Discount Health Cards Deceive Texans Looking for Affordable Health Insurance

Interesting telemarketing call I received about noon today. Of course it was a recorded message call asking me to press one to be connected to a live “health care expert”. What was the extent of the call? Health care for “about” three dollars a day. Wow! Sign me up! And that was for the entire family. Unbelievable! I continued to listen out of shear comic relief as I, being a licensed health insurance broker since 1993, know there is no true health insurance policy that will cover any Texas family for three bucks a day. Well, I decided not to press one to speak to a live rip off artist as I have spoke with them in the past. I just didn’t have the patience this day but though it might be time for a little discussion on the matter of Health Discount Cards.

It seems anytime we have a downward spiral in the economy these little bankruptcy creators stick their head up out of the sand. Simply put, most times they over hype the actual benefits received for enrollment. And, most times doctors and hospitals look at you with disbelief when you present one for payment.

Hey Texas, no matter what the guy on the other end of the phone tells you, no matter how crafty their website is, these plans are not insurance under any shape form or fashion. Period. No doctor or medical facility is required to accept these cards for even the discount they imply. 

My experience with these plans is that most claim to provide “up to” eighty percent coverage. Notice the “up to” part. Most Texas consumers that get roped into these plans fail to hear the “up to” part, or the nice little guy on the other end of the phone conveniently fails to mention the “up to” part. These goofy discount plans also tout doctor visits are also covered and the one I got today stated if I act today I would get free dental and vision coverage. Wow! These plans also profess guaranteed issue, regardless of medical history. Well, they should, these are not health insurance policies and because there is absolutely no underwriting they can make these claims and ravage the poor defenseless consumers of health insurance in Texas. Texans with medical conditions are desperate and generally take these plans because of the statements of guaranteed issue coverage, however Texas is whats called a risk pool state, meaning most anyone can get coverage if they just contact a licensed health insurance broker.

Also of note the State of Texas has attempted to aggressively go after these plans and Attorney General Greg Abbott has even posted on his website that they are nothing more than “phony, deceptive, or nearly worthless health care discount card”. Wow! I could not have said it better myself. Also, the Texas Department of Insurance posted a warning in early 2005 warning consumers of these plans.

Of note, since these plans are not insurance and do not require a state insurance license to market them, telephone “boiler” rooms tend to market the lions share of these products using television and radio advertisement to generate phone traffic into a room full of sharks waiting to attack any poor Texas victim.

Now, how do these plans actually work? Well, in theory these plans attempt to use the same basic premise that PPO health insurance plans use. All PPO plans have a network of doctors and hospitals. In order for a provider to be in network the doctor agrees to discount his services, this practice is also known as “re-pricing”. There is no hard and fast “normal” discount, it can range from five to eighty percent. It just all depends on the contract the provider has with the network or health insurance company. The doctor or hospital then bills the Texas health insurance company for services at the re-priced amount and the insurance provider pays the bill, eliminating the Texas consumer the hassle of paying for services received up front, filling out claim forms and then waiting for reimbursement. The problem with discount cards is there is no insurance company that has agreed to pay the remaining balance due, so no doctor is obligated to accept the cards as the Texas Attorney General stated in his memo.

Back in 2004 I had a detailed discussion with City of Arlington Mayor Robert Cluck who is also a doctor, I spoke with Mayor Cluck about discount cards and he just laughed, I then informed him that he was in several discount card networks and I asked how he intended to handle these, his statement back to me was that if the patient did not have health insurance he would not accept them. Simply put, he would not allow the patient to receive the discount as claimed by the discount card. No insurance, no special pricing. Now Dr. Cluck may have softened his stance since 2004, but I have known the man for several years and he just isn’t the type of person to change his mind much.

So where does that leave the Texas health insurance consumer? Well, I advise you to stay away from these mickey mouse programs. Stick with true blue health insurance, it just is not worth the headache and potential emotional pain you could be subjected to when dealing with these cards. If you have health conditions and know for a fact you can’t be covered by traditional health insurance that requires underwriting then look into the Texas Health Risk Pool. If you are in decent health then find an experienced broker or agent and allow him to provide you with quotes or visit any number of websites that provide quotes that you can do yourself. Just be careful what you are signing up for, it could very well be that you just bought a discount card and the shock will come at time of service.

