Doctor Develops New Approach to Pay for Basic Health Care

October 23rd, 2007 by Brad C

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Leave it up to the private sector to find a better way. For $125 a month, a Wheeling, West Virginia doctor will provide primary and urgent care, lab work, x-rays, and even some generic drugs. Dr. Vic Wood figured out a way to offer a pre-paid care plan, and now hundreds of doctors across the US are mirroring his efforts.

Wood chose to go into medicine after a career as a state trooper because of a passion to help people. Instead he was faced with reams of insurance paperwork, flat insurance reimbursement rates and uninsured patients. He had to find an alternative to keep his clinic afloat and control health care costs.

After studying the situation thoroughly, Wood determined the number of visits, tests, and prescriptions the average individual and family used annually. His low rates of $83 per individual or $125 per family made health coverage affordable for Wheeling residents.

The next hurdle Dr. Wood faced was with the state insurance commission, who challenged that his plan was actually a form of health insurance and thus subject to the requirements insurance companies faced to provide coverage. Ultimately a chance meeting with the governor led to a state-approved trial of Wood’s program.

This scenario raises several issues faced by health care providers and insurance companies. Providers want to spend their time treating patients, not doing paperwork. Insurance companies are forced to require volumes of records to meet state requirements and cover their corporate butts with documentation in an era of sue-happy lawyers and hundred million dollar punitive damage awards, not to mention insurance fraud, while still making a profit; they raise their premiums to insure they complete all of these tasks.

I wish I had a flat fee service available here – I’d happily pay that and supplement it with a major medical plan for the really big stuff. My basic needs would be covered, and costs could be controlled. By having a primary care physician available, I would not have to go to an expensive specialist or emergency room for routine care, which costs everyone less.

Kudos to Dr. Wood and his fellow visionaries determined to find a way to make health care affordable whether patients. Let’s hope that insurance companies and insurance commissions closely study the results of these programs and adept every possible lesson to help reign in the costs of health insurance while still delivering quality care.

Listen to Doctor Develops New Approach to Pay for Basic Health Care
Listen to Doctor Develops New Approach to Pay for Basic Health Care

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Planning for Retirement? Plan for Health Insurance too

September 12th, 2007 by Jeannine C

We all know that health insurance isn’t cheap, and that your rates are based in part on your medical history and risk.  That’s why the older you get, the more your health insurance costs.  Very few companies offer health care coverage as part of their retirement plans either.  So as you financially plan for retirement, the cost of health insurance must be considered.

One thing I’ve learned from my mother is that Medicare doesn’t cover everything.  In fact, The Washington Post recently noted that usually Medicare only pays 51% of medical costs, and coverage doesn’t start until you turn 65.  Medicare Part A covers hospitalization; this coverage is what you’ve been paying for during your working career, so there’s no charge for it.  Medicare Part B, which covers non-hospital expenses, runs anywhere from $93.50 to $161.40 a month, based on current income.  Medicare also has deductibles and no cap on out-of-pocket expenses.

My mom chose to purchase Medigap coverage, which helps to cover Medicare’s shortfalls and is available through many health insurance companies.  There are 12 standard policies to choose from, so you only need to compare prices, but even then there’s enough range that you still must shop.  “We still see enough of a difference that it’s worth checking out different insurers through different agents to find the best cost policy,” said Donna O’Rourke, senior health analyst for TheStreet.com.  She sited an example of one plan which was quoted with an $1100 difference between two different companies.

Bottom line – as you plan for retirement, include the cost of a monthly health insurance premium in your budget.  And no matter what age you are, it’s always important to shop for health insurance, comparing the quotes from several different health insurance companies to find the best price.

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Listen to Planning for Retirement? Plan for Health Insurance too

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Major Medical Health Insurance Keeps You Healthy

September 8th, 2007 by Brad C

Study after study proves that people with health insurance are healthier than people without health insurance.

There are many reasons why this is true, but the biggest reason is that people with affordable individual health insurance will see a doctor when a medical problem begins, instead of putting it off.  That way small health problems don’t become big ones.  It sounds so simple, yet it affects people’s health in such critical ways. 

Even if you only have basic health insurance coverage, make sure that you see a medical professional if you develop any type of health condition.  I know that’s it hard to justify a doctor’s visit when the gas bill is due, but just spend a few minutes thinking of the consequences if the medical problem isn’t addressed, and you’ll see that it’s worth the doctor’s bill.  Even if you don’t have any level of health care insurance coverage, find a clinic or public health service and take care of the problem.  Your health is too valuable to risk over money!

There are many ways to save money on health insurance, finding item after item to eliminate and reduce the cost until it fits within your budget.  Many families have found that buying a major medical health insurance policy can fit their needs and their budget.  Major medical insurance usually has a co-pay and a high deductible; benefits kick in during a serious health situation, such as a broken bone, surgery, or serious illness.  Knowing that you have coverage for the really big stuff does provide some peace of mind. 

The process of shopping for major medical health insurance is the same as other types of medical insurance.  It’s just even more critical to shop around for the right health insurance company.  So take the time to compare free health insurance quotes from several companies.  Examine each included item to see if you really need it, see how much raising the deductible a bit more can lower your premiums, and keep working on it until you find affordable health insurance.

