Friday, December 30, 2011

Empire BCBS To Abandon NYC Small Business Market?

What a crummy organization....BCBS plans should be broken apart in the U.S. plain and simple, or be forced to occupy less than 45% marketshare in any particular market....that would get some healthy competition.

They have long been regarded as subpar in the New York City Market (i.e. Empire BCBS) as most consumers would rather go to an NYC DMV, or Rykers Island than to be forced to call customer service at Empire. They are just awful....

So though it is not surprising, or unwarranted, Empire BCBS announced a few weeks back that they would terminate almost their entire book of small businesses and give those companies an option to buy one of 3 remaining and crummy products (that have never sold to begin with) or go about searching for another insurance company. This has created a move/buying frenzy with Aetna and Oxford frankly, and brokers have been moving large blocks of Empire BCBS business in droves. Again, Empire, so funny, they are just clueless, but then again, they are a Blue Cross organization, so what should I expect.

Well guess what, in a city with 11 million folks we are now down to only TWO (2) reputable health insurance companies - Oxford Health Plans (a United Health Group company) and Aetna. Emblem Health, the old "Atlantis" company, and HIP are options, but have never been considered real competitors to these two.

So, in another market where we have lots of customers for example, Charlotte, NC, we have at least 7 solid health plans - United Healthcare, Cigna, Aetna, Coventry Wellpath, Humana, and the local monopoly BCBS of NC...so, within a 50 mile radius of Charlotte we have like 1.25 million folks or something close to that, a medically underwritten market (unlike NYC's socialized community-rated market...which is double the price and imploding as evidenced by Empire's pull out) and 7 good options? Compare that to NYC and 11 million and you scratch your head? Well yes, you do, b/c Obamacare has been based on a socialized system because he is a socialist to begin with and we already have TONS of evidence that a socialized system will never work in the US so why base a dumb law (Obamacare again) on socialism?

If we do not change fast in the U.S. Obama is going to turn us in to a third world country.....we are in real trouble with healthcare, but generally speaking, we are on the hottest burner on the stove in just about every category because of this absurd administration....

Obamacare?

So where is Obamacare? Where are the efficiencies? How has he and his terrible administration set the U.S. for a better, more affordable system? Answer is simple....HE HAS NOT, and HE WILL NOT.

The only savior in the U.S. is consumerism and our company now has hundreds of small and middle market clients that have instituted consumer-directed health plans (CDHP)with enormous savings and cost-stability year in year out for the last 5 years while at the same time traditional plans have imploded.

Obama doesn't want to give credit to the savior because he did not come up with it. As a matter of fact consumer-directed plans have been around for a long time, but there was not an economic event that forced the adoption of the plans. Now rolling in to 2012 which undoubtedly will be another poor economic year (and even worse if Obama stays in office) we will be faced with the same challenges as before. Whether Independent, Democrat, or Republican, from the standpoint of health insurance I pray nightly we get a Republican President who understands consumerism and will listen to all parties. Our government in the U.S. can't even run DMV, or Medicare (remember that IS health insurance and our precious government has bankrupted it already!!) so why in the world do I want them touching the coverage I hold in high regard for myself, my wife, and 4 growing children.

Our clients have been seeing on average a 3% increase in costs on CDHP plans compared to 25% for traditional plans (in some cases closer to 40%)....proof is in the pudding, give me CONSUMERISM!

Friday, November 11, 2011

A New President

It is time, plain and simple. Obama must go, he has not performed and in the world in which I operate if I do not perform, I get fired. So should he.

We need a leader who happens to be President, not a President who has no leadership skills (sorry Obama, that is you).

Obamacare, terrible, must go....Economy, terrible, must be stimulated...Bernanke, come on you are smart, but this whole economy and the puppet government is starting to make me worry that Atlas Shrugged, the movie, is coming true. As a producer who generates revenue and jobs, this economy in the U.S. and the government trying to "do" everything has proven one thing...the government can't do much of anything profitable or right. Fire them too.

Saturday, August 13, 2011

Obamacare seems to be NObamacare

Well I remember seeing the bumper stickers when he was running for office (from folks that did not care for Mr. Obama) that said Nobama....seems now that is NObamacare.

Seems in appellate courts the unconstitutional argument is gaining ground, and we have a full blow Depression #2 coming in the U.S. if not the world (just check out the stock market gyrations over the week of Aug8-12 2011)...

So I think (just my opinion) that reform will happen, but not super-sized like Obama guaranteed, but super-small sized as I suspected from the get-to. In my company we have seen a MASSIVE migration to high-deductible health plans and health reimbursement arrangements/health savings accounts. Insurance carriers hate them because they actually work and drive down premium costs, over-billing, double charging and unnecessary utilization...it is the fix in this country and with NObamacare, it will end up being the only solution from which we can draw.

