Chapter 1 — YOU GOTTA LAUGH: My Life in the Trenches of the Health Insurance Business = Think you have maternity coverage? Think again.

A new book by Stephanie Cohen, CEO
Golden & Cohen, www.golden-cohen.com

Welcome to the first entry of the book we’ll be publishing in 2010 entitled, "You gotta laugh: Life in the trenches of the health insurance business." The goal is to find a way to improve the U.S. healthcare system for everyone. We truly believe that by talking about this issue, and starting a conversation about what changes need to be made and how we can make them, we will be able to move mountains.

What do you do when you have it in writing from your insurance company that you have maternity coverage — but when you go to use the benefit, the customer service department tells you otherwise?

The situation:When our client Randy, a nurse, found out a few years ago that she was having her first baby she was thrilled. Immediately, she called the insurance company to confirm her pregnancy benefits — the fundamental first step prior to having any major test, ongoing therapies or any surgery.

To Randy, making the call was merely a formality, because when she originally purchased the policy years before she was single and didn’t opt for the maternity rider. However, after she got married, she added maternity coverage because she knew she’d someday want to start a family.

Indeed, when she made the call to the insurance company, they confirmed that she had the insurance she needed. However, after her first check-up at the OB/GYN, she received a letter saying she was, in fact, not covered.

Panic ensued, followed by a slightly hysterical call to our office. We quickly phoned the carrier, and unfortunately it took two weeks of repeated calls to them to get the information we needed. At last, we received an email from a reliable supervisor confirming that the rider had been added and she was covered.

Fast forward to three years later. Randy once again is pregnant, and following proper health insurance protocol, she called the insurance company to notify them of her condition. Here's the shocker: The agent on the line tells her she has no coverage. Surely this was a mistake, Randy thinks, so she hung up, composed herself, and called back.

This time another agent told her that she herself had dropped her maternity coverage the day her first child was born. Who would drop coverage on the day they are in delivery, she asked? Most people in the throes of 27 hours of labor are not calling their insurance company.

Frustrated and confused, Randy called us and we remembered she received an email from the insurance company months earlier stating that she had maternity coverage. We both had saved the letter, and we promptly took it to the head of the claims department.

Still, despite the fact that the letter clearly stated that she had maternity coverage, it took three people making nine calls for four weeks to get a definitive answer that Randy did, in fact, have coverage and that the policy would pay for her delivery. What we never did discover was why the coverage was dropped in the first place. Who authorized the change? And why did it take so long to resolve the matter?

You gotta laugh.

Here’s how you can take control

1. When you are thinking about getting pregnant, call your broker or insurance carrier to confirm that you are covered.
2. Make sure to get the name and telephone number of the person you spoke with, the department and supervisor’s name and telephone number, and the reference number for the call.
3. Always write down the date and time that you placed the call.
4. When buying a policy, if you are of childbearing age, be certain that you are covered for maternity.
5. Get a copy of your contract and review it carefully to be sure you are covered for all the potential situations that you may need the insurance for in the future.

If I were the health insurance ambassador

If I were in charge of health insurance policy, I would require every carrier to clearly outline and explain what is covered in the policy. When amendments are made, the policy needs to be updated and the customer needs to be notified. I would also post these changes on the insurance company’s website using easy-to-understand language.

Too often, this information is buried in the policy and is difficult — if not impossible — for consumers to understand. I’d also make sure that carriers were required to respond to issues like Randy’s within 48 hours, so as not to leave paying customers hanging. This is their health we’re talking about, and they are spending large sums of money and trusting that the insurance firms will fulfill their end of the bargain.

I often ask myself, why is this such a big problem. Is it corporate greed? Or are health insurance companies so big and bloated that no one knows what is going on? Either way, there obviously needs to be a change in the system.

The painful truth

The reality is that for now consumers are stuck having to fight for their rights and too often their calls are not returned in a timely manner. This serves to frustrate them more, and makes the insurance industry seem like an even greater villain. For now, there’s little that can be done to change the system. The best solution for the consumer is to know what you are buying, ask a lot of questions, and have a great broker that you can trust.

