Healthy Family Insurance Blog

Healthy Family Insurance Health Insurance Exchange

Does that sound cool or what! I am thinking of starting my own exchange where people can go to obtain information and coverage on health insurance. In fact it seems like this is what I have been doing for years! I and about 140,000 other agents in the nation have been licensed, appointed and duly authorized to do health insurance business as a business long before the government decided to offer the same.

So I will continue to add more and better information about how to make a good decision about health insurance be that individual or Medicare coverage. We can also offer personalized help in the decision making process that will be uniquely tailored to your individual needs. Let’s see a bureaucrat do a better more efficient job that this!
What we will do that will be a marked improvement in ability to serve our clients is I have formed a relationship with an agency that has many appointments with many other carriers for Medicare related products. In addition, Long term care is sometimes needed for these same individuals, and that is available also. Look for these changes in before the upcoming Medicare annual enrolment period. There will be an expansion of info on the subject of Medicare with all of its regulations and nuances.

It is my goal to make it a lot simpler and give people information that is useful and effective toward making a decision about product. In addition, I wish to offer personalized attention for all who desire a consultation.
Once again, look for the upgrade to the website in the next two months!
http://www.healthyfamilyinsurance.net/

What Now! Health Insurance Reform

How will Health Insurance Reform affect you in 2010? For health insurance coverage in Washington State, there are very few changes.
The following is a general guide to what is coming: Insurance companies will be forced to issue policies for children with pre-existing conditions. The lifetime limits will be eliminated even though very few people ever get to that limit. Preventive coverage will be fully covered with no co-pays of deductibles. Dependent children could be covered until age 26.

People with Medicare part D will receive a $250 rebate to begin to close the coverage gap in the prescription drug benefit. It will gradually increase each year until it 2020.

Small business under 25 employees will have a tax credit of up to 35% on the employer paid portion of the insurance premium. That credit will rise to 50% by 2014. Employers smaller than ten will receive a full credit.

So, what should you do now? I still maintain the importance of having an agent you can trust to advise you and guide you through the maze of plans out there and help you make a decision according the risk! There is no better way to get the best coverage for your particular individual situation than to work through the process with the advice of an agent. These people are licensed and must pass continuing education requirements that keep them up to date on the changes that inevitable come to the many plans available.

To see a plan for coverage in Washington State, cut and paste the following link: http://www.healthyfamilyinsurance.net/

How to find health insurance in Washington State

If you need to get health insurance coverage for yourself and or your family, the best thing you can do is talk to an agent. Your health insurance agent can help you find a plan that fits you best. He or she knows what the rules are and they are also familiar with the market so they can get you hooked up with the best possible plan. It does not cost anything more to have an agent so it is a win/win situation.

In Eastern Washington, see Tom Hubbard online at the main page on this website:

http://healthyfamilyinsurance.net

Why I Like Group Health in Washington State

When it comes to coverage and price, it is hard to beat a Group Health plan. And now with the better doctor network (Alliant Plus) they will cover a whole lot more doctors than before. They cover my doctor here in Spokane, even if he is not in the preferred network! (After deductible for out of network, with no balance billing)

I personally have a high deductible (catastrophic) plan with a 5000 deductible. I have unlimited doctor visits and unlimited diagnostic x-ray and lab work (within the network) where the deductible is waived! Try that with another high deductible plan! This works well for someone who does not need prescription drug coverage or maternity as they are not covered. If you have been healthy and have a reasonable expectation that you will continue to be healthy, then a high deductible plan offers a cheap price and a low likelihood of having to meet the deductible.

Now, if you need drug coverage and maternity, there are plans of this genre that have that coverage as well and yet they are still cheaper than the competition.

To see if they are right for you, click on the Group Health logo on the home page!

http://www.healthyfamilyinsurance.net/index.php

WHY I DON’T LIKE HSA’S

HSA’s have been couched as a great way to ‘reform’ the health insurance industry, and they could. My problem with them is the insurance industry prices them too high and they have little 'first dollar' coverage when compared to other high deductible plans.

