Patient Charity Update

Are you uninsured and looking for help?

Patient Charity may hold the key.

Patient Charity is updated on a regular basis and contains links to a number of sites containing information on a wide range of topics.

Here is a sample.

Coverage For All, a resource of taxpayer funded and charitable programs for the poor and uninsured.

Insure Kids Now, up to date information on SCHIP for every state.

Patient Advocate Foundation, a national non-profit organization that seeks to safeguard patients through effective mediation assuring access to care, maintenance of employment and preservation of their financial stability relative to their diagnosis of life threatening or debilitating diseases.

In addition, there are also resources for those who want and can afford insurance but have been locked out of the individual major medical market due to existing health concerns. Several resources include:

BeniCard, a national network of more than 450,000 providers (doctors, hospitals & pharmacy's) who have agreed to participate in discount pricing for the uninsured.

Core Health, a guaranteed issue insurance plan available to eligible members age 18 - 65.

In addition to resources for the uninsured, you will find valuable information for insured patients. We have links to forms and sites for all the major carriers.

Health Insurance and BCBSGA

How does health insurance with Blue Cross Blue Shield of Georgia work?

In today's market (2/2/2009) BCBSGA offer's a mixture of old and new plan designs.

About half the plans available have whiskers. The HSA compatible HDHP is mostly overpriced for the Georgia market. The old Blue Value series of copay plans are still available, but not online.

The newer series, SmartSense and Premier, were introduced in the summer of 2008 and are available for review online.

Blue's underwriting can be both challenging and unpredictable. At one time they bragged about approving 96% of applications.

It now appears the approval rate is significantly lower.

Those who submit direct to Blue typically experience a much higher rejection rate than those who submit through a knowledgeable agent.

Blue is still trying to find themselves in the Georgia market. They have been losing market share to "newcomers" with names like Aetna, United, Humana and Coventry.

The older plans, while pricey, are more comprehensive than the newer plans.

The lower priced SmartSense covers up to 3 office visits per year before applying to the deductible.

All other covered charges are payable at 70% after the deductible has been satisfied. This includes lab, X-ray, preventive care (over age 5), emergency care, hospital, etc.

SmartSense only covers generic Rx. Brand name meds are not covered but may be discounted. There are no maternity benefits other than complications.

Premier plans are approximately one third higher in premium but include more first dollar items. The Premier plan covers unlimited doctor visits at $35 each. The deductible is waived for preventive care for all ages and payable at 80% of covered charges.

Generic Rx are covered by a copay. Brand name drugs are covered by a convoluted formula after a deductible. If a member elects a brand name drug, and a generic is available, the member will pay the difference between the generic and brand name drug plus any copay and coinsurance.

Got it?

All other services, including emergency care, are subject to the deductible and then payable at 80%.

Maternity is an option but it is pricey and there are better plans available through other carriers.

Customer service is not their strong suit.

Their online access is decent, but there are much better offerings through other carriers.

You can also call their customer service line at 1-800-441-2273. Customer service hours are M - F from 7 AM to 7 PM.

New business underwriting normally takes 10 business days but can sometime move a bit quicker.

Blue's billing practices are among the worst. Some times they may forget to bill for 60 days or longer. Asking for a refund is like asking for a federal grant. Once they take your money it can take months to get a refund.

In spite of the issues, BCBSGA is a player in today's market, although not as dominant as they once were.

You can run BCBSGA quotes by clicking this link.

You can compare BCBSGA against other plans by clicking through to Georgia Insurance Shop.

A Look at Creation

If you are offended by humor, don't click this link.

(Powerpoint viewer required).

Turning No into Yes

I had a referral a few weeks ago. A really nice guy. Sixty years old and in reasonably good health.

He takes something for high blood pressure, acid reflux and cholesterol.

And he is deaf in one ear as a result of a benign cyst from a few years ago.

He has coverage now, if you can call it that. The plan covers almost nothing and will leave him financially ruined if he ever has a major claim.

Every carrier refused to make an offer due to the cyst.

Every carrier but one.

They agreed to consider his application before making a final determination. We didn't have a problem with that and thought it was only fair.

We sent the application in, and waited.

A week later we got a letter declining coverage.

That would probably stop most people dead in their tracks, but I am not most people.

I have over 30 years in this industry, and know what works and what doesn't. I also know that "no" sometimes means "yes" . . . IF you know how to properly appeal your case.

So I made a call to "my people" inside the carriers home office and presented my case. I showed them earlier correspondence from underwriting indicating the cyst was not a problem, and then we reviewed their declination which was a complete reversal.

My contact agreed I had done a thorough job of laying out the situation in the pre-screen process, prior to the application. There were no surprises. The condition was exactly as first revealed.

So the appeal started.

It took a bit longer than anticipated and I did get feedback while waiting. It seems the initial review wasn't as thorough as it should have been, but the "final" underwriting was also a bit sloppy.

Today they called and said an offer would be coming in the mail. The policy will be issued standard, with exclusionary riders for acid reflux and the hearing loss.

Sounds like a fantastic offer to me.

My client is pleased.

