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Frequently
Asked Questions
These
are a listing of my posts at AskLizRyan and AskInChicago Yahoo Groups
along with the CW Network listserv. Many people have commented that they
would like these in one place, so here they are.
Going
forward, I will also be adding other content that I post other places
along with content used with permission from colleagues.
NOTE:
These aren't in perfect chronological order. The most current are at the
end (starting 9/15/08, they are at the beginning).
TO
SEARCH: Press Ctrl and the F key together to bring up Microsoft
Window’s “Find” function and type the key words you are looking for.
[Ctrl+F]
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Posted 11-7-2009 (9-29-2008)
Several
months ago you responded to a question about BCBS insurance policies.
You said you would not sell Basic Blue or Blue Value. I'd be
interested to know why.
That’s a great question. Let’s
tackle Blue Value first.
Blue Value is an older plan offered
by BCBS of IL. There are no office visits (they go towards deductible). There
is nothing inherently wrong with this plan. The reason why I don’t sell
it is because the Blue Edge HSA plans do the same thing better at a
cheaper rate and you have the option of setting up a pre-tax health
saving account at your bank. You can use this bank account to pay for
your medical, dental, vision, chiropractic, prescriptions, and any other
medically necessary item, all using pre-tax dollars.
Furthermore, since BV is an older plan,
very few new people are being written on it. This means that the only
people left are older or have medical issues and will cause the annual
rate increases to be higher than the other plans.
Second is Basic Blue. I have heard from
other agents that some of their clients have had to pay $50,000 and more
dollars because they slipped between the cracks of this plan. You must
“read between the lines” to see what it doesn’t cover. For example, you
are having migraines; the doctor prescribes a bunch of tests such as an
MRI, CT Scan, etc. If these tests aren’t done on the same day as surgery,
the plan doesn’t cover them.
Furthermore, let’s say that the doctor
prescribes a new breakthrough drug. No drugs are covered on this plan
except chemotherapy or drugs after a transplant. Drug therapy can costs
thousands per month, just ask our seniors.
Mental health and substance abuse are
also not covered.
I’d much rather see a person on a $5000
deductible plan that covers everything or Celtic’s “Basic” plan where you
get two office visits and everything else goes towards a deductible than
place a person on the Basic Blue plan.
Life’s too short to sell crap.
Posted 10/20/2008
Response to
Time article about $30 health Insurance
Click here to view the article.
This is
an interesting article that states up front “so many of these policies
can be shoddy.” As long as you know what you are getting, it is better
than going without. Some of the plans stated don’t include a prescription
drug option or have a cap. With prices of cancer drugs reaching thousands
a month, you might still go bankrupt due to medical costs anyway. The
reason why these plans have to have gaps in coverage is due to the cost
of healthcare. United Healthcare just released that it spent 81 cents for
every dollar taken in on claims. If you pay $30/month on a plan
($360/year), just 3 visits to the doctor erases the insurance company’s
profit. When considering one of these plans, take into account, at
minimum, the following. First is the maximum benefit (what is the per
procedure, per year, per lifetime benefit). Assurant got into trouble
because people were selling their “mini-med” plans as major medical. They
usually had only a $25,000 - $50,000 annual benefit. Second is the deductible
– is it one you can afford if you had a major health crisis? If not, opt
for paying a more for a smaller deductible. Third is prescription drug
coverage – this is where many plans have minimal coverage (either a big
copay or cap on the per year benefit) or don’t cover prescriptions at
all. Fourth are copays – some of these plans will charge you a copay from
$100 per procedure or day in the hospital on up. This effectively raises
your deductible, except that copays are per event and don’t go towards
your deductible. Go into the hospital twice in a year, pay the copays
twice. For more details of what to watch out for, please download a free
article “Tips for evaluating Individual/Family Health Insurance.” Find it
at http://www.robertslayton.com/Articles.htm.
Remember, what you don’t know WILL hurt you. That’s why you should use an
insurance agent who knows the marketplace and good insurance companies.
Robert
Slayton
Robert Slayton Associates Insurance
“We don’t sell crap” :-D
http://www.robertslayton.com
http://www.twitter.com/rcslayton
Posted 9/29/2008
Article about
college health insurance for students
I have had a number of people ask me about their children’s
college health insurance plans. This article is about one of those plans:
http://tinyurl.com/3neqrc
(http://www.floridahealthnews.org/index.cfm/go/public.articleView/article/9159/top/true).
Not all plans recommended by colleges for students are bad, but many
have restrictions or limits that will shock you. By the way, notice who
the insurance company is? It’s also been mentioned many times within this
newsgroup. Here are several tips, more tips can be found in a free
article “Tips for Evaluating Individual/Family Health Insurance” on my
website (http://www.robertslayton.com).
1. The lifetime maximum needs to be at least $3 million (industry average
is $5 million). 2. There shouldn’t be an annual maximum (if possible –
some insurance companies cap it at $50,000 or $100,000 which is way too
low – Golden Rule’s newer plans in Illinois have a $1 million cap per
year which isn’t so bad). 3. There MUST be an annual out of pocket
maximum. If there isn’t then run, don’t walk, away from the policy. 4.
Make sure that prescriptions and outpatient tests are covered (even if
you must meet your deductible first, that’s okay). More and more health
insurance plans are skipping the prescription drug benefit leaving you
with a serious hole in your coverage. If anyone has questions, feel free
to contact me offline.
Robert
Robert Slayton Associates Insurance
www.twitter.com/rcslayton
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Posted
9/15/2008
September is
Life Insurance Awareness Month
Just like replacing batteries in your
smoke detector once a year, everyone should do a check up on their life
insurance (and disability/long term care insurance too). I’ve put a
little sheet out on my website that you can download for this check up.
Go to http://www.robertslayton.com/checkup.pdf.
Did you know that life insurance can be
used to transfer wealth between generations with no tax penalty (before a
person dies)? That, if properly structured, you can grow money at an
interest rate equal to or greater than a CD or Annuity within a life
insurance wrapper and without paying income taxes on the increase? That
you can choose a plan that if you are disabled, still contributes dollars
towards your retirement (sometimes called “self-completing”)? It is one
of the few instruments left that the government hasn’t changed. If you
want more information, talk to your financial planner or your insurance
agent. BTW, if you want more info on the tax advantages, I have another
sheet, but can’t post it on my website due to legal reasons. If you want
this, just email me.
