Affordable Health Care in Georgia Doesn’t Exist in Albany

If you live in southwest Georgia and want affordable health care you are out of luck. The Albany area, served by Phoebe Putney hospitals, has some of the highest prices in the nation. This means Albany are residents pay more for their Obamacare health insurance than just about anyone else.            affordable health care in albany georgia

But wait. It get’s worse.

If you have a Blue Cross #Obamacare plan, Phoebe Putney is not in their HMO network. In fact, there are no BCBSGA participating hospitals within 100 miles of Albany, Georgia. Blue Cross charges more than most other carriers for a similar plan and gives you fewer hospitals.

How do you save money on your health insurance premiums and still have affordable health care in southwest Georgia? We have a solution but you need to understand why health care in Albany is so expensive.

A report from Kaiser Health News details the high cost of affordable care in southwest Georgia and points the blame clearly at Phoebe Putney hospital. But first a little background on their research.

If Lee Mullins lived in Pittsburgh, he could buy mid-level health coverage for his family for $940 a month. If he lived in Beverly Hills, he would pay $1,405.

But Mullins, who builds custom swimming pools, lives in Southwest Georgia. Here, a similar health plan for his family of four costs $2,654 a month.

This largely agrarian pocket of Georgia, where peanuts and pecans are major crops and hunters bag alligators up to 10 feet long, is nearly the most expensive place in the nation to buy health insurance through the new online marketplaces created by the federal health law. The only place with higher premiums are the Colorado mountain resort areas around Aspen and Vail, a high-cost-of-living area unlike Georgia.

The report, while interesting, misses the mark.

Yes, health insurance is high there, partly because of Phoebe Putney, and partially because of Obamacare. But you have options if you want more affordable health insurance coverage and you want to have access to Phoebe Putney hospitals and doctors.

All the dynamics that drive up health costs have coalesced here in Southwest Georgia, pushing up premiums.  Expensive chronic conditions such as obesity and cancer are common among the quarter million people in this region. One hospital system dominates the area, leaving little competition. Only one insurer is offering policies in the online marketplace, and many physicians are not participating, limiting consumer choice.

If want to buy your health insurance on the Obamacare exchange, your only choice is Blue Cross of Georgia.

But if you buy OFF the exchange you have more choices. Georgia Insurance Shop offers consumers in Lee and Dougherty county and surrounding areas several approved ACA health insurance plans that include Phoebe Putney in their network. When you look for affordable health care in Albany you have to know where to shop and compare ACA health insurance options.

We have several health insurance plans with broader networks and much lower premiums than BCBSGA. The Kaiser article implies you don’t have options, but in fact you have several choices. But you need to hurry. Your last chance to sign up for a health insurance plan, or make a change in March 31, 2014. After that your next open enrollment is November, 15.

I bet you didn’t know about that Obamacare requirement. The government considers that a feature, not a bug.

You can have affordable health care in southwest Georgia but you have to think beyond Blue Cross. Click now to find health insurance plans in your area.

Obamacare 2014 – What Happens Next?

Obamacare 2014 finally sputtered out of the gate and we are 13 days into a new way of doing things. What next? If you don’t like your new plan, can you change? Did you lose your doctor(s) in the transition? Is the obamacare 2014premium affordable but the deductible too high? Did the plan you get match what you thought you were buying? Do you feel like Private Benjamin (Goldie Hawn)? “I did join the army, but I joined a different army. I joined the one with the condo’s and private rooms”.

First the good news. For now at least, you are not “married” to your Obamacare 2014 plan. You can still make a change and live to see another day.


Can my Obamacare 2014 plan be returned for a different model?

In most cases yes. In some situations it takes 10 minutes. But if you bought on the exchange and you want a DIFFERENT subsidized plan the answer is, forget it. You may be able to exchange one subsidized plan for another but getting there won’t be easy or a lot of fun.

Moving from a subsidized plan to one OFF the exchange (no subsidy) should be simple. Moving from a non-exchange plan to another non-exchange plan can be accomplished in 10 minutes.


