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.

How to Apply for Health Insurance in Georgia

Believe it or not, there is an art (and a bit of science as well) to applying for health insurance in Georgia if you want to get the best offer. Some Georgia health insurance companies are routinely rejecting half of applications submitted. Overall, roughly 80% of applications that are not rejected will result in a modified counter-offer from the health insurance company.

So how do you improve your odds?

Work with an experienced agent. Seriously. We do this every day and know what underwriters are looking for and what they need to underwrite an application. Someone who only completes a health insurance application once in a blue moon will invariably provide too much information or not enough.

Health insurance applications are purposely tricky and redundant. If you are not careful you will give conflicting responses which will delay your application and reduce your chances of a better offer.

Medical history is important, including any medications you have been prescribed in the last 5 years. Some medical conditions and symptoms discussed but never diagnosed or treated can get your application rejected. Starting a new medication can result in a rejection as can stopping a medication without doctors approval. Any change in medication or dosage in the most recent 6 months can trigger a decline or disappointing offer.

Exact dates are not needed but general timelines are. Knowing the medical condition, medication(s), dosage and how often the medication is administered helps the health insurance underwriter to get a good idea of what kind of risk you present.

The application process consists of an electronic or paper application followed by (in most cases) a telephone interview. Too often clients will kill their chances of getting a fair offer during the phone interview unless they know what to expect. We counsel all clients on the entire process, and all applications are pre-screened before ever submitting to the health insurance company for review.

Health insurance companies also rely on information from MIB (Medical Information Bureau) as well as a prescription drug database such as IntelliScript or Ingenix (MedPoint).

You can request a copy of your IntelliScript report by calling (877) 211-4816; copies of your MedPoint information are available by calling (888) 206-0335. You can also go online for IntelliScript or MedPoint.

Each health insurance company is different in the way they underwrite an application. A rejection or increased rate with one company may produce a better offer from a different health insurance company. One thing is certain. Applying to several companies at once or in succession greatly reduces your chance of getting a good offer.

Like most things in life, you can do it yourself or work with someone who knows how the game is played. If you want to know what to expect and be assured of getting the best possible offer, work with a professional agent when applying for health insurance in Georgia.

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.

Pitfalls of Buying Short Term Medical Insurance in Georgia

Many times people will buy a Georgia Short Term Medical (STM) plan as a stop-gap or bridge between coverage. Most of the time things work out. You have purchased a plan, “just in case something happens”, and you never have to use the plan.

But sometimes you actually need your short term health insurance plan to do more than originally planned.

As indicated, short term medical insurance plans are designed to fill a gap in coverage when transitioning from one health insurance plan to another. Many times you will purchase the coverage for a specific time period, such as 3 months. Others may have an undetermined need and purchase their STM on a month to month basis.

In either case, coverage expires at the end of the term, usually 6 months or in some cases 12 months. If you need health insurance after the term expires you apply for a new plan.

Unlike traditional major medical insurance, short term medical plans do not renew. With each application you start a new waiting period on pre-existing conditions.

Short term medical plans usually have very loose (by traditional standards) underwriting qualifications. As such, many who cannot qualify for a traditional health insurance plan may be accepted by a short term medical plan.

STM plans have a very unique characteristic that allows this “flex underwriting” and at the same time keeps the rates low. Short term health insurance plans do not cover anything for which you have been diagnosed or treated for in the 5 years immediately prior to the effective date of coverage.

This is true if you are a new applicant, or re-applying for a new term with the same health insurance company.

Therein lies the rub.

I got a call a short while ago from a client. Last year we looked at health insurance plans that would meet her needs and budget. Money was tight and since she was getting married in a few months she decided to pick a short term medical plan with a lower price.

She applied. Coverage was issued. Her wedding date was postponed.

Coverage expired at the end of 6 months so she applied for a new health insurance plan and was approved.

Three weeks after the new short term medical plan went into effect she was involved in an auto accident. Injuries were serious and to make matters worse, the other driver only had minimal auto insurance coverage.

