Wednesday, March 3, 2010

Side by Side Comparison of Health Care Bill Proposals

Kaiser Family Foundation presented a side-by-side comparison of the major health care reforms  initiatives between President Obama, House and Senate. The comparison is a useful tool to better help understand the commonalities or differences between all parties.

This past week on February 25th, a Health Care Summit was held by President Obama with key Republican and Democrat congressional leaders. The intent of the summit was to find common ground on the Health Care Bill and ultimately pass it into law with bipartisan support.

It is highly unlikely that a bipartisanship spirit renewal took place at the Summit; however, President Obama is contemplating adding four  policy areas identified by Republicans as follows:

  • Random and undecover investigations of Medicare providers
  • Health courts to resolve medical malpractice disputes
  • Increase Medicaid reimbursements for doctors
  • Expanding Health Savings Accounts (HSAs)

Regardless of President Obama's overture, the Republican base is not in agreement with any version of the health care bill other than starting the legislative process over.

Tuesday, February 23, 2010

Companies ordered to stop selling limited medical insurance

Florida Insurance Commissioner  ordered  several companies  to stop selling limited medical insurance in Florida.

The companies named in the Order have 21 days to respond to the state of Florida Division of Insurance Regulation regarding the allegations of selling insurance without state authority and representing the product as major medical insurance.

The companies ordered to stop selling limited medical insurance are:
  • Beema-Pakistan Co, Ltd., Pakistan
  •  Benefits Association, New York City 
  • Serve America Assurance Ltd., Blythewood, S.C.
  • Affinity Group Benefits Association, American Trade Association, Smart Data Solutions LLC and SDS Management Group, Springfield, TN

Friday, February 19, 2010

Who is Sassylizard?

Sassylizard is a mother of 3 amazing kids, one is a recent graduate of the University of Florida, Gainesville ,one soon-to-be graduate in May 2010 and the last child is in his first year of highschool.

One of her 2010 goals is to write several search-engine friendly articles.

Sassylizard is a health insurance subject-matter- know-it-almost-all. She continues to learn and doesn't subscribe to knowing everything. 

She works in an executive management capacity with national carriers, agencies, or as a consultant in the fields of agent recruitment, regulatory compliance, licensing and operations. 

Sassylizard's favorite role is being a consumer advocate for her clients and readership by empowering them with knowledge and understanding of the mechanics of health insurance. She is commonly known to say, "Information is power."

Follow Sassylizard's blog at, . On occasions she will write on current industry matters, products, or share her opinion on specific trends and practices.

Thursday, February 18, 2010

Small business group health insurance

Do you ever wonder how a small business qualifies for group health insurance? Read my article on the underwriting qualifiers companies use in the underwriting process to approve or decline a small business group for health insurance.

How to get small business group health insurance

Friday, February 12, 2010

Limited Medical Insurance Plans

Limited medical insurance plans offer benefits for hospital stays, doctors visits, surgeries, accidents, emergency or urgent care. These types of health insurance programs are very popular now more than ever due to our current economic woes where so many people are unemployed and looking to cut-down on costs, have exhausted their COBRA benefits or have no other health coverage options. I absolutely don't recommend that you consider limited medical insurance plans if you currently have full  coverage and can afford to keep it.

An individual limited-medical -guarantee-issue health policy accepts individuals regardless of the medical condition. The limited medical benefits plan is a type of health insurance; but,it is not comprehensive in its coverage. For example, on an 80/20 health plan, 80% of your medical benefits will be paid by the insurance carrier.

On the other hand, unlike full  comprehensive benefits,  limited medical  plans with a hospital benefit of $1000 a day, will cover your hospital stay to $1000. Any expense beyond $1000 is your responsibility. Granted with the rising costs of medical care, it may not seem like much for a limited medical  insurance benefit, but, wouldn't you take a $1000 over nothing-at-all to help you with the medical bill?

Private health insurance plans choose their clients through a health evaluation process commonly knowns as health underwriting. Insurance companies evaluate individual's health risk, but differ on their assessment on the risk. For example, assuming a male applicant is 25 pounds over the standard weight range for his age group, carriers may choose to accept or decline the individual for health coverage. The fact is that being overweight or obese can trigger other costly medical conditions that healthcare companies foresee as an expensive risk to absorb, such as diabetes, high blood pressure or heart ailments.

If you have been declined for major medical comprehensive health coverage by more than one carrier, you may want to consider guarantee-issue individual  limited-medical  insurance.

Be cautious, especially if you are one of the millions that is uninsurable or uninsured. In shopping for individual limited-medical insurance be attentive to the representations being made in particular by call-center sales personnel regarding these health plans.

 I am concerned with the rise of ruthless individuals who pry on others' medical or financial situation to make a profit. Let me be perfectly clear, there are call centers that hire unlicensed sales personnel to pimp these forms of  insurance products and misrepresent them as full health insurance coverage. These individuals hide behind their headsets and are oblivious to what is right or honorable including the business owners who look the other way towards greed.

Wednesday, February 10, 2010

Anthem Blue Cross and Blue Shield of California -UP YOURS to 800,000 policyholders

The Los Angeles Times reported that effective on March 1st, Anthem Blue Cross and Blue Shield of California, the largest for-profit insurance carrier in the state, announced that many of its 800,000 individual health policyholders are going to receive a premium increase between 30% and 39%. If that wasn't enough bad news for Californians, the insurer will also "adjust rates more frequently" than on an annual basis.