I blog about this all the time, and it seems to be coming true almost on accident - again economy, stock market, clueless leadership on Capitol Hill and White House.

Let's see what happens. Check on your company's plans with out Geeks at www.healthinsurancegeeks.com.

Tuesday, August 2, 2011

Where is Health Reform?

I don't know, ask Obama and his cronies...we will have the US government's debt downgraded shortly, we can't keep up with the debt load, and somehow I am to believe that the government could do something creative with healthcare. GIVE ME A BREAK PEOPLE!!!!!!!! COMEDY! COMEDY!

I seriously would love to sit across from Obama, I would laugh out loud. We should fire half of the folks that work on the Capital, downgrade their health insurance offerings, allow insurance companies to sell cross state borders so we have tons of competition, and oh yeah I forgot, privatize Medicaid and Medicare. The government 100% should not be involved in these things period. They can't run anything profitably because most folks in government have never run a company that employs workers and actually has to break even or show a profit to keep the doors open....welcome to my world people.

Regulate health insurance companies a bit more and have them run the show for ALL OF THIS within parameters that the government can "set up."...then stay the hell out of our insurance please.

I am done now.

Monday, July 11, 2011

The Types of Companies that Appreciate What we do at HealthInsuranceGeeks

We have had a tremendous first few years of growth at Health Insurance Geeks. It has been augmented with the political climate in Washington, the economic collapse of 2008, and what seems to be the "new" thing to do at growing companies - make money, save money and become MUCH MORE FISCALLY RESPONSIBLE!

These are all great things for us, as we have been beating a specific drum for many years and it seems as though companies just started listening to our beat when savings and efficiences became priority number 1.

I hope this is just the beginning of the new landscape for how we purchase health insurance in the United States, how health insurance carriers are governed, as well as the limited involvement in the actual management and rationing of healthcare by the government.

We have seen a dramatic uptick in the amount of corporate customers (specifically companies with 75 employees give or take a few) who are listening with wide open ears now to our language - CONSUMERISM. Employees and employers are now learning more about the true cost of healthcare, and purchasing plans from carriers that are both sigfinicantly less premium, while offering the exact same level of coverage for the big ticket catastrophic items we all insurance against to begin with in the U.S.

So long as we focus on "what is my copay" we are on a health insurance escalator that will not go down....as we move away from copay-based plans, we will happily begin lowering costs, be on a downward escalator, and will see all of the constituents in the supply chain - doctors, hospitals, labs, ambulator centers/imaging centers, rehabilitation centers, etc... - begin to be incented for quality, and no longer quantity. It will also mean less of all of those constituents as the unprofitable will die. I guess that is how things should be in the real world.

Friday, June 10, 2011

Health Insurance Geeks & Technology Companies

So we started our company and knew we wanted to be different. Somehow my co-founder and I started our careers during the HMO invasion in New York City and worked for a company that was at the forefront led by someone still called a visionary. That company was Oxford Health Plans. Good or bad it taught us how to be innovative, create a vision, and to always go waaaaaaaaaaaaay above and beyond. It was just the way at that company during the time we worked there.

That said, we also knew we would build our own version of something in the bloated, stodgy world of health insurance, and frankly, we never felt the health insurance companies ever did anything efficient. Having spent the greater part of 10 years building great efficient models within large commercial banks, we learned also that banks too were pretty bloated, though they were at the same time looking for quick scores. They could not bear to wait a few years to see progress....so that brings us to Health Insurance Geeks and how we started and what our mission was to become....be different, think big, never lose focus of who got you here THE CUSTOMER, and always take the methodical patient approach of completely changing a paradigm. We did this with a small dedicated staff, and also found that the very companies that too were breaking ground in technology, love us too....the great market of digital technology, internet advertising, mobile technology....basically anything utilizing all of the great laptop/mobile creations of the last 10 years and how to drive new companies towards it.... we have a stable of technology companies as our customers and boy are we lucky that is what happened. It has spawned a frenetic growth spree, and just when you think you do not want to raise money and take your model to the rest of the United States, you find investors knocking on YOUR doors....not how it was in the beginning when we needed capital, but my co-founder and I decided to reach in to our own pockets, use our money...talk about skin in the game. We got scalped, thank God! Teaches you how to run a lean and mean company but beat the competition, and to always look for a better, more efficient way.

