Like always, we will be providing quotes from all the major players in the market, so in this case all the major Texas Medicare Supplement conpanies. Also, we will be providing the same level of dedicated service to all our visitors to our new site.

Unlike our Peeler Insurance site, this site is still growing and new content as well as changes to the current content will take place daily. We hope you enjoy the visit.

Now if you are a parent needing to cover your children you are out of luck. Period. Unless a parent is on the policy and for allot of families that’s not an option in this economy. I did expect this since every other major Texas Health Insurance company pulled the plug on child only policies over the past 60 days, I guess I was just holding out hope that Humana Texas would stand tall, but nope.. No way.

Ok, Why? Well again as I have written in prior articles this is 100% unequivocally related to the phase in of the new Health Care reform law signed by the president on March 23rd. The new law states that effective September 23rd 2010 children under the age of 19 are to be guaranteed issue with no pre-existing condition limitations regardless of having prior coverage. In english: you have a child with a heart transplant scheduled next week, in theory you could have secured a health plan and had the condition covered on the spot. Wild is it not?

Here are some situations that now will now come up regularly. Scenario 1) Single parent wants to cover her son and daughter but do to a medical condition on mom she cant get coverage. She has no coverage through her job since she is a self employed accountant. What happens? She is out of luck, the kids can’t get covered through the individual market, she makes over the income requirement for medicaid and CHIPS and the federal risk pool requires the kids to have been denied coverage due to medical condition AND be uninsured for at least 6 months. Let’s just hope the kids don’t get sick between now and 2014 when the entire health care reform package kicks in and mom can get coverage.

Scenario 2) Divorced dad who is required under court order to provide coverage to his children as per divorce decree. Oh, he lives in Washington state but the kids live here in Texas. Sorry Mr. divorce judge, the dad will be forced to violate the court order as no one will insure the kids. Most plans written in other states require you to utilize network doctors in the primary state. This one is going to be interesting

That’s just two situations I pulled out of the air, who knows how many problems this will cause. Now who to blame? Well on one hand we could blame the big bad insurance companies but why? Their job is to remain solvent and this can and will cripple their bottom line and reserves. It does the country no good to have all the big Texas Health Insurance companies belly up and laying off all their employees. Should we blame the government? Well, that’s for you to decide, but I have decided. This health care reform package is killing our health care delivery system.

They are gone, they are all gone.

First, I was led to believe the premiums were going to be affordable. They are not, unless you consider $323 a month for a kid and almost $700 for someone 55 years old affordable. Thats not affordable but that’s not why I’m writing this article, it’s based on something entirely different. This article is about why the plan is not working.

I had a client with whom I have insured their kids for years call this week and indicate she needs a plan that will have no waiting period on her husband. I asked why are you now suddenly needing coverage on him since he has not had coverage for years? They only cover their 2 kids because financially they just cant afford a policy on mom and dad. her comment to me was he was having a tingling feeling in his leg and she thought it might be a major condition that runs in his family called Crohns. She also said the symptoms he is experiencing are the exact same as the other members of his family started having when they were diagnosed with the condition. So now she is looking for a policy that will cover this condition and needs it NOW!

His options were limited, first because he has not had coverage for years there will be a pre-existing condition limitation on ANY policy he secures through the open market however because there has been no doctor visited or testing preformed there is no way to know what to include on the application that would be submitted to the Texas Health Insurance company. What should she put on the application, that he “thinks” he has Crohn’s? No, I think that is flat stupid to self diagnose yourself with medical conditions. Does he tell the insurance company he is having unexplained pain in his leg? Yes, that’s the answer I advise however the next move on the part of the insurance company will be to require the consumer to go get a test preformed. If he doesn’t get the test the file will be closed as “incomplete” not medically denied. I promise you if he fails to mention it, which was he desire the company would find the condition somewhere in his record the moment a claim came through and it would not be covered after thousand of dollars in medical bills were incurred.

My client should be able to apply for the new Pre-Existing Health Insurance Plan offered through Obama Care, but stop! There is a problem there as well. Since he does not have a letter indicating he was denied for medical reasons he is not eligible for that plan either. The plan requires that, and I quote “You must have had a problem getting insurance due to a pre-existing condition”. I don’t see how he would be denied for a pre-existing condition until medical testing was compleated or ordered. He just doesnt qualify for the Govt Pre-Existing plan, yet.

So this poor family finds itself in a black hole, can’t get a Texas Health Insurance plan on the open market without lying and saying he is healthy and doesnt qualify for the Federal Government Plan because he has not been turned down by traditional insurance and he can only have that happen by lying that he is sick to the traditional Texas Health Insurance company. What a joke!

Now, how do you eliminate this problem from ever affecting you family? Please dont go without health insurance, you never know what may happen.

This new company decision is for effective dates of September 15th 2010 and later, so basically we will not submit to Cigna for child only policies from this point forward.

Humana Health Insurance Texas is all that’s left and I expect they will follow the leader here and bail out soon, could be this week.

Again, as I have discussed in prior post the reason for the Cigna scamper is related to the brand new and exciting savior to consumers called the Patient Protection and Affordable Care Act (PPACA), also known as Obama Care. With the new requirement of guaranteed issue effective at the end of September the Texas Health Insurance companies just said “check mate” to Obama. They win, you loose all because of an ill conceived provision in the new law.

The problem with the new GI provision for kids is this: First, it’s guaranteed issue. Second, and probably the kicker is there is no mandate that kids be covered so in theory parents could be on their way to the hospital and be on the phone with me buying coverage for the sick child. The law says no pre-existing condition limitations so the sick child would be covered pronto, on the spot for that big fat million dollar claim and what does the insurance company get out of the deal? About a hundred bucks in premium. Not worth it to them. Another problem is they didn’t require prior coverage to eliminate the pre-existing provision, that would make the most sense and eliminate the family from waiting until little Johnny get deathly ill to secure coverage.

The fun is just beginning…

Bottom line, due to the new federal mandates associated with the Patient Protection and Affordable Care Act, also known as Obama Care, or Health Care Reform ALL children are mandated guaranteed issue with no mandate on all kids having coverage. There is also, as the way it is now, no caps on what you can charge for coverage on these policies so look for those that do stay in the kiddie coverage game to just flat-out blister the prices for child only plans.

Now there are only TWO  companies left in the game that a broker can help you get coverage from for you child only applications. Humana and Cigna, but with Cigna you better have a healthy child or no broker will assist you and if your child has health conditions you won’t be able to afford it. So in reality we have ONE, Humana, that’s it. I think there are a few 2nd tier carriers that may offer kid coverage so I’m speaking about the big boy insurance companies.

Stay tuned… It just keeps getting better and better with the new health care reform laws.

Just as I predicted after the passage of Obama Care Blue Cross Blue Shield of Texas has eliminated new sales of three products. These products were not products I actively marketed as they had internal limits that I just could not stomach. The three products, PPO Select Value Care, PPO Select Basic and the  Foundation Hospital Care plans were removed from quoting July 29th 2010. None of these plans met the new federal guidelines of Health Care Reform and due to the limited nature I feel this was a good move.

This new action will most likely cause consumers with these policies rates to climb at enormous amounts, that’s the normal action when a product is no longer offered.

Limited policies do nothing but confuse the Texas Health Insurance consumer because most clients can’t fathom these type of policies even exist. Also, from the very beginning of the Obama Care discussion I felt plans and companies would vanish, some good some bad.. very bad however this is positive for consumers.

Almost all insurance companies offer in their portfolio several different product selections and they all have what I call their “dog” policy so with that look for even more products to be removed from their marketing efforts. Soon, very soon.

Blue Cross Blue Shield of Texas is still offering their other excellent products like the High Deductible HSA plans and their PPO Doctor Co-Pay plans, both offer great rates and more than adequate coverage.

Preventive Health Benefits under PPACA Outlined
Blue Cross and Blue Shield of Texas (BCBSTX) benefit coding experts, medical directors and customer service leaders have carefully reviewed the recently released Interim Final Rule for preventive health benefits under the Patient Protection and Affordable Care Act of 2010 (PPACA). These benefits will be paid without any cost-sharing (deductibles, copays or coinsurance) when using network providers (100 percent coverage not applicable when using out-of-network providers). Using a combination of procedure codes (which providers use to indicate the services they render) and diagnostic codes for individual patients, we have determined what updates are needed to our claims adjudication systems to comply with PPACA.

At a high level, the following categories of benefits will be preventive and will be paid at 100 percent:

Here is the excert of the email discussing this process:
Beginning 8/1/2010, the ability to generate quotes for CIGNA Individual & Family Plans with effective dates of 10/1/2010
and 10/15/2010 will be temporarily unavailable while we update our systems and plans. We expect quoting to be available
mid-late August, contingent upon state approvals. Some states may require longer than others to reinstate. As states
become available, we will provide updates via email and the News You Can Use section of CIGNAforBrokers.com. Please
note that Small Group quoting will not be impacted.

Stay tuned!!

Blue Cross Blue Shield of Texas is simply following the lead of other companies that have pulled this stunt, United HealthCare comes to mind as they exited the child only market about a month ago. One interesting point is BCBS will introduce new plans for the child only market sometime in the future known as “Blue Pathway”, the plan was just filed with the state department of insurance.

Two things about the filling with the insurance department. First, these fillings take time, lots of time, in my 18 years in this business I have seen it sometimes takes months and months to get approval from TDI all because of legal wording in the insurance contract. Lawyers go back and forth over minor details until one side gives in and this process could take up to a year, don’t know so no one should think the new Blue Pathways will be on “store shelves” any time soon. I have also seen new policies just flat die at compliance, never to be seen again.  Also, Blue Cross Blue Shield of Texas has made a decision to ONLY market this product direct, meaning your local, helpful and knowledge broker has been cut out of the loop. Why? Simple, BCBS has said in the past their major distribution channel is the broker community and by eliminating us from the picture drastically cuts down on the number of applications they will receive. Thats the goal folks. In my opinion they just flat-out don’t want the business, who would? Its guaranteed issue without a coverage mandate.

Don’t have a clue what Blue Pathways will look like but I can only guess it will not be as rich in benefits as some of their current offerings, if it was why not just use their current portfolio to offer guaranteed coverage on kids? Makes no sence unless the benefits will be reduced… or the monthly premium is jacked up to federal deficit levels, you just wait and see, that is if there is anything to see, may never get out of TDI compliance.

Should we be mad at Blue Cross Blue Shield of Texas, or any other Texas Health Insurance company for doing this? No, I don’t think so, it’s not their fault. Insurance companies are not in the business of selling policies to consumers as they sit in the emergency room and that’s how this provision of health care reform is written. There is no mandate that kids must be covered AND there is no pre-existing condition waiting period so in theory a family could wait till little Johnny needs that heart transplant and call up their local broker or insurance company and under law they must sell him a policy, that is if they offer child only coverage AND he would get the policy the insurance company offers to kids.

So, what do I feel will happen? Parents looking for child only coverage will find only one or two options, and those options will NOT be affordable. Rates that today are $75, $150 a month for one child could be $500 to $1000 a month, who knows. I do know how insurance companies work and that leads me to believe the rates will be large.

