Welcome to my Observations on Health Insurance Blog With this blog I want to share with you my thoughts and perceptions of the ever changing world of Individual Health Insurance in the state of Colorado. I hope to be able to bring you new information, as well as possible different perspectives on an industry I am involved with every day.
Charley Mallon
Boulder, Colorado
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By Charley Mallon, on February 22nd, 2012
 Don’t have the slightest clue what your health insurance covers?
As part of the Affordable Care Act the government intends to take care of that. According to a recent article by the Associated Press “the Obama administration says that’s going to change, starting this year. Officials announced that private health plans will have to provide consumers with a user-friendly summary of what’s covered, along with key cost details such as copays and deductibles.”
“Just six pages long. And no fine print.”
“Officials are calling the summaries a “nutrition label for health care,” trying to capitalize on the name recognition of those information panels found on packaged foods at the supermarket. Consumer groups say the health care version isn’t perfect, but it’s a start.”
“These documents will allow consumers to compare plans on an apples-to-apples basis,” said Medicare chief Marilyn Tavenner, who is also overseeing implementation of President Barack Obama’s health care law. If an insurance plan offers substandard coverage in some respect, they won’t be able to hide it in dozens of pages of text, she added.”
Call me cynical, but judging by past “clarification” efforts by the government on wording to our tax code, federal laws and something called “Plan Descriptions” for present health insurance policies, I am doubtful of anything useful coming out of this venture.
By Charley Mallon, on February 15th, 2012 It’s an old joke:
What is the difference between jogging and running?
Answer: Running is my speed and faster, anyone else is just jogging.
I have been running/jogging on a fairly regular basis since I was 25, so that is 40 plus years now.
In thinking about it, the reason I run is split 50/50 between wanting to stay fit and the internal cleansing I feel after a half hour run through the neighborhood. I have often equated running to taking a shower on the inside.
I attempt to go out four times a week, anything more often and I start to feel run-down and lose interest. I try to augment the running with light weight work outs at the local YMCA, but I have never been able to maintain that for longer than a couple of months at a time. Running is so much easier, just change shoes and clothes and you are out the door.
I go out all year long, but avoid the streets when there is snow and ice as I have taken some falls. On those occasions I avail myself of the YMCA indoor track (16 laps to the mile), but that feels more like work than play.
When I used to do a lot of businss travel, I would take my gear with me and try to get a run in in the evening.
I prefer to run the many fairly smooth dirt trails we have here in Boulder. However, I avoid those steep, rock and root strewn tracks along the foothills. On those, I believe it is not a question of if you will fall, but when.
I think about various things when I run and lately I have done some calculating in my head. I believe I am approaching having accumulated enough distance running to have circumnavigated the earth, 25,000 miles.
So, as I grow older and my pace surely slows, I’ll still be running, while those slower will only be jogging.
By Charley Mallon, on February 8th, 2012 Changes to your health insurance coverage required by the Affordable Care Act have been phasing in for over two years now. Despite the complaints from a very vocal opposition, most of these provisions have proven to be very popular with the American public.
Key changes for individual health plans
2010
* Young adults can stay on their parent’s plan until they turn 26, or later if state law allows it.
* Lifetime dollar limits on key benefits like hospital stays no longer apply.
* For many plans, annual dollar limits on key benefits like hospital stays no longer apply.*
* Children younger than 19 can get coverage even if they had a disability or illness before signing up
for coverage. Some states have further defined the rules for children’s coverage.
* Certain preventive services like vaccines are covered 100% in network.*
* Health plans have new features the law called “patient protections.”*
* Members have more rights to appeal health plan decisions about health benefits and eligibility for
coverage.*
* A policy can be rescinded (canceled) only if the member intentionally misrepresents material facts
or is involved in fraud.
2011
* Members may be eligible for a rebate if their plan doesn’t spend at least 80% of premiums on
medical care and quality improvement during the year (some states have a different percent).
* Members get more access to information about rate changes that have been reviewed by the state
or federal government.
* Members who have a health savings account (HSA) can use HSA money for over-the-counter
medications only if they have a prescription.
* Members pay a higher tax rate if they use HSA money for unapproved items.
2012
* Benefit summaries will start to use a standard format that makes it easier to compare plans.
2014
* Regardless of health history, everyone will be eligible to apply for coverage. There may be required
“open enrollment” periods.
* There will be a requirement to have a minimum amount of health insurance coverage. Those who
don’t may have to pay a fine. There are some exceptions.
