Georgia Hospital Closing

Calhoun Memorial Hospital is closing. The loss of this Georgia hospital is a combination of the failing economy and financial strain caused by uninsured patients and increased number of Medicaid patients.

A handful of other rural hospitals in the state also may be teetering on the brink, with rising levels of uninsured patients and with Medicaid continuing to pay low rates for services.

HomeTown Health, an organization of rural hospitals in Georgia, says a half-dozen facilities could follow Calhoun Memorial’s move and shut down in the coming months.

Georgia Health News

Providers that accept Medicaid patients receive roughly 20% less than Medicare pays for the same services and Medicare pays about 15% less than private insurance carriers. With more patients relying on Medicaid doctors and hospitals feel the squeeze and have to take action.

Hospitals that accept any kind of federal funds cannot refuse Medicaid patients but doctors and other medical providers are not obligated to treat Medicaid patients.

The 25-bed “critical access’’ Calhoun Memorial is the first rural Georgia hospital to close since Telfair Regional Hospital in McRae, in south-central Georgia, closed in 2008, Lewis said Monday.

Earl Whiteley, CEO of Calhoun Memorial, cited the increase in charity care that the Calhoun County hospital incurred as a major reason for the hospital’s demise.

He told GHN on Monday that indigent charity care rose from $834,000 in 2008 to $1.8 million last year.

“You just can’t continue to give away free care,’’ Whiteley said.

Tell that to the low information voters that gave Obama another 4 years.

Whitley said part of the financial crisis is due to the loss of indigent care funds under Obamacare. Those patients were supposed to be covered under Medicaid expansion but Georgia, like most other states, do not have the money to pay their share of the cost of Medicaid.

Prior to Friday’s action, the Calhoun hospital authority had sold an assisted living facility and its nursing home. The hospital had stopped admitting patients, so there were none left to transfer to other hospitals. A medical clinic will remain open in Arlington, Whiteley said.

The economic impact on Arlington and Calhoun County will be profound, with up to 100 employees losing jobs.

With the closing of this Georgia hospital, local residents will have to drive about 45 minutes to the nearest hospital.

Obamacare – Georgia Opts Out

Georgia has decided to opt out of the Obamacare health insurance exchange. The "exchange" is envisioned as an electronic market place where buyers can review plans and rates and pick the plan that best suits their needs and budget.

In other words, something like this.

Makes you wonder why the folks in DC would want to reinvent the wheel, doesn't it?

Deal said in a statement that “Obamacare” is a one-size-fits-all approach with too many regulations that prevent Georgia from tailoring an exchange to meet the unique needs of its residents and small businesses. It also places a costly burden on states, he said.

“We have no interest in spending our tax dollars on an exchange that is state-based in name only,” he said. “I would support a free market-based approach that could serve as a useful tool for Georgia’s small businesses, but the federal guidelines forbid that.”

AJC, "Georgia cedes control of Obamacare exchange"

In addition to the economics of establishing and running such a program, Gov. Deal makes some good points.

Under Obamacare rules, you can't pick the plan you want, you have to take what the government has decided is best for you. If you are in a low income situation you have no choice. Off to Medicaid you go.

Try to find a doctor willing to treat you. It won't be easy.

Medicaid reimbursements are terribly low and doctors actually lose money when they treat Medicaid patients.

The exchanges are a pillar of the landmark law that aims to provide millions of uninsured Americans with health coverage. They are online marketplaces where consumers and small businesses will be able to compare the quality and prices of health plans. An estimated 900,000 Georgians are expected to shop on the exchange website — where people will also be able to find out if they are eligible for Medicaid, the government health program for the poor, or federal subsidies designed to make coverage affordable.

Great concept.

I doubt it will ever work as conceived. Too many moving parts. Too expensive, and we as a state or country, can't afford it.

But we are not alone.

As of Thursday, 19 other states, including South Carolina and Virginia, had also opted not to create exchanges, according to the nonprofit Kaiser Health News. Another 19 mostly Democratic-run states and the District of Columbia are moving forward with exchanges. Meanwhile, at least five others plan to partner with the federal government, with the rest still undecided, Kaiser reported.


“The lack of a complete and open rulemaking process and the deficit of information being shared with states have created a virtual roadblock for governors, who must decipher what type of exchange is appropriate for their state,” said Virginia Gov. Bob McDonnell, who co-authored the letter with Gov. Bobby Jindal of Louisiana.
Like so many other ideas cooked up in Washington, this one can be marked with a big FAIL. The concept of Obamacare, and specifically the exchanges, will go the way of Solyndra and other money pits conceived in Washington.

