Frustrations with Health Insurance in Georgia

Are you having trouble buying health insurance in Georgia? If you are to believe the reporting in Sunday’s AJC,

Policies are suddenly canceled. Monthly premiums rival the size of mortgage payments. Huge bills go unpaid because of surprising gaps in coverage.

If it bleeds, it leads. That’s the mantra for news.

Problem is, the reporting falls short in gathering the facts.

With individual plans, carriers can legally charge higher premiums based on age, gender or health. They can refuse to cover conditions that group plans routinely include, or deny coverage outright for people with problems such as arthritis or diabetes.

This is all true. But it is also true in all but a handful of states where carriers are prohibited from underwriting medical conditions. In states like New York, Maine, New Hampshire and Massachusetts carriers are required to issue policies to anyone without regard to their health history.

Someone with terminal cancer can apply for coverage and receive a policy. The terms and price would be the same as someone the same age who is in excellent health.

The result is, premiums in those states are 2x – 3x higher than premiums for similar plans in neighboring states where medical underwriting is allowed.

So providing coverage on everyone regardless of health is not a problem.

Rich Mazurek, 37, of Suwannee, is among thousands of Georgians who can’t get coverage at all.

Mazurek has rheumatoid arthritis and ventured into the individual market because he lost his job and couldn’t afford premiums under COBRA, the law that allows ex-employees to keep their coverage for a while at their own expense: “I was totally naive. I was declined by more than 20 companies.”

RA can be very expensive to treat. Some medications used to treat RA (like Enbrel) can run $1600 per month.

Even though COBRA may have appeared expensive, it is a bargain compared to going without coverage for his condition.

The insurance market did not fail him. He failed to take advantage of coverage that was available.

Sams, the taxidermist, has experienced the gamut of individual policy problems.

He lost his insurance in a dispute over whether he’d disclosed his acid reflux disease. After what he called “two years of anguish” trying to find a new policy, he ended up back with the company that canceled him.

There are only two reasons why a carrier will cancel someone.

Fraud, or failure to pay your premium.

If he committed fraud, I would be very surprised if the same carrier would take him back. There is more to this story than is being reported.

Carriers don’t cancel for failure to disclose GERD (acid reflux). They either back-date an exclusionary rider or charge an extra premium.

It’s always interesting when reporters puff up a story just to sell newspapers.

The biggest mistake the individuals highlighted in this article made was failing to talk to a knowledgeable agent. Had Rich Mazurek called me the day he lost his coverage I would have saved him a lot of time and anguish. There was no need to waste time contacting 20 carriers or even bothering to apply for coverage. Our conversation would have ended in 5 minutes of laying out his options. First COBRA, then either enhanced conversion or a policy throught the Georgia assignment system.

Sam’s the taxidermist was a bit easier. GERD is not that difficult to underwrite as long as there are no other complications. Either he tried to do things by himself or simply failed to talk with a qualified agent.

Looking for health insurance is not a DIY weekend project. With some carriers, half the applications are rejected. Less than 5% of applications submitted through my office are declined. Many times I find coverage for people who have been rejected by carriers in the past. Sometimes I am even able to resubmit applications to carriers who have rejected an applicant and get coverage issued.

I don’t sell newspapers, but I do know how to find coverage for almost everyone who calls.

If you are looking to buy affordable health insurance in Georgia, you know where to find me.

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