Ok, who should we blame for this? What caused this mess.. Simple, next time you get mad about the next rate increase, or the fact you can’t afford little Johnny’s coverage call Obama and his gang, this has his name written all over it. Why? Insurance companies are not in the business of providing charity, they are a business and must remain profitable, if not they go belly up, jobs are lost and the economy dwindles even more. Forcing Texas health Insurance companies to cover sick kids as they are on the way to the hospital is just flat dumb. Offering them coverage is an automatic massive claim with little premium dollars in return. Remember, Mr. Obama required no federal mandate requiring coverage, so any child can get a policy at any time, even on the way to treatment for a major health condition.

As we sit today there are still companies offering child only coverage so don’t panic… yet. if you are looking for coverage for you kids, call us, there are still options.

Ok, why all the confusion? Well, soon.. very soon actually children will be guaranteed issue as per the new ObamaCare law and as companies gear up for the radical change they are all making procedural moves to handle the blow to their bottom line. Insuring children with no regard to health status can and will drive premiums up, it’s just simple math. Higher premiums as a result of this new mandate will be coming soon and we can blame ObamaCare(sorry Obama, I did not attend your meeting this week where you ordered insurance companies not to blame you for the increases).

Some things that have happened are this: First, United HealthCare of Texas, also known as Golden Rule insurance company pulled the plug just a few days back on child only policies. No more policies will be accepted for kids unless a parent is included on the policy. By all accounts this move is related to the soon to be mandate of kids approved regardless of health status. A consumer can still get their kiddos covered, provided one parent comes along for the ride on the policy. Also, Blue Cross Blue Shield of Texas DID cease writing children under the age of one year old. The BCBS move is no big deal as their premiums on newborns was excessively high.

There is also scuttlebutt that Blue Cross Blue Shield of Tx will soon exit all child only coverage, keep in mind this is just me putting the pieces together from emails and conversations I have been a part of from company reps.

I feel the short-term future will lay out like this: All companies will exit the child only market, it’s only a matter of time and that my friends will hurt the consumers looking to protect their most cherished responsibility. This future move will require adults to be included on a policy before a company will entertain offering coverage to kids, this action will drive up monthly premiums since an adult is now added. The end result will be less young kids will have Texas Health Insurance coverage causing more and more families to visit the emergency rooms for treatment or to self treat their kids at home. Those parents that find their dependants needing more complex medical treatment will then find bankruptcy staring them in the face to pay the large medical bills their kids have incurred.

Back in the day when I dabbled in politics as an offical of one of our local communities i always asked myself this question before a vote: what is the unintended consequences of this new law or program? Well, it’s to bad our current group of elected officials didn’t ask this question before they voted.

Thank you ObamaCare for placing a big target on the backs of thousands of good hard-working parents trying to protect their family.

They keep dropping like flies. Is this what we wanted when the health care reform debate started over a year ago? That makes what? Five now that have vanished since the debate started. Well, American Community was never a product I choose to market due to certain provisions in their Texas Health Insurance policy I didn’t like. Guess I read that one right for a change.

Ok, so what’s about to happen: A Michigan Circuit Court placed American Community into rehab and a Transition Plan Agreement was approved to move all the American Community clients to Golden Rule Insurance Company, part of the United healthCare clan of companies. Not the fun starts for those clients.

I have been through this before with the exit of Unicare of Texas but for all the American Community of Texas policyholders I’m sure you are both scared and confused. Call me, I will help you. You don’t have much time though, August 15th 2010 is the date that Golden Rule takes over your plan. If it works like the Unicare exit there will be some administrative paperwork involved in the transition and you better act quickly on doing market research to determine if this is your best course of action by accepting the offer.

United HealthCare of Texas and Golden Rule have not always been the best option for Texas health Insurance consumers, sometimes, yes they work great but over the last few years they have not been the best option when you perform a benefit and cost analyst. Better options exist through both Cigna and Blue Cross Blue Shield of Texas. Things have changed in the last few months to place Golden Rule in a better position with their monthly premiums, more so in the south Texas area.

So, now what? I suggest you contact me  immediately upon receiving your packet from American Community or Golden Rule, don’t delay, they have deadlines in place that probably will be hard and fast, meaning no flexibility. They are offering current American Community clients to transition to Golden Rule regardless of medical history so consumers with non insurable health conditions should be safe but again, your decision to accept the offer will most likely be required in writing and will be required before the deadline. one thing we don’t know yet, what will Golden Rule charge monthly for your coverage.

bottom line, contact a Texas Health Insurance agent ASAP!

Just to refresh a few memories high deductible HSA plans were introduced during the Bush years back in 2003. The concept is there is a single family deductible and out-of-pocket, not a per person deductible. HSA plans also do not offer co-pays for non preventive benefits, the family deductible must be met first. There is also tax advantages like paying for medical expenses with pre tax dollars but that’s not what this story is about, this is more about Blue Cross Blue Shield of Texas rate structure and why they destroy the competition by in some cases as much as $150 a month over their competitors.

I have no clue why their rates are cheaper, who knows maybe better actuaries that actually know what they are doing, maybe a thought process that more volume at a lower price will generate more profit due to more members. Whatever it is “thank you’ Blue Cross Blue Shield of Texas for giving the consumers affordable options.

Their policies basically look no different from the next company, they offer about the same benefits that all HSA plan offer. Major Medical coverage up to $5 million per person, one deductible per family and maximum out or pockets selections of $6, 7 and 10 thousand a year for family coverage. Of course there is out-patient prescription drug coverage and wellness care after the deductible is met so im my view “not bad”.

Lets look at this example. Take an example  I have been working on for a family in Corpus Christie, they are late 40′s early 50′s with one kid. Blue Cross Blue Shield of Texas comes in for an HSA plan at 490 when every one else I quoted was 50 to 150 a month more. Very easy decision in my view when most every doctor and hospital accepts the strong name ID they bring to the table.

Again, take a look at Blue Cross Blue Shield of Texas before you make that next health insurance move, you might be as shocked as some of the consumers I am speaking with have been.

Some of the provisions of the UHC position indicate that they do reserve the right to hammer the rates based on health status or deny approval but if the kiddos are approved they will be covered without exclusion riders. UHC also made a procedural move a few day back by indicating they would no longer offer child only applications therefore in order to get the new benefit an adult must also be covered on a policy.

United HealthCare, a national name in the insurance market, offers some excellent benefits for Texas Health Insurance consumers with plans that cover doctor co-pays, preventive care as well as excellent drug prescription benefits. They also offer high deductible HSA compatible policies that work well for families willing to eliminate doctor co-pays.

Here is what we don’t know yet: What will the final outcome be as it relates to price? Who knows, they just implemented this procedural change yesterday. But after a few weeks the agent community should know after we have submitted a few to see how underwriting will approach this issue.

Overall, this could be a great change for Texas Health Insurance consumers. If you are one of the thousands of families struggling to find coverage for your kids, call me today.

American Medical Security was never a major player, I don’t think we submitted an AMS application in well over 3 years, but still we lost another one. Before long there will be only a handful of companies offering Texas Health Insurance Plans and that my friends means one thing, higher monthly premiums for good hardworking consumers.

If you are a current American Medical Security policyholder I suggest you contact your trusted broker and review new plan options as what most often happens when companies stop the flow of new business we see rates climb at faster than the normal rate due to no new healthy consumers in the system. Now is the time to make your exit! Call us, we have the experience in dealing with these withdrawals and will gladly find you a product that fits your needs.

Obama is requiring several new mandates to start pre 2014, the much hyped start date of the mandated coverage previsions of the new law. Mandates like children becoming guaranteed issue with no pre-existing conditions, kids allowed to continue on parents policy until age 26 regardless of status in most cases, elimination of lifetime caps and soon the elimination of yearly caps on policies are some of the major provisions that are causing Texas Health Insurance companies to blister the rates. Get used to it, period.

Want to blame someone for your next rate increase, this time you can’t blame us, the hard-working insurance professionals. I suggest you place that big fat bullseye on the man at the top, Obama. But wait, it ain’t over till the fat lady sings as I remember Dandy Don Meredith singing on Monday Night Football back in my younger days. You think premiums will escalate now? Check out what is going to transpire in 2014. The Kaiser Family Foundation has developed a nifty premium calculator to help determine your probable cost post 2014. I promise you this, if you make more than $70,000 a year for a family of four you will shocked to death with the increased premiums you will probably pay. The foundation is using information provided from the PPACA law as well as information gathered from the CBO to determine probable premiums. User beware.

From the Press release: “American National Insurance Company’s subsidiaries, American National life Insurance Company of Texas and Standard Life and Accident Insurance Company will discontinue the sale of Individual Medical Insurance effective June 30th, 2010. American National will continue to serve the Medicare Supplement and large group markets as well as other supplementary products.” According to the press release the reason for the exit is the passage of the healthcare reform legislation.

Ok, so what now? Well American National Life Insurance of Texas and their parent American National Insurance Company have been around forever. Back when I was a kid my parents purchased one of their widely popular children life insurance policies on me. That was almost 50 years ago. Everyone over 60 knows of these guys, it’s sad to see them leave… But why? Why not stay?

American National sold very few what I consider full Texas Major Medical Insurance policies. Most of their offerings had limits, limits to the degree that I would not offer their products. Their pricing on their better products was just not competitive in this tough Texas Health Insurance market. The products that were low-cost simply, in my opinion, were not quality coverage. Back in the day American National Life Insurance Company of Texas had some quality stuff, and I marketed it heavily but not for the last 5  years. 

It seems their target market was more aligned with the captive agent, those who only sell for one company. They also were more focused on paper applications, meaning an agent had to physically visit the Texas Health Insurance consumer. Those days are over, most of the bigger players in this business do online applications and the consumer never sees the agent.

The healthcare reform law jammed through Washington spells out very clearly the fate of insurance policies that have limits and it appears ANLIC found its products to be non conforming so rather than conform they ejected. They won’t be the only one to have their product portfolio destroyed by the new insurance law. Out of all the provisions in the new legislation this is one I support. I feel consumers look to agents for guidance on which policy to purchase for their family and all to often agents are provided with a oppertunity to supply a consumer a policy that fails on the quality end of the spectrum. We should eliminate all the Texas limited benefit health insurance policies and the hospital surgical expense policies. Overall consumers will be better off because half the time the consumer doesn’t have a clue what their policy will cover, it’s hard enough to provide adequate coverage from what is considered major medical policies and insuring a client in a limited benefit policy just makes it that much more difficult for folks to understand.

As an independent broker I am tired of competing against policies that I know are limited in coverage, however because what another agent told them they just flat-out don’t believe me when I tell them the coverage they are considering falls short of their coverage goals, or the price of these limited policies is so much cheaper that the consumer elects to gamble with their personal bankroll. So for this reason I am glad that these limited policies are being eliminated, as well as the agents that make their living marketing limited benefit products. Nothing against American National, I think the world of them, I just didn’t like the direction they had chosen to go with some of their products.

If you are a current policy holder of American National Life Insurance Company of Texas now would be a good time to shop for new Texas Health Insurance Quotes. As a broker representing all of the major players in the market we can provide you quotes instantly from companies like Aetna, Blue Cross and Blue Shield of Texas, Cigna. United HealthCare and Humana just to name a few. I recommend you review your options quickly as who knows what happens next.

If you are a current policyholder of ANLIC don’t panic, there was no mention in the press release of the elimination of current policyholders, but that could be an option, we just don’t know yet. I hope not. I’m sure there will be more to come from American National Life Insurance Company of Texas very soon as well as other companies following their move. Stay Tuned!!

