One of the craziest things that has ever happened to me as a webmaster in health insurance happened when I started getting inundated with harassing phone calls and emails from the insurance companies for posting underwriting guidelines in my website.  I don’t know why these documents are so secretive and guarded but I can say I was threatened with losing contracts and lawsuits if I didn’t pull them.  As a result I caved in, sort of. I left the guidelines up but with no real way of navigating to them.  The links were down in other words.

Most health insurance companies do not pay attention what I do over here so it seemed odd that I was getting ganged up on a daily basis during this period.  What had happened was Blue Cross Blue Shield of Florida had found my postings and literally ratted me out to everyone.  Usually, these companies would murder each other given a chance, but they were working together to protect their awful secrets.

Well, what has changed? Not a whole heck of a lot though we have grown both in size and stature in the industry and my blog (where you are reading this) is not really part of a commercial website so if you are wondering, I am going to republish at least a few of them.  This blog doesn’t sell health insurance or make attempts to represent the carriers we work for in our professional lives so I am pretty sure it will fly unnoticed.

Why are these documents so carefully protected?  I am not sure as it is not like most agents and carrier personnel don’t have easy access to them, but for some reason if they got into the hands of the general public who gets declined it could potentially be used in a lawsuit?  I don’t know this is mostly conjecture.

Blue Cross Blue Shield of Florida Underwriting Guidelines

Cigna Underwriting Guidelines

Humana Underwriting Guidelines

Aetna Underwriting Guidelines

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Cobra is great if your sick, even if your not it can sometimes be appealing especially if you are over 50.  But don’t fall into the trap of sticking with Cobra!  Let me tell you a little story that was just told to me yesterday by a potential client.

In Utah where the economy is flailing under the weight of this recession the construction industry has been hit most painfully as you can guess.  And this poor guy got laid off, and being that he was over 50 he elected Cobra.  Why?  Because the Cobra insurance plan came in cheaper for him.  This is usually not the case but can happen when you work at a large company and are over 50 at a company with where the majority of the workforce is younger males.  The older guy gets the benefit of the same rate class that the younger guys get.  But this article is not about group health insurance premiums.

What is most sad, is that he was perfectly healthy at the time he elected Cobra and could have had his choice of Utah health insurance companies.  Within a few months he developed cancer, and about a year after that, his Cobra expired.  Now he is left with only one decision, go on a Cobra HIPAA conversion plan where the premiums are usually close to the 3 times the average health insurance premium.

So he called us yesterday and we gave him some solid advice but basically he left us searching for loopholes which we found of course, but many other people aren’t so lucky.  This is why it is critical that you not take a Cobra if you can qualify for an individual health insurance plan.

I can go on and tell some even more gruesome stories of pain and suffering caused by Cobra, but will instead just give a piece of solid advice.  Call us at 888-803-5917 for help figuring out the best coverage for you.  We are happy to help you even if there is no commission involved, because frankly if we don’t do it no one else will.  Seriously no one cares about your problems.  I can tell you all the places that this guy called before reaching us and how awful the advice he received was, if he received any help at all.  We will take the time with  you to explain all of your options and are the only brokerage in this country that know everything about health coverage from Medicaid, to free clinics, to Cobra, and all state health insurance laws as well.

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In the past, what has come to be common knowledge is that racial inequalities in medical care not only exist, but are substantial.  Why do people of color tend to have less postive incomes then their white counterparts?  Is it due to financial differences or is it something else.  Well the studies show that it is not unfortuantely attributed to differences in income or education, but instead something completely different.

To put a reason for this disparity a group of researchers from Yale and the Urban Institute did a study of 133,000 patients who were treated for 10 specific surgeries in New York City and the surrounding burroughs from 2001 to 2004.

The results of the study which were just published on Monday found that across the board counting all 10 procedures, white patients were treated by better hospitals and surgeons (meaning that they came from higher volume facilities) then blacks, Asians, and Hispanic patients.

The final study showed that after averaging all procedures together white patients enjoyed better conditions in better facilites and by better staff in 37.6% of cases, while blacks only had this advantage in 20.6% of cases, 24% for Asians, and 26% for Hispanics.

