Health Insurance

Negotiate prices for medical care?

2011-06-28T11:43:00.000-07:00

Negotiate prices for medical care? Here's an excellent article with some strong tips about negotiating medical care.

What is Out-of-Pocket Maximum?

2011-01-07T10:10:00.001-08:00

Out-of-pocket maximum is the combination of deductible plus coinsurance. If a plan had a $2000 deductible and coinsurance maximum of $2000, the out-of-pocket maximum would be $4000. Most carriers do not add these two together, instead they describe the deductible and coinsurance as separate totals.

What is a deductible?

2011-01-07T10:08:00.001-08:00

Deductible is the amount of covered expenses that the insured must pay before a plan or insurance contract starts to pay. With most health insurance carriers the Office Visit copay does not reduce the deductible.

What is coinsurance?

2011-01-07T10:04:00.000-08:00

Coinsurance is the limit on the amount an individual is required to pay for health care services covered by his or her benefits plan after the deductibles and any copays are paid. Refers to care received from the network of participating physicians, hospitals and health care professionals. It is often described as a percentage 90/10, 80/20, 70/30, followed by a dollar number. In the case of 80/20 it may say coinsurance maximum or out-of-pocket maximum $2000. This means that you pay 20% of medical costs until you've paid $2000 (20% of $10,000 is $2000).

Half of all Americans are Diabetics?

2010-11-29T19:15:00.000-08:00

Diabetes is a serious disease. And one article projects that half of all Americans could be diabetics by 2020! Increased medical costs - a diabetic spends roughly 3 times what a similar healthy person does on medical expenses. More than half of diagnosed diabetics today are on Medicare or Medicaid. The culprit - obesity. The solution weight management and exercise. The reality, an already burdened Medicare system will swamped.

Medicare and available doctors

2010-11-29T19:01:00.000-08:00

Here's the problem. To control Medicare costs, the government reduces the reimbursement to physicians. How many small businesses would continue to sell a product that wasn't profitable? Few if any. What a choice. Suppose you could deliver the same service to two different people, one pays $100 and the other pays $23. It's a no brainer. Check out one physicians frustration.

Pharmaceuticals

2010-11-19T09:37:00.000-08:00

An announcement this week of long available prescription drug that has been pulled off the market - Darvon/Darvocet got me thinking about the cost of prescription drugs. A little research and I found that 90% of elderly Americans and 58% of adults rely on prescription drugs for some sort of malady. I don't know about you but that's astonishing to me from a health perspective and even more astonishing from a cost perspective. I can tell you that the number one factor in health insurance costs are the costs of prescription drugs. Most companies offering individual health insurance will increase rates on an applicant for any prescription drug currently being taken on a regular basis. Taking three or more prescription drugs and it may be difficult to obtain coverage. I had a client that was a Cancer survivor for over 5 years. When applying for health insurance coverage the insurance carriers ignored the Cancer when considering premium increase yet almost doubled the premium for the combination of high blood pressure (HBP), high cholesterol and anti-depressant meds.

Travel abroad for reduced cost medical treatment

2010-11-18T10:09:00.001-08:00

An interesting concept, travel abroad for medical treatment. The passage of the Patient Protection and Affordable Care Act addresses access, but most health care economists agree that medical expenses will continue to rise. Medical travel, which has received increased interest from U.S. residents and employers, is now a highly attractive and viable option for businesses and their employees that may help consumers deal with the increased load that they must bear. Satori World Medical is one of several companies offering turnkey travel and medical treatment for a variety of conditions. Procedures like Gastric Bypass, coronary artery bypass, some back/disc/spine procedures and others may be 40-80% less overseas. Not for everyone, but interesting nonetheless.

Health Insurance costs rising again

2010-11-17T17:19:00.000-08:00

Employees to see higher deductibles and will take on more of the cost of employer sponsored health care. One to two percent is attributable to reform mandates from PPACA.

Can Health Care reform be repealed?

2010-11-17T17:08:00.000-08:00

According to this article no. The president is unlikely to sign legislation that would overturn the Patient Protection and Affordable Care Act. And much of the legislation won't be in effect until 2014. The biggest challenge is that the PPACA was a framework, the rest of the structure will be implemented by bureaucrats in the various agencies. One of the big discussion points is the mandate that insurance carriers return 80 - 85% of revenue collected from premiums to policy holders for claims and benefits. The discussion now is what goes into this 85%. Customer service? Agent commissions? Advertising? Stay tuned.

Medicare

2010-11-15T09:38:00.000-08:00

People with Medicare have choices and they can make plan changes for 2011. The change period, called AEP (Annual Election Period) runs from November 15 - December 31, 2010. People that are turning 65 can elect their Medicare choice anytime in the 3 months prior to, 3 months after or the month they turn 65. The best site for information is the Medicare.gov website.

Fake Health Insurance?

2010-07-08T06:57:00.000-07:00

It seems hard to believe that there is such a thing as fake health insurance yet apparently there is. It seems those likely to succumb to this fraud are people with pre-existing health conditions, people looking for low-cost health insurance, those without jobs or those without employer coverage. I've been in this business for years and there is no such thing as cheap health insurance. And, in general, if you haven't heard of the company or are unable look at company financial details on a business site, well, I wouldn't try to get health insurance from them.

Bad past health habits?