So it is perfect that bloated insurance companies are getting tee'd up by the current administration with talks of reform and more reform....btw, we will never have a complete reformation, but rather bits and pieces over time that will erode the current way of doing business. Think insurance companies always put the customer first....how about this tidbit, many NY and NJ area health insurance companies are pulling their low-priced high-deductible plans, because they ARE WORKING and driving down premium, and creating consumer directed models, but are screwing up their PROFITABILITY....these clowns....

So anyone reading this can probably smell the passion right through the computer, I live, breath, read, listen to anything consumer-directed because it is the way we are saving and delivering for our technology and non-technology companies alike....any time of business that likes to break through and think out of the box, owes a chat, call, email, something to www.healthinsurancegeeks.com....we lead our prospects and customers right to the fountain of premium "youth".....

Wednesday, April 20, 2011

High-Deductible Health Insurance Plans

Our tribe here at Health Insurance Geeks has been growing exponentially, and it has been rewarding, as we have been pounding our drum to a different beat for years now.

I read often of dips and events that create new industries or explosive growth for outliers, and it appears we have been the benefactor of just that....we waited patiently and kept our mission, and now it is paying off big time.

Some of our clients who are stuck in the old way of thinking or are not ready for the proactive work necessary to move to a consumer-directed health insurance model with a high-deductible health plan, but I can say this...ALL of our clients have had it front and center by us, and they are simply the best solution to our quagmire here in the U.S. with respect to affordability of health insurance for the skyrocketing prices of healthcare services.

The lobbyists in Washington would never open the backroom doors they do all of their negotiations in, but lets be honest, the whole problem is profit and greed. As an entrepreneur who used his life savings to build something he believed in, and made it a success on a model where our earnings are substantially less (less premium means less income for us) I can say it can be done. We as consulting brokers have also been scalped many times over the last 17 yrs as far as how and what we earn. It is funny that pharma advertising has not become illegal like it once was? Health Insurance carriers have not been forced to operate as nonprofit, nor have all of the hospitals? Have Mercy, if that happened, the CEOs would not be able to afford their helicopter leases and the 30,000 sq foot mansions in the Hamptons.

Hey I am a capitalist like the next guy, but first and foremost someone who loves his clients, and loves what he does...as long as I can put my 4 kids through college and take care of my family and continue to love what I do, I can't ever see profit and greed taking control of my motives. Unfortunately, I have been involved in venture capital transactions and spent lots of time around senior executives in banks and insurance companies, and my LORD, I never heard the word customer...it was always EBITDA, or something relevant to how we continue to make more and more money, and the customer seemed left out....

That is why Health Insurance Geeks (www.healthinsurancegeeks.com) has done so well, always, always, keep the folks who made us, our customers, FIRST.

Monday, April 11, 2011

Consumer-directed Plans

Well it is interesting to me as an expert in the field of company-sponsored benefits, specifically group health insurance, that most carriers are selling against the solution to the quandary in the U.S. - consumer-directed health plans.

As somoeone who understands underwriting as well as anyone, I guess this is simple, health insurance carriers do not possibly want to offer something for 25-50% less premium (consumer-directed plans with HRA or HSA and high-deductibles) as they will STILL get stuck with high claims....remember folks, 5-105 of a company's employees drive 80-90% of claims volume. That means a few employees and/or their dependents can blow up an employer's health plan even if they have say 100 employees.

So simply the insurance carriers, whether charging 400/single employee for a copay plan, or 175/employee with a high-deductible plan, they will still be on the book for a portion of a huge claims (remember these clever guys reinsurance claims over a specific level, say 25k, 50k, or 75k and build that additional stop loss premium in to a group composite rate...)....so maybe Obama and his henchmen need to negotiate better with the Republican Congress and figure out a way to back stop, stoploss for carriers in exchange for them lowering their rate base and passing the real problem in the U.S. (chronically ill patients either not managing illnesses well - think Obesity, Asthma, Heart and Diabetes all in one cluster, or someone who just has huge claims and is catastrophically ill - cancer et al).

The real problem is not healthcare in the U.S., but how to better manage the 5-10% of the population who is consuming enormous amounts of costly healthcare in an inefficient system....if the government truly wants to help, folks who are chronically ill should be mandated to quality based medicine, and the providers in those systems should be compensated MORE, yes MORE, to manage better.

That folks in a nutshell is the solution, but we have these idiots in Washington arguing about things that are not the solution....universal care, single payor, government or no government...none of it matters, evidence-based medicine does....less hospitals, though BETTER hospitals and the same for physicians....more physician assistants, nurse practitioners, and places like Walmart walk in clinics and CVS minute clinics for the routine cold - GTEAT solutions.

We the people demand a solution, not the eggheads in the government.

