. The CBO (Congressional Budget Office) has put a price tag on the latest version that just barely comes in under PresBO’s limit of $900 billion.

The version of the bill draft that the CBO and JCT analysts used would require most legal U.S. residents to have health insurance; set up insurance “exchanges” that some individuals and families could use to buy subsidized health coverage; expand eligibility for Medicaid; slash the growth of Medicare’s payment rates for most services; and impose an excise tax on insurance plans with relatively high premiums.

Some items of note.

The bill only includes federal budget expenditures. It does not factor in the increased health insurance premiums to cover mandated items like banning underwriting of pre-existing medical conditions (guaranteed issue), community rating, age rated limits, mental health parity, etc. which will at the very least, DOUBLE current health insurance premiums.

So much for coming up with affordable health insurance premiums.

We have to at least wonder about the savings that will originate by “slashing the growth of Medicare payment rates” and what this means to medical providers and Medicare beneficiaries as well.

The obvious answer is, fewer docs willing to accept Medicare patients and more out of pocket for Medicare beneficiaries for non-covered items.

And how about that excise tax on high premium policies?

The expansion of health coverage would add $829 billion in costs from 2010 to 2019, but it should add $201 billion in health plan excise tax revenue, achieve $110 billion in miscellaneous net savings, lead to $404 in federal spending reductions, and lead to $196 billion in other federal revenue increases, the analysts estimate.

You don’t suppose people will cut benefits to lower the premium and avoid the excise tax do you? Wonder how that will muck up the works for the bean counters in Washington?

Given the track record of the CBO and their inability to accurately project costs for Medicare, the Part D drug coverage and Medicare Advantage plans we don’t hold much hope that projections on this will be any better.

In other words, I’m not buying their numbers.

For those who want to read the letter from the CBO Director to Sen. Baucus, here you go.

We want to thank Cigna for making this summary possible.

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.

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 . . .