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West Virginia Maternity? Heart Attack and Women

Here’s a Doosy!

This morning I got to my office to find this gem in my inbox.  I can’t say that she is wrong, and I admire her tenacity.  Look for my comments at the end. Question: I had health insurance my whole life. I have been a small LLC, member only, business for over 15 years. My [...]

Benefits Questions on Aetna Group Policy

Question–I’m a female and I am an employee (full-time bank teller) with Bank of America, in Atlanta, Georgia. The health benefits that they provide are through Aetna and they provide me health, dental and vision, and no maternity or OB-GYN coverage, which is okay with me. However, I’ve NEVER used the coverage, and I became [...]

West Virginia Maternity?

West Virginia Maternity?

Today we got this question from Amanda regarding maternity in the state of West Virgina.   Comments: Can you please tell me if BCBS is the ONLY provider who offers maternity coverage in WV.  I am having a terrible time identifying other carriers who provide maternity coverage.  And is WV the only state with this [...]

Heart Attack and Women

Heart Attack and Women

We have all read a lot of articles during the past several years describing how heart attack symptoms are different for women than they are for men, with women tending to have shortness of breath, difficulty breathing, dizziness, nausea, pain or pressure in the arms, jaw, back, neck and shoulders, clamminess, sweating, fluttering of the [...]

Here’s a Doosy!

This morning I got to my office to find this gem in my inbox.  I can’t say that she is wrong, and I admire her tenacity.  Look for my comments at the end.

Question: I had health insurance my whole life. I have been a small LLC, member only, business for over 15 years. My health insurance rates began rising 35% annually once I turned 45. On average, in the last 10 years, I paid $5,000/year. I seldom went to the doctors and when I did I have been misdiagnosed. In the last 10 years of having health insurance I paid $50,000 getting reimbursed for less than $500. In 2009, while applying for health insurance I was denied by CareFirst. CareFirst cited high cholesterol (low ratio with 100 HDL that they do not recognized); high eye pressure that I have had for over 20 years and am monitored by an eye doctor (since the early 80s), high BMI (which I am a large boned person) and I was in my late 50s as a woman. While they denied me, they gave me a brochure to Maryland HIP program that is sponsored by CareFirst, so CareFirst takes no risks and gets the overhead/profit. The cost would be around $4000-$5000/annually with a higher deductable a  nd ineligibly for any HSA. I decided not to bite.

I am angry because in my lifetime I have paid over $100,000 and maybe was reimbursed for less that $10,000 if even that. What happened? I was suckered. I was lead to believe that I would have coverage since I was paying into the system my whole life. My advice to all young people and all people is to stay out of the health insurance programs because they take your money for profit and they drop you as you age and become more risky. Health insurance only want to make high bonuses off anyone’s policies. Health insurance companies will cover you only if you are healthy and if you show signs or are statistically a risk, because of getting old, they will drop you.

My great grandparents and grandparents lived into their nineties and never needed much health care, so I will rely on my genes. I mainly wanted insurance for accidents, especially careless people that text and drive.

Another thing I went to my doctor with pains on my left side (stomach). Blood test were taken and the doctor diagnosed me with acid reflux, which I never had or have had. I received insurance statements that my doctor submitted a claim for the blood test, along with LabCorps claims, twice. The doctor and LabCorp tried billing me for the difference. The funny thing is 60% was covered by insurance the 1st time and the other 40% was cover the second submittal by Lab Corp. Then LabCorp had the audacity to try to bill me for the two balances. The total insurance reimbursement was $1000. When I contacted the insurance company to complain, they were nonchalant about it. I asked if they would honor the payee of the insurance and they stated that they only honored the provider. It turned out that I had shingles which no blood test would ever find.

Most individuals have insurance through their companies and never see the insurance statements. I am uncertain if corporations spend time reviewing or even receiving insurance claims about their employees.
The insurance companies have a fraudulent system of over compensation of claims that is one reason why they are insistent people keep getting their insurance through their employers. This over compensation of claims distorts the health care costs.

I don’t feel I need advice from you. I have resolved not to participate in such fraudulent systems as health care insurance. Believe me there are plenty of older women small business owners who have similar stories as mine. My advice to you is to get the word out that the health care and health insurance companies should not be for profit. Once this Country’s health care system is not for profit, then perhaps health care can again be an honorable profession. In the meantime, I will do everything I can to get the word out to the young not to carry health insurance, instead save their money and after 40 years they will have $200K to $300K to cover what ever health issue they have.


Well this isn’t actually a question I don’t think, and I have no idea who this woman is,  much less why she wrote this on my health insurance contact form, or what her goals were in writing it.  I will say it is extremely well written and she is obviously very intelligent and of course, bitter.

