Monthly Archives: August 2017

Turned Down For Health Insurance

If you’ve been living without health insurance, you’re not alone. 15.9 percent of all Americans are uninsured as reported by the UHF (United Health Foundation). Sadly, sometimes even when people are trying to be financially and socially responsible they’ll find that they’re unable to qualify for a health insurance policy.

According to survey by U.S. Census Bureau, nearly 60 percent of the population gets health insurance in the form of group policies through their employer. There are other people who get covered by government-sponsored health care, such as children, the elderly, and those with low incomes. Until recently, however, those outside of these groups were largely at the mercy of the policies of for-profit insurance companies when it came to whether they could get coverage.

If initially turned down, ask again or apply with another insurance provider

If you find that you’re in this group that has difficulty getting coverage, the first thing you should do is to try to find out what happened. In some cases, you may be rejected due to an error on the part of the company. If the reasons for your rejection were minor, you may also still be able to get individual insurance through another company. However, if you have a major pre-existing condition such as Cancer or Diabetes, it’s unlikely that any insurance company will consider you a good risk and you’ll have to seek out other options.

State high risk health insurance pools as an option

It is for this reason that a national high-risk insurance pool will be created within 90 days following the passage of the March 2010 Health Care Reform Act for people with existing medical conditions. The pool is backed by $5 billion in federal subsidies, and will offer subsidized premiums to people who have been uninsured for at least six months and have medical problems that have resulted in their being rejected from other insurance options. In some cases these risk pools will be run through the state governments. Either way, the law says that these pools will remain available until the new health care reforms have fully taken effect in 2014.

Prior to this legislation, high risk pools were already available in 34 states and covered 183,000 citizens. From the perspective of someone who wants a policy, the important thing to note is that the quality of coverage offered can vary widely depending on the attitude and policies of the state offering them. Some states are just more generous than others in programs like this, and if you believe that you’re likely to need to use your health care policy regularly, it’ll be worth your while to get a sense of the kind of coverage that your state offers. You should also remember that even though you’ll already be paying higher premiums than a typical insurance plan, you’ll still have to make sure you have enough money in reserve to cover deductibles and co-payments or health care will be as unattainable to you as ever.

In extreme cases, if you find your state’s high risk pool to be a completely unacceptable option, you still have choices but none of them are easy. If you’ve been working at running your own business or at a small business, you may be able to get into a group plan if you can find employment at a large company. In an extreme case, if you know that another state offers a high risk pool option that would work for you, and you have the means to do it (such as family in that area), you could even consider relocating.

Dos and Don’ts When Completing Individual Health Insurance

If you do not have access to a group employer plan then the other option you have is to apply for individual health insurance plan. Individual health insurance application require more information from you then group health insurance plans that you might have had through job. The reason for that is that individual, and that applies to family health plans, are medically underwritten. That means that a person called medical underwriter will go over your medical application and decide if you are a good risk for the insurance company. The main reason for medical underwriting is to keep over all cost for every one low. The more insurance company has to pay out in claims the more they have to charge every one for health insurance to keep the average cost down.

If you have already had a chance to take a look at individual application then you probably know that it can be long. How much of the application you have to fill out depends on your previous medical history. If you are in perfect health then there is not much that you can write on your application other then some basic information. If you are some one who has been to the doctors for lab work, test or takes prescription medication then you would have to include that on your application. Most individual application require you to provide information of your doctor or the last doctor you have been to. If you are not sure of the name of the doctor you can always include the hospital name, clinic name or doctors practice name. When it comes for the dates of your last doctor office visit or any other dates. If you do not remember exact dates, just put down your best estimate.

The most important thing to keep in mind when filling out individual or family application, especially if you do have some medical issues, is to understand this. Until there is a permanent change to health care system and health insurance is not medically underwritten. Insurance company will consider every condition that you have and every medication that you take. The reason for that is that in most states in the US health insurance companies require to cover everything once you are approved. That means that all of your medical conditions and prescription drugs have to be cover by law once you have been approved for coverage. That is if you are approved. I hate to use this analogy because we a talking about human lives, but the simple way to explain health insurance is to compare it to car insurance. For example lets say you get in the minor car accident and you do not have car insurance. Your car is still drivable and it looks like you will need a new bumper and some paint. The next day you go out and purchase car insurance to cover your accident. Well we know it does not work like that. If you could just go out and get car insurance only after you had an accident then no one would pay for car insurance. Why pay if you can just get it after you had an accident. No one would pay for car insurance and car insurance companies would not exist. Then you would be fully responsible for all the damages out of your own pocket. I know I would rather pay that $100 a month just in case something does happen.

Most people do not recognize that health insurance works in the same way. Health insurance companies are not going to approve some one who requires immediate medical assistance. That includes pending follow up visits to the doctor, recent surgery (after a surgery a lot of complications can arise), prescription drugs and anything that is known upfront that could potentially be covered expense. Insurance companies use a “actuarial tables” to underwrite individual applications. If based on what you have put down on the application could potentially cost insurance company money, chances are your application will not be approved.

