Health Insurance Question for fulltime players

[RamGad]

Death Valley's post about being hospitalized for a week really got me worried. I've been playing full time for about a year now, and I'm still young enough to think I'm invincible so I've procrastinated on getting health insurance.

I was wondering if anyone could tell me the best health insurance plan is. I talked to some dude a month ago or so, but he seemed way to anxious to sign me up. Not sure if he just gets a finder's fee or a lifetime cut of my payments, but I had a feeling he was recommending the company that gave him the best kickback. Is there any company that stands out way above the rest, like ING for savings, or Progressive for car insurance? Any advice would be greatly appreciated. Thanks so much in advance.

by the way, I don't have any health problems. E.R. coverage would probably suffice.

[RollaJ]

get married /images/graemlins/wink.gif

[Michael O'Malley]

[ QUOTE ]
Death Valley's post about being hospitalized for a week really got me worried. I've been playing full time for about a year now, and I'm still young enough to think I'm invincible so I've procrastinated on getting health insurance.

I was wondering if anyone could tell me the best health insurance plan is. I talked to some dude a month ago or so, but he seemed way to anxious to sign me up. Not sure if he just gets a finder's fee or a lifetime cut of my payments, but I had a feeling he was recommending the company that gave him the best kickback. Is there any company that stands out way above the rest, like ING for savings, or Progressive for car insurance? Any advice would be greatly appreciated. Thanks so much in advance.

by the way, I don't have any health problems. E.R. coverage would probably suffice.

[/ QUOTE ]

From 2000 - 2004, all I did was play poker, travel around the world and goof off. I thought I was invincible, saw no need for health insurance and blew my mom off when she would send me emails and little notes with information about health insurance. For 4 years I never had a need for it.
In 2004 I went to work at Wynn and picked up health insurance. Last month I ended up in emergency surgery with a ruptured appendix. I was in the hospital for 4 days and out of work for 2 weeks. Last week I got the last bill, a grand total of just over $50,000.
Coincidentally tomorrow is my last day at Wynn, I am going back to playing, traveling and goofing off. I will definately have health insurance this time around, and I would advise anyone else to do the same thing.
Blue Cross Blue Shield has been recomended to me. Look for something that covers major medical, unless you are looking for a plan that covers the small stuff too.

[otctrader]

Health insurance products are structured by the state you live in, so the coverage provided by a major national firm such as Aetna or Blue Cross can vary widely depending where you live.

Individual plans for the most part stink compared to the big national plans offered to employees of major corporations. The coverage is less, deductibles higher, and premiums are far higher.

Some states will let you get a small discount by filing for health insurance as a "group of one" or sole proprietor, if you file taxes with a Schedule C and/or get 1099 (independent contractor) income. Some states also offer subsidized health plans, but qualification is often based on income; New York is <$25k for individuals, i.e. poverty level.

Your best bet is to do research on the web pertaining to your state, then talk to several agents. Back when I was looking, I found most were either uneducated or didn't care, since my individual coverage was a waste of time for them (they make their money selling to large groups). I'm personally leery of the "ER only" plans since non-ER issues can still make you miserable and poor too.

Don't skimp. I pay over $5000 a year for my individual coverage in New York (tax deductible if you file a Schedule C), and although the only doctor's visit I had in the last 12 months was my annual physical, the peace of mind is worth it.

[RamGad]

Thanks so much guys for your replies. Just for the record, I'm in Wa state if anybody can recommend it. Thanks in advance.

r.g.

[jasonHoldEm]

I'm also shopping...I found www.ehealthinsurance.com (http://www.ehealthinsurance.com) via google. Don't know much about the site (and personally I don't think I'll order health insurance via the internet), but it looks like a good place to get started for informational purposes.

J

[scott8]

I am 25 and healthy and a full time pro.
My advice is you MUST get health insurance!

Its usually around 100$ a month, and one of things that you hope you never need. But could you imagine having your entire bankroll wiped b/c of an accident?