We encourage you to share your insurance nightmares with us, too. Send an email to our newsletter editor, hope@inkandescentpr.com.

Scott Golden weighs in on latest health care vote

THIS JUST IN: The Senate cleared a crucial procedural hurdle to bring its health-care bill to the brink of final passage by Christmas Eve.

The partisan vote of 60 to 40 shut down a Republican filibuster of the $871 billion package and followed days of tough negotiations with Democratic holdouts. "Read more here": http://www.washingtonpost.com/wp-dyn/content/article/2009/12/20/AR2009122002872.html?hpid=topnews.

*SCOTT GOLDEN SAYS:* The Senate bill will be approved by the end of week. That is not the most interesting event that will occur before we leave 2009, however.

When the House and Senate attempt to create a bill that both will accept, there will be fireworks.

Why? The Public Option. The House has one. The Senate does not.

Liberal groups are putting pressure on Democrats to vote NO if there is no Public Option. The public, in general, has become more skeptical about proposed changes. The process seems to be a race against time. The longer the process goes on, the more of a chance of the entire bill coming apart.

This is why there is such a sense of urgency. It is now or never.

Stay tuned for more in our "January newsletter":http://www.golden-cohen.com/newsletter.

A letter from Senator Barbara A. Mikulski

Dear Ms. Cohen:

Thank you for getting in touch with me about health care reform. It's great to hear from you.

Health care is one of the most important issues facing families and our economy. We need to pass comprehensive health reform that:

• reduces costs for families, business and government
•protects people's choice of doctors, hospitals and health plans
• assures affordable, quality health care for all Americans

As a member of the Health, Education, Labor and Pensions (HELP) Committee, I helped write the Affordable Health Choices Act, which was passed by our committee on July 15, 2009. This bill takes a giant step forward in providing health care that is available, undeniable and affordable for all Americans. It allows you to keep what you have if you like your current coverage. It prohibits insurance companies from denying coverage to those with preexisting conditions. It enables people to keep their health insurance if they lose their jobs.

Families and business are facing staggering health care costs. Premiums have doubled over the last 10 years. Without reform, these costs will continue to rise. The HELP bill reduces costs by:

• reducing administrative costs
• reducing medical and medication errors
• preventing hospital readmissions
• better managing chronic diseases
• reducing fraud and abuse in the health care system
• eliminating waste through promoting effective, evidence based medicine

I understand your concerns regarding the creation of public health care option. You should know that the HELP legislation is very clear: if you like the insurance you have today, you can keep it. The creation of the public option simply offers additional choice and competition to the current system. The public option is voluntary for patients and providers, it will be self-supporting, and will compete on a level playing field because it must abide by the same rules as private health insurance plans.

This is a historic moment. Forty years ago, the United States of America landed a man on the moon. I think that's a wonderful achievement. But if we can send people into space and be able to afford to do it, we can also help people get to a doctor and be able to afford to do it.

Thanks once again for writing. Please let me know if I can be of assistance in the future.

Sincerely,

Barbara A. Mikulski
United States Senator

My letter to Senator Barbara A. Mikulski

Dear Senator Mikulski,

As a health insurance broker who owns a firm employing 15 employees and insures more than 1500 groups in Maryland, the District of Columbia, and Virginia, it is very upsetting to me that the issues pertaining to te costs of care have not been properly addressed.

Has anyone mentioned the costs of prescriptions and reform within the pharmaceutical companies? What about the issue of tort reform, or the fact that many of the uninsured are illegal immigrants who do not pay into the system?

Until we look at the real cost of care, any reform that Congress initiates will do us no good. Arguably, the bills proposed and or passed will cost us more money than what's being spent thus far. In our experience, each year the average American has a physical, mammogram, Pap Smear, two sick visits, an X-ray, and a prescription such as Lipitor. How can a $200 per month benefit cover the cost of all of that?

Furthermore, why should some be able to walk in a hospital with no insurance and be provided with free healthcare when others pay for it? Wouldn't it be better to incentivize those on Medicaid to get off, and buy a useful, affordable health insurance policy healthcare after a certain tme period?

I firmly believe there are many ways to cut costs and keep premiums down. We believe it is a sad state of affairs that the real issues are not being addressed to heal or health insurance issues.