Tuesday, March 29, 2011

Consumer-directed Plans and Self-funding

Ooh, I like this topic as I believe in them both as long as the liabilities are fenced appropriately with specific stop-loss (think of that as a CAP on a specific employee or family's claims) and aggregate stop-loss (CAP on your entire company's spend)....and doing this with a health reimbursement arrangement owned by the company or employer. This is Shangri La for a guy like me but here is the catch, it requires experts like us guiding, coaching and analyzing for our clients as this is pretty complex stuff that requires expertize. And if done correctly can really be a better way than just giving health insurance carriers the premium dollars to make the margin (PROFIT) they want on your case. I liken this to a fully insured company of say 400 employees that DOES NOT self-fund but wants the power of a health reimbursement arrangement (it is the tool that can pay deductibles for employees and be written off as a business expense as well)...well here is the catch, the greedy underwriters at insurance companies will push for a certain amount of premium regardless of the plan design selected (with pricing matrices they will push the plan they want as they MUST get the premium they want regardless....they know they will have X in claims, then administrative costs, plus profit...so they corner clients).

So it is more of a challenge to fit an HRA in to a fully insured case where carriers have claims data they use "against" you, as well as manual rates (your age, gender, marital status, home zip code) that they blend....so they have 2 "shells" they use on the table and benefit from whichever one they want to use against you to fit you in to their profit box.

This topic I could go on and on, but in general if you shop with a competent broker like Health Insurance Geeks and Nexus, and drive their commissions (when was the last time you reviewed what your broker charge, versus what they delivered in PRICE?...forget all the B.S. services they say they provide, I am talking about premium coming DOWN rather than your broker selling you on the INCREASE!)....

Shady, greedy, self-serving brokers make us crazy here....we work our tails off for our clients on less commissions as we are not reporting to shareholders or dummy boards, hmm-hmm ooops let's call them unnecessary executives in the game of price....

I feel companies who are less than let's say 1,000 employees, should ALWAYS be with a boutique, otherwise they are paying for nonsense.

visit www.healthinsurancegeeks.com or www.nexusbenefits.com for more of our ideas.

Friday, March 25, 2011

Why the Copay is the Enemy and the Fat Farm of the Health Insurance Carriers

I liken it to drug addiction....in this country the smart folks up in the ivory towers in the world of health insurance knew 2 things...we would LOVE the copay, which we all do now, and that we were going to have a disaster on our hands in 20 yrs...that was back in the early 1990s and voila, here we are....

The copay is both the enemy and the problem, because it hides the cost of everything...if my doctor bills 1200 dollars for a 15 minute visit, but I pay a $25 copay what do I care? However, on the other hand, when my employer moves to a consumer-directed health plan with a high deductible (where I get billed the negotiated physician rates between him/her and my insurance carrier) now I get to see this full $1200 and the allowable amount.

As both an expert in this field, a business owner/entrepreneur and also a consumer, when we move to this model many years ago here at my company, I started BLOWING up my Pediatrician, PCP and also specialists...I remember the first time with my youngest daughter when the Pediatrician wrote 4 prescriptions for her...off to CVS we went and again VOILA, we were told the BRAND NAMES were a total of like 800-900 for the 4 meds, 30 day supplies....I started laughing....immediately called the Pediatrician and said "re-write those bad-boys with all generics"....my bill was like 60-70 for ALL 4 FOR 30 DAYS!!!

That sums it up folks....going to deductibles, negotiated pricing, NO COPAYS for anything, FREE PREVENTIVE MEDICINE, great tools for employers and communcation forums for employees, and we can get out of this mess....also I DO NOT NEED A MEDICAL DOCTOR, to see me to re-order my allergy medicine for another year, which has both been working, and that I have been taking effectively for over 10 yrs...welcome the NURSE PRACTITIONER, OR PHYSICIAN ASSISTANT (btw, tell your kids it is going to be the field to get in to in the next 5-50 yrs...essential to our healthcare success).

This topic, I could ramble for thousands of words right from my hip because I study it, practice it, live in it, believe in it, and have hundreds of clients with whom we have implemented it, and the phone calls on premium increases VANISH!

I hope this helps, and I love writing about this stuff. I would imagine health insurance carriers hate seeing this stuff, however they also know it works...Cigna, Aetna, United Healthcare, they have all had their own employees in these models for 10 or more years....the folks who really hate this are HOSPITALS and DOCTORS because to the scamming ones out there (billing on quantity not quality) they know their offices with Monet artwork are also going to need to become more efficient.