Or worse, not being able to afford something b/c of lack of insurance?

I go through Kaiser which makes mine around 125$ a month, but there are cheaper alternatives.

-SC

[naschburger2]

I am an insurance agent in arizona. If you travel to poker tournaments in different states. I think blue cross blue shield might be a good alternative since you may use there preferred provider networks in any of the states. They are also going to be there to service you when you need them. I might also suggest an HSA which is a combination of a high deductible health insurance plan and a tax advantaged savings plan that can be used to pay your medical, dental or even vision needs with pretax dollars or used for retirement in the future. If you have any questions let me know and I will try to answer them.

[jasonHoldEm]

Could you give us a quick overview of how a HSA works (or perhaps more importantly how to get one), it's something I want to do (I have a general idea how they work) I just don't know how to go about signing up.

Thanks,
J

[StacysMom]

I posted this in another thread and got no replies, I would like some /images/graemlins/wink.gif

I am still on my parents insurance so I am rather ignorant on this issue.

But I can still make an anology that is up for criticism.

Insurance is essentially playing a lower limit game with an unbeatable rake structure because you don't want to maintain the becesary BR for the big game.

Does anyone here just essentially pay themselves premiums in a designated "health" account? THis would avoid the rake.

[scott8]

[ QUOTE ]

I am still on my parents insurance so I am rather ignorant on this issue.


[/ QUOTE ]

[slavic]

Do a search for health insurance plans offered in your state and then look at their disaster insurance policies. IF you are sufficiently bankrolled what you will find are relativly low cost policies that cover nothing until you spend 10k and then they kick in.

This likely won't cost you more than a few hundred a year, and if you get hurt or sick, it will save your hide. In the past year I have racked up a very high 6 figures hospital sum for two health issues, and 18 months ago I would never have even guessed I would have had a problem. The point is that you never can tell and this is not an area that you really want to gamble.

[StacysMom]

well scott, I truly appreciate your constructive comment. I hope to hear more from you some day! I especcially like the part where I acknowledge a lack of knowledge, and then you point out that I don't know everything. Great Post

[BigBaitsim (milo)]

Not having health insurance is very dangerous. While you are unlikely to have a severe or costly injury/illness at a young age, if it happens you can be financially crippled for years to come. Add to this the financial disincentive for seeing a doctor when you should (and thereby missing a serious problem that could have been caught early) and this one's a no-brainer.

[slavic]

[ QUOTE ]
I posted this in another thread and got no replies, I would like some /images/graemlins/wink.gif

I am still on my parents insurance so I am rather ignorant on this issue.

But I can still make an anology that is up for criticism.

Insurance is essentially playing a lower limit game with an unbeatable rake structure because you don't want to maintain the becesary BR for the big game.

Does anyone here just essentially pay themselves premiums in a designated "health" account? THis would avoid the rake.

[/ QUOTE ]

Let me offer you a game. (hypothetical)

We will use a fair random number generator ok.

it will throw out an integer between 0 and 99. 99 of these numbers will be safe for you and you will win $1400, if the one off number comes up, unfortunatly we have to kill you.

Your EV is very high on this, how many times do you want to play?

[jasonHoldEm]

[ QUOTE ]
pay themselves premiums in a designated "health" account? THis would avoid the rake.

[/ QUOTE ]

Statistically speaking this would work in theory, but it sure would suck if you were the one who got cancer a year after you started this savings plan. Also, I think the very large majority of people don't have the discipline to handle this sort of savings plan (I know I'd be buying a new house/car/pizza with the money).

J

[scott8]

[ QUOTE ]
well scott, I truly appreciate your constructive comment. I hope to hear more from you some day! I especcially like the part where I acknowledge a lack of knowledge, and then you point out that I don't know everything. Great Post

[/ QUOTE ]

No problem.

I liked where you admitted to knowing nothing and then proceeded to make an analogy as if you did.

