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

2011-03-23 by 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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Blue Shield canceled it’s latest rate increase–is that good?

2011-03-19 by Colleen King


This past week, after much controversy, Blue Shield of California canceled it’s rate increase set for May. It was supposed to be in March, they were asked to delay it 60 days by the insurance commissioner, which they did. So after already having two rate increases since October of last year, Blue Shield canceled this current rate increase and has said no more ‘rate actions’ through the end of the year. Click here for the details.


Basically, it appears that one reason this was able to happen was expenditures for health care services late 2010 were less than anticipated. SO, does that mean everything’s okay?


Not sure; what if expenditures exceed what is expected? Conventional thinking is that when times are tough, people skip care that is not essential. This is either because they have no insurance or their insurance puts more of the initial costs on the member. That’s how you keep insurance premiums down, especially when you hear about rate increases like these.


I’m concerned about what happens next year, wondering if rates will fly up to a ridiculous level. Carriers are being expected to do things and cover services in ways not previously experienced, and don’t know how to price for it, so they shoot rates up. And it’s not just Blue Shield, it’s happening with all the carriers.


So to all of you who said to me ‘hey, I thought health care reform was supposed to drop rates,’ I told you it wasn’t going to happen any time soon. Believe me, I’m sorry I was right!

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Category: Uncategorized



Prescription drugs and the high cost of health insurance–related?

2011-03-01 by Colleen King

Okay, so it’s one reason that insurance premiums are so high, but it’s a big one.


On AOL today there was an article about several drugs that will be coming off patent–big name drugs like Lipitor. Drug companies, in order to recoup their ‘research and development’ costs have exclusive rights to a drug they develop for several years. Read here for more. And check out the BILLIONS in sales each of these generates!


Is your drug on this list? Well, if you take Lipitor, Protonix, Zyprexa, Concerta or several others, over the next 2-3 years you’ll see a drop in costs. If you don’t have health insurance, one thing that I’ve told my clients to do is check at Costco. You don’t have to be a member for prescription purchases necessarily. They have a ‘price checker’ on their site that I refer to often. Prices can vary by location, and the pricing here is based on buying from Costco.com. Check your local Costco to see what the cost actually is. The one in Northridge near me is usually pretty close.


Point is, to bring down the cost of health care in general and insurance too, you have to be a saavy consumer. Many studies show that people spend more time researching an auto or TV purchase that things related to their health care. Enough of ‘buyer beware,’ time make smart choices. You can start with your drug purchases.

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Category: Uncategorized