Where she is wrong, is her understanding of the word insurance.  Insurance is a transfer of risk.  Similar to auto insurance in fact.  Just because you pay into a policy does not mean it should pay out unless the peril comes to fruition.  I’m sure she has not recovered all of her car insurance premiums back either.

Where is she is 100% correct (and what makes her mistake above almost irrelevant), is that health insurance should be a right not a privilege.  She has been paying into an insurance plan for many years faithfully and now that she can’t find a suitable plan at an affordable price she is right to scream!

Lets draw a parallel to auto insurance, had she wrecked her car several times her auto insurance would be extremely expensive.  But as she said, she has not had health claims to warrant these rate ups.

Thus, she is being rated based on her age which is a factor she cannot change.  Because health insurance is subject to risks you cannot avoid, it should be a government program, much like the fire department.  The fire department used to a private enterprise, until obvious hazards became clear.  Health insurance should be a public utility in the same way.

Sadly, its not and indeed we profit from that fact.  But we are the best of the bunch who will promise to help you even if we make no money on the transaction.

Posted in Health Insurance Q&A0 Comments

Benefits Questions on Aetna Group Policy

Question–I’m a female and I am an employee (full-time bank teller) with Bank of America, in Atlanta, Georgia. The health benefits that they provide are through Aetna and they provide me health, dental and vision, and no maternity or OB-GYN coverage, which is okay with me.

However, I’ve NEVER used the coverage, and I became pregnant and stayed away from work on unpaid leave, and my fiancee (now husband) was supporting me paying all my bills.  But then he became ill, and now he himself is in hospice and is sick.  Meanwhile, we did not pay Aetna for two reasons; firstly, the amount owed became outrageous since they were not able to collect anything from my payroll check from the bank, since I was on UNPAID leave, and secondly, Aetna did not want to accept my offer of $100 per month for a $600 bill, which I think is ridiculous.

Aetna said that they could not accept a payment arrangement, but they could arrange for monies to be taken from my check. On another note, today, I opened my check, and for a third time, $300 is missing.  I have some savings and family members are helping me, but these things will soon run out, and that coupled with this situation with Aetna could cost me everything, my apartment and car.  I could lose literally everything….all because of Aetna.

My credit is in the 800s, THANK GOD, which gives me no reason at all to file bankruptcy, which I don’t think would even help a health benefits case anyway. Also, please understand that Bank of America has NOTHING to do with this. They always transfer me to Aetna when I call.  Tomorrow is Monday, and I’m calling first thing in the morning to see if they will cease collecting money from my check. I’m not trying to avoid paying the bill, but I cannot do it on their terms, and what’s more, I did not sign anything.

The benefits package was sent to me after I clicked a “yes” box on my Bank of America employment application, when it asked did I want to enroll in benefits. There was nothing in the benefits packet that said anything relating to what they’re doing to me. I do have an attorney, but since I’m paying them through a payment plan, the work that they do for me is limited until they’re paid in full. So My question is this:  Does Aetna have a legal right to continue to do this, causing me to lose everything? Please advise.

Answer-  I really feel for you and wish I could do something concrete like call or pressure Aetna to make an exception this one time but they simply won’t listen to me, especially as this is group business related not individual.  That being said, the answer to your question is pretty simple.

When you sign up for health benefits, you sign up for a whole year or enrollment period, in most situations, although some employers/insurance companies will let you cancel during the year.  Bank of America sounds like it does not let you cancel.

However, based on what you are saying about your husband getting seriously sick it might be a huge mistake to try to cancel even if you could.

If you have any of the following events occur though you might be able to wiggle out of the plan;

- Divorce or change in the marital status
- death of the dependent
- change in the dependent status
- change in your employment status

I would not recommend divorcing your spouse (or killing him) to get out of your insurance bill.

Posted in Health Insurance Q&A0 Comments

West Virginia Maternity?

West Virginia Maternity?

Today we got this question from Amanda regarding maternity in the state of West Virgina.


Comments: Can you please tell me if BCBS is the ONLY provider who offers maternity coverage in WV.  I am having a terrible time identifying other carriers who provide maternity coverage.  And is WV the only state with this problem?

Thank you kindly,

Amanda W.

Actually Amanda, Coventry also offers maternity in West Virgina, but only on 3 plans including the A13, A14, and the Classic Copay 80.  Luckily for you, we sell both Coventry and Blue Cross, and I recommend you call our sales floor at 888 803 5917 to help you navigate this complex issue.

Additionally Medicaid also provides maternity coverage as evidenced below.

POVERTY-LEVEL PREGNANT WOMEN AND INFANTS UNDER AGE ONE – Pregnant women and children under age one with family income at or below 150% of the current Federal Poverty Level (FPL). No asset test. Children born to Medicaid eligible mothers remain eligible for 1 year after birth without the need for a Medicaid application when the child remains in the home with the mother.