Doctor Shortage

Want to see a Georgia doctor?

Take a number.

This is especially so if you are a new patient, do not have health insurance, have Medicare, Medicaid or PeachCare. So if we are having problems now, what happens when it is free?

Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the number of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president.

You can’t just push a button and “poof” you have new doctors. It takes years to “grow” a new crop of docs.

One proposal — to increase Medicare payments to general practitioners, at the expense of high-paid specialists — has touched off a lobbying fight.

This is called squeezing the balloon.

Cut reimbursement to one sector to cover the cost of services for another sector. It is also known as robbing Peter to pay Paul.

That has never worked. Why would Obama-man think it will work now? [Read more…]

What Do MERP's and Georgia Health Insurance Have in Common?

What is a MERP and what does it have to do with Georgia health insurance?

A long time client called the other day with the same question. He has a high deductible health plan with an HSA, but needed a way to extend his tax breaks beyond the limit of the HSA. A family member needed to have inpatient psychiatric care and the $5,000 monthly bill would stretch the limit of his HSA.

Someone had suggested a MERP so he called me for advice.

Frankly, MERP’s are something I have not used, or even thought about, for some time. The Medical Expense Reimbursement Plan (MERP) is allowed under Section 105 of the Internal Revenue Code. We helped clients set up quite a few MERP’s long before HSA’s and HRA’s came along.

So what is a MERP and how does it work with health insurance?

The MERP is a specialized bank account that is established by an employer for the purpose of reimbursing employees (and their dependents) for certain eligible medical expenses. We found several sites that provide information on MERP’s including the one here. We also located a sample MERP document as well as a MERP explanatory PDF.

If you are looking for Georgia health insurance rates and information on MERP’s you have found the right place.

A Stimulating Conundrum

Washington’s idea of a stimulus package seems to be springing leaks. They want to spend taxpayer money to create jobs and stimulate the economy.

So why are they buying condoms from China?

the U.S. Agency for International Development, which has distributed an estimated 10 billion U.S.-made AIDS-preventing condoms in poor countries around the world.

But not anymore.

They will still be handing out condoms, just not ones made in the United States.

In a move expected to cost 300 American jobs, the government is switching to cheaper off-shore condoms, including some made in China.

Outsourcing condoms. What is the world coming to?

“Of course, we considered how many U.S. jobs would be affected by this move,” said a USAID official who spoke on the condition that he would not be named. But he said the reasons for the change included lower prices (2 cents versus more than 5 cents for U.S.-made condoms) and the fact that Congress dropped “buy American language” in a recent appropriations bill.

Makes you wonder how effective is a 2 cent condom?

Or a nickel one for that matter.

Besides, he said, the sole U.S. supplier — an Alabama company called Alatech — had previous delivery problems under the program.

Delivery problems. Probably a joke in there somewhere but this is serious business.

It’s clear that Alatech’s problems over the years, which apparently have been resolved, may have driven U.S. officials to seek much less expensive foreign-made condoms in the first place.

But that’s cold comfort to Fannie Thomas, who has been making AIDS-preventing condoms in southeastern Alabama for nearly 40 years in the small town of Eufaula.

When the company loses this contract the plant will have no choice but to shut down, putting some 300 people, including Fannie Thomas, out of work.

Many residents in Georgia are losing their job and their health insurance. Sometimes COBRA is an option, sometimes not. There are many low cost alternatives available including short term medical, high deductible catastrophic health insurance as well as traditional health insurance plans.

Post Issue Underwriting

So what the heck is post issue underwriting?

Glad you asked.

That’s when you apply for coverage, the policy is issued. Then at some point in the future, usually following a claim, you get a letter from the health insurance carrier. They want to know all doctors you have seen in the last 5 years and all medications you have taken.

The envelope has a form you are to sign, allowing them to contact the doctors and obtain medical records.

Welcome to post issue underwriting.

You submitted an application. Probably went through a recorded telephone interview. They pulled your medical records (such as they are) from MIB and may have checked your prescription drug history with someone like Milliman Intelliscript.

You passed with flying colors.

Or did you?

Your claim may have been for a persistent cough or a nagging pain in your back. Or it may have been something as simple as your annual exam.

The next thing you know, they’re baaacckk . . .

What are they looking for?

Something you purposely, or even carelessly omitted in your medical history. Something so minor to you, it was probably dismissed or forgotten.

They are looking for a reason to deny your claim or even rescind your policy retroactively to the effective date.

Can they do that?