* People who don’t get health insurance at work will be able to shop for it through an exchange.
* All plans will cover certain key benefits. There won’t be an annual dollar limit on these benefits.
* New pricing rules take effect.
* Routine patient costs for clinical trials of life-threatening diseases will be covered.*
* This is not required for grandfathered individual health plans. In some cases companies have decided to apply a change in both grandfathered and non-grandfathered plans. According to the Department of Health and Human Services (HHS), this doesn’t cause a grandfathered plan to lose its grandfathered status.
By Charley Mallon, on February 1st, 2012 One of the little discussed provisions in the new Afordable Care Act (Obamacare) that is going to be very popular with the American public is the requirement called Minimum Loss Ratio (MLR). Starting January 1, 2011, health insurance companies must reimburse their clients for excessive premium dollars collected. Health insurance companies are now required to spend 80% (individual policies) or 85% (group policies) of monies collected on patient care, leaving them with only 15-20% for administrative expenses. Anything left over must be returned to clients by August of the following year.
It is my belief that when these checks start rolling in, the American public will feel a lot more positive about the whole Afordable Care Act.
By Charley Mallon, on January 25th, 2012  I am often asked how long it takes to get an application for health insurance approved. The answer is always the same, “it depends on how long the insurance company takes to review or “underwrite” the information you submit. Underwriting is a term insurance companies use that basically means “background check.” Individual health insurance companies have the ability to pick and choose to whom they will offer coverage. So, they require that you fill out an application form, answering a comprehensive list of personal medical and life style questions.
Once they receive this information from you, the underwriting begins. In addition to reviewing the information you have provided, they may plug your Social Security number into something called the Medical Information Bureau (MIB). The MIB is a sort of clearing house that collects patient information from doctors, hospitals, pharmaceutical companies and other insurance companies.
The underwriters may also call the applicant for clarification of details and, if need be, request records from your doctor before they are ready to make a decision on the application. The more information they need, the longer it takes for them to make an offer.
So, the answer to the question of how long it will take to get your application approved is, “usually a week to 10 days if doctors’ records are not required. If doctors’ records are required, it will take as long as it takes for the doctors’ office to respond to this request.”
That is why it is important to work with a knowledgeable insurance broker to fill out an application properly to avoid misunderstandings and delays from the onset.
If you’d like to find our what a professional individual health insurance broker can do for you, please give me a call at 303-541-9533.
By Charley Mallon, on January 18th, 2012 Have you been trying to shed some of those extra pounds gained over the holidays? I sure have, and the older I get, the harder it has been for me to do so. But it turns out that extra weight is not just a problem for us in our health and appearance, it can really hit us in the pocketbook as well. In a new article written by Emily King, Research Associate for the Colorado Health Institute, she outlines the cost to the citizens of Colorado of our growing obesity epidemic.
1.637 billion is a really big number. It’s twice as big as the number of Facebook users worldwide, and that many people would fill every major sports arena in Denver approximately 10,000 times. 1.637 billion dollars would buy you 7,000 new houses, 20 Royal Weddings, five iPads for every resident of Denver, or 14,035 metric tons of original Pinkberry yogurt.
1.637 billion is also the number of dollars Colorado spent on obesity in 2009, according to a new study published this month in the journal Obesity. A team of researchers analyzed medical costs in all 50 states, and then estimated the portion of those costs that were due to obesity, i.e., Americans with a body mass index greater than 30.
The researchers found that in 2009, Colorado spent $1.637 billion treating diseases and conditions related to obesity. In other words, if all obese Coloradans were of normal weight, we would see our annual medical expenditures drop by $1.637 billion.
By Charley Mallon, on January 11th, 2012
With all the bad publicity the health insurance industry receives, it is easy to conclude that their unbounded greed is driving average Americans to the  poor house with ever increasing premiums. But the truth is health insurance companies are are about as responsible for increased costs as is your neighborhood grocer when they raise the cost of a loaf of bread.
It is the ever increasing costs of medical care and a system that rewards your doctor for ordering expensive and often unnecessary, ineffective tests and procedures that most affect these increases. (Why does my 95 year old mother’s doctor insist that she get a Mammogram every year when she has never had a hint of a problem?)
Consider the following from recent industry publications:
*Medical technology is the key driver of health care spending, accounting for an estimated half to two-thirds of spending growth. As new tests and more costly equipment come out, we can expect to see an increase in their use, even though they’re not necessarily more effective than existing, less expensive services.