Sincerely,
Robert Slayton
Robert Slayton Associates Insurance
http://www.robertslayton.com
www.twitter.com/rcslayton
Posted
7/14/2008
Should I
obtain health insurance through an Association? I’ve heard it is cheaper
(applies to both individual and employer health insurance)
By
John Sinibaldi, an insurance agent in Seminole FL
Several
years ago the laws were relaxed in Florida, allowing associations to form
(within certain strict guidelines) for the purpose of offering group
health to small businesses. Everyone was happy (except me - I
thought the new law was just so much smoke and mirrors and a huge waste
of time, and one under which nothing would change).
Now it is several years later. How many of the new or existing
associations who tried to take advantage of the new rules were actually
able to find a carrier with which to partner? Zero. That's
right, none, nada, bupkis, goose egg. Why? Read on for a
decidely non-scientific but probably pretty accurate analysis of what
happens with association plans and why they'll never become viable in
Florida (in my opinion):
The concept of purchasing insurance in "bulk" is probably one
of the most misunderstood of all actuarial concepts, even by folks who
should know better. (In Florida, under Governor Jeb Bush, the head
of the Agency for Health Care Administration actually thought that simply
combining a bunch of small groups under one umbrella would somehow
automatically lower premiums. Unbelievable!)
In a nutshell, most associations offering true small group products (i.e.
guaranteed-issue comprehensive major medical) do NOT offer significantly
lower premiums for similar products than those available in small group
(in fact, overall they're usually more expensive). Why? For
several reasons:
1. There is a cost to running the business through an association -
which in essence is, itself, an additional layer of administration (one
that doesn't exist if the employer is working directly with the carrier).
2. If the underlying risk is equal (same demographics, same claims
history), the additional layer of the association would probably cause
the premiums to be higher.
3. Most associations want something for the work involved in
sponsoring a plan - so they're going to want a piece of the pie in some
way. Whether that is a per-member fee, or a cut of the commissions,
or whatever, it still adds cost to the process.
4. Probably most important of all, all association health plans
struggle with the issue of adverse selection when the end-users are small
businesses. Why? Simply, if the association's premiums are
lower than those of the carriers writing directly with small businesses,
then those businesses will go to the association plan. If higher,
those businesses will stay in the traditional small group market.
When are the premiums lower in the association plan? When the
association's premiums are composite rated, and the small group is
comprised of older employees. In the traditional market, these
groups would be rated based on their employees' ages - making the
premiums very expensive. Almost universally, these businesses would
flock to the association plan (because with the composite rates over a
much broader base of employees, the per-employee premiums would probably
be lower) - and over time, the influx of older emloyees (higher risk)
would drive those premiums up astronomically through adverse selection.
When are the premiums lower in the traditional small group market?
When the group is comprised of mostly young, healthy male
employees. In this case, the traditional market is almost always
lower cost than the association plan, so these employers avoid the
association plan like the plague. This means that these low-risk
employees almost never participate in the association plans (and because
they're not participating, they're not adding value to the overall
process for the association by offsetting the higher risk from the older
employees). Again, adverse selection - in this case, no incentive
for younger employees to participate in the association plan.
The bottom line is this: No carrier wants to get involved in what
is an almost guaranteed road to death spiral rates.
Feel free to copy and forward this to your client - they need to know why
it will be next to impossible to implement an association plan - not to mention
why it will probably be MORE expensive to do so, not less expensive.
John
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Posted 6/15/2008
Should I get
health insurance for my child through his College?
The
advice you’ve gotten from the others is good. Universities tend to have
lower cost insurance, but you need to be extremely careful as some of
them are limited benefit plans. When reviewing these insurance plans, you
want to make sure that there are no caps on payments for hospitalization,
surgery, or medications (as long as you are in network). You also want to
make sure there is a maximum out of pocket. Look at my article on “Tips
for evaluating individual/family health insurance” at http://www.robertslayton.com.
Then click on “free articles.” Next, depending upon where they are going
to school depends on which plan works best (you have to make sure that
the insurance company’s network is available where your kids go to
school). Feel free to go to my website and play with rates (from my
website, click on “Products” then on the link for individual health
insurance). In general, the higher the deductible, the lower the rate.
Look at Celtic’s “Basic” plan (on my website). It is bare bones, but it
doesn’t limit the major items and everything can go towards the
deductible unlike UniCare’s “Saver 2000” plan. It is much better to have
a high deductible with good insurance than a low cost plan that doesn’t
pay when you need it. Don’t be drawn into Blue Cross Blue Shield’s “Basic
Blue” plan. Let’s just say I refuse to sell it. Feel free to contact me
with questions.
3/18/2008
I’m Thinking
about getting insurance through an Association – is this a good thing?
People
often misunderstand what Association health insurance is. Just because
you purchase through an Association does not mean you’ll be getting a
better deal or better insurance. For example, the National Association
for the Self Employed (NASE) and the Alliance for Affordable Services
(they are sister companies owned by the same corporation) tout
“Association” health insurance, but their rates are higher than standard
individual insurance. Furthermore, they were censured by 31 states for
their practices with a lawsuit by the state of Massachusetts. Some keys to
individual/family health insurance are as follows (this also goes for any
“Association” plan you may want to buy into). 1. Is it real health
insurance and not just a limited medical benefit plan? Are payments
capped for hospitalization, surgery, or other services (this is bad)?
Does everything need a copay (which actually means that the low
deductible you thought you were getting is really much more – for example
a $500 hospital copay means your deductible is actually $500 more than
listed)? 2. How does the insurance company determine your renewal rates?
Is it based upon your family’s current health status or are rates pooled
within the plan. Most insurance companies use pooled rates. Typical
determinants are attained age, profitability of the insurance plan (if
the insurance company lost money on the plan, they will raise everyone’s
rates higher), and cost of medical services in the geographic area where
you live. The Alliance for Affordable Services (the last time I checked)
does not raise your rate “as an individual” rather based upon how much
they’ve paid in claims. If they’ve paid less than $10,000 in a year, you
get the lowest rate increase, paid $10K - $20K a higher rate, etc. So
they don’t “single you out” but you do pay based upon your health. The last
thing you need is to have your rates go up 100%+ because you are going
through cancer treatment. 3. Does the insurance company pay their claims?