Affordable Health Insurance in Texas is Just a Mouse Click Away

Are you like thousands of Texans searching the Internet looking for more affordable health insurance in Texas? Well, some fancy, expensive survey says about eight in ten Americans will be bouncing around the Internet doing just that in the within the next five years. Now I’m not sure I agree with those type of survey results but for grins lets look over what a well informed Texas health insurance consumer should do and more importantly what not to do when making that plunge into online Texas health insurance shopping.

First rattle out of the box, if you are looking for more comprehensive coverage stay away from words like “saver plans”. Nine times out of ten these plans always have strange hidden limits. After the Bush Administration relaxed the requirements on required mandates for some plans these “saver” type plans started rearing their ugly head. Most times these plans have limits on the number of doctor visits a patient can have and also may be loaded with access fees. An example of the limit on doctor visits can be found in the Unicare Saver 2000 plan. These fees come into play when having expensive test or surgery. An example of the access fees can be found with World Insurance Saver Plans. Also, some saver plans have little or no out patient benefits for things like x-ray and lab services. Oh, and good luck finding an adequate drug prescription card with these plans. These plans also my fly with the name “Right Start” as evident in the Assurant Health Insurance policy being pushed. Purchase these plans without knowing the limitations and a massive shock will take place at claim time. Another caution to the wind. Be careful with plans with the words Hospital and Surgical in the name.

Generally, in the health insurance market in Texas the individual consumer will have three choices when selecting a policy. One is called a major medical, the next is the hospital surgical expense plans and lastly you have the limited benefit expense plans. By all means always stick with the major medical policy. The major medical health insurance policies in Texas have several variations of benefits structure and some will fall into the “saver” category but they are head and shoulders above the benefits given by the hospital surgical and limited benefit plans. I think most consumers  that are looking for affordable health insurance in Texas still are expecting their health insurance policy to deliver in the event of a major injury or sickness. In my opinion both the hospital surgical expense plan and the limited benefit plans will be more likely to leave you high and dry at claim time.

Just a brief explanation of the two policies I have advised caution to. The hospital and surgical expense plans most times will only cover inpatient hospital expenses and sometimes out patient surgery. Most times the policy will not offer coverage for any out patient testing, therapy or treatment unless you are hospital confined. Anyone who has had any major treatment in the last few years knows how hard it is to be admitted to a hospital so these policies are virtually worthless in my view. Then we have the limited benefit plans, sometimes called limited benefit hospital surgical expense plans. There is the double whammy. These policies should be run out of the state of Texas. Not only do they operate as the above mentioned health policy but they put limits on inpatient expenses and surgery. It is not uncommon to find these policies limiting the amount they will pay to the surgeon, dollar caps on hospital room and also limiting any and all items used to treat you. A company called Mega Life. or N.A.S.E  has been very popular in promoting these plans. Again, I feel you are wasting you time and money with these plans but more importantly, you may be exposing your family to major hardship in the event one of your loved ones needs medical treatment.

Ok, so now you are armed with a few bits of information of what to look for when searching online. Now, find a health insurance in Texas website and start researching quotes. Hopefully my site will be enough for you search, I do represent most all the major health insurance companies in Texas, but feel free to search any site providing quotes from several health insurance carriers. Read each brochure from plans that fits into your price range. Look for the limits we have discussed here. If you see something that looks strange don’t just glance over it, find out the facts. Generally if it looks strange to you, the Texas health insurance consumer, you found a limit in the policy. Assume nothing because I promise you, limits do exist in the individual health insurance market in Texas. I recommend sticking with the “Major Medical” brand of policies, it’s the safe bet. But my number one recommendation in finding affordable health insurance in Texas, call and discuss your needs with a qualified broker. Don’t try to “wing” it by hopping online, looking at a few quotes, selecting the cheapest one and clicking apply. Yes, doing that makes my job easy but I feel you are taking a huge risk, let us help you. When claim time comes, you will be glad you did. Affordable health insurance in Texas is out there, you just need to know what to look out for.