Most other high deductible plans have some ‘first dollar’ coverage where you can go to the doctor when you get sick, get tested and they will waive the deductible for the first 4-6 visits. For those of us who are healthy, this is great because we rarely go to the doc for anything. So what happens is the price of the HSA is higher than the other high deductible plan. At that point the value of the HSA begins to diminish. Add to that if you cannot afford to pay the premium and fund the deductible amount every year then you have lost the reason to do an HSA.

If you can afford to fund the HSA every year, your healthy, and don’t use the deductible fund , then a HSA is for you. But still you pay more for the insurance than you should!

How to buy your own health coverage

Buying private medical insurance is no picnic, but group benefits aren't an option for everyone. Here's what you need to know to shop for an individual health policy.
As companies cut expenses and more entrepreneurs strike out on their own, the individual health insurance market is growing.
"There's been a precipitous drop in the number of businesses offering coverage," says Sam Gibbs, the senior vice president of ehealthinsurance, an online insurance broker.
These days, the same people who traded company pension plans for self-managed 401(k)s are being asked to take on one more chore that used to be handled by human resources: shopping, selecting and purchasing And it can be daunting.
Plowing through the process
Rob Snow put it off for more than a year. When he left a successful online company at age 39 to start Snow Portfolio Management in Bethesda, Md., he took advantage of COBRA, or the Consolidated Omnibus Budget Reconciliation Act , which allowed him to remain on his old company's group plan as long as he paid the premiums. But that privilege extends only for 18 months. And he was nearing the end of it. (For more, see "Know your COBRA rights.")
So, one weekend, Snow sat down at his computer and searched for "health insurance" -- and got a million hits. "I probably spent an entire day scrolling through those," he says. "I got worn out. I probably didn't do anything for three weeks."
But Snow eventually went back to the computer and zeroed in on a few sites that allowed him to get quotes or compare policies.
His pick was a regular preferred provider organization, or PPO, plan with a high deductible that allowed the family to keep their doctors -- one of his wife's must-haves. "There's no way she was ever going to change pediatricians," he says. And the monthly premiums were $603, a savings of as much as $435 per month for their family of five.
"One of the reasons I probably saved as much as I did was that we're all, thankfully, pretty healthy," Snow says.
Not surprisingly, when you're buying health insurance, your health is a key factor.
"The healthy individual out there buying insurance does not have that much trouble," says Sandy Praeger, Kansas' insurance commissioner and the 2008 president of the National Association of Insurance Commissioners . But for people with health issues or pre-existing conditions, "it can be tough, if not impossible, to find coverage in the individual market."
And then there's shopping for policies. For people who've never had to do it themselves, "there is the perception that you make a call or two and you've got it," says Jerry Flanagan, the health care policy director for consumer watchdog , an advocacy group. "You have to do a lot of research, know what you're getting and buy it before you cancel your (current) coverage.
"The individual market is a very difficult place for consumers to find affordable care with good coverage," Flanagan says.
Key insurance questions
If you're purchasing your own health coverage, there are three big issues:
• Can you get coverage?
• Can you afford the premiums?
• Does it cover what you need covered?

