Imagine a doctor’s appointment without the commute, or the waiting rooms with strange smells, forced to peruse magazines you would never typically pick up just to ignore your surroundings. The living room sofa, your local drugstore, or the coffee shop are the potential faces of the new waiting room. With the capabilities of telemedicine, the virtual realm has extended itself to online doctor visits, providing the high-speed pace of service we come to expect in this age. We also can miraculously find better prices on everything we need online, so why not skip the PCP, or in-store clinic, and go straight to the first available board-certified physician? The convenience and the price sound unbeatable, but there are several factors that may not make it such a perfect operation.

Several things are compromised in this situation: the patient’s security, the health care system’s security, and the welfare of the medical field. A virtual doctor is not the same as having a personalized visit, someone peering inside your ear canal, inspecting the problem. Listening to a patient’s description and trusting their words is a cheap, easy road to manipulation of the system. How much abuse does the medical system already experience? Telemedicine could create an increase in this mistreatment for personal and ultimately illegal benefit. Also, what about people who have dedicated their lives to helping people (in person)? Sure, a $45, 10-minute visit is appealing, but in the long run, you are short changing yourself and others. Doctor’s salaries have already seen significant cuts in the past few years, and this virtual “solution” could lead to hard-earned degrees, and decades of valuable medical experience going to waste.

There is little trust that can be had over any internet transaction. Though board certifications are present, these doctors are still not examining your symptoms with their own eyes and ears. Pixels and sound waves, however HD the quality, are not medical devices. As for the patient’s information, there should hopefully be a secure application process, as sometimes efficiency can take precedence over security. People may be so eager to receive quick, affordable health care that they do not realize who is collecting their information. UnitedHealth Group is surely reputable, but there is always the possibility of information selling and interception.

In short, keep doctors in business; they might still be paying back loans for med school, and have families to insure themselves. Also, help in the effort to minimize manipulation of the health care system. Many people seem to get away with lying to doctors in person, imagine the possibilities when it’s buffered by thousands of miles and an LCD screen.

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A Proposed Rule Could Make Millions Ineligible For Health Insurance Subsidies
by Erik Berman

A major issue in the workplace today is the U.S. Government’s Health Care Insurance subsidy proposal to allow low to moderate income employees to opt out of their employer’s health insurance coverage and instead get federal subsidies to buy insurance through new state-based marketplaces, called “exchanges.”

A health insurance exchange is an exchange run by a private sector company or nonprofit.  They
are designed to help consumers find plans personalized to their specific health conditions, preferred doctor/hospital networks, and budget. These exchanges are sometimes called marketplaces or intermediaries, and work directly with insurance carriers, effectively acting as an extension of the carrier.

President Obama promoted the concept of a health insurance exchange as a key component of his health reform initiative. Obama said that it should be “…a market where Americans can one-stop shop for a health care plan, compare benefits and prices, and choose the plan that’s best for them, in the same way that Members of Congress and their families can.

There is a debate going on right now over who actually qualifies for subsidies and whether or not the government has the authority to force most people to buy health insurance. It’s up to the Supreme Court to resolve how tax credits will be used to subsidize coverage and how many people will qualify.

A proposed Treasury Department rule says workers and their families cannot qualify for those subsidies unless their employer’s health plan is unaffordable because it exceeds 9.5 percent of their household income. There is a legal battle going on right now between Democrats and Republicans about the U.S. Government’s proposed mandate to force people to buy health insurance and to possibly allow tax credit subsidies for low –moderate income employees. Most people agree that health insurance should be available to everyone at reasonable rates and the U.S. Government should not be able to force you to buy it, especially if you cannot afford it.

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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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