September 26, 2006 by bob.

Q. I am looking for health insurance. The plan I have now is no good and it costs too much. Can you help?

A. That isn’t much to go on . . .

When we talked I was a bit surprised to find out you did not know the name of the carrier, nor did you know the deductible or your out of pocket. All you knew is your office copay and monthly premium.

I shouldn’t be that surprised as your situation is not that different from many of the people I talk to. When asking details about their coverage, the typical answer is “I don’t know”.

I must conclude that the I don’t know plan is a popular one since so many have it.

The premium you are paying is about 30% too much. You have a lot of benefits you will probably never use. Your out of pocket is also out of line with the “norm” and is something you need to know in comparing plans.

The most simple method of comparing plans is to look at your annual premium + your out of pocket on a major claim. The plan with the lowest total at risk (premium + OOP) is the plan that you should choose.

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September 24, 2006 by bob.

Q. I want a copay plan. I have always had one with my employer but now that I am looking for coverage on my own some agents are trying to talk me in to a plan that does not have copays. Won’t this cost me more when I go to the doctor?

A. The simple answer to your question is yes. It WILL cost more to go to the doctor under a plan that does not have a copay . . . but only IF you look at what you pay for services rendered.

Under most copay plans you will be responsible for anywhere from $10 - $50 for an office visit. Any balance is paid for by the carrier direct to the provider. The cost of this extra provider payment, as well as the administrative fees associated with adjudicating and paying a small claim are added to your premiums.

In your situattion the two plans most similar in benefits had premiums of $327/month and $464/ month. So you are paying $137 EXTRA each month to have a $40 copay.

If you did not have a copay your net cost (after repricing) for the doctor visit would be in the $60 - $70 range.

If you go to the doctor every month for the next 12 months the copay plan will cost you $137 + $40 every month for a total of $2124 per year.

If you do likewise under the no copay plan you will pay $840 per year for the cost of your office visits.

The difference in the two plans is $2124 - $840 = $1284 per year.

Which is a better “deal”?

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September 19, 2006 by bob.

Q. I am losing my coverage with my employer and just need something to cover my son’s medication. The prescription runs $120 per month but we have only been paying $10 under our health plan. My husband also takes medication, but his prespription is very affordable. What is available?

A. You are not losing coverage, it is simply changing from a plan that is subsidized by your employer to one where you are expected to pay the full (true) cost of the health insurance. This is called COBRA.

If you are healthy, COBRA is very expensive. If you are not, it is a bargain.

We can cover you & your son for much less than you would be paying with COBRA and he will have full coverage for his pre-ex condition including the meds.

Your husband is another story . . .

His condition & meds, although inexpensive to treat, makes him uninsurable. I understand you can buy his medicine for very little, but the medicine is not the issue. There is a reason why carriers will not insure your husband. Because of what COULD happen while on the medicine, they are unable to assume the risk. If carriers don’t want to buy a potential large claim, that should set off warning bells that maybe you should look at othe options . . . such as COBRA for him while you & your son look at something less expensive.

Trying to pay $30 for meds is no big deal, even if he is out of work. Trying to pay off a $100,000 or more medical bill is tough even if he IS working.

Think about it.

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September 15, 2006 by bob.

Just an update . . .

My clients who decided to buy health insurance from their auto insurance agent received an underwriting decision today.

The auto guy quoted a plan that was almost identical to the one I proposed. His final premium was over $100 per month more than my premium and the offer had 5 exclusionary riders.

My offer had 1 rider.

Case closed!

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September 8, 2006 by bob.

Q. I have Spina Bifida Occulta but have managed it very well for the 51 years I have been on this earth. I have never been wheelchair bound, always ambulatory. I use lower leg braces during the day while working (truck driver) but take them off at night. I do not use a cane or any other assist. As I am moving to another state, I will be losing my group insurance coverage. An agent in the state I am moving to has found 2 carriers that are willing to write my coverage but will exclude Spina Bifida. Since I have never had any problems why are they excluding my condition? Should I try another agent?

A. Most carriers will automatically decline anyone who applies for individual health insurance and has Spina Bifida, so you should consider yourself fortunate there is any offer at all on the table.

By your own admission, the illness is not costly nor is it limiting in your ability to be mobile and function.

Full coverage will be available under a group plan, but most likely at a cost that is 3x what you will pay for the individual coverage.

I think you need to take the offer.