Why would I want to change my 2014 Obamacare plan?

Many reasons.

Maybe you just came out of the ether are realized the plan you bought has no copay’s and you have to fund the first $6000 or more before the plan pays. Or you bought a plan with an HMO network and there is only one hospital in the network. If you bought a Blue Cross plan (on or off the exchange) and thought “Everyone takes Blue Cross” you need to understand about 70% of the docs and many hospitals in the Blue HMO are not included in your plan.

We have several carriers and plans off the exchange that may be a better fit for you. One 2014 Obamacare plan that is only available outside the exchange limits your out of pocket expenses to $950 per year. If you are one that will be using their plan a lot you really should consider this one. We have several people that use over $1000 per month in prescription drugs and this plan is a perfect fit. After January they will never have to pay for another Rx or doctor visit.

What a country!

We will be glad to discuss options or you can go through the drive through and use our free and easy quote engine to shop and compare rates at ACA Health Insurance Georgia.


Did you lose your doctor(s)?

It happens. Many doctors are not participating in Obamacare 2014 and especially if you bought on the exchange. But there is a wide range of options outside the exchange and most of these plans (except Blue Cross) have most of the doctors and hospitals in Georgia. Even if you wander into a doctors office that is not in network you still have coverage for most non-emergency care situations.

If you did lose your doctor because you signed up for an HMO it is not too late to get back into a PPO. Shop and compare!


Can’t afford your high deductible?

High deductible plans are great as long as you are in good health. But if you normally use your plan a lot, with doctor bills, hospital stays and high prescription drug costs you may actually come out ahead with a lower deductible plan.

We have plans off the exchange with $0 deductibles, $950 and $1000 deductibles. It is so fast and easy to shop and compare plans and rates on ACA health insurance.


Did you get what you wanted and needed?

If your Obamacare 2014 plan isn’t a good fit exchange it now before it is too late. You only have a few weeks left to still get a 2014 Obamacare plan that works the way you need it to.

Obamacare Cancels Policies on 650,000

On December 31, 2013 650,000 participants in the GA SHBP (state health benefit plan) lost their old health insurance plan. Why? Because Obamacare cancels policies when they don’t meet federal requirements. obamacare cancels policies

The Georgia State Health Benefit Plan provides health insurance for all state employees. Municipal groups and school systems can opt into the SHBP or establish their own plan. TRAGIC, a group started by Ashley Cline, vows to fight the state over their loss of coverage. Teachers Rally Against Group Insurance Changes (TRAGIC) is a Facebook group that has made numerous calls to the Governor’s office and plans a rally at the capitol steps on February 18, 2014 to make their frustrations known.

In spite of the presidential promise over the last four years that you can keep your plan, the fact remains. Obamacare cancels policies.

As pointed out in my earlier post, their cause is noble but misdirected. The loss of their prior plan was mandated by Obamacare and had nothing to do with the new TPA (Blue Cross), the Governor or the Department of Community Health that awarded the contract to Blue Cross.

I tried to explain this to the group and to Mrs. Cline but my counsel fell of deaf ears. Now they are back in the news again.

Cline said the plan to call was the first action step for the group and was posted this week.

“This week we’re going to contact the governor in force … we’re also going to turn our sights toward contacting the nine-member board who makes these decisions,” Cline said. “Our goal is to impact decision in the future.”

Cherokee Tribune

The contract with Blue Cross is for 3 years. The plan design is sanctioned by ACA. The benefits they had prior to 1/1/14 are too costly to continue in light of the new ACA mandated Essential Health Benefits and other provisions the federal government believes you should have. If your plan isn’t one the government likes then your policy is cancelled because it isn’t an Obamacare design.

The Cherokee county school district, and any other district that does not like the SHBP plan design should develop their own plan that complies with ACA rules.

Jamie Lynn Wills, mother of two and a teacher in Cherokee County, said she’s just starting to see the impact of the changed health insurance plan.

