Miami (Not) Nice

[Welcome Industry Radar readers!]

Finding health insurance in Georgia is usually not that difficult, if you know the rules. Most people, including the bulk of agents, do not. I have a reputation for taking on challenging cases and almost always finding a good offer. That's because I know the rules of engagement.

John Dorschner of the Miami Herald isn't playing nice. His ignorance of risk management coupled with publishing (on the web) a carrier guide that is clearly marked "Confidential & proprietary" makes one question his ethics. His article subitled "How health insurers secretly blacklist those with certain ailments" while based in truth shows his ignorance.

Trying to buy health insurance on your own and have gallstones? You'll automatically be denied coverage. Rheumatoid arthritis? Automatic denial. Severe acne? Probably denied. Do you take metformin, a popular drug for diabetes? Denied. Use the anti-clotting drug Plavix or Seroquel, prescribed for anti-psychotic or sleep problems? Forget about it.

This confidential information on some insurers' practices is available on the Web -- if you know where to look.

So for the price of a newspaper, Johnny boy is going to spill the beans.

Any idea how much gallbladder surgery runs? About $4800 according to Out of Pocket.

How about a popular RA drug such as Enbrel? Try $1500 for a 30 day supply. Plavix ($565) or Seroquel ($126) are a bit more reasonable but these meds are just a small portion of the cost of treating such illnesses.

Johnny Reporter apparently doesn't own a calculator or know how to use it.

What's more, you can discover that if you lie to an insurer about your medical history and drug use, you will be rejected because data-mining companies sell information to insurers about your health, including detailed usage of prescription drugs.

Is Johnny suggesting you should perjure yourself in order to secure coverage? Isn't this like the liar loans that led to the mortgage crisis?

Where is this guys moral compass?

``Basically, they're taking only the healthy so they can get the fattest profits. If you really need insurance, then you can't get it.''

Kind of like, if you really need a loan, you can't get it. Unless of course you applied for a mortgage in the last 10 years or so. We know how that one ends.

Sorry, but refusing coverage to someone who is knowingly going to "bust the bank" is not about profits. Approximately half a dozen states have mandated guaranteed acceptance health insurance and guess what? Carriers are allowed by the Dep't of Insurance to charge roughly 3x the premium for similar coverage in non-guaranteed acceptance states and still make a profit.

The reason some carriers will deny coverage is because the risk of accepting that individual is so high that an adequate rate would exceed the amount allowed by the state Dep't of Insurance.

In other words, the GOVERNMENT, not the carrier, is limiting the rate and controlling access to the market. If the GOVERNMENT did not restrict the carriers from charging an adequate premium anyone could find coverage for any pre-existing condition, treatment plan or medication.

Sandra Foertsch, who sells individual policies, says the fundamental concern of insurers is clear: ''They don't want to buy a claim,'' meaning that they would start to collect $500 monthly premiums from a person and quickly pay out more than that to doctors and other providers.

Sandra Foertsch is an example of an agent without a clue. She is someone who needs to find a job asking folks if their order is for here or to go.

Searching the Web, The Miami Herald found underwriting guidelines for Coventry Health Care, which owns Vista; Wellpoint; Assurant Health; and Blue Cross Blue Shield of Nebraska.

Among the health problems that the guides say should be rejected: diabetes, hepatitis C, multiple sclerosis, schizophrenia, quadriplegia, Parkinson's disease and AIDS/HIV.

Again, Johnny Reporter shows his ignorance about risk management and his apparent disdain for legal disclaimers that the information is proprietary.

Beyond that, let's face it. Carriers are not the federal government who can write checks without having money in the bank and do so to the tune of trillions of dollars.

I wonder if the Miami Herald has access to unlimited funds and is able to pay for reporters without regard to their ability to understand basic economics or legal disclaimers? Perhaps Johnny Reporter is a graduate of the College of Community Organizing and firmly believes anything can be solved by simply throwing more money at it.

Johnny Reproter is showing his ignorance in a starring role in Miami Not Nice. It's pretty difficult to take this guy seriously, but apparently some do.

Folks looking for health insurance don't have to deal with people like Sandra Foertsch or take advice from Johnny Reporter. Clients of Georgia Insurance Shop with apnea, type II diabetes, gallstones and other ailments can often find the coverage they need.