Georgia SHBP Blues

If things go as expected, state and local employee’s enrolled in the Georgia SHBP might be singing the Blues. Cigna and United Health Care may lose their lucrative contract to provide coverage for the state health plan and Blue Cross muscles their way back in.                    Georgia SHBP

An issue that Reese and his staff (at Community Health) face is the new contract for the State Health Benefit Plan (Georgia SHBP), which covers more than 650,000 state employees, teachers, school personnel, retirees and dependents.

Currently, UnitedHealthcare and Cigna hold the contract, with United covering more than 90 percent of members. Community Health had been expected to announce the winner of the new contract early in July. The winner would begin serving members Jan. 1.

Speculation on the winning bidder has centered on a single vendor — Blue Cross and Blue Shield of Georgia, the state’s largest health insurer.

Georgia Health News

Blue Cross had the Georgia SHBP for years and lost it to United and Cigna about 5 years ago. At the time the transition was not without issues as United scrambled to complete their network in the rural areas of the state. Within a few months hospitals in almost every county were eventually signed up with United and the turmoil subsided.

But some industry officials say they fear that Blue Cross’ reimbursements for services will be lower than the current rates, and lead to a financial squeeze for some medical providers.

Now that it’s mid-July, contract concerns are swirling. Community Health said it anticipates making an announcement on the winning vendor soon. But beyond that, it said, it “cannot comment on open and ongoing procurements.’’

Blue has already thrown their hat in the ring and as of now will be the only carrier offering coverage on the Obamacare exchanges in all Georgia regions.

Individuals seeking a premium subsidy can only get taxpayer assistance if they buy through the exchange and in some areas your choice will be Blue Cross or Blue Cross.

So much for more competition under Obamacare . . .

Doctors and hospitals currently participating in the Georgia SHBP may opt out of the Blue Cross contract if they feel the reimbursements are too low compared to what they have been accustomed to with United and Cigna. This could be bad news for employees who have health insurance through the Georgia SHBP.

 

United HealthOne Wises Up

United HealthOne, AKA Golden Rule Insurance, screwed up. Almost 8 months later they are backpedaling. Waiting periods for new applicants will be shortened.

Every other carrier allows you to pick an effective date for new major medical insurance plans for any day of the month. A few make you pick either the 1st or the month or the 15th, but no one made you wait 30 days for your coverage to begin.

No one that is, except United HealthOne.

COBRA expiring in 3 days?

No problem, unless of course you wanted United HealthOne.

You either had to buy a short term policy for 30 days and deal with all the pitfalls of STM plans and then HOPE your health did not change during the waiting period, or you did what most of my clients did.

Pick a plan with a better health insurance company.

Now United HealthOne has decided to eliminate the 30 day waiting period . . . and replace it with a 15 day waiting period.

So what happens if your health changes in the interim?

Same thing that would occur if you applied for coverage under the old rules.

Say you apply for a plan today but coverage won't be effective until 15 (or 30) days in the future. While you are waiting for your plan to kick in, you are in an accident.

A serious accident.

With long term ill effects and requiring future medical treatment.

United HealthOne is not required to cover treatment incurred after the proposed effective date. Also, United HealthOne can change the terms of their offer including applying new waivers and raising your rates.

They can also withdraw their offer leaving you without any coverage.

Bummer.

If you live in Georgia and don't want to play games with your health insurance, let Georgia Insurance Shop help you find an affordable health insurance plan to fit your needs and budget.

Obamacare – Just Say No!

Seems newly elected South Carolina governor Nikki Haley wants to fight a takeover of our health care system by the Obamacare monster. According to Yahoo News the following exchange took place.

South Carolina's governor-elect Nikki Haley said in an interview later that she told Obama that South Carolina could not afford the health care mandate, and that it would cripple small businesses.

"I respectfully asked him to consider repealing the bill," she said, to which he clearly stated he would not. "I pushed him further and said if that's the case, because of states' rights would you at least consider South Carolina opting out of the program?"

Obama told her he would consider letting South Carolina opt out, Haley said, if South Carolina could find its own solution that included a state exchange, preventing companies from bumping people for preexisting conditions and allowing insurance pooling.

South Carolina is not the only state that will suffer under the boot heel of Obamacrap. So will every other state, every business large and small, and every individual.

No word on what, if anything, Gov. Nathan Deal had to say about helping out Georgia.

Looking to Buy Affordable Health Insurance in Atlanta, Georgia?

Georgia Insurance Shop has low rates on major medical insurance from all the top health insurance companies in Georgia. New lower rates and new plans coming online very soon for January, 2011 effective dates. New plans from Kaiser and United HealthOne coming soon.

Blue Cross and Hospital at Odds

Exeter (New Hampshire) Hospital and Anthem Blue Cross may go their separate ways come January. Expect more of this kind of conflict as Obamacare put's pressure on health insurance companies to hold down premiums.

Health insurance companies play an important role in holding the line on increasing health care costs but in doing so they usually take the brunt of public battles such as this.

A New Hampshire hospital says Anthem Blue Cross Blue Shield has decided to cancel its 2011 contract because the hospital’s costs are too high.

A spokesman for Anthem says Exeter Hospital’s costs are about 50 percent higher than the state average. Christopher Dugan tells WMUR-TV that a CT scan, for example, costs $900 at Wentworth-Douglas Hospital in Dover. He says the same procedure would cost $2,400 at Exeter.

We have seen this kind of thing in Atlanta, Georgia as well. In the last few years St. Joseph Hospital and United Healthcare  went down to the wire before finally renewing their contract. Before that Blue Cross of Georgia has had battles with Piedmont Hospital where the contract actually expired leaving Piedmont patients out of network until a new contract was signed a week or so later.

When "couples" split up it doesn't mean you cannot go to that hospital, or see your doctor any more. You can continue to have treatment but your out of pocket expenses will be higher.

A similar occurrence happens when your medication is either removed from the formulary, or is moved to a higher tier. You can still continue taking the medication as long as you are willing to incur more out of pocket expenses.

In the case of providers leaving the network, if it is permanent you can always pick a different doctor or hospital to attend to your needs. Prescription drugs are usually a bit more flexible and often there are lower cost alternatives.

Affordable Major Medical Insurance in Georgia

If you are looking to buy affordable health insurance in Georgia, ask us for a competitive quote. Georgia Insurance Shop has rates and plans from all the major health insurance companies including Blue Cross of Georgia, Humana, Cigna, United HealthOne and more.

 

Georgia Health Insurance Waiting Period

Watching Obamacare unfold is not a pretty sight. We have the anticipation of much higher rates for children which will be unveiled in 30 days or less. Some health insurance companies, including Golden Rule – United HealthCare have announced they will not longer accept applications on children that are not part of an adult contract. Others have announced they are waiting on approval of new, child only, health insurance plans.

Now comes a new surprise.

Applications submitted to Golden Rule on or after 9/1/2010 will have a mandatory 30 day waiting period before coverage becomes effective.

Submit an application on 9/1/10 and the earliest coverage will be effective is 10/1/2010.

This is going to take some advance planning if you want to buy health insurance from Golden Rule. So far they are the only health insurance company with this stipulation. It is going to be interesting to see the creative ways carriers deal with the constraints of Obamacare.