Author Archives: Reeve Conover

Update on HealthRepublic Claims

When the Federal Government failed to make the promised payments under ObamaCare to the Coops around the country, more than half of those failed, not having adequate reserves this early in their development.

HealthRepublic is one of those Co-ops.  By last published account, they owe somewhere in the range of $200 million in claims to hospitals and other providers.  They are now out of business, have no funds, and no staff.  There is noone to speak to on this at HealthRepublic.

The New York State Department of Financial Services has jurisdiction (and, IMHO, responsibility and liability) over this failure.   The ONLY outlet I have is to tell you to file a complaint with that bureau at http://www.dfs.ny.gov/consumer/fileacomplaint.htm and I would urge you to do so.   Hopefully a huge onslaught of complaints will put increasing pressure on the Legislature, which is aware of the problem and seeking resolution.

The Greater New York Hospital Association has proposed to the legislature that the state establish a guaranty fund, which is financed by a temporary assessment on other insurers when a health plan becomes insolvent, that could retroactively pay bills and protect hospitals and patients. New York is the only state without such a fund, said association Senior Vice President Kathleen Shore.  Blue Cross apparently opposes this.

This unprecedented failure begs the question “Am I responsible for these bills?”  The short answer is yes, as the documents you sign with providers make it your responsibility to pay your claims, and not the insurance carriers.  It is unknown if this will stand up in a court of law, but with this many claims, it is the hope that the New York State Governor and legislature will move quickly to resolve these claims.

My calls to the New York State Dept of Financial Services have not bee returned.  I will update you as soon as I get any other information.

Why your broker won’t help you get coverage…

From insurance Business America, 2/11/16:

 

The bad news for health insurance agents continues.

Earlier this week, three of the largest insurance companies in the country announced they would not be paying broker commissions for consumers that sign up for plans after the open enrollment season deadline.

Anthem, Aetna and Cigna announced the ban on broker commissions independently, hoping the actions would dissuade people from signing up for their individual marketplace plans outside of the designated period.

Additionally, Cigna and Humana announced they will no longer pay commissions on the more expensive “gold” plans sold through the Affordable Care Act marketplaces in an effort to encourage enrollment in cheaper, higher-deductible plans at the “silver” or “bronze” level.

The actions come amid criticism from insurers on “special enrollment periods” that allow consumers to shop for insurance outside of the designated window each year. Health insurers have said that consumers are using the provisions granting a special enrollment period – such as job loss or a move – to sign up for insurance when they are sick and plan to use healthcare services.

Because they cannot bar consumers from signing up, however, they are pushing back by dissuading agents – who have been instrumental in enrolling customers to their plans – from taking the time to do so.

Agents have suffered heavy commission losses from the “Top 5” health insurer already this year, with UnitedHealth Group first scaling back and then altogether eliminating compensation for brokers.

Just weeks after UnitedHealth’s announcement, Manhattan-based startup Oscar sent a letter to agents saying it will no longer be paying brokers $14 per contract per month for individual subscribers or $26 for enrolled families as planned. Instead, all Oscar policies will generate only $6 per contract per month regardless of people in the plan.

These decisions have led agents to readjust their business models. Many have elected to no longer assist clients who select Oscar or UnitedHealth plans, while others are focusing more heavily on other markets.

Obamacare Pummels Blue Cross Blue Shield Of NC–What Can We Learn From This?

Forbes posted an article on January 30, 2016 with this title.  Very scary stuff-

According to this morning’s News and Observer, “The dramatic deterioration in Blue Cross’ ACA business is causing increasing alarm among agents and public health officials.”  In response to its bleak experience with the Obamacare exchange, the company has decided to eliminate sales commissions for agents, terminate advertising of Obamacare policies, and stop accepting applications on-line through a web link that provides insurance price quotes–all moves calculated to limited Obamacare enrollment.”

The losses incurred by Obamacare policies has caused the company to have an overall loss of $50.6 million dollars.  They have not lost money in more than a decade.  Considering that they are the largest carrier in North Carolina, and with United Healthcares’ announcement that they are likely leaving Obamacare as well, this does not bode well for individuals looking to get coverage next year.

Nor does it bode well for the United States’ ability to pay for this law, which has always been in question, and for the future of the law itself.

Read the full article here.

CIGNA banned from Medicare Sales

Cigna was temporarily banned from marketing its Medicare products to new customers, after the U.S. found deficiencies in how the health insurer ran its plans, citing widespread violations that the government said threatened patients’ health.  This means that existing customers can keep their policies but no new customers can be brought on board.

I appears this relates more to the Medicare Advantage plans than Prescription Plans.

It will remain to be seen if this impacts the pending merger with Anthem Health.

IRA Reminder

You have until April 18 to make your IRA contribution this year

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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA.
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