Underwriting Depression and Georgia Health Insurance Policies

If you are applying for a Georgia health insurance plan and have depression, or anxiety, you need to know there is a BIG difference in the way health insurance companies will rate their offer.

Here is the situation.

Male, age 24, good health except  . . . he has anxiety. (Anxiety and depression are underwritten in the same manner)

The condition is controlled with generic Paxil (paroxetine HCL). The medication is $4 at Wal-Mart.

The plans he was considering had Rx deductibles of $300 to $4,000.

Health insurance company A wants a 40% rate increase.

Health insurance company B wants 50% more.

Health insurance company C is willing to offer a standard rate.

This is one of those stupid carrier tricks we try to avoid with our clients.

At Georgia Insurance Shop we pre-screen almost every application to make sure there are no surprises like this.

Cutting Corners on Health Insurance Applications

If you think you are going to get away misrepresenting your medical history on a health insurance application you are dead wrong. This advice goes for the applicant as well as the agent assisting.

I participate in several online forums, offering advice on health insurance matters for a nickel.

Actually, I don’t charge anything but my avatar is Lucy of Peanuts fame offering psychiatric advice for a nickel. I may not be as wise as Lucy, but I do enjoy the interaction.

One forum had a post from an “outsider” whose COBRA was expiring. He had sought the advice and assistance of an agent who quickly suggested a plan then rushed him through the application. The application was completed and submitted.

Later when the applicant actually reviewed the application he found “15 errors” and decided to post information on a forum in an attempt to find out how to handle this issue. The following items were left off his medical history.

These are all within the last 10 years:

Rhinitis – Allergy immunotherapy (ongoing )

Dry Eye – keratoconjunctivitis sicca (ongoing)

Sjogren’s Syndrome TEST (potential cause of dry eye) LAB RESULTS NORMAL

Prostatitis – pain from enlarged prostate – (released from care)

Metatarsarsalgia (released)

Bulging Discs and/or Disc Joint pain (physical therapy prescribed, no surgery)

Shoulder – partial tear of right rotator cuff (physical therapy prescribed, surgery is by choice)

Recurrent Fibroma on plantar fascia (avoid surgery)

Near Sighted & Astigmatism (Eye glass/ contact lens Rx)

Midcarpal Instability (excersize recmd’)

Knee Pain (released)

Giant Papillia Congitis (released)

Hairloss (Propecia Rx)

Cyst-benign on scalp (one removed on back)

Inguinal Hernia Repair Surgery (2)

Planter Fascia Fibroma Repair Surgery

Receding gums

High Cholesterol check (just modify diet, no rx)

Anxiety and depression (took 3 meds 6 years ago)

Anal Fissure (released)

Flat feet pain (orthotics made)

Ingrown toenail (released)

TMJ- Temporomandibular joint disorder (bite guard made)

Dry Lip problem

Acne

Pneumonia mild case

Deviated septum diagnosed (no treatment)

This is quite a list, and some of the things did not need to be included in the medical history. Hair loss, receding gums, dry lip, flat feet and an ingrown toenail are non-issues unless there is something more sinister to the condition.

The rest of the conditions should not have been omitted from the medical history.

After reviewing the data, several agents (to my surprise) suggested he cancel the application then file a new one with the same carrier or possibly a different carrier. All suggested he get the advice of a competent agent and, justifiably so, condemned the assisting agent for such shoddy work.

I took a different trek.

The short answer is, this person will not qualify for medically underwritten health insurance with any carrier. He is deemed a “basket case” and “repeat offender” who (so it seems) goes to the doc at the drop of a hat. The medication he is taking is rather expensive, running over $300 per month. He has no less than 3 issues that could well require surgery running in the thousands of dollars.

When I suggested he abandon any hope of finding major medical coverage he was incredulous. His view is, there is nothing really wrong with him.

Well, that is a matter of perspective.

He never revealed his home state, so no way to know which options are best. But depending on where he lives there may be a risk pool, a carrier of last resort, open enrollment or HIPAA conversion.

