SHBP Protest Groups Misguided

Georgia SHBP protest groups are misinformed and misguided. Teachers Rally Against Group Insurance Changes shbp protest(T.R.A.G.I.C.) formed a Facebook group in early January to express their frustration in changes to the GA State Health Benefit Plan. Obamacare is at the root of their complaints, but they refuse to concede this point and would rather direct their efforts toward the governor’s office.

Members and supporters of SHBP protest groups are certainly vocal but completely misguided in their efforts. They have not connected the dots between changes in the SHBP and Obamacare. TRAGIC and their supporters also fail to accept responsibility for the choices they made during last falls open enrollment.

  • The 2013 SHBP package was not ACA compliant
  • SHBP 2014 was required to be updated to meet Obamacare mandates
  • SHBP fall open enrollment clearly outlined benefit changes for 2014
  • Covered participants of SHBP had a choice of accepting the change or purchasing coverage in the open market

My wife and I are covered under the SHBP. We were given handouts at employee meetings and links to the state website where SHBP plan options were delineated. Yet no one complained at that time. SHBP protest groups did not spring up until AFTER the benefits were active on January 1, 2014.

Did they fail to read the handouts or visit the choices site?

One must assume the whiners never bothered to study the plans and weigh options outside the SHBP. The plan cannot be changed at this point. There is no going back. The Obamacare plans are not popular among individuals who have tried to use the exchange which is part of the reason why enrollment goals have not been met. For the 2 million or so that have selected a plan, estimates that 60 – 80% have yet to pay their first premium.

Over 65 million visitors to healthcare.gov but only 2 million have “signed up” for a plan they are required by law to have. Perhaps fewer than 500,000 have paid for their purchase.

Had the SHBP protest groups followed a similar process and studied the plans many of them may have refused to accept the plan designs and sought other coverage.

But they didn’t.

SHBP covered participants don’t get a Mulligan. Barring a Special Election Period because of a qualifying event, they will need to learn to live with their choice.

We reviewed the plans during open enrollment. We understood there were changes. Premiums were higher. Benefits were lower. Higher deductibles and more out of pocket.

We also considered our health care needs, our budget and looked at options OFF the exchange. (Most SHBP plan participants are not eligible for a subsidy so exchange plans should not even be a consideration).

So what can you do if you are in the SHBP to minimize your cost for health care?

  • Maximize your HRA dollars and go through the wellness steps at BeWell
  • If you have not read your plan, do it now.
  • Go to the BCBSGA/shbp site and look up everyone of your providers.
  • Print it out, especially participating urgent care facilities
  • Register with Express Scripts. Look up all your meds
  • Consider changing to generics
  • Evaluate 90 day mail order options
  • Consider ordering from a Canadian pharmacy such as Blue Sky

Rather than treating your health insurance plan like an “all you can eat” buffet, learn to manage your dollars. The sooner you master this skill the better off you will be. The current plan design is the future of health insurance. Protest groups like TRAGIC will not be able to roll back the calendar to the old days so get over yourself. If you spent as much time educating your members on ways to save money on health care everyone would be better off.

Many chronic health conditions can be effectively managed with a healthier lifestyle. Diet and exercise can do wonders for hypertension, high cholesterol, back pain and type II diabetes.

You can change the way you manage and pay for your health care, or you can join a Georgia SHBP protest group and be miserable. Your choice.

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.

TRAGIC – Teachers Rally Against Georgia Insurance Changes

The Facebook page TRAGIC  (Teachers Rally Against Georgia Insurance Change) is a noble cause but totally misdirected. The group started by Ashley Cline are upset (rightly so) because of changes in the Georgia State Health Benefit Plan (SHBP) that came to light on 1/1/2014.

Mrs. Cline is upset with the state for the plan changes. If she doesn’t like the plan she should petition her school board to get their own plan, separate from the SHBP. Marching on the state capital (as they plan to do) is a waste of time and effort.