This is what makes my business so rewarding.

Health Insurance and Aetna

How does health insurance with Aetna work?

In today's market (1/26/2009) Aetna offer's the best overall value of any carrier in Georgia.

Of course, that can all change.

Aetna's underwriting can be the most onerous in some ways and flexible in others. I have a reasonably good offer rate for applications submitted through my office. This is mostly due to the extensive pre-screening I do. Even still, about 10% of applications submitted through my office are declined.

Those who submit direct to Aetna typically experience a significantly higher rejection rate.

Aetna has some of the best HSA plans on the market.

The also have some plans that leave much to be desired, such as the Preventive and Hospital Care plan and the Open Value 10,000.

Customer service is good but not great. It takes way too long to issue a policy . . . usually 2 months.

The good news is, you can go online withing 24 hours of approval to review benefits, locate providers and print ID cards.

You can also call their customer service line at 1-800-MY-HEALTH.

New business underwriting normally takes 10 business days but can sometime move a bit quicker.

The only real complaints clients have about Aetna involve billing and the way medications are handled.

Aetna's billing practices are among the worst. Sometimes it takes them 3 months to collect the initial premium. Other times they may forget to bill for 60 days or longer.

A new Aetna "member" is advised to have their doctor contact Aetna to get approval on existing medications. If you don't you may end up paying more for refills than is necessary.

In spite of the issues, Aetna is a major player in today's market.

You can run Aetna quotes by clicking this link.

You can compare Aetna against other plans by clicking through to Georgia Insurance Shop.

COBRA Options

You lose your job and your employer sponsored health coverage. What do you do when you are unemployed?

In many cases, COBRA is an option. But there are situations when COBRA is not available.

If your employer has fewer than 20 employees, COBRA (at the federal level) does not apply. Many states have enacted their own "COBRA compliance" statutes that provide some continuation of coverage so you may have options even if you work for a smaller employer.

COBRA is an EXTENSION of the employer group plan. If the plan is terminated, you do not have COBRA options.

But here are some things you can do . . .

COBRA can be applied for in whole or parsed by family members who have conditions that cannot be covered with individual health insurance. Just because you are insured under your employer plan as a family unit does not mean that all family members must elect COBRA.

For many, a STM (short term medical) plan is fine. In Georgia, a STM plan is considered creditable coverage and can be used for up to 12 months to bridge you over to a new employer group plan. You can review STM plans by clicking THIS LINK.

Even though STM can cover you for up to 12 months, it is not advisable to keep it for more than 60 - 90 days.

You may want to have more options than are available in STM plans. Fully underwritten, traditional plans are available in many variations. You can run rates on roughly 140 different plans by clicking THIS LINK.

These are just a few options. For more information, visit my Resource page at Georgia Insurance Shop.

Health Insurance and You

OK, so you bought a health insurance plan. Now what?

If you are like most people, you will read it AFTER you have a claim. That is too late.

Health insurance policies are great for insomniacs. If you can read one of those without falling asleep you really DO need help.

Navigating your policy is just the first step. Unless you know how to MAXIMIZE your benefits, you will end up spending more than is necessary.

Most folks I meet spend way too much on coverage they don't need and then overpay again by making expensive decisions on health care. I can teach almost anyone how to cut their total health care expenditures by 30% - 40% without sacrificing coverage.

That usually translates to anywhere from $300 to $5,000 per year.

Let's face it. The money you pay to a carrier is gone. The only way to get it back is to have a major claim and who want's to do that?

Not all policies are the same, not even with the same carrier. Each carrier has "good" policies and some really lousy ones.

Beyond that, navigating the maze of websites, phone numbers and networks really IS rocket surgery.

Hopefully we can help you make sense by providing tips on maximizing your health care dollars on a carrier by carrier basis.

Stay tuned . . .

Save Money on Drugs

How do you save money on prescription medications?

There are quite a few ways. Many maintenance meds are available by mailorder in 90 day supplies. You can purchase meds at warehouse clubs such as Costco or Sam's (membership not required).

If you have health insurance all the top carriers have negotiated wholesale pricing for their policyholders.

You can purchase from other countries such as Canada or Israel. We have links to patient assistance programs as well as two top international pharmacy's at Patient Charity.

You can sign up for Rx discount cards but those are almost always a waste of money. You certainly don't need them if you have health insurance and you don't need them if you shop wisely. Most of the time a wise shopper can buy the same medication for less than the pricing available through the card.

And then there are generics . . .

But don't stop there. Several places such as Wal-Mart, Kmart and Kroger have $4 generic plans but that only covers some 300 medications.

There are THOUSANDS of older brand name drugs that are THERAPEUTIC EQUIVALENT'S to the newer, higher priced medication so often pushed by drug companies and doctors.

Therapeutic equivalents include generics AND brand name drugs that have been proven to be just as effective in most cases as higher priced drugs. You can find a list of therapeutic equivalents by visiting this FDA site.

You may also want to ask your doctor, pharmacist or carrier to suggest lower cost alternatives.

Every dollar you do not spend is a dollar saved in your pocket.