June 30, 2006 by bob.

Q. A few months back I purchased a group HMO plan from a well known carrier. Their price was significantly less than other carriers for similar benefits. Now I find the doctors in my area no longer accept patients who use this carrier. What do I do now?

A. You always get exactly what you pay for. That carrier has historical problems with their HMO and providers refuse to renew their contract. This happened a couple of years ago and many clients had to either pay out of pocket and see their regular doc or travel across town to see a different doc.

The plan you picked was about 30% below the other carriers. That should have been a clue that something was wrong.

The odds are good the HMO and the hospital (and docs) in that group practice will eventually make amends, but that may not happen for a couple of months. You can either pony up the additional premium and get a better plan with a different carrier; change plans with the same carrier but switch to a PPO at an even higher price and lesser benefits; or you can ride it out.

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June 27, 2006 by bob.

Q. I have never heard of some of the companies agents are pushing. I have called the Better Business Bureau but they don’t have any information either. What can I do?

A. The BBB does not regulate carriers and will not have any information that is useful if you are looking at health insurance plans. If you have been lured into a pitch about a discount plan, you may find some information, particularly if there have been numerous complaints about their sales tactics. You will also find information with the AG’s office.

Your best source for information, other than the agent you are considering, is your state DOI (Dept of Insurance). Another credible source is NAIC.

Some states, GA in particular, allow you to see what kind of licensing and how long the agent has been licensed. You can also review the continuing ed courses the agent has taken.

In addition, use your own intuition. If the pitch the agent uses sounds too good to be true it probably is. Don’t be afraid to ask questions. If the agent doesn’t have the answer, or sloughs it off, you probably don’t need to be dealing with him or her.

If people would simply take the time to investigate there wouldn’t be as many issues that have to be handled at consumer sites such as Clark Howard.

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June 22, 2006 by bob.

Q. I am trying to find a deal on health insurance and most of the sites I visit are run by agents that just want to call and talk me into a plan I don’t want or need. How can I find health insurance without having to go through an agent?

A. You are correct that many of the sites on the web are either company sites manned by company agents, or independent sites sponsored by as many as half a dozen agents who will “fight” for your business.

You will also find a few sites that are essentially DIY where you enter your data and pick a plan then apply. They also offer limited support through licensed agents who are usually inexperienced. There is a common misconception that these DIY sites are more objective.

That is not the case.

Most of the DIY sites only offer a few carriers and do not include all the options. In Georgia the top 8 carriers offer almost 1900 plans and variations for individual health insurance. The most recognized DIY site only includes 5 carriers and fewer than 160 plans and options.

To truly find the best “deal” you need an agent who knows the market and can direct you to the right choices based on your needs, budget and health history.

Even if you find a plan you like, the next hurdle is underwriting. About 80% of the time the final offer you receive from a carrier is not what you were expecting.

A good agent can reverse those figures and tell you with 90 - 95% accuracy what your final rates will be.

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June 20, 2006 by bob.

Q. I am overweight, not morbidly obese, just big but otherwise healthy. Yet I have been turned down for health insurance. Why don’t companies recognize that some people are just naturally heavy?

A. Carriers look at statistics and set their rates & rules accordingly. While much of the population carries more weight than they should it is also good to realize how this can affect your future health.

Being overweight can lead to diabetes, hypertension, an enlarged heart and much more. The symptoms of disease may not show up for years but by then the damage is done. The best thing you can do for yourself and your quality of life is to get your weight down to a more healthy level.

That was your mother talking, now for a response to your question . . .

There are several outlets for those who cannot qualify for major medical coverage. Here are just a few.

Hard to Find Health Plans

Georgia Basic Health

Secure 12×3

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June 19, 2006 by bob.

Q. I notice you suggest finding a plan that does not include a rider on health conditions. Why is this?

A. Pretty simple actually. What is the ONE thing you want your plan to do?

Pay your claim.

If the plan only pays for some claims, and not for others, why have the policy?

Riders are a way for carriers to offer more affordable coverage and avoid risk. There is nothing wrong with choosing an affordable plan, but if it hangs you out to dry you don’t need it.

Consider two plans. One has full coverage including your hypertension, the other has a rider. The full coverage plan is similar in benefits but is 10% more than the one with the rider.

Here are some things to consider.

The rider plan will not cover your hypertension meds.

The rider plan will not cover your hypertension related doctor visits.

If you have a high deductible plan, expenses for your ridered condition do not accumulate toward the deductible.

If you have a stroke, or heart attack, your ridered plan may not pay for your medical bills.

Is that enough reason?

Would you buy an auto insurance plan that covers you if you have an accident in any month that does not have an “R” in it? Or would you rather have a 12 month policy, even if it cost a bit more?