Henry Waxman, the Democratic chairman of the House Committee on Energy and Commerce and Subcommittee on Oversight and Investigations Chairman Bart Stupak (D-Michigan) have requested for Angela F. Braly, chief executive of Blue Cross parent company WellPoint, to testify before the subcommittee on February 24 to justify the insurers reasons for the sizable rate increase proposed.

Friday, February 5, 2010

Best Insurance Plans in the Nation

The results of the 2009 Best Health Insurance Plans in the nation by J.D. Power and Associates is available. A total of 131 participating health insurance companies members were surveyed on their satisfaction with the carrier's provider, hospital,and pharmacy choices, benefit features, access to care, preventive care coverage, claims processing, member communication, explanation of benefits statements and Customer Service.

Insurance companies such as, Aetna, Blue Cross/Blue Shield, Healthnet, HIP Health Plans, Humana, Kaiser Foundation Health Plan, Pilgrims Health, Regence, United Healhcare were some of the 131 carriers whose members participated in the survey.

Click on any of the states or areas listed below to review the carriers ratings:

Arizona Utah
East South Central
Illinois Indiana
Minnesota Wisconsin
New England
New York New Jersey
Pennsylvania Delaware
South Atlantic
Virginia Maryland D.C.

Tuesday, February 2, 2010

Humana's CEO Mike McAllister Discusses Health Care Reform

Humana's CEO Mike McAllister discusses healthcare reform and its importance on affordable and accessible health care.

On the matter of rising medical costs, he emphasizes there are systemic inefficiencies; however, our lifestyle and behaviors, such as being overweight, are also "drivers" of increasing health care expenditures.

There has to be a fundamental change on the causes of higher medical costs in order for health insurance premiums to be affordable and reform, successful.

For more information on finding affordable health plans or lowering your health care costs without sacrificing on health coverage, read the article,
How to a Find a Cheap Health Insurance Plan

Friday, January 29, 2010

Spending more money on your health care than needed

Do you know your policy's health insurance benefits, deductibles, out-of-pocket limits and co payments? If you think you have an idea but somewhat unsure, then you may be spending more money on your health care coverage than what's actually needed.

Who manages your checking account? The bank, you, or both? The same analogy applies to your health care costs and benefits. Your health insurance is a partnership between you, the medical providers and the insurance company. If you are not involved in the equation, you could underminine yourself by paying a co payment that is not required, spending more than the out-of-pocket maximum expense, or exceeding the annual deductible.

Keep your medical expenditures intact.

An annual deducitble is a specific amount of money paid on as you go basis (doctor office visits) or in one lump sum (hospitalization), before the insurance company participates in the cost of your health care expenses. The carrier only becomes aware of the medical expenditures incurred when you file a claim against your annual deductible. Be sure to include your receipts and keep a copy for yourself. Be aware there are some medical benefits, whereby the annual deductible is not required for immediate access to the benefit.

Once you have met your deductible, then you are eligible to cost share with the insurance carrier for approved medical expenses. Assuming, you have an 80/20 policy, 80% of the costs will be paid by the insurance company and the remaining or 20% will be paid by you. Hence, for example, on a medical bill of $100, your share will be $20.

The cost-share or the 20% from the example given above has a maxium dollar amount or an out-of-pocket limit. Let's assume it is $2500. When your 20% equals $2,500, the good news is that the carrier becomes 100% responsible for the covered medical expenses up to the policy's lifetime maximum, if any. Be aware that co payments and deductibles are usaully not considered an out-of-pocket expense.

To summarize, the steps are, 1) meet your annual deductible, 2)cost-share up to the out-of-pocket limit, and 3) once you have met the prior steps in order of sequence, the insurance carrier covers 100% of the eligible medical expenses up to the applicable policy maximum.

Most insurance companies provide their membership access to online resource tools to assist their memberhsip with information about their health insurance benefits, claims or topics of interest. This is a superb way to manage your coverage or become aware instanteously of the claims made against your benefits by providers and the amounts paid or denied by the carrier.

Information is power. Be familiar with your annual deductible, out-of-pocket and benefits co payments and their applicabilty; particularly, to assure you're in balance with your share of the financial responsibilty.

Tuesday, January 26, 2010

Massachusetts vote spoke with fork tongues

Massachusetts voters may have spoken in wanting less government as most political analysts reported. But, let me play the devils advocate and extrapolate on one subject matter, health care coverage and government intervention.

It appears that Massachusetts resident's vote spoke with 'fork tongues'. Massachusetts enacted legislation in 2006, under then Governor Romney (R) that mandated Massachusetts residents to have universal health care coverage through an individual mandate. Individuals unable to afford the premiums are provided a government subsidy to obtain coverage; resulting in 98% of its residents as insured.

A recent Kaiser report findings indicates that Massachusetts residents are content with the passage of universal health care mandate even though premiums are higher. Understandably, the mandate requires acceptance of all pre-existing medical conditions; consequently, raising the insurance carrier's exposure to increase medical claims and premiums.

The same intervention applies to workers that receive employer provided health care coverage. Employer provided health care plans takes into consideration the groups claims experience versus an individual health plan where the monthly cost imposed is the sum of one versus the sum of all. We pay for each others medical history-good or bad. The federal government mandates through the passage of HIPPA not to discriminate and accept pre-exisitng medical conditions such as newborns born with birth defects or pregnant women, requirement of employer premium participation, and the right to the continuation of our employer sponsored coverage after we loose our jobs or a divorce or another qualifiable life event.

In health care, there are inequalities and government involvement is appropriate. If not, we the people, couldn't afford to pay or obtain health care coverage if we could.