NAME: Kris J. Willy
TITLE: Health Insurance Guru
EMPLOYER: Owner of The Colorado
Health Solutions Agency
to Colorado Health Solutions
Since this is my
very first blog posting I would like to welcome you and say thanks for stopping
by. The intention of this bog is to inform you of ideas and changes that I will
run into and learn about every day. If I run across something that I feel you
will benefit from, I will definitely post it here.
This blog will contain Colorado Health Insurance information, ideas, facts,
changes in carriers plans and rates, client's stories and experiences, and just
about anything else I feel you should know.
Feel free to drop my a line at anytime with ideas or suggestions at Kris@ColoradoHealthSolutions.com
Once again I thank you and look forward to hearing from you!
Health Insurance Specialist
This is the time of
year most people will be getting their annual health insurance rate
increases. Some will be manageable, some will be un-manageable. I get
asked the question time and time again, "the health insurance company is
singling me out based on claims", or "why did I get a 30% rate
increase when I didn't even see the doctor once last year?". Listen,
no one wants to get a rate increase, but it's going to happen from year to
year. There is a formula behind how the insurance companies adjust your
rates, here is the breakdown and how it is done:
If you've ever read
your policy you may have seen this "We reserve the right to periodically
adjust the premium rates charged for coverage's under the policy." Ok
that seems pretty straight forward, but what do they really mean?
Premium rates are
calculated based upon numerous factors such as:
1) New business
rates - Insurance companies will adjust the rates based on the volume of new
business, as they say the more the merrier!
2) Provider network - Each health insurance company has it's own
network they either share or own. If doctors inside this network negotiate
different rates from year to year you will see a higher or lower adjustment.
3) Geographic location - Yes you may be charged more because you
live in the mountains. Each zip code has it's own adjusted rate with each
carrier. It basically comes down to how much medical treatment costs in
the area you live. This is why it is recommended you shop around to find
the best rate based on where you live.
4) Age - Everyone should know this one, you will pay more from
year to year based on your age.
5) Gender - Most people say, it's illegal for insurance companies
to single out based on sex. No it's not in health insurance, as a rule of
thumb female will generally cost more to insure up to a certain age.
6) Tobacco usage status - Pretty straight forward, if you smoke of
use tobacco products you will pay more. An average of 30-40% more than a
7) Medical trend - Are doctor's and hospitals charging more for a
given procedure this year than last? This is yet another factor that comes
into play when your rates are adjusted.
8) Durational rating factors - How long have you been on your
policy? Odds are the longer you're with a company the higher the rate
increase you will get. It simply comes down to the size of the block of
insured's you're with. I'll explain in the next paragraph.
9) Health status of the entire block of insured's in which you are
included - Ahh here is the biggie! When you sign up on a health insurance
plan you are lumped into a block of insured's. Let's call this block
you're in block X. The first year you have decent rates, then
bam! Your rates go up 30%, what happened? Odds are that you are
lumped into an un-healthy block of insured's. What happens when you get a
30% rate increase? You start shopping around, and so do the other people
in your block. So now all the "healthy" people end up leaving
the block you're in which leaves who in the current block X? The
un-healthy who can not switch now that they are "uninsurable".
So the un-healthy have to stay in the block due to pre-existing conditions,
therefore using their health plans more and more. The size of your block
has now shrunk to the point that the health insurance company is now paying out
more than they are getting in from premiums. What happens next year, an
even bigger rate increase! This is why it is important to at least price
out new policies from year to year.
10) And other factors as permitted under state law - No one really
knows what they mean by this, I guess you can contact the state insurance
commissioner to get the answer to this one.
We specialize in
finding you affordable health insurance based on your needs and
budget. There are new health insurance plans that come out from year to
year that WILL save you money. Is your current broker or agent showing you
these plans? If not shouldn't you have a broker that will? Let me
know if I can be of any service to you now or in the future. Our clients
are why we are in business!
Have a great day and stay healthy!
Colorado Health Insurance Specialist
Generic prescription drugs are becoming more common!
As most people
currently taking prescription drugs have found out, Wal-Mart and Sam's Club are
currently offering a pretty decent size list of generic drugs for only $4. (30
day supply) As I assumed we are now going to see more and more companies
joining in on the fun. Who is the next in line? How about Target!
tags drugs at $4
Corp. said it will sell certain generic prescription drugs for $4 at all of its
pharmacies, effective immediately. The rollout affects
slightly more than 300 drugs, formulations and dosages, including popular
medicines such as prednisone, tetracycline, amoxicillin and erythromycin. Target has at least
19 Denver-area stores with pharmacies. Target said it made
the move to avoid confusion among its customers.