There is also this document from the West Virgina Health and Human Resources Department on maternity including perinatal care and improving pregnancy outcomes.

Posted in Health Insurance Q&A0 Comments

Heart Attack and Women

Heart Attack and Women

We have all read a lot of articles during the past several years describing how heart attack symptoms are different for women than they are for men, with women tending to have shortness of breath, difficulty breathing, dizziness, nausea, pain or pressure in the arms, jaw, back, neck and shoulders, clamminess, sweating, fluttering of the heart, abdominal pain, stomach pain, fatigue, anxiety, tightness or squeezing pressure in the chest, or strong chest pains. Many women do not recognize these symptoms as relating to a heart attack or they don’t think that women have heart attacks.

Sometimes a woman will have a few of the symptoms, or maybe only one. Not recognizing the symptoms as relating to a possible heart attack may cause a delay in calling 911 for emergency care, and could cause a loss of life. It is said that if a person is having a heart attack, it is important to get medical attention within the first two hours, and the sooner the better. Many medical articles recommend that if you possible heart attack symptoms, you take an aspirin to prevent further blood clotting, get to a hospital, and make sure you get an EKG or blood enzyme test to determine if you are having a heart attack. Although many women who are insured don’t recognize the symptoms, many women who are uninsured wait too long before seeking medical care because the financial result could be devastating to them.

It is so very important to visit a doctor regularly to be able to identify possible problems before they become serious. A good health insurance policy will allow you to get the preventive medical attention that you need to avoid life threatening situations from developing, and with the proper health insurance policy, you will not hesitate to seek treatment when the first symptoms develop.

Once you have had a heart attack, getting health insurance is impossible unless we set up a one man group or do PCIP.  Why?   Because heart attacks usually are the result of another condition which is likely worse.

Posted in General Health0 Comments

Endocarditis & Health Insurance Question

Endocarditis & Health Insurance Question

Got a great question today from James in Virginia.

Question: I’m in the process of changing jobs, and I currently have group coverage through United Health Care, as a Walgreen’s employee. I’ve been covered for about three years now. A few months before I became employed there, I became suddenly and dangerously sick, and it turned out I contracted a case of endocarditis. One of the contributing factors was my congenital heart defect, called a Ventricular Septal Defect (VSD). I have since fully recovered and am likely healthier now than I was before I became ill. I have begun the process of looking for a private insurance policy, as the job I’m preparing to take doesn’t offer group coverage. I have already been turned down by Humana, so before I go applying to every Tom, Dick, and Larry in the industry, I wondered if you might have any idea which companies might offer me the best chance of finding coverage. I am a resident of Virginia. THANK YOU for any help you can offer!




Well its a great question James and a year ago I would have been under duress to provide a great answer but now due to PCIP, we should apply with one more carrier so we can show 2 declines.  Once we are declined again we can go to PCIP and get a great plan for way less than an individual plan would cost anyways.

However, what about Endocarditis itself?  Is it insurable?  Endocarditis is considered insurable by some carriers, but only after 3 years of being disease free and at a very substantial premium.  Most carriers like Coventry (check the Coventry Underwriting Guidelines here) call it an immediate decline.  In any case, PCIP will likely be the best place to end up.

What is Endocarditis and Why Is not Insurable?

Endocarditis is an inflammation of your heart’s inner lining. The most common type, bacterial endocarditis, occurs when germs enter your heart.  Endocarditis is uncommon in people with healthy hearts which is why most insurance companies want to avoid the condition. People at greatest risk of endocarditis have a damaged heart valve, an artificial heart valve or other heart defects.

Endocarditis typically occurs when bacteria or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to damaged areas in your heart. Left untreated, endocarditis can damage or destroy your heart valves and can lead to life-threatening complications. Treatments for endocarditis include antibiotics and, in severe cases, surgery.

Endocarditis has evolved into several variations, keeping it near the top of the list of diseases that must not be misdiagnosed or overlooked. Endocarditis can be broken down into the following categories:

  • Native valve endocarditis (NVE), acute and subacute
  • Prosthetic valve endocarditis (PVE),[8] early and late
  • Intravenous drug abuse (IVDA) endocarditis


 Follow Up from James


Sorry it’s taken me so long to get back to you. Recently I’ve started my new job, and for the time being, I’m working 7 days a week. Are there any evenings which I might be able to call and reach you after 5pm? That’s pretty much the only time I’m free to call, and I want to see if you can help me get the coverage I need. It sounds like you can. I may be willing to fall back on PCIP coverage as a last resort if it’s completely necessary, because in addition to myself, I’ll need coverage for my daughter as well. But for various reasons, I’d much rather avoid relying on a government-sponsored health plan. If I can afford to keep my coverage in the private sector, I’m willing to pay a higher premium, so long as it’s not so high I can’t afford it. Right now, I’m paying Walgreen’s approximately $270 a month for the coverage for myself and my soon-to-be 4 year old daughter.


