White House Releases 'Patient Bill of Rights'

Marking the first 90 days since he signed health care reform into law President Barack Obama spelled out how the short term benefits would be implemented.  The big items such as expanding coverage for the 32 million of the uninsured does not occur until 2014.

I wrote in my previous post that insurance rates are rising, which is knock against health care reform.  I see the White House release of the patients bill of rights as a publicity stunt to gain back traction for the reform. With the said, lets analyses the so called short term benefits.

— Guaranteed coverage for children with pre-existing health problems. The administration estimates that about 540,000 children with health problems are uninsured, and some 51,000 are likely to gain coverage. It's still unclear whether families will be able to afford the premiums. The law does not limit what insurers can charge.
It’s still unclear how insurance companies will price the new guaranteed coverage for children. If premiums are too high, families may still be unable to get health insurance.  Though I do love the effort of making sure all of our children are covered.

—A ban on lifetime coverage limits. More than 100 million people are enrolled in plans that currently impose such limits, the White House said.
This cap allowed the actuaries to set premiums and keep them down.  The removal of the cap will automatically increase the risk for the insurance companies and thus increasing the premiums.

— Phasing out annual coverage limits. Starting this year, plans can set annual limits no lower than $750,000. Such limits rise to $2 million in 2012, and will be completely prohibited in 2014.
See my comment above.

— Forbidding insurers from canceling the policies of people who get sick. Unintentional mistakes on application forms cannot be used to revoke a policy.
I actually like the first part of these benefit, i don't believe insurance carriers can cancel peoples policies because they are sick.  That is part of the risk for the insurance companies and they should not be allowed to just cut it to increase profits.  As for the part of unintentional mistakes, i love to see the definition of unintentional mistake.

— Guaranteed choice of primary care doctors and pediatricians from a plan’s network. No referral needed for women to see an ob-gyn specialist. No prior approval needed to seek emergency care out-of-network.
These is straight forward and i try to avoid carriers that don't already follow this approach.
The new rules apply to most health plans, except in cases where they are “grandfathered” under the law.

Health Care Premiums Starting to Rise

In a recent survey released Monday by the the Kaiser Family Foundation. (KHN is a part of the foundation.)

The foundation surveyed just over 1,000 people who don't get insurance from their employer. finding that people who own their own health insurance report the most recent rate increase requests have averaged 20 percent.  77 percent reported an increase and 16 percent of them switched to less expensive plans. As a result of those who switched, the average increase for all respondents was 13 percent.

It easy to say insurance premiums rise every year, however not a 20% clip, the rate in the past was generally around 10%.

Insurers are blaming rising medical cost as the driving force.  I predicted in an earlier blog the increase was inevitable.  My reasoning was not due to increase in medical cost, but rather due to the health care reform law.

One aspect of the law is guaranteed insurability.  This law prevents insurance from charging higher premiums on those that have health issues, that's great for the sick but bad for the healthy.  Insurance companies need to raise the premiums somewhere to cover the cost of the sick so the healthy get zapped.  In other words lower premiums for those with health issues and higher premiums for those that are healthy.

In a recent article in the New York Times Today, it was reported that the Obama administration is set warn the insurance industry against imposing hefty rate increases. The White House is afraid that insurance carriers would blame the new law, i do not believe that would be the initially as the carriers do not want to deal with the government at this point and would just continue to blame rising medical costs.

“Our message to them is to work with this law, not against it; don’t try and take advantage of it or we will work with state authorities and gather the authority we have to stop rate gouging,” David Axelrod, Mr. Obama’s senior adviser, said in an interview. “Our concern is that they not try and, under the cover of the act, get in under the wire here on rate increases.”


Insurers have warned since early in the debate that the overhaul might result in increased premiums for many consumers. Based on risk analysis if you have to have an unhealthy individual with a low insurance premium on the books, you would need to increase several health individual premiums to make up the loss. 

Maintaining a health life style would become meaningless from a health insurance policy prospective as all would be charged the same premium.  You work hard to keep your self healthy and pay for those that don't.  There are obvious outliers to this comment as i am not talking about issues that cannot be prevented.

When Can I Expect My Medicare Part D $250 Rebate?

If you have Medicare prescription drug coverage and will reach the coverage gap in 2010, Medicare will automatically send you a tax-free, one-time $250 rebate check starting in mid-June.

The Affordable Care Act contains a rebate provision for Part D Medicare recipients. If you have Medicare prescription drug coverage, and are not already receiving Medicare Extra Help, Medicare will automatically send you a tax-free, one-time $250 rebate check after you reach the coverage gap (also called the "donut hole") in 2010. This rebate is intended to help with out-of-pocket costs for Medicare prescription drug coverage.