My partners and I would love to sit down with you to show you what the real problems are in healthcare as we sell, service and provide the products that the consumers are purchasing.

I will look forward to hearing from you.

Stephanie Cohen, CEO
Golden & Cohen www.golden-cohen.com

Q&A with Scott Golden was posted today on OurBlook.com

A website that offers innovative solutions to todays problems, "OurBlook":http://www.ourblook.com, today posted an "interview with Scott Golden":http://www.ourblook.com/Heathcare/Scott-Golden-on-Healthcare-Reform.html, chief financial officer of Golden & Cohen, a health benefits consulting company in the Washington, D.C. area.

Here's a sample:

*Question:* President Obama has made it clear he isn’t working to set up a precursor to a single-payer health care system. Meanwhile, the insurance industry says that any version of a public plan will kill private industry. Is there any precedent for a public/private partnership in health insurance?

*Scott Golden:* The way the proposal is being described, there are no partnerships, so the public plan would compete against private plans. There is nothing on point with this scenario to date, which is why there is great speculation as to what might happen.

Click here to read the entire interview.

Today's challenge: Is customer service a thing of the past?

By Stephanie Cohen, CEO, Golden & Cohen

 

As a regular new addition to our Golden & Cohen blog, I'm planning to write about the situations, crises, and challenges that I experience regularly, which, quite honestly, leave me scratching my head. One that happened just last week falls under the heading, "So this is what they call good customer service?"

 

A client's Health Reimbursement Arrangement (HRA) was up for renewal. (For those new to this health insurance product, and HRA is offered in conjunction with a high-deductible health plan, and can be funded by the employer for each participating employee. It pays for the deductible and other medical expenses typically covered under the medical plan. Unused funds can be carried over to the next year to cover future health care expenses, an incentive to employees to use their personal HRA wisely. If funds are exhausted, the employee is responsible for satisfying the remaining deductible before the plan begins to pay. If the employee changes jobs, the money stays with the employer.)

 

In this case, the deductible was $1000 per employee for the last year, but because of the lagging economy the company wanted to increase its per person deductible to $1500. 

 

You'd think this would be a simple adjustment, but in fact the insurance carrier who was administering the HRA countered saying that the company could make the change — but they wouldn't have access to the insurance companies administration as this product does not have access to the administrator. 

 

This was unacceptable, of course, because that meant that someone else would need to handle the administration of the hundreds of people covered under this plan. As the broker the likely candidate would have been our company. Certainly, that is an expense that we did not want to incur, but more importantly it didn't seem right that the insurance company would still be making incredible amounts of money and not want to be responsible for any costs associated with managing the customer's employees. 

 

Fortunately, I was able to get a waiver and for this year and got the insurance company to agree to continue administering the plan, at least, the insurance company will be covering the administrative fees associated with this account. 

 

But the situation leaves me asking this question: Is the concept of customer service, not even good service but service at all, going to be a thing of the past? 

 

Scott Golden featured in today's Baltimore Business Journal

In an article entitled, “Complexity, cost concern local insurers,” featured in this week’s Baltimore Business Journal, reporter Elizabeth Heubeck writes, “If Scott Golden were a gambling man, he wouldn’t bet on the U.S. government creating a federally-run universal health care system.

“I think Obama is using that as a threat so that the insurance carriers will step up and put in their own price controls,” said Golden, co-founder of the Gaithersburg-based health benefits consulting firm Golden & Cohen.

Given this scenario, Golden envisions insurance carriers saving money by “spending less, giving less to brokers, or requiring that subscribers pay more.” Ultimately, Golden believes, brokers like him will make less money.

Read the entire article here.

Health insurance expert Scott Golden featured in Physician’s Money Digest

From real estate to the job market, the current recession has impacted just about everyone and every segment of the economy,” writes reporter Ed Rabinowitz in a July 14 article published in Physician’s Money Digest. “However, according to an article in the New York Times, concierge medical practices, while certainly not recession proof, do not appear to have been impacted as severely as might have been expected. Consumers/patients are still forking over $1,500 per year and up for what is promised to be personalized care and around-the-clock access.”