Actually, benefit changes were announced during open enrollment in October, 2013 but the reality of the changes didn’t hit this group of (mostly) teachers until last week when some of them actually tried to use their plan.

TRAGIC is upset over benefit changes in the SHBP. They want to blame the Governor and believe their protests will restore their “old” benefit plan.

It won’t.

Higher premiums, higher deductibles, higher out of pocket, elimination of copay’s and skinny doctor networks are a direct result of Obamacare. The benefit reductions they are experiencing today were set in motion 4 years ago with the signing of ACA.

Teachers Rallying Against Georgia Insurance Changes (TRAGIC) already has some 4,000 members who have signed a petition to oppose the state’s health insurance.

The new insurance plan affects not only teachers but an estimated 650,000 state employees.

Teachers said the plan they were forced to sign up for has higher premiums and fewer benefits.

CBS Atlanta

Actually, no one was forced to sign anything. Coverage was offered during open enrollment. Members could sign up for coverage or not.

Having gone through the enrollment process myself, I can say there was no coercion. I will also say that details on the plan were sketchy at best and incomplete.

In some cases we were totally misled.

Our benefit package indicated the plan would use the BCBSGA PPO network. Two weeks ago we discovered the PPO network would not be used but instead our plan had the much smaller and more restrictive POS network.

Fewer doctors. Fewer hospitals.

We also found out that the Rx benefit (administered by Express-Scripts) was NOT part of the health insurance plan. As a completely separate benefit drug claims do not accrue toward the major medical deductible or the out of pocket maximum.

This is where the wrath of TRAGIC should be directed.

Instead they are taking out their frustrations on the Governor’s office in hopes of restoring United Healthcare, the former TPA for SHBP.

Changing benefit administrators won’t bring back the old plan with copay’s and lower deductibles. TRAGIC is in denial about the real culprit.

Obamacare.

TRAGIC is encouraging teachers and state workers to call the governor’s office and express their concerns about the healthcare plan.

“It’s just another attack on teachers from the state government,” said John Carter, a middle school band teacher. “That’s all it is. It is a cash grab, and there’s no other way to put it.  It’s balancing our state budget on the backs of our teachers.”

No, it isn’t.

It is all about Obamacare.

TRAGIC needs to come out of the ether.

 

The Baby Daddy and Obamacare

Who is the baby daddy? In many cases it is #Obamacare. If you bought a subsidized Georgia health insurance plan from the baby daddyObamacare  exchange working taxpayers are funding at least a portion of your cost of your premiums. When you bring a baby into the world you need to tell the insurance company and Obamacare.

Why?

Because Obamacare is your baby daddy.

With regular private insurance, parents just notify the health plan. Insurers will still cover new babies, the administration says, but parents will also have to contact the government at some point later on.

Yahoo News

Working taxpayers, by way of the federal government, are providing tax breaks (premium subsidies) so you can afford to have health insurance. Since we are paying some of your bills we need to know when you have a baby (or adopt). We are your baby daddy.

Such changes affect financial assistance available under the law, so the government has to be brought into the loop.

That new baby may mean your taxpayer funded subsidy amount will change. Your gross premiums will increase. That is a given. But your net (after subsidy) may also increase.

But wait. There’s more.

It’s not just having a new baby that could create bureaucratic hassles, but other life changes affecting a consumer’s taxpayer-subsidized premiums. The list includes marriage and divorce, a death in the family, a new job or a change in income, even moving to a different community.

When you sign up for Obamcare the federal government needs to know more about your (formerly) private life. This includes marriage, divorce, children turning 19, moving to a new zip code  . . .

The role of the baby daddy is much expanded.

Insurers say computerized “change in circumstance” updates to deal with family and life developments were supposed to have been part of the federal system from the start.

But that feature got postponed as the government scrambled to fix technical problems that overwhelmed the health care website during its first couple of months.