Go to the department of insurance to see how many complaints they have (http://www.idfpr.com/DOI/Complaints/ComplaintRatioLinks06.asp)
Note: It’s the ratio of enrollees to complaints that counts. If you have
100,000 people on the plan, you will have more complaints than if you
only had 10,000. BTW, Health Care Service Corporation is Blue Cross Blue
Shield of Illinois. Also check out www.ripoffreport.com. If it’s a scam,
chances are it’s listed. There are many other items to look for. For a free
article on this subject, go to www.robertslayton.com, click on “free
articles” then on “Tips for evaluating individual/family health insurance
plans.” Finally, if you want to compare rates, feel free to
play on my website. I have some of the best carriers listed, check them
out. No one (me) will contact you unless you specifically request it. www.robertslayton.com/health-ins.htm.
Robert Slayton, President, Robert Slayton Associates Insurance.
Posted
3/7/2008
RE: [Ask! in
Chicago] Health insurance through an association?
Hi
Robert,
I don't
know about association insurance but I do know that I would not think of
securing health insurance for my family without first talking to Dean
Klassman "the insurance doctor". You can reach Dean at
847-454-0660. Cheers, Evan Evan Kane evan@... <mailto:evan@...>
(NOTE
FROM LIZ: Thanks Evan, we also have one of the Midwest's top insurance
folks in our group, namely Robert Slayton - Robert has tremendous
knowledge about all types of insurance which he has provided to the Ask!
in Chicago and Ask Liz Ryan members often - you can reach Robert at robert@... - cheers, Liz)
Posted
4/22/2008
What is the
best health insurance for an independent contractor?
Which company
is best for a particular person/family depends on their age, where they
live, family configuration (single male versus family), and type of plan
desired (traditional health insurance plan with doctor copays versus the
newer HSA compatible plans). Insurance companies choose which markets
(combination of the above factors) they want to be competitive in and
price accordingly. I wrote a post back in December listing my review of
the major health insurance companies in Illinois. If you want, I can send
it to you or post it again if you can’t find it. Furthermore, I strongly
recommend you read my “Tips for evaluating individual/family health
insurance.” You can find it at http://www.robertslayton.com/Articles.htm.
You can also play around with rates from the major carriers on my
website. No one will call or spam you unless you request it (I own the
site and don’t do that). Go to http://www.robertslayton.com/health-ins.htm
and start playing. Be aware, however, that what you don’t know WILL hurt
you. Choose a competent health insurance broker (who sells many different
companies) who wants to work with you, especially if you have any
pre-existing conditions you are concerned about. I have an employee whose
only job is to prescreen people before applying, that way we have a good
idea of how a person’s condition will be treated up front. If you have
more questions, feel free to contact me.
Robert
Slayton
President
Robert
Slayton Associates Insurance
Robert@robertslayton.com
630-779-1144
Posted
5/22/2008
Outofpocket.com
I
attended a meeting last week and heard about a place you can comparison
shop for medical procedures. It’s outofpocket.com. The website also has a
bunch of links to look at. I thought everyone might want to check it out
because, contrary to popular belief, if you know the actual pricing of a
procedure, it is possible to negotiate a better rate than your insurance
company. Obviously, this shopping only works for non-emergency
procedures.
Posted
4/11/2008
Tax Software
and HSAs
Everyone,
if you have a Health Savings Account (HSA) and need to fill out form
8889, be aware, most of the tax software programs do NOT fill it in
correctly. You will need to manually override the program and enter the
correct numbers yourself. Go to the IRS website and pull down both the
form and instructions. Manually fill out their copy, then put those numbers
into the boxes within the tax software. Remember, for 2007 the limits
were $2850 for an individual and $5650 for a family. Anyone who turned 55
or older in 2007 can contribute an extra $800/year as a catch up
contribution. Hopefully by the time you read this, the tax software
programs have fixed it, but better safe (and not insane) than sorry.
Posted
2/15/2008
Insurance
Claim Denial Appeal
Funny
that you should be talking about this. The Wall Street Journal just had
an article about the State of New York launching a probe against the
practice you talk about. “Probe Targets Health Insurers On Payments” Feb
14, 2008. Not sure if this link works, but here goes: http://online.wsj.com/article_email/SB120292255343965679-lMyQjAxMDI4MDEyMzkxMjMyWj.html.
As for what should be in the appeal letter, I’d survey the costs of the
same procedure and say that their numbers are wrong. The problem comes in
that the database they use measures actual payouts. As most claims are
“in network” those are the ones that get measured. At the same time you
are appealing, you might want to go back to the surgeon and ask what
their network negotiated rate is as they probably belong to some network.
See if you can get them to reduce the rate to their network negotiated
rate. There is a company called “TRPN” that has a variety of networks
which it applies to out of network charges for many doctors and
hospitals. For more information, send me an email off-line and I can
email the website. There are even companies that negotiate out of network
charges and take a cut of the money saved by the employer/employee. These
companies usually only work on large claims (over $50,000). Good luck.
Robert Slayton, President, Robert Slayton Associates Insurance.
Posted
2/2/2008
Overview of
Individual/Family Health Insurance Coverage
A couple
of thoughts. First, find a great agent. Go to www.nahu.org
and click on “Find an Agent” these are the top agents in the country and
you can find one that specializes in individual/private health insurance.
Second, private insurance is not necessarily more expensive than group or
association insurance. It depends on the state’s mandates, the age of the
person, where they live, etc. In Illinois, 75% of the time private
insurance is much less expensive (I just saved a family over $1,000/month
going from a group plan to an individual policy). You won’t know unless
you explore. Third, be very careful of association plans. Many times what
the insurance agent tells you versus what reality is are very different.
The parent company of the National Association for the Self Employed
(NASE) and Alliance for Affordable Services was recently censured by 31
states because of their sales practices. The state of Massachusetts has a
massive lawsuit against the parent company because most of the plans they
offer are actually limited benefit plans with caps on services. This
means that they leave you out in the cold when you need them most. Go to
my website and pull off a 2 page doc that lists questions you need to ask
and basic guidelines when shopping for individual insurance. What you
don’t know WILL hurt you. Here is the link: http://www.robertslayton.com/HealthInsTips.pdf.
Good luck, Robert Slayton, President Robert Slayton Associations
Insurance. Board member of the DuPage Association of Health Underwriters,
Board member of the Illinois Association of Health Underwriters, past
delegate of the National Association of Health Underwriters.
http://www.robertslayton.com.
Posted
2/26/2008
Is this a
legitimate company – is it real health insurance?
Read www.ripoffreport.com
and you’ll see that it is not real insurance. If it is too good to be
true, chances are it is a limited benefit plan or just a discount plan.
