Can You Be Denied Health Insurance After Health Care Reform?

February 17, 2011 @ 17:32 Filed under: health care reform — Alston

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The health care reform mandates are expected to eventually prevent health insurance companies from denying coverage to people based on their preexisting conditions or medical histories. However, not all of those mandates are in place as of now.

Many people have been hoping and planning for the day when their medical history wouldn’t be held against them when wanted to be covered by a health insurance plan. Many people, including myself, believe that one’s need for medical services should not mean that they lose the roof over their head and the food on their table.

After many news reports and article after article full of information about the passing of the health care reform act many people believe that that day and time came months ago. It hasn’t. At least not yet.

The mandates are being phased in over time. Right now, at least for the most part, the old rules are in place for adults. The way children are underwritten has changed. Therefore how and if they can get medical treatment from doctors and other providers covered has changed as well. No significant changes have been made in the way adults are underwritten thus far.

Qualifying for group health insurance coverage of doctor and hospital costs in Connecticut is not based on your medical history. (The rules are different for individual non group policies or polices not purchased through our work.) You can even purchase a “one person group” health insurance policy from a health insurance company if you are self-employed and have no employees. This is the same as it was before.

Children cannot be denied coverage based on their medical condition. They must, however, be on a policy that includes at least one parent. If neither parent qualifies for a health insurance the child will also be denied.

This applies to policies purchased after the September 2010 mandates. If your child was covered by a policy child-only health plan prior to the September 23rd of 2010 you should continue to pay its premium as it can be kept active. (This is an unintended, unfortunate result of some of the September health care reform mandates. For more information, please view my video about how health care reform is hurting children.)

If you need health insurance for a child in Connecticut but not for the child’s parents, the HUSKY program may be your best option. HUSKY is a state-sponsored health insurance program that works well for many families. You will find, however that their list of providers is more limited than the list associated with a health policy one might get from a company like Blue Cross Blue Shield. Husky is available to all income levels, but the amount you pay each month is based on your family’s income.

A Health insurance company can deny an adult who applies for and individual or family health policy that is not employer-sponsored. They can deny based on an applicant’s preexisting condition or conditions. They can charge more or less based on an adult’ health history. (Some companies can double the premiums for those who need a doctor’s care for a medical condition. This means making the monthly payment is very difficult or impossible for many Connecticut residents.) They can exclude coverage for treatment involving specific body parts or medical conditions. In short, nothing has changed so far and it will be some time before things do.

Unless the health care reform law is repealed or amended one’s medical history will not prevent them from qualifying for health insurance as of the year 2014. This will be a great day for many who would otherwise risk losing their homes and life savings because of the cost of few months’ worth of medical treatments.

(It is important to note that not all medical conditions will result in a denial or even a modification of a health insurance policy. For more information you can read my post regarding how to find coverage for preexisting conditions in Connecticut.

For advice regarding your specific medical condition please call and speak with me, Alston Balkcom or my son Joel Balkcom. You can reach us at late as 9 pm at 1-203-374-3645 or 1 800 insurance.

how to find coverage for preexisting conditions in connecticut

Health Insurance Denial Myth

February 10, 2011 @ 22:36 Filed under: Finding Health Insurance — Tags: — Alston

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Many people think that having an insurance denial on their record is a “kiss of death” and prevents them from getting coverage from other carriers. This belief can cost you a lot of money if you have a major claim that could have been insured had you pursued other options.

On almost a weekly basis, we are able to help clients get health care coverage after they have been denied. Sometimes we are able to help our clients get coverage with the same carrier that denied them. Sometimes we can’t help and recommend other options such as Medicare.

In my experience, the only type of medical insurance where a previous denial hurts you is short-term health insurance. (Short-term health insurance offers very little protection and is not something I recommend for many of my clients.) A denial has no impact on your ability to qualify for a group insurance policy.

A denial can have a small impact on the underwriting process for other types of insurance. It may take longer for the company to make a decision. But the denial shouldn’t impact whether or not you will be approved for one of their health insurance plans.