Colorado Health Insurance Specialist
Underestimate Health Care Costs!
recently read an informative article the other day that really didn't surprise
me one bit. It had to do with people underestimating the cost of health
care in this country. Honestly, I talk to people everyday who are ignorant to
the cost of an overnight hospital stay as well as other medical
procedures. For example, I spoke with a female at Starbucks the other day
and she said that she is going to pay out of her own pocket the cost of a
physical exam, as opposed to getting a health plan that would cover it or at
least help pay for the testing. I then asked her, "How much do you
think a complete physical exam costs someone who isn't insured? She said,
oh probably about $75. I kind of chuckled and told her the procedure
normally costs anywhere from $300 to $500. She was very surprised, as are
so many other people when they realize the cost of health care today.
It doesn't have to be this way! It just goes to
show that most consumers are misled by the media, an agent, or what they hear
on the street when it comes to choosing a health plan. Most people are on
the wrong type of plan! They may have limits and caps on surgeries or
prescription drug coverage without even knowing it. The fact is most
people are only an illness away from financial disaster!
If there were a one size fits all plan out there it would be easy wouldn't
it? No one person or family is the same, therefore you must look at the
important things in a health plan. It will save you a headache and a lot
of money in the long run!
Sure You're In Network!
Please remember to run a network search before you see any doctor, go to
any lab facility or any hospital unless it's an emergency. If it's a
non-emergency and you see a non-network provider you may be responsible for the
charges between the network price and the total charge. If you're unsure
about how to run a network search or forgot which network you are in please
call me, I'm always here to assist you.
I also encourage you to call me before a scheduled surgical procedure so I can
make sure all providers and facilities are in network. I will also make
sure any and all pre-authorization requirements are met. Simply call or
e-mail me and I will do the rest for you!
Your Medical Bills!
After your doctor's appointment, your
doctor's office submits a bill to your insurance company. A claim lists the
services your doctor provided to you for that visit. The insurance company uses
the information in the claim to pay the doctor for those services.
When the insurance company pays your doctor, it usually sends you a report
called an EOB, or an Explanation of Benefits that shows you what it did. You
need to be able to read and understand the EOB to know what your insurance
company is paying for, what it's not paying for, and why. FYI, an EOB is not a
Your doctor's office might send you a statement. A statement shows how much
your doctor's office billed your insurance company for the services you
received. If you receive a statement before your insurance company pays your
doctor, you do not need to pay the amounts listed at that time. After your
insurance company pays your doctor, you may need to pay the doctor any balance
due if any. Here are some things to look for:
the dates of service and description of services on your EOB and billing
statement aren't the same, or if they don't match other records you may
have of the visit, contact your doctor's office first to verify.
you have questions about why your insurance company did not cover
something or about the amount you have to pay, contact me immediately and
I will look into it for you.
Finally, you should keep your EOB's and
statements organized so that you can access them easily should questions arise.
The bottom line is all insurance companies are going to pay benefits based
on the "coding" that comes from the insurance company. If a
doctor or hospital codes a procedure incorrectly, the insurance carrier may not
pay the claim based on your policy's benefits. If you ever assume or
think that a procedure or doctor's visit is not coded correctly, please call me
and we can verify. Doctor's and hospitals can easily re-code a procedure with
can make all the difference on whether a claim is paid or denied.
you really getting the most out of your current Life Insurance policy?
Term Rates have
dropped and are lower than ever right now! If you haven't looked at your
current policy and coverage amounts I highly recommend doing so! Over 90% of the time I can get you more coverage and
protection for the same price or for less than you are paying right now! I work with hundreds of companies and can help you
maximize your current policy!
Either call or send me an e-mail and I will see if
there is a better options available to you! It doesn't hurt to at least
the Uninsured More!
without insurance and those who pay out of pocket were charged more for
services, according to a study published in the May-June issue of the journal
2004, those who paid for their own medical care were charged 2.57 times as much
on average as those with health insurance. While that number has risen
steadily since 1984, the most significant increases have occurred since
found this article in the July issue of the Agents Journal. I run into
people every single day who are uninsured that tell me the same thing, "If
I get sick or hurt I'll just pay for it out of pocket." You can do
that, but you will not only be paying more, but you also take on the risk of
being financially ruined. I then proceed to ask them this, "If you
get hurt and wind up in the hospital for a week, how are you going to pay the
$50,000 bill?" I get a deer in the headlight look for a second, then
they respond, "I'll just file medical bankruptcy or pay $25 a
month." I continue to tell them hospitals will usually require 5-10%
of the total bill each month. Then ask them if they know that the
bankruptcy laws have recently changed, and it is now pretty much impossible to
write off your medical bills. If you have assets, house, car, property,
retirement, a business etc. they can and will take it from you! I've seen
it happen first hand, and it's not pretty.