The Cost of COBRA Shocks Many Needing Affordable Health Insurance in Texas

In today’s whacked out economy thousands of Texans are finding pink slips on their desk notifying them that their employment is ending. Eighteen years ago I was in the same situation which is how I became a Texas health insurance broker. After the shock and disappointment of loosing your job what happens next? Well, because you have a family to protect, it should be to review your options for health coverage and you need to act fast! You have a very, very short window to act.

After leaving your employment and exhausting any severance package, your former employer will notify you of you COBRA benefits, also known as The Consolidated Omnibus Budget Reconciliation Act. The law which was enacted in 1986 is to allow former employees to continue their group coverage for a certain period of time, generally for 18 months. This generally takes place a few weeks after termination. After you receive your COBRA packet you have a short window to make  the decision of electing to continue COBRA coverage or denying the offer, that time period, which I will discuss in more detail later in this article is 63 days.

Ok, so what do you have when you open the COBRA packet? Well, for starters, confusion. One of the first things you will notice is that the COBRA benefits are astronomical higher than what you expected. In all actuality the monthly premium is about what you former employer had been paying for your coverage plus a small administration fee. The primary reason for the elevated premiums are related to federal mandates that are incorporated into the group policy. I wont go into great detail of those mandates for the sake of time, but unlike individual health insurance in Texas policies, group health insurance policies are governed by the federal government.

An individual health insurance policy in Texas most times will be several hundred dollars a month cheaper than COBRA, mainly do to no federal mandates not being incorporated into the coverage. All individual health insurance policies are governed by each state. However, before you jump head first and decline COBRA, there are a few very important things that must be considered.

Consumers purchasing individual health insurance in Texas must go through medical underwriting, if health conditions exist it is wise to discuss with a qualified health insurance broker if you are a candidate for individual coverage. If a Texas consumer is taking multiple medications, or has a current medical condition, COBRA may be your only option, Texas law allows the exclusion of certain medical conditions or the flat out denial of coverage if the health insurance company feels you do not meet their guidelines for coverage. Most qualified health insurance brokers dealing with multiple companies can find a company to accept you for coverage, but in some cases not and you will be “stuck” with the enormous COBRA premium.

Another difference between COBRA and individual coverage is you may find that now you will have higher deductibles and co pays. Although the cost savings will more than offset the few extra dollars that a new copay will be. The invention of the prescription drug deductible that has a choke hold on most individual health insurance policies in Texas is now making its way into the group market, but you may find a small deductible for name brand drugs, but again, the deductible is small compared to the savings over the COBRA continuation policy.

Lastly, regarding the differences in the two policies, things like maternity and fertility treatment will be non existent on individual health insurance in Texas policies, so if you are pregnant or planing on becoming pregnant, stay on your COBRA.

Like I mentioned earlier, your time frame to elect COBRA is 63 days. Once you receiveyour COBRA packet, immediately contact a qualified health insurance in Texas agent or broker to start the process of exploring options. Next, if your staring COBRA in the face,don’t try to secure a health insurance policy online without the help of a broker, speak directly to the agent and by all means, be completely honest regarding health history, you have such a short window of action time that your agent or broker needs all the facts up front in order to give you the best advice. Generally it takes two to four weeks to have a decision back from an underwriter regarding you approval status. If the consumer is declined or has some sort of exclusion rider the agent will have one last shot in securing you coverage and still be within the 63 days. Again, since the window of time is so short, I recommend an established health insurance broker, located in Texas. You need someone that has massive experience in dealing with the underwriters and knows  the pulse of the Texas health insurance market , not someone that is located in some far away state that has never even been to Texas. Also deal with a broker contracted with all the major health insurance providers. That’s why we have contracts with multiple companies, they all have a different view of certain conditions.

