Spoke with yet another person who decided on a plan with copays. This plan would save him about half the cost of an office visit ($30 savings) but was subject to a $2,500 deductible and a $7,500 out of pocket maximum.
As we discussed his health history, he had only seen the doctor a few times in each of the past 5 years. He only took a generic medication for high blood pressure.
His copay plan would cost him over $450 per month. By moving to an HSA he saved himself about $2,500 per year and would only be out $3,000 in the event of a catastrophe.
I’ve said it for awhile, copay plans provide “phantom insurance.” My new client would be paying $200 per month to save $30 on an office visit. That’s not insurance - that’s a ripoff.
A few weeks ago I received an email from a client who I enrolled in a Medicare Private Fee for Service Plan. Since he was under 65, a Medicare Supplement was way too expensive and in fact, he could not qualify for it. However, the issue with the PPFS plans is that although there is no network, providers are under no obligation to accept the insurance.
Well, it seems that everyone was all set for surgery except that when my client arrived at the hospital for the pre-admission tests, they informed him they would not accept the insurance. This man desperately needed surgery on his back and the best doctor for the job only had privledges at this one hospital.
My client called me as he was at this point desperate. He had already contacted the insurance carrier along with the hospital and got nowhere. Time for me to get involved.
I made a number of phone calls and convinced the insurance company to make every effort possible to speak with the hospital. Apparently it worked!
Here’s the email received from my client:
Rick,
I appreciate all of your effort. The day started with me meeting my Dr. to get a referral for another surgeon. The day ended with the hospital accepting the insurance, and my surgery is scheduled for 6/24/08.
Cannot thank you enough for your effort.
Sincerely,
Jay
Of course, this email made my day. This is why it is important to work with an agent that cares.
A couple of days ago I was asked to help a 61 year old woman with her health insurance. She has been insured with Blue Cross of California for many years and her premium had increased to over $1,000 per month! She could no longer afford this high cost.
The problem is that she is quite overweight and takes a couple of generic medication for high blood pressure. She had recently applied for coverage with Health Net but her weight did not allow the company to consider a policy.
Aetna looked like a good alternative because their height/weight tables are more lenient. I sent them a pre-underwriting request and they came back with an offer. I should be able to save this woman somewhere between $450 and $600 per month depending on the level of coverage.
A knowledgeable agent will not only help you choose the company with the most favorable underwriting for your medical history, but will also help choose the company based upon their application. Most applications ask similar questions, but the time period will vary.
For example, Anthem Blue Cross asks for medical treatment in the past 10 years. This is true for Blue Shield and most other carriers - with one exception. If you are between 50-64 you may be eligible for a policy with an AARP endorsed plan through Aetna. Aetna is one of the largest insurers in the United States and has a terrific reputation with physicians, hospitals and consumers alike.
Not only are the rates for Aetna competitive, their medical questions go back only 5 years. This may be extremely important. For example, if treatment for cancer ended 6 years ago with no followup, you would still likely be either declined or highly rated by most carriers. Since Aetna only goes back 5 years, the likelihood is a standard rating (in the absence of other issues).
Very few agents have access to this program from AARP and we are one of the few agencies approved to sell this plan.
I just contacted one of my clients because she was receiving yet another rate increase from her current plan with Health Net. She, her husband, and 2 sons live in the San Fernando Valley and their monthly premium had increased from about $400 to $550 in about 18 months. This was unacceptable so we were looking for an alternative.
Her 13 year old son was diagnosed with a heart murmur when he was under a year old. This never required any treatment and has not nor will it cause a problem. When this was disclosed to Blue Cross serveral years ago, they turned him down.
I recommened the Lumenos HSA plan from Anthem Blue Cross. When my client reminded me about the declination, I took a look at the application. It specifically questions diagnosis, treatment, etc. in the past TEN years. The child is now 13 so it would not even be disclosed on the new application.
We’re looking for the entire family to be issued with a standard rating with a monthly premium savings of over $150.
This reminds me of why it’s important to have your insurance agent continually reviewing the available plans. Lumenos has only been available for a year or so and has terrific benefits. Saving a family of four about $1,800 with better coverage than their current insurance really makes my day!