We have had a tough year, not from the amount of production but from the overall uncertainty and turmoil associated with the health care environment caused by President Obama and his democratic associates. Consumers of Texas health insurance were cheated this year in rate increases caused by both the fact that virtually NO new products were introduced by companies and the massive amounts of money that had to be spent on lobbying efforts to fend off the takeover of 20% of the economy, health care.

Now, where are we going? Health care reform is dead. Period. This plan, so strongly endorsed by the democrats and so strongly disliked by the voters will never, ever come back. The election of Scott Brown in Massachusetts completely moved the needle back to the side of the people and for that we should be grateful. Will we have reform in a different version soon? Yes, I hope so and I have proposed several options of solid, efficient Texas Health Care Reform that the boys in Washington should carry out. Will they? Probably not, there will be small non game changing reform that will only allow the democrats to “save face” and declare they passed reform, much like President Clinton claimed back in the ’90′s.

Health care reform efforts killed normal operations in the Texas medical insurance market. Since our website: Peelerinsurance.com ranks on page one for all the major search engines I have the ability to show some trending I noticed as it relates to the reform efforts. During the dog and pony show we witnessed in the media for the last 9 months searches dropped in some cases by 50% and actual request for rates dropped a total of 75% however searches for health care reform matters was up about 400%. Bottom line, no one was buying new coverage, every one was waiting for their “Free Insurance”, sorry that ain’t gonna happen. I was lucky that I have a large client base that never left, they stayed put on the texas Medical Insurance plan they currently have, but I did notice several raised their deductibles to off set rate increases. Also, I noticed every time President Obama spoke to the nation about health care searches would completely dry up for several days, remember change was ‘a coming, at least thats what the american public thought.

Since the election in  Massachusetts a few weeks ago spelling the end to reform searches have shot up, back to normal levels. The phone is ringing off the hook again with Texas health insurance consumers. Families now know their will be no free insurance.

Another problem last year was because of the uncertanity of the overall Texas health Insurance market no major companies introduced new plan design, that has never happened in my almost 18 years in the business. When the market is selling two year old policies you get extremely high loss ratios in those policies resulting in extremely high new business rates. I hate this happened but what do you expect when the insurance companies did not know if they would be in business tomorrow and under what regulations they would be under. developing new policy designs cost a ton of money and I can see where the carriers did not feel the need to do te research and developement.  

Already companies are hinting at new plan designs are in the works and for that I’m happy and one major insurance company has sent out a memo they will sunset some of their plans, all in an effort I think to introduce new policies. This will be a major step forward for the upcoming year, I think rates will retreat back to more manageable levels.

We lost a major heavyweight in the market at the end of last year, Unicare Life and Health of Texas pulled out of the health insurance market in Texas. This was a devastating blow to the texas Health Insurance consumer as we need more competition, not less. Why did they leave? Well, my thoughts on the matter have been well documented but again I think it all relates to health care reform and the effect it had on the companies last year.

Where do we go from here? We stay the course, wait for things to settle down and insurance companies will introduce new, more competitive plans that serve the needs of Texans. It’s been a tough year for consumers with the uncertanity of both the economy and reform efforts but from all indications thing are getting back to normal in the insurance industry. Lets just hope that the powers in Washington get out-of-the-way, and keep their hands off the greatest health care system in the world. You democrats have caused so much fear in the minds of Texas Health Insurance consumers by not trying to reform health care, but to just flat take over 20% of the economy. We want reform, not a takeover…Do better next time, OK?

Based on communications I have had with both Unicare and Blue Cross and Blue Shield of Texas there is no reason to panic as Blue Cross of Texas will absorb the currently active policies into their block of business meaning no consumer currently holding a Unicare policy will be without coverage.

There will be a transition period for current Unicare policy holders to accept the migration to a similar plan and rates with Blue Cross starting November 1st, 2009. Here at Peeler Insurance we are currently in aggressive contact with all our Unicare policy holders in an effort to assist in this transition. We expect this to be a very smooth process and should be compleated by the middle of November.

Also, late this afternoon Blue Cross released the breakdown of affected Unicare policy holders as it relates to monthly premium. The premiums remained almost the same as the consumers are currently paying and it appears on policies where deductibles did not match Blue Cross offered the lower deductibles. here is an example: some  Unicare policies have deductibles of $2000 and $3000 where blue Cross does not offer those deductibles, they went with the next lowest deductible in their offer.

This news comes as a shock to all members of the health insurance community. For the lack of a better term, we were “blind-sided” by this action. Just late last week I was in contact with a Unicare executive who had invited me to a sales similar so they were caught off-guard as well.

For years Unicare offered the lowest premiums on coverage for Texas health insurance consumers, only in the last 2 years had they changed their offerings to a more rich in benefit policy as well as adjusting rates. I can only assume that continued years of low premiums finely caught up with them. This all ties into the current health care reform battle going on in congress and the supporters of the ‘public option” plan should understand and see that if health insurance companies are forced to compete with an option that has an unfair advantage of setting payment schedules to doctors and hospitals(medicare like) and insurance companies attempt to compete you will cripple and destroy ever insurance company in the United States. Let this event serve as the first bullet over the bow of the American free enterprise system as it relates to the protection of you and your family’s health coverage and choice. Unicare did exactly what every health insurance company will be forced to do after the passage of the current plans endorsed by the democrats, compete with extremely low premiums in an attempt to “buy” business like Unicare did back in the ’90 and early 2000′s. Wake up America!

I support reform as much as anyone, I just support the right reform. I have an offical position on the reform debate here.

If you are a current Unicare policy holder and i’m not your agent of record, please, call me to help you through this or get a current Texas Health Insurance Quote. I will give you the same commitment to service that I have provided my clients for the past 16 years.

So to sum it all up, I feel this transition will be very smooth and easy. I know each and every Unicare client that has Peeler Insurance as their agent of record will be handled with “kid gloves”. My only focus is to insure the transition is snap.

God Speed Unicare!

Here is the release provided to the agents today:

October 28, 2009  

Dear Broker:

UniCare has made a difficult strategic decision to exit commercial health insurance markets in Texas. Following a transition period, UniCare will no longer provide health benefits in Texas. 

While UniCare continues to be financially secure, competitive pressures have made it increasingly difficult for us to maintain our high standards for excellent customer service and affordable, quality benefits that you expect from us. 

UniCare is pleased to collaborate with Blue Cross and Blue Shield of Texas (BCBSTX), which will offer guaranteed replacement coverage to UniCare’s existing employer groups and individual policyholders. We believe that BCBSTX is best positioned to offer quality products, a high level of benefits and the superior customer service that our customers have come to expect. In addition, like UniCare, BCBSTX is a statewide plan that includes a comprehensive network of physicians and hospitals to choose from. 

For UniCare customers who elect to transition their benefits to BCBSTX, UniCare will pay all claims for covered services rendered on or before December 31, 2009. BCBSTX will pay all claims for covered services from the time and date specified in their offer letter. There will be no break in coverage. 

For UniCare customers who do not choose to transition their benefits to BCBSTX, UniCare will offer to renew their policy but only for a term ending on June 1, 2010. If the customers’ renewal date falls after June 1, 2010, UniCare will terminate coverage effective June 1, 2010 if permitted to do so by the terms of the policy, or otherwise continue to provide coverage up to the renewal date. 

BCBSTX will be in contact with you soon to discuss an offer to transition your customers’ health benefits. In the meantime, if you have questions regarding UniCare’s decision, please use the below contact information:

• For questions regarding Large Group, contact your UniCare Account Manager or BCBSTX Sales Representative
• For questions regarding Small Group and Individual, contact your UniCare Agent Support team at 877-864-2468

If your customers also have dental, vision, group life or disability coverage through UniCare, the BCBSTX offer will also include that coverage. 

Until UniCare has completed its exit from the market, we will continue to process claims as we do today and honor the commission structure that is in place. 

We have enjoyed a productive working relationship with you and want to help make this transition as seamless as possible. BCBSTX looks forward to the opportunity to work with you to provide your customers with the same level of quality health care benefits and service that they received with UniCare. 

Sincerely,

Lawrence G. Schreiber 
Vice President and General Manager 
UniCare

Attachment: Go here to view Frequently Asked Questions

Being someone that for the most part understands what it takes to get a Texas health policy through underwriting I rarely get clients denied for approval. I have been at this long enough to know not to waste my time with lost causes, however over the last month about 40% of my new business has been denied. Why? I think fear. I think the big health insurance in Texas companies don’t want to get stuck with clients with minor health conditions, they want only the cleanest of the clean. Very sad. Whose fault is it? It’s the current group of yahoos that control congress and their supreme leader Obama.

OK look, if you owned a Texas health insurance company and was threatened that guaranteed issue and the elimination of exclusions and pre existing conditions might be coming would you not even make an offer to those consumers? If I was the CEO of that large health insurance company i know I would not wasn’t that marginal client.

So, my advice to health insurance in Texas consumers looking to secure coverage, you better be healthy, you better not be taking loads of medications, basically you better not be normal as all Texans have some minor something medically they are dealing with. And then next time elect people not trying to do a complete takeover of your life so they can feed their ego with a power grab.

Now, if you and your family are healthy, looking for affordable health insurance in Texas feel free to apply for coverage, I will fight like hell to get you issued.

My wife and I were blessed just last month with the arrival of our twins, with that we are now receiving medical bills and explanation of benefit(EOB) forms out the gazoo. I have spent hours combing over the bills and EOB’s with much enjoyment. OK, no enjoyment. I hate it just like you do but did it all the same. Here is what I am finding out, on average the Texas health insurance company, in this case Aetna, is paying right at 60% of what the doctor is actually billing the insurance company.

Billing to date reflects a total cost from conception to release from the hospital of $44,614. The actualy negoiated cost after PPO discounts sliped in at $26,645, right at 60 cents on the dollar of actuall billed amount. This is crazy.

Health insurance companies in Texas receive a discount on services from the health care providers when they are in their network of facilities. This has been going on since I became a health insurance in Texas broker. My problem is why do doctors and hospitals feel the need to charge the higher amount in the first place.

Now, ask yourself this question. Who pays the base rate, in this case the 45 grand? If I get a discount who doesn’t? If no one pays the base rate as some doctors claim why have it there in the first place? Now, here is the answer the all the questions, unsuspecting, naive consumers pay it, that’s who. Doctors are ripping off Texans right and left and the practice must be stopped. Lets just go to a set schedule using the mindset of how Medicare does it, however the amounts should be bumped up due to the low schedule Medicare uses. This system will work.

By instituting a federal law to regulate medical billing as I have discussed here it what you achieve, first you will no longer need PPO plans, all charges will be set with very minor modifications like geographical billing trends. Doctors and other providers like drug companies have been a runaway mine train with medical billing for years steadly ripping off Texans day after day. Simply put, control the spending and you will control Texas health insurance premiums. It is nothing more than common economics.

According to a report released by Wellpoint Health 87 cents of every dollar goes to pay medical expenses. 87 cents! To me that number is astronomicaly high. Also according to their report their profits come in at about 3% of every dollar. Marketing, provider support and consumer support at 4 cents of every dollar. Other addmin cost and goverment payments are at 6 cents. So overall if you think about it the 87% of every dollar being paid to doctors, hospitals and drug companies is more than adaquate. So the problem lies in what your doctors are charging you, bottom line, lower medical claims you will lower premiums and the end result will be affordable health insurance in Texas.