Perhaps, if you had simply asked a question concerning the importance of health insurance a different response would have been appropriate.

However, you went the jackass route, and look where it got you.

[otctrader]

Another caveat as it pertains to MSA's is that you will incur charges from doctors/hospitals at full retail cost, which can be up to 4-10x what the insurer negotiates. I look at my statements, and routinely see doctors bill for $1,000+ and get paid less than 25% of that by insurance.

Under any major insurance, of course, you aren't responsible for the difference - however under an MSA you're pretty much forced to pay the arbitrary charges a doctor sets (take it or leave it).

[Stellastarr]

Move to Canada.

[slavic]

[ QUOTE ]
Another caveat as it pertains to MSA's is that you will incur charges from doctors/hospitals at full retail cost, which can be up to 4-10x what the insurer negotiates. I look at my statements, and routinely see doctors bill for $1,000+ and get paid less than 25% of that by insurance.

Under any major insurance, of course, you aren't responsible for the difference - however under an MSA you're pretty much forced to pay the arbitrary charges a doctor sets (take it or leave it).

[/ QUOTE ]

To the best of my knowledge doctors rates are negotiable by an individual. It may not seem like it and if you accept service before hand, it likely won't be, but you are able to work with most doctors on costs if you are paying by yourself.

The best examples of this are the more commercial medical procedures offered in the US. Take Lasik, or cosmetic surgery for example.

[ddubois]

"Hi, I severed my finger in the lawnmower, and I'm thinking of having it re-attached. Can you provide me an estimate for this service? ... Wow, that's alot! Would you be willing to come down on that price?"

[SirArthur]

Call Blue Shield and ask them to send you some information, an application etc.

I have an individual PPO plan with Blue Shield, it costs me around $100 per month. I chose one of the cheaper plans; thus I have a deductible of $2000.

Came in handy though, because while playing football last December I broke my ankle, tore ligaments, and amassed a few thousand worth of medical bills with tons of X-rays, a bone scan, physical therapy, etc.

Get health insurance now, anyway you can.
Or you can sue to gain the rights of an illegal alien, and get your health care for free like they can.

[otctrader]

[ QUOTE ]
Get health insurance now, anyway you can.
Or you can sue to gain the rights of an illegal alien, and get your health care for free like they can.

[/ QUOTE ]

Yeah isn't that great; we have to shell out thousands for insurance yet illegals and convicted felons enjoy top-notch care for free.

[Benjamin]

[ QUOTE ]
Another caveat as it pertains to MSA's is that you will incur charges from doctors/hospitals at full retail cost, which can be up to 4-10x what the insurer negotiates.

[/ QUOTE ]

One distinction: HSA vs MSA. Health Savings Accounts are distinct from (newer and better) than Medical Savings accounts.

And my understanding of HSAs is that you typically get to use your insurance card on stuff you are paying yourself before you hit your deductible limit to secure the negotiated lower rates.

B.

[naschburger2]

Let me clarify a few things. First, the health insursance on an HSA works just like a high deductible health insurance plans and therefore otc is incorrect about paying higher doctor and hospital chages. As long as you opt for the preferred provider option and go to docs and hospitals on the list you pay the same rate as the insurance company until your deductible is met.
There are different deductibles available and they are higher for families than for singles. You pay the deductible and then the insurance company pays up to 100% after that point each year. You can contibute up to your deductible each year to the health saving plan which may be offered by the health carrier or by an independent bank or security firm. The health savings plan works like an IRA all deposits are fully deductible and can be taken out for income after age 59 1/2. The big advantage is that the funds can be used at any time for paying medical, dental, vision benefits and the health insurance premium is less since it has a high deductible. You are usually given a debit card or check book to pay for these bills from your HSA and those for health insurance should first be repriced by the carrier at the preferred provider rate but just use it directly for dental and vision. The change from MSA to HSA made this plan available to all workers and I think it works great for poker players that delare income since you are gambling a smaller premium that you will remain healthy but if you do have a major illness it won't bankrupt you. Also, with an income that is very variable you can deposit to the HSA when you are doing well and just pay the health insurance premium when things are not going well. Sorry about the ramble.