The good news is, her short term plan did what it was supposed to do and has paid out over $100,000 in benefits to cover 4 surgery’s as well as medication, doctor visits and so forth.

The bad news is, she will need at least 3 more surgery’s and her 6 month policy is coming to an end in a month.

She called, looking for a permanent major medical plan that will pick up where this one leaves off and pay for future surgery, rehab, etc..

I had to break the bad news to her. She can’t get a new major medical plan with anyone until she is released from a doctor’s care for her existing conditions. Any new STM plan will not cover treatment for this injury since it is a pre-existing condition.

This was not good news.

I am not the type to beat up my clients and make them take one plan over another. Rather, I outline their options, give them advice, and let them pick. If they are leaning toward a plan that has pitfalls, I encourage them to avoid that plan but in the end I say the same thing.

“This is your plan and your money. Pick the one that satisfies your needs and budget”.

That is what my client did. She picked a plan that fit what she felt like were her needs at the time. The few dollars saved will do nothing to make up for the emotional and financial impact of future treatment without the benefit of health insurance to pay the bills.

Georgia Insurance Shop is a leading resource for health insurance information. We offer a wide range of affordable Georgia health insurance plans to fit any need or budget and we do not charge extra for expert advice.

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 . . .

Lying Eye's

You can’t hide your lyin’ eyes
And your smile is a thin disguise
I thought by now you’d realize
There ain’t no way to hide your lyin eyes

The Eagles knew it. Seems a California judge feels the same way.

In a key victory for Blue Shield of California, a judge ruled the health insurer acted properly when it rescinded a couple’s policy because they made misrepresentations about medical history on their application for coverage.

Rescission’s are a difficult part of the individual health insurance market, but if you lie on an application you will get caught.

Blue Shield opened a rescission investigation after Steve Hailey was hospitalized soon after he signed the application for coverage that claimed he had no prior health problems, Blue Shield said. When medical records indicated he failed to disclose numerous serious medical conditions, Blue Shield rescinded the contract. Between the time it opened its investigation and the time the policy was rescinded, Hailey was involved in a car accident, Blue Shield said.

According to press reports, Hailey accused Blue Shield of wrongly dropping his coverage after the accident left him with bills of more than $400,000.

Tough break.

He lied about his medical history in order to obtain health insurance, then was involved in an auto accident. Some would call that justice.

After five years of litigation, the decision “proves that Blue Shield of California had every right to rescind the Haileys’ coverage,” Jacobs said in the statement. The Haileys admitted that they understood the Blue Shield application and that the application “was clear and unambiguous,” he said.

Five years and countless lawyer fee’s.

Thanks to Jeff Milne for this tip.

Miami (Not) Nice

Finding health insurance in Georgia is usually not that difficult, if you know the rules. Most people, including the bulk of agents, do not. I have a reputation for taking on challenging cases and almost always finding a good offer. That’s because I know the rules of engagement.

John Dorschner of the Miami Herald isn’t playing nice. His ignorance of risk management coupled with publishing (on the web) a carrier guide that is clearly marked “Confidential & proprietary” makes one question his ethics. His article subitled “How health insurers secretly blacklist those with certain ailments” while based in truth shows his ignorance.

Trying to buy health insurance on your own and have gallstones? You’ll automatically be denied coverage. Rheumatoid arthritis? Automatic denial. Severe acne? Probably denied. Do you take metformin, a popular drug for diabetes? Denied. Use the anti-clotting drug Plavix or Seroquel, prescribed for anti-psychotic or sleep problems? Forget about it.

This confidential information on some insurers’ practices is available on the Web — if you know where to look.

So for the price of a newspaper, Johnny boy is going to spill the beans. [Read more…]

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.

Sick in America – Part 2

Whose body is it? Will your carrier pay?

If you EVER have a question or issue with your plan, call me. I have been in this business for over 30 years and know the rules of engagement. If anyone can get a legitimate claim paid, it is me.

Compare plans, including high deductible, HSA’s by visiting our website and running your own rates. We are always available to answer questions on the phone or by email.