Listen to Major Medical Health Insurance Keeps You Healthy
Listen to Major Medical Health Insurance Keeps You Healthy

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California Health Insurance

August 30th, 2007 by Jeannine C

It’s estimated that as much as 20% of the population in California is not covered by health insurance.  While there are many programs offering medical services to those without insurance, the first choice is always to have your own coverage, which puts you in control of your own health.  Before you buy California health insurance, you need to know about the choices of policies available in the state so you can make the wisest choice for you and your family.

Basically there are five types of health insurance policies in California

  • HMO – Health Maintenance Organizations, which require that you only use physicians or providers within their system, unless it’s an emergency. 
  • PPO – Preferred provider Organizations, that provide a list of approved service providers but also allow you to see physicians not on the list with reduced benefits.
  • Indemnity Policies – use any doctor or hospital you choose, after meeting a deductible and/or paying a co-pay.
  • Self-Insured Health Plans, normally used by unions or school districts, which draw from a pool of funds to pay for member’s healthcare expenses.
  • MEWA – Multiple Employer Welfare Arrangements are trust funds available through professional or trade organizations to cover employee healthcare.

California has very specific laws concerning pre-existing conditions, so if that’s an issue, make sure that you know your California Health Insurance rights.  For more information, you can always call the California Department of Health at 800-927-HELP.

Listen to California Health Insurance
Listen to California Health Insurance

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Medicare Will No Longer Pay For Hospital Mistakes

August 23rd, 2007 by Brad C

A recent rule change by Medicare means that the government will no longer pay the bill for hospital accidents that could have been prevented, such as leaving an object in a surgical patient.  This change is designed to improve the accuracy of Medicare’s payments and improve the quality of hospital care for patients.  Private insurance companies are already preparing to follow suit.

There are eight specific conditions itemized in the rule:

  • Blood incompatibility
  • Air embolism
  • Falls
  • Mediastinitis (an infection after heart surgery)
  • Urinary tract infections from using catheters
  • Vascular infections from using catheters
  • Pressure ulcers (bed sores)
  • Objects left in a patient during surgery

Hospitals must begin reporting these conditions on October 1st of this year, then starting on October 1, 2008, they must absorb the cost of the treatment required to address these preventable situations.  At least three more conditions will be added to the list next year. 

Most experts agree that while these problems are usually not an intentional act to increase the hospital bill, estimated taxpayer savings will easily be hundreds of millions of dollars within the $408 billion Medicare program. 

The implications of this are huge for health insurance providers as well.  Every dollar paid out to cover hospital mistakes affects our health insurance premiums, whether we have individual health insurance or are part of a group health plan.  Now that the hospitals must pay for their mistakes, hopefully patient care will improve as well.  Ultimately this may be a first critical step toward reigning in the cost of healthcare.

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Listen to Medicare Will No Longer Pay For Hospital Mistakes

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Some Vaccinations Not Covered by Health Insurance

August 9th, 2007 by Brad C

Now there’s one more thing to consider when choosing a health insurance policy that protects your school age children - vaccination coverage.  A study by Harvard assistant professor Dr. Grace Lee concluded that many children are underinsured, resulting in incomplete vaccination programs.

There are several factors which helped to create this problem.  In the last five years the number of recommended vaccines has nearly doubled, along with requirements in the timing, age levels, and combinations for maximum results from the injections.

The cost has skyrocketed as well in the last dozen years - from $155 in 1995 to $1170 in 2007.  Additional shots, like three doses of the human papillomavirus vaccine (at $150 each), hepatitis A, influenza, rotavirus and Tdap caused the increase.  All the changes have resulted in gaps in coverage, such as some insurance policies not covering all the vaccines while others cover the vaccine but not the procedure.  Government programs have provided some relief for the situation, but are not completely covering the shortfall.

So what’s a parent to do?  As you compare coverage of prospective insurance companies, make sure that health vaccinations are one of the included items.  If you don’t specifically see inoculations listed, call each company’s customer service line and ask what is covered.  Do keep in mind that only more expensive policies may cover everything, so decide whether it is better for your budget to have a less expensive policy and pay for some of the shots yourself.  That is why it is so important to compare health insurance rates and coverages before you buy your policy.

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Listen to Some Vaccinations Not Covered by Health Insurance
Listen to Some Vaccinations Not Covered by Health Insurance

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Autism and Health Insurance

August 8th, 2007 by Brad C

Now that over 560,000 children in the US have been diagnosed with autism, the obligations of the health insurance industry are under serious debate.  Early, intense intervention can make a large difference in a child’s development, but of course it is expensive.  Insurance companies argue that covering those expenses will raise the cost of health insurance for everyone else.  That debate is currently focused on Wisconsin, where Gov. Jim Doyle and Senate Democrats are pushing legislation that would require and define health insurance coverage for autism, according to a recent posting on Forbes.com.