[Jaquen H'gar]

[ QUOTE ]
[ QUOTE ]
Another caveat as it pertains to MSA's is that you will incur charges from doctors/hospitals at full retail cost, which can be up to 4-10x what the insurer negotiates. I look at my statements, and routinely see doctors bill for $1,000+ and get paid less than 25% of that by insurance.

Under any major insurance, of course, you aren't responsible for the difference - however under an MSA you're pretty much forced to pay the arbitrary charges a doctor sets (take it or leave it).

[/ QUOTE ]

To the best of my knowledge doctors rates are negotiable by an individual. It may not seem like it and if you accept service before hand, it likely won't be, but you are able to work with most doctors on costs if you are paying by yourself.

The best examples of this are the more commercial medical procedures offered in the US. Take Lasik, or cosmetic surgery for example.

[/ QUOTE ]

You shouldn't confuse apples and oranges, cosmetic (i.e. unnecessary) procedures with other medical care. Most non-cosmetic procedures are for the most part non-negotiable unless its provided free and even then, there may be problems. If a physician accepts Medicare patients then he can't be cutting deals with his other patients unless he cuts the same deal with them, at least according to the U.S. government. CMS (Medicare) considers this as the doctor defrauding them by not giving them whatever discount he gives you. Doctors can even get into trouble by giving away free medical care if they don't do enough to fully document the patient is stone ass broke. Usually this documentation is more hassle than its worth. In addition, the way most medical practices are set up, the doctor likely doesn't even know how much you are being charged for his services. What? Yeah, that's right. Generally the doctors are very ignorant of how much you are being charged and somewhat ignorant of insurance/Medicare reimbursement (they can ballpark it). Charges are set every few years commensurate with surrounding doctors' charges. The doctor marks a code on the billing sheet documenting his level of care. This sheet goes to the billing office/service who applies a predetermined price and bills you. Insurance companies disallow some of these charges based on prior negotiations with the doctor. Medicare doesn't negotiate, they simply set a reimbursal rate and the doctor can accept it or not.

Here's an real life example with real charges: placing a central venous catheter in a patient, can be done at bedside with local anesthesia but usually done in an OR.

Doctor's charge: $750
Medicare allows: $239
Blue Cross pays 120% of Medicare allowance: $286

Your bill will look like this:
BLUE CROSS patient (if deductible already met): Charge $750, adjustment -$464, BC pays $228, you owe $58
NO INSURANCE patient: Charge $750, you owe $750.

So why do physicians charge so much if it is going to be disallowed? Why charge $750 if Blue Cross will only pay up to $300 and Medicare less than that? Because Medicare will adjust what they pay down. If a doctor only charged $300 for the above procedure, Medicare would only pay about $100. Blue Cross generally sets their reimbursement rates at Medicare + 10-30%, sometimes much higher for specific procedures.

The real negotiation in medical charges for the uninsured is not how much of a discount you are going to get but what the payment plan will be.

In addition, even if you are lucky and get a surgeon to completely wave his surgical fee, you are still going to be on the hook for the hospital or surgical center charges which will easily be 2-5x that of the physician's. Here you are dealing with a corporation and so will not likely to be able to speak one-on-one with somebody with the power to give you a discount.

Take it from somebody that has had this (uninsured status) happen TWICE in the past year, neither my fault. My son was hospitalized for three days. Presumably we had insurance. We get the discounted bills from the doctor and hospital stating what we owed after our specific insurance company disallowed and then payed 80%. We paid. Two months later we get letters from doctor and hospital stating insurance company NEVER paid and we owed the balance. I call my insurance company and get an answering machine, saying leave a message. How does a big (presumably) company not have a live person or automated call answerer. One week after useless trying, newspaper reports my insurance company has gone broke and will not pay anything. Yep, I got stuck with the bills. Fortunately, being very familiar with medical billing, I went through my bills with a fine tooth comb and found several errors that saved several hundred $$. Still, I was out thousands.