One agent suggested he start a business and hire a second employee so he could set up a group health insurance plan.

I thought that was off the mark since he had not established a business in the 18 months he was on COBRA so what are the chances of doing so now and getting it up an running in less than 30 days to the point of even qualifying for, much less affording a group health plan.

I have never understood why people like to deal direct with home offices rather than using the services of an agent. I interact with carriers daily and can tell you that unless you know the right questions and who to ask you will almost never get a solution to your problem.

And it seems many people don’t take the time to interview agents. If there is any direct involvement at all it is only to get a rate and maybe ask a cursory question.

Your agent can be your best advocate or worst enemy. If you don’t bother to ask questions and interview prospective agents you may never know if you have a good one or not. Having dealt directly with agents for over 20 years as a home office employee I can tell you the “good” agents are hard to find. That is sad, but true.

People who fill out applications by themselves either give too much information or not enough. Either way diminishes your chances of getting a good offer.

There is an art to completing an application in such as way as to give the underwriter everything they need to properly do their job without overwhelming them with extraneous items that cause them to shut down and simply deny your application for coverage.

You offer as much as they need and nothing more. If the underwriter needs additional information they will come back and ask.

In the last 90 days I have placed coverage for 5 individuals who were rejected for coverage with one or more health insurance companies. One individual was actually placed with a company that had rejected him a few months earlier. It was simply a matter of cleaning up his application and providing enough information so the underwriter could say yes.

I specialize in hard to place clients and have better than a 90% success rate if I agree to take on your case. It is never easy and sometimes can take weeks from start to finish but the reward is in knowing I have helped someone find the coverage they need at a price they can afford.

Oh yeah, we also take on the easy cases. Every chance we get . . .

We Never Thought About Health Care

We never thought about health care until we actually needed it . . .

I have empathy for this woman, and what she and her family are experiencing. But if this is the way the Obama House wants to sell health care reform, it is lost on me.

Health insurance is no different from any other form of insurance. You must purchase it BEFORE you need it.

The guy in the casket at the front of the church probably needed life insurance, but it is too late to buy it now.

This story is reminiscent of the folks standing in front of the burned out apartment building claiming they lost everything because they failed to buy renters insurance. Why is this supposed to be my problem?

Poppa Washington

The Oracle of Washington, who knows all, see’s all, is poised to pronounce what is good for us in the way of health care.

This is the same group that thought it was a great idea to make housing available to everyone regardless of their ability to repay their mortgage.

The same group that thinks spending more than you earn is a great idea.

First they loaned money they didn’t have to folks in Detroit who make our cars. Then they decided to assume control of an industry they know nothing about. Their solution is to sell one company to the Italian’s so that company can now import cars that no one bought 20 years ago.

Apparently Washington thinks America is ready for the “Fix It Again Tony” (Fiat). The car that voluntarily withdrew from the U.S. market rather than meet (what was then) tough emission standards.

The other car company has either sold, or is in the process of selling off the Hummer. They will also cut back on other big cars with high profit margins in favor of smaller cars with little or no profit margin.

And let’s not forget the guy (Brian Deese) in Washington who is the “brains” behind the bailout, no wait, bankruptcy of the automakers is a 31 year old law school dropout.

But wait, there’s more!

The new head of GM (Ed Whitacre) by his own admission “knows nothing about cars” but why should that stop him?

So now that we will be building and buying (or so they hope) smaller cars in order to save the American auto industry, what is next on the agenda?

Bigger health insurance.

Washington want’s to provide (their term, not mine) “basic, universal” health care (actually coverage, but why split hairs) for everyone.

So what is their idea of basic?

We don’t really know because that is a moving target, but using politicians outside the beltway as a guide, perhaps we can get some insight into what needs to be covered by health insurance.

According to the NCPA (National Center for Policy Analysis) state mandates, benefits that MUST be covered by health insurance, increase the cost of health insurance by 20 – 50%, depending on the state.

Here is a sampling.

Nine states require coverage (no pun intended) for hair prostheses (wigs).