These results show a consistent and identifable pattern of racism that is consistent for every group except for whites.  Again, the study was able to prove that economic status does not play a part in the resulting less preferential treatment of minorities, which leaves the question of what is causing the difference.

An example that the study showed was that Asians were likely to be either without health insurance or on Medicaid, even though they came from better socioeconomic neighborhoods than the black patients.

So again why the disparity?  The researchers have a couple of theories of course, but they are just that theories. 

One theory was that white patients have better information from friends and families about hospitals and doctors.  New York has tried to address this situation by publishing report cards on medical staff and hospitals.  Since the inception of the program, black patients have seen an increase in the quality of surgeons for coronary artery disease but still less than whites.

The final theory, is that even though New York City is a melting pot, it also anchors one of the five most segregated metropolitan areas in the country, according to U.S. census data. On top of that, only 9.5% of surgeons and 22% of hospitals in the study were classified as “high-volume,” and those hospitals may be clustered in neighborhoods populated by whites, they wrote. (To test this theory, it would be useful to see whether white and minority patients treated in a given hospital were equally likely to be treated by a high-volume surgeon.)

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Copays seemingly go up every year, and hopefully insurers will take notice of this study as well, and do something about rocketing copayments.

The study had participation by nearly 900,000 seniors in 36 Medicare Advantage plans during 2001 to 2006.  Half of the plans raised their copays for office visits, and researchers were able to build statistical models which showed patterns of procrastination among the group in the higher copays.  Prescription drug coverage was not tested in the study, but if they were to study it, I can tell them the results.  Generics, Canada, and going without.

In the study, it seems that copays doubled from around $7 for the primary and $13 for the specialist to about $14 and $22 respectively, remember this is 2001 to 2006, and for the control group their copays stayed low at $8.33 at the primary and $11.38 at the specialist.

The results?  For every 100 people that enrolled in the plans that had increasing copays there were on average 20 fewer office visits but 2 additional hospital admissions and 13 more hospital days per year for this group then the control group.

The study also showed that the increases in copayments had the most profound effect on the poor and minorities in low income neighborhoods.

If you think about it the copayment system runs counter-intuitive to the entire idea of managed care, which is supposed to encourage preventative medicine.  Insurance Companies, I hope you are reading this.

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Individual Maternity Health Insurance Coverage in Florida or How To Apply For Medicaid!

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Blue Cross Blue Shield Florida Health Insurance National Insurance Coverage Definitions

Ok this is bound to a boring post, but as I get asked this question so many times I feel its time to answer it one health insurance company at a time.  Here is the Blue Cross Blue Shield Plan Coverage Information for people with Blue Cross of Florida (or any Blue Cross from any state) who travel to other states or seek medical attention from out of state or national providers.

Firstly lets discuss the Blue Cross Blue Shield plan in Florida and define them.  Blue Cross Blue Shield of Florida is kind of like a non profit franchise of the Blue Cross Blue Shield Association.  This means that they won the lottery and get to sell health insurance under the Blue Cross name which guarantees you success in the individual health market and thus are like the mob.  But if you have them, they are probably the best insurance company in the state, their network is amazing and they never rescind policies (at least in Florida).  So they will not fight you when they have to pay claims.  But they will raise your premiums!  Of course they can’t target one person or family with an increase so I suppose this is irrelevant except that it speaks to the insanity of our current health insurance industry, and of course the medical field in general.