“The biggest impact so far, is that I can no longer take my children to see their doctor,” Wills said. “I just lost it on the phone, I broke into tears. It’s an emotional thing because they know my children. The doctor was there when one of my daughters was born. She knows my children inside-out.”

Wills said her family was “so attached” to their pediatrician, and now they can’t see her again.

Actually, that Ms. Willis is misinformed.

She and her family members are free to use any doctor they wish. If they use a non-par doctor they will simply pay more for the services.

In making the switch to an Obamacare plan design Blue Cross priced the benefits based on a limited POS network. During the open enrollment period in October, 2013 employees were given summaries of the 3 new plans so there should not have been any surprises on January 1, with one exception.

The materials we received indicated the plan would use a much broader Blue Cross PPO network.

That was a misrepresentation.

My wife and I also have coverage through the SHBP. We selected a Bronze plan and made sure our doctors were in the PPO network.

They were, but they are not in the POS network actually used by Blue Cross. Wonder how that happened?

We know that Obamacare cancels policies and we can roll with the punches. Our medical needs are minimal and changing a few doctors is not an issue for us but I do understand the frustration expressed by Ms. Willis and others in their group. Communication about the new plan design during open enrollment was sketchy at best. Neither Blue Cross nor the consultant for our school system were helpful or knowledgeable. No doubt we would have been in worse shape had we not known the questions to ask and how to properly evaluate the new plans.

I empathize with the members of TRAGIC but they are not the only ones impacted by Obamacare. This scene will continue to play out in the private sector as employees review their new benefit levels and try to use their plan over the next few months. The SHBP impacts not only teachers, but 650,000 Georgia citizens that lost their old plan due to Obamacare.

Obamacare is here to stay and with it comes leaner health insurance plans with higher deductibles and higher premiums. If employers and employees are willing to pay even higher premiums they can get some semblance of their old coverage back, but I doubt many can afford that move. It is time to accept the fact that Obamacare cancels policies.

Obamacare Plans Block Access to Health Care

Thousands of patients are scrambling to get medical procedures done before the new year. Why? New Obamacare plans block access to health careaccess to health care providers.

Those who were receiving medical care before being forced to sign up to a new plan on will, in many cases, be locked out of hospitals and prevented from seeing doctors who they had typically used. The WSJ contends that about 70% of new plans are more restrictive in the range of doctors and hospitals available to patients than their predecessors.


Most ACA Obamacare health insurance plans sold on the exchange in Georgia are HMO policies with limited access to health care from doctors and hospitals. Some plans only have one hospital in network. If you live in rural Georgia you may drive past several hospitals to get to one that is in your network.

If you buy a Blue Cross of Georgia plan your only choice, on or off the exchange, is an HMO. When you have an HMO you have limited access to health care.

If you want unfettered access to health care you need to consider broad network PPO plans available OUTSIDE the exchange. Bob Vineyard at Georgia Insurance Shop can help you choose from up to 80 different ACA health insurance plans that are only available off the exchange.

Supporters of the Affordable Care Act may argue that procedures will continue to be available, the plans severely curb access to health care from certain doctors and hospitals, preventing patients from getting the level of care they are used to at their usual price. In particular, insurers now using the Obamacare system have begun to exclude major academic institutions from their coverage, as these compete with cheaper community hospitals ostensibly providing the same service.

Under Obamacare it is no longer your doctor, your choice, if you buy from the exchange.

If you already bought an exchange plan, or a BCBSGA plan (on or off the exchange) it is not too late to correct your mistake. Let us help you find a plan that fits your needs and budget and gives you full access to health care.


Blue Cross of Georgia May Empty Your Wallet

If you have a Georgia health insurance policy through Blue Cross (BCBSGA), you may be in for an unwelcome surprise. Some of their plans may not cover your brand name drug.

I discovered this quite by accident while helping a friend navigate her new BCBSGA health insurance policy purchased through Blue Cross direct (no agent involved). She is a bit overweight and takes medication to control high blood pressure and cholesterol. In applying for coverage she did ask if her medications would be covered.

The rep indicated that two of the three medications were not on their formulary, but that is as far as they went.