Doctor Co Pay Plans
Far and away the most popular plans on the Dallas health insurance scene are the little sister to group coverage offered by employers known as the Doctor Co Pay plans. These plans offer co pays before a yearly deductible for things like routine doctor visits, preventive care and normal sickness visits. They also offer co pays for prescription drugs. Anything outside the normal doctor visit will generally apply to a yearly deductible. Several policies also offer lab and x rays with your co pay.

Based on consumers utilizing my quoting software and quotes provided by myself for Dallas Texas health insurance consumers that have called me direct the most affordable health insurance in Dallas is Cigna. Most times Cigna is 25% cheaper than the competition. After direct meetings with Cigna executives I was informed that the Dallas/Ft. Worth Metropolitan area is a major “target market” for them. This is validated with the expansion of a huge new service center being constructed in Frisco.

High Deductible HSA Plans
High Deductible HSA  plans introduced back in 2003 have s-l-o-w-l-y attempted to take foothold here in North Texas. At their introduction they were actually more expensive that the Doctor Co Pay plans. Things have changed and prices have either fallen or not escalated to the point of Co Pay plans and now they do offer lower premiums but there are striking differences between the two. For starters there is only one deductible and out of pocket for the entire family. This does allow Dallas Texas health insurance consumers to better gauge their potential yearly expense outlay. Also keep in mind they offer no co pays for routine doctor visits and drug prescriptions, those services apply to the deductible. The neet thing about High Deductible HSA plans in Texas is they offer some decent tax advantages over traditional Dallas Tx health insurance.

The most cost effective High Deductible HSAplan in Dallas? Blue Cross & Blue Shield of Texas, by a mile. Most times no one even comes close. I have noticed they slide in at about 25 to 30 % cheaper than the others. Another biggie for the folks at Blue Cross is the rate increases that they are assessing on their business, this year they are hitting consumers in the LOW SINGLE DIGITS! Most consumers that have the Blue Cross HSA plans are keeping their powder dry when rate increases happen basically due to the fact that their rate are still lowest in Dallas after a year. Several of my clients only got clipped at about $4 a month. That should make us all happy.

Catastrophic Health Insurance
When the economy started going south back at the end of last year I was forced to dust off the old mainstay from the 1980′s. The old Catastrophic Health Insurance policies are a simple enough policy to understand, you meet your deductible and the policy starts paying at a clip of about 80%. Oh, there is a maximum out of pocket a family will experience but it will be much higher than the High Deductible HSA plans. For the most part all services apply to the deductible and there is generally two or three deductibles per family. Some policies like Blue Cross offer drug prescription coverage separate from the big major medical deductible, so that’s nice but for the most part everything applies to the deductible. Also note that they differ from the High Deductible HSA plans in that they don’t offer the cool tax advantages found in the HSA.

The winner based on cost for the Catastrophic Health Insurance plans in Dallas again goes to Blue Cross and Blue Shield of Texas. Again they just cant be touched in the Dallas health insurance market for these type of policies. Coverage is nice as well offering extremely high limits that every family needs. These plans are a great choice for the low budget consumer looking for affordable Dallas health insurance.

Ok, so there you go. Now keep in mind every family is different in North Texas, rates are always predicated on age, size, zip code and health history but overall these plans should come out just as I indicated. feel free to see for yourself by getting your Dallas health insurance quote today! You will see the same trend I did.

When you get that little letter from your Texas health insurance company informing you that in 30 days they will whack your premiums up 30% I’m sure at first light you do some sort of Google Search for insurance. Millions and millions of results show up here in the great state of Texas. You start clicking, find some site that you can understand and plug all your personal data in. Right? But it’s what happens next that chaps the rear off Texas health insurance consumers. You can no more than close out the web page and the phone starts ringing. People from “boiler rooms” located all over the country and probably none located in your state or area start hammering the dog out of you. One right after the other… for 2 weeks. Then that private email box that you have protected from spam for years starts getting email form every online pharmacy and weight loss program in the world. And the health insurance community does it’s fair share of peppering you with email for months.

OK, Why? First off when requesting a quote online from “lead generating” sites the info is sold to about 7 agents. It never fails that one of those ”agents” is another lead generation site and the info is resold to about 10 more agents. Sorry Texans, that’s just the way it works. And I feel the same as you, it stinks to high heaven. Now, how do we avoid this mess?

Do this, before entering in any information to get a quote look the Texas health insurance site over. Look to see if they are local or located here in Texas, if not, or you can’t figure it out then they are not local they are probably a lead generator. If the free health insurance quote in Texas site does not appear to be an agency site by listing the agent or brokers name and address then again, it’s a lead generator and the calls will never stop. Also, the site should be very, very specific about things. Lead generators will most often be vague and you can’t figure out who or what you are dealing with.

Sites like Peeler Insurance, which is owned and operated by me, have zero incentive to farm out your information. We are the agent or broker. We don’t want to compete against our self by selling the info. Also, most times sites that offer Texas health insurance quotes and that are controlled by brokers for their own business growth are from local agents, like me. Born and raised Texan!

Another point is that when visiting an agent or broker controlled website rates will be generated on the spot, immediately for you to review, without being bugged to death. Lead generator sites most times withhold this information and the “boiler room” agents attempt to hammer a policy down your throat.

So, next time you are looking for Texas health insurance quotes please be careful and before entering any data into the request form make sure they are a local, independent Texas health insurance agent.

To be sure you are dealing with a local Texas health insurance broker that will NEVER sell the information off to some shady dude, you should  get your free Texas family health insurance quote today!

I thought it would be a good idea to briefly discuss what exactly Texas health insurance consumers can expect when they run Texas health insurance quotes from my website. When visiting my website you will be flooded with hundreds of options that offer your traditional PPO Doctor Co Pay plans. When reviewing the thing you will notice that when comparing “apples to apples” Cigna will most often times crush the competition with Blue Cross & Blue Shield and World Insurance Company in second and third.

OK, to set this up I used your typical family looking for health insurance in Dallas Texas. Family of four with mom and dad being in their 40′s. We used a standard deductible of $2500 and loaded the policy with all the bells and whistles like drug prescription coverage, preventive care benefits and full doctor visit co pays. After all that Cigna came in at about $500 a month with Blue Cross and World about 50 bucks a month higher. See! Cigna Wins!

Cigna, Blue Cross & Blue Shield and World are all excellent rated health insurance companies companies in Dallas. I would have no problem providing these companies to my family so whomever you choose you should be happy. If it was me I would choose Cigna just simply based on price. Money talks, period. And at 50 bucks a month that will buy allot of of baby formula. We just had twins in case you didn’t know.

Health insurance in Dallas has never had the competitive environment it has now. There are more active players fighting for business, better coverage options to consumers of health insurance in Dallas Texas than ever before. Now is the time to get your Dallas health insurance quote and see for yourself.

 Unicare always was the cheapest Texas health insurance policy, but even back in the day they had things that drove agents and brokers bananas. Underwriting was a joke, turning down applicant after applicant, and when you did get a policy through the underwriting needle they would place an exclusion rider on some minor health condition. But as a broker I always had to remember, their rates were most times 25% below market. That made them a company we as agents could not turn our backs on.

Well, times have changed. Now their rates are just too far out of reach for many Texans looking for affordable health insurance in Texas. What should be noted is they presently have a policy out called the Enhanced Fit plans that are sweet. Again though, it most times does not come close to being cost competitive in today’s hyper competitive Texas health insurance market. Here is the good news, there is one place Unicare destroys the competition on both benefits and most times price. Kids health insurance.

The Unicare Enhanced Fit product offers exceptional coverage for out patient procedure like x-rays and lab work, all paid with a co-pay. There are only a few Texas health insurance companies that pay out-patient expenses with a co-pay, most apply these charges to the yearly deductible. Also, Unicare provides preventive care benefits for kids up to age 18. Wow! Most individual health insurance plans in Texas only provide that benefit up to age 6 to comply with state mandates; Unicare is exceeding that requirement by 12 years. For emergency room treatment the Enhanced Fit product only requires a $100 co-pay, unlike so many that hammer the Texas consumer with deductible AND a co-pay. Of course, there is no pre set limit on the number of yearly doctor visits and Unicare also has no pre set maximums on their out patient prescription drugs, it’s up the plan maximum of $5 million.

From a price standpoint Unicare is still too expensive for the entire family but their children health insurance in Texas rates are not that bad. Still a little higher, but all things considered they fit in nicely. See for yourself by getting a free kids health insurance quote.

This Unicare product is exactly what I would put my kids on if I did not have group coverage. If my wife ever left her job the first place I would turn is to Unicare for our kids. 

So, if you are only looking for coverage on the little ones in your family, get a Texas health insurance quote. I know you will be happy from a benefit standpoint and you will also find the price ain’t all that bad.

 It appears that Cynthia Johnston had a bad little accident back in January when North Texas got hammered with our ice storm. Ms. Johnston apparently slipped and busted up her femur bone. Seems the doctors had to preform surgery and insert a rod in her leg to assist in the repair. All I guess seemed fine with Ms. Johnston situation except for the broken leg. Looks like she had a Texas health insurance policy, so I’m sure she thought everything would be taken care of. According to the DMN story her hospital bill alone was about $51,000. Wow! Wonder how much her surgeon billed her in addition to the $51 thousand. Wonder if that amount included the anesthesiologist? How much will the therapy run after the hospital stay?

If the DMN story is accurate her surgeon, anesthesiologist and therapy will all bill separately. Those grand totals will most likely run another $20,000. Now, why all this talk about some lady that broke her leg? Simple. The story mentions that her Texas health insurance company would only pay for “room and board”. Meaning Ms. Johnston was probably hotter than a goat eating a blow torch when she got notified of the Texas health insurance companies claim payment plan. I know I would have been. Now, why did this happen. Well, it appears she was on some type of limited benefit Texas health insurance plan. Don’t reallyknow what company sold the policy without looking at it and doing an analysis. But you can take it to the bank it was not a Major Medical Texas health insurance plan.

Listen, we as consumers need to stop purchasing these gimmicks. I see them all the time. I was up late last night watching TV and Cynergy Health was running adds like crazy. Of course the TV add made me believe it was a full coverage plan, heck, I almost wanted it, however, with the great little pause button on my Tivo I read the fine print. Limited Benefit Policy. Point blank, right in front of my eyes, everyone should be able to see it, right? Well, you can if you pause the TV right before the advertisement ends, hop up off the couch, get 1 foot away and have a 55 inch HD plasma like I do, then you will see it.

Just like in the commercial, the facts are sometimes hidden by both Texas health insurance agents and Texas health insurance companies. You as a consumer have a responsibility in this battle, one is to do your homework on each policy or find a respectable experienced health insurance in Texas broker that just has to much at stake to write these mickey mouse policies. I promise you one thing, I will never, ever promote one of these policies. Ever! I am just to scared of them. At the present time I don’t even allow these policies to be quoted on my client driven website at Peeler Insurance. I also know for a fact that I am one of the few Texas health insurance agencies that will not allow a client to review these plans that are not a PPO Doctor Co Pay Plan without personally speaking to me. I don’t think I have one client on these type of Texas health insurance plans. I would prefer the client just go to another broker, at least I don’t wake up at night in a cold sweat worrying if I will get sued the next day.

