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.
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 out what a professional individual health insurance broker can do for you, please give me a call at 303-541-9533.
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
Did you know that 90% of all hypothyroid cases are autoimmune? Autoimmune thyroid, commonly know as Hashimoto’s disease is the most common autoimmune disease in the United States (estimated at 35 million). The body interprets itself as a threat and makes antibodies against the thyroid tissue, which over time leads to tissue destruction and symptoms. Did you know that thyroid medications do not address the autoimmune component of this condition? Thyroid supplementation is very important with an elevated TSH (thyroid stimulating hormone) but the traditional model of medicine ignores the underlying autoimmune aspect of Hashimoto’s hypothyroidism. Although patients are often told to “diet & exercise” or take another medication(s), these are ineffective and allow the hypothyroid condition to progress. So what causes Hashimoto’s Disease and what can be done to feel better?
Hashimoto’s Disease along with all other autoimmune conditions develops when three criteria are present in the body: Leaky Gut (permeability), Genetic Susceptibility, and a Trigger. There are several known triggers that exacerbate autoimmune conditions and hypothyroidism including: gluten intolerance, vitamin D polymorphism (the body’s inability to use natural vitamin D), iodine excess, heavy metal toxicity, estrogen surges, pregnancy (especially postpartum changes), gastrointestinal infections, and insulin surges. Perhaps the most common and most critical is gluten intolerance (not just celiac disease!), to which 80% of Americans have a genetic predisposition. The majority of these conditions are addressed at Red Tail Wellness Center and rather than symptom suppression, we focus on removing the root cause and allowing your body to heal itself.
People who suffer from this debilitating condition are some of the most rewarding clients to work with as great changes can be made very simply. Since autoimmunity is complex, a detailed history is always taken at the first visit. It is during this visit that many insights regarding your particular case surface and a more specific treatment plan can be determined. We have found that determining and addressing immune dominance is integral in the treatment of Hashimoto’s Disease. (As described in: Why do I Still Have Thyroid Symptoms? by Datis Kharrazian – #1 seller on Amazon). Put simply, is one side of your immune system driving the antibody reaction, thus destroying the thyroid over time? It is nearly impossible to manage an autoimmune condition without addressing and regulating the immune system! With new technologies, testing and natural therapies people have begun to take back their health and finally reach the vitality they’ve missed for decades! For more information please contact the Red Tail Wellness Center at 303-882-8447 or for more information on thyroid please visit my website.
I don’t believe so, but that is what I read in a recent comment section of an on-line article about health insurance.
Health insurance premiums have been going up at a much faster rate than inflation in general and many people attribute that to exorbitant heath insurance profits. But the truth of the matter is that 87% of every premium dollar goes to covering medical care and services.
What is driving up the cost of health care?
According to the Center for Medicare and Medicaid Services, Kaiser Family Foundation, BusinessWeek, Pricewaterhousecoopers and many other sources:
+ More expensive technology, used more often.
Are all those tests that add to your doctor’s income really necessary?
+ Doctors in the U.S. earn two to three times as much as other industrialized countries.
+ Medical price inflation
Expensive new tests, Rx and procedures drive 51% of the growth in health care spending.
+ Cost shifting
Underpayments of Medicare and Medicaid are picked up by private insurance companies.
+ High cost of complying with government regulations.
Private health insurance companies spend $339.2 billion in order to comply with government health regulations.
+ Poor patient lifestyles
Obesity
Tobacco use
Sedentary lifestyle
Poor nutrition
+ Healthcare fraud and abuse
Conservatively estimated at 3% of total annual healthcare spending.
Someone is getting rich on your premium, but with health insurance companies averaging 3 cents profit for dollar they received, they may not be the villains may people think they are.
Next time you drive by one of those new marble palaces that passes for a hospital today, ask yourself “who’s paying for this?”
Dr. Don SchmidtCanyon Chiropractic Center - Boulder, Colorado
Thank you for saving us money on our health insurance! We really appreciated your willingness to 'hand hold' us through the process. It can be a daunting task to choose from all the available insurance plans out there. You made it almost easy!
Don MartingMartin Auctioneering - Longmont, Colorado
I can't thank you enough for helping me and saving me a significant amount of money. I truly believe that you had my best interest at heart.