Thirteen states require coverage for IVF (in vitro fertilization), a topic that is near and dear to our hearts.

Four states mandate coverage for massage therapists, three states for naturopaths. Fifteen states require coverage for “bone mass measurement” and thirty have mandates for dental anesthesia.

Now I am to be included in those who do not like pain and will go out of my way to avoid it. But since when is the cost of dental anesthesia so great that it must be an insured item? I would gladly pay for dental anesthesia even it if wasn’t covered and I bet I am not alone. So why do 30 states feel it must be an insurance mandate?

Is this their idea of “basic” coverage? How do residents of the other 27 states get by without having their dental anesthesia covered by insurance?

The list goes on . . .

One reason why health insurance is expensive is because we are insuring things that don’t need to be insured . . . like all of the things listed above.

I constantly remind clients that their auto insurance (mandated in all 50 states) does not cover things like tires, brakes and oil changes. But now that Washington has decided we will build smaller cars (regardless of whether anyone buys them), what if they decided it was for our own good that auto insurer’s cover oil changes?

Your auto insurance premiums would rise proportionate to the number of miles you drive. If you drive 12,000 miles per year that is 4 oil changes at $40 each so your premium needs to increase by $250 to cover the cost of the anticipated oil change plus the administrative handling fee for processing your claim.

I imagine quite a few folks would balk at that but some would cheer because they no longer have to pay for oil changes.

This same mentality seems pervasive among politicians when it comes to health insurance. This is especially true when no one has to pay for health insurance any more, it will be provided for by the government.

Like their free Medicare coverage.

Taking a cue from a pizza company, I can imagine the commercials for the change that is coming from Washington.

“Smaller cars, bigger health insurance, Poppa Washington.”

Ta-Da!

According to the New York Times the House has revealed a plan for sweeping health care reform in the United States.

But there are a few hitches.

They don’t know how much it will cost.

They don’t know how to fund it.

But other than that . . .

The draft bill would require all Americans to carry health insurance. Most employers would have to provide coverage to employees or pay a fee equivalent to 8 percent of their payroll.

Everyone must have health insurance or else what?

Then there is this goody.

The plan would also end many insurance company practices that deny coverage or charge higher premiums to sick people.

This is no problem. A handful of states already prohibit carriers from denying coverage (aka guaranteed issue) and/or charging a higher premium (known as community rating) for those with health problems.

Premiums in those states are 2x to 3x higher than comparable plans in states where carriers are free to medically underwrite coverage.

The 852-page House bill, as expected, is more expansive than the legislation taking shape in the Senate, where work on the issue bogged down this week after early cost estimates came in far higher than expected.

No one read the 1100 page stimulus bill. Wonder if anyone will read this one?

That’s probably expecting too much, don’t you think?

The proposal would expand Medicaid eligibility, increase Medicaid payments to primary care doctors and gradually close a gap in Medicare coverage of prescription drugs known as a doughnut hole.

If this were a car company, the design would look like a gas guzzling Hummer on steroids.

But wait! American car companies are not supposed to produce these kinds of car’s any more. America wants smaller, fuel efficient “green” car’s.

The bill would impose a new “tax on individuals without acceptable health care coverage.”

I can hardly wait to find out how “acceptable coverage is defined.

The tax would be based on a person’s income and could not exceed the average cost of a basic health insurance policy.

Define “basic”.

The House bill shows what Democrats mean when they speak of a “robust” public insurance plan.

Under the bill, the public plan would be run by the Department of Health and Human Services and would offer three or four policies, with different levels of benefits. The plan would initially use Medicare fee schedules, paying most doctors and hospitals at Medicare rates, plus about 5 percent. After three years, the health secretary could negotiate with doctors and hospitals.

American’s turning 65 have a difficult time finding doc’s willing to accept Medicare patients due to the low reimbursement. Anyone want to wager if folks under the “public plan” will encounter similar obstacles?

But the bill says, “There shall be no administrative or judicial review of a payment rate or methodology” used to pay health care providers in the public plan.