These Limited Benefit plans will always get action in a depressed economy due to their somewhat lower pricing, and that’s unfortunate. They look great at time of sell, but have one claim and you could be facing financial destruction the likes you have never seen. Is it really worth saving $10 or $20 a month for these limits? I heard this once when I served in politics. You can put a pig in a dress, bottom line, it’s still a pig!

If Texas health insurance consumers are looking for quality Major Medical PPO Doctor Co Pay, Catastrophic or High Deductible HSA plans, then Peeler Insurance is for you. Take a look by getting your Texas health insurance quote, but do so knowing this, i only promote and sell what we call full coverage policies where in Ms. Johnston’s case there would have been a reasonable deductible and then the policy would pay up to about $3 or $5 million dollars. This would have been an easy case for her and her retirement nest egg would be salvaged.

Wellpoint convinced Express Scripts to pay them almost $4.7 billion for the pharmacy division making Express Scripts number two in all the land for administering pharmacy benefits. Now, how does this help Unicare become more competitive? Simple, drug prescription coverage is far and away the biggest killer for insurance companies at claim time. With all the high dollar drugs on the market today a consumer can flat out destroy the profitably of insurance companies. With so many drugs being advertised on the airways costing hundreds of dollars a month how can a Texas health insurance company be competitive?

At present Unicare offers the best product benefit wise in all the health insurance in Texas market with their Enhanced Fit portfolio that is loaded with out-patient benefits. Problem with the policy is it’s a killer on the monthly premium. Most times Unicare prices out about 25% over market, folks, that just wont get it done in today’s super competitive price sensitive Texas health insurance playing field. One new drug prescription will most times equal the monthly premium of a policy and with that a company just can’t remain competitive.

Peeler Insurance has also learned through sources that Unicare will be introducing a new product portfolio soon that will have more competitive pricing. Hopefully that will supply additional market share.

All in all this move by parent Wellpoint should give Unicare some much needed breathing room to jump back into the Texas family health insurance market. I also hope that this transaction will allow them the ability to offer rate relief on their super benefit rich Enhanced Fit products. Stay tuned.

To find out if Unicare offeres your family the lowest rate get your free no hassle online Texas health insurance quote today.

This time around I feel that it will be more than the technology sector getting squeezed out, I feel all sectors of our workforce is subject to the squeeze. I know this sounds scary, being a contractor, but if you just follow a few simple steeps you will be fine.

First off, you need to secure Texas health insurance benefits, and fast. You can not allow a lapse of greater than 63 days to take place, otherwise pre-existing condition limitations will most likely come into play. I have found most Texans migrating to a contractor position are used to the super rich Texas health insurance benefits that were offered by their employer. With that being the case I would advise going with a Texas doctor co-pay plan, these plans best resemble the traditional health insurance offered by group insurance.

These plans will differ in just a few areas, mainly with the yearly deductible choices. There are few if any plans that offer deductibles as low as most group plans. The traditional deductible on an individual health insurance plan in Texas is about $2000. In regards to co-pays, you should be able to find one at about $25 per office visit. Most legitimate doctor co-pay plans in Texas will offer some type of out patient prescription drug coverage with a co-pay.

Now, where do the big differences come in? Underwriting. All individual health insurance in Texas must pass through medical underwriting, only group health insurance plans mandate guaranteed issue. This is the single biggest misconception floating around out there. So many Texans leaving employment contact me for Texas health insurance and get very argumentative with me when I inform them medical underwriting will factor into getting a policy issued. Sorry, federal law doesn’t require individual health insurance in Texas to provide you with coverage.

Now, after getting a policy approved what can you expect? Well, for starters lower Texas health insurance premiums. The rates are all over the map depending on the deductible and benefit choices, but most often there will be substantial savings. The easiest way to find out is to simply get a Texas health insurance quote online from my site.

I know loosing the comfy security of working for a large company that provided benefits is spooky but don’t fret, individual health insurance in Texas brokers are here to help. We deal with this stuff all day every day, it’s just a walk in the park. I promise! See for yourself by getting a free instant Texas health insurance quote right now!

Yes, this scene gets played out every year. Texas health insurance companies with no regard to the present economy blister the rates every year and I scramble to run rate comparisons to determine if we should explore other affordable health insurance in Texas options. This year I am proud to report we had a 90% success rate in providing lower cost options over their current Texas health insurance policy.

Some individual health insurance in Texas agents differ with my business approach. They think I’m crazy to run new rates for existing clients. These agents feel I should just leave a current client on their current policy and when the client calls in complaining just tell them that’s the way it is or just take the easy way out and raise the deductible to offset the higher monthly premium. To me that’s a load of garbage. The only way you keep clients long term and build a strong client base is to always be in a position to offer similar coverage from different companies. That is one of the major reasons I am appointed to sell with all the major players in the Texas health insurance market.

OK, now with my twins due any day, this month was by far the most stressful and long. I think I slept on average 4 hours per night and was in my office working about 18 hours a day. That is one big reason this Texas health insurance blog has not had as many post as I would like but, duty calls and my clients must be taken care of. Period!

This month Aetna, Humana, Unicare, World and Blue Cross & Blue Shield decided it was high time for a rate adjustment, andadjust they did. I found that on most accounts Cigna Health Insurance offered the best option for existing Texas health insurance consumers to migrate to. Cigna has a very respectful PPO doctor co pay plan and offered much the same benefits to consumers that had both Aetna and Humana. From the high deductible front Blue Corss and Blue Shield was found to offer the best movement option. They really seem to control the HSA and catastrophic health insurance in Texas market . For some reason Unicare, once the only player on price in Texas, is getting left in the dust.

Now, form the underwriting side of things I experienced no major roadblocks. Cigna really stepped up to the plate and offered what I felt were fair decisions and I only had a limited handful of Texas health insurance clients that were affected negatively to their underwriting actions. Blue Cross & Blue Shield has always been somewhat fair and they delivered as expected. So, overall, any client that wanted to lower their monthly Texas health insurance premiums or avoid a monthly increase did just that.

It seems that Cigna Health Insurance was preforming very well price wise in both North Texas and down Houston way, I found that in other parts of the state they can be a challenge from a premium standpoint. In the hill country areaI found Blue Cross & Blue Shield making a strong foothold.

There are still more rate increases for some of my clients that will come off rate guarantees throughout the year and I will handle them in much the same way as I did the 2nd quarter rate increases but at least they don’t all come at once as is always the case in April.

There is still a few housekeeping and administrative maneuvers I must preform for my clients but for the most part, it’s game over.

If you are not a Texas health insurance client of Peeler Insurance and you found that little rate increase letter in the mail and didn’t act upon it, either visit my website or call me for your free Texas health insurance quote today. We may not be able to get that April 1st effective date but May 1 is coming fast.

So, there you have it. Another year we dodged the Texas health insurance rate increase bullet. Now I can get some much needed rest before my lovely wife says… honey, it’s time to go to the hospital and we accept the arrival of Andreas and Natalie.

Two bills introduced last week by these two liberal yahoos form the north east will eliminate insurance companies ability to do medical underwriting and mandate guaranteed issue on any and all health insurance policies. OK, sure, on the surface this sounds like a great idea. No more underwriting means come one come all. Never another rejection letter or exclusion for health conditions will make a few of my clients happy, heck, I have uninsurable health conditions, I should like this proposal. Do I? Absolutely not!

With the bills the liberal Obama clones are pushing I will never be forced to call a client and inform them of a denial, rate up or exclusion riders, that will be sweet, but something very important is missing from the equation. Selective enrolment. What is that you may ask. Well, its my word, I made it up. Basically it means that there are no requirements that all Texas residents are required to be covered. I feel that it will have only sick people applying for coverage.

Now here is how this will play out. Texas presently has more uninsured residents than any other state. We just have people in this state that just flat don’t want coverage. The southern mentality of some residents is that heck, I’m healthy, I don’t need health insurance in Texas. Guess what, those people are not going to get Texas health insurance with the adoption of this new law. The only Texans that will apply and purchase health insurance in Texas will be those with major health conditions like cancer, heart attacks and AIDS just to name a few. These people, who by the way have always had an option of purchasing Texas health insurance without pre existing condition limitations through  the Texas Health Risk Pool but didn’t do it because of cost, will flood the health insurance in Texas rolls and drive cost up faster than stock car at Texas Motor Speedway.

I predict that the first year all will be well, but come that second year all hell will break loose. Consumers that have been covered will now experience either one of two things, rate increases at a clip of 50% or policies being reintroduced with limited benefits, or both.

Now, how could this idea work? I just don’t know, but one way is to require all Americans to be covered. By increasing the number of Americans on the insurance rolls then the risk is spread out more evenly. I do have a better idea and I have spoke about it before. Leave the present system in place, don’t rock that apple cart. Focus your attention on the Texas Health Risk Pool. Make the risk pool a national pool. Now, premiums inside the risk pool will be higher than traditional insurance just because consumers with health conditions will posses those policies. One idea to offset the sure to be higher prices is to require a subsidy from each and every health insurance company based on the market share that you have. Example would be if Aetna controlled 7% of the health insurance market they would be required to pay 7% or any subsidy. Now, since Obama will most assuredly be throwing tax dollars at the perceived health insurance problem he can chunk some money to pay half of the subsidy.

OK, now what have you done with my proposal? I feel you have stabilized the problem. All Americans now have the right to be covered with health insurance. But here is a little secret. I bet the number of uninsured Texans doesn’t change much. Some Texans just will not purchase health insurance in Texas. Period. And keep in mind, we don’t like to be told we must do anything in this state. Right now health insurance in Texas has never had more competitive companies offering more than adequate benefits. This is the time to get your Texas health insurance quote and see what I mean.

The big question asked by Texas health insurance consumers is why do I need this thing. Well, it’s simple. When you elect to go in a different direction with your Texas health insurance plan this letter acts as somewhat of a “get out of jail” card. A certificate of creditable coverage provides proof that you were covered for Texas health insurance and for how long and and will also provide evidence of how long you have been without coverage.

Now, why do I call this a “get out of jail” card? Well, most major medical Texas health inurance plans opperating in the individual arena honor this certificate when applying pre existing condition limitations. If you have been covered without a gap of 63 days between coverage then, unless the health condition is excluded by name, the condition will often times be covered from day one. Keep in mind though that Texas law does allow excluding a health condition by name so if your health condition is a costly condition you may find an exclusionary rider attached to the policy at time of approval.

Presently there are two Texas health insurance plans for individuals that do not apply exclusion riders, Aetna and Cigna, so with these two Texas health plans if accepted for coverage there are never exclusion riders. All that is needed is to provide your certificate of creditable coverage and the condition will be covered, provided of course the policy pays for  such treatment.

All that is need is to fax of mail the certificate to the Texas health insurance company upon receipt of this all important document from the old insurance company. After that, your set, that allergy claim or blood pressure treatment should be covered unless it was excluded.

Generally it takes a week or so to get your certificate of creditable coverage for your old Texas health insurance company, so be patient. Also of note, be smart, the most important thing is to be completely honest on the application by disclosing whatever health conditions you may have. Also, because so many of the Texas health insurance plans on the market allow exclusions by name is is critical to work with an experienced Texas health insurance  broker that knows the ins and outs of each company. If you have not lapsed coverage for a period greater than 63 days, be 100% truthfully on the application and deal with experienced Texas health insurance brokers, then your health condition could be covered from day one. So now that you are prepared with the facts it’s time to get you new Texas health insurance quote!