The debate stems from the classification of autism as an emotional disorder rather than a neurological condition.  Coverage of mental health issues usually is much more limited than physical conditions, including higher deductibles, lower payouts and an annual cap on the total amount of benefits.  As a medical condition, coverage caps increase significantly, and many more options are available to insured individuals.  Currently 17 states have legislation requiring that autism be covered as a medical condition.

It is a difficult question.  Our friend’s daughter is autistic, and caring for her dominates their lives and their finances.  The good news is that every state has programs that already provide assistance to families afflicted with autism.  But if hundreds of thousands of additional dollars were spent on each autistic child, the money has to come from somewhere, and in the insurance industry, that means higher premiums for everyone.

My heart goes out to these families, but life isn’t always fair.  If this legislation passes, do we then pass the same legislation for every other devastating disease?  Think what our health insurance premiums would be then.  What’s your opinion?

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Listen to Autism and Health Insurance
Listen to Autism and Health Insurance

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Those Extra Pounds Could Raise Your Group Health Premium

August 7th, 2007 by Jeannine C

It figures that a company in the medical industry would find a way to tie insurance premiums to personal health.  Clarian Health, an Indianapolis-based hospital system, plans to implement a new group health insurance fee structure in 2009 that charges extra premium amounts for employees with certain health issues and habits.

Employees with a body mass index (ratio of height to weight) over 30 will pay an extra $10 per paycheck for being overweight.  If they smoke its $5 more, and if their cholesterol, blood pressure or glucose is high, then add another $5 each!

Clarian has decided that being forced to actually pay for bad habits is more effective than just encouraging workers to take better care of their health.  (A letter from their doctor stating that a medical issue is beyond an employee’s control will have the extra fees waived).  Of the 8,000 employees enrolled in the company’s health plan, about a third are obese and a quarter use tobacco.

Finally there’s a way to incorporate a little personal responsibility into health insurance premiums.  Many people make the choice to eat poorly, to smoke, or not to exercise.  Their health suffers as a result, which leads to higher medical expenses.  Now those individuals will help to defray those costs.

Have no doubt, other companies are watching closely to see whether this plan succeeds, and what kind of legal challenges surface, such as possible Americans with Disabilities Act (ADA) issues.  Though it will be a few years before we know whether or not this proposal is successful, it certainly will shake up the world of employee health care.

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Listen to Those Extra Pounds Could Raise Your Group Health Premium
Listen to Those Extra Pounds Could Raise Your Group Health Premium

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Arizona Health Insurance

August 6th, 2007 by Jeannine C

If you are an Arizona resident searching for health insurance, make sure you know your rights first. Arizona has a moderate amount of laws concerning health insurance which means that consumers are protected but companies can still operate profitably within the state.  This gives Arizona residents a great deal of choices when it comes to choosing a health insurance provider.

Arizona has made important provisions in many areas, such as guaranteed emergency ambulance services and medical screens without prior authorization, and a method to add newborns and adopted children to existing family policies without risk of refusal, despite any medical conditions the children may have.

More serious items include a requirement that policies which cover diabetes must cover all medically necessary prescribed diabetes equipment too, and that insurance companies must treat all allopathic, osteopathic and chiropractic physicians equally, giving consumers numerous options in their choice of healthcare providers.

All types of insurance coverage are available in Arizona, including Major Medical, HMO, Preferred Provider, and Health Savings Account plans.  Choose the deductible amounts and covered items that best fit the needs of you and your family.

More information on Arizona health insurance is available on our site, or through the Arizona Department of Insurance website. We can also help you find health insurance carriers in Arizona or any state.

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Listen to Arizona Health Insurance
Listen to Arizona Health Insurance

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Lessons From The Minneapolis Bridge Collapse

August 4th, 2007 by Jeannine C

The Twin Cities are still in shock over this week’s disastrous I-35W bridge collapse, as everyone across the country searches for a way to help.  Sadly, once the initial reaction wears off, the families of the injured and lost will have to deal with a new reality incorporating the human cost of the catastrophe.

Fortunately the insurance industry has promised to handle claims from the incident promptly.  “There will be no exclusions - it will all be coverable,” said Mark Kulda, a vice president for the Insurance Federation of Minnesota, according to the Insurance Journal.  Initially the claims will be against auto insurance, worker’s compensation, commercial property damage, and life insurance policies.

It made me think about whether I am prepared should something unexpectedly happen to me.  This is the true purpose of insurance - to be ready for anything.  Though we all hate to think about it, life is a fragile gift which can change at any moment.

In case of an accident, I’m covered by my employer’s health insurance policy, but I know many people that are self-employed and responsible for their own healthcare.  Fortunately, by spending a little time online, it is possible for these individuals to find affordable self-employed medical insurance for themselves and their families.  This week’s events proved just how important it is to be prepared at all times for medical emergencies.

Man or woman, young or old, if others depend on you for financial or emotional support then you should consider some type of life insurance policy in case something should happen.  Thanks to the relatively low cost of term life insurance, there are policies for almost any budget, which will financially help your family through the difficult transition

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Listen to Lessons From The Minneapolis Bridge Collapse
Listen to Lessons From The Minneapolis Bridge Collapse

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