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Health care reform made all preventive care free, right?

09-23-2011by Colleen King

In the effort to increase access to care the Patient Protection and Affordable Care Act (PPACA) mandated that preventive services be covered on newly developed plans with no share of cost and before a deductible is met.


Or so we thought–Check out this article from the US Department of Labor. One thing that was not really mentioned is where you go for services may determine whether or not there is a sharing of cost or not. The example here is that if you go to a free standing, ambulatory surgery center for a colonosopy, you probably won’t have a co-pay. But if you go to the outpatient department of a hospital, you probably will because cost of care at those types of facilities typically is higher.


So that’s why I call this the asterisk, or the footnote, yet another, in health care reform. The bill was passed with little detail really delineated, just a ton of concepts. So my advice So Cal, is if you have to have anything more complex than a blood test, so you minimize your costs call the member services number on the back of your insurance card. We have a lot of free standing ambulatory surgery centers in Los Angeles, and a lot of hospitals. Make sure you find your most cost effective options! Money’s still not growing on trees, at least not in the San Fernando Valley.


Have a great weekend!.

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Category: Uncategorized


Who has the most expensive health insurance premiums for individual plans in the country?

08-17-2011by Colleen King

In dealing with people day to day, most think California has to be the most expensive state in the nation. Not so, believe it or not, it could be worse.


Health care reform, the Patient Protection and Affordable Care Act (PPACA) were suppose to get us on the road to more affordable health insurance. Notice I didn’t say health CARE. The PPACA did not deal with health care costs at all, just health INSURANCE costs. But I digress…..According to StateHealthFacts.org, California is 9th in ranking least to most expensive. There’s a foot note, as usually with California, that HMO plans were not factored in to this and according to this 2010 data this takes all plans, all ages so of course there will be some radical deviations. But I still thought it was interesting.


The national average is $215/month. California comes in at $157/month. Check out this list, and notice who comes in at the end.  Massachusetts, where coverage is required. New York and New Jersey are pretty darn bad too. This is why we have to be very careful of what we ask for, and how we implement it, because we just might get it.


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Category: Uncategorized


How fast can you get me health insurance?

08-15-2011by Colleen King

When a call starts like this, it’s rarely good. This usually means someone has something wrong, or someone’s pregnant.


Problem is, the intent of Health Insurance is in case something goes wrong. If something has happened, you don’t need insurance, you need financing and insurance companies don’t do that. This whole idea is why requiring people to buy insurance unfortunately is going to be important if health care reform is going to work. Otherwise, what will happen is people will only apply when they have an issue, then drop coverage when all’s well. The concept of insurance, all types of insurance, is that people have to pay in whether they need it or not then there is money in the risk pool for when something is needed. And a risk pool is never something you want to be in the shallow end of, that’s for sure.


That’s an issue that has come up with ‘child only’ plans. Under age 19, due to health care reform, all kids have to be accepted regardless of pre-existing conditions. They can be charged above standard rates, but the carriers have to take them. One thing that is starting to happen is carriers are putting a 15 day delay in place from the time an application is submitted to when it can become effective, to avoid this jumping in, jumping out thing. At first carriers said okay,we just won’t write any ‘child only’ policies, we don’t know the risk. California then passed legislation saying okay fine, you don’t write ‘child only’ policies, you don’t write any individual health plans in California for 5 years. More on this in another article.


My main point is, we can’t close the barn door after the horse is out, so that’s why you need health insurance. Before something happens!

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Category: Uncategorized


Health care reform is already messing things up, even the simple health insurance rate changes

04-14-2011by Colleen King

Okay, many people are really unhappy with health insurance right now. People either don’t have because it’s unaffordable or they are uninsurable. Or they do, but their rates are going up. So it’s time to call your agent, see what else is available.


Well, here’s the problem. The carriers can’t even agree on what needs to change when. Or actually, what to do about it. Last quarter of 2010 was outrageous. Anthem had rates available through 9/22. Blue Shield’s rates were good through 9/30. Kaiser, they’re fine, ain’t changing a thing. Cigna only does 1st and 15th of the month effective dates. And there’s more, but you get the idea. It’s continuing to happen, changes all the time, it’s causing a lot of extra work for everyone.


So big deal–so what? Well here’s the thing. As you may have heard, things are tight for many people these days. So a jump in expenses of $50-$100 a month, maybe more, maybe less, is a big deal. And normally when the rate changes come in, I can give information that is solid. So can any good agent. But now, with the variation in rates and effective dates, and new information popping up every day, it’s frustrating.


I’m trying to help people make a move to avoid their increases and easier said than done. So if you have an agent you’ve worked with for a while, and they seem like they have a new onset of ADD, there’s a legit reason. You have to dodge a series of rates. You want to advise people to request specific effective dates so that they get the current rates. But I know for me, my phone is ringing off the hook and email is overwhelming. So hang in there, we can get you changed most likely–have faith!

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Health Insurance, the letter of creditable coverage and why it’s important.

03-23-2011by Colleen King


When you change health insurance plans, or just drop coverage, your previous carrier will send you what’s called a Letter of Creditable Coverage. This will show the start and end day of your coverage with them. So what, what does this mean?


This could be very important especially if you are moving to a different policy as many people are doing right now, in order to cut their premium. If you have a condition you need care for, and you did not have prior coverage, the new carrier could see it as a pre-existing condition and not be obligated to cover it for the first six months of your new policy. And this is legitimate, it’s not just insurance companies looking to not pay claims. They are looking to not pay claims they are not obligated to. Isn’t that what you are looking for when credit card bills or cell phone bills show up, charges that aren’t yours to pay?


This came to mind recently when a client of mine told me she needed proof of prior coverage as her new carrier was asking for it. She had a procedure, the new carrier wanted to make sure there was no lapse in coverage over 63 days (that’s the magic number, have no idea how they came up with it) so we had to contact the old carrier.


Carriers vary in their ‘workability’ so if you get one of these letters, keep it. One carrier I work with reguarly, I called to get one for a client and even though I wasn’t the agent of record on that old policy, but being able to give certain identifying information, they emailed me what we needed within 10 minutes. This client’s old carrier had to snail mail the letter to her, and it took two weeks.


Most of the time you won’t need it, but when you get one, keep it to make SURE you won’t need it (Murphy’s Law). Unless of course you won the Mega Millions lottery, but even then, why spend it on something you don’t have to!


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Category: Uncategorized