[Shoe]

Does anyone know how to get the discounted rates that the insurance companies get? For example... they bill you $500... insurance company says we'll only pay $250 or whatever, and get that rate.

I have a really high deductible and the insurance company didn't lower my charges at all, even though i think they would have if they were the ones paying the bill.

[jasonHoldEm]

Hi naschburger2,

Thanks for your answer, one more question though...can you pay for your health insurance premiums out of your HSA or is it for medical bills only (i.e. doctor hospital, etc)? Perhaps that's a stupid question, but I wasn't sure. /images/graemlins/confused.gif

Thanks,
J

[slavic]

[ QUOTE ]
The real negotiation in medical charges for the uninsured is not how much of a discount you are going to get but what the payment plan will be.

In addition, even if you are lucky and get a surgeon to completely wave his surgical fee, you are still going to be on the hook for the hospital or surgical center charges which will easily be 2-5x that of the physician's. Here you are dealing with a corporation and so will not likely to be able to speak one-on-one with somebody with the power to give you a discount.

[/ QUOTE ]

You are correct in what you point out. You are also correct that the government is suppose to get the highest general discount, you are incorrect in saying that they can not offer a greater discount on a deal basis if there is a compelling documentable reason. Even still they can certainly offer a self pay discount and frequently do, you can check with your phisicians office ahead of time, and like I stated above, yes once something has happened it's too late and really what you are negotiating for is a payment plan. Fortunatly in the US they can't impoverish you over medical bills.

I, like yourself also had an incredible hospitilization bill that actually was a fair bit more significant that wht you are saying. I paid most of it out of my pocket, but the one thing that was made very clear to me is that these items are quite negotiable and that there is room to work out items assuming you have time. Most people neither take the time or have the patience ot do this and an insurance provider normally already has a preset good deal for you, such that it is just better to have insurance.

[naschburger2]

no it cannot be used to pay for your health insurance premiums. I believe premiums for certain other policies like long term care can be paid with the HSA funds. Keep in mind you can use the HSA funds for many items that aren't covered by your health insurance policy such as dental and eyeglasses. If you shop and have any questions feel free to pm me or post here.

[Jaquen H'gar]

[ QUOTE ]
You are correct in what you point out. You are also correct that the government is suppose to get the highest general discount, you are incorrect in saying that they can not offer a greater discount on a deal basis if there is a compelling documentable reason.

[/ QUOTE ]

Actually, I did say they could do this but the documentation can be a pain in the ass. If the physician doesn't accept Medicare, the gov't has no say-so. The way most docs get away with charging less is to cut back on the medical documentation. If the physician provides a level 5 service (e.g. $200 charge) but only documents to that of a level 1 (e.g. $40 charge), then per Medicare/insurance regs he can only bill a level 1. Medicare actually instituted these regs hoping to cut down on what they would have to pay so it is ironic.


[ QUOTE ]
I, like yourself also had an incredible hospitilization bill that actually was a fair bit more significant that wht you are saying. I paid most of it out of my pocket, but the one thing that was made very clear to me is that these items are quite negotiable and that there is room to work out items assuming you have time.

[/ QUOTE ]

Unfortunately, other than a heart bypass, organ transplant, or spinal surgery, most large hospitalization bills are for emergency conditions precluding negotiation ahead of time, but your point is well taken.

[Jaquen H'gar]

[ QUOTE ]
Does anyone know how to get the discounted rates that the insurance companies get? For example... they bill you $500... insurance company says we'll only pay $250 or whatever, and get that rate.

