Most major medical plans do not cover ROUTINE eye exams, eyeglasses or contacts but there are items that a good vision insurance plan will cover.

However, there are some situations in which your major medical plan WILL pay for vision care and corrective lenses. If you have diabetes, glaucoma or macular degeneration your health insurance may pay for exams and treatment.

Cataract surgery is one of the most common elective procedures covered by major medical. An elective procedure is one that is not strictly for cosmetic purposes and is designed to improve your quality of life.

Many Georgia citizens buy a vision insurance plan to offset the cost of routine care not covered by major medical. A quality vision care plan is now available in Georgia for less than $16 per month.

This vision insurance plan allows you to see any eye care professional but has the added benefit of a lower copay if you use a network provider.

Eye exams (including dilation if necessary) from participating providers are covered with a $10 copay. The plan also covers lenses, frames and contact lenses.

A routine eye exam can detect changes not only in your vision but your overall health. A professional eye exam can detect other disease such as diabetes, hypertension, multiple sclerosis, high blood pressure, osteoporosis and rheumatoid arthritis. With more than 35,000 participating eye care providers there is almost certain to be one in your area.

Click here for full details on this vision insurance plan. Click, review, quote and apply direct online.

If you have trouble reading this page you may need a vision insurance plan.

One of the little discussed aspects of Obamneycare is the loss of personal service. Insurance agents. Love them or hate them, agents perform a service in helping the consumer navigate their options, help them find a plan that suits their needs and budget and advise them of potential pitfalls of one plan vs. another.

Agents also save you from the morass of home office non-service and the dreaded "Press 1 for English".

Home office staff costs money. Salaries, overhead, benefits all have a cost. Home office staff is paid regardless of whether they are productive or not. Even worse, the answers they provide don't even have to be accurate or helpful.

By contrast, agents are not compensated until after you make a purchase and are satisfied. But all that is about to change.

Come 2014 "Exchanges" will be where many American's buy insurance. You will be encouraged to go online or call an 800 number and pick a plan. You will discuss your needs with salaried navigators that are unlicensed and unregulated.

This is something like PCIP, only bigger.

PCIP, the health insurance program for those with pre-existing medical conditions, was supposed to capture 4 million uninsured citizens in the first two years.

So far fewer than 30,000 have signed up, many states have run out of money and states like California will put you on a waiting list if you call. And the Exchange is supposed to serve over 200 million people.

Maybe it is just me, but I sense a problem brewing.

Now comes this report on ERRP.

InsureBlog has posted a scathing expose' on how taxpayer money was used to fund union health insurance plans.

Read ERRP - We Had to Pass the Bill so you can find out what is in it.

Kaiser Classic Plans offer deductibles of $1500 – $5000. Other features include:

• Unlimited doctor visits with copay's of $35 or $60
• Many preventive services covered at 100% and not subject to deductible or copay
• Urgent care facility copay of $75
• Emergency room copay of $250
• 80% coinsurance after the deductible
• Comprehensive mental health benefits
• Compare plans, quote and apply

Kaiser Essential Plans include cost saving provisions. Deductibles range from $1500 – $7500. Other features include:

• 100% coinsurance after the major medical deductible.
• Unlimited primary care office visit copay of $75
• Outpatient lab and X-ray covered at 100%
• MRI, PET, CAT copay of $250
• Mental health copay
• Outpatient surgery copay
• Most preventive care covered at 100% and not subject to deductible or copay
• Compare plans, quote and apply

Kaiser Advantage Plans deliver the most value. Deductibles range from $1500 – $7500. Other benefits include:

• Unlimited primary care visits with $45 copay
• Specialty visits offer $75 copay
• Most preventive care covered at 100% and not subject to deductible or copay
• 70% coinsurance after the deductible
• $100 urgent care copay
• $500 emergency room copay
• Compare plans, quote and apply

​We think you will like the NEW Kaiser plans for 2012.

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Apply direct with Cigna.

Run rates. Compare plans. Appy direct.

Georgia Insurance Shop has the lowest major medical rates in the state.

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You can also apply direct using this link.

Medicare AEP – It's Not for Everyone

The biggest misconception about Medicare AEP is that it applies to everyone. Not so.

If you already have a Medicare Advantage plan, or you want to SWITCH to an Advantage plan (including PDP), AEP is for you.

Everyone else sits out.

During the Annual Election Period you may make your initial purchase of an Advantage plan or make a change in your coverage. If you don't like the Advantage plan you have now, you can switch. If you don't like original Medicare and a Medigap plan, you can purchase an Advantage plan.