This article is about getting coverage in other states and seeing out of state providerswith your individual or even group Florida health insurance plan from Blue Cross Blue Shield of Florida and guess what?  They are also amazing in this respect as well!  It seems unfair, and I say it is but they are still the best individual health insurance in Florida should you qualify and I am happy and privileged for the most part to be associated with them.  I would however, make some changes if they ever let me sit on the board!  I have copied their Blue Card national coverage highlights into the post so that you can get their definitions of your coverage but the bottom line is if you get sick and want to go the best doctors in the world then in Florida anyways Blue Cross Blue Shield is your best choice.

blue cross blue shield florida

Overview Of Blue Card Program

The BlueCard Program enables Blue Cross and Blue Shield of Florida (BCBSF) members who travel or live out of the service area (i.e. outside of Florida) to access participating providers of independent Blue Cross and/or Blue Shield organizations and receive all the same benefits of their BCBSF health plan

Purpose

Designed to provide access to the Blue Plan networks nationwide to Blue Plans and their members, facilitate efficient claims processing and customer service, and help Blue Plans maintain strong relationships with their local providers

Program Summary

• The BlueCard program is recognized by the suitcase logo on the member ID card

• Home Plan – where the subscriber’s contract is issued or where the group is headquartered.This Blue Plan holds member eligibility and benefit information

• Host Plan – the Blue Plan in the area where services are rendered.The members’ responsibility will be determined by their benefit contract

• The Home Plan pays an Administrative Expense Allowance and Access Fee to the Host Plan for administration of its members’ claims and access to the Host Plan’s provider networks

Eligibility

All non-Medicare BCBSF members are eligible to take advantage of the program

Product Design

Standard policies and procedures using common formats (ITS software) enable Blue Plans to exchange computerized membership, claims, provider and reimbursement information to support claims processing and customer service

Network

Nearly 90% of U.S. doctors and more than 80% of U.S. hospitals have a contract with a Blue Cross and/or Blue Shield Plan

Product/Claims Administration

• Single network for claims processing and reimbursement

• Provider files the claim to the Local/Host Blue Plan

• The Local/Host Plan prices the claim • The Home Plan verifies benefits and

eligibility • The Local/Host Pan finalizes the

claim with the provider

Member Access

• Toll-free telephone support (800-676-BLUE) during customer service hours of operation

• Provider information accessible through w w w. bc b s f l . c o m

Cost

No additional access fees for international claims • Standard BlueCard fees apply for claims in the United States

florida health insurance from the quote experts

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Part of the reason for the outrageous health insurance premiums in Florida is that no one shops their medical procedures.  This means that if you need a colonoscopy you call your doctor he tells where, when, and who to go to.  This will mean that your health insurance company will end up with the brunt of this expense, or you will and it will be applied toward your deductible. 

health costs rising

Nowadays due to the escalation of health insurance premiums we all have very large deductibles, this means that you are paying for all your medical procedures in most years and since you are paying as opposed to your employer and/or insurance company you better get smart and start shopping!  This will make everyone more honest and help keep premiums down and thus make more people eligible for medical coverage. 

Firstly if you going for blood work or a more advanced treatment or diagnostic make a few phone calls yourself or use the internet to make sure the test is even necessary as many doctors simply don’t care.  Secondly, after getting pricing Blue Cross Blue Shield of Florida has released the following tool which will make it easier to shop your procedure.  The following is from an email from blue cross describing a tool that we already have ECHealthInsurance.  If you are unsure of a given procedure’s cost call us at 888 803 5917 so we can tell you how much it is in your county from various facilities and more importantly from the neighboring counties which will can be sometimes 30% cheaper with a distance of only a few miles! 

Using Care Comparison, members can access total estimated cost ranges associated with approximately 39 specific medical procedures performed at more than 2,800 local hospitals, outpatient surgery centers, free-standing radiology facilities or other medical facilities. In addition, BCBSF will soon be adding another 23 procedures to this already extensive listing. With the addition of this innovative tool, BCBSF and the other participating Blue Plans can now offer access to valuable quality and cost information to more than 48 million Americans. Your clients and customers will now be able to make more informed health care decisions based on this extensive repository of claims quality and cost information.

Additionally, the Blue Cross and Blue Shield Association (BCBSA) has selected Care Comparison as its standard methodology for a national transparency solution that will be made available to all Blue Plans.

You can access all our shopping tools by calling us at 888 803 5917 or by visiting our soon to be updated section on this.