I look at it this way, if I were to get sick or hurt and wind up in the
hospital I can manage and pay a $5,000 to $10,000 deductible or bill. But
if I were to take the huge risk and go uninsured, myself as well as most people
will find it difficult to recover from and pay a $50,000 bill. What if
the bill was $250,000? You don't think the hospital and doctors will come
after you for this? If you have assets they can and will make you
liquidate them to pay your bills, again I've seen it happen!
So the next time you talk with a friend or a family member who is uninsured,
ask them why? If they think they can't afford Colorado health insurance
they are wrong! They just can't afford the extremely benefit rich low
deductible plan. They CAN however afford a higher deductible catastrophic
plan which WILL protect everything they've worked so hard for in life.
you know someone who is uninsured or underinsured I'd love to help them
out. Please pass along my contact info so I can help them get protected.
Disturbingly Useful Health Tips!
I found this
interesting little article on msn.com the other day. And for the record,
no I haven't tried them yet, but I'm in a trusting mood. Enjoy!
1. If your
throat tickles, scratch your ear!
When you were 9,
playing your armpit was a cool trick. Now, as an adult, you can still
appreciate a good body-based feat, but you're more discriminating. Take that
tickle in your throat; it's not worth gagging over. Here's a better way to
scratch your itch: "When the nerves in the ear are stimulated, it creates
a reflex in the throat that can cause a muscle spasm," says Scott
Schaffer, M.D., president of an ear, nose and throat specialty center in
Gibbsboro, New Jersey. "This spasm relieves the tickle."
2. Clear your
Forget Sudafed. An
easier, quicker, and cheaper way to relieve sinus pressure is by alternately
thrusting your tongue against the roof of your mouth, then pressing between
your eyebrows with one finger. This causes the vomer bone, which runs through
the nasal passages to the mouth, to rock back and forth, says Lisa DeStefano,
D.O., an assistant professor at the Michigan State University college of
osteopathic medicine. The motion loosens congestion; after 20 seconds, you'll
feel your sinuses start to drain.
3. Thaw your
Too much Chipwich
too fast will freeze the brains of lesser men. As for you, press your tongue
flat against the roof of your mouth, covering as much as you can. "Since
the nerves in the roof of your mouth get extremely cold, your body thinks your
brain is freezing, too," says Abo. "In compensating, it overheats,
causing an ice-cream headache." The more pressure you apply to the roof of
your mouth, the faster your headache will subside.
4. Wake the dead!
If your hand falls
asleep while you're driving or sitting in an odd position, rock your head from
side to side. It'll painlessly banish your pins and needles in less than a
minute, says Dr. DeStefano. A tingly hand or arm is often the result of
compression in the bundle of nerves in your neck; loosening your neck muscles
releases the pressure. Compressed nerves lower in the body govern the feet, so
don't let your sleeping dogs lie. Stand up and walk around.
Medical Fact or Fiction?
I ran across an
interesting article the other day that I though you might get a kick out
of. I remember my grandmother telling us as kids, "don't go outside
with a wet head, you'll catch a cold". Was she correct on this?
This article was written and published by Dr. Isadore Rosenfeld on January
You don't catch cold because you're chilled or exposed to a draft.
Fact or fiction?
Fiction! We used to think
that colds are more common in winter simply because people spend more time
indoors, where they are exposed to each other's germs. Cold weather was not
believed to have anything to do with it. However, recent research suggests that
when you are chilled, the blood vessels in your nose constrict and deliver less
warm blood to its lining-which means fewer white blood cells to boost the
immune system and fight disease. If you happen to be harboring a cold virus but
don't as yet have any symptoms, this decreased supply of white blood cells
allows the virus to multiply and give you a full-blown cold.
Chocolate reduces the absorption of calcium in a person's diet.
Fact or Fiction?
Fact! Many foods that are high in oxalic acid-including spinach, rhubarb,
chard and chocolate-reduce calcium absorption in the small intestine because
they combine with the calcium to form an insoluble salt that the body cannot
grilled food can cause cancer. Fact or Fiction?
some extent! In
areas of the world where grilled meat is frequently eaten (such as Japan),
there is a high-er incidence of stomach cancer. That's because prolonged
barbecuing of meat at high temperatures forms cancer-causing compounds on the
charred areas of the food. Carcinogens also are present in the smoke released
by meat on the grill. So, it's a good idea to limit your consumption of
barbecued meats to days when you can't resist the temptation to cook outdoors.
When you do so, try not to char the food. Keep the heat low and the cooking
time relatively short (but long enough to kill any bacteria).
and drinking dairy products when you are congested makes the phlegm thicker and
more difficult to expectorate. Fact or Fiction?
studies have questioned the truth of this widely held belief. However, many
doctors (and patients) remain convinced that milk and other dairy products do
tend either to cause more phlegm or to make it thicker. This is presumably due
to the fat and casein (protein) in dairy foods. If you like milk and cheese,
try them when you are congested and see what happens. If they make the phlegm
worse, hold off until you're healthy again.