If after discussing your health history with your agent and if he recommends proceeding with the process, act fast on applying for coverage. Give your agent enough time to work with the underwriters to get a decision as soon as possible. Ask the agent what the backup plan is if adverse action is taken by the first company.

COBRA is a great policy but normal Texans should not be forced to accept the overwhelming premiums due. Take the time to search out additional options, find a policy you like, act fast in applying, and hopefully during a time of financial hardship you can save a few hundred dollars a month.

The Maternity Shell Game on Individual Health Insurance in Texas

Over the last week I have had several potential clients inquire about maternity coverage. My response was the same as it has been for the last few years for the health insurance consumer in Texas. There are no options. Yes, some health insurance companies on the individual market offer a tricked up benefit but all in all there is no true blue maternity benefit. These poor defenseless clients that called me had several agents telling them that they could provide all the maternity they would need, all said in an effort to get an application on a client. What desperate measures some agents will go to for an application. Do they not think the client will call them on the carpet on this? I guess the agents would just avoid the calls when they got confronted on it and hope the consumer would not file a complaint with the insurance commission. So basically this writing is more of a public service to inform the Texas health insurance consumer what their options are.

Back several years ago we had a few companies offering full maternity benefits in Texas. Things were great at that time, but since the State if Texas does not mandate maternity for individual policies, insurance companies were offering the benefit just for business share gain. It didn’t take long for the two big players that were offering maternity, Unicare and Blue Cross and Blue Shield to realize they were loosing massive amounts of money on this benefit. Unicare eliminated the benefit some ten years ago and Blue Cross followed step not long after.

Let’s explore why Unicare and Blue Cross eliminated the benefit and why no other major health insurance companies even offer full maternity. There is absolutely no way that a health insurance company in Texas can turn a profit on a benefit that is special in nature and requested by the client at time of sale. Dental and vision fall into the same quagmire as maternity. If the consumer request it they are going to use it, therefore, massive money loss for the health insurance company. A single male or a family in their fifties wont request maternity, only  females that are in their twenties will request it. Insurance is nothing more than high stakes gambling on who and what benefits you will use on a policy. that’s why each client must go through medical underwriting. Maternity is a guarantee of use benefit.

What is available? Well, few options but most all of them fall into the same category of “defined amout’ benefit, meaning, there is a set dollar amount they will pay for childbirth. always falling well short of the cost of delivering a child, not including all the doctor visits and exams required before the child is born. Lets look at one company that offers the defined benefit option. United Healthcare, for years they have offered the same maternity benefit. Years one and two amount to two thousand dollars in benefit escalating to six thousand dollars in benefit after the benefit has been in place for five or more years. In my view that’s not maternity. That’s nothing more that a dog and pony show. But Texas health insurance consumers actually purchase the benefit. I will not sell it, I won’t even present it. I don’t need the potential problems of a client forgetting that I told them of the limits.

Now, how does this so called maternity benefit affect the monthly premiums of the United Healthcare policy? They charge one hundred six dollars a month for this benefit to be added to a policy. That works out to twelve hundred seventy two dollars a year. Oh, you can not be pregnant until after the policy is issused so most likely a Texas health insurance consumer will pay on the benefit for about fifteen months before having a child. That works out to about sixteen hundred dollars paid for a two thousand dollar benefit. The math just does not work out for the benefit to be a wise choice for the Texas health insurance consumer.

Also of note, last I checked, my wife is presently pregnant with twins so I have checked, it will cost well over the amount of the benefit offered by the insurance companies providing maternity. Try the ten thousand dollar range to have a child in Texas, give or take a thousand or two. So some lousily two thousand dollar benefit is worthless.

The defined benefit option is far and away the most prevalent maternity option offered in the Texas health insurance market however, there are two other options being offered in Texas. One is a discount plan. Save your money, discount plans are a complete wast of money and one day soon I will write about that boondoggle. But the other option is offered through Assurant Health. They offer full coverage for normal routine maternity after a five or ten thousand dollar maternity deductible. So in reality if you take the five grand deductible you receive about half of the delivery covered. One big problem, Assurant is far and away the most expensive health insurance policy available in the Texas market place. In some cases they are double or triple the cost of normal quality coverage. So until Assurant Health brings their prices in line with the other PPO plans in Texas forget about them.