Please use my “Tips for Evaluating Individual/Family Health Insurance”
article at my website as a guide to avoid rip offs and scams. Find it at www.robertslayton.com
and click on “Free Articles.” If you want a real agent to explore real
insurance companies, I recommend going to www.nahu.org and clicking on “Find an
Agent.” This association is where legitimate people hang out. Robert
Slayton, President, Robert Slayton Associates Insurance.
Posted
4/23/2007
Searching for
a new hospitalization/PPO plan
You
don’t mention which state you reside in (every state has different plans,
rates, etc.). If you want to talk to an expert, go to www.nahu.org
and choose “find an agent.” The best health insurance agents in the
country belong to this organization (National Association of Health
Underwriters). Agents typically can answer off the top of their head
which plans work best for you. They also know the companies and how they
pay claims (if they pay claims). Here’s an article on what to look for
when shopping for individual/family health insurance: http://www.robertslayton.com/HealthInsTips.pdf
. If you will be choosing a company, it always pays to check them out on www.ripoffreport.com.
Good luck!
Posted
2/2/2007?
Speaking of
Health Insurance - Small Business Plans
I
find the best agents belong to the National Association of Health
Underwriters. You can go to http://www.nahu.org <http://www.nahu.org/>
and click on "find an agent" and it will tell you a little bit
more about what each agent does.
Stick
with a broker, they have access to all the health insurance plans. Most
brokers do limit the companies they work with. Personally, I stick with
about 7 I know to be the top companies in my state, who have great claims
paying processes, and who will not stop doing business in my state.
Tell
them your situation and listen closely, what they say will give you a
good indication as to whether they are blowing smoke or know what they
are talking about.
Ask
them what companies they represent and why.
Ask
them what procedure they use for renewals. This is key. It is easy to
find someone to give you a plan, it is hard to find an agent who actually
services their clients. It is the renewal process that makes or breaks an
agent. I've come in and saved a small 5 person company over $17,000/year
because the previous agent didn't go to market to look at comparable
plans. The renewal process should include pre-planning (60 - 90 days in
advance), analysis of the renewal (60 - 45 days in advance), and analysis
of the market (60 - 45 days in advance). This gives you enough time to
switch carriers if it makes business sense.
Ask
for references. When checking on those references, ask how the agent
handled their renewals. Also ask them how long it takes their agent to
get back to them. Finally see whether the agent who sells the business is
also the person who services the business. Many large agencies use a
slick sales person up front and then shifts all the administrative work
to clerks.
This
is not a perfect list, but at least will get your juices flowing. If you
want me to post your request and find agents for you via NAHU, I can do
that too.
Posted
12/27/2007
Can an
insurance company rescind my policy (drop me)?
It is
against the law for any health insurance company to drop you for any
reason other than you not paying your premiums or if they stop offering
the plan of insurance you are on. If the company drops your particular
plan, they will allow you to move to a comparable plan of insurance. The
only time a person is left high and dry is if the company decides to
withdraw totally from the state you reside in. As for BCBS of IL, they do
not raise rates based upon your health or if you've been a pain in the
butt to them. They raise rates based upon your attained age,
profitability of the plan you are on (in aggregate), and profitability in
your particular area (e.g. Chicago). There are probably a couple other
factors, but those are the big three. As for your appeal, have you read
through your certificate of coverage? Have you checked the Illinois
Department of Insurance for items that are mandatory for them to cover
(called state mandates - http://www.idfpr.com/doi/HealthInsurance/Mandated_benefits.asp)?
Those will be your two legs to stand on if it comes down to a court
battle. Robert Slayton, President, Robert Slayton Associates Insurance, http://www.robertslayton.com
<http://www.robertslayton.com/>
, board member of the Illinois Association of Health Underwriters.
Posted
12/07/2007
My 2 Cents on
Health Insurance Companies
Re:Need
Reco: Private Health Insurance for Independent Consultant
Here is
my 2 cents (this is my personal view, talk to your agent about
specifics). Blue Cross Blue Shield, best benefits (other than the Blue
Value and Basic Blue plans, which I refuse to sell), there is a 12 month
pre-ex on everything for everyone not coming from another Blue Cross
plan, they will raise your rates a minimum of twice a year and you will
need to reunderwrite about every other year to get a lower rate. Humana,
second best benefits, they rolled out new plans this summer which meet
the needs of most people. No pre-ex if you disclose a condition on the
application and they don’t exclude it. Be careful as many of their plans
don’t offer prescription drug coverage (it must say with Rx). Celtic, a
“local” company that only does health insurance. Good basic insurance as
long as you choose the “plus” option for the traditional plans. It does
have a “clunker” where if you need physical/occupational/speech therapy,
they will only count $25/visit towards your deductible. This means you
will essentially be paying for it out of pocket. UniCare has been popular
over the years and their new “FIT” plans finally give you unlimited
office visits. They have a 12 month pre-ex on everything and the same
clunker as Celtic. Aetna is expensive but fits into the market in that
they will only accept or reject you, no riders or pre-ex on disclosed
items. They will also cover some medical conditions that other carriers
will decline for. Assurant is good coverage (as long as you don’t choose
the “right start” programs, which I refuse to sell), but expensive.
Golden Rule is back in the game since United Healthcare (who owns them)
signed a long term agreement with Advocate hospitals. That said, they
still tend to be expensive.
The
parent company that owns Mega Life and Mid-West National Life Insurance
Company of Tennessee (sold by NASE and the Alliance for Affordable
Services) are being investigated in 31 states and are being sued by the
state of Massachusetts because they typically represent limited benefit
medical plans as health insurance.
Please
read my article entitled “Tips for Evaluating Individual Health
Insurance” found at http://www.robertslayton.com/HealthInsTips.pdf. What you don’t
know, WILL hurt you.
If
you want to play with rates, feel free to do so on my website (I own it
and I don’t spam people). No one will call you unless you request it. http://www.robertslayton.com/health-ins.htm
Robert
Slayton, President, Robert Slayton Associations Insurance. Board member
of the Illinois Association of Health Underwriters and DuPage Association
of Health Underwriters. Robert@....
Posted
12/19/2007
Outofpocket.com
I thought
I'd let everyone know about this resource and hope some of you will
contribute to the database. OutofPocket.com's (http://www.outofpocket.com
<http://www.outofpocket.com/>
) purpose is to help bring health care prices to light by fostering price
transparency, a critically important component that is clearly needed to
ensure that healthcare costs don't get out of hand. Take a look, pass it
around, and contribute so that the next time you need something done, you
can find the right person at the right price. As an insurance agent, I've
seen private doctors charge $1400 for an x-ray with the client paying the
"network" price of $1395. For the same x-ray, I've seen other
doctors charge less than $200, so it pays to shop around if you are able.