Similar rules apply to PDP (prescription drug plans, otherwise known as Medicare Part D). During AEP you may switch PDP's or purchase a PDP for the first time.

Changing your Medigap Plan in Georgia

If you have a Medicare supplement plan you can switch to another plan with the same carrier or a new carrier at ANY TIME DURING THE YEAR. You do not have to wait until AEP because AEP does not apply to you.

Often the best time to compare Medigap rates is in December or right after the first of the year. Many Medigap carriers such as Blue Cross and AARP bump their rates for everyone in January. Unlike most carriers that offer a 12 month initial rate guarantee, BCBSGA and AARP use a common renewal date for rate increases.

Changing Medicare gap plans is relatively easy but you will be subject to medical underwriting. Most people can pass with flying colors. Bob Vineyard at Georgia Medicare Plans will pre-screen you in 3 minutes or less. If you qualify, he will show you the best Medigap rates for selected plans in your area.

Medigap or Medicare Advantage?

The biggest challenge for most Georgia seniors is deciding between original Medicare and a supplement plan or picking one of the Advantage plans.

Medicare plus Medigap is a relatively simple task since all Medigap plans are identical.

Advantage plans are as varied and confusing as repariing a transmission on a car.

Medicare Plus Medigap

Almost every doctor and hospital in Georgia accept Medicare assignment. This means if you have Medicare and Medigap you can go almost anywhere in the state or country and not have to worry about being treated.

The same is true for your Medigap plan.

If your doctor or hospital accepts Medicare assignment they will also accept your Medigap plan. Your doctor does not know who your Medicare supplement carrier is nor do they care.

The claim process is simple.

Your doctor files the claim with Medicare. In most cases in two weeks or so Medicare adjudicates the claim and sends it on to your gap carrier for payment.

If Medicare approves your claim your Medigap carrier MUST pay the claim, no questions asked. Most gap claims are paid within a week after receipt from Medicare.

When your doctor accepts Medicare assignment there are no claim forms for you to complete. Everything is handled for you by your doctor.

Medicare Advantage

While most doctors and hospitals accept Medicare assignment only about half of the doctors participate in Medicare Advantage plans.

When you purchase or switch to an Advantage plan a new set of rules apply. Your regular doctor may not participate in the Advantage plan you pick so choose wisely. This is especially true with specialists. Your primary care doctor may accept your Advantage plan but your specialist may not.

Advantage plans are confusing. Insurance carriers use gimmicks to make it seem like their plan is better than the others. A common practice is the $0 premium plan.

How sexy is that?

You get health insurance and pay nothing for it.

The devil is in the details.

Advantage plans have a lot of moving parts. At any time you may be expected to pay a deductible or copay if you plan on using the services of a doctor or lab. That may not be bad as long as you are healthy but when your health takes a turn for the worse the copay's and deductibles add up. You can easily find yourself spending $3000 – $6000 or more out of pocket compared to less than $200 with most Medigap plans.

While you won't find Medigap plans with $0 premiums most of the Advantage plans are in the $60 – $80 range. For about the same amount of money you could have a Medigap plan with much less out of pocket.

Bob Vineyard and Georgia Medicare Plans has the lowest Medigap rates in Georgia.

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Long after the fall of the Roman Empire, the Church has been a rock, not just for their followers, but for civilization itself. The Church even survived a 500 year battle with Islam, but now one of core tenets of the Church is in the cross-hairs of Obamneycare. Obama himself has drawn a line in the sand and dared the Catholic Church to cross the line.

Obamneycare makes provisions for exemption for certain religious groups including Muslims, Christian Scientists, Scientologists, Amish and Native Americans.

The folks in DC want to save Medicare. This will be accomplished with major surgery. Your doctor will be paid less, but so what? He earns more than you and can afford to take a pay cut, right?

Some medical services may no longer be paid for by Medicare, but no big deal. You probably didn't really need that treatement and you have lived a long life already. Your time on this earth can't be that much longer.

Medical Records No Longer Private

According to U S News the Obama administration will be requiring all doctors to submit your medical records to the government.

You don't have a problem with that do you?

HHS is making plans to get its hands on your health care records, one way or another, whether you want them to have it or not.

The department's first choice is to collect them directly. If they can't manage that, Plan B is to require the states to collect the data and take it from there. Plan C is to lean on health insurers, using a new regulatory scheme that would require private companies to crunch the data according to new federal mandates the ways the feds want it.

Does any of this bother you, or is it just me?

Been to the doctor lately? Things are different now.

This is Not Your Father's Doctor Visit . . .

A few weeks ago we were out of town and my wife became ill. I took her to a local doc in a box which was an experience in itself.