When do you need it, and when can you do without?
With group policies, insurance companies have to cover anyone the company hires. But with individual policies, carriers are free to cherry-pick customers.
"In most states, companies can charge you more or deny coverage for pre-existing conditions," Flanagan says. But in a handful of states, they can't. Get the details from your state insurance department so that you know what to expect.
And sometimes the exclusions or limitations don't even concern a current condition. If you're a woman of childbearing age, you could face a large deductible on anything related to maternity care.
In the face of exclusions or less-than-perfect health, "I think what a lot of people are opting for are scaled-back plans," Praeger says. Policies may not cover certain areas, such as mental health services, maternity care or drugs. And they may limit the number of times you can see a doctor or have certain screenings.
How to start shopping
One of the biggest hurdles for consumers who are used to having group coverage at work is just starting the search.
If you're buying, you need to find out who's selling. The best way to do that is to get a referral from someone you trust. Or, go to your state insurance department's Web site for a list of licensed companies and brokers who sell health insurance in your area. The state site will also have information about complaints (including complaint ratios) that paint a picture of which companies are giving the best service.
Many states offer a "buyer's guide" to walk you through the process and will provide cost comparisons from different types of policies, Praeger says.
Also, you can find local agents of the National Association of Health Underwriters through the group's Website.
Then take some time to consider what you want in a policy, Flanagan says. What's your target premium? What kind of deductible and co-pay? What's the scope of service you need (exclusions, screenings, annual checkups, etc.)?
After that, thoroughly search the Internet. Visit sites that offer quotes to see what kind of coverage you're offered and at what price. Compare not just different carriers but different types of plans with the same carrier.
As you compile information, keep a chart, Flanagan says. Jot down each company's name, its premium, what it covers and what it doesn't, along with any outstanding benefits or drawbacks.
Ask questions:
• What are all the restrictions with this policy? If you're not happy with the answers, tell your agent the type of coverage you want and have him shop it.
• Are your doctors and their hospitals included in the plan, including the closest hospital? "If they aren't, are you willing to make a change for a lower price?" says Praeger.
• Is unnecessary coverage included in the plan? "If you're a 22-year-old male, you don't need maternity benefits," eHealthInsurance's Gibbs says. "You'd be surprised" how companies bundle coverage, he says.
• Does the carrier have a policy limitation on how often it raises its rates? That low premium you're quoted "might change twice in the first year," says Flanagan.
• How long has the carrier been licensed in your state, and is the license current?
"Consumers really have to arm themselves before they get insurance," Flanagan says.
Finding an agent
Independent agents will represent more than one company, so you can cover more ground with one call.
However, not all independent agents are bias-free, Flanagan warns. Some may receive incentives to push certain policies or may get commissions from carriers, he says. So be prepared to make some more calls (and do some extra research on your own) to make sure you're truly being offered the best deal, he says.
A good independent agent will know who is serving people with your health or lifestyle profile, Gibbs says.
Consider value, not just cost
With insurance, everyone knows to shop deductibles. But with health insurance, you also want to look at the total payout for an illness and also for the life of the policy.
Be suspicious of premiums that seem too low. Make sure you're aware of the details with policies that give you lower premiums in exchange for limits on the number of times you may see a doctor or the number of hospital or lab-related services you're allowed.
And beware of discount plans, Praeger says. Many are "out-and-out fraud."
Take care with the application
Once you've narrowed your choices to a few options, check the carriers' financial solvency at A.M. Best. You also want to follow up and make sure each company has a good reputation with customers.
When you finally do select the winner, fill out the application carefully. "That application will look very different from what (an applicant) filled out for their employer" under group coverage, Flanagan says. It will be more complicated and lengthy.
Keep your answers honest, and be prepared to produce copies of your medical records. Review any information the broker is sending on your behalf, and make sure it's accurate. If you have questions, call the company and get explanations.
Don't cancel any current health policies until you've been accepted into a new plan, the check has cleared, and you've reached the "effective date" (starting date) of your new policy.
This article was reported and written by Dana Dratch for Bankrate.com.

What You Don't Know About Your Health Insurance Could Hurt You Badly


Eliza Navarro Bangit, Esq.
Georgetown University Health Policy Institute

illions of people are forced to find new health insurance coverage because they lose their jobs, their retiree benefits are cut or their premiums soar. But the mumbo jumbo that fills health insurance policies can cost you thousands of dollars in unexpected expenses, because you often don’t get what the policy seems to promise.
That’s because health insurance policies are full of language that is difficult to decipher and important details that are hard to grasp -- whether your policy is provided by an employer or individually purchased. Since policies are not regulated by the federal government but by each state, there is no mandate as to what they should contain. In recent surveys, more than half of respondents did not understand their current health insurance policies... and those who thought that they had good policies had loopholes, limits and exclusions that they didn’t know existed.
The problem has not gone unrecognized. Aside from the heated debate about creating a national health insurance program, members of Congress have proposed a bill that would require insurers to more clearly communicate to consumers what is covered in a policy -- and what is not covered.
Whether you have a health insurance policy already (either through your employer or on your own) or are considering buying health insurance (perhaps because you have recently been laid off), it pays to know what the fine print says and what to do if there are loopholes or limits that could cost you. What you need to know...