Wednesday, March 9, 2011

More on Healthcare Consumerism

Two great things happened today...one was with my co-founder and business partner and the other with one of my clients. First my business partner was explaining how one of his clients that he migrated to a consumer-directed high-deductible health plan strategy had just had an epiphany as they discovered together the cost of a brand name drug (an injectable) versus the generic substitute....it was for a 90 day supply and the brand was 2,000....YES, $2,000 bucks!!!! The generic substitute was $50 for a 90 day supply.

Now had we not moved this client to a non-copay based plan he would have never discovered this little nugget that is a great example of why a single rate for an employer health plan now is soaring closer to $1,000 than ever for what we call a "rich" plan design...funny thing is what we now call a "rich" plan design, back in 1997 we would have scoffed at vehemently...back then what we call rich now was probably 175 bucks a month for a single...now 14 yrs later it is closer to $1,000. Unreal and the reason is the example above...the DEVIL copay system that hides the costs of things.....

Second example was great...talking to a client of mine for 10 years and we have had a HOMERUN moving them from the DEVIL to a new world, through a consumer-directed model. She and I were going through this years' renewal and ideas on how to starve their insurance carrier this year and POOF!! We came up with a great analogy...health insurance needs to become more like auto insurance....deductibles...can you imagine if you had a $10 copay for a wreck in to a pole that could cost $10k...you would almost look for a pole to hit to make the others in the car laugh a little...who would even care, $10 bucks, why not! Now that is not how auto insurance works....$2500 deductible is pretty common to keep the premium down and as a result you would not catch me dead screwing around in a car and playing with POLES! Same deal in health insurance.....if we pay a larger cost of Rx especially, and doctor's visits and charges/lab xray too, we are going to SHOP WAY MORE and watch our dollars....a result as well will be a radical reduction in healthcare consumption etc...

Now finally one thing to highlight is the really sick in this country, the 15% or so....maybe those are the folks Obamanomics should focus on as they are the real problem no one talks about....they drive 80% of the claims and many times have the same 4 ailments that drive most claims anyway. In no way am I suggesting that they should get subpar care, but large consumers of the system and dollars need to pay their fare share, and that is where the government should both back-stop claims from insurance carriers/employers, while also pointing the VERY sick in to very efficient systems...like Mayo, Cleveland Clinic, etc....see this link

http://www.100tophospitals.com/

The true best hospitals in the U.S. should be rewarded for being such, and the poor ones should be shut down. We have too many....funny that NYC does not even have a top 25 system, which is simply appauling as its costs are 2-3 times other places in the U.S....this is the stuff these clowns in Washington need to work on.

Monday, February 28, 2011

Health Insurance Consumerism - It is Time

Oil is creaping back in to the middle 3 dollar range at most pumps (and rising other commodity prices), foreclosures are mounting like crazy - in Charlotte NC where we have a home 51% of all 2010 sales were foreclosures....unrest in the middle east, and these insane media/journalists on various shows bring on these also insane "pitch" men for whatever it is they want us to believe talking about how things are in pretty good shape? Are these folks using street drugs?? I mean are they serious? If you took out Obamanomics, i.e. just pour an agregious amount of tax payer dollars in to the broken system to prop it up and make it look like it is not that bad....a mistake, and another lie to us, the US drones. Reality, unemployment is probably 20-25% - what if folks have worked somewhere for 10 yrs at a 1099 and get layed off...oops, we don't count them and they don't count? Ridiculous.... with that as my backdrop, we are in the a great Dip and at the Tipping Point for what we do in my company, which is liberate small companies (5-300 employees primarily) from the bondage of health insurance carriers, their brokers, and the awful advice and push they both give their clients.

High-deductible health plans are the answer to the quandry, and giving employers tools to incorporate consumerism is also the answer. Why do you think Cigna, Aetna, United Healthcare have had THEIR own employees forced in to high-deductible health plans for over 10 years...THEY KNOW THESE THINGS WORK FOLKS!! THEY JUST DON'T WANT YOU TO KNOW THEY DO, BECAUSE THEIR PREMIUM TANKS AND SO DOES THEIR VALUE.

I represent the solution, and Health Insurance Geeks push answers....it does not mean everyone will heed the message but at least we are part of the solution, not part of the broken problem that the majority of brokers and health insurance carriers are still trying to protect.

Wednesday, February 9, 2011

My Manifesto - Remove Politicians from Health Insurance

They and them.....are the problems. They meaning all of the politicians jousting to make sure they save their seats, their donors, their pitch, their perks, and THEM, the vested executives of health insurance companies that simply are not following what we are begging for in the US....affordable coverage. Funny thing about this is it is simple to solve really...we just need to lead the TRIBE (and I am a happy Leader of the tribe to which I refer) .... a HUGE TRIBE can get lots done...we need a full court press against large employers, unions, and insurance companies and the politicians intertwined within to FORCE them to deal with disgruntled Americans on this subject. Look what Twitter and Facebook did in Egypt, I mean COME ON PEOPLE!