Her husband contacted me for advice and we went looking for a plan that would cover all of her medications. I found two plans that included all three med’s and after further review, we picked one that was a better fit.

She applied for coverage through Georgia Insurance Shop and everything went fine until the underwriting phone interview. During the recorded interview she revealed that she had lost weight over the last 12 months. The weight listed on her application was right on the border for a potential decline so the health insurance company did the responsible thing and requested medical records.

As it turns out her last recorded weight was higher than listed, and her weight from a year ago even higher. The combination of these factors, plus the medications resulted in her application being denied.

So why did Blue Cross accept her and this carrier did not?

Blue failed to conduct a thorough investigation on the front end. And yes, this can come back to haunt her in more ways than one.

Her husband asked for suggestions to save money on the cost of medication, so I linked him to some mailorder Rx sites. I told him to have his wife call Blue Cross (I can’t do it since I am not her agent) and ask how much these non-formulary drugs will cost under her Blue Cross plan.

The response . . . full retail and she cannot use their mailorder facility. Not only that, but since they are not covered there is no deductible credit either.

That was a shock.

It is not unusual to find that your medication may not be on a formulary, but very unusual to discover the drug is not covered under any circumstances.

So this lady is in a bit of a pickle . . . and so is everyone else who bought this plan.

The med’s she takes that are not covered are relatively inexpensive . . . less than $200 at retail. So what happens if she develops a new condition that requires her to take an expensive medication that falls outside their formulary?

Not covered.

No copays, no discounts, no deductible credit.

That’s a real bummer.

So how do you find out if a medication is covered under a formulary?

Well you have to ask. But if you fail to ask the right question you may not get the answer you need.

How do you find out what is covered on the BCBSGA formulary?

Buy a policy, then go to their website or call customer service. Even if you are dealing with an agent, that agent will not be able to tell you unless he/she is also a Blue Cross policyholder.

If you have bought a Blue Cross of Georgia individual major medical policy in the last two years, you need to ask them if non-formulary drugs are covered under your plan. If not, you need to make a change right now if you can.

I have been in this business for more than 35 years and have never run across a provision like this that is so well hidden you will never find out until it is too late. This has prompted me to pose a direct question to other health insurance companies I represent and ask how their plan treats non-formulary drugs.

If you are looking for affordable health insurance in Georgia, be very careful and don’t be afraid to ask questions.

Application Denied by Blue Cross

When you have an application for health insurance denied by Blue Cross of Georgia (or any other health insurance company), what do you do?

It depends.

Yesterday someone looking for health insurance in Georgia found my site, ran a quote with BCBSGA and applied online in less than 15 minutes. This morning I was notified their application was rejected by Blue Cross.

After reviewing the application it is very obvious why Blue made such a quick decision. There are some options available for now, and could be others by summer.

Health insurance companies are rejecting 40 – 50% of all applications. Once you are denied coverage it does not mean you cannot be accepted by a different carrier but you do need to be careful. The worst thing you can do is submit multiple applications to multiple health insurance companies.

Many people that have their application for health insurance rejected can find coverage if they know the rules of engagement. I have a good record of finding coverage for those who have health issues. When you know what the health insurance companies are looking for, and how each one underwrites, you have a leg up.

Shopping for Georgia health insurance can be frustrating, and even more so if you have applied for health insurance and had your application rejected. The thing to know is, it is possible to find affordable health insurance in Georgia and have your policy issued without a hitch if you know how to work the system in your favor.

About Those BCBSGA Rate Increases . . .

If it seems like Blue Cross is the favorite punching bag of Washington and the media, it is not just your imagination.  Anthem/Wellpoint, parent of several Blue Cross plans (including Blue Cross of Georgia), is catching most of the heat.

Frankly, most of the criticism is a cheap, political ploy that is more theatrics than substance. But now it seems the AJC has jumped on the bandwagon in attacking the Georgia Blue Cross plans.

Alex Sabbeth’s anger went through the roof when he recently received nearly a 72 percent increase in his health insurance premium.