“It’s just another example of ‘We’ll fix that later,'” said Bob Laszewski, an industry consultant who said he’s gotten complaints from several insurer clients. “This needed to be done well before January. It’s sort of a fly-by-night approach.”

No surprises here. Just more examples of incompetence in the Obama administration.

Just like many real life baby daddy’s, the Obama administration wants no part of actually taking care of matters. Big on promise, short on follow through.

Typical baby daddy.

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 HealthCare.gov 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.

Breitbart

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.

 

Obamacare Fees Raise Premiums

Ring in the 2014 New Year with higher health insurance premiums thanks to Obamacare feesObamacare fees. Most carriers are hiding the add-on Obamacare fees while others are putting them right out there for you to see.

Good for them.

one insurance company, Blue Cross Blue Shield of Alabama, laid bare the taxes on its bills with a separate line item for “Affordable Care Act Fees and Taxes.”

The new taxes on one customer’s bill added up to $23.14 a month, or $277.68 annually, according to Kaiser Health News. It boosted the monthly premium from $322.26 to $345.40 for that individual.

NY Post

But wait. There’s more!

There’s also a $2 fee per policy that goes into a new medical-research trust fund called the Patient Centered Outcomes Research Institute.

Feeling black-balled yet?

And the gift of Obamacare fees doesn’t stop there.

Insurers pay a 3.5 percent user fee to sell medical plans on the HealthCare.gov Web site.

And yes, that is passed on to you, the consumer.

Americans also will pay hidden taxes, such as the 2.3 percent medical-device tax that will inflate the cost of items such as pacemakers, stents and prosthetic limbs.

The 2.3% Obamacare fees are added to gross sales. Those fees are passed on to the consumers, resulting in higher medical costs, and higher health insurance premiums.

Calling them Obamacare fees isn’t fair since the Supreme Court said it was really a tax. Fee or tax. Just calling a spade a spade.

 

 

If You Like Your Doctor . . . .

Everyone remembers the (broken) promise of “If you like your health insurance plan, you can keep it. Period”, but fewer remember, or made note of, the second broken promise. “If you like your doctor, you can keep if you like your doctor emanuelthem. Period”.

Enter the spinmaster.

Chris Wallace, said: “President Obama famously promised, if you like your doctor, you can keep your doctor. Doesn’t that turn out to be just as false, just as misleading, as his promise about if you like your plan, you can keep your plan? Isn’t it a fact, sir, that a number, most, in fact, of the Obamacare health plans that are being offered on the exchanges exclude a number of doctors and hospitals to lower costs?”

“The president never said you were going to have unlimited choice of any doctor in the country you want to go to,” said the Obamacare architect (Dr. Ezekiel Emanuel).

Weekly Standard

Dr. Ezekiel Emanuel is the brother of former White House Chief of Staff Rahm Emanuel.

It seems arrogance runs in the family.

(Chris Wallace) “It’s a simple yes or no question. Did he say if you like your doctor, you can keep your doctor?”

(Emanuel) “Yes. But look, if you want to pay more for an insurance company that covers your doctor, you can do that. This is a matter of choice. We know in all sorts of places you pay more for certain — for a wider range of choices or wider range of benefits.The issue isn’t the selective networks. People keep saying, Oh, the problem is you’re going to have a selective network–“

What Dr. Emanuel is saying is true. If you don’t mind limiting your choice of doctors or hospitals you can buy your policy on the exchange. If you are willing to pay more to see your non-network doctor, that is your choice.

But if you like your doctor, and want to keep your doctor, you should consider buying your plan OUTSIDE of the exchange where you can get full PPO networks.

Shop and compare OFF exchange plans. Your doctor, your choice.

 

Is Your Doctor Boycotting Obamacare?

One of the questions still remaining about ACA is this. Is your doctor boycotting Obamacare? Just because you have a health doctor boycotting obamacareinsurance card in your pocket, does not mean you have unfettered access to affordable health care. Health insurance bought on the exchange means you have coverage with limited doctor and hospital networks.

