Health Care Uncovered

Choosing the Right Plan - Health Insurance 101

I got a call from a friend and entrepreneur today.

The last time she called she said, "I stayed up all night reading your book and now I'm freaking out! I haven't had health insurance in 3 years and now I'm afraid I'll lose my home if something happens to me."

After telling her that the book is supposed to keep her from freaking out, we discussed her options, including finding an affordable health insurance plan, and questions she needed to ask before deciding on one.

Today, she called with the results.

"I have two plans from einsurance.com. One is $165/month with a $5,000 deductible and a 40% co-insurance (what she has to pay out of pocket) after the deductible is met. The other is $187/month with a $3,000 deductible and a 80% co-insurance. Which one is better?"

I reach for a pen, pad of paper and more caffeine. Ok, let's see...

What's the lifetime maximum coverage amount? $3 million. Good.

Do they both cover inpatient and outpatient treatment? Yes. Good.

What about exclusions and limitations in coverage? Not sure? Find out.

Is your doctor and local hospital contracted? Yes. Good.

She's close to making a decision but calls the NASE for more options.

They present one of the same health insurance plans but when she asks if it covers inpatient and outpatient care, they tell her, "NO." Not only that, the plan doesn't cover doctors other than at a one time, yearly exam.

What? You don't have to be an insurance expert to know this is a bad deal.

My friend calls einsurance back to inform them of their misinformation and surprise! they find another, superior, PPO health plan for $184/month, a $2,500 deductible with 100% coverage after paying $5,000 out-of-pocket and a $5 million coverage maximum for inpatient AND outpatient treatment.

She's one smart cookie who got an excellent, affordable health care plan because she had the right information and knew what questions to ask.

Health Insurance 101

If you're in need of a quality health insurance plan, compare plans in your state through the NASE, NAHU, and coverageforall.com and save yourself from a "junk" plan that will leave you underinsured by following this checklist of questions:

• How much will premiums increase each year? What's the grace period for payments?
• What's the lifetime maximum for coverage? Will it cover your chronic illness & supplies?
• Does the plan cover preventive healthcare?
• Does it cover inpatient and outpatient treatment?
• Do you need a referral to access your doctors?
• What are your out of pocket costs (deductibles, co-insurance, co-pays)?
• What is the maximum prescription drug coverage amount? Are your Rx meds covered?
• What are the exclusions and limitations of the plan?
• How are claims paid? Will you have to pay out of pocket and then submit a claim?

Remember, an affordable plan must be a quality plan.

The doctor will see you now.

Health Care Reform Reality Check

I'm all fired up!

Health care reform has begun America and I hope you're paying attention.

Keeping their promise to insure dependents under age 26 by September 2010 and those with pre-existing conditions through state high-risk insurance pools beginning July 1, 2010, yesterday, the U.S. government launched the new health insurance website, to help you "Take Health Care Into Your Own Hands."

Just choose your state from the drop-down menu, answer a few questions and wa-la, you're given a custom list of private insurance and publicly funded health care coverage options. Sounds easy.

Let's take it for a ride.

Ok. I'm a pregnant woman who lives in Colorado, aged 26-64, looking for insurance that will cover my pregnancy.

Here are my list of options:

Get a job with health insurance. That's out.

Join a high-risk insurance pool - Can't have had insurance in the last 6 months? That's out.

Find a facility that offers free or low cost care. Next.

Private insurance. Let's see what's available.

I click on the last option to find a list of insurance companies. None cover pregnancy.

I am even more outraged after I read the benefit details of insurance plans that will launch in October.

21 plans are listed for Humana Health Insurance Company - which I'm assuming will represent the practices of other major insurers - and here's what I find:

• Separate, additional deductibles for medical, prescription drug, mental health, and certain illnesses.
• High medical deductibles, as much as $30,000 for out-of-network care.
• Average 20% to 50% co-insurance after your deductible is met.
• The right to "balance bill" or collect from you what your insurance didn't pay the provider.
• Restrictive and outright ridiculous limitations and exclusions including pregnancy, well baby care, non-emergency hospital stays that occur on Friday & Saturdays, hearing & eye exams, foot care, drugs for toenail fungus, vasectomy, tubal ligation, contraceptives...you get the picture.

Premiums will be disclosed in October, but this will be the least of your worries as you "Take Health Care Into Your Own Hands."

 

What do you think? As always, I welcome your comments.