He sees it as proof of the health insurance industry’s desire for profits.

“Out of a habit of greed, they are raising people’s rates,”

This is a fairly common reaction, but without basis in fact.

Sabbeth’s policy — with a $10,000 deductible — was with Blue Cross/Blue Shield of Georgia. He had been paying $241.99 a month. The company’s letter told him that the new rate would be $415.40 a month, a one-shot increase of 71.6 percent.

He had just turned 60 years old, and while he is in good health he does have noncancerous lesions removed from his face about once a year.

Depending on how long he has been with Blue Cross, the increase could be part of their “normal” routine. Having worked with BCBSGA for several years I know their policies tend to get fairly pricey from the third year on. They are generally not a company I recommend if one is going to need coverage for more than a couple of years.

Blue is one of the few carriers that still use 5 year age brackets which means a big jump in renewal rates for ages that end in 0 or 5.

And the skin lesions have nothing to do with his renewal.

Sabbeth is concerned that the insurance company is trying to drive him off with the increase. He’s already searching around for a new policy.

Searching for a new policy is the right thing to do as long as he is aware his pre-existing condition will affect any final offer from a new carrier. Depending on the details, and the carrier he picks, it may not be a major issue. But most folks don’t know how to navigate the process of searching for and finding a plan that covers what is needed and delivers real value.

At Georgia Insurance Shop we pre-screen all applications before they are ever submitted to the carrier for review.

About Those Blue Cross – WellPoint Profits . . .

The Obamahouse and media have seized on the WellPoint Blue Cross profits and are using the bully pulpit to drum up support for health insurance reform. ABC News provides some insight into the profit structure of WellPoint and for those who are paying attention, takes the hot air out of the Obama-Sebelius tag team attack.

Let’s take a look at the ABC News interview with WellPoint CEO Angela Braly.

Q: How does WellPoint make its money?

A: The Indianapolis insurer made about $4.7 billion in 2009, a total stoked by the $2.2 billion it received from the sale of a pharmacy benefits management subsidiary.

Outside that, WellPoint made most of its money through employer-sponsored group health insurance. It reported $2.4 billion in operating profit from that segment last year, which amounts to about 58 percent of its total earnings.

The insurer has said it gets only about 10 percent of its operating income from individual health insurance like the kind it sells in California.

For sure, $4.7 billion sounds like a lot of money to the average Joe.

But so does a $1.4 trillion dollar deficit. I don’t recall anyone complaining about that.

But I digress . . .

WellPoint made almost half their profit through the sale of a PBM subsidiary. MOST of their profit comes from employer group health insurance plans.

No one is complaining about that either. So what about those individual health insurance plans that have a target on their back?

Only 10% of their revenue, not profit, revenue, comes from the sale of individual health insurance.

The interview goes on to address why individual health insurance premiums in California will be increasing by double digits, and why businesses don’t set prices based on profits.

Interesting read.

At least for those with an open mind.

Or those who don’t have a personal agenda . . .

BCBSGA SmartSense POS is Live

The new BCBSGA SmartSense POS is now available for review and quotes. A much improved and more affordable health insurance plan with lower rates, the SmartSense POS is available in most Georgia zip codes. New features include:

  • Enhanced Rx benefit
  • Office visit $30 copay for primary or specialist
  • New $500 copay for ER
  • Optional life and dental benefits

We have compared rates for various ages in the Atlanta area and have found these new plans to be much improved over the older plan. Choice of deductibles from $750 to $20,000 provide a lot of flexibility in pricing.

Compare the new BCBSGA SmartSense POS to other Georgia health insurance plans at Georgia Insurance Shop.

First the good news. Blue Cross (BCBSGA) is introducing new Georgia health insurance plans effective 11/14/2009. The plans use a different network which will allow them to offer lower pricing and more benefit options.

Now the bad news.

You cannot get this information online yet, and no word when it will be available online. If you want details and a quote in the interim, call us. You can still view affordable Georgia health insurance plans from multiple carriers at our primary site.