Health Insurance Question for fulltime players

[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]

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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.

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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]

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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.

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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]

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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).

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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.

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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. [img]/images/graemlins/confused.gif[/img]

Thanks,
J

[slavic]

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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.

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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.