Children's Health Insurance Rates Redux

Humana has not been approved to offer health insurance plans for children after 9/22/2010. They are still waiting approval from the state of Georgia on children's health insurance rates. Until further notice, requests for health insurance rates for HumanaOne for effective dates of 9/23/2010 and later will not include premiums or coverage for children under the age of 19.

Mandates imposed by Obamacare are creating a shortage of available options for children's health insurance in Georgia.

Craig is Gone

Over the 35+ years I have been involved in the health insurance business I have come to know a lot of people. Most are likeable, some are not.

Thanks to the internet my range of contacts has expanded considerably. I have friends in several states and many of them are also in the health insurance business.

I participate in consumer forums, social networking sites and business forums. Through one forum dedicated to insurance agents I came to know Craig.

Craig was a few years younger than me, but not by much. He was a frequent poster on that forum and it was through one exchange a few months ago I learned he had cancer.

The thread highlighted the cost of prescription medication, especially cancer med's. If there is one area of health insurance that I insist everyone cover, it is the cost of prescription medications. You never know when you will need medication, for cancer or anything else. If your health insurance policy doesn't include coverage for med's you are up the proverbial creek without a paddle.

Erbitux has been used in the last few years as a last resort medication for certain cancers, notably colon cancer. I say last resort because like so many medications these days the cost is astronomical.

In March of this year Craig commented his latest dose of Erbitux was $13,360 for 10mg.

Yes, that is correct. $13,360 for 10mg of Erbitux.

Without health insurance that includes an Rx benefit (not just a discount card) most people would have to forget treatment for their illness.

In March Craig reported he was doing well. By June things had changed.

Craig died over the weekend. Our prayers go out to his family.

The Internet Makes You Dumb

For all the wealth of information that can be found on the internet, people have become dumber, not smarter because of the web. No, this is not a scientific survey, just my personal observation. But it repeats itself over and over.

Let me prove my point.

Yesterday I received an email from a woman who wanted a particular health insurance plan and an HSA. She told me the plan she wanted and informed me her HSA would be with a brokerage house.

In responding to her request I informed her the plan she had picked out would not allow her to establish an HSA.

She came back and told me she had studied all there is to know about HSA's and she knows the rules by heart. She then said she would be willing to look at another plan, from the same health insurance company. 

My reply was that plan would work but I asked why she wanted a group health plan when, for many people, an individual health insurance plan is much less expensive.

She sent another response, telling me she had minor pre-existing conditions (high blood pressure) and her "partner" also needed coverage and had asthma. She then proceeded to complain about health insurance in general and tell me she would only buy coverage if I could produce a plan to her exact specifications.

It became quite obvious that she had all the answers and did not need me, so I simply said I did not know anyone who could help her and opted to end any future email exchanges.

The next situation occurred less than 24 hours later. This morning someone visited Georgia Insurance Shop looking for information on health insurance plans. I decided to give the woman a call and see if I could help.

She is relocating from New York and her COBRA will not travel with her. She is overweight, a tobacco user and diabetic.

No one will issue coverage and I told her so.

She did not believe me.

I suggested she go ahead and apply for coverage with any health insurance company, it didn't matter which one since all will deny her. When she has the denial letter she can then apply for PCIP.

Her response was to tell me she was in the medical field and she already knew she would not qualify for that plan and that I did not know what I was talking about.

Actually I do, but I saw no reason to argue since she already had all the answers and I had better things to do than talk to a doorknob.

So as you can see, in spite of all the information and resources available to us the internet makes some of us dumb. Some days I hate Al Gore for inventing the internet.

The Check is in the Mail

States are having trouble making ends meet and a lot of that is due to mandates from Washington. Funding for expanded SCHIP and Medicaid was supposed to come (at least in part) from D.C., but it seems the folks in Washington are finally realizing they have already spent the money given to us by the Chinese and the corner loan shark is not willing to float them money.

On top of it all, Obama is threatening to kick some B.P. butt and Helen Thomas is off visiting some of her Jewish friends in Palestine.

And now this.

The New York Times reports that at least 30 states are in the hole for Medicaid unless Congress sends them more money. What most folks may not know is the party is about to end. All that is left now is for our children and grandchildren to empty the ashtrays and pick up the left over beer bottles from the Obama celebration of letting the good times roll on someone else’s dime.

COBRA subsidies, funding for Medicaid and SCHIP was paid for with checks kited from Washington. Most states figured they didn’t have to pare back or raise taxes as long as Obamabucks were flowing.

Unless Congress approves more Medicaid spending, which at this point seems unlikely, the states are going to have some serious funding problems. Some of our Congress critters have taken off their party hats and are threatening to sit on their hands should new votes come up for spending bills. This applies to folks with a “D” as well as those with an “R” after their name. The voter revolt is becoming quite vocal over all the spending and heads are already rolling with more to follow.

Gov. Edward G. Rendell of Pennsylvania, for instance, penciled $850 million in federal Medicaid assistance into the revenue side of his state’s ledger, reducing its projected shortfall to $1.2 billion. The only way to compensate for the loss, he said in an interview, would be to lay off at least 20,000 government workers, including teachers and police officers, at a time when the state is starting to add jobs.