Sounds like no oversight to me. Isn’t this what led to Fannie Mae & Freddie Mac crashing on the rocks?

The bill would limit what doctors could charge patients in the public insurance plan, just as Medicare limits what doctors can charge beneficiaries.

Wonder how the doc’s feel about that?

The bill would require drug companies to finance improvements in the Medicare drug benefit. Drug companies would have to pay rebates to the government on drugs dispensed to low-income Medicare beneficiaries.

Gosh, this sounds an awful lot like cost shifting to the private sector.

The bill would expand Medicaid to cover millions of people with incomes below 133 percent of the poverty level ($14,400 for an individual, $29,330 for a family of four). The cost would be borne by the federal government.

The government would also offer subsidies to make insurance more affordable for people with incomes from 133 percent to 400 percent of the poverty level ($43,300 for an individual, $88,200 for a family of four).

I still have difficulty thinking of a family that earns $88,200 as poor. I guess it is something I will have to get over.

Health Care Reform – Washington Style

Washington is promising a coming change in health care.

Coverage for everyone. More affordable premiums. What’s not to love?

How about funding? How will we (the taxpayer) pay for this?

Nothing is final yet, but . . .

Higher prices (taxes) for beer, wine, tobacco products and soft drinks.

But what if these higher prices mean less consumption which translates into lower tax collections? Oh well . . .

Taxes on employer provided health insurance. In other words, if you have health insurance you need to pay a tax so those who don’t have health insurance can have health insurance.

Got it?

Seems to me like it is better for you (or your employer) to drop coverage so you can get it for free.

And let’s not forget Washington’s favorite target. The rich.

They want to tax the rich to pay for health insurance for the poor.

Sounds good until you notice they have also appointed a pay czar to limit how much business executives receive in compensation. So if they limit pay on those greedy CEO’s, where will the find the wealthy?

Only Washington would want to tax the rich and then turn around and limit the number of rich people.

But they have more silly ideas on how to fund health care for all.

In addition to raising taxes, they want to put restrictions on health care costs. Part of the Spendulus Bill (all $819 billion of it) allocates includes $147 billion for health care related issues.

So how does that $147 make health care, and health insurance, more affordable?

Roughly $86 billion will go to help states cover Medicaid costs; tax cuts for COBRA subsidy will consume $25 billion. My calculator says that is $121 billion and they have done nothing to make health CARE affordable.

So how much is Washington dedicating to do something to actually LOWER the cost of health care . . . which will actually lower health insurance premiums.

We have $26 billion left so let’s see how they plan to make an investment in lowering health care costs.

They will invest $20 billion to develop EMR (electronic medical records). You should note there is no proof EMR will significantly lower the cost of care. Some estimates put it at less than 2%.

Community health centers will receive $2 billion, the VA $1 billion and American Indian reservations will get $500 million.

Let’s recap.

$819 billion with $147 billion allocated for health care, and of that, only $26 billion to really have an impact on the cost of health care.

And how much does health care cost us?

About $2 trillion per year.

$26 billion to save, maybe in a good year, 2% or $40 billion.

Washington just doesn’t get it. If they want to really save money they need to focus on the folks who are using the system the most.

Like the 5% of the population that consumer 50% of all health care expenditures.

So the answer is simple. Locate the 5% that are eating us alive and tell them we can’t afford to pay for their care.

That is a change you can believe in.

Solving the health care problem is easy.

Maternity and Time Insurance

Time (AKA Assurant) offers more flexibility in maternity options than most.

It is also one of the more expensive plans on the market.

Most plans from Time have benefit caps and restrictions that make it less desirable compared to more comprehensive plans available from other carriers. While the maternity benefit is available on most plans, the only base plan I suggest is the HSA qualified One Deductible plan.

The Time maternity benefit is similar to all other plans (except Golden Rule/United HealthOne) in that you have a separate maternity deductible. You pay first, when the deductible is satisfied, the plan pays.

Time does have a waiting period, but only 90 days. This compares favorably to most of their competitors that require a 12 month waiting period before benefits can be accessed.