A previous denial will trigger a red flag. However, you won’t be denied (unless you are applying for a short-term policy) because of the red flag. This usually just causes the company to ask you or your doctor additional questions about the condition and the health care you have received for it.

When you apply for a policy, the insurance company wants to make sure that you meet their underwriting guidelines. They are not very concerned about whether or not you met some other company’s guidelines.

If you apply to Company A and they want a person your height you to weigh under 250 pounds and you weigh 260 pounds, they will deny you. If Company B wants you to weigh under 270, they will approve you so long as you meet their other underwriting guidelines.

It makes no sense for the second company to deny you for one of their plans simply because the first company did. It may not seem like it, but insurance companies are not in the business of saying “no.” Although they lose money on those who have excessive claims, they only make money from the people they say “yes” to.

However, if they want you to weigh less than 260 they will deny as well. But it is important to note that the denial will be based on their guidelines. You won’t be denied because you were denied by another company.

Most letters of appeal don’t result in the company making a different decision. However, applying to another company that has more lenient guidelines often does.

There are several reasons why you shouldn’t automatically take a “no” as their final answer. Your condition may improve. The underwriting guidelines may change.

Your condition may be looked on more favorably as it ages. You may have been denied a month after you were diagnosed with a condition and your prognosis was unclear. However, after more time has passed and your doctor’s treatment has proven to have controlled the condition, you may be approved for coverage.

Even if you have been denied by multiple companies, you may be approved by the next one. We can help you in the process by suggesting the company or companies that is most likely to say “yes.”

Please call us with any questions about your health care options. We (Alston and Joel Balkcom) are in the business of helping our Connecticut neighbors find quality low-cost health insurance coverage. We can be reached at 1 800 insurance or 1 203 374 3645.

Can An Employer Cancel Health Insurance?

February 3, 2011 @ 03:59 Filed under: Health Insurance Tips — Alston

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One of the big problems with our current health insurance system is that health insurance is often tied to employment. This means that if you lose your job, you also lose your health insurance. It also means that if your employer cancels the health insurance for your company, you can lose your coverage due to no fault of your own.

To answer the question in the title: an employer can cancel the health insurance for its employees. This can affect not only the current employees, but also the former employees who are currently have their health insurance through COBRA. (COBRA is a federal law.  It is not a federal program. The insurance you have on COBRA is the same group health insurance available current employees of your old job.)

COBRA automatically terminates when the employer no longer offers group health insurance to the employees who currently work for them. For this reason a private, non group family or individual health insurance policy can provide you with more security. (Your insurance benefits may be tied to a state or region, but otherwise will likely be something you can keep so long as you pay your monthly premiums.

I have occasionally heard stories from clients who left their jobs and have had their COBRA cancelled for nonpayment even though they paid their premiums to their former employer. The employers took their money and failed to pay their premiums on time.

Companies that are struggling to survive often drop the health insurance offered to their employees. Sometimes they are unable to pay premiums on time this can have the same impact on their employees as an intentional cancellation. COBRA can be a bad choice if your employer is struggling to stay in business.

(COBRA is a temporary solution. In most situations a former employee can only keep this coverage for a year and a half. Because of this I advise most people to purchase a non-group health insurance policy that they can cancel any month but that they can choose to keep until they are 65 and eligible for Medicare. There is no guarantee that they will still be healthy when their COBRA eligibility ends.)

If your employer fails to pay the required monthly premium for your policy, the insurance company isn’t likely to reinstate your policy. If you have paid your premium to your employer, and they didn’t pay the premium to the insurer, they have probably broken the law. However, the insurance company won’t care if what your employer did was legal or not. They may not care if the premium was paid, but paid two days late.

Since an employer can cancel your health insurance and leave you with no coverage. You might be caught holding the bag for the cost of your medical care. You may be better served by purchasing your insurance benefits on a non-group basis. This way you are in charge of whether you stay covered or not. These policies are often less expensive than group policies and can offer more security and portability.