Enjoy. Robert Slayton, President, Robert Slayton Associates Insurance, http://www.robertslayton.com
<http://www.robertslayton.com/>
, 630-779-1144.
Posted
11/30/2007
Switching
Individual Insurance plans
For
those of you who are on an individual/family insurance plan and are
evaluating whether to continue with your current policy or switch to a
competitor, here is an article I wrote to help guide you in choosing the
best plan. It includes a worksheet on the second page for you to "do
the math" to see if it makes sense. Find it at http://www.robertslayton.com/HealthInsTips.pdf.
Have a great holiday season! Robert Slayton, President, Robert Slayton
Associates Insurance. http://www.robertslayton.com.
Posted
10/25/2007
Re:Policy on
Mileage Reimbursement ~ Accident on business time
Technically
your employer should pay for the damages. Going to and from work is
personal, all other errands on behalf of the employer is part of the job.
Your employer needs to have "hired, non-owned" vehicle coverage
on their commercial/business policy. If you were in a major accident
where someone was permanently disabled, your employer would be one of the
people named in the million dollar lawsuit. If your employer did not have
this coverage, their whole business would be at stake (an employer's
policy never includes "hired, non-owned" coverage unless
specifically stated - it's a huge gaping hole for most businesses in the
United States and is separate coverage from general liability). The
employer should speak with their business insurance agent about this
situation to assure they have all the correct coverage in place. In my
sister company, at least one of their clients is sued each year due to an
employee using their own vehicle and getting into a tragic accident. That
is why we always include this "hired, non-owned" coverage for
people who run frequent errands. Robert Slayton, http://www.robertslayton.com.
Posted
10/18/2007
NASE and the
Alliance For Affordable Services
For
those who need to purchase health insurance, be careful of the company
you choose. HealthMarkets (who owns both the National Association for the
Self Employed and The Alliance for Affordable Services) is being
investigated in 36 states. Here is an article: http://ebn.benefitnews.com/asset/article/281725/index.html
about it. Also, there is a nice resource to investigate any company, it is
www.ripoffreport.com <http://www.ripoffreport.com/> . These
are comments by people who have been burned by that particular company.
Posted
10/15/2007
Grace Period
for switching insurance carriers for no pre-existing conditions
Several
people have mentioned a grace period and both comments are correct, that
it depends upon two things. First is what state they are from and second
the underlying federal HIPAA regulation. The HIPAA regulation states that
if you do not have a break of more than 63 days between insurance plans
(health, dental, etc.), then it is considered continuous coverage. This
regulation only deals with shifting between employer sponsored (or
"group") health insurance plans. Some states (as the person
from New York pointed out - BTW, I'm taking her word for it as I don't
have a license there) have chosen to apply this regulation to individual
insurance too. A person who moves from one employer sponsored
health plan to another employer sponsored health plan gets credit for
every month they were on the previous health insurance plan. This means
that if a person was on a plan from the previous 12 months, they
essentially have no waiting period. If the person had been on the health
insurance plan for only 4 months (with no prior coverage), then they
would only be credited for those 4 months.
In
Illinois, private health insurance (read individual/family coverage) will
also apply for trimming this waiting period.
If a
person tries to go from group insurance to individual insurance (in
Illinois), then HIPAA does not apply. You will have to satisfy at least a
12 month pre-ex. That said, there are good insurance companies who will
waive that pre-ex as long as all conditions are listed on the application
and the insurance company does not place an exclusion on any of the
conditions (most of the time they don't, but it depends on the condition,
it's severity, and how expensive the medications being taken).
The
pregnant person, if from Illinois, cannot qualify for individual
insurance. She can get another job within the 63 days (and hope her
insurance starts immediately) or she can go on the Illinois Comprehensive
Health Insurance Plan (ICHIP) designed for uninsurable people. My best
guess is that since she is not working, she would qualify for the
Illinois "moms and babies" public aid plan which pays for all
prenatal care, birth, and some post natal care for both mom and baby.
It's a great program that works extremely well. If anyone has
questions, please feel free to contact me at Robert@..., http://www.robertslayton.com
Posted
10/8/2007
Rescinding of
Health Insurance Policy
Still on old
Health Insurance
The
question arises, what would happen if you had a major health event (e.g.
heart attack, organ transplant, stroke)? Would your insurance company try
to rescind the policy or sue you for the money? I'd check with your
state's department of insurance (anonymously) to see how these situations
have been handled. If you don't have any major health problems, I'd get an
individual policy. They are typically cheaper than group insurance and
you can keep it forever. Once the new policy is in place, then you don't
need to worry about the old company plan. Ultimately, you will need to
get your own insurance and the best time to get that insurance is when
you don't have any major health problems. If you want an article to help
you choose a plan, click on the following link: http://www.robertslayton.com/Articles.htm, then on
"Tips for evaluating individual/family health insurance plans."
Robert Slayton Robert@..., www.robertslayton.com.
Posted
9/25/2007
Re: [Ask Liz
Ryan] Re:COBRA
Thanks
Robert,
That was
a great explanation, particularly about the pre-existing conditions
limitations.
Robert
Slayton <robert@...> wrote: So many great
questions! COBRA is a complex topic along with HIPAA, so I am going to
give you one perspective and several suggestions. First, short term
medical (STM) insurance does pay claims as long as it was something that
was NOT pre-existing (most plans have you pay a deductible first, then
20% of the next $10K of bills, then they pay 100% up to a typical $1 or
$2 million maximum). <snip>
Posted
9/25/2007
Re:COBRA
So many
great questions! COBRA is a complex topic along with HIPAA, so I am going
to give you one perspective and several suggestions. First, short term
medical (STM) insurance does pay claims as long as it was something that
was NOT pre-existing (most plans have you pay a deductible first, then
20% of the next $10K of bills, then they pay 100% up to a typical $1 or
$2 million maximum). All STM plans have pre-existing condition clauses
(some that go back 2 years). What this means is that if you are healthy
with no pre-ex, then they are a good choice. If you have a questionable
chronic condition, then COBRA is a smart choice. Second, if you have a 63
day break in "credible coverage", then the pre-ex clause in the
new insurance applies. That said, most carriers in the states where I do
business will accept both an individual health insurance plan along with
a STM plan as prior credible coverage. My recommendation is to call your
future employer to see whether they would accept a STM plan as proof of
prior credible coverage. Once on board and if they ask, you will need to
provide them with your STM plan coverage and the "proof of credible
coverage" from the previous insurance to make up the past 12 months
of continuous coverage. Third, yes you can elect COBRA before 60 days,
then wait 45 days and if nothing major happens, then not pay the premium.
