OT- Health Insurance question, any agents/experts out there?

[Rigmaster]

OK,

so I've been living on the edge, without health insurance for about 2 years now- since being laid off from my previous job after 15+ years. I've been paying ~$350/mo for BCBS insurance for my wife + 3 year old son, but the additional cost for myself was just too much.

We spoke to an agent today about some insurance through "Alliance for Affordable Services", backed by Mid-West Life insurance of Tennessee (we live in NC). It all sounded great, almost too good to be true- they can cover all 3 of us for less than BCBS coverage for just my wife + son- for a bit less coverage. We completed the application, and got the paperwork. It all sounded good, but I wanted to read over the info to make sure we were not making a bad choice. One thing that is now catching my eye is this- "Surgeon benefit= 80% up to the maximum benefit option $3000"..... Now, it seems to me that you'd be hard-pressed to get a surgeon to do much more than remove a splinter for $3000. The more I read over this form, the more questions are popping up.

Anyone on the board familiar with this company or this type of insurance??
They claim to be "affiliated" with a group called "Alliance for Affordable Services", which is supposed to be a non-profit group that allows them to get group rates for insurance, as well as all sorts of other products and services, from office supplies to hotel rooms to rental cars.
I am planning to call the NC Dept of Insurance on monday to see if they are legit, or if they have many complaints against them- but I'd like to get as much info as I can. I did a Google search, but only come up with some class action suits, and some organizational problems that they have had in the past- certainly not an overwhelming negative response, but it brings up some more questions.

Any info or input would be greatly appreciated.

Thanks!

Bret.

[Kalevera]

Bret, you don't even want to KNOW what BCBS extracts from my family. Some people just don't know how lucky they are when it comes to employment benefits. One thing that we did to help save money was to start a "group" within the family. Doubtful that would work given that the junior Rig' is pushing 3 these days, but it helps defray some of the cost.

Best, whit

[632 Regal]

Bret, I went with an individual representative that sports about 100 different companies and goes with what is important for you and your family first. I hooked up with some company that is inexpensive since there is no health probs and the co-pays and deductibles are less than 5k....well my kid got sick and I couldnt cover the deductibles and co-insurances, I mean who the hell can tell. anyways the plan is great as long as you dont need it. There is no good deal as far as I can guess and if you arent a ****ing lawyer youll never know what isnt good until you need it...this is organized crime your talking about so definetly watch the P's and Q's...

good luck bro!

[MBXB]

Bret,

You have email.

[Incantation]

hey mang

as a financial planner i do integrate health benefits into plans for many clients/businesses that i have worked with. i would be more helpful if i knew the american system (canadian here) but generally speaking the below holds true for most developed nations with health plans:


the bottom line amongst these is that it's a very level playing field. there isn't one that is particularly better than any others on a whole.

what you will find, though, is that many plans are competitive in a specific area at the cost of not being so competitive in other area(s).

the trade-off will always involve these factors:
-monthly premium
-deductible
-co-insurance factor
-benefits

i would encourage you to speak to a broker or financial planner about it; you won't need the lawyer; someone with experience should know the ropes. getting a few opinions is always a good idea too..

hope that helps

[Tiger]

Hey Bret,
I am sorry to hear that you got laid off. That is a shame. I am not an agent but I do know extensively about health insurance as I was in your situation too... My matter is worse as I am an individual.
I took a look at some of the plans I see on http://www.ehealthinsurance.com. You really must watch out on the deductible and the copayment. These two concern me very much. The deductible means that if in event of major bill as surgery or hospitalization, these are the amount that you... YOU... must spend before the insurance bill pick up the rest. Some I see is like $5000! We'll compound this problem with copayment...

The copayment, not office visit, means how much of the negotiated major bill you must pay before the insurance will pick up the rest. So if you got a bill for $10,000 and you got a 30% copayment, you got to pay $3000 and the insurance will pay the rest.

Now here is the catch, if your deductible is $5000 and your copayment is $3000 for 30% of $10,000... it means you must pay $5000 and the insurance will cover the rest.... not $3000. The $5000 apply for each year... but heck, only one bill bill will wipe you out! $5000 is alot of bills to pay before insurance will fork out their money.

The above are PPO plan which give you alot of choices on who you will visit and who will do the major surgery. I don't see HMO plans on the above site... but it should be available in your state... If I were on budget and see my family doc on their list, I would choose HMO. It is cheaper and no major deductibles to deal with. I don't know what city you live in but I punched in Aberdeen zip code.

As for the plan you just signed up,,,, DUMP IT. Stick with major insurance carriers... call them up and ask them to send you the info packet so you can make informed choices. Don't go back to that agent you were with...especially he pushed you into this plan... go to another agents to do more shopping.

From the prices I have seen, I can see your family covered including yourself for the same price as you are paying through COBRA. Maybe cheaper...

[Badkrma]

I am an agent in Nevada and I can only give you this advice, as with anything, you get what you pay for. I have to go over to the office today, I will look that company up for you in the BEST rating guide and let you know their financial strength.

Tiger, You are a little off. If you have a $5000 deductilble with a 30% coinsurance and a stop loss of $10,000..... For a hospital bill that is $10,000 you will have your deductible of $5,000 and then you will pay 30% of the remaining $5,000 or you will hve to pay $6,500 for that $10,000 bill. You will only have to have another $5,000 in insurable bills to have the plan pick up at 100% (stop loss being $10,000 in bills after your deductible is meet).

PM me if you have any questions.

Stephen

[SRR2]

I'd add to your list, at least for PPO kinds of plans, how widely the plan is accepted and what kinds of discounts they've negotiated. The latter is nearly impossible to discover, but is almost as important as the premium. A cheap plan with little or no discounts can hammer you as badly as one with higher premiums and a lower cost network of providers. One way to find out would be to chat up the insurance coordinator at a mid-to-large provider and find out who gets the best pricing deal. I know that the BCBS plan that my wife and I have offers HUGE discounts off the providers' billed rates. And that translates to much lower overall costs. And the advangtage of BCBS is that they're accepted nearly everywhere. Oh, and then there's the mail order pharmacy. Can't beat that with a stick.

[Tiger]

Oh my gosh... that's even worse!

[dynamic_e]

I used to sell for Midwest. Not really a good product for a family. The deductable idea is great for a healthier family, but Midwest is known for denying claims, and not covering what agent's say is covered. They are cheap, but there is a reason for that. $350 for BCBS is nothing compared to the cost out here in MA. It's $350 for a single person here.

In NC, look into Fordis/John Alden for good coverge for low cost...

Just my 2cents as a finanical advisor/insurance guy.