Also, I’m honored you chose my question for your blog. I’d love to have a link to the blog so I can see it for myself. Thanks! Talk to you soon. Thank you again for making yourself available to help me with my health insurance coverage.

Follow Up Answer to James

Well James, I am glad to hear you are working and getting by in this tough economy.  You can call our office anytime at 888 803 5917, most nights we (including me) are here until 7pm.  Your daughter assuming she is healthy can go on KidCare depending on which state you live in (Virginia does have a KidCare program) and generally costs $100 or so per month.  I do realize that is also a government plan, but it is more of a state thing than a federal government thing.  Though to be precise the program is probably funded by the federal government.

In any case, we can help you though we might need to get creative for the 6 months before you can get PCIP.

Posted in Health Insurance Q&A0 Comments



Hemochromatosis…a great reason to have a good health insurance policy.

Hemochromatosis is a disease where too much iron accumulates in your body, often described as iron overload. Iron is a mineral, and too much of it becomes toxic to your organs, including the pancreas, liver and heart, leading to diseases including diabetes, heart disease, and cirrhosis or cancer of the liver.

In some people the iron accumulates in the part of the brain that produces chemicals, and causes depression. The main type of hemochromatosis is caused by a genetic defect, passed on by both parents. It is often not diagnosed until significant damage has been done to the organs, and can eventually result in death when the organs shut down or become so severely damaged by the iron that they cease to perform their normal functions.

Diagnosis can be easily done through blood testing, and once diagnosed, regular treatments can lead a person to live a normal life, providing the organs have not yet suffered serious damage. If you are diagnosed as having hemochromatosis, you will requires lifelong blood testing and treatments to remove the excess iron from your body.

You may not realize that you are at risk for this genetic disease because your parents might be carriers and not express the symptoms of the disease themselves, or one or both of your parents may have suffered from various diseases, and perhaps died from them, not realizing that their diseases were secondary diseases resulting from untreated iron overload. A good health insurance policy will protect you from financial complications if you end up with a diagnosis for hemochromatosis and require lifelong testing and treatments. Ask your doctor to test you for this disease, which can be ruled out with a blood test.

HHC is not an automatic decline condition by every health insurance company nor is it automatically a condition for acceptance through PCIP.  Insurance companies will make case by case decisions regarding the insurability of each person.

Posted in Health Insurance Q&A0 Comments

Bigger Cobra Update

Cobra & ARRA News

From the Department of Labor’s website, the following Cobra news was released today, Congress has extended the COBRA extension and Premium Assistance bill for another two months until the end of February.


News Statement

Release Date: December 21, 2009
Contact Name: Gloria Della or Joseph De Wolk
Phone Number: 202.725.8422/202.579.4681

Statement of Phyllis C. Borzi on COBRA subsidy extension

Washington, DC – Phyllis C. Borzi, Assistant Secretary of the Employee Benefits Security Administration (EBSA) today released the following statement regarding the Consolidated Omnibus Budget Reconciliation Act (COBRA) and the recent extension of the premium reduction under the American Recovery and Reinvestment Act (ARRA):

“I am pleased Congress has acted and the President has signed the Fiscal Year 2010 Defense Appropriations Act. The act extends the eligibility period for the COBRA premium reduction for an additional two months (through Feb. 28, 2010) and the maximum period for receiving the subsidy for an additional six months (from nine to 15 months). Millions of unemployed Americans and their families will be better able to afford and keep their health benefit coverage because of this new law.

“Individuals who had reached the end of the reduced premium period before the legislation extended it to 15 months will have additional time to pay the reduced premiums related to the extension. To continue their coverage they must pay the 35% of premium costs by (60 days after date of enactment) or, if later, 30 days after notice of the extension is provided by their plan administrator.

“We encourage you to subscribe to our COBRA Web site, www.dol.gov/cobra, to get information on new notice requirements, updated guidance, fact sheets, and frequently asked questions as they become available.

“Individuals should contact their plan or health insurance provider for information regarding the extension under their health plan. If you need further assistance contact an EBSA Benefits Advisor toll-free at 1-866-444-3272.”

U.S. Department of Labor news releases are accessible on the Department’s Newsroom page. The information in this news release will be made available in alternate format (large print, Braille, audio tape or disc) from the COAST office upon request. Please specify which news release when placing your request at 202.693.7828 or TTY 202.693.7755. The Labor Department is committed to providing America’s employers and employees with easy access to understandable information on how to comply with its laws and regulations. For more information, please visit the Department’s Compliance Assistance page.