Rabinowitz writes: According to Scott Golden, chief financial officer of the health benefits firm Golden & Cohen, for physicians with a loyal following, the opportunity exists through the concierge model to make equal or more money than before, see fewer patients, and practice medicine the way they want. And he expects that trend to continue. “One of the goals of the Obama Administration is to get the uninsured in the system,” Golden says. “That means more people and probably the same amount of doctors, so you’re going to see the same [access] problem getting worse. But only the practices that can deliver on their promises will be able to survive.”

Read the entire article here.

Golden & Cohen make prestigious Washington Business Journal BOOK OF LISTS

Washington Business Journal, June 2009 — We are very excited to announce that this year, once again we have made the list of the Top 10 largest health insurance firms in the Washington Business Journal Book of Lists.

“We are incredibly proud of our accomplishments, as we have built our business brick by brick,” says Stephanie Cohen, CEO of Golden & Cohen. “We want to thank all our loyal clients, many of whom have been with us since our inception. We will continue to work hard everyday to make sure each and every client is receiving world-class service and the best possible insurance strategy for their needs and budget.”

In fact, making Washington Business Journal’s prestigious list just spurs us on to rank even higher, adds Jack Cohen, COO. “Making this list, or any list, merely reflects the real driver of our growth and success: whether our clients are satisfied and are referring us to their clients and friends.”

Click here to read more.

Top-rated insurance providers Golden & Cohen launch new website

GAITHERSBURG MD, May 5, 2009 — Golden & Cohen, top-rated specialists on group and individual insurance benefits and retirement planning, launched a new website today to provide their current and potential clients with more detailed information on the best insurance options: www.golden-cohen.com.

“The new website outlines all of the products we offer—from group and individual dental, disability, and life insurance, to group vision insurance and individual pension plans,” explains Stephanie Cohen, co-founder and the company’s chief operating officer. “Beyond that, we offer benefits management services such as benchmarking, cafeteria plans, COBRA, and wellness programs. We also provide our clients with access to human resources management, including employee benefits plans and performance reviews.”

Click here to see the new site!

Who’s Hiring in the Health Industry? Scott Golden tells Health News Digest

HEALTH NEWS DIGEST, April 2009 — “The economic downturn is taking its toll on employees in all industries — but health insurance companies will increasingly be a good place to look for work,” writes Scott Golden, chief financial officer of the Maryland-based health benefits brokerage firm Golden & Cohen, in this week’s issue of HealthNewsDigest.com.

Golden says: The economic downturn is taking its toll on employees in all industries — but health insurance companies will increasingly be a good place to look for work.

Although it’s unclear what direction the Obama administration will take in terms of providing more Americans with access to health insurance, what is certain is that the health insurance industry will see many changes and opportunities in the coming years. That’s good news for smart, savvy business people who are ready to step in. Following are scenarios that forceast how the industry might change — and opportunities that are likely to result.

Click here to read more.

Stephanie Cohen gives insight into "An Insurance Agent’s Guide to Working a Room"

AGENT’S SALES JOURNAL, April 2009 — “Stephanie Cohen has no problem networking — in fact, she’s a real pro,” writes reporter Lin Grensing-Pophal in an article in this month’s Agent Sales Journal. “As CEO of the health benefits firm Golden & Cohen, Cohen takes networking to an entirely new level. In October, she hosted the DC Health Summit, a meeting of 100 top health care insurance providers, doctors, hospitals, business owners, and politicians. Her goal: to establish a consortium of leaders that will begin a national dialogue about the connection between wellness programs and lower health care insurance rates.” Click here to read more.

Stephanie Cohen offers advice: "How the Obama Administration May Affect Your Business"

AGENT’S SALES JOURNAL, January 2009 — A new White House administration always spells change of some sort — and nowhere will that change be felt more this time around than in the financial sector, explains reporter Laura Gater in the cover story of this month’s Sales Agent Journal. “Specifically, President-elect Barack Obama has made certain proposals to reform estate taxes, health insurance, and the Medicare and Medicaid systems, along with alluding to changes within the long term care industry. But how will you see your business change as a result over the next four years? Click here to read more.