[/ QUOTE ]

If you don't have insurance, you should ask ahead of time if the physician will accept Blue Cross rates/reimbursement. Most will be glad to. The billing personnel for the physician can tell you what Blue Cross pays for each procedure. You just might have to remind them when you get the big bill!

[ QUOTE ]
I have a really high deductible and the insurance company didn't lower my charges at all, even though i think they would have if they were the ones paying the bill.

[/ QUOTE ]

They would lower it even if they weren't paying (i.e. still below your deductible). The charges may not have been lowered because you were billed at exactly or possibly less than what your insurance would pay. If your insurance company agrees to pay $500 for service X, then no adjustment will be made if you are billed $500 or less. Just a thought.

[raisethatmofo]

I just got health insurance this week. I play poker only for money.

I went here: http://www.anthem.com/jsp/antiphona/home.jsp

I got the $120/month plan. I believe it was $500 deductible PPO. It was the B plan on the left side after you get the list of plans. I got the one that paid for doctor visits etc. The works almost. I think the other plans are kind of rip offs. Good company in my opinion. I got health insurance within 2 weeks of signing up. I'll probably save about $500/year on prescription drugs and office visits alone with almost pays for half the coverage right there. No claim forms, either. Not bad.

[Shoe]

Thanks for the info. I never actually called the insurance company to see if I got charged their normal rates or not.

I was charged about $330 to see a neurologist for about a half hour (no special tests or machines were used). I understand they are a specialist and will cost more than a regular doctor, but I thought that price was pretty ridicolous. I paid it because I have a 3k deductible and figured there was nothing i could do.

However, i did not go in for additional tests that she recommended because the damn doctor's office couldn't even give me a quote for how much the procedure would cost. They could not even give me an estimate. (I would have gone to the tests, but I was having a problem with my foot that got better on it's own shortly after my visit). How are you supposed to negotiate a price if they won't even quote you a price ahead of time?

I felt like taking this to court and saying they can't charge me for past consideration or something like that (i know that wouldn't work, but they should atleast be able to give me some rates or something). oh well.

[StellarWind]

[ QUOTE ]
Does anyone here just essentially pay themselves premiums in a designated "health" account? THis would avoid the rake.

[/ QUOTE ]
Even a billionaire should probably have health insurance.

Health insurance is not just risk prevention. You are also buying the insurer's volume discounts, prenegotiated rate schedule (you can't negotiate price in an emergency), and vigilance against mistakes and gouging.

It's a national disgrace that those without insurance pay the highest prices, but it's true.

[Jaquen H'gar]

[ QUOTE ]
I was charged about $330 to see a neurologist for about a half hour (no special tests or machines were used). I understand they are a specialist and will cost more than a regular doctor, but I thought that price was pretty ridicolous.

[/ QUOTE ]

Man, that's stout but I don't know what part of the country you're in. In middle America, I would expect a level 5 (highest) initial consultation to be around $200 for a neurologist. And based on your description of your problem, I would have anticipated only a level 4 visit ($150).

Completely off topic, did you know docs are rewarded for being ignorant? It's true. A specialist sees you. If he immediately knows what's wrong with you and diagnoses/treats it, it's likely a level 3-4. If he documents that he has no clue what's wrong with you (through his own lack of competency or because your problem is mystifying), it's a level 5 and worth another $50-75. Based on this system of reimbursement, I don't think Jesus would have made much money healing the blind and the lame /images/graemlins/smile.gif

[StacysMom]

[ QUOTE ]
[ QUOTE ]
Does anyone here just essentially pay themselves premiums in a designated "health" account? THis would avoid the rake.

[/ QUOTE ]
Even a billionaire should probably have health insurance.

Health insurance is not just risk prevention. You are also buying the insurer's volume discounts, prenegotiated rate schedule (you can't negotiate price in an emergency), and vigilance against mistakes and gouging.

It's a national disgrace that those without insurance pay the highest prices, but it's true.

[/ QUOTE ]

I never knew this was the case. I now see the light... INSURANCE IS THE GG!