The COBRA police won't come knocking, but you will still have more than a
63 day break in coverage. Of course if you are healthy and don't have any
medical issues, then this is not a problem. Finally, we do have a complex
healthcare system and an average consumer shouldn't go it alone. Choose a
quality insurance agent (www.nahu.org <http://www.nahu.org/> is a great place
to start) to guide you through the maze. Agents don't charge you
anything, the rates they give you are typically the same as if you were
to go direct, and they have a vested interest in making sure you are
happy. Good luck, if you have more questions, feel free to respond
directly to me or via this wonderful forum. RobertSlayton
www.robertslayton.com <http://www.robertslayton.com/> .
Posted
9/7/2007
MegaLife
Strikes Again
This is why
you need to be careful about the individual health insurance company you
choose. http://www.usatoday.com/money/industries/insurance/2007-09-04-limited-coverage_N.htm
Posted
9/6/2007
Re: Sams Club
Insurance
I decided to run some quotes off of the Sam's Club website
and compare them to the rates I give to my clients (individual/family
health insurance in Illinois). The quotes are exactly the same. The main
problem with purchasing health insurance from Sam's Club is that the
average person still doesn't know what they are looking for. Many of the
cheapest plans have no drug benefit (discount only, not applied to
deductible). If you do have a medical issue, you won't really know
whether an insurance company will accept you until after you apply. What
you don't know WILL hurt you when it comes to insurance. Why not seek out
an expert in the field of health insurance and allow them to assist you
in your search. There is no cost for their services, the price of the
insurance will be the same, and the end result should be better. How do
you find a good agent? Start at www.nahu.org <http://www.nahu.org/>
and click on "Find an Agent". This is the professional
association for health, life, disability, and long term care agents. Talk
to several agents and you'll find out who's the best one for you.
Download my "Tips for Evaluating Health Insurance Plans" as a starting
point in your search. This file has just been updated with a grid on the
second page to assist you with comparing different plans. Go to http://www.robertslayton.com/HealthInsTips.pdf
for this article. Robert Slayton www.robertslayton.com <http://www.robertslayton.com/>
. For those of you using this sheet, please give me feedback on how to
make it better. Thanks.
(NOTE FROM LIZ: Thanks for this tip, Robert! This is a
fantastic resource -- Liz)
Posted
9/4/2007
Re:insurance
Run,
don't walk, away from the indemnity plan by AARP. If you qualify for the
HDHP with a $5000 deductible, that is the way to go. Indemnity plans are
NOT major medical health insurance and have their place if you cannot get
standard insurance and cannot afford the uninsured pool offered by most
states. Go to http://www.ahd.com
<http://www.ahp.com/>
and click on a local hospital and scroll down to see the average charges
(not costs) of some of the more common procedures. You'll quickly see
that the indemnity plan will ruin you financially if you have any major
problems. Better to pay for your own checkups using pre-tax money (via a
Health Savings Account) and know that your maximum out of pocket will be
$5,000 or $10,000, than to brave the unknown. Here's an article to help
you think about your choice: http://www.robertslayton.com/HealthInsTips.pdf.
Robert Slayton www.robertslayton.com
Posted
8/22/2007
Re:Long
Term Health Plan needed
Try
looking at http://www.nahu.org
<http://www.nahu.org/>
for an agent. People who are a part of this organization are typically
the best in their class.
Posted
7/24/2008
Could you
please explain about how and when they might be able to cancel our
policies.
One thing I
forgot to ask about the three companies that you recommended was about
cancellation of policy by the companies themselves. Could you
please explain about how and when they might be able to cancel our
policies. Anytime? What if we are diagnosed with a serious
illness that would take treatment over an extended period of time?
Excellent
question! Here, in general are the answers.
1. A
company can only cancel your policy for non-payment of premiums, proving
you left out a major item on your application intentionally that would
have caused them to not originally give you coverage, or if they choose
to discontinue doing business in the state of Illinois.
2. Blue
Cross has a 12 month pre existing condition clause. This means they will
not pay for any condition that was present in the past 12 months at
application time.
If you are
diagnosed with a major illness within the first several years of any
insurance company's policy, they will get your medical records to see
whether there is anything in them about the condition (or any other major
condition that was not disclosed on the application). Most of the time
they don't find anything and pay the bills.
As the
companies I offer don't increase a person's rate due to their medical
conditions, you will receive the average rate increase for a person your
age, in your geographic location, on the same plan you are on.
Without
going into legal-eze, that is it in a nutshell.
Posted
7/26/2008
I’m
frustrated with your comments about needing $5 million in lifetime
coverage as I can’t get standard health insurance and am on the ICHIP
plan which only gives $1.5 million in coverage.
I sense
your frustration with an unfair and imperfect system. You are right and
make excellent points in your email. I’m glad you took the time to write
me and am impressed with how reserved you were in your points (you were
very polite and didn’t bash me). My comment about 5 million is for people
who have other options (which you already know). Currently 1.5 million is
okay for insurance. The older you are, the less total amount you will
probably need (due to becoming Medicare eligible sooner). The most
expensive surgery is around $200,000 with about $50,000/year in
maintenance (these are logical guesses based upon some older
information). If you can go with medical tourism, the cost of voluntary
surgery is about ¼ by going outside the US (same quality, same US trained
doctors, less expensive costs).
Personally,
I had a neck issue. Like you, I feel the worst place in the world to go
with a back/neck problem is traditional medicine. I went to see an
acupuncturist who helped me get rid of the problem. I paid cash so that
there would be no record of these visits in case I needed to change
insurance companies. On another occasion (about 4 months ago) I had to
negotiate with my daughter’s pediatrician about a medical condition so
that her records and the insurance carrier’s requirements to cover her
would match. It’s not easy, it’s not fair, but it’s reality.
Let’s
talk about your conditions specifically, then about options (note: most
options will be distasteful, but for some people they make sense).