“It would actually kill everything the stimulus has done,” said Mr. Rendell, a Democrat. “It would be enormously destructive.”

Yes, “stimulus” really has a nice ring to it until the voters realize that (1) it isn’t working and (2) eventually someone will have to pay for this mess. Jobs created or saved sounds good until you realize that 95% of the new jobs were part time Census workers. Toto has pulled back the curtain to reveal the Wizard is a fake.

The Medicaid provision, which would extend assistance first granted in last year’s stimulus package, was considered such a sure bet by many governors and legislative leaders that they prematurely included the money in their budgeting. But under pressure from conservative Democrats to rein in deficit spending, House leaders in late May eliminated $24 billion in aid to states from a tax and jobs bill that was approved and forwarded to the Senate.

This is called betting on the come. If you know your opponent it can work to your advantage in poker, but it doesn’t work so well when the bank is busted and the folks you are playing against decide to call it a night.

Although the federal Medicaid share varies by state, the stimulus act raised it to an average of 66 percent, from 57 percent, according to the Kaiser Family Foundation.

The reimbursement increase was limited to a 27-month period that ends on Dec. 31. Almost as soon as it took effect, governors began fretting about the fiscal precipice they would face when the enhanced payments ended. In February, governors from 42 states and several territories signed a letter to Congressional leaders pleading for a six-month extension.

But with the public alarmed about deficit spending, House leaders found that they could not muster the Democratic votes needed to pass the tax and jobs bill without jettisoning several expensive components.

So what happens now?

Seems that in addition to folks in DC worrying about getting laid off the same fate might await those at the state level. This is not a good year to be an incumbent.

Golden Rule Leaves Children Behind

Golden Rule (United Healthcare/UHC) is no longer issuing "child only" health insurance policies in Georgia. The official announcement was passed along this morning.

This follows on the heels of withdrawing maternity options for all new health insurance policies issued after 4/30/2010.

To my knowledge, Golden Rule is the first to withdraw from the child only health insurance market but there may be more over the next few months. This is in response to the provision in Obamacare (Patient Protection and Unaffordable Health Care Act) that requires health insurance companies to issue coverage to children under the age of 18. This new mandate begins in September, 2010 but many companies are already preparing new, higher rates, for children applying after September 1.

As for now, Golden Rule will still allow children under 18 to still be covered under their parent(s) plan. I do not expect any changes in that regard, and premiums for family plans that cover children will not rise dramatically until fall.

We will attempt to keep our readers advised of any new changes as a result of Obamacare.

You can shop for affordable health insurance for children, families and adults at Georgia Insurance Shop.

Imerica Policyhoders – Find New Coverage ASAP

If you bought a Georgia health insurance policy from Imerica you need to find new coverage fast.


DATE: MARCH 25, 2010



This communication is to update you as to Imerica’s status.

Imerica cannot be rehabilitated, and we expect that Imerica will be placed into liquidation in the next 30 – 45 days.

By a separate mailing, policyholders have been advised of this development. They have also been advised that, while State Life and Health Insurance Guaranty Associations will continue coverage and pay claims for a limited time, they should take steps to obtain insurance coverage to replace their Imerica policy as soon as possible. As such, you are free to transfer Imerica policies without being in violation of the November 18, 2009 receivership order.

Policyholders were also advised that Imerica has partnered with Golden Rule Insurance Company to give them a direct contact about replacing their Imerica coverage.

Once Imerica is placed into liquidation, you as well as all other claimants owed money by Imerica will be forwarded information as to the process to file a claim for the money owed to you. As was indicated in the November 20, 2009 communication to you, commission payments are general creditor claims which are below administrative and policyholder claims and cannot be paid until all administrative and policyholder claims are paid in full. It is unknown at this time whether there will be funds available to pay any percentage to you or other general creditors.

If you have questions or need additional information, please contact Imerica at 1-877-imerica, Menu Option 4.


Fewer Maternity Options for Georgia Health Insurance

If you want to buy health insurance in Georgia with a maternity option you will have fewer choices after April 20, 2010. Time health insurance company (still referred to by many as Assurant) will no longer offer a maternity benefit on policies issued after April 20th.

Time has not been a particularly competitive Georgia health insurance company for some time, but their maternity rider made them a good fit on occasion. Offering four maternity deductible options and only a 90 day waiting period, I found a reason to offer them to individuals and families looking for an affordable maternity option.

With Time leaving this market there are only three health insurance companies in Georgia that will offer maternity and all but one require the policy to be in place for a minimum of 12 months before benefits are payable.

Georgia Health Insurance Companies are Incompetent

After years of dealing with health insurance on behalf of clients, I am convinced that Georgia health insurance companies are mostly incompetent and definitely indifferent. Seriously.

For the most part, they do manage to issue a health insurance policy . . . some quicker than others. And they pay most health insurance claims on a timely basis and get them right the first time.