I SIMPLY DO NOT WANT THE GOVERNMENT TOUCHING ANYTHING HEALTH INSURANCE RELATED...read that again please. Our government is responsible for many of our current bankrupt entitlements and I do not care who points a finger in either direction, Democrat, Republican, Independent, whatever...

In a country (yes us in the US) where we can't even fill top level IT and engineering jobs from within because our talent pool is frankly less than those in other developing countries, we are up against the ropes and ready to go down like Apollo Creed in Rocky III (I think it was that one)...pretty scary stuff for someone like me born on a tiny island off the coast of western Greece to a Greek dad and American mom...they brought my sister and I to the land of opportunity, the great U.S. and raised us here. Now 40 yrs later our society is crippled with debt, inter-political fighting and nothing is getting better, actually worse.

I read about what a Tribe can do (thanks again Seth Godin, you're great) and am throwing a stake in the sand and trying to build my tribe. My company actually sells individual, family and employer-sponsored health insurance, and here I am trying to lead the TRIBE to do things differently. My contemporaries or Peers think I am nuts "our business will get killed"....actually exact opposite. The losers that are trying to oversell, under-educate and profit will lose in the end, and I am not one of them. I just want to help people, employers, their families and employees, and lead my clients to solutions that give them the power to chose, spend wisely and always have predictable financial models in which they can have faith.

In my company we say constantly "the copay is and was the devil"....smart insurance companies knew we would all get addicted to the copays like "crack" and now when we try to lead folks away from that old "COPAY" they shiver...what's the copay? what's the copay? well the answer should be $1,000/mos/employee in premium is the copay. What flavor would you like please? No copay, no health insurance problems...no ridiculous mandated benefits (pay for what we buy like car insurance) no health insurance problems. No middleman in the prescription supply chain (yes you insurance companies) no health insurance problems. No drug advertising like it was long ago, no health insurance problems. But first, nuke the copay, and start asking our doctors what they will charge us. I mean COME ON, can you imagine getting your car overhauled at Honda and not knowing what it would cost? The lazy here in the US would say, man that sounds great!! Okay, lazy, you can't afford the new "copay adjusted" cost of a Honda CIVIC which is now $80,000 and a great lease payment is 2100/mos...okay, who can afford that? Well the 500% increase of it would be just like what has happened in the U.S. with the copay. It melted the system.

I am done for today.

Thursday, February 3, 2011

Individual & Family Health Insurance coupled with Group-Sponsored Plans

So get this....now many employers are passing on the full cost of dependent care (think your spouse and children) on to their employers. So when that happens we as employees see quickly how much insurance really costs.

The smart thing to do is to price out if you can do better on your own. Assuming you are relatively healthy, not diabetic and take limited maintenance medications for mild ailments, you certainly can do better on your own. The one thing to look out for are the nuances in product development. Things like maternity that are mandated benefits for employer-sponsored plans, are not in the individual market. But, for those folks who have already built families and are getting crushed with premium pay-throughs, take a look at our rate site and see if you can do better - www.healthinsurancegeeks.com.

The Geeks

Friday, January 28, 2011

Individual & Family Health Insurance, and HEART

The end of 2010 and now early in to 2011 I have seen a surge in a queries for individual health plans, as well as family health plans - sometimes the dependents of a worker, i.e. spouse and children. In addition the amount of folks on COBRA and coming to an end has been astonishing. I really do not trust the 9.5+% unemployment rate by the way...I feel it is much closer to 20% when you look at real life and the folks who are working minimum wage jobs to make ends meet as opposed to their normal vocation....I could go on and on, but back to my point.

Many, many employers are passing on the cost of health insurance other than that for the employees, to the EMPLOYEES. It has been a massive change in the last couple of years as the U.S. and global economies have abolutely melted down. I see many more folks coming to our organization in search of alternative than in some instances paying 1k +/mos in insurance premiums that their employers are burdening them with as we have now fallen off the cost cliff at least here in the U.S.

So, what do you do? Well, depending on some states like CA and KY for instance this can be super news as child-only policies are still offered and in addition pre-x is gone for children under 19, so they can't be assessed those...having said that I have still seen insurance companies rate them up quite a it, as well as burying the costs in parents if they are attached to a family plan. Now the bad news, other than those 2 states, we at least can't sell child-only policies.