First,
if you haven’t had any treatments for your herniated disc for the past 5
years and have been symptom free, there are several carriers who will
consider you without an elimination rider. Most carriers go back 7 years,
some 10 years, Blue Cross forever. Humana happens to be one of the
carriers who will always apply an elimination rider to disc problems. If
you want, I can have my assistant prescreen your conditions with all the
major carriers (without using your name) and we can see what we come up
with. I’ll need more info if you are interested. As for the SSRI, I’d
have to check. There have been times that companies have said yes when I
thought they’d say no.
Another
example is that one of my clients had duodenum switch surgery (a type of
gastric bypass surgery). We went through the prescreen process and
exactly one carrier would consider her for coverage. She applied and was
covered with no pre existing condition clauses (this carrier either
accepts everything or declines a person). I place clients all the time
who have been turned down by another carrier. The problem is that the
public can’t talk to the underwriters of the different insurance
companies. This means that you either have to apply and pray or speak
with an agent who is willing to go through the labor intensive prescreen
process.
Second,
let’s say that no one will take you. You could start your own business
and have one employee and get guaranteed issue employer sponsored group
health coverage. As long as you have been covered by any major medical
plan for the past year there will be no pre existing condition clauses.
Furthermore, the insurance companies cannot place elimination riders on
the group health insurance plan.
Third,
some people are willing to pick up a part time job to secure health
insurance benefits. Work at Starbucks 20 hours/week and you can qualify
(I haven’t checked in awhile, but I believe that’s still the case).
Fourth,
if you were to blow through 1.5 million in coverage, chances are you’d be
considered disabled anyway. If a person under 65 years old has been on
social security disability for 24 months, they qualify for a Medicare
supplement plan.
Fifth,
there are some states that offer guaranteed issue health insurance with
no pre ex clauses (such as New Jersey). If you move to one of these
states, expect to pay double to triple the ICHIP rate for coverage, but
you’d get a new maximum.
Sixth, a
person can secure work at a major corporation offering health insurance
coverage.
As to
your final comment about insurance companies not caring about the
consumer, it is partially true. Insurance companies are in business to
make a profit (usually pegged at 25% - so for every dollar they take in,
they pay out 75 cents). It doesn’t make sense for them to take a person
who could potentially cost them more than they take in with premiums. I
think it stinks, but when I’ve analyzed universal health coverage in
other countries, looked at each time a state within the US has tried (and
failed) at providing universal coverage, there is no one best answer.
My best
guess is that there will be a dual system combining private insurance
carriers and government insurance. How it plays out is anybody’s guess.
I’m a member of NAHU (nahu.org) and they have a system that would help
with the costs and coverage. Here’s a link: http://www.nahu.org/legislative/healthyaccess/index.cfm.
One
thing most people miss is that health insurance is simply a financing
mechanism to pay for health care (like leasing a car). If the cost of
health care was less, then the cost of insurance would be less. Most of
the states currently trying to implement some kind of universal coverage
miss this point. That is why Massachusetts and Maine have huge deficits
due to their health insurance coverage.
Posted
7/30/2008
I am a
asklizryan listserv member and I saw a few of your postings providing
feedback on individual health insurance. I was wondering if I could ask
you for some direct feedback on a plan my family is looking into. I
specifically remember you saying to use caution with association plans.
So, the plan is through the American Counseling Association, it is BCBS
Blue Choice Select PPO. I can give you the details if you want, but any
redflags from knowing the plan type and that it is through an
association? Thanks so much Robert, I appreciate your feedback.
Association
plans aren’t necessarily bad, it’s just there are many companies that use
the “Association” name to imply that it is different and somehow better
than any other plan. Sometimes Association plans are not subject to some
of the mandates in Illinois and can hurt a person who needs one of those
mandated items.
Anyhow,
it looks like this is BCBS of Illinois? If it is, then the Blue Choice
Select PPO is a good plan. Be aware that it uses a smaller network than
the traditional PPO plan. This means if you travel beyond DeKalb, you’ll
have trouble locating an in-network doctor. The maximum out of pocket is
$3,000 per person with a maximum of 3 people ($9,000 potential out of
pocket, not including the deductible). What the plan covers is excellent
(I offer that plan to my clients too). If it is through another Blue
Cross from a different state, then you’d need to email or fax me a plan
outline (I’d be happy to look).
I’ve
attached the plan outline for that plan along with a comparison of their
traditional PPO plans. One other item to know about BCBS of Illinois is
that they have a 1 year pre existing condition clause for people not
coming from another Blue Cross plan. This means that if anyone has been
treated for something in the past 12 months and it appears in the first
12 months of your plan. Blue Cross will not cover it. For most people
this isn’t a big issue. If you are self employed, you might want to look
into the HSA compatible plans. I’ve found that sometimes the savings in
premium cost covers most of the deductible and you can open an HSA
account at your local bank and put money into it pre-tax to use for
medical, dental, vision, prescription, chiropractic, and any other
medically necessary item. If you want more info, let me know.
I
would ask one favor of you in return. I’d love to know whether the rate
that you are getting from the ACA (BTW, I used to be a member, was an NCC
and NCCC and past trustee of NECA) are the same or different than an
agent would provide. Either you can go online to my website and check the
premiums yourself (http://www.robertslayton.com/health-ins.htm, then click on Blue
Cross) or provide me with your zip code, genders and dates of birth and I
can do the quoting.
Finally,
if you have any medical issues (other than occasional colds, etc.), you
might want to go through an agent so that they can prescreen your issues
to assure BCBS will take you with no exclusion riders.
Good
luck and thanks for your inquiry.
Robert
www.twitter.com/rcslayton
www.robertslayton.com/FAQ.htm
--------------------------
In
further emails, we discovered the rate the ACA is charging is exactly the
same as the standard rate in Illinois. Taking the family's actual quotes
for insurance (Blue Choice Select $500 deductible plan) I compare it
below with a $3500 HSA plan. Look at the numbers - it's quite
interesting.
----
You might want to think about the HSA plans. If you
choose a $2200 deductible plan, your annual savings would be $1319.28.
This means that the first $1319.28 of care is "free."
If you choose a $3500 deductible plan, you save $2246.64 per
year.
I'm not saying you have to go with the HSA plans, what
I'm saying is that it would be a good thing to explore.
First, the deductible is a family aggregate deductible
meaning that everyone contributes to one deductible. Once the family
deductible is met, then BCBS pays 100% thereafter. On the Blue Choice
Select plan, you have 3 deductibles ($500 each = $1500 total), plus 3
coinsurance maximums ($3,000 each = $9,000).
The way to compare is to take an average year, then
worst case scenario year. I'll give you an example below, but use your
own numbers for a more realistic view.