Fact Sheet: COBRA Premium Reduction

Printer Friendly Version

U.S. Department of Labor
Employee Benefits Security Administration
January 27, 2010

Changes Regarding COBRA Continuation Coverage Under ARRA, as amended by the 2010 DOD Act

The 2010 DOD Act extended the COBRA premium reduction eligibility period for two months until February 28, 2010 and increased the maximum period for receiving the subsidy for an additional six months (from nine to 15 months).

Individuals who have reached the end of the original premium reduction period are in a “transition period” giving them additional time to pay extension-related reduced premiums. An individual’s transition period is the period that begins immediately after the end of the maximum number of months (generally nine) of premium reduction available under ARRA prior to its amendment. An individual is in a transition period only if the premium reduction provisions would continue to apply due to the extension from nine to 15 months and they otherwise remain eligible for the premium reduction. These individuals must be provided a notice (see below for details) of the extension within 60 days of the first day of their transition period. An individual’s transition period may include multiple periods of coverage. The retroactive payment(s) for the period(s) of coverage must be made by the later of February 17, 2010, 30 days from when the notice was provided, or the end of the otherwise applicable payment grace period. (For more information about the “transition period” see the Frequently Asked Questions on the COBRA Premium Reduction Extension Provisions on the EBSA website at www.dol.gov/cobra.)

Individuals who lost their subsidy and paid the full 100 percent premium for December 2009 should contact their plan administrator or employer sponsoring the plan to discuss a credit for future months of coverage or a reimbursement of the overpayment.

Eligibility for the Premium Reduction: The premium reduction for COBRA continuation coverage is available to “assistance eligible individuals”.

An “assistance eligible individual” is the employee or a member of his/her family who:

  • has a qualifying event for continuation coverage under COBRA or a State law that provides comparable continuation coverage (for example, so-called “mini-COBRA” laws) that is the employee’s involuntary termination at any point from September 1, 2008 through February 28, 2010; and
  • elects COBRA coverage timely.

Those who are eligible for other group health coverage (such as a spouse’s plan) or Medicare are not eligible for the premium reduction. There is no premium reduction for periods of coverage that began prior to February 17, 2009.

Assistance eligible individuals who pay 35 percent of their COBRA premium must be treated as having paid the full amount. The premium reduction (65 percent of the full premium) is reimbursable to the employer, insurer or health plan as a credit against certain employment taxes.

Period of Coverage

The premium reduction applies to periods of coverage beginning on or after February 17, 2009. A period of coverage is a month or shorter period for which the plan charges a COBRA premium. The premium reduction for an individual ends upon eligibility for other group coverage (or Medicare), after 15 months of the reduction, or when the maximum period of COBRA coverage ends, whichever occurs first. Individuals paying reduced COBRA premiums must inform their plans if they become eligible for coverage under another group health plan or Medicare.

Notice Requirements

ARRA, as amended by the 2010 DOD Act, mandates that plans notify certain current and former participants and beneficiaries about the premium reduction. The Department has updated its existing models and created an additional model to help plans and individuals comply with these requirements. Each model notice is designed for a particular group of individuals and contains information to help satisfy ARRA’s notice provisions, including those added by the 2010 DOD Act.

Plans subject to the Federal COBRA provisions must provide a General Notice to all qualified beneficiaries, not just covered employees, who experienced a qualifying event at any time from September 1, 2008 through February 28, 2010, regardless of the type of qualifying event, and who have not yet been provided an election notice. Individuals who experience any qualifying event after December 19, 2009 must get the updated General Notice within the normal timeframes for providing a COBRA election notice. The updated model General Notice includes information on the premium reduction as well as information required in a COBRA election notice.

Plan administrators must also provide notice to certain individuals who have already been provided a COBRA election notice that did not include information regarding ARRA, as amended. The Department has developed a model Premium Assistance Extension Notice. This model notice includes information about the changes made to the premium reduction provisions of ARRA by the 2010 DOD Act. Listed below are the affected individuals and the associated timing requirements.

  • Individuals who were “assistance eligible individuals” as of October 31, 2009 (unless they are in a transition period – see below) and individuals who experienced a termination of employment on or after October 31, 2009 and lost health coverage (unless they were already provided a timely, updated General Notice) must be provided notice of the changes made to the premium reduction provisions of ARRA by the 2010 DOD Act by February 17, 2010;
  • Individuals who are in a “transition period” must be provided notice of the changes made to the premium reduction provisions of ARRA by the 2010 DOD Act within 60 days of the first day of the transition period. (The transition period begins immediately after the end of the nine months of premium reduction in effect under ARRA before the amendments made by the 2010 DOD Act, as long as the premium reduction provisions of the 2010 DOD Act would apply due to the extension from nine to 15 months).

Note: Some individuals may be entitled to multiple notices. To satisfy the notice requirements, these individuals may be provided a single notice that includes all of the required information so long as the notice is provided by the earliest date required.