Can Insurance Companies Drop You?

January 25, 2011 @ 02:27 Filed under: Medical Insurance Miscellaneous — Alston

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Connecticut health insurance companies can drop you but only in certain circumstances. Insurance companies can drop you if you fail to pay your premiums on time or if you make a material misrepresentation.

Insurance companies cannot cancel your insurance coverage simply because you file a major claim or if your health has taken a turn for the worse. The crucial issue is whether or not you met their underwriting standards on your policy’s effective date.

Your contract won’t be cancelled if you simply post your payment a few days late either. You can expect to have a 30 day grace period to give you some leeway if you cannot make your premium payment on time.

If you have made a material misrepresentation on your health insurance application your company may be able to rescind your contract. The important word here is “material.”

A simple misstatement is not enough to cause a medical insurance policy to be rescinded. If the policy would have been approved had they known the correct information they cannot rescind the contract. This is based on the underwriting guidelines in effect at the time.

I have been an insurance agent for over 25 years now and have never had a client’s policy rescinded. I think that this is for two reasons. Most people complete their applications honestly. And the insurance companies usually check medical records and will simply fail to approve most applications where the applicant has a significant medical issue.

Health insurance companies can only cancel a contract based on a misrepresentation during the first two years of a contract. They also have to refund all of the premiums you paid minus any money they have paid in claims on your behalf.

The companies have more latitude if you do something like have another person take your exam. They can go beyond the two year limit, but this happens very rarely.

Purchasing Medical Insurance on a Month To Month Basis

January 19, 2011 @ 02:41 Filed under: Health Insurance Tips,Medical Insurance Miscellaneous — Alston

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Can you purchase health insurance on a month to month basis?

Many people ask us this question. This is usually because they need health insurance because they have been laid off and want to know if they will be able to cancel their coverage when they find an employer that provides health insurance again.

Yes you can purchase health insurance on a month to month basis. You are not locked into an annual contract when you purchase a family or individual health insurance policy through us. Most policies are paid for on a monthly basis and can be cancelled at the end of any given month.

Certain short term health insurance policies will give the consumer a discount if they pay ahead. If you take this option, you will not be eligible for a refund if you decide to terminate your coverage earlier.

(Short-term health insurance policies are rarely the best option for our clients. Even if you plan to keep your policy for a short period of time, purchasing a “permanent” policy and then canceling later is a better option. Short-term health insurance policies provide very little protection.)

Also a few policies have a quarterly payment option. You may be eligible for a partial refund if you get other coverage in the middle of a given quarter. Call us for specifics if you are considering purchasing a plan with this option.

Let us know if you have questions about any of the policies we offer. You can reach us at 1800insurance if you are in Connecticut. You can also call 203 374 3645.

Connecticut Health Insurance for Seniors

November 24, 2010 @ 00:20 Filed under: Medicare or Medicare Advantage — Alston

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There are more health insurance choices for Connecticut seniors than there were just a few years ago. The newer options are offer better coverage and are less expensive for many CT seniors and other Medicare beneficiaries.

Today seniors can improve on Medicare Parts A and B by purchasing either a Medicare Supplement or a Medicare Advantage policy.  Both types of policies are available through our agency.

Medicare Part A will give you coverage in the hospital. Medicare Part B will give you coverage in the doctor’s office. Together they will provide you with substantial coverage, but coverage that is far from complete. You may have substantial deductibles, coinsurance payment and copays that will have to pay if you have medical expenses. You will also have to pay for your own prescription medicines.

For that reason many seniors choose to add to their coverage by purchasing a Medicare Supplement and a Prescription Drug Plan. This combination can provide nearly complete coverage in all the major areas.

Very similar coverage can be purchased through a Medicare Part C policy. A Medicare Part C policy is also known as a Medicare Advantage policy. More and more Connecticut seniors are purchasing this type of health insurance.

Why? You can get better coverage at a lower price.