Your doctor,your choice becomes your doctor, no choice.

Shop and compare plans from your trusted ACA health insurance friends.

 

Is Your Doctor Boycotting ACA Health Insurance Coverage?

Ask if your doctor is in network before you buy a health insurance policy. Here is what Dr. Bill Grace has to say about doctors boycotting Obamacare.

“Right now that back end (of healthcare.gov) is in chaos. … We don’t even know if we should sign up for these plans, because we have a suspicion that many of [them] offer very little reimbursement or offer a loss to the physicians who are going to see these patients,” Grace told Larry Kudlow on CNBC’s “Kudlow Report”.

“No physician wants to take money out of his pocket and put it in the government’s.”

CNBC

Most exchange based ACA plans use HMO networks. In some cases there is only one hospital in the network and that hospital may be miles away.

How many doctors offices and hospitals will you drive by on your way to get to a health care provider that participates in your plan?

Your exchange based health insurance plan does not guarantee you access to affordable health care.

The solution is to buy OFF the exchange.

Georgia Insurance Shop, your trusted ACA health insurance resource,  offers plans only available outside the exchange. Each plan has a broad network that allows you to keep your current doctor.

Your doctor, your choice.

Shop and compare up to 40 different ACA health insurance plans (with more on the way). Follow this link to shop for coverage.

 

Limited Doctor and Hospital Networks

But as Obamacare puts more people in the Medicaid system, Grace said fewer doctors are treating Medicaid patients.

“The problem is, who’s going to care for you when you have Medicaid?” he said. “For an hour-and-15-minute evaluation of a cancer patient, I get $6.50. That won’t even pay for the electricity. What kind of physician will you get … what kind of specialist will you get?”

With reimbursement that low is it any wonder why doctors are boycotting Obamacare?

Let us help you find a health insurance plan that fits your needs and budget and allows you to use any doctor.

Obamacare 834

Do you know what Obamacare 834 is? Neither did I. It’s a bug in healthcare.gov. Because of 834 your exchange application may neverObamacare 834 be approved by the insurance carrier you chose. Obamacare 834 means your child becomes your spouse.

Obamacare 834 is like Catch 22, except more insidious.

834 transmissions are the files that HealthCare.gov fires off to insurance companies when someone signs up for their plans. The companies say that some of these files have come in with inaccurate information.

Washington Post

It could be me, but seems like this is something that should have been checked out before flipping the switch on healthcare.guv.

Bataille announced Monday that about 80 percent of those errors stemmed from “one bug that prevented a Social Security number from being included. That caused the system not to generate an 834.”

So why have we never heard of 834 before?

Either the folks running the site had no clue, or they just didn’t want to talk about it.

Three reporters — one from the Los Angeles Times, one from The Wall Street Journal and I — asked Bataille for information on how many of the 834s sent out so far have had an error.

Maybe this is a secret.

Like “How many people have actually applied for health insurance through healthcare.gub?”,

This is where Monday’s media call started to get more tense than the dozens that have happened in the past, with reporter after reporter asking about the numbers of 834 errors and not getting a response from the administration. As The Wall Street Journal reporter reasoned, if the administration knows that 80 percent of the errors are coming from a certain bug — then simple math should figure out the total number.

Again, either the lack of response is due to incompetence or a desire to cover up the truth.

If you applied for a plan on healthcare.guv but have not been billed, or had any correspondence from your selected carrier, you should contact the company and see if they know who you are and have a COMPLETE application for you.

This is YOUR responsibility. The folks at healthcare.gub will not be your advocate.

You should know that the Obamacare 834 bug only affects applications submitted through the exchange. If you bought OUTSIDE of the exchange, you won’t have this problem.

ACA health insurance plans bought OFF the exchange have broader networks and feature a 5 minute, no hassle application. Many of our clients have reviewed plans and rates, applied and been approved in less than 20 minutes.

Avoid the Catch 22 of 834. Buy OFF the exchange. Shop and compare plans now.