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Follow Up To Article on Florida Health Insurance Reform

If I have to tell another 60 year old divorced female to go apply for medicaid or to try to get coverage through the county, I will go nuts. If you’ve been following the news then you know that everyday the health reform that is being discussed is seeming less and less likely. The only good news is that 30% of the uninsured Florida are probably eligible for social assistance and either don’t know how to get or or our too embarrassed to try. If you think you might be eligible for these plans then you should run to our website and call your South Florida county plan as well the medicaid and other program information that I’ve listed. Nearly every city in the South Florida tri county area has a free clinic which most of you don’t know.
Every day at http://www.ECHealthInsurance.com we get calls from people that want Florida Health Insurance coverage but can’t afford it, and more frequently cannot even get health coverage due to preexisting conditions. I want health reform alright, but I don’t want it for kids, or middle aged people, the people that need it the most are 60-65 and are middle class or are just “medically undesirable”, and can’t afford $1500 a month for a decent health insurance plan.
If you live in Florida we have compiled a list of every free and subsidized county plan so if you are don’t want to call us at 888.803.5917 you can visit our blog about Florida subsidized care @ http://www.echealthinsurance.com/blog/readthispag/
We are also promoting the new Miami Dade Blue plan and other low priced alternatives for people that want coverage but can’t afford the current policies in South Florida. We will even do a free one or two man group plan for you which pay no commissions or give you the papers to fill out for the Florida Health Insurance Company of your choice. August is open enrollment in Florida for 1 man groups, and I can tell you the individual health insurance companies hate these plans but they have to take you! So please get yourself coverage! For a free health insurance quote visit our quote page at http://www.echealthinsurance.com

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Florida Health Insurance Quotes

Before applying for individual health insurance in Florida It is Important To Consider These Things:

Prior to Applying

To be considered for coverage:

• Applicant and enrolling spouse must be between the age of 18 and 64 ½ .
• Dependent children of applicant or enrolling spouse must be under age 19, or under 26 if a full-time student. A dependent child under the age of 2 months of age must have had a first well-child exam after release from the hospital.
• For a Child-only policy, a child must be between 2 years and 17 years of age. If more than one child is applying, all children must reside in the same household.
• The Applicants primary residence address must be inside the  Individual Health Servicecoverage area at least 6 full months of the year.
• Applicants that are not U.S. Citizens may be considered for coverage if they have been a legal resident of the United States for a minimum of one year and have a valid Resident Alien Card (green card), or unexpired VISA in force through the next 18 months (a copy of the card will be required). A U.S. physicians visit within the past two years is required.
• Individuals, age 55 or older, must have seen a physician within the past two years.

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Does My Insurance Cover Gardasil For Girls?

What is Gardasil?

Gardasil is a vaccine created by Merck and Co. In 2006 it was approved by the FDA for use in women as a vaccination against the HPV (human papillomavirus). HPV can cause cervical cancer in women and it is estimated that more than 6 million Americans are infected with HPV every year. HPV is spread through human sexual contact and causes genital warts and may lead to cervical cancer in womena and in very rare cases, anal or penile cancer in men. Most people who contract HPV experience few or no symptoms at all.

Gardasil is recommended only for girls who have not been sexually active, as it does nothing to help those who have already contracted HPV. Gardasil protects from 4 out of more than 100 different viruses that cause HPV. Out of those 100, only about 12 have the potential to cause cervical cancer and Gardasil protects against 2 of those.

How is Gardasil Administered?

Gardasil is administered as a series of 3 shots over six months. Each shot costs $120 as recommended by Merck and Co., but the actual amount charged by your doctor may include their fees or a markup on the vaccine itself. The vaccine is generally only offered to women between the ages of 9 and 26 because that is the age range it was tested on by Merck and Co. and when the FDA approved the vaccine they stuck with that demogratphic.

So Does My Insurance Cover Gardasil?

It probably does. At this point more than 96% of health plans in the nation have provision to cover Gardasil for girls. You should check with your specific provider, but if it turns out that they do not cover you, and you have a hardship in paying for the vaccine, there are programs available directly through Merck and Co. that can help you get the vaccine for free. There are other programs available as well – some from the government – which can assist with paying for this vaccine.

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