I will start out by saying there has never in my 16 plus years in the individual health insurance in Texas market been a time where there are more quality options and companies available to the Texas health insurance consumer. We have all the major Texas health insurance companies slugging it out with each other. I cant think of but one or two of the national companies that have not entered Texas to take a stab at market share. Also, the benefit configurations these Texas health plans offer are again, better than I have seen in years. You want doctor co-pay plans, got ‘em, you want adequate preventive care, got them too. Looking for plans that cover lab and xray outpatient, those exist also. High deductible HSA qualified in your vocabulary, tons of those options sitting out there. So the state of Texas health insurance plans is super strong. Now is definitely the time to get your Texas health insurance quotes!

Now, lets discuss the state of underwriting. Well, sad to say that’s one of the areas of concern. Underwriting operates just like the credit market. Texas health insurance companies are reluctant to offer coverage if you are saddled with health conditions and if you consume several prescription medications. The way Texas health insurance companies are operating reminds me of the late 90′s. It seems to be getting harder and harder to squeeze Texans with health conditions through that underwriting needle. I do think it will loosen up once the economy straightens out, so look for relaxed underwriting toward the end of the first quarter of 2010. Healthy people still get issued with no problems and we are getting some health conditions approved , there are just more “hoops” Texans are being forced to jump through to accomplish approval of their health insurance in Texas policy.

Lastly, the state of premiums. Come on guys, stop raising prices. Texans can only endure so much and we are reaching the point of no return with some companies. I know the putrid stock market has blistered your bottom line, but you cant survive if there are no Texas health insurance clients on the books. Why not we instill a rate freeze for 12 months? Normal second quarter rate increase have been brutal. Several Texas health insurance companies raise rates for their yearly new business on the first day of the second quarter. Now, kudos to Cigna health insurance of Texas for having one of the lowest price plans on the market, in some cases Cigna is 20% cheaper than the other Texas health insurance companies. Also ataboy’s all around to Blue Cross  Blue Shield of Texas for having a very minor rate reduction on some age bands for second quarter of 2009, and only a 3 or 4% increase on existing business with some plans. So the state of pricing for Texas health insurance is ‘fluid”. Get your Texas health insurance quote to see if Blue Cross of Texas or Cigna is cheaper than your current plan, I bet is is.

Like I said before the State of Texas health insurance appears to be confusing however find a veteran broker located here in Texas and allow him to assist you in navigating the crazy state of Texas health insurance.

Just last week I had a Texas health insurance client that was upset because she was denied coverage due to the health of her child. After doing some research I found the child was taking a drug called Abilify. According to her this drug was used to treat Attention Deficit Disorder. OK, that’s fine but the problem was the drug cost. Abilify cost somewhere around $450 a month.Yes, I said 450 bucks a month! Her entire family premium was about the same monthly as the drug cost so of course the Texas health insurance company said no thanks. Can you blame them? Even before the first claim was filed the Texas health insurance company was loosing money on this family. We need to keep in mind health insurance companies are in the business to turn a profit, so obviously they won’t take someone that is a loss from the beginning.

There are hundreds of stories like the one mentioned above I could discuss but the bottom line is this, Texas health insurance companies will not approve consumers with high drug expenses. Some insurance companies will offer exclusions for the health condition being treated but no matter what, if your drug cost get anywhere close to half the premium amount, forget it. You are not getting issued for that health condition.

So, whats the problem? My view is this problem lies squarely at the shoes of pharmaceutical companies and the U.S. Congress.

Have you ever noticed the amount of campaign contributions that drug companies make to elected public officials? If not you should take a peek at that little meal ticket. Kind of hard to regulate an industry that feeds your family. And please Congress, don’t give me the song and dance that you make unbiased decisions regardless of the contributions. I was involved in politics for years, I took campaign donations for my election, I know how the game is played so that unbiased speech won’t work with me. Also, ever noticed the influence the big huge pharmaceutical lobbyist have? The dollars spent wooing our congressional leader is stunning.

OK, the next thing to do to control this runaway drug policy will not make my fellow pro business republicans happy. Eliminate drug prescription advertisement. This policy would stop drug companies from wetting the appetite of the Texas health insurance consumer with the latest and greatest new expensive drug. Texans watch these advertisements on television and then march into their doctor and tell them they have the health condition they saw in the add and want that drug . Why not leave the medical advice to the doctors.

Any Texan that looks into the cost of drugs in other countries like Canada and Mexico will be shocked at the gouging the consumer of affordable health insurance in Texas receives. Why is it that my in-laws in Sweden can purchase drugs at such reduced rates?

All we seem to hear about now is health care reform, why not reform and regulate the way drug companies do business? Eliminate drug companies from applying high pressure tactics on our elected officials. I promise you that this will go a long way to improving Texas health insurance cost.

Keep in mind that there are still affordable health insurance options in Texas available for individuals and families but don’t bring a laundry list of drugs with you.

Today I would like to introduce a shocking development in the Texas individual health insurance market. Cigna Health of Texas has structured their rates at up to 25% cheaper than the competition. Unbelievable! In some parts of Texas these numbers are shocking. In the North Texas market I am finding Cigna Health about one hundred dollars or more a month less. That, my friends is a blessing in today’s rugged economy.

Cigna Health has been offering their individual health insurance in Texas for about 6 months, however as with any new product portfolio the agents had to learn their nuisances and procedures. Since their offering six months ago all rates had to be constructed manually which made it almost impossible for Texas health insurance consumers to get product information. As of last Thursday they now run active on most major quoting software, including ours at Peelerinsurance.com. Thank you Cigna!

From a product standpoint the new Cigna Health product looks very similar to Aetna Health Insurance. If you have followed my writings you know I have sang the prasies of the Aetna plan for individuals in Texas because of their benefits. The big variance between Aetna and Cigna is price, Cigna destroys them. But from a benefit configuration compairsion you won’t find much differences, thats great news if you in the market for indvidual health insurance.

Cigna Health offers you traditional PPO doctor co-pay plans and adequate HSA qualified high deductible plans. Although Blue Cross and Blue Shield still manhandles the Texas HSA market Cigna should be your first look for co-pay plans.

Cigna Healths full coverage plans offer co-pays in the 25 to 30 dollar range and is offering yearly deductibles as low as $1000 a year. Of course Cigna Health of Texas has all the preventive care benefits you expect from a major Texas health insurance plan and also provides prescription drug coverage for both generic and name brand drugs. Their offerings have extremely high lifetime maximums to protect Texans in the event of a catastrophic sickness or accident.

I think the new Cigna Health plans offered in Texas is far and away the best news our industry has heard in the last two years. With premiums this low Texans can finally take back control of their Texas health insurance budget. And it could not have come at a better time.

Do yourself a favor, visit our website and access a free instant Texas health insurance quote. The numbers you see may be shocking and maybe you too can take back control of your families budget.

The Texas catastrophic health plan that is being marketed today works in a very simple fashion. The consumer looking for individual health insurance in Texas can expect these policies to have a deductible somewhere above $1500 per year and then most services are covered including doctor visits and out patient services up to reasonably high lifetime maximums. Several companies also offer preventive care as a covered expense. These Texas health insurance plans will offer the most affordable health insurance for the Texas family.

Some very important things to note about the catastrophic plans I am talking about is these plans are not to be classified as a limited benefit policy. When looking at a Texas health insurance plan that claims to be catastrophic the Texas health insurance consumer should confirm that it is a major medical policy and not a limited benefit or hospital and surgical expense plan. On several occasions I have noticed the term catastrophic tossed around like candy at a circus for these limited policies.

Because catastrophic policies do not offer co-pays for services like doctor visits and drugs, the monthly cost of this Texas health insurance plan is usually a couple of hundred bucks a month less than their counterpart, the doctor co-pay plan for larger Texas families. These plans are an excellent option for folks looking for low cost health insurance in Texas. Another ideal client for the Texas catastrophic health plan is the older Texan hovering around retirement age.

Rate increases affect all health insurance in Texas and these catastrophic plans are not immune, however with less potential claims in the form of doctor co-pays and drugs I have found these policies to be less affected by massive yearly increases. You most likely will get an increase, however in theory they should be more manageable. I noticed Blue Cross and Blue Shield of Texas having the lowest rate increases in recent memory with these very policies for business written in 2008. Their increase was around 5 to 7 percent, on a average family that is about 15 to 20 dollars a month. Theses numbers just can’t be beat compared to some of the increases I have witnessed this year. 

These are the cheapest full coverage plans offered in the Texas health insurance market.

In order to secure your Texas health insurance quote on a catastrophic health insurance policy in Texas just contact me. These quotes are provided on a case by case basis and are not provided on my quoting software.

If you have been laid off you probably already know what COBRA is. Simply put, COBRA is designed to allow former employees of companies with greater than 20 workers to continue their present insurance coverage at an inflated rate. This coverage is only valid for 18 in most cases.

I have published several articles on COBRA and you owe it to yourself to read them.

The critical items that consumers need to know about this process are listed below.

1. Decisions related to Texas health insurance must be made and processed within 63 days from receipt of COBRA letter.

Now, what should you do after being notified of your job loss? First off, you only have a small window of time to execute your health care decisions. You are allowed a 63 day window to make decisions and elect COBRA. That may seem like ample time to do something, but in reality it’s not. In the event you choose to go a different direction other than COBRA it can sometimes take upwards of 45 days to get approval for an individual health insurance policy in Texas. Generally you can get approval within two or three weeks, but in about a third of the cases it can go out past one month. The last thing you want is for that 63 day clock to expire.

1. Not all family members have to take COBRA and in most cases even the former employee can decline coverage while insuring other family members.

In most cases just because you are the employee affected with the job loss does not mean that you must take COBRA on yourself in order to provide COBRA for another family member. Let’s say one family member has a health condition that would preclude them for purchasing an individual Texas health insurance policy, generally you can elect COBRA on that family member and remove the remaining members as well as yourself from coverage. This will drastically reduce your monthly cost to COBRA. I would advise you to call the insurance company and confirm this practice as well as get a monthly price for the members that will possibly continue COBRA coverage. This trick will then allow all healthy family members to purchase an individual Texas health insurance policy and substantially lower premiums.

1. Do not, under any circumstances allow coverage to lapse or go uninsured.

During unemployment I know money is tight, health insurance is sometimes seen as expendable. I have heard all the lines in my 16 years in the Texas health insurance market. Hearing things like, we never use it or we never get sick are a very disturbing for me to hear. I’m glad you never get sick, good for you. Up until I was 40 I didn’t either, but things change. The problem though is some of the laws we have related to health insurance in Texas. The biggie is if a lapse in coverage of greater than 63 days occurs your credit for pre existing conditions will vanish and you will be faced with a waiting periods of up to 24 months on new Texas health insurance coverage. The critical key, DO NOT ALLOW COVERAGE TO LAPSE!

Laws related to Texasindividual health coverage works closely the same as group, it states that as long as there has not been a 63 day gap in coverage and the condition is listed on the application there is no pre existing unless the Texas health insurance company excludes it by name.