More "so-so" news is just the underwriting process for attaining family plans instead of taking in the chops from your employer - let me explain:

I work for X company, and used to pay 30% of the full premium for my family - for example 1600/mos in total premium charged to my company by the health insurance company, and $480 getting taken pre-tax from my paycheck bimonthly for example ($240/paycheck)...that was how it used to be....Now my company is saying, we will pay 100% of you (the rate charged to the health insurance company for me is let's say $500, and the $1100 is now being passed on to me to cover my family. So I went from $240/paycheck for all of us, now shooting up to $550/paycheck...like a 220% increase)....

We are seeing this ALL OVER THE PLACE! So then we get the phone calls and it is good news if you are healthy - and what I mean by that is no diabetes, no heart ailments, or major chronic illnesses in the family etc...if you fall in to this category you can taken the controls back fast and purchase private health insurance for a much better premium. Now let's say your loved one (the fomer dependent on the employer plan) has diabetes, and you have an autistic child. YOU MUST STAY PUT!! You will not be able to secure health insurance outside of CA or KY for just your child, and then anywhere else in the U.S. basically (other than NJ and NY for example) your spouse will be declined b/c of the Diabetes, and then the children can't get a private plan b/c there are no child-only policies...get it? The insurance companies screwing us again.

And by the way, let's talk high-deductible health plans, a la consumer-directed health plans. I do feel they are our savior, but health insurance carriers are still gouging us price-wise...Oxford Health Plans in NYC for example...they are an awesome company, but for the plan designs they offer, they have cornered us in to buying what they want to sell us ($800/single employee) POS and PPO plans that have astronomical pricetags, and make them record profits. When we compare those plans to their high-deductible health plan offerings with managable deductibles (let's say $1500/year for a single person) it is easy for a broker, consultant or the insurance company/and consumer for that matter to talk themselves out of buying the savior (high-deductible health plans) b/c we can transfixed on that $1500 deductible as opposed to the rich PPO with 0 deductible in-network anyway. So here is what maddens me, the $1500 plan is still $425 + per single employee monthly. That is not priced well, period. In my company we joke about TARP (troubled-asset recovering program) that the Fed Govt established to basically stabalize our country and bail out some banks. If what should happen to health insurance companies did (i.e. that $425 plan, sank to $250 where I think it belongs) we would then need HEART (HealthInsuranceCompany Eroded-Asset Reconfigured Trust) or something of that nature as they would have their claims reserves set up with a premium 50% lower let's say, and would all tank in a quarter. It is funny to say it so matter-of-factly, but I believe it in my bones. But some would say it SHOULD HAPPEN! Well, one thing is for sure, I do not what the government involved in health insurance, and believe for starters Medicare should be run privately...we have given the government plenty of time to bankrupt that system....so make that private, keep health insurance private, but do please blow up the profit machine, the current metrics, all of the waste with too many employees and too much paper (everything automated to some degree)...coming from a distrbution perspective (which I am) big deal, slam my commission (which is how I pay my mortgage, and not much more these days) and allow me to continue to help individuals and small companies as I love to do, and let's make it a day. We have already had our revenue hammered by more than 55%, which frankly has been fine with me. I am in business to help and in order to make the revenue work, it just means I need to help 55% more people every day than I used to for the same static money. Again, fine with me, as that means in the end I actually help MORE PEOPLE.

Sounds all great right? Well I am one of the honest guys in this business, but I am surrounded by dirtbacks and agregious big companies who want their executives to keep fat paychecks. So blow em up, keep the smaller/boutique businesses humming (the engine of the U.S.) as they should be and always should be. The big corporate interests and the government are the problem.

I could write 20,000 more words without a break, but these are my thoughts for the day, and I think a good brain dump.

Thursday, January 20, 2011

Republicans Push for Repeal of Obamacare

Well folks, here we go, round one....and you knew it was coming. At least we have free preventative visits annually for adults over 19 (males/females annual physicals) and females get their free OBGYN visits. In addition children's wellness including immunizations, also all FREE.

No lifetime limits on benefits, and no medical underwriting for children under 19. That part is already sealed and is good news. Now for the big problem, which is how to afford a system for healthcare with no medical underwriting especially for individuals and small businesses, how to get everyone in the country in to the system so we do not have adverse selection, and how to keep the system run privately rather than adding another big burden to our government who has proven they know how to crippled our finances and have long before Obama came along....just see Social Security and Medicare for a reference point. GOVERNMENT, stay out of our healthcare, and go away. You spend like drunken sailors.