But dealing with health insurance companies at the consumer level is like trying to get something done at the Post Office or Department of Motor Vehicles. Consumers who contact health insurance companies for a rate quote will be given little more than “welcome to Big Insurance Company, what would you like to order today?”.

You might as well be visiting your local McDonalds.

I have had prospective clients call me after learning that their plan doesn’t cover outpatient doctor visits or medication . . . it only pays for services rendered while in the hospital. Of course they found out over a year later when they actually used their plan and discovered several thousand dollars of medication and outpatient service claims were denied.

Others have been encouraged to submit an application for health insurance and see what the underwriting department says. Of course that requires paying the first (and sometimes second) months premium and waiting a month or more for a decision. A few minutes on the phone and I knew right away their application was going to be rejected.

How about once the policy is issued? Surely you can get service then?

Don’t count on it.

A few of my clients have decided to handle things on their own by calling the health insurance company direct and asking about options for cutting their premium. One client was told the only difference in the plan she had and the one they suggested was the “new” plan did not cover maternity. Since she was 60 at the time she figured it was time to save a few dollars by dropping maternity.

Heads up.

By the time you get to 60 the cost of maternity is no longer factored into your plan. What the home office rep failed to say was the new plan had higher doctor copays, did not cover lab work until after the deductible was satisfied and had a much lower lifetime maximum. By the time I was notified of the change (when she got a whopping bill for lab work) it was too late to unwind the plan and put her back on the original plan.

Another client, seeking to save money and not wanting to “bother” me with something simple, called home office to request a lower premium option. Not only did the new plan eliminate coverage for doctor visits and prescription drugs, but the change resulted in the company dropping his daughter off the plan since “she did not meet current underwriting standards.”

Fortunately I was able to stop that one before the change was effected and we were able to unwind the damage done by incompetence in the home office.

You may think all plans are the same, and you will get good advice and good service from health insurance companies in Georgia but you are sorely mistaken. I deal with them every day, but have the ability to bypass the customer service reps and deal directly with managers and decision makers.

There are no additional charges or fee’s when you deal with a health insurance agent, and you pay the same premium whether you deal with a health insurance agent that is competent or incompetent. We have over 30 years experience in dealing with the problems, issues and challenges you will face. Buying affordable health insurance in Georgia goes a lot smoother when you allow us to help.

How to Apply for Health Insurance in Georgia

Believe it or not, there is an art (and a bit of science as well) to applying for health insurance in Georgia if you want to get the best offer. Some Georgia health insurance companies are routinely rejecting half of applications submitted. Overall, roughly 80% of applications that are not rejected will result in a modified counter-offer from the health insurance company.

So how do you improve your odds?

Work with an experienced agent. Seriously. We do this every day and know what underwriters are looking for and what they need to underwrite an application. Someone who only completes a health insurance application once in a blue moon will invariably provide too much information or not enough.

Health insurance applications are purposely tricky and redundant. If you are not careful you will give conflicting responses which will delay your application and reduce your chances of a better offer.

Medical history is important, including any medications you have been prescribed in the last 5 years. Some medical conditions and symptoms discussed but never diagnosed or treated can get your application rejected. Starting a new medication can result in a rejection as can stopping a medication without doctors approval. Any change in medication or dosage in the most recent 6 months can trigger a decline or disappointing offer.

Exact dates are not needed but general timelines are. Knowing the medical condition, medication(s), dosage and how often the medication is administered helps the health insurance underwriter to get a good idea of what kind of risk you present.

The application process consists of an electronic or paper application followed by (in most cases) a telephone interview. Too often clients will kill their chances of getting a fair offer during the phone interview unless they know what to expect. We counsel all clients on the entire process, and all applications are pre-screened before ever submitting to the health insurance company for review.

Health insurance companies also rely on information from MIB (Medical Information Bureau) as well as a prescription drug database such as IntelliScript or Ingenix (MedPoint).

You can request a copy of your IntelliScript report by calling (877) 211-4816; copies of your MedPoint information are available by calling (888) 206-0335. You can also go online for IntelliScript or MedPoint.

Each health insurance company is different in the way they underwrite an application. A rejection or increased rate with one company may produce a better offer from a different health insurance company. One thing is certain. Applying to several companies at once or in succession greatly reduces your chance of getting a good offer.

Like most things in life, you can do it yourself or work with someone who knows how the game is played. If you want to know what to expect and be assured of getting the best possible offer, work with a professional agent when applying for health insurance in Georgia.

Asthmatics – Finding Health Insurance in Georgia

For most people with asthma, finding health insurance in Georgia will not be a problem. Each Georgia health insurance company will review your medical history and medication and make a determination.

Some major medical insurance companies will charge an additional rate, over and above the standard rate, to cover the risk while others will rider or exclude coverage for treating asthma.

Each health insurance company views asthma differently and your health insurance agent can be your guide by reviewing and pre-screening your application with multiple insurance companies.

All health insurance companies ask if you have visited the ER in connection with asthma or have been admitted in the last 5 years. If the answer is yes to either, you can almost certainly be assured your application will be declined.

When looking for Georgia health insurance, make sure your insurance broker asks for full details on your medical conditions and pre-screens your history before submitting an application.