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May 05, 2006

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Comments

eRobin

Will you still be posting at Ezra's? How long will this blog stay up?

Martin

We'll miss you. Have fun in DC!

Mara

I've been a faithful reader for a long time. I'm sorry you won't be writing anymore.
Best wishes,
Mara

Steve Mudge

Hey Kate, good luck in DC! Glad you're heading back into the world, but congratulations and thanks for writing about your experiences and informing us along the way. You and Ezra have certainly convinced me of the need for universal healthcare in the US.

Nate Ogden

cost of care itself is comprised of different factors, mainly what the provider charges for a servie and the amount of those services consumed by the insured. Provider reimbursement has not skyrocketed meaning it's consumption. Only the consumer can control that.

Kiersten Marek

Kate, Your contribution to the blogosphere will be sorely missed.

opit

Darn it, Kate, would more encouragement have helped? You had a niche (that's right,like Asimov's pun "A Niche in Time Saves Stein") blog here.
Just so there's some good to be said about political activity pro singlepayer, try
http://www.ctv.ca/servlet/AticleNews?story/
CTVNews/20060529/doctors_healthcareappeal_060

StealthBadger

We still miss you!!

C. Steven Tucker

I have been a health insurance broker for over a decade and every day I read more and more “horror” stories that are posted on the internet regarding insurance companies not paying claims, refusing to cover specific illnesses and physician's not getting reimbursed. Unfortunately, the reality is that insurance companies are driven by profits, not people. If the insurance company can find a legal reason not to pay for something, chances are they will find it, and you, the CONSUMER will suffer. However, what many people fail to realize is that there are very few “loopholes” in insurance policies. The majority of the time, when health insurance is purchased, the prospective insured doesn’t even know what kind of coverage the policy is providing, so there is really no need for the insurance company to try to use a “loophole” to get out of paying for something. Any insurance agent will tell you, often after your policy has been issued, that the terms of coverage are right in your policy, along with a copy of the application that you signed agreeing to those terms. Since most people throw their insurance policy in a drawer or filing cabinet as soon as they get it, the insurance company is counting on you not reading your policy. Therefore, no “loopholes” are needed for a legally binding contract that you had 10 days to cancel (10 day free look) if you weren’t happy with the terms of coverage.

So do most policy holders really know what is in their 47-82 page insurance policy? Yes, lots of confusing insurance jargon. Sure, the average policy holder could probably tell you how much their monthly premiums are, but will they be able to tell you what the insurance policy they purchased doesn’t cover? Usually the policy holder doesn’t even realize what their policy doesn’t cover, until they file a claim and receive a denial letter from the insurance company.

Unlike car buying, where the buyer knows that the engine and transmission are standard and that power windows and cruise control are optional, health insurance is a maze of confusion. Unfortunately, many health plans are purposefully designed where only a few things (benefits) are standard and, important things, like “maternity” and “organ transplant” coverage are optional. Usually a policy holder doesn’t find out that their policy doesn’t cover something “important” until receive a huge bill from the hospital stating that “benefits were denied.”

Yes, we can all complain about insurance companies, but we all know that they serve a necessary evil. Very few of us could afford to pay for open heart surgery, if we needed it, without insurance. This being the case, how can you, the consumer, protect yourself against the big, bad, greedy insurance companies? And, how will you really know if you are getting the best plan for the lowest price? Simple…buy the type of health plan that you really “NEED.”

Sure, everyone wants to have affordable, quality health coverage, but in my experience, particularly dealing with the small business and self-employed market, very few people individuals can distinguish between the benefits they “want” and the benefits they really “NEED.’

I have read many comments on various blogs about plans that cover 100% (no deductible and no-coinsurance) and I agree that those types of plans have a great curb appeal. However, I would not recommend working overtime and giving up time with your family just to be able to afford a plan with 100% coverage. Do those types of plans offer greater peace of mind? Absolutely! But is a 100% coverage something that you really NEED? Probably not.

Just like you would do, if you were purchasing options for a new car, you have to weigh your “wants” and “needs.” For example, although heated seats are a nice feature, “Do you really need heated seats if you live in Arizona?” Not unless you are planning to frequently drive to Alaska. So if you are healthy, take no medications and rarely go to the doctor, do you really need a plan with 100% coverage, and a $5 copay for prescription drugs? Is it really worth it to give the insurance company an extra $300 a month to have this type of plan?

Is it worth $200 more a month to have a $250 deductible and a full drug card vs. an 80/20 plan with a $1,000 deductible and a discount drug card. Wouldn’t the 80/20 plan still offer you the adequate coverage that you really NEED? Isn’t it better to put that extra $200 ($2,400 per year) in the bank, just in case you have to pay your $1,000 deductible or buy some $12 Amoxicillin if you need it, than to give your hard-earned money to the insurance company every month? Remember, the insurance company offers NO REFUNDS in premiums for staying healthy.

So is it really in your best interest to have to work overtime and give up time with your family to “afford” your health plan? In my experience, this is one of the primary reasons that most people feel like they have been defrauded or "ripped-off." I hear it time and time again from almost every business owner I talk to. “I have to run my business; I don’t have to be sick!” “I think I have gone to the doctor two times in the last three years.” “My insurance company keeps raising my rates and I don’t even use my insurance?”