So, we need to be able to buy insurance cross boarder from state-to-state from my perspective, and if North Carolina or Pennsylvania want to underwrite my family and me, have at it....we need MORE competition, and more carriers, and more price points, and more options, and need to be able to tell the doctor who wants to charge us 375 bucks for a 20 minute visit, "How does 175 sound. Dr. Smith next door charges that, went to Harvard, has a practice with great metrics that I have reviewed, and has no malpractice suits against him. How about you?"

We need to get here, and we will with more competition, with strong consumer-directed health plan models (been talking about them for almost 20 yrs now)...we are in the Healthcare DIP (see Seth Godin on that one)...and have been for years. We are going to outlast the DIP in my business model, that I know. The benefactors are going to be those of us that have built organizations around assuming we will have a much more efficient model one day everywhere, but are currently already doing it.

These are the most exciting times of my career. My peers for the most part, all consume themselves with worry, or bury their heads in the sand. That will get us nowhere.......

Monday, January 10, 2011

2011 and the Obamacare Collapse

I think most agree Obamacare is dead in the water, as frankly it should be...it focused on political jousting, and health insurance carriers when it did not focus on the problem that health insurance carriers are faced with - how to FUND claims from agregious hospitals, and physicians and how to control billing/costs of services. In addition, we as consumers, employees, business owners (I am all 3) need to be pro-active with our healthcare, and start asking physicians more questions when we get prescribed medicines for example that cost 600 dollars for a 30 day supply (remember pharmaceutical companies DO NOT want you to get well per say, then you do not need their overadvertised medicine). The copay system which is entirely the problem (who cares what the cost is if we pay $30, $40, $50 whatever)....so back to consumerism, which where I grew up in this business, was the drumbeat almost 20 years ago. We saw it coming, and now it is reality. And your advisors (yes, I am picking on your insurance brokers) are giving you poor advice b/c most of them are also part of the problem. Remember your broker gets paid a percentage of premium and usually DOES NOT WANT you to leave the problem (the copay system) so they can continue to get fat and happy. Insurance carriers do not beat the drum, because they are faced with the same fate. So they are both the problem.

We built our company knowing reform in some way was coming (though we have been saying this for almost 20 yrs now) and that we were going to need to survive in a world where commissions get hammered because the premium stucture should and hopefully will collapse. And quite frankly as Seth Godin (author) states in a great audiobook The Dip, we are in the middle of a dip in healthcare/health insurance. Those of us part of the solution are dying for this to happen faster - collapse of the inflated premium structure to fund the problem - the copay system....btw, doctors also bill as much as possible (so do hospitals) as they are incented by quantity not quality in the current system.

Obama has actually used the word quality some and has referenced the Cleveland Clinic, and Mayo for example - two world class institutions with the best care. Unbelievable that the best are actually efficient right? Well listen to Godin, he will explain how that is....well LOTS of folks attached to the current supply chain that need to get nuked, and this has nothing to do with single payor healthcare or government run healthcare. They (GOVT) have proven to us over many years that they (the government) know how to do one thing - create bankrupt organizations - a la Post Office, Medicare, Social Security to name 3. Call any government agency and see how great the service is - "hold sir, I have my union mandatory smoke break now."

Don't let these government clowns touch my healthcare nor it for my family of 6, PLEASE!! Do however, "light up" hospitals and physicians ...we have too many who really are not that great (outcomes, readmissions, infection rates) overcharging (seems right inline with previous note about quality not being great) and we do not beat the drum enough of the ones who charge a fair dollar for incredible outcomes (there have been published examples of this in NYC all over the place)...the hospitals who are part of the problem need to be shut down, we can triage and push lots of Primary Care to "telemedicine" - come on, we have Skype now, so push my doctor to get online, see me eye to eye, and triage my bronchitis with GENERIC meds and save this failing system. We are ready for this folks....I have invested my life's savings in an organization pushing this system so obviously I have self-interests, but I am part of the solution not the problem. Everyone I listen to on TV also has self-interests but I do not understand how we can't all be a part of the solution - bring costs WAY down, bring outcomes WAY up, and make the advisors (brokers, consultants, insurance carriers) learn to live on half the revenue. The good will always rise to the top, and the bad will hopefully fail and/or go in to another business.

I think that's it for now...I need to do more brain dumps, more often. Q4 always makes our business bananas, so I go underwater a bit. My final comment is this....we passed on lots of business last year that just could not understand how high-deductible health plans work and the tools coupled with them that make them work. I actually wanted to tell some of those "decision makers" (usually the ones calling themselves that, are NOT) that they simply are part of the problem and not open-minded enough to understand the solution. I understand my arrogance in that statement, but it is true.