Now, under state mandates complication of pregnancy are covered on all major medical health insurance policies in Texas. So in the even the Texas consumer dosen’t have one of the tricked up maternity benefits they can still rest easy in knowing complications will be covered.

So where does that leave the Texas health insurance consumer? Simple, there is no maternity benefits available presently in the individual market. Until the Texas state legislature mandates this benefit young families are better off finding employment that offers group coverage where childbirth is offered. One day I hope this benefit will be available because I get real frustrated turning away clients due to this very request. Also, if you are in the market for an individual health insurance policy in Texas and the agent you are talking to says maternity is available, I suggest you question him extensively, ask for the benefit description in writing in the form of an outline of coverage before you move forward, otherwise the surprise at the hospital may not only be the newborn baby.

Aetna Dominates Health Insurance Market in Texas

In my almost two decades in the health insurance market in Texas the question I get asked most by the Texas consumer is “which health insurance company is the best ?”. That question can be answered many different ways and probably receive  a different answer each time, however if you look at the total picture there is only one that stands atop the mountain. Aetna.

Of course as an individual health insurance in Texas broker I represent and work with all the major health insurance companies in Texas so I have no allegiance to any one company. But pound for pound Aetna delivers. I judge an insurance company on a few factors and variables. I look at quality of company, benefit configuration, claims payment, doctor network and customer satisfaction. I feel overall Aetna Insurance Company knocks it out of the park on all five. 

From the benefit configuration standpoint the individual policies offered through Aetna offer more coverage than anyone. Their managed choice PPO plans offer a reasonable copay for doctor visits that included minor lab and x-rays if done and billed at the time of doctor visit. So many plans offered to the Texas health insurance consumer apply all lab and x-rays to the calendar year deductible. Aetna  pays it with a copay. That’s outstanding, and with this benefit they move ahead of the competition. Texas health insurance consumers expect these benefits, and when a policy doesn’t cover it with a copay, they always become upset. The Aetna PPO plans also have an urgent care benefit for those times on a Sunday afternoon or in the middle of the night when an unexpected emergency or sickness pops up. Clients would experience a small fifty dollar copay and all charges would then be covered. This benefit eliminates the need to visit an emergency room, saving the health insurance consumer in Texas hundreds of hard earned dollars.

Aetna policies also offer outstanding preventive benefits. For those routine well woman exams like a pap smear and mammogram, there is absolutely no copay or deductible, those charges are paid at one hundred percent! The Aetna policy also offers an adaquate routine physical exam benefit for the other family members. All the preventive benefits are first day benefits, meaning there is not a pre set waiting period before the benefit can be utilized like so many other policies offered in the individual health insurance market in Texas.

The major medical portion of the Aetna policy offers five million dollars of coverage which at this point is standard with most policies available in Texas. The co insurance percentage is your traditional eighty/twenty that also is very normal currently in Texas.

I will always judge a Texas health insurance company by customer satisfaction. Not some satisfaction survey produced by the insurance company. Customer satisfaction as it relates to you, the Texas health insurance consumer. I will always take feedback from my daily dealings with clients and the yearly review I do with each and every client of my agency. My clients just absolutely love Aetna. The number of complaints I can count on one hand, actually I believe I have only had one or two clients that had any semblance of problems with Aetna. Relating this to some of the major insurance companies doing business in the Texas market, Aetna blows them away on satisfaction. Why is this? Simple, Aetna pays claims. Period. If they didn’t, I would hear about it. My in box would be full of requests to review a medical claims. I have not reviewed an Aetna medical claim for a client in over two years. They pay what they are supposed to, allowing you the Texas health insurance consumer to go about your life. Not dealing with me and some claim rep at an insurance company for 3 hours a day for the next week.