As a business owner myself, I can understand my client’s frustrations. But how easy is it to determine what you really NEED? Is there a simple formula that everyone can follow? Can we all really make buying health insurance that much easier? Yes! Become an INFORMED Consumer. Every time I contact a prospective client or call one of my client referrals, I ask a handful of specific questions that directly relate to the policy that particular individual currently has in place. You know….that policy that they are relying on to protect them from having to file bankruptcy due to medical debt. That one that they bought to cover that $400,000 life-saving organ transplant that they may need or those 40 chemotherapy treatments that they may have to undergo should they develop cancer.

So what happens almost 100% of the time when I ask them “BASIC” questions about their health insurance policy? They can’t answer them. Below are some of the questions that I usually ask a prospective client…. see how well you do in answering them.

1. What Insurance Company are you with and what is the name of your plan?
2. What is your deductible?
3. What is your coinsurance percentage?
4. What is your stop loss number? (This determines your maximum out of pocket expense per year).
5. What is the Lifetime maximum benefit the insurance company will pay out if you become seriously ill and does your plan have any “per illness” maximums? (e.g. the plan has a 5 million dollar lifetime maximum, but only pays out 1 million per illness)
6. Is your plan a schedule plan, in that it only pays a certain amount for a specific list of procedures? (e.g., Mega Life & Health & Midwest National Life, a.k.a. National Association of the Self-Employed NASE)
7. Does your plan have doctor copays and are you limited to a certain number of doctor visits per year?
9. Does your plan offer outpatient prescription drug coverage and if it does, do you pay a copay for your prescription or do you have to meet a separate drug deductible before you receive any benefits?
10. Does your plan have any reduction in benefits for organ transplants and if so, what is maximum the plan will pay if you need an organ transplant or a second transplant?
9. Do you have to pay a separate deductible for each hospital admission or for each emergency room visit?
10. Are there any restrictions or benefit “caps” on out-patient services, such as, physical therapy, speech therapy, chemotherapy, radiation therapy, etc. or are there separate "access" fees for these services?

If YOU can't answer all ten questions either, does that mean YOU are not a smart consumer? No! It just means that you dealt with a "bad" agent. A “great” agent will really take the time to understand your health insurance needs and help you understand your insurance benefits. A “great” agent looks out for YOUR best interest and NOT the interest of the insurance company.

So how do you know if you have a "great" agent? If you can answer all of the above questions without looking at your health insurance policy, you have a "great" agent. If you can't, you don't. Just like any other profession, there are insurance agents that really care about the clients they work with, and there are others that avoid your questions and duck your calls when you leave messages about your unpaid claims or your skyrocketing health insurance rates.

So how do YOU become an INFORMED consumer? Easy, ask your agent a lot of questions and make sure that the answers are thoroughly explained to you. If you don’t feel comfortable with the coverage, price, etc. ask if you can see another plan so you can make a full comparison before you buy. Additionally, read the “fine print” in your health plan brochure and policy and ask your agent what every asterisk (*) next to the benefit description really means.

Furthermore, do your own due diligence. For example, if you research MEGA Life and Health, a.k.a. Midwest National Life a.k.a. National Association for the Self Employed (N.A.S.E), you will find that those companies have 14 class action lawsuits that have been brought against them since 1995. So ask yourself, “Is this a company I would trust to pay my insurance claims?

Furthermore, ask your agent is he is a “captive” agent or an insurance “broker.”
“Captive” agents can only offer ONE insurance company’s products. “Independent” agents or insurance “brokers” can offer you a variety insurance plans from many insurance companies and can often customize a plan to meet your insurance needs and budget.
Health insurance is probably one of the only things that I would not recommend buying off of the internet. In my opinion, there are too many variables to consider. A health insurance purchase requires the level of personal attention the internet can not provide. So use Ebay and Amazon for your less important purchases and use a knowledgeable, ethical and reputable insurance agent for the most important purchase you will ever make….your health insurance policy.

Lastly, if you have concerns about an insurance company or agent, contact your state's Department of Insurance BEFORE you buy your policy. Your state’s Department of Insurance can tell you if there have been any complaints filed by policy holders against that insurance company and the reason for the complaints. If you suspect that your agent is trying to sell you a fraudulent insurance policy, (e.g. you have to join an association to qualify for health insurance, you have to become a member of a union, you have to become part of a group or a professional association) you should contact your state’s Department of Insurance to check to see if you agent is licensed and to verify that the insurance policy and insurance company are registered in your state.

In closing, I hope I have given you enough information so you can become an INFORMED consumer. However, I still feel that these words of wisdom still go along way:
1. “If it sounds too good to be true, it probably is!"
2. “If you only buy on price, you get what you pay for.”

C. Steven Tucker
Licensed Insurance Agent
Small Business Insurance Services, Inc.
"The Best Policy Is A Great Agent"
www.smallbusinessinsuranceservices.com
Call Toll Free: (866) SBIS123 (724-7123)

iknowall

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iknowall

Search for in all major search engines simultaneously on the site http://www.iknowall.com.
Simultaneous search on Google, Yahoo and MSN Live Search.

Try http://www.iknowall.com

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