WHAT TO LOOK FOR

No health insurance plan will pay for everything, but some provide more than others. Watch for...
Comprehensive coverage. Seek out the most comprehensive policy that you can afford. Look first at the policy’s list of covered benefits, which should include hospital stays and expenses, outpatient treatment, doctors’ visits, prescription drugs, mental health treatments, rehabilitation care and lab and imaging tests. If a medical service is not mentioned in the policy -- for example, outpatient chemotherapy -- chances are that it is not covered.
Find out which providers and hospitals (especially specialty hospitals) are covered by the policy. Be aware that even a policy that covers what is "medically necessary" may exclude particular services or cap them. A recent study analyzed the estimated out-of-pocket costs for heart attack treatment under several different health plans in California. Although cardiac rehabilitation is standard medical treatment for heart attack patients, one of the insurance policies did not cover this treatment at all.
If you are buying your own policy, review the health plans in your state at eHealthInsurance (800-977-8860, www.ehealthinsurance.com) or Vimo (866-955-8466, www.vimo.com). To evaluate different policies, our team at Georgetown University Health Policy Institute has created a worksheet, available at http://healthinsuranceinfo.net/managing-medical-bills/worksheet.pdf.
How the deductibles work. This is the amount of money that you will pay for medical care each year before your health insurance kicks in.
When reviewing a policy, check to see if all of your costs for medical care will apply to one deductible or to two -- for example, a separate deductible for drug costs. Determine if the deductibles apply separately to individuals and to family members. If you have a high deductible and each family member has a separate deductible, it can be costly. There are no exact guidelines regarding reasonable deductible amounts.
Best: Weigh the health insurance premium against the protection that the policy offers -- what are the covered benefits, what is excluded and limited, what is the cost if you get sick.
A protective out-of-pocket maximum. Look for a policy that protects you with an out-of-pocket maximum, the most that you will have to pay for medical expenses in a given year. Add up the deductibles, copayments and coinsurance to determine the out-of-pocket maximum.
Avoid: Policies that exclude the deductible or any copayments or coinsurance from the out-of-pocket maximum.
In some cases, costs for office visits, prescriptions and mental health outpatient visits are not counted toward your out-of-pocket maximum. If so, then your actual out-of-pocket expenses can be much more -- even thousands of dollars more per year -- if you get really sick.
No caps on lifetime or annual benefits. The problem with any kind of limit on lifetime or annual benefits is that you could be left on your own to pay for treatment costs that are much greater than you expected. If you get sick, you want to be sure that your policy can easily accommodate big bills. Check to ensure that the policy has no cap on specific kinds of treatment, such as hospital and outpatient medical treatment, doctor visits, drugs and diagnostic imaging tests.
The contract, not a brochure. Ask for the contract, called Evidence of Coverage (EOC), which is legally binding. Insurers may say that the EOC is available only after a purchase, but don’t take no for an answer. Examine the contract carefully.
Loopholes. It’s hard to catch every detail, especially since loopholes can crop up anywhere.
Example: A policy offered by AARP began hospital coverage on the second day of a hospital stay. But the first day -- when diagnostic tests and emergency procedures are performed -- typically is the priciest. AARP has since suspended sales of this policy.
Best: Get a referral for a licensed insurance broker from someone you trust. A broker can help speed up the shopping and application process.

HOW TO CUT UNEXPECTED COSTS

If you do find a loophole or aren’t satisfied with your policy, you can...
Switch policies. Very often, it is not until you are using an insurance policy that you find out what it really covers (or doesn’t). If you have health insurance through your employer, and several policies are offered, you can usually change policies during open enrollment, a period of time set up annually when employees can change or make changes to their insurance. If you have your own health insurance policy and you are healthy, you should have no trouble finding another one. But do not cancel your existing policy until your new one takes over. If you have a preexisting medical condition, insurers in many states can deny coverage (except in Massachusetts, Maine, Vermont, New York or New Jersey), exclude coverage for a specific condition or charge you more.
Appeal. If you have a claim that was denied and you don’t think that it should have been, you can appeal the decision. Most states require health insurance providers to have both an internal and external (independent) review process to handle complaints and appeals. The Henry J. Kaiser Family Foundation offers comprehensive information about the process at www.kff.org/consumerguide/00-intro.cfm.