Insurance issuers that provide group health insurance coverage must provide notice to persons who became eligible for continuation coverage under a State law. The Department updated its model Alternative Notice to assist issuers with satisfying this requirement. However, continuation coverage requirements vary among States and issuers should modify this model notice as necessary to conform it to the applicable State law. Issuers may also find the model Premium Assistance Extension Notice or the updated model General Notice appropriate for use in certain situations.

Expedited Review of Denials of Premium Reduction: Individuals who are denied treatment as assistance eligible individuals and thus are denied eligibility for the premium reduction (whether by their plan, employer or insurer) may request an expedited review of the denial by the U.S. Department of Labor. The Department must make a determination within 15 business days of receipt of a completed request for review. The official application form is available at www.dol.gov/COBRA and can be filed online or submitted by fax or mail.

Switching Benefit Options: If an employer offers additional coverage options to active employees, the employer may (but is not required to) allow assistance eligible individuals to switch the coverage options they had when they became eligible for COBRA. To retain eligibility for the ARRA premium reduction, the different coverage must have the same or lower premiums as the individual’s original coverage. The different coverage cannot be coverage that provides only dental, vision, a health flexible spending account, or coverage for treatment that is furnished in an on-site facility maintained by the employer.

Income limits: If an individual’s modified adjusted gross income for the tax year in which the premium assistance is received exceeds $145,000 (or $290,000 for joint filers), then the amount of the premium reduction during the tax year must be repaid. For taxpayers with adjusted gross income between $125,000 and $145,000 (or $250,000 and $290,000 for joint filers), the amount of the premium reduction that must be repaid is reduced proportionately. Individuals may permanently waive the right to premium reduction but may not later obtain the premium reduction if their adjusted gross incomes end up below the limits. If you think that your income may exceed the amounts above, consult your tax preparer or contact the IRS at www.irs.gov.

This fact sheet has been developed by the U.S. Department of Labor, Employee Benefits Security Administration, Washington, DC 20210. It will be made available in alternate formats upon request: Voice phone: 202.693.8664; TTY: 202.501.3911. In addition, the information in this fact sheet constitutes a small entity compliance guide for purposes of the Small Business Regulatory Enforcement Fairness Act of 1996.

Posted in Health Insurance News0 Comments

Many Agree, the House Bill that Just Passed is “NOT What the Doctor Ordered”

Many Agree, the House Bill that Just Passed is “NOT What the Doctor Ordered”

All of us at East Coast Health Insurance have asserted the same sentiment, that is, that although we advocate health care reform and feel that health care costs need to be mitigated a public option is not the solution. Rather a public option would only aggravate the current problem that is evident in our currently government sponsored programs such as Medicare and Medicaid and add yet another mediocre program.

Now Medicare and Medicaid in theory, much like communism, works great but in practice especially with the private insurance industry and pharmaceutical companies lurking around every corner it just doesn’t seem to be working as effectively or efficiently as it should be.

So instead of launching another program that will inevitably end up on a 20/20 special sparking awareness of the billions of dollars being spent on “public option” fraud, why don’t we come up with checks and balances and perhaps even implement new systems in our currently run programs, Medicare and Medicaid. These programs can and must thrive, and launching another government sponsored program is not going to get the job done – we need to look at the matter at hand and fix it instead of sweeping it under the rug for our kids to find when they need to redeem their Medicare benefits. John McCain asserted that Medicare is GOING BROKE in 7 years; and just in case you were wondering if I was quoting some random right-winged politician, it should be noted that President Obama even credited Senator McCain with advocating the same principles found in his own proposal during the election.

And now our very own Senator LeMieux has come forward with his statement regarding the newly passed House Bill and below you can check out his insight into the 1990 page bill – instead of reading the entire thing, I believe the Senator’s cliff notes found on the Senate floor and his website are more than sufficient.

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Posted in Health Insurance News, Health Reform Opinion, Health Reform Update6 Comments

Premium Increases

Here is a Question from Anonymous in Florida:

What Determines the Premium Increases for Individual Health Insurance and How High Can They Go?


Answer:  Well Anonymous this is actually a great question that we get asked time and again.  The first part of your question is about Premium Increases.  On individual health insurance, premiums can only be increased for an entire demographic.  So for instance, they can’t target John Doe aged 40 in Miami for his own 30% increase.  Either everyone gets it or nobody gets it.  But, there can be multiple increases for the same region but in the different age bands.   So all the 40-45 year old males might get a 15% rate increase and all 18-24 males might only get a 4% increase.   Additionally, when it comes to domiciled health insurance companies (which is all of the health insurance companies that East Coast Health Insurance represents, except United Health Care) their rate increases must be approved by the state.  Oftentimes this means absolutely nothing as we have seen 20% increases year over year.