In an average year, the family sees the doctor 12
times total (average cost per visit $100 = $1200/year).
Prescriptions are $200/year.
That's it.
On the Blue Choice plan (BCS), you would have paid the
following:
Premium = $8,306.16
Doctors visits = $30 copay x 12 = $360
Prescriptions = $10 copay x 2 = $20
Total cost of insurance = $8686.16/year
Blue Edge HSA $3500 deductible plan
Premium = $6,059.52
Doctors visits = $100 x 12 = $1200
Prescriptions = $200
Total cost of insurance = $7459.52
Worst Case Scenario - Two people have major problems
and need hospitalization/surgery (this is a four person family - two
adults, two children)
BCS
Premium = $8,306.16
Doctors visits = $30 copay x 20 = $600
Prescriptions = $10 generic (x2) + 35% brand name for $100/month for 4
months = $300
Max out 2 deductibles = $1000
Max out 2 coinsurances = $6000
Total cost of insurance = $16,206.16
Blue Edge HSA $3500 deductible plan
Premium = $6,059.52
Max the deductible out (deductible includes all doctors visits and
prescriptions) = $3500
Total cost of insurance = $9,559.52
I hope this gets you thinking. The second page of my
"Tips for Evaluating health insurance" includes a grid you can
use to compare. I've attached it here.
Oh, I forgot, the $3500 you spent on health insurance costs,
if you would have used an HSA bank account to pay for them, would reduce
your taxes by $3500. This means that if you are in the 25% tax bracket,
the actual cost of that $3500 you paid would have been $2625.
Posted 8/5/2008
Article on iCann Health Insurance from BusinessWeek.
Awhile back someone asked about iCan Health Insurance. The
one on TV with Infomercial King Billy Mays. Business Week just wrote an
article on it. Here it is.
http://tinyurl.com/5tadol
Use my article on “Tips for Evaluating Individual/Family
Health Insurance Plans” (www.robertslayton.com, click on Free
Articles, then the article itself); it would help you evaluate plans such
as this.
BTW, I’ve had some feedback on my last post from people who
are uninsurable and can’t get $5 million in lifetime benefit. My response
is that you need to take whatever you can (typically $1.5 - $2 million).
If you find yourself running up against the maximum, then email me and I
can brainstorm some options (there are almost always options).
Posted 8/30/2008
COBRA,
HB 5285, and Short Term Medical
Here
are a couple of items to think about Short Term versus COBRA and the
ruling Gigi was talking about.
The
Governor signed an amendatory veto of HB 5285 expanding coverage to
unmarried dependent children up to age 26 and age 30 if a veteran. It
doesn't take effect until 1/1/2009. Currently several factions are
arguing that the implementation date should be 6/1/2009 due to it's late
passing and there will probably be at least one law suit brought against
his action.
There
are several factors to weigh in when deciding whether to choose COBRA,
Short term medical insurance, or permanent individual/family insurance.
These are what I use when helping a client choose.
First,
do you have a definite date when other insurance will start or a high probability
of securing group insurance within 12 months. If the answer is yes, then
a short term medical policy makes sense. In the case of the person who
wrote in, her daughter's new health insurance kicks in October 1st. So a
short term policy makes sense. COBRA was over $400/month. The short term
policy was around $123 for the 35 days the policy was needed.
For
many people who are laid off, they don't have a definite date of re
employment, so my suggestion is to go with regular individual/family
insurance. The other reason to do this is many small employers no longer
offer health insurance and it would be a shame to pass up on the perfect
job for lack of health insurance. Please note: if you or one of your
family members has a health condition that might make you uninsurable on
the individual market, then you must stay on COBRA. If you are unsure
whether your condition is insurable or not, then contact an agent who
knows the individual health insurance market or go to www.nahu.org and click on "find an
agent." The best health insurance agents are part of this
organization.
Second,
people are talking about the 63 day break in coverage rule (from HIPAA).
Simply stated, if you have more than a 63 day break in coverage, the new
health insurer can impose up to a 12 month pre existing condition clause
(meaning they won't cover any conditions that you've had in the past 12
months before joining the plan in the future 12 months you are on the
plan). If you are healthy, it is a non-issue. If you have one or more
health conditions, you need to be cautious about this break in coverage.
All
health insurers in Illinois will accept an individual major medical
policy as proof of prior coverage. They will even count a short term
major medical policy towards satisfying this condition. Every month
you've been on a major medical policy counts as satisfying one month of
that pre-ex. What this means is that if you were on a major medical
policy for only six months (with no prior coverage), then you have
satisfied 6 months of the pre ex.
If
anyone has more questions, feel free to contact me. For more interesting
trivia on health insurance, see http://www.robertslayton.com/FAQ.htm.
Robert
Slayton, CDHC
Robert
Slayton Associates Insurance
http://www.robertslayton.com
Posted 9/1/2008
I
believe I’ve spent over $1,000 more than I should have on medical bills
and need a medical bill advocate.
You've uncovered a can of worms that is
only going to get worse in the coming years as many carriers are starting
to use Medicare and Medicaid reimbursements for out of network charges
(this is a bad thing). Let's start at the beginning.
If you were in network with your medical
bills, then there should be no balance billing as part of the agreement
between the medical provider and insurer states that the provider has
agreed to accept the reimbursement by the insurance company as the full
amount. Many times someone has surgery and everyone except the
anesthesiologist (for example) is in network. This means that you'll get
balanced billed by them. In many cases, you can fight this if you are in
an in-network hospital with in-network doctors, some companies will treat
it as in network for reimbursement. You'll still pay a balance, but not
as much. Please note, always try to get a letter from the hospital or
medical provider stating that they will only use in-network people for
your procedure. If (big if, but clients have been able to get the letter)
you get the letter and get an out of network charge, you can fax a copy
of the letter to the insurance company to have the charge switched to in
network.
If you are out of network, then the
doctors can balance bill you. Go to websites like www.outofpocket.com to
find comparative pricing on the procedures and fight like heck to have
them give you a reasonable charge for the procedure.
If there are miscellaneous charges
that you think are not correct, seek out a utilization review nurse
(maybe ask the insurance company if they have one you can work with).
They are the ones who review medical bills to see whether they are
billing you for unnecessary items. I don't know of any independent ones,
but there are companies who do this for businesses. Usually it's on large
amounts (over $50,000) and they take a percentage of the savings.
Good luck.
Robert
Robert Slayton Associates Insurance
www.robertslayton.com
www.twitter.com/rcslayton
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