Thursday, May 27, 2010

Claims and as a Consumer The Things You Should Know

I have found through my research that almost no insurance broker handles what I feel is the most important part of our jobs ... claims execution!

The procedure is that NO client is to pay a bill or claim without letting me do my job ... confirm what the correct payment should be. Our mission is to insure that our clients pay the CONTRACTED RATE only. This amounts to 25% of what the bill would be if one was not insured.

The "usual and customary" or "the contacted rate" is key to why we get insurance. If one was not insured the old saying " I went to the hospital and paid $20 for an aspirin" would apply. With insurance you would pay 20 cents, and your broker, who comes free to you would make sure of this.
I have saved our clients countless dollars as they have "side-stepped" double dipping, over charges, cash deals that would have cost them 50% more! Saving our clients money is what we do!

In summary please make sure you find a broker that handles every claim. Any broker can take an application ... it is the great broker that handles every issue for their client ... especially CLAIMS!

Tuesday, May 25, 2010

What to Do When the COBRA Subsidy Runs Out

Back in February 2009 the President signed The American Recovery and Reinvestment Act. This stimulus bill provides the unemployed a 65% subsidy for 15 months, this allowed many to keep their former employers health insurance under COBRA.   The employer plan is generally more comprehensive than an individual plan, plus with the subsidy it is also cheaper.

The Subsidy is available for 15 months, which means if you were laid off in March of 2009, your subsidy time is almost up.  You will now need to pay the full premium. Employer plans are group plans and in general group plans are more expensive than individual plans.  If you and your family are healthy than you should be to get a less expensive but equal or better plan than from what you already have.  As tempting as it may be, don’t shop on price alone. Cheaper does not always mean better. Make sure you know what you’re getting.

If your family has any preexisting conditions it may be difficult to get individual health insurance.  You would probably be rated up and have a higher premium, but thanks to HIPAA you should be able to purchase the policy without any exclusions.

You can research plans by going to a website like USA Health Insurance Center or seek out the advice of a professional insurance broker

Make sure not to delay and that you do not have a gap in coverage of more than 63 days or the guaranteed insurability of HIPPA expires and even if you are healthy, you might need to go through a medical exam to prove it.

Monday, May 24, 2010

Cost of Out of Network Care under the New Health Care Bill

Insurance companies can no longer pay less for emergency care at “out of network” hospitals — the hospitals with which they don’t have contracted rates. The provisions go into effect for every health plan issued after Sept. 23.A bill from an put of network hospital would not be lower but would remain the same, the difference would be that your insurance would cover the exact amount that they would have covered for an in network hospitals.

The insurance companies contract with hospitals and negotiate a lower price for procedures.  The cost is usually 75%  less than what the hospital would charge someone without insurance.  Hospitals that are out of network will charge someone like they do not have insurance.  The insurance company would always pay less for out of network visits.  As an example, if you had an emergency visit that would normally cost $20,000, however with the in network contracted rates the cost for the visit is $5,000. For in net work the insurance company would pay 80% assuming you would have a 20% deductible.  If the hospital was out of network your insurance only covers 60% of the contracted rate, $3,000.  With the new law, they are required to cover $4,000, like they would have covered with an in network hospital.  You are still responsible for the remaining $16,000.

Sure this is a little help but certainly not enough.  When looking for a plan, don't just go for the cheapest rate, that plan may not be suitable for you.  Find out what plans are accepted at you local are hospitals, urgent care facilities, and your doctors.  You may end up paying a couple of extra bucks, but in the long run, you would could save a bundle.  Your broker should be able to help you determine the right plan for you.

Monday, May 17, 2010

Main Points of the New Healthcare Reform Law for 2010

1. No more lifetime caps. Most people do realize this but there policy has a lifetime cap on how much the insurance company would pay out. The cap is generally in the millions. If you have a catastrophic injury requiring multiple expensive surgeries, you may reach this cap and everything else is owed to the DR out of pocket. This is a great added benefit, however with the added benefit there will be added cost. The insurance companies use this cap to keep insurance costs down, because they can calculate how much they can potential have to pay out. Without a cap the payout calculation would increase far beyond would the actual numbers might be and thus compellingly increasing the policy premium.

2. Young Adult provision. All young adults to remain on their parent’s policy until the age of 26, if they are no already covered through their own employer covered plan.

3. Preventative services must be offered with new plans. Most plans already offer this feature. It costs the insurance company less to keep you healthy, then to treat you when you get sick.

4. This is one some employers may not like. Providing space and time for a mother to nurse or “pump” milk for their baby during its first year. I have two kids; it took my wife over a half an hour to nurse our first child and less than 10 minutes to nurse our second child. At least the Government put in a hardship clause , employer with less than 50 employees who can show that nursing, pumping or providing space would cause the company undue hardship.