The one drawback of a Medicare Part C policy is that it does not cover you well if you use out-of-network providers. Most of these plans are HMOs, which means that you will only have coverage for emergency care if you seek treatment outside of the network.

The best option for health insurance for many Connecticut seniors is a Medicare Advantage policy. For others a Medicare Supplement policy will be better. To see how these policies might work for you, please request a href=”https://1800insurancect.com/Health/Medicare-Supplement/index.htm” title=”Connecticut health insurance senior”>Senior health insurance quotes from us online or call us at 203-374-3645.

Medicare Insurance Agents – Part C – Part D – Medigap

November 19, 2010 @ 11:25 Filed under: Medicare or Medicare Advantage — Alston

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If you only have Original Medicare, you have substantial coverage in the hospital as well as in the doctor’s office. This is not enough coverage for many Medicare Beneficiaries, however. If you only have Medicare Part A and Part B you may have a lot of expenses to pay that Medicare will not cover.

Medicare Part A provides coverage for hospital charges primarily but doesn’t cover all expenses. You will have a deductible of $1,132 in 2011. This is not an annual deductible. This is a per-benefit period deductible. This means that you could pay it more than once per year if your hospital stays are more than 60 days apart. You may also incur substantial per day charges in the hospital if you need care for more than 60 days in a benefit period.

Medicare Part B primarily covers physician charges outside of the hospital, but this coverage is far from complete. You will have an annual deductible of $162 in 2011 for Part B services. In addition to this you will be responsible for at least 20% of any charges in excess of your deductible. If your doctor doesn’t accept assignment, you could be responsible for a higher percentage of his or her fees.

You can avoid most of this liability by purchasing a Medicare Advantage policy that covers prescription drugs (most do). You may also get more comprehensive coverage by purchasing a Medicare Supplement policy with a separate Prescription Drug Plan.

We can help you with decisions about all of the above. Please give us a call at 203-374-3645 or 1-800-INSURANce if you would like for us to help you explore options for senior health insurance (as well as health care insurance for other Medicare Beneficiaries.)

Tonik Health Insurance Review

November 14, 2010 @ 01:19 Filed under: Tonik — Alston

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Tonik is an individual medical insurance policy offered by Anthem Blue Cross Blue Shield. It taps into their national network and has a lot of excellent features. There is a lot to like about the policy, but there are a few drawbacks.

(This post is about the Tonik health insurance policy that is offered in Connecticut in November of 2010. The Tonik policy may differ in your state. The policy may have changed before you get a chance to read this.)

Often people will get confused by the name of the policy. Tonik is not a name that inspires trust and confidence in a lot of people. Many will assume that Tonik is some upstart health insurance company.

The name, however, is just a name. Blue Cross is the company behind the policy. Tonik isn’t even a subsidiary company. It is just the name of one of the policies offered by Anthem Blue Cross Blue Shield.

The policy has the same network as their Century Preferred policy. This means that you can visit in network doctors and hospitals all over the country when you have the Tonik plan. 85% of the nation’s providers accept Blue Cross Blue Shield.

The coverage provided by Tonik insurance policies is excellent on the $1500 deductible option. The deductible is waived when you visit your doctor. You will only have to pay a copayment. The same is true for prescriptions, emergency room visits, walk in clinics and vision exams.

(It should be noted that your deductible will apply to x-rays and labs. You will only have a copayment to pay for the consultation in a doctor’s office, but any labs are subject to the deductible.)

Dental coverage is also included in the policy. The services covered are limited almost exclusively to preventive care. The coverage isn’t as robust as what you might find on an employer sponsored dental insurance policy. However few individual health insurance policies have any dental insurance coverage.

Like all other policies that were purchased after September 23, 2010 there is not deductible or cost share for many preventive care services. These services include an annual general exam as well as an OB/GYN exam for adult female subscribers.

The Tonik $1500 deductible plan has better coverage than most policies with similar deductibles. However there are some drawbacks.

One is the price. Right now a policy with Aetna with the same deductible may be a better deal for many. More services are subject to the deductible, but the pricing difference may make up for that difference.

