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It used to be an automatic decline with most insurance companies if the applicant was diagnosed with diabetes. Things have changed for the for those people who do not use insulin.
Case in point. I was asked to help a 60 year old find insurance coverage. Seems he had exhaused his Cobra benefits and did not want to pay the high cost for the guaranteed issue program under HIPAA.
His medication was generic so the cost was not the issue. The problem was that he did not know where to turn to obtain a reasonable price for coverage.
I approached both Anthem Blue Cross and Aetna. Both carriers would be willing to insure him at a small increase in premium. He chose an HSA plan from Anthem at a very reasonable premium. His policy was issued in under 3 weeks without any waiting period for pre-existing conditions.
There are several insurance companies who have lifetime limits of $100,000 to $1,000,000. While the latter amount seems to be high, many treatments will exhaust this in less than a year.
We never recommend plans with limits under $5,000,000. In fact, most carriers in California will offer even higher limits.
Why do you need a comprehensive plan with high lifetime limits. Take a look at this and then take a look at your current plan.
http://www.msnbc.msn.com/id/25644309/
Imaging, having a “good” insurance program and still going bankrupt!
You see advertisements for low cost plans - Family Plans for $49 per Month - or other seemingly amazing prices. These plans not only offer false promises of a discount on health care, but can have some people thinking they are offering protection.
One of the biggest issues is that these plans can only provide some help with those bills most of us can afford anyway. Office visits for $40 or $50 really is only a $15 discount off the typical cash price. Saving 40% on lab work only saves a few hundred dollars per year.
However, reducing the cost of a $100,000 surgery by 40% still leaves a bill of $60,000. What value is the “health plan” in that case?
Real insurance is not as expensive as most people think - PROVIDED THEY CHOOSE THE RIGHT PLAN.
Don’t do this on your own. It costs you nothing to use a professional who can show you copay plans, hmo plans, and hsa plans. You wouldn’t go to court without a lawyer - don’t buy insurance without using an agent.
Aside from the money saved on premiums, HSA plans generally have much lower out of pocket costs than traditional copay plan. I took a look at a 40 year old man in Los Angeles to see the range of pricing and out of pocket costs for various HSA plans.
Plan Name Monthly Premium Out of Pocket Maximum
Anthem Blue Cross Lumenos HSA 1500m $321 $1,500
Anthem Blue Cross Lumenos HSA 3000m $243 $3,000
Health Net Saver HSA 1800 $190 $1,800
Aetna PPO HSA 3000 $145 $3,000
I think the best value is the Aetna plan for $145 per month. With this plan you can fund $250 into an HSA account bringing a total monthly expenditure to $395. Between your fund and your insurance policy, you have no other costs for covered medical expenses.
And best of all, any of the money you don’t use in your fund is yours to keep.
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.