I hope this illustrates the importance of keeping that “continuous” flow going and not allowing the break in coverage to happen. I promise you that if an insurance company notices that you have broken that 63 day magic number they will “nit pick” almost every claim. So the key, any credible coverage, regardless of deductible and benefit configuration is better than no coverage.

1. Any old policy will do, providing it is recognized as “credible  coverage”.

Credible coverage is the only type of policy that will satisfy the pre existing condition clause. Credible coverage generally falls into the major medical family of policies. Texas health insurance has so many variations available that you must be careful what you purchase if you are electing something other than COBRA. Policies that will not satisfy the credible coverage terms would be discount cards and some limited benefit hospital plans. Generally dealing with an experienced veteran agent or broker will do the trick. 

Ok, now what do you do now? Well, here is what I would do, call or email me or get a Texas health insurance quote from our website. All the plans that I have running on the Peeler Insurance website are solid doctor co-pay plans, these plans best resemble your present group coverage. These plans will meet every requirement I have mentioned above. Below are some important points when dealing with Peeler Insurance.

• IF every family member is free of any medications, no pre existing condition, no surgeries in the last 12 months and your height and weight fall within acceptable standards then you should be OK to run the rate for yourself free of agent intervention. However, I would prefer to speak with you so as to insure we are selecting the correct plan for your family.

• Keep in mind that all plans on the automated Peeler Insurance website are doctor co-pay plans. High Deductible HSA Qualified Texas health plans and low cost Catastrophic Texas health insurance  can only be done by speaking to me personally. In these economic times you owe it to yourself to explore these options as sometimes you can save hundreds of dollars a month more.

• One of our biggest and best Texas health insurance companies can only be quoted manually. Cigna Health Insurance offers some of the lowest rates in Texasbut at this time we are forced to run Cigna on another software program. Cigna requires this in order to migrate with their software system.
  

• Peeler Insurance works with most of the major Texas health insurance companies and each one has a different set of standards as it relates to offering coverage. Sometimes not everyone will be approved but after 16 years in the Texas individual health insurance market I know what most insurance companies will and won’t accept. Speaking with me personally is very important in order to provide you the best advice on how each different Texas health insurance company will view your health status and history. 

Be prepared to save several hundred dollars a month, most times we find that COBRA premiums are twice or three times as much as Texas individual health insurance, sometimes even more. 

I have also found a COBRA FAQ’S guide from the Department of Labor.

Remember, time is the critical point here. The moment you recieve your COBRA packet, or the moment you have been advised by you company of the COBRA premiums contact my office. 

Now, why am I mentioning all this? Simple, over the last two weeks it appears that most of the health insurance companies have done an about face on underwriting. Prospective consumers of individual health insurance in Texas are getting negitave underwriting decision at an alarming rate. Clients that 6 months ago would be approved prefered or standard are now being denied coverage. Also, private health insurance consumers are having medical records and paramedical exams requested at the same alarming rate.

Aetna health insurance in Texas has so disappointed me over the last 2 weeks that I am almost to the point of backing away for quoting them unless the consumer and their family are so squeaky clean from a medical standpoint that our creator looks at them as role models. This is ridiculous. Aetna has always been one of the more liberal outfits when it comes to underwriting. According to an inside source a meeting was conducted in mid January with company staffers to inform them that the underwriting “nut” would be tightened down. This source went on to express that changes had to happen because of the low profit margin Aetna has built into their policies and there was growing concern that President Obama would authorize administrative policies that adversely affected their ability to remain profitable. Of course this information would never be confirmed by Aetna corporate, but like I said my knowledge is from an inside source.

I have also noticed another very large health insurance company in Texas ordering not only medical records but wanted the applicant to consent to a paramedical exam. A paramedical exam is a short physical exam usually preformed at the insurance companies expense and preformed at the Texas health insurance consumers home or place of business. Another Texas individual health insurance company ordered a massive full blown physical exam and expected the client to pay for it. Of course I advised against it as I felt this was nothing more than the insurance company attempting to get the client to cancel the underwriting process.

Almost every individual health insurance company in Texas has a process called pre screening available to Texas health insurance brokers but for the last 10 years I have never had to use it as I almost always knew with unbelievable accuracy what decision the health insurance company would render. I now find myself spending hours each days pushing emails back and forth to underwriting pre screen departments so I can get a little better handle on their view regarding different health conditions.

Health insurance companies in Texas will say nothing has changed but I say, hogwash. I know something has changed and my daily conversations with fellow agents and brokers confirms this. They are having the same difficult problems. Now, my theory on why. I think this wrecked economy has insurance companies feeling the same pinch that banks are. Since insurance companies invest a large percentage of their money in real estate and other vehicles that have taken a massive hit they could be tapped out and only lucky to survive to the next day. Another factor that could be coming into play is the threat by President Obama to snatch the health insurance companies up by the hair on their head and shake some common sense into them with health care reform. Whatever the true reason, the one being penalized is the individual health insurance in Texas consumer.

What should the shopper for affordable health insurance in Texas do? One, and this is a biggie, deal with an established veteran broker or agent. We are the only ones that have the experience to navigate through the changes and upheaval. One thought, with these changes, i will become even more conservative in my underwriting approach and would rather error on the side of caution. This is not the time to take risks, still shop your Texas health insurance, but be careful.

Let’s just look at this from a business standpoint. Dr. Burzynski indicates she will reduce her patient base from 3000 patients down to 600. The good doctor goes on to say that she will cut her workload to about 9 patients a day, down from 25. In return she will charge a $1500 yearly “usage fee”, this fee also provides a little annual physical that if I had my guess will be processed through the health insurance company. The story also indicates Burzunski presently sees 25 patients a day. If we use an average billed amount after PPO repricing of $150 that computes out to $938,000 a year in gross revenue in a 50 week year. Now, lets look at how the new concierge service would work from a financial perspective. Under the new “boutique” system the good doctor will cut her patient base to 600 and charge 1500 bucks per patient per year, we are at $900,000 before she sees even one patient! The doctor also indicates that she will see 9 patients a day, that calculates out to almost $340,000 in additional revenue. The total you ask? 1.2 million per year in revenue over the $938,000 under the old system. Another advantage of this new system for the doctors is having less workload. If workloads are cut could staff be next?

Now, think about this for a moment. You are a current patient of her practice, your spouse and children have been visiting her for several years, she knows everything there is about your medical history and the next thing you know is that in order to be blessed with her presence you must fork out $1500 a pop per family member. What do you do? Well, obviously the doctor doesn’t care, pay up or get out. I thought doctors got into medicine to serve the people. That’s what we always hear them say. Doctors always preach that they are committed to service and at the drop of a hat will blame the big bad Texas health insurance companies for all their problems. This is nothing but a load of bunk. I feel this system only benefits one group, doctors. Period.

Have doctors forgotten we are in the midst of the worst economy since 1929? Do they still think money grows on trees? Doctors, I have a question. Why are some of you gouging us? Why are you holding us hostage?

Again, doctors have squalled for years that health care and the Texas health insurance system needs to be fixed. Doctors have went on and on about how Texas health insurance companies are tying their hands behind their backs and preventing them from properly treating their patients. Doctors, I think it’s time for that talk to stop! Your new practice is not only tying patients hands behind their backs, but you have a gun pointed at their heads.  

Work less, make more, it’s the American dream!

Keep in mind this is only my opinion as a veteran Texas health insurance broker.

World Insurance Premier Series Plus has just hit the streets for Texas health insurance clients. This new and exciting product offers an unbelievable amount of first dollar outpatient benefits. Procedures like MRI’s and CAT scans are offered up before the deductible has to be met, this is a first in my recent memory. Also, your first two doctor co-pays are waived and lab and x-rays are covered with a co-pay. Of course this plan offers the traditional major medical coverage with high life time maximums so consumers can rest assured that any major claim should be paid. From a monthly price standpoint I am finding the Premier Plus Series falling right in line with the other insurance companies in Texas.

Another fabulous offering to the purchaser of individual health insurance is from Cigna Texas. This product resembles the products offered from Aetna Texas which in past writings I have discussed Aetna’s more than adequate portfolio. The major benefit that Cigna brings to the table? Price. Period. Their products will more than handle the needs of most consumers in the Texas individual health insurance  market however, their monthly cost in most cases fall well below market. The only drawback with Cigna is their underwriting guidelines are some of the most difficult. Texans with health conditions may find that Cigna will deny coverage where a company like Aetna or Humana will have no problem with the consumers past medical history. The old adage of you get what you pay for does NOT hold true with Cigna, they offer great coverage at the lowest rate, you just need to be in above average health to qualify.

These offering from World Insurance and Cigna are not the only new products being introduced in the Texas health insurance market, just the ones that are catching the most attention. I encourage every Texan in the individual health insurance in Texas market to ask your broker or agent for information and a Texas health insurance quote on these products. I think you will be shocked at the savings and benefits. It’s about time!

Over the past few months I have noticed an influx of Texas health insurance consumers that have been active clients for years calling me to discuss their options. Each and every time we have been able to find other solutions to bring their premiums down slightly until such time as the economic ship has been righted. How should you do it? Simple, rework the configuration of benefits.

Now keep in mind, all these recommendations should only be for the short term, until financially things have straightened out. If you are lucky and you are not experiencing negative effects of the economy, please don’t alter your individual health insurance coverage as these changes do have their drawbacks. Texas health insurance companies will allow you to do things like raise a deductible or eliminate doctor visit co-pays, but when you attempt to put them back on a policy your family will be forced to go back through the underwriting process and any new health conditions could preclude you from getting your old policy design back. So think long and hard about this or discuss it with a qualified broker before doing it. The main thing here is just don’t cancel the coverage outright, things can get very messy if you do that. Being uninsured for a period greater than 63 days is the kiss of death in the health insurance world, you loose any and all pre-existing credit you have gained and would have to start back at square one when you get a new policy.

Most of the health insurance policies that are being purchased in Texas are known as the PPO doctor co-pay plans. Also, most policies have a major deductible of somewhere around $2500 per year. Some solutions would be to raise the deductible up one level, either to a $3500 or $5000 deductible. You would still have the doctor visit option on your policy for things like preventive care and  the common colds we all get, you would also keep any additional outpatient benefits like urgent care or drug prescription coverage. Most times raising the deductible will cure a families budget crunch.

Another option is to eliminate the doctor visit co-pay feature on your health insurance policy. I don’t like to see this done, but if it will save your policy from cancellation then you have to look at it closely. Another option is to look at policies with higher doctor co-pays. Several of the policies we market offer 20 and 25 dollar co-pays, you could explore companies that offer 40 and 45 dollar co-pays for the time being until brighter days shine.

One thing I will warn you about as I have in other articles I have written. Do not scrap the policy to sign up for some type of limited benefit policy. Every recommendation I have talked about still keeps the Texas health insurance consumer in the major medical family of coverages. My advised changes are only altering the policy, not making radical benefit changes like limiting the amount of coverage for inpatient or outpatient procedures. The last thing in the world you, the Texas health insurance consumer wants is to be stuck on a smoke and mirrors policy that leaves you bankrupt at claim time.

Although these recommended changes could potential expose you to a tad bit more out of pocket in the event of a major claim, or you may experience a wee bit higher co-pay, these changes will at least save the policy. The number one goal if you are experiencing limited dollars is to keep your family moving forward, by altering your Texas health insurance policy for the short term it can not only save you a few bucks, but allow you to not be forced to cancel important medical coverage. If these ideas make sense, please find a responsible, experienced health insurance broker or allow me to review your choices. This economic mess will be over soon, we all just have to get through it the best we can, I can help you do that.