Another difference is the way newborns are treated. With most health insurance policies a child born to an insured will qualify for a no questions asked policy so long as a parent requests coverage within the first 30 days of their child’s life.

This is not the case with Tonik. Tonik is a one person policy. You cannot add a spouse or child to the policy. You can apply for a separate policy for another family member but they will need to go through medical underwriting to see if they qualify.

Tonik is an excellent policy that is backed by Anthem Blue Cross. Anthem is excellent company. It may be slightly overpriced at this time, but the coverage is better than most other Connecticut health insurance policies with similar deductibles.

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Ever wonder what insurance agents do when we aren’t selling insurance?  Sometimes I hang out in this Insurance Forum

Cost of Cobra Insurance

November 8, 2010 @ 13:22 Filed under: Cobra health insurance — Alston

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The cost of COBRA health insurance is the amount that your former employer pays to the insurance company for your health insurance plus an optional small administrative surcharge. In many cases this cost is higher than the cost of buying a health insurance policy that you can purchase on your own.

How Much Is Cobra Insurance?

Many people are surprised by their cobra insurance premiums because they paid so much less for their medical insurance when they were working. This is because the only paid part of the cost of their insurance when they were employed. Employers typically subsidize the cost of health care for their active employees, but do not do so for former employees.

How Does Cobra Insurance Work?

COBRA or the Consolidated Omnibus Budget Reconciliation Act is not an insurance company. It is a law that forces most employers that have over 20 employees to offer health insurance to their recently terminated employees.

COBRA health insurance policies allow certain former employees to stay on the group health insurance policies offered by their former employers. The employee has to pay their own insurance premiums.

You can usually keep your COBRA coverage for 18 months. In certain circumstances the length of time can be longer. You can find more details on this Federal Department of Labor website.

Cobra Alternatives

If you are healthy and the other family members who need coverage are healthy, you will probably be able to find a lower price by exploring cobra alternatives. (People who have high blood pressure and or high cholesterol will usually qualify if the condition or condition is under control with medications.)

Those who have more serious medical conditions may find that COBRA is the best alternative for them even though it may be expensive. They might find that they will be denied for an individual health insurance policy or that they will be charged extra for their condition if they purchase an individual or family policy directly from their employer.

How to Lower Health Insurance Premiums

November 4, 2010 @ 13:43 Filed under: Finding Health Insurance,Health Insurance Tips — Alston

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It is important to know that with insurance although you often get more when you pay more, you don’t always get a full dollar’s worth of additional coverage for every extra dollar you pay for coverage. For this reason catastrophic coverage or high deductible coverage is often the best value.

There are administrative and other costs that are included in your health insurance premium. These additional costs mean that if you have average medical expenses, you will do better if you paid for those medical expenses out of your pocket.

When you pay for expenses out of your pocket, you just pay the cost of the bill. The insurance company administrative expenses are not tacked on.

Since we cannot guarantee that our bills will be average, we take too much risk if we decide to be our own insurance company for all of our health care needs. However, if we are willing to pay for the medical expenses associated with minor illnesses, we can raise our deductible and get a rate reduction that usually more than justifies the additional risk.

Although you will have to pay for more of your expenses when you have a high deductible health insurance policy, you can still get the insurance company’s reduced rate when you pay out of your pocket. Your insurance company will pay a reduced rate when you get care from one of their network providers. You pay the same rate when you have a health insurance policy but have yet to meet your deductible.

Insurance works best when we let the big insurance company pay for the big expenses and you pay for the smaller expenses out of our pockets. By accepting the right amount of risk ourselves and transferring the right amount of risk to the insurance company our overall costs can be much lower.

You can get quotes for low cost high deductible health insurance from this site. We look forward to helping you save money.

Blue Cross Blue Shield health insurance questions? Call me, I specialize in health insurance and can give you quotes from every Connecticut health insurance company.

“I hope that you enjoy and benefit from my blog”
Alston J. Balkcom
CT Insurance Agent
Licensed since 1985
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