A Witch Hunt in Washington: Health Insurance Companies to Blame

There's a witch hunt in the streets of Washington this week.

As protests outside the Health Insurance Plans meeting reach fever pitch in D.C., it is quite clear Americans blame the insurance companies for the rising costs of health care.

I admit, I've had my own fantasies of cruel and unusual punishment.

But wait. Let's step back and widen the lens, lest our emotions cloud reality.

While I don't intend to defend the insurance companies, I can't ignore that there's been almost no focus on the skyrocketing increase in the cost of medical care.

40% increases in hospital costs, extraordinary increases in drug prices (more than doubled from 2000-2008) and expensive, unnecessary medical tests and procedures can't be ignored.

Consider that profit margins from insurance companies are 4% while profit margins from pharmaceutical companies are 20% and biotech 29%. There's plenty of blame to go around.

It's astounding. A quarter of American health care dollars are spent on unnecessary tests to protect themselves from being sued. As a health care provider, I know we can add unnecessary medications to the list.

A survey of Massachusetts doctors found that 83% ordered unnecessary tests, hospital admissions, and referrals that costs $1.4 billion a year in that state alone. A problem that costs $700 billion nationwide. A problem that gets passed on to you and me.

Now, I know a lot of us were conditioned to believe that the "doctor knows best," but this belief has come with a huge price.

If we want true health care reform, we must be conscious of how we spend our health care dollars so we can collectively drive down costs.

I urge everyone to question all tests, procedures, medications and referrals by asking your doctor the following:

• Why do I need the test, medication, procedure or referral?
• What is it going to show or do for me? 
• Is it absolutely necessary to make a diagnosis?
• What are the possible side effects or complications?
• Is there a cheaper alternative?  i.e. ultrasound vs. CT scan
• Will my insurance pay for it?
• What will I have to pay out of pocket?

If the answers are not clear and convincing, do not agree to it.

Doing this can potentially save you, and the nation, a lot of money and grief in the long run.

Well, it's a start anyway.

 

What do you think? I welcome your comments.

 

Cartoons by Andertoons

Obama's Dirty Plan to Pass Health Care Bill

Be very afraid.

Obama has found a way to pass the current health care bill without Republican approval.

A tactic that would force lawmakers to pass the Senate health care bill as it exists now -- with no changes - just in time for Easter dinner.

Yes, that's right.

On the eve of the big health care summit in Washington, which democrats and republicans expect little to come out of, there is a bigger agenda for Obama; to prove the Republicans are not cooperating so he can use what's called budget reconciliation, a provision of the 1974 Congressional Budget Act, to pass his health care bill with only 51 votes, hijacking the Republican senate majority's right to filibuster.

President Clinton tried to use reconciliation in 1993 to pass Hillary's health care plan but was denied.

If Obama gets his way, it will show once again that Washington is not listening to the American people. That they do not have to work together to come up with a health care plan that will benefit Americans. 

The only power is our voice and it's time to turn up the volume.

Can you hear me Mr. President?

 

What do you think? As always, I welcome your comments. 

Insurance Premiums Surpass Monthly Mortgages

Last week, about 700,000 Californians got a big shock from Anthem Blue Cross, the state's largest for-profit insurer. In a letter, Anthem stated that they plan to raise monthly premiums by at least 30% writing, "Anthem Blue Cross will usually adjust rates every 12 months; however, we may adjust more frequently in accordance with the terms of your health benefit plan." This on top of what many Anthem customers say were large increases last year, has pushed premiums above monthly mortgage payments.

Premium increases 10 times higher than the national spending growth from a company that made $2.7 billion last quarter alone.

Their reason? High health care costs. End of story.

And Anthem is not the only company with plans for double digit rate hikes.

It's becoming more apparent that too many health insurance companies are in business for their shareholders not their policyholders. If you don't like their rates, they say you can go somewhere else. I say, "Good luck with that."

And while congress keeps talking about reform, they've yet to slay the dragons who threaten to take your health and home in the name of profits. Then again, they didn't do much to help homeowners during the worse housing market crash in recent history.

So, as insurance premiums surpass monthly mortgages during record unemployment, many families will be forced to choose between life's most basic needs. Families like Adam and Amy Freeman who had to choose between their home and their baby while racking up more than $2 million in medical bills. Families like you and me.

Without the power of the People to find better options, the American dream is endangered.

 

Search for the best health plans at:

America's Best Health Plans 2009-10

NCQA Health Plan Report Card

 

Cartoons by Andertoons