*Services that people don’t need, like tests that have already been done and treatments used despite lack of proof that they work. One-third of procedures performed in the U.S. appear to be unnecessary. Remember, your doctor gets a “cut” of every test he/she orders.
*Cost shifting by doctors and hospitals from their perceived underpayments from Medicare and Medicaid to the general public.
*Nearly two thirds of Americans fill a prescription every year.
*Preventable risk factors like obesity, smoking, lack of exercise and drug abuse can lead to chronic illnesses which account for 75% or U.S. health care spending.
*Health care fraud conservatively adds 3% to health care spending.
Only a shift to awarding doctors and hospitals for the effectiveness (both health and cost) of their treatments and not for the number of line items billed to an insurance company, will ultimately slow the run away costs of medical care in the United States.
By Charley Mallon, on January 4th, 2012 Your non-grandfathered health insurance is required to cover wellness benefits at 100%. However, many of these benefits are “age related.” Please find below some of the more commonly used wellness services and the ages, if appropriate, when they begin being covered.
Women
Well-woman visits 18-64
Pap testing 18
Mammograms 40
HPV Immunization 11-26
HPV DNA testing 30
Osteoporosis Screening 65 (60 if at high risk)
Prenatal visits and testing
STD’s Contraception counseling
Men
Prostate exam 50
STD’s
All Adults
Annual physical
Preventative colonoscopy 50 (every 10 years)
Influenza immunizations
Children
Well child visits 0-13 Immunizations 0-18
If you’d like to know more, please give me a call at 303-541-9533
By Charley Mallon, on December 28th, 2011 When a health insurance company receives your application for health insurance, their underwriters review it to see if it meets their guidelines for coverage.
If, due to pre-existing medical or lifestyle conditions, you do not meet their requirements, your application may be declined.
My first advice, if you are declined, is to request that your broker (or if you are not working with someone, give me a call at 303-541-9533) do an “anonymous pre-screen” of your situation with other insurance companies to see if they will accept you.
As insurance companies all have different underwriting criteria, I have had clients denied by one company receive a “preferred” rating with another.
If the pre-screens come back negative, then realistic alternatives are the Colorado High Risk plans CoverColorado or GettingUsCovered.
CoverColorado is designed for applicants who have had another health insurance plan within the past 90 days and GettingUsCovered is the appropriate plan for those who have been with coverage for a longer period.
Both plans require proof that you have been a Colorado resident for at least 6 months and will start a new policy on the first of a month, providing they have received a completed application by the 15th of the preceding month.
You will receive a letter from the company that first denied you that will enable you to apply for one of these plans. They will be more expensive, but will cover all pre-existing conditions.
By Charley Mallon, on December 21st, 2011  Do you believe in Karma?
I can remember years ago when things were not going well for us in the sanitary paper business, standing up in front of the sales people who reported to me and saying “at least we don’t sell insurance,” thinking that was the bottom of the barrel.
In 1999 I decided to retire from my corporate job, but I made two mistakes; I thought I didn’t want to work any longer and I believed I had enough money. WRONG!
The money is easy to understand, but it turns out I didn’t not want to work any more, I just did not want to do the type of big-company, travel-heavy sales work I had been doing for 26 years.
After two years of doing little but traveling and playing poor golf (I thought I’d get better with practice, but I never did), I needed to find a job. The first thing I did was phone all my old friends in the paper business to see if there were any opportunities there; thinking, that with my experience, I’d find the best opportunities in that business.
After speaking to a lot of contacts, it became apparent that there were few opportunities and, if I did get a chance to interview for a position, I had better do well. As I had not interviewed for a position in 18 years, I decided I needed practice. So, I picked up a copy of the Denver Post and checked out the classified ads for any company that was conducting interviews.
A health insurance company that was hiring agents caught my eye. I called to set up an interview time and met with the manager later that week. It was not a very good interview, but I was offered the job, and, having nothing else going on at the time, I accepted the position until something developed in the paper business.
Two things soon become apparent to me about this insurance business, I both liked it and I was good at it. I soon left this first organization when I found out they were not all that they had claimed to be, and started my own company, Colorado Affordable Health.
I’ve been doing this for more than 9 years now and, despite having once thought that selling insurance was a terrible thing to end up doing, I enjoy the work and the people. I hope to be able to continue with it into the foreseeable future.
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