5. This is the one some employers may like, a tax credit on the premiums. Businesses with 25 or less employees can receive up to a 35% tax credit from the premiums. Not for profits regardless of size can receive up to a 25% tax credit. Of course there are caveats to obtaining the full tax credit, the average salary of the employees must be below 50k and the business must contribute at least 50% of the premium. As with all government tax breaks, this one also has a sliding scale, so as I mentioned earlier, “the max it 35%” it does not mean you are going to get it.

A complete run down of some of the hightlights that are to come is available on the governments website http://bit.ly/9wkFGT/

Wednesday, May 12, 2010

The Legality of the Health Care Reform Bill Argued in Court

From the following Reuters article http://bit.ly/dtdMiO

The Thomas More Law Center out of  Michigan had filed a lawsuit on March 23, the day Obama signed the law, and asked the court for an injunction to block it from taking effect.

The argument was based on the following points:

  • The group said a provision requiring most Americans to buy health insurance under threat of financial penalty was beyond the scope of Congress' power and was an unconstitutional tax.
The Obama administration compares this to Social Security, all Americans had to pay for SS.  What the government failed to mention is that if you can not pay SS because you have no income, you were not penalized for not contributing to SS.
  • The group also said it violated their constitutional rights because federal tax dollars would be used to fund abortions.
This argument is a rather weak one and pulls at the heart string of those that are anti-abortion.  A government policed health plan should cover everything and not be limited.

Surprisingly the Justice Department did not argue this point but rather aimed to stall the argument
  • "They bring this suit four years before the provision they challenge takes effect, demonstrate no current injury, and merely speculate whether the law will harm them once it is in force,".
As for the penalty of no health insurance, the Justice Department had this to say

  • Congress did not exceed its authority. It said those who did not want to buy insurance may qualify for an exemption from any penalty and that U.S. law prohibits lawsuits aimed at blocking the collection of taxes.
To this I raise the question is this a tax or a penalty.  The exemption from buying insurance is not that simple and you need to meet certain criteria and guidelines to qualify.  Just because the exemption provision is there, it does not mean you would qualify for it.

This will be in the courts for sometime, as more states have sued and i am sure we will not see the end of this until it reaches the Supreme Court.

Small Business Owner to Get Tax Credit for Employee Healthcare

Currently, small businesses may qualify for a tax credit which will cover a percentage of the cost of premiums for health insurance plans. The IRS mailed out postcards to small businesses notifying them of this new tax credit, so any small business owner who may not be providing health insurance for their workers or who currently does provide health insurance, may want to look to see if they qualify for this tax credit.

Providing health insurance coverage is an essential perk to retaining employees and signing on new talent. The group insurances is expensive, small business owners have to deal with the risks of someone getting sick and being out an extended period of time, because they did not get treatment right away, by trying to avoid the cost of the health care or simply they left to go work for a competitor. In small companies the loss of one individual can do irreparable harm to the business operations.

This extra incentive in the form of a tax credit may be what some small business owners need to provide health care for their employees enabling them to keep employees motivated and turnover low while allowing them to attract better talent and growing their business.

Tuesday, May 11, 2010

Health Insurance Coverage For Young Adults Moves Forward

Today the Obama administration issued proposed regulations to implement a provision in the health care law that would allow adult children to stay on their parents’ health insurance policy until age 26. The regulation would allow children who do not live with their parents or who are not a dependent on a parent’s tax return to receive the expanded coverage. The young adult could be married and still qualify but neither their spouse or their child could receive the expanded coverage. According to the Department of Health and Human Services, the new regulation is expected to increase the cost of employer sponsored health insurance by 0.7 percent next year, or $3,380 for each dependent


This is all smoke and mirrors.

If you are on a group plan through your employer, you and your employer will split the increase depending on how much of a percentage you pay for health insurance. In essence the employer is the one footing the bill, or maybe not, I see employers increasing the percentage an employee puts in for health insurance to cover the increase. Ultimately there is nothing extra benefiting the employee.

If you have individual family insurance, you premium will go up by 1% as well however it would probably be cheaper for the child to be on their own separate plans. The 19-26 age groups are the cheapest to insure and if insured separately from the family plan, would come in cheaper than the 1% increase, in some states it would be $2,000 cheaper. This option is not available for employer group plans.

This legislation does add on advantage to those under 26, if they are high risk individuals, they would not be able to get insurance on their own. Through an employer group plan, they would have guaranteed insurability.

This would explain the 1% increase from a family plan to an individual plan for the child. The only people that will their children to the age of 26 are those that have children in the high risk pool. To cover the cost, the insurance companies would need to raise the premiums on the group plans and I believe it will be more than 1%.

If you do not have a child that is 24-26 and think you will come away unscathed, you are mistaken. Who is footing this bill, well everyone, equally of course. If you are in a group plan this increase to the family plan will affect everyone not just those with adult age children.