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.

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 Texas health insurance 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.

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.

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.

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!

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.

To keep matters short I won’t  get into deep detail regarding the tax advantages HSA’s can offer to the Texas health insurance consumer. Bottom line regarding the tax advantages you are allowed to contribute up to a set amount into an IRA fund and withdraw monies for medical expenses. If you wish to know more about the tax advantages there are thousands of websites explaining the matter in more detail.

HSA plans are very simple plans, you have one deductible to meet for all insured family members, unlike your traditional PPO doctor co-pay plans which generally have two or three deductible per family. Most times the deductibles hover around $6000 per family. After the deductible has been met the plans that I write generally pay 100% after the deductible. Most PPO doctor co-pay plans then pay at the traditional eighty-twenty co-insurance. So HSA plans DO offer potentially lower out of pockets in the event a family has a major sickness or injury. There are some agents in the Texas health insurance market that do write HSA plans with higher deductibles and out of pockets but for the most part I see the Texas HSA plans with about the before mentioned six grand out of pocket.

So far so good, right? Well unfortunately wrong. Here is where they start to differ from their major medical sisters. HSA plans apply all medical expenses to the deductible. A Texas health insurance consumer can not have doctor visits and drug prescriptions covered until the deductible has been met, otherwise they fall out of compliance with federal IRS guidelines. The new trend with HSA plans is to cover a limited amount of preventive care before the deductible has been met, however the numbers that don’t cover preventive still out number the ones that do at this point. So simply put a client that goes to the doctor for the common cold or flu will pay all expenses out of pocket up until a point the family deductible has been met.

Texas health insurance consumers should understand that they are buying a straight high deductible plan with no additional benefits when they purchase an HSA plan from a Texas health insurance agent. Period. Clients that rank having doctor visits covered and drug prescription coverage with a co-pay are not ideal clients for these plans. The family will be very unhappy if they allow a Texas health insurance agent to convince them these plans are the right fit for them.

I find that Texas HSA plans work well for those families that have no children or the kids in the family are teenagers. I have also found the HSA plans work well for families that are over fifty-five, as they rarely go to the doctor. Texas consumers that buy the HSA and have a couple of kids under six could be very disappointed in the performance of their Texas health insurance policy.

One interesting note about HSA plans, they are the easiest plans to understand out of all the plans in the Texas health insurance marketplace. It’s simple, meet the deductible, plan kicks in.

In most cases HSA plans offer much lower monthly premiums than your traditional doctor co-pay plans. In some cases the monthly price drop can be a couple hundred dollars a month. That’s a substantial savings for consumers that are experiencing the financial hardships that our present economy is causing.

So to summarize, the HSA plan is great for families that do not go to the doctor often and they also provide some semblance of a cost certain on out of pocket expenses, however if you are someone that needs the doctor co-pay for the times you take your children to the doctor, and need the drug prescription co-pay the HSA will not work for you.

I think the HSA plans have not taken off in popularity as much as congress and some very single minded Texas health insurance agents thought they would. Who knows, maybe they someday will, I just dont think you can ever replace the mindset of having a doctor co-pay, so I think the plans will only be a marginal player in the Texas health insurance marketplace.

I do feel if you rarely use your coverage and are getting pinched by the extremely high premiums of today’s Texas health plans, get a quote today. They might well work for you, but if your expecting something that more resembles group coverage stay with your PPO doctor co-pay plan, otherwise unhappiness is just around the corner.

Let’s try an digest this confusion. United HealthCare, which offers it’s individual Texas health insurance policies through Golden Rule Insurance Company has been one of the most expensive plans on the Texas health insurance playing field. I quote them every day but their rates just don’t match up with the Aetna’s, and Blue Cross type of full doctor co-pay PPO policies that are being offered in Texas. Although the coverage offered by Golden Rule was solid, it was just to difficult to present to consumers when on average it was over one hundred dollars a month more.

Apparently Golden Rule recognized that they were not the large player their name comands and slightly revamped their portfolio for the new year. Here is the problem, they are offering the Texas health insurance broker the choice of selling one of two plans. One plan is similar to the current plan with solid coverage. The rates on this “standard” plan have decreased slightly. The second option that is being offered to brokers is a policy called the “Platinum Series”, this plan cost on average about ten percent more than the standard plan for similar benefits. The new Platinum Series plans also require a non-refundable thirty-five dollar application fee. Also a very strong note need to be played regarding how this Texas health insurance plan can be marketed. The Platinum Series plans offer the broker selling the Texas health insurance policy the ability to chop the number of doctor visits down to only four visits a year. When a Texas health insurance broker reduces the number of doctor visits on the Golden Rule policy the monthly premium the clients pays is now about the same price as the standard plan. In short, the Texas health insurance consumer would get lower benefits for the same monthly premium by selecting a broker that only offers the Platinum Series. it doesn’t make any sense to me either.

Now here is the big question. Why would any Texas health insurance broker agree to market this plan? It has a non-refundable thirty five dollar application fee, it has a wait of six months for any preventive care/wellness benefits, and brokers will be forced to sell the limit on doctor visits set at four a year to be competitive. The answer is actually quiet simple. It’s all about commission. The Platinum Series products offer higher commissions to the brokers presenting it.

We as agents and brokers in the Texas Health Insurance market had decisions to make when this offering took place. Do we wish to market the standard or the Platinum Series plans, we had to choose one or the other. We were not allowed to market both. The decision I made at peelerinsurance.com was to ONLY market the standard plans. I will continue to stand firm on my position of only offering the highest quality Texas health insurance products to the Texas consumer regardless of commission. It just goes against everything i believe in and everything I have worked so hard to accomplish in the Texas health insurance market to offer a product that I know is overpriced just for my own gain. It’s called morals and to me this lacks them as well as lacking fairness.

Some days I wonder if I will ever figure out what goes through the minds of insurance companies and agents by the actions they take, but greed is a nasty animal.

Now that you know the facts how can you the Texas Health Insurance consumer avoid this greed trap? After getting a quote from your chosen broker ask them if the plan is the Platinum Series product. Although I would like to think that they will tell you the truth you may wish to question further and ask if there is a limit on doctor visits or the six month wait on preventive care. Of course the application fee should also clue the consumer in as to what policy the broker is offering. If the answer is yes to any of those questions move on to someone else, or, call me. I will be more than happy to provide you quotes on the standard major medical doctor co-pay plans from Golden Rule.

First for a little explanation of how PPO networks work. A Texas health insurance company enters into a contract with doctors and hospitals, also known as providers. The agreement states that the providers will charge a certain price for a certain medical procedure. These discounts can amount to as much as fifty or sixty percent. The advantage to the provider is they have some semblance of a guarantee of getting their services paid from the Texas health insurance company. The advantage to the insurance company is in cost containment and control. As long as your provider is in network you have a simple co-pay or deductible to meet and the provider then bills the Texas health insurance company. Before there were PPO plans consumers were forced to pay the bill up front and file the claim on their own without much help from the provider. Clients would wait weeks before the Texas health insurance company would release payment to the client for the bill.

OK, this exact case I’m going to explain happened just a few days ago. The consumer had been visiting a doctor that at the time WAS in network. Thousands of dollars in testing had already been done and it was determined the client needed brain surgery. The doctor scheduled her brain surgery for a few weeks out. During the pre-op meetings my client was informed that her doctor no longer was a member of her PPO network, as the provider had decided to stop taking all insurance plans. Brain surgery is less than two weeks away and her provider just dropped the biggest bomb of her life. The client is now left scrambling to figure out what to do. The doctor didn’t seem to care that his client would now have to pay thousands upon thousands of additional dollars in order to have the surgery. After speaking with the insurance company it was determined that she could attempt to convince the provider to sign a continuity of care agreement, this is an agreement that for just her surgical procedure he would bill all charges as in network. He still would not budge, he held firm on his new business practice of NO INSURANCE. Cash only.

The reason I feel this story is so important is this. Most Texas health insurance agents or brokers do take the time to inquire about who your present doctors and providers are but things can change. Any time a consumer needs to have a medical procedure please ask questions, inquire about PPO network status. Before a surgery is preformed request to know who will be the anesthesiologist and confirm he is in network. Confirm that the facility or hospital is in network. So many times consumers of Texas health insurance policies just assume that if my surgeon is in network all the providers will be in network. That assumption is wrong up to fifty percent of the time in my opinion. 

When a doctor is considered out of network on a Texas health insurance PPO plan, out of network deductibles and charges apply. These amounts can add up to thousands and thousands of dollars that are unexpected. Always protect yourself, ask questions call the facility and confirm your status. Just because the providers show up in an outdated network book or on the Internet as in network means nothing. Things change and these type of changes can only do harm to the consumers of Texas health insurance policies.

OK, lets set this up. You take your young son to the doctor because of an apparant cold he has. While at the visit the doctor decides to run a few test to get a better idea of what he is dealing with. Lets say some blood test and a throat culture are done. He determines all is fine your son just has a cold, gives you a few sample drugs and your on your way with only the twenty dollar co-pay. It’s all over, right? Well, unfortunately WRONG!!

Two weeks later you open the mail and you have received this strange bill from the doctors office for lets say three hundred dollars, this bill says something about all the testing that was preformed the day of your sons visit as not covered by your insurance company. Whats the first thing most Texas families do? Call the agent or Texas health insurance company asking why was it not covered. I have taken countless of calls related to this very issue.

Most times the lab work preformed on your son was not denied for coverage, is was applied to your yearly deductible. This is so very frustrating to both the agent and you the client. For years most individual health insurance companies in Texas would have a co-pay for the doctor visit ONLY and all other charges applied to a deductible that was so extremely high the consumer would never meet it. Almost 100% of policies operated in this fashion for years up until just a year or so ago. Now I am finding more and more Texas health insurance policies allowing lab and x-rays to be covered in the co-pay eliminating the hassle and stress of figuring out a claim.

In my view it all started with Aetna, about three years ago when they introduced their individual health insurance policy in Texas they paid lab and x-rays within the small co-pay, provided the charges were incurred at the time of the doctor visit and done in his office. This health insurance policy eliminated clients calling and discussing claim problems with their agent instantly. It was amazing. But most all the other Texas health insurance policies all still applied charges outside the normal doctor visit consultation to the base deductible.

Moving the clock forward to today I find that more and more Texas health insurance companies are starting to pay lab charges within the co-pay and the Texas health insurance consumer is the winner. Texas health insurance companies like Unicare, Golden Rule/Unitedhealth Care, and Humana have to a certain degree  all followed Aetna on this practice and more and more of my business seems to be moving toward these companies. Unicare made the biggest change by also allowing more preventive coverage for children under eighteen and a simple co-pay for emergency room treatment. They made drastic changes with their benefit configuring and just comparing apples to apples Unicare offers the best policy on paper than any company in the Texas health insurance market.

When you decide it’s time to start looking at a new Texas health insurance plan keep in mind the pitfalls of the doctor co-pay and get assurances from your Texas health insurance agent or broker than the new plan you are getting is what’s called an all inclusive co-pay so you don’t have any hidden surprises awaiting you in the mail. Your wallet will thank you!