As first time visitors, she was required to complete a detailed medical history. About 10 minutes or so with a nurse, answering questions, then sign here.

No, you do not get a copy of this information. We are filing it electronically for your protection.

The entire visit took about an hour, most of that time was wait time even though we were the first ones in when the doors opened.

The entire bill for a routine exam and urinalysis was grossed up to $496. After network discounts it came to $248.

The break out was like this.

Gross charges $61 for professional visit, $40 for lab. Balance was for the medical history and establishing her account as a new patient.

Excuse me?

$395 for medical records that the patient doesn't even get to see but are transmitted to HHS.

At this rate I don't think Obamneycrap is going to save anyone any money.

How is this new government health care plan working for you?

Obamaneycare, a Giant Step Backwards

We were told that Obamacare was necessary because too many Americans were without health insurance—which is not the same thing as them being without medical care when it is needed. Rather than fix the stated problem, however, it has made things worse, even before it is fully implemented. According to some recent estimates more than 1 million Americans have lost their coverage in the period since Obamacare became law.

This is not progress.

No kidding.

Reminds me of the old saw. I am from the government and I am here to help you.

I don't think so . . .

If you think they will stop here you are wrong.

In addition to cutting Medicare benefits, they also think your Medigap coverage is too "rich" and want to cut those benefits as well.

Georgia Medicare Plans can help you find the lowest Medigap rates in your area. We have plans from Dalton to Tifton with carriers such as Aetna, Blue Cross, Humana and more. Ask for a Medigap quote today.

Georgia State Representative Rusty Kidd found out the hard way when he took a tumble down a flight of stairs and had to be airlifted to Atlanta for treatment.

Kidd recovered. But he got another jolt when he opened a bill for the helicopter ride — about $27,000. Kidd’s insurer paid what it thought was reasonable: about $8,000. The company wanted Kidd to pay the rest.

“The average person can’t pay $19,000 and I can’t pay $19,000,” said Kidd, an independent.

People such as Kidd, who have what is considered full medical coverage, can end up with crushing medical bills on top of what they pay in deductibles and co-pays through a practice called “balance billing.”

It happens when patients get care from a hospital, doctor or ambulance company that is not part of the network of providers under contract with the patient’s insurer.

This is what insurers refer to as P.A.R.E. (Pathology, Anesthesiology, Radiology, Emergency) claims. While you MAY find par (network) providers in these situations the chances are these providers are not part of any network and are free to bill a "market" rate for their services.

Consumers who study their insurance benefit statements often marvel at the difference between the full-priced charges for a lab test or a hospital stay and the discounted rate negotiated by the insurer. The negotiated rate is often just a fraction of the full charge. Doctors and hospitals say their full charges reflect the expense of providing charity care and accepting government insurance plans that don’t cover their costs. But those footing the bill say that being asked to pay a charge that is often many times what an in-network or a Medicare patient pays simply isn’t reasonable.

How does the consumer know the amount charged isn't reasonable?

If two people buy an airplane ticket from Atlanta to New York, and one pays $99 while the other pays $450 for the same flight, which fare is "reasonable"?

Retail stores inflate their prices to cover such things as bank fee's charged for using debit and charge cards. Is it fair or reasonable for them to "overcharge" customers who pay cash?

Doctors say they also get squeezed by inadequate payments. What many insurers consider a “reasonable” payment is a sum many doctors say is too low. Some doctors are supporting a bill that would allow Medicare patients and their doctors to negotiate a rate — with the patient agreeing to pay what Medicare doesn’t cover.

Failing to pay what doctors consider a reasonable rate is hurting both the doctors and their patients, said Donald J. Palmisano Jr., executive director of the Medical Association of Georgia. “The patient doesn’t realize why they are paying more money and the physician is getting frustrated with the insurance company.”

There is no reason for the doctor to blame the insurance company. When a medical provider such as a doctor joins a PPO or HMO network they tacitly agree to the NEGOTIATED pricing for services rendered. In other words, by signing the contract they agree to accept the designated pricing as payment in full for services rendered.

Just as the non-par doc is free to bill a market rate, you are free to try and negotiate a lower fee directly with the provider. Since the provider is out of network, your health insurance company is unable to compel the provider to accept their payment as "in full". This is a private negotiation between you and the provider.

If you are unwilling to pay the amount as billed, and the provider is unwilling to discount their services, you are obligated to pay as billed. If you fail to do so the provider is free to turn your account over to collections.

This is not just limited to health insurance carriers. The same applies to docs that accept Medicare assignment.

If they don't like the payment schedule, don't sign the contract.

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