Georgia Obamacare Combatants

Ned, did you get an answer from your E&O carrier on coverage if you sell an STM and the claim is denied (p-x) and/or policy cancelled?
 
I am covered as long as everything was disclosed to insured. I am having clients sign a disclosure form. One problem I am seeing is some clients want to do these plans even if they have a minor pre ex. For example, friend had kidney stones 4 years ago, knows no claim would be paid, but can't afford an 1800 per month premium.
 
I am covered as long as everything was disclosed to insured. I am having clients sign a disclosure form. One problem I am seeing is some clients want to do these plans even if they have a minor pre ex. For example, friend had kidney stones 4 years ago, knows no claim would be paid, but can't afford an 1800 per month premium.

Is there a "Medicaid Plus" plan for your area? That's what I'm putting those people on...
 
What are the advantages of putting someone on Medicaid Plus? Tough finding docs that take Medicaid in this area.
 
What are the advantages of putting someone on Medicaid Plus? Tough finding docs that take Medicaid in this area.

I agree, but here's my reasoning:

If I get Medicaid Plus at $500 or BCBS HMO at $1500, then I pay cash for the doc visits. RX is covered under my local Medicaid Plus provider. Still under the $1K savings.

That assumes you are healthy.

If you are sick, its BCBS.
 
I agree, but here's my reasoning:

If I get Medicaid Plus at $500 or BCBS HMO at $1500, then I pay cash for the doc visits. RX is covered under my local Medicaid Plus provider. Still under the $1K savings.

That assumes you are healthy.

If you are sick, its BCBS.[/QUOTE

Why do you see this as a better option than stm? Assuming no pre ex. My wholesaler is one of the largest brokers of STM and all denied claims they have seen, which is few, were non disclosure by the insured.
 
I worry a little bit about STM claim denial, but that's not my reasoning. (And I agree with your FMO)

Assume 300 to 600% of FPL.

The STM premium has to be added with the penalty, doc visits and RX to determine true cost.

The Medicaid Plus plans are MEC. So true cost is premium plus office visits.

Preventative is not covered either way.

The numbers lean towards Medicaid Plus.
 
Please explain what are Medicaid Plus plans ? WTF

For DFW, its Molina and Ambetter.

The carriers that were traditionally Medicaid providers prior to 2014. They are now on the Exchange, with the smallest networks and cheapest rates.

The issue (for me at least) is that I can write Molina for $1000 on a family of 4 or BCBSTX for $2000.

As always, I really don't care what they pick. I give the options (which includes STM and penalty), they make a decision. As long as mamas name is on the app. ;)
 
Many (most?) of the non-disclosed p-x conditions were oversight or failure to understand the definition of p-x. Assurant was notorious for denying due to p-x and resulted in a fair amount of litigation.



Gaskill, a 63-year-old retiree, says she began buying policies from Assurant Health in 2005. After a six-month policy expired, she signed up for a new one with Assurant.

Her new policy went into effect on Jan. 24, 2006, according to an Oct. 10 letter from Assurant Health to the Connecticut Insurance Department. Gaskill says she bought the six-month policies instead of more traditional insurance because they were what she could afford.

In March, she went to the doctor for a small lump under her ear. It had been there awhile, but it did not hurt or bother her so she did not make an appointment until it seemed a bit larger than before.

The doctor asked how long she had the lump.

"I said 'maybe a year,' " says Gaskill, who has since moved to St. Petersburg, Fla. "I never thought that would be held against me."

The lump turned out to be cancer. After checking her medical records, Assurant revoked her policy, leaving her with $30,000 in surgical bills.

In its letter to the insurance department, Assurant said it canceled the policy because "an ordinarily prudent person would seek diagnosis or treatment when a lump initially presents itself." Therefore, the lump was considered "pre-existing" and not covered under Gaskill's current six-month policy.

"I believe I'm a prudent person, but I didn't think I needed to see a doctor over this little thing," says Gaskill, who now has coverage through a state high-risk insurance pool.


USATODAY.com
 

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