Health Insurance Battles: Six Tricks that Work


Health insurers have lots of sneaky ways to deny insurance claims because, of course, the less they pay, the more money they get to keep. I got some good advice from professional patient advocate, speaker and radio-show host Trisha Torrey on what we consumers can do to help get coverage when the insurers are trying to wiggle out of their obligations...

Six Secrets to Get Your Health Insurance Company to Pay

1. Be persistent. Health insurance representatives generally will speak as if their decisions come from policies that allow for no variation. What the companies don’t want you to know is that sometimes when you get turned down by one representative, another may be more willing to give you the answer you want to hear.

Try this: If a claim is denied, it’s worth checking to see whether you get consistent answers from two different sources -- perhaps call again to see if another representative makes the same decision and/or speak to someone with more authority.

2. Get everything in writing to even out the playing field. Insurance companies are scrupulous about keeping copies of all medical paperwork and correspondence involving your care -- including letters and e-mail correspondence. They also may record telephone conversations and, if there is a dispute about who said what and when, you’ll do far better if you’ve also kept careful records.

To play at the same level: Retain copies of all correspondence (paper and online) that you send and receive. Also keep a log of notes and details of all phone calls (date and time, the name of the person you spoke to, what you discussed, any verbal commitments, etc.). And never accept only a verbal commitment from an insurance company -- always ask for confirmation in writing.

3. If you had no choice, you had no choice. If you weren’t able to choose who your provider was, you should not have to pay higher, out-of-network costs.

For example: When your in-network surgeon chooses to use an out-of-network anesthesiologist for your surgery... or sends you to an out-of-network lab for blood work... the choice of provider was out of your control.

What to do: Insurers may do their best to deny the top level of reimbursement, but Torrey says to be persistent in stating your case and insisting on coverage. Similarly, when emergency care is needed and you are therefore not in control of health-care decisions, you may not be liable for higher out-of-network costs. Check your policy. Also, in some states, out-of-network emergency care coverage is mandated by law.

4. Tell all... there’s no such thing as too much information. Requirements are tightening up for screening tests that look for signs of disease before symptoms develop, and some insurers limit the diagnostic tests they’ll cover, too. Check your policy to be sure.

To get around this: Be sure you clearly and specifically report the symptoms you are concerned about, even if they’re embarrassing (for instance, for colonoscopy a change in bowel movements or traces of blood in your stool).

5. Even an insurance company can be intimidated by credentials and titles. Irate consumers aren’t very scary to big insurance companies... but doctors and congressional representatives can make them nervous. If coverage is initially denied to you for a test or other service, an explanatory call from your physician might get a different outcome.

A good strategy: On critical correspondence, copy your congressperson, state insurance commissioner or another state board that regulates health plans. You can find links to the regulatory entities in all 50 states at the Web site of the National Association of Insurance Commissioners & the Center for Insurance Policy and Research (www.naic.org -- check "States & Jurisdiction Map"). That way, the insurer will have to answer to them for the decisions it makes.

6. Patient advocates know what works... and insurers know it. Insurers are not fans of these persistent, well-informed third parties who can help slice through red tape and are good at negotiating favorable coverage and settlements.

How to find one: Start with a service you don’t even have to pay for -- the nonprofit Patient Advocate Foundation (www.patientadvocate.org or 800-532-5274), which provides free case-management services for people with serious diseases, such as cancer, and has lots of experience needling insurance companies. (Note: This organization is staffed by volunteers, so its phones often are busy. If you find that is the case, you can go directly to its "Request Patient Assistance with a Case Manager" form by clicking http://gallery.patientadvocate.org/requests/paf_cm_request.php.)

There are also for-profit patient advocate firms that employ nurses and other health-care professionals to argue cases on patients’ behalf. They may charge as much as $150 to $200/hour -- but for a big bill, it might be worth it. You can find patient advocates in your region at Torrey’s Web site, AdvoConnection.com, a directory of patient advocates.

As Torrey notes, insurers are a wily lot -- but you can get real results by using these secrets to turn the tables on them and get the health coverage you need and deserve.


Source(s):

Trisha Torrey, patient advocate, syndicated newspaper columnist, radio talk-show host and national speaker based in upstate New York. She is author of You Bet Your Life! The 10 Mistakes Every Patient Makes (available February 2010). Visit her blog at EveryPatientsAdvocate.com/blog.