Most Medicare drug plans have a coverage gap. This means that after your plan has spent a certain amount of money for covered drugs, you have to pay all drug costs out-of-pocket (up to a limit). Your Explanation of Benefits notice will tell you how much you have spent on covered drugs and whether you have entered the coverage gap.

There are no forms to fill out; Medicare will automatically send a rebate check to you. These checks will be mailed to beneficiaries starting in mid-June. Checks will be mailed monthly throughout the year as beneficiaries enter the coverage gap.

If you enter the coverage gap after the rebate check program has begun, you should expect to receive your check within 45 days. Your rebate may be delayed if Medicare does not have information from your Medicare drug plan showing that you reached the coverage gap in time to include you in the next mailing. You should contact your Medicare drug plan to make sure all of your information has been sent to Medicare.

If you do not receive your rebate check, contact Medicare at 1.800.MEDICARE (1.800.633.4227 ).
TTY users should call 1.877.486.2048.

For the government's brochure on the Part D rebate click here.

Who is Fighting for Your Insurance Claims?

I cam across this article on MSNBC http://bit.ly/aAiFDY.  To summarize Doctors are complaining that Claims-processing errors by health insurance companies are creating undo administrative costs.  The insurance companies on average are get getting 80% of the claims correct.  I am sure Doctors always notice when they are short changed and every so often when they are over paid.

The Doctors have the AMA (American Medical Association) fighting their battles as a group.  In the case of over payment who is fighting on your behalf. 

We have found through our research that almost no insurance broker handles what we feel is the most important part our our jobs ... claims execution!

Our procedure is that NO client is to pay a bill or claim without letting us do our job ... confirm what the correct payment should be. Our mission is to insure that our clients pay the CONTRACTED RATE only. This amounts to 25% of what the bill would be if one was not insured.

The "usual and customary" or "the contacted rate" is key to why we get insurance. If one was not insured the old saying " I went to the hospital and paid $20 for an aspirin" would apply. With insurance you would pay 20 cents, and your broker, who comes free to you would make sure of this.

We have saved our clients countless dollars as they have "side-stepped" double dipping, over charges, cash deals that would have cost them 50% more! Saving our clients money is what we do!

In summary please make sure you find a broker that handles every claim. Any broker can take an application ... it is the great broker that handles every issue for their client ... especially CLAIMS!

Making the Right Private Health Insurance Decision

There are plentiful insurance plans to choose from, but with small differences between the options how to you choose. Many of my clients are aware through their own research, that there are many insurance providers out there each with dozens of plans at different premiums.  They searched out a broker for guidance and advise.  I even had a perspective client (now a current client) tell me that he just wanted information and did not need a broker.  I was more than glad to help.  It came up in the conversation that he was going to purchase the plan directly from the provider rather than through a broker because it was cheaper.  You can imagine his surprise when i informed him that the price is exactly the same weather he uses a broker or not except even he goes directly through the provider, he losses the free usage of a broker. The prices are exactly the same as going to the insurer directly, our services are free.

Its best to seek the advise of an independent broker who is not tied to one provider and who has access to a large number of insurers.   An exclusive agent may try to pigeon hole you into a plan that is not a prefect fit for you, because that is all they have to offer, with an independent broker, the Sky's the limit.

There are many things to consider when choosing a provider, in the past, pre-existing medical conditions have been excluded from cover, along with all related conditions. Someone suffering from high blood pressure would find they were also not covered for such conditions as heart attacks, strokes. The costs incurred could would be astronomical.  There are plans out there that look to cover pre-existing conditions, the premium would be higher than that of a healthy individual.


Choosing the right area of cover is another important task. If someone stays in there home area the best and most cost effective plans are the local one, for example Sierra Health Insurance Plans of NV have by far the best plans for anyone that is generally located around there home base of NV(and are not looking for maternity coverage).  If you are a business man that travels often, you would need a bigger a provider that is present in most states.  These premiums would generally be higher for the prime time names, but you would avoid out of network fees, should an emergency arise and you are of town.


So, is a major player always the best bet?

Not always i observed that smaller companies can be much better in their administration, and customer service. They also have the ability to treat each customer as an individual rather than a number. As they are smaller, they can be quicker to pro-actively respond to the changing needs within the market place. That said, larger companies can be more widely recognised by medical institutions in some remote places.

There really is a lot to consider, things are changing more than ever, and more quickly than ever before in the insurance market. That’s when the expert advice and guidance of an experienced broker becomes vital.