Health Care Uncovered

Healthy Resolution for a Health Care Revolution

Welcome to 2011! Fasten your seatbelts for the healthcare ride.

The 2011 healthcare headlines read like a suspense novel. My pulse is bounding.

There's a quiet panic in Washington as empowered Republicans step up their game to repeal the health law next week. Perfect timing for Blue Shield of California to announce premium hikes of as much as 59% for tens of thousands of customers March 1, 2011.

Who's going to stop them? After all, it's our poor health that's forcing them to do it, right?

If your new year's resolution isn't to get healthy once and for all, I urge you to reconsider.

With "skies the limit" on insurance premiums and deductibles, soon, none of us will have the luxury of having or using health insurance.

Something has to change. We have to change. Now!

2011 is the year for each of us to start a movement toward health & prevention, the number one way to gain control of health care costs.

Here's the good news; We don't have to do it alone. There are many health coaches, fitness trainers & programs to help.

According to Christopher Fey, chairman and CEO of U.S. Preventive Medicine, "America is moving from the reactive treatment of illness to the proactive preservation of health." They have teamed up with Sam's Club to provide members a deep discount on their Prevention Plan, the same plan offered to employees of major corporations. The Prevention Plan, is a personalized, step-by-step health management program designed to help people take control of their individual health, but it's so much more. Watch this video for more details.

I am so impressed with this program, priced at a low $99/year, I have signed up. 

It's time for us to make healthy resolutions to start a health care revolution; to take control of our health and make health care affordable.

Will you join me?

 

Other online health & fitness programs:

http://www.transformation.com

http://www.thebestlife.com

http://www.sharecare.com/topic/dr-oz-move-to-lose-it-challenge

http://www.mywellchoiceplus.com

http://www.sparkpeople.com/

http://www.quitnet.com Quit smoking

 

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.

Are You Paying More With Health Insurance?

Are YOU paying more because you have health insurance?

You may be very surprised to learn that sometimes hospitals charge upwards of 400% more for services billed to your insurance company versus paying cash without insurance.

With increasing deductibles and co-insurance, this means you will be the one paying more, not your insurance company.

So why not just ask for the cash price instead of using insurance?

Not so fast.

Watch as Houston's KPRC local news explains.

As you will see, and as I've said before, if you want to save on your healthcare bills, you must know the fair market or cash price and shop around.

If you can prepare ahead of time, look up your tests and procedures at Healthcare Blue Book. If you have insurance compare this price with the hospital's contracted insurance price and their cash price. If you can't do this ahead of time, call the hospital and negotiate your bill. 

I also encourage people without insurance to compare the cash price with the hospital's contracted insurance or Medicare rate.

Keep in mind, not all healthcare services cost less when paying cash. Insurance companies negotiate rates with hospitals which means you should pay less.

The bottom line? The more you know the less you could pay.

Don't let your insurance company leave your assets half covered like a cheap hospital gown.

 

Comments?

The Truth About Healthcare Reform

There should be dancing in the streets.

Over the weekend, President Obama said health reform is already delivering 'real benefits' to millions of people and putting more power in the hands of patients and out of the hands of insurance companies.  

Wait, did I miss the insurance company revolution?

The headlines I read are, "Upset with high cost of healthcare" and "Blue Cross Blue Shield requests to raise premiums 24.6%."

The truth, according to insurance company and industry experts is that mandated coverage that will kick in soon, including allowing adult children to stay on parent's plans, will cause premiums to rise faster and greater than ever before over the next few years.

While Obama pushes expanded coverage, he has ignored skyrocketing medical costs, making it impossible for insurance companies to lower premiums long-term.

If affordable healthcare isn't the goal then Washington has sold us a bill of lies.

Then again, they are allowed to change the rules as they go along.

Case in point. Yesterday, the Congressional Budget Office said the new healthcare law could cost $115 billion more than originally projected over 10 years, while still saving the country money.

Read the full report here.

It looks like health care reform is putting more power in the hands of government, not the American people.

 

What do think? I welcome your comments.

Size Matters for Small Businesses and Healthcare Reform

There's a lot of buzz.

Just about everyone I talk to lately tells me how the health care bill is going to help small businesses.

When I ask, "how?" they're not quite sure. That's just what they've heard. It's all over the news.

And how can I blame them. Most Americans and politicians don't know what's really in the ridiculously long bill written in government speak. Obama himself touts that the bill will be great...once it's finalized.

I hope that means, once it's readable, understandable and SHORTER so my 80 year old grandmother can read it on her Kindle.

Until then, I take two and stay up 'til three in the morning searching the bill for the facts.

It's no surprise, the new healthcare bill will have a big impact on small companies.

What is surprising is that most "small" companies will not get a tax break because "small" only applies to companies with less than 25 employees. Also, any employee who earns more than $80,000 per year will be excluded from the credit.

While Obama has not mentioned health care reform since April 1st, Monday, the IRS sent out postcards to millions of small-business owners, informing them of tax credits they may receive to provide health care benefits to their employees.

When's the last time you got good news from the IRS?

 

Here's what else you may not know:

• The smallest companies (less than 25 employees) with the lowest wage workers will get the biggest tax credit. How many companies are going to hire more than 25 employees?

• Companies with less than 50 employees are not required to provide coverage.

• Small companies with 50 or more employees will have to provide coverage or pay big fines. How many small companies are going to hire more than 49 employees?

• The health care bill does not limit the cost of health insurance premiums until 2014.

• Employees of companies that receive a tax credit cannot receive government assistance with their share of the premium, which may be too high.

Download my full report How the New Healthcare Bill will Affect Small Businesses

Take two and call me in the morning.

 

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