Health Insurance margins are pretty much constant at the industry average of 4% so that is why you might see uneven premium increases across various demographics.  This would occur because lets say Cigna had an exceptionally bad loss on 40 – 45 year old males, so they have to hit this demographic harder than others.  And, this might only occur in a particular city or county so the difficulties in guessing rate increases becomes even more difficult unless you are able to look at detailed Actuary Tables for the results in a certain demographic.

But to answer the last part of your question individual health insurance premiums can go up as high 30% if they are approved by the State.  In practice, however the average annual increase for domiciled health insurance companies is 12%.   Many companies like Humana and United Health One raise their premiums 3% every quarter for new enrollments.  These increases are passed on to the older members on their policy anniversary date in order to have homogeneous premiums for various demographics.

What makes up premium increases besides claims experience?  Inflation (this is the most scary one), rising health care costs (this is the 2nd most scary one), and of course the fact that you are a year older unless you figured out a way to age backwards like Benjamin Button.  The scariest thing is that in the next few years health care and health care costs will make up nearly 25% of our GDP unless someone fixes our health care system and the current bill that is headed for the Senate does not even address rising health care costs.


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October is Breast Cancer Awareness Month: WAKE UP and Get a Free or Low Cost Mammogram in South Florida

October is Breast Cancer Awareness Month: WAKE UP and Get a Free or Low Cost Mammogram in South Florida

According to the National Cancer Institute, 192,370 women will be diagnosed with breast cancer in 2009, and more than 40,000 women will die from the disease this year alone.

While our economy is in dire straits and the war continues, that’s right there’s still a war going on although all the media seemingly focuses on is whether Obama was born in Hawaii or which celebrity is in rehab…anyway, my apologies for the tangent!  Bottom line is that while the unemployment rate rises steadily and the economy worsens people are dying of cancer.  Yeah, we all have problems – WHY HAVE ANOTHER ONE – if you go get a mammogram you can save yourself and your family a whole lot of time and worry and funeral planning.  Perhaps this is coming off to abrasive and this is not meant for those who have no resources and information necessary to obtain this crucial bit of information or that were in fact diagnosed or battling breast cancer.  I was 25 when I found out that I needed emergency surgery for what was on it’s happy way to cervical cancer – yet I still smoke – stupid I know!  So back to the matter at hand, although many people may be aware that this month is just that, Breast Cancer AWARENESS month, I wanted to be sure to advise what resource centers are available in South Florida that are offering mammograms at little to no cost.  My mother is 53 and refuses to have a mammogram, and I cannot do anything to make her have one so instead I turn to this post in hopes that my plea may reach other people even if it’s just one person.  Seventy-five percent of people who die from breast cancer DID NOT HAVE A MAMMOGRAM; this is not an exaggeration or a guess but rather clearly stated by Robin Quivers on the Howard Stern show a couple of days ago..and of course she obtained that information from a viable source. So I don’t remember exactly where, but just to be sure that I do not lose any credibility along with this site’s information I went ahead and posted additional information that will only solidify the notion that preventive healthcare, and for our purposes mammograms specifically are beneficial and have proven to save lives.

If you have health insurance, then HOPEFULLY you know this little piece of legislation I have below that clearly states that an insurance carrier (if your insurance does not cover this then you either have a discount plan, indemnity plan, really lacking benefits, or something really bad anyway and should contact a licensed health insurance agent to compare health insurance options to find a REAL PLAN that covers the REAL IMPORTANT STUFF like MAMMOGRAMS). I hope the information below sheds some more light on your right to have a mammogram and not only that but the importance of doing so and finally on how accessible it is through contacting one of the many resource centers in South Florida - especially during the month of October!

Florida Statutes 627.6613 – Coverage for mammograms

Florida Statutes > Title XXXVII > Chapter 627 > Part VII > § 627.6613 – Coverage for mammograms

Current as of: 2008 Session
Check for updates

627.6613 Coverage for mammograms.

(1) A group, blanket, or franchise accident or health insurance policy issued, amended, delivered, or renewed in this state must provide coverage for at least the following:

(a) A baseline mammogram for any woman who is 35 years of age or older, but younger than 40 years of age.

(b) A mammogram every 2 years for any woman who is 40 years of age or older, but younger than 50 years of age, or more frequently based on the patient’s physician’s recommendation.

(c) A mammogram every year for any woman who is 50 years of age or older.

(d) One or more mammograms a year, based upon a physician’s recommendation, for any woman who is at risk for breast cancer because of a personal or family history of breast cancer, because of having a history of biopsy-proven benign breast disease, because of having a mother, sister, or daughter who has or has had breast cancer, or because a woman has not given birth before the age of 30.

Breast Cancer Research Highlights From The American Association Of Physicists In Medicine Meeting In Anaheim, July 26-30

Half of all Americans will be diagnosed at some point in their lives with cancer, the number two killer in the United States. One of the most common types, especially among women, is breast cancer. According to the National Cancer Institute, 192,370 women will be diagnosed with breast cancer in 2009, and more than 40,000 women will die from the disease this year alone.