You bet.

If they can prove you withheld material information about your health you are out of luck.

That’s the bad news.

But here is the good news.

If you used an agent who knows the business. Understands how carriers think and what they look for, then (her comes the shameless plug) you are in good hands. I have worked with carriers for over 30 years. Who knows better how they think and what they will do than someone who has actually been on the inside and walked the halls of the home office?

I do a lot of things to diminish the possibility of post issue underwriting. Things like anonymous pre-screening a clients health history with potential carriers before submitting an application. We also do a trial run on every application. Even though all carriers accept (and prefer) electronic apps, we do a practice run on a paper app before ever submitting to the carrier. I review each application with my client, alerting them to potential issues and tell them what to expect during the phone interview.

I don’t like surprises and I assume my clients don’t either. Clients are never alone when I am hired to be their agent and advisor.

If you need your claim paid, would you rather fight the carrier’s on your own or have a professional “hit man” on your side?

The choice is yours.

Georgia health insurance can be tricky. Finding the right plan is only part of the battle. The real challenge comes the first time you file a claim.

A test of a policy is not in the obvious benefits, but rather what it does NOT pay.

PeachCare and Trauma Centers

Funding for Georgia health care is about to change. Money is tight. Every where. Especially at the state and federal level although you would not know Washington has gone beyond their last dime based on how they have spent money they don't have over the last 6 months or so.

But that is another story.

Let's talk about Georgia.

Even with Santa Claus handing out bags full of money from Washington via the Spendulus bill, Georgia is still coming up short on funding for PeachCare. And eventually even the idiots in Washington will realize they can't keep funding projects when they can't balance their checkbook. So Georgia is going to have to address funding for all programs, including entitlement's, on their own. [Read more…]

Perdue Cold Cuts

Here at Georgia Health Insurance we like to stay on top how the state is spending our tax dollars. Like most states, and the federal government, we are looking at steep budget cuts to keep from going under. All areas are subject to the knife. Roads, schools and even Medicaid are trying to find ways to keep rolling on less money.

When you cut Medicaid, everyone loses, both rich and poor.

Governor Perdue has proposed a 10% cut in Medicaid funding to hospitals. This translates into a loss of almost $81 million.

The proposed Medicaid cut is expected to be magnified since hospitals will lose $2 in federal matching funds for every $1 in state Medicaid money that gets cut, said Kevin Bloye, spokesman for the Georgia Hospital Association.

“When you add the federal matching dollars,” Bloye said, “hospitals could lose an additional $120 million.”

Most hospitals lose money serving Medicaid patients, so this only makes it worse.

The Medicaid cuts could be the “last straw” for some hospitals in the state, industry insiders said.

Hospitals are suffering from rocketing unpaid medical bills, a decline in high margin elective procedures, and the growing rolls of uninsured.

So what happens when hospitals refuse to accept Medicaid patients?

Everyone loses.

“We can see hospital closures, we can see major damage to large hospital systems and we can see individual physicians who are getting out of the business, all because we didn’t take the stimulus package money and use it directly for Medicaid,” hospital lobbyist Jimmy Lewis said.

Oh yeah. About that Spendulus money.

The stimulus money doesn’t come “close” to offsetting the tax revenue hit facing Georgia, Brantley said.

So even Obamaman can’t save us.

Having fun?

Insurance Myths & Dragons

Most folks don’t know as much about health insurance as they think they do. It’s amazing how often I talk to people here in Atlanta and other parts of Georgia and hear comments such as these.

I don’t want an HMO plan because they are all bad.

Blue Cross is accepted by all the doctors so it must be the best.

I can’t afford a high deductible plan.

I need a plan with a copay so I can afford to go to the doctor.

I don’t need doctor coverage, just something in case I go to the hospital.

I need a plan with a copay so I can afford my medicine.

I don’t need drug coverage since I don’t take any medication. [Read more…]

Health Insurance and Coventry

Coventry is a relative newcomer to Georgia. They entered the individual major medical market in Atlanta and a few other metro area’s in the second quarter of 2007.

To staff their offices they hired quite a few folks away from BCBSGA which, in my opinion, proved to be a bad move.

Coventry decided the best way to make a splash was to essentially duplicate popular plans offered by BCBSGA, making a few changes, and coupling the major med with a dental plan from Delta Dental.

In an effort to quickly gain market share they offered rates that were 20 – 30% below market and coupled it with loose underwriting that resulted in almost every application receiving approval.

They quickly got religion and made an abrupt, and almost schizophrenic shift in underwriting [Read more…]