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June 19, 2006 by bob.

Q. I am talking to another agent who represents some of the same carriers you have. He says his plan has more doctors in their network and he says his plan is better than the one you suggest. Why don’t you push the same plan he is offering?

A. The answer is simple. Although the rates and benefits are similar between the two plans, the difference is you will have full coverage under the plan I have suggested. With that other plan, which I can offer, you will not be covered for hypertension. That means your medication, doctor visits and anything related to hypertension will be denied.

So why is the other plan better for you?

It isn’t.

But the other plan is better for the agent. Assuming he earns the same commission I do on both plans, he makes twice as much if you buy the other plan but you get less coverage.

Now who wins?

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June 16, 2006 by bob.

Q. The plan you suggested is too expensive and they ask too many underwriting questions. I don’t have the time to chase down answers to their silly questions and get medical records. I found a plan with another carrier that is almost half the price you quoted and they didn’t ask as many questions. I see you represent this company. Why didn’t you tell me I could get the same plan at a lower price and with less hassle?

A. Because it’s not the same plan.

I didn’t tell you about the plan because it was not right for you . . . or for anyone else either. The reason why the plan is almost half price is because it only covers about half as much as the one we submitted to underwriting. Had you checked the benefits and found a plan that was virtually identical to the one I quoted, you would have found that the carrier you chose charges about 30% MORE for the same benefits.

The plan you have applied for (through another broker) does not pay for your prescription medications. Based on the meds you are taking, expect to pay about $200 per month out of pocket in addition to your premium. Also that carrier will place an ER (exclusion rider) for your high cholesterol. This means the money you are spending on meds will not apply towards your annual deductible.

And here is something to consider.

If you have a stroke, and the stroke can be tied back to your cholesterol problems, they won’t pay for your stroke either.

So the bottom line is this. The plan I recommended was about 40% higher than the plan you allowed the other broker to sell. But it WOULD cover your medications, and it WOULD cover any related illness.

What you got is like purchasing a car for a cross country trip, only to discover the car will die on you after 100 miles.

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June 15, 2006 by bob.

Q. I currently have group coverage through my employer. Our plan is offered through Aetna so I applied for coverage with them and they turned me down. Can they do that?

A. This is a common misconception. People think because they have had group coverage with a carrier for years they can simply switch over to the same plan but on an individual basis.

This is not the case.

The underwriting rules are quite different for individual coverage vs. group plans. A carrier looking at you for individual coverage can accept you with full coverage, exclude certain conditions, apply a higher than standard rate, or decline you for coverage altogether.

Just because they declined you does not mean you cannot get coverage, but it does make it more difficult. I have close to a 95% placement rate acrosss the board. Maybe we can find something for you.

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June 14, 2006 by bob.

Q. I have a good health insurance policy and wonder if there is anything else I need. The plan has a $1000 deductible, but I have yet to even reach that. What do you suggest?

A. The first thing I would do is raise the deductible even higher . . . say to $2,000 or even $2,500. You will probably save enough in premiums to fund the difference in the higher deductible.

The next thing you need to do is make sure you are liquid. Experts recommend at least 90 days income but shoot for 180 days if possible.

The biggest problem most folks run in to when they have a major claim is a shortage of CASH. The sick days run out, regular bills still come in and on top of that you have copays & deductibles to meet. Even a minor illness or accident can keep you out of work for a week. Something serious can keep you from going to work for months.

There are many good supplemental plans that are not very expensive. For about $1 per day you can have a plan that pays up to $5,000 in cash, direct to you when you are admitted in the hospital.

You should also consider a cancer or critical illness policy. These plans can start as low as $5 per month for a $10,000 CASH benefit.

Another option is disability coverage. When people take out a mortgage loan, or refinance they are deluged with offers to buy life insurance. Fact is, almost half the foreclosures are due to disability of the wage earner. Fewer than 5% are due to the death of the primary wage earner. Disability coverage can be relatively inexpensive, starting around $1 per day.

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June 12, 2006 by bob.

Q. I have been looking online and talking to several agents about health insurance. Many of them quote rates that are much lower for the same coverage as you are quoting. Why are your rates so much higher?

A. My rates aren’t higher, they are accurate, based on the data you gave me. I did not quote you preferred rates because your weight exceeds the guidelines for the carriers we have discussed and you use maintenance medications. Assuming you are looking at the same benefits, my rates have been adjusted to reflect the anticipated underwriting loads. In other words, the rates quoted are more closely aligned with final rates from underwriting.

Anyone can quote a “cheater” rate but then you will be very disappointed when you finally get an offer from the carrier.

Is it better to know going in what your rate & terms will be, or would you rather be disappointed?

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