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September 2, 2006 by bob.

Q. We have used the same agent for years for our homeowners & auto insurance. Because of the trusted relationship, we asked him to quote our health insurance. As it turns out, his company no longer writes health insurance direct but does allow him to write coverage through another company. We just got their offer and we are very disappointed. The rates came back $90/month more and there are many exclusion riders on the policy. Could we have done better?

A. You definitely could have done better.

Your P&C agent may know his stuff when it comes to auto & homeowners but he is in uncharted waters when it comes to health insurance. This should be evident by the offer.

Your medical history is quite extensive. I might be able to get you through underwriting with fewer riders, but I know I can save you almost $100 per month on premiums.

The carrier he used has rated your premium because of your weight. The carrier I would suggest will consider you a standard risk and will not load your premium.

I appreciate your loyalty, but is it worth paying an extra $1200 per year, every year just to have him service your health insurance?

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August 31, 2006 by bob.

Q. My health plan it work is going up in price to over $800 per month. I can just barely afford it now. I looked at a plan for $300 per month that includes a maternity benefit that we need. The problem is, it is an HMO and we would have to change doctors. What should I do?

A. The easy answer is, fire your doc.

Is that relationship so sacred that you are willing to pay $500 per month, over $6000 per year just to see him a few times during the year? I am sure you are comfortable with your doctor, but if $800 is not in your budget it is time to evalutate your priorities.

Have you considered going with the HMO and paying to see “your” doc out of pocket? Surely it would be much less than $6000 over the course of the year.

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August 29, 2006 by bob.

Q. I have mostly made up my mind to buy from a particular carrier. I had some conversation with the carrier and they turned me over to an in-house agent. He gave me a quote and sent me a link to complete an application. Should I go forward or deal with someone local?

A. Good question.

The in-house agent may have your best interest at heart or he may just be toting the company line. For sure, all he has to offer is that company’s product line. The company you mention does have some good products, and the one he recommended is probably the same one I would suggest.

As long as he stays with the company, and you are happy with your plan, there is nothing wrong with dealing with an in-house agent.

But how impartial will he be when it comes to disputing a claim? Will he be interested in fighting for your best interests or more conscious about preserving his job?

And how about renewals? Will he show you other options or only what that carrier has to offer? Will they be just as competitive next year relative to other carriers as they are this year?

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August 26, 2006 by bob.

Q. My health insurance was getting too expensive so I shopped around. I talked to several agents including one who spent a lot of time with me, explaining all the different options and showed me how the plan I had, and the ones I was considering, had a lot of benefits I would hardly ever use. By eliminating those items, I could save about 30% on my premiums.

Unlike most agents, he did not pressure me to buy on the spot. He answered all my questions and allowed me to study each plan option.

Yesterday he called to check in with me. I told him I had already bought from another agent who came to my home. He asked which plan and which company offered the plan. When I told him he said I had made a big mistake.

I explained that I checked out the company with the state insurance department and there were no complaints.

He told me I should have checked with patient billing at my doctor’s office and a local hospital. He said I would find that providers will usually refuse to accept assignment of benefits and will require me to pay them then file my own claim.

I think he is just angry I did not buy from him.

A. I think you are wrong.

The agent is not angry but rather is incredulous that you would buy from an agent that only had one company to offer and that company has such a poor product and reputation. He is correct. Most providers will NOT accept assignment and you WILL have to pay the provider then try and get reimbursement.

Rarely will the DOI make disparaging remarks about a carrier. The closest to that are press releases indicating a company was fined for a particular action.

If you want to know which companies do the best job of keeping your doctors happy, ask the billing department. Happy billing departments mean less headache for you.

I agree with the agent who tried to help you. You made a big mistake.

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August 23, 2006 by bob.

Q. I am looking for a plan that includes low copays, especially for Chiropractic and Dermatology. The plan needs to fit my budget. What is available for me?

A. Most plans will cover Chiropractic & Dematological visits . . . unless you have a chronic condition that requires regular treatment. In that case the condition would be considered pre-existing and would be excluded by a rider.

If you visit a Chiropractor more than 12 times per year, you can expect a Chiropractic exclusion rider. Your skin condition may also warrant a rider.

Low copays are nice but come with a price.

Given your pre-ex conditions, that may be ridered off the plan, you will probably come out better with a plan that does not include copays. The premium savings could offset the loss of benefits due to riders.

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