Breast Cancer Screening

Summary of the Evidence

By Linda L. Humphrey, M.D., M.P.H.a; Mark Helfand, M.D., M.S.a; Benjamin K.S. Chan, M.S.a; and Steven H. Woolf, M.D., M.P.H.b.

Address correspondence to: Linda Humphrey, Oregon Health & Science University, Mailcode BICC, 3181 SW Sam Jackson Park Road, Portland, OR 97201-3098; E-mail: humphrey@ohsu.edu.

This article originally appeared in the Annals of Internal Medicine. Select for copyright and source information.


Breast cancer is the second leading cause of cancer death among North American women. Approximately 1 in 8.2 women will receive a diagnosis of breast cancer during her lifetime, and 1 in 30 will die of the disease.1 Breast cancer incidence increases with age,1 and although significant progress has been made in identifying risk factors and genetic markers, more than 50 percent of cases occur in women without known major predictors.2-5

This review was commissioned to assist the current U.S. Preventive Services Task Force (USPSTF) in updating its recommendations on breast cancer screening. We focus on information that was not available in 1996, when the previous USPSTF examined the issue.6 Our goal was to critically appraise and synthesize evidence about the overall effectiveness of breast cancer screening, as well as its effectiveness among women younger than 50 years of age.

Effectiveness of Mammography in Reducing Breast Cancer Mortality

Table 4 (Printable Version: PDF File, 8 KB) summarizes the most recent results from trials that included at least some participants older than 50 years of age. The four Swedish trials that compared two to six rounds of mammography with usual care23,26 reported 9 percent to 32 percent reductions in the risk for death from breast cancer.


Fair-quality, relatively consistent evidence suggests that mammography screening reduces breast cancer death among women 40 to 74 years of age

Women older than 70 years of age have the highest incidence of breast cancer, and test performance in these women is likely to be similar to that in women 50 to 70 years of age. Therefore, theoretically, mammography should be at least as effective for women older than 65 years of age as it is for younger women.

Miami doctor offers free mammograms to unemployed

By John Dorschner | The Miami Herald

With the number of uninsured rising daily, a prominent South Miami radiologist is offering free mammogram screenings for women who have lost their jobs and health insurance.

“In the spirit of Barack Obama, we need to volunteer to help our country,” said Nilza Kallos, who operates the Breast Health Center and Diagnostic Ultrasound.

She challenged other physicians to make similar offers. “This could be like an invitation to other doctors to step up,” she said.

“I’ve heard surgeons say they don’t have enough work. Well, how about helping those who need help?”

Kallos’ offer comes as many financially pressed patients are curtailing care because they can’t afford it. Some are insured and can’t even afford the co-payments. Few doctors in South Florida are matching Kallos’ free offer, but many in Broward and Miami-Dade are offering discounts to those who need them.

“The situation has reached the crisis stage,” says Bernd Wollschlaeger, a North Miami Beach physician and president of the Dade County Medical Association.

“I think we need to do something.”

He says he and others are lowering their prices for their uninsured patients or giving them other help if they can’t afford to pay. “If you donate some of your time, it comes back to help you,” because patients will remember helpful doctors when the economy improves.

Here are a couple of centers as well as an article regarding how one may be able to obtain a free or low cost mammogram during the month of October especially, I implore anyone over the age of 35 who has not received a base line mammogram to take advantage of this opportunity and even moreso, to those who are over 40 and should be getting a mammogram once a year!  For many more resource centers please go to www.miamihealthquote.com in which lists all the government assistance programs as well as providers in South Florida who offer free or low cost medical services!

You can make an appointment for an array of medical services ranging from mammograms to behavioral health services at the Helen B Bentley Family Health Center in Miami, Fl.

Fees charged for services are based on one’s financial ability to pay. Affordable healthcare. Community based healthcare center. Fees for services and based on client’s ability to pay determined through financial evaluation.

Helen B. Bentley
Family Health Center

3090 SW 37th Avenue • Miami, FL 33133
Phone: 305-447-4950 • Fax: 305-444-7866


October 19th, 2006
7:30 a.m. to 8:30 am
Aventura Community Recreation Center
3375 NE 188 Street
Aventura, FL 33180
Breakfast with Breast Cancer Expert – Topic: Breast Cancer Awareness Lecture and Screenings – Physician: Dr. Alana Harris and Project Screen will be providing information on free and low cost mammograms – Food: Light breakfast will be served. – RSVP: 1-888-256-7692

Memorial Healthcare System Directory

Memorial Healthcare System3501 Johnson Street | Hollywood, Florida 33021
(954) 987-2000
Phone List | Maps & Directions

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