If health insurance companies automatically approved all the application then it would be the same scenario as with car insurance example, that no one would pay for health insurance. I know I would not, why pay for insurance if I can get it when I get sick. If no one would pay for insurance then there would no insurance companies to cover us for unforeseen large medical expenses. I am certainly not prepared to pay $400,000 or higher for medical emergency.

Getting approved for health insurance could take some preparation. If you are currently taking prescription drugs, find out how to can slowly get off them. I am not a doctor and certainly would never tell anyone to not take drugs that were subscribed by their doctor. I think sometimes great health starts with us, with small daily choice we make. Take care of your body and it will take care of you. When completing application sometimes being too honest can cost you also. That does not mean lying. Going to chiropractor and writing on the application that you have had back pains and you will need to see a specialist. On top of that is that you have not has any health insurance previous is just way to suspicious. It looks like you are trying to get health insurance to get medical care for something that you do not want to pay yourself. Do not make it worse then it is and always phrase everything in the positive. Instead of you writing that you are having back pain, taking Advil and going to chiropractor. Phrase it that you went to chiropractor for maintenance just to realigning your back. I see a lot of people get declined for coverage even though they are in perfect health just because how and what they wrote on the application.

Real people will be looking at your application if you are making it worse then it is or you are volunteering too much information then it is only your fault if you get declined. Your answers should be, everything is fine, just a check up, results were normal. Also before you know that you might be looking for health insurance do not go see your doctor until you do have coverage. If you go to the doctor and they find something “wrong” with you then bye, bye health insurance. Now you are stuck. When at the doctors office, again, be careful what you tell your doctor because it will end up in your medical records. When self diagnosing your self do not volunteer that information to your doctor, it is your doctors job to find if there is an issue. If you have been declined for health insurance there are options available to you so is having or not having health insurance. Having any health insurance plan is infinitely better then not having anything at all. It is a know fact that you will get a better treatment if the hospital knows that you have some way to pay for your medical care and that they are not just working for free taking care of you. The one and the most important thing that you can do is to take care of your health. Eat your broccoli.

Health Insurance in California, Now What

If you are reading this then you probably have been declined for health insurance in the recent past. When you get declined for health insurance it probably has something to do with your medical history. Since California is one of the underwritten states health care companies have the right to declined people for health insurance. Who health insurance company might decline and who it might not all depends on risk assessment using actuarial tables. Anytime when you fill out individual application for health coverage and answer yes on one of the medical questions your application might be manually reviews by one of the underwriters. It is a person who is responsible to reviewing application using actuarial tables. Actuarial tables are statistics done by the insurance companies, hospitals, doctors, researchers that predict the cost of insuring some one with a specific medical history.

Some states like New York, New Jersey and Washington require insurance companies to insure everyone. Those three states do not have medical underwriting and everyone is automatically approved for health coverage. In order to insure everyone with medical history insurance companies increase rates to the point where it becomes un-affordable to most people. What keeps the average monthly premiums low is low utilization of health care. If there are more people with high medical insurance utilization with a specific health insurance company they have to raise the rates for everyone in order to keep up with paying medical claims. That also drives people who do not use health insurance that often to drop health insurance all together and yet driving rates even higher. This leaves no choice for insurance carriers but to drive rates even higher. New York, New Jersey and Washington have highest premiums for medical coverage and a lot of families find health care out of reach.

In California if you have been declined for health coverage you have options. If you out of job or currently on low income you can qualify for Medical and if you have kids they can qualify for a program called Healthy Families. Most states including California have high risk pools that are designed for people who have been declined for individual health insurance. In California this program is called MRMIP. Just the quick search on the Internet will guide to a government website. MRMIP is a program that is managed by the state and your big name medical insurance providers participate in it. Chances are you will be able to keep the same health insurance company if you are already use to them. MRMIP program has limits and it might have a waiting period.

One of the best options might be when it comes to getting the most coverage for your money is through a group plan. In the state of California all group plans by law are required to be a guaranteed issue. That means that there is no medical underwriting. This options requires more work from you. Insurance companies are not just going to let you set up a group plan if you have been declined for individual health insurance. Since insurance companies are required to insurance everyone who is part of the group state requires insurance companies to have rules when it comes to setting up a group plan. Some of the basic requirements change from the insurance company to the insurance company.

The best way to find out is talk to insurance broker. The basics that insurance companies are going to be looking for are that you have to have a reason for starting a group plan other then getting medical insurance. It is illegal to start a group plan just to get health insurance. That means that you have to have a business and that could be anything. To have a group plan you obviously have to have more then just yourself It takes at least two people to start a group plan. All the people that are going to be on the group plan are either have to be the owners of the business or have to be on the payroll. Some insurance companies require either a DE-6 form or six weeks of payroll records. If every one if the owner then you will be required to provide proof of the ownership listing everyone that is going to be on a group plan as the owner. This might not be simple but is is certainly doable and it is definitely worth it if you do not have any coverage and cannot get it on your own.