To continue with ‘real health care reform’, Incentives are the best thing we can do to begin to change people’s behavior. There was a financial incentive for people to engage in behavior resulting in poor health and there must also be an incentive to change, or it will not happen. Many of us will not change unless we have to so there does need to be government mandated, positive incentives to change. We must reward healthy behavior and lifestyle as well as productivity resulting from proper behavior. On the other hand, those who chose to lead lifestyles that promote the current ‘disease care’ system, must be motivated to change by negative means.

If I must pay health insurance rates to care for the chronically ill who are so because of lifestyle choices, then I want them to pay a whole lot more. While we cannot eliminate interdependency, we can punish those who refuse to participate in the greater good, as though they were tax evaders.

One company has, in the last five years, had zero increase in healthcare costs while the national cost is three times the rate of inflation. They have incentives that include healthy options such as gym memberships, and subsidies for healthy options at the company cafeteria. In addition this same company offers discounts on health insurance for those with low BMI’s and non smokers.

One additional reform whose design is to move government out of the role of elder care is an incentive to pay more for coverage while in our working years. This is in order to have care as we move into an age when we can no longer work. Changing the current tax and spend to a collection and investment system designed to cover costs of healthcare when we are old. To eliminate Medicare and the intrusive and inefficient nature of government by replacing the way money collected for eldercare is used. No longer using the funds from young people to fund a government payor system, we save the money to pay for those who are yet to enter the system, reversing the ‘great society’ of LBJ.

I have a dream too, a nation with much less government control. One nation, of the people, by the people, and for the people. What a concept!

Want to see a different slant on health-care reform? Read on! It seems that the rapid increase in healthcare costs has been paralleled by the expansion of our un-healthy lifestyles. In a word, behavior is one of the largest indicators of healthcare cost. Observe the following statistic.

74 percent of health-care costs are driven by four chronic diseases:
   A. Cardiovascular disease
   B. Cancer
   C. Diabetes
   D. Obesity

What does this tell us about why healthcare costs are moving up? Our lifestyle choices do affect the cost of healthcare. Diet and exercise is after all the primary driver in containing the costs. Perhaps more to the point, our own lack of discipline is killing us. As a society, there must be incentives to live healthy lifestyles. It must start from our president as a national example. He must quit smoking and contributing to the image of an unhealthy lifestyle and start promoting a real and effective solution to the over-utilization of our healthcare system.

Right now our insurance companies are moving us away from the 'nose wipe' plans of the past to plans with much less 'first dollar' coverage. These plans include larger deductibles and coverages only after that deductible is met. In this way we have a personal incentive to keep our costs down, when it hurts us! However, this needs to be taken to a level of positive incentive, much like what happens with HSA's (Health Savings Accounts)
Some large private companies have already begun to incentivize health by offering discounts on the price of insurance for those whose body mass index is below 30%. Also there are discounts for those who have good cholesterol & blood pressure levels and who don't smoke.
It would be my own contention the there must be even more levels of incentives that include most measures of healthy lifestyles including paying slightly higher premiums while we are young healthy and working to pay for future costs when we are old and need the coverage.
This kind of incentive must ever be protected from 'Government' since they have already proven they can squander our future as in Social Security.
For more on this subject, watch for future articles.

The very idea that federal government should run, takeover, or participate or even influence health care is unconstitutional. Truly our governmental officials have overstepped their bounds again in attempting to socialize medicine. As we move as a society toward socialism, it is the logical progression of things for the federal government to attempt to usurp more and more of our rights responsibilities and privileges afforded to us by our constitution.

The individual citizenry must take responsibility by suing our government officials in order to force them to abide by our constitution. Our liberal counterparts have done a great job in forcing their views of the endangered species act and its use as a tool to pantheize our society. How long will it be before states rights advocates begin to win in the Supreme Court?

We have a culture war on our hands and it will take a whole lot of fundamental effort in order to change the minds of those that now vote, or form the minds of those yet too young. The social engineers of yesterday have taught us how this is done, and we must begin to apply those principles now before the right to do so is gone.