Maternity deductible choices are $1,000 – $2,500 – $5,000 and $10,000.

As is always the case, the lower the deductible the higher the cost of the benefit.

In spite of my misgivings about Time products and pricing, I do like their approach to maternity. The $10,000 deductible is usually only a few dollars per month and gives the insured full access to network pricing when using par providers.

This can produce significant savings over “retail” pricing. It allows you access to pre-negotiated pricing and avoiding the hassle of haggling over how much you will pay.

You may run quotes for various plans by visiting My Time Insurance, or contact us for details and underwriting advice.

A Hit and a Miss

While reading the Vent in the Sunday AJC there were two vents that caught my eye. Both were comments on health care, or health insurance.

“The health insurance industry vows to slow rate increases by 1.5 percentage points a year. My premium goes up 35% each year. That’s a change I can believe in?”

I believe the news article this venter referred to was actually stating health CARE leaders (medical providers) vowed to reduce increases by 1.5%.

Of course, even this was politicized and mischaracterized.

Still, the venter has a point. Perhaps the 1.5% savings falls under the something is better than nothing.

As for the 35% increase, I wonder if this is exaggerated. I can’t think of a single client who has experienced anything near that . . . ever.

The other vent either falls under the category of total embellishment or completely out of touch with reality. [Read more…]

Free Lipitor and Viagra

Georgia insurance shop is the place to come when you are looking to buy affordable health insurance and Georgia Health Insurance 411 is your resource for learning ways to save money on health care.

Drug manufacturer Pfizer, maker of popular drugs like Lipitor and Viagra, has announced it will provide 70 of their most popular drugs at no charge to people who have lost jobs and health insurance since 1/1/2009.

The 70-plus drugs covered in the program include several diabetes drugs and some of Pfizer’s top money makers, from cholesterol fighter Lipitor and painkiller Celebrex to fibromyalgia treatment Lyrica and Viagra for impotence. Drugs from several other popular classes such as antibiotics, antidepressants, antifungal treatments, heart mediations, contraceptives and smoking cessation products also are included. Cheaper generic versions are available for quite a few of the drugs.

This is a very generous offer from an industry that quite often takes it on the chin. Because of this move, you can lower your cholesterol and have sex while you are waiting on the next job to come along.

This move will help out existing and new clients as well. We have quite a few new clients who have found themselves out of work and looking for affordable health insurance in Georgia.

My Smarter Half

Hank Stern is an Ohio agent, a good friend, and the guy who is responsible for getting me involved in (some might say addicted to) blogging. He usually takes the more cerebral approach to things while I am more the curmudgeon who has earned the nickname “Krusty”.

Personalities aside, he comes up with some really good stuff from time to time and I feel compelled to steal it. This is one of those times.

As we’ve repeatedly shown, adding mandated benefits to health plans increases premiums for everyone, while rarely addressing underlying costs. Touted by special interest groups, it’s sometimes difficult for politicians to say “no.” And insurance companies make attractive targets: easily portrayed as “the bad guys,” one almost imagines carrier CEOs twirling handlebar mustaches while grinning at how they’ve once again shortchanged their clients.

Which is why an email we recently received from For Grace is so disturbing and disingenuous:

“Chronic pain attacks 76.2 million Americans each day. When those people visit their physician in search of medicine or treatments to help alleviate their suffering, many find their health plans prevent them from getting the prescriptions their doctors have deemed best to treat their condition. Some of the ways this is done include little known practices such as “step therapy,” “fail first” and “therapeutic switching.”

For Grace is a nonprofit advocacy group which claims to be “devoted to ensuring the ethical and equal treatment of all women in pain.” While that sounds noble, their email betrays a rather twisted portrayal of how the system really works.
For starters, insurance companies have no power to dictate to providers how they treat their patients, nor can carriers prohibit their insureds “from getting the prescriptions their doctors have deemed best.” Insurance companies have the power only to decide how much (if any) they will pay toward the cost of those treatments.

The rest of his take is equally informative. InsureBlog is a fan favorite with a wide selection of readers.