2010-06-29T12:17:00.000-07:00

Much of the talk about health care reform centers around preventive visits to detect significant health problems earlier. Most health insurance policies have some preventive care coverage. I'm not a doctor, but I have learned that I can get my lab tests done inexpensively at the lab my insurance uses and these tests are substantially discounted. Most lab results come with comments on how the results compare with "norms". For example my cholesterol was 224. Well within normal requirements, and the breakdown of HDL to LDL was also revealed. However my triglycerides were at 200 vs 150 for "normal". A quick check on the Internet revealed that 200 was quite OK for my age, but to lower triglycerides, I should exercise more, adjust diet to reduce fat and cholesterol and lose a few pounds. Total cost - less than $35. So what about youthful discretion's? What impact would these have - read on.

Some insurance may not be needed !

2010-06-29T10:41:00.000-07:00

By definition, insurance is the exchange of money with an insurance company for the insurance company accepting financial risk. The litmus test is whether or not the cost of the insurance is worth the exchange of risk. Buying health insurance to avoid the cost of an office visit, probably doesn't pass this test. Buying health insurance to avoid the medical costs associated with a critical illness, such as cancer is definately worth the cost. What about other insurance? Perhaps there are savings by reviewing other insurance coverages. Check this article out - 10 Insurance policies not worth the money.

Too much medical care?

2010-06-28T11:06:00.000-07:00

An interesting article about too much medical care, especially in the end stages of life. Life is highly regarded by most Americans. How much medical care is too much? In times of low stress is the time to set boundaries on care for in times of high stress, decisions are difficult. Will that last batch of chemotherapy work? What if it makes things worse? An interesting read.

Transparency in health care

2010-06-02T12:38:00.001-07:00

Do you know much a lab test costs for cholesterol levels? Any idea how much a knee replacement would cost? Or even an office visit with your regular doctor? Transparency in health care is the movement to make the actual cost of the medical process transparent to the user. Ideally one could shop area hospitals by cost and reputation and success rates for knee replacements or other medical procedures. Same goes for doctors. Want an idea what a sports physical would cost or other service provided by your doctor? Transparency would require medical professionals to post a list of services and costs for those services. Sounds reasonable doesn't it? You wouldn't purchase a house without knowing the mortgage payment would you? More on transparency in health care.

How much are health insurers spending on you?

2010-05-25T06:35:00.001-07:00

Part of Health Care reform is an attempt to regulate how much health insurers spend on their policy holders. This is called a loss ratio and the reform legislation calls for an insurer to spend $0.80 per $1.00 in premium to pay claims and provide services. The other 20% would be for salaries, agent commissions, overhead, buildings and other administrative and non-claim expenses. For large companies, those with more than 100 employees, the ratio increases to $0.85/$1.00 in premium. Read here for more details http://money.cnn.com/2010/05/25/news/companies/medical_loss_ratio/index.htm?source=cnn_bin&hpt=Sbin Does this make sense to you? One study shows that only 7% of cost increases are contributed by administration costs (including insurance premiums). The leading contributors - Hospitals and Physicians http://www.kaiseredu.org/topics_im.asp?imID=1&parentID=61&id=358.

2010-05-21T12:29:00.000-07:00

Here's a great example of discounts for medical services when one has health insurance. http://www.aetna.com/provider/data/ProviderNetwork.pdf . Sure it's an Aetna example, but it translates to other carriers as well. Basically when a provider agrees to join an insurance network, they also agree to the fee schedule. So a $150 list price office visit, gets discounted to $90. And a five-day hospital stay gets reduced from $25,000 to $8750. However, if your deductible is say $3000, you are only out of pocket $3000 on a 100% coinsurance plan.

A Healthy Statistic

2010-05-17T09:19:00.000-07:00

So it's said that people, especially men, that are married are healthier, how about an update on that oft quoted "50% of marriages end in divorce statistic"? Check this out ...
http://www.time.com/time/magazine/article/0,9171,1989124,00.html?hpt=T2

Georgia joins lawsuit against Health Care Reform

2010-05-14T15:25:00.000-07:00

Georgia joined 19 other states that are protesting the changes that Health Care reform requires of states. http://www.ajc.com/health/georgia-joins-states-suit-527563.html . Time will tell what this means. For the short term it looks like the Federal Government will be the source for the high risk pools mandated to be available in July 2010 by the Health Care reform legislation.

Large Companies consider dropping health benefits

2010-05-12T13:16:00.001-07:00

Wow! Large companies dropping health benefits for employees? Looks like several considered it and in this article http://rawstory.com/rs/2010/0506/att-verizon-considered-dropping-health-insurance-employees/ it makes financial sense, but there are lots of other considerations, like employee moral, unions etc. We may see more of this.

Health Insurance Premiums UP

2010-05-12T12:36:00.001-07:00

This confirms what I've been seeing with premiums starting in July 2010. Premiums are increasing. http://money.cnn.com/2010/04/23/news/economy/health_reform_insurers_react/index.htm
If you had a new plan, premiums should have been guaranteed for the first 12 months. Thereafter, carriers generally reassess rates on the anniversary date of the policy and generally hold premiums constant for the next 12 months. Some carriers increase rates on the policy anniversary, on birth dates and when changes are made to the plan. Carriers do have the option of raising premiums on a class of people, they can't single out a specific person or family for a rate increase. Often what a carrier will do is introduce a "new" plan and increase premiums across the board on the old plans.