A few other things Aetna offers, they have one of the strongest network of doctors available. Although this is common place when a consumer deals with an industry giant the size of Aetna. We need to be reminded of it if you are looking at coverage from one of the “no name” health insurance companies in Texas. Having your doctor in network just eases life a bit. No one wants to change doctors. With Aetna you will be safe.

Before I bring up a few things I would like to change about Aetna let’s discuss one last point. This is probably the single biggest difference in Aetna and anyone else in the Texas health insurance market. Aetna Health Insurance does not do exclusions on health conditions. Texas state law allows individual policies to exclude health conditions regardless of HIPPAstatus. Aetna is one of only two health insurance companies in Texas that doesn’t exclude health conditions. If a Texas health insurance consumer has had coverage within the sixty three day HIPPA time frame there will be no pre-existing condition limitations. This is outstanding, and as a broker I feel so much more comfortable offering a policy that i know will deliver. I can’t count the number of times other companies attempt to deny a claim based on pre-existing condition clauses and exclusions. Aetna will offer a rate adjustment rather than the exclusion. This is a very fair practice also due to Aetna’s very liberal underwriting position. Aetna is also inclined to accept clients that other insurance companies will not accept due to health history.

There are very few things I would change about Aetna but one thing I wish I could see improvement on is on the administrative side. Request for change of billing items sometimes must be done twice before Aetna does it. If you have a qualified, competent agent this should not be a problem, but there have been a few times we have to re submit information for administrative changes. Also, at one point Aetna had the lowest rates in the Texas health insurance market. Today their prices are just a little above market. I have noticed their prices have leveled off a bit and starting to come more in line with market. that’s great news for the health insurance in Texas consumer.

When it’s time to shop for you new individual health insurance policy in Texas, look at Aetna first, compare quotes, I know you can’t find a better policy anywhere in Texas, so much so I have Aetna health Insurance on my family. You will be glad you did!

With The End of 2008 Comes Higher Premiums For Health Insurance in Texas

We are approaching the end of another year in the Texas health insurance market and it has brought us a tougher economy and escalating monthly premiums. Will the increases ever stop? Probably not, but there are some things to consider over the month of December about your individual Texas health insurance policy.

It is common place for health insurance companies to adjust their rates within the first quarter of any new year. It is also fairly common for companies to adjust their portfolio offerings as well. We have seen this so far with United Healthcare. I’m sure others will follow shortly.

Over the last eight months health insurance companies in Texas have been aggressively raising monthly premiums on new business, I can only attribute this to the health insurance industry fearing any future government regulations that the new President might impose. If the health insurance industry “runs up” the monthly cost before government intervention they have a cushion to fall back on after implementation of regulations. All this started happening when Aetna shot premiums up and revamped their Texas health insurance portfolio back in April. Not long after that it was a free for all on premium increases. The Health insurance market in Texas and the entire nation for that matter has had a free ride over the last eight years, they know the party is about over so it’s almost like Custer’s last stand. Do I think the government will take over health care? No I don’t, but I do feel a tweaking of the system will follow as several big named insurance companies that do business in Texas have already come out in favor of the regulations.

So what does the consumers of health insurance in Texas need to do? Evulate your coverage now. If your premiums are coming up for renewal within the next two months do a cost comparison before the end of the year. I think it’s important to compare prices now and get a new policy in place before the beginning of the new year. This process generally takes about two or three weeks so there is still ample time to execute this transaction before January 1. Most companies will provide a twelve month rate guarantee so at least the Texas health insurance consumer will have some semblance of security until 2010. After 2009 I feel the industry will have a little better grasp of what a new government administration has in store for health insurance.

Also of note, any consumer of health insurance in Texas that received a rate increase from their individual health insurance provider a few months back but stayed on their present coverage because they had already met any deductibles for this year, now is the time to look into a new policy. Remember, deductibles and co insurance starts over at the beginning of the year so now is the time to evaluate a change.

So to sum it all up, if you received that nasty rate increase letter in the mail but just pushed it into the top drawer because of the time consuming Christmas shopping that must be done, pull the letter out, and call an established Texas health insurance broker and let him do the rest, your holiday season will brighter with a few extra dollars in your pocket.