It is always easier to just blame the insurance company that they have declined you for health coverage. If you have been declined and are looking for health insurance you just have to be more proactive in getting your coverage. Once you work with a broker on getting on the requirements on setting up a group plan then it is forever yours and no one can take that coverage away from you unless you stop paying for it.

California Health Insurance

You have just completed an online form requesting a free health insurance quote and moments later you are being inundated with phone calls from insurance agents hoping to get your business. Try not to become overwhelmed or annoyed by these “pesky sales people” because they are really not telemarketers. Most of them are well-trained state licensed professionals who can really help you make a good decision regarding which health plan is best and most affordable for your individual or group coverage needs.

You may be under the misconception that if you buy your health plan directly from the insurance company, and cut out the “middle person”, you will save money. This is absolutely not the case. In fact, insurance companies rely on agents for most of their business and that’s why they pay them commissions for bringing in customers. It does not cost a consumer one penny more to use a licensed California health insurance agent to obtain their insurance coverage.

There are many differences between California health insurance and other states including how it is applied for.

For example, while Blue Cross and Blue Shield are one company in other states, here in California, each is separate and applied to individually as Anthem Blue Cross of California and Blue Shield of California.

California health insurance law AB 1672 is an improvement over the federal HIPAA law that covers all states in that it includes the following with regard to California group coverage:

1. Individuals with pre-existing medical conditions may change over to a new group health plan without an exclusionary period.

2. It allows small businesses and professional organizations to have access to health plans providing they have between 2 and 50 full time employees.

3. It keeps insurance rates from climbing after a claim is filed.

4. Employees who have health problems may change jobs or health plans without being rated higher for having pre-existing conditions.

That said, the very best health insurance agent for your individual and business needs is an “Independent Agent.” Why? Because they represent multiple insurance carriers, not just one. An independent agent can help you select the most appropriate cost-effective plan offering the most benefits for your dollar as available from the major carriers, rather than feeding you just one company’s line of health plans which may not suit your particular needs. Many people are too complacent and settle for what their current insurance company has to offer. They could use a good independent agent to sort through the many plans available from multiple insurance carriers to find and provide the best choice of options.

Another misunderstanding you may have is that insurance agents set the premium rates for the health insurance plans they sell. Thinking if you shop around you may get a better price for the same plan. Premium rates are based on your age, zip code or county in which you reside and are controlled completely by the insurance companies. Every agent uses the exact same rate guides set by the insurance companies. The condition of your health may affect your premium, which may be rated up after the insurance company’s underwriting department has reviewed your medical records. Again, the insurance company, not the agent, determines that outcome.

Now, let’s talk about the benefits of having a good insurance agent representing you. Most consumers neither know nor understand the benefits of a health plan being offered and need the expertise of an agent to explain the benefits to them in full. For example, do you know what the difference is between an “out-of-pocket maximum” and an “annual deductible?”

An out of pocket maximum is the most you will have to pay in a given year for deductible and coinsurance for covered benefits before your insurance starts to pay 100% of most expenses until the year ends.

An annual deductible is usually the amount you pay each year before your health plan starts paying anything for covered services. Generally, the higher the deductible, the lower the premium. Certain services such as prescription drugs carry separate deductibles. Plans may vary and sometimes benefits will kick in before you have to meet the deductible.

A knowledgeable health insurance agent can be a guide through the maze and help you choose the right plan to meet your needs and budget while obtaining the most benefits for your dollars spent. An agent will also make clear how the benefits for a generic prescription may differ from the benefits for a brand prescription on a particular plan.

After you have a health plan in place, a good, caring agent will remind you to pay your premium on time so the insurance company doesn’t cancel you. Your agent can also be an enormous resource for assistance if you run into a problem with a health insurance claim. Instead of waiting on hold at the insurance company’s 800 number for thirty to forty- five minutes, call your agent and explain your problem and if you have chosen the right agent, you will get help and may save yourself lots of time and frustration, maybe even some money by having an expert in your corner where your best interests come first.

So next time you or someone you know, fills out one of those on-line forms for a health insurance quote and you get several phone calls from health insurance agents wanting your business, be grateful that a professional wants to help you for free to choose the right plan and you’ll have an important friend for life.

My name is Diane Le Montre, License # 0D18343, your California Health Insurance Specialist with more than 25 years experience. I am an Authorized Independent Agent for the major California health insurance companies including Anthem Blue Cross, Blue Shield of California, Health Net, Cigna, Aetna, UnitedHealthcare and Kaiser.

Let me guide you through the maze of obtaining proper health insurance coverage for you, your family or business, with an individual or group plan based upon your specific needs. I will find the best coverage for your insurance dollar by analyzing the various plans of the major insurance companies I represent.