health insurance?

tarac

Grumbler in Training
Joined
Mar 2, 2006
Posts
7
Loc
Augusta GA
Hi all. I was wondering if anyone could recommend a provider for us? Someone who works to provide frame shop owners and their employees with reasonable coverage....

Can anyone give me some advice?
shrug.gif
 
Health insurance is under the control of the state insurance commissioner in the state where you live. Advice from outside the state might not be pertinent to your situation.
You might check with local business organizations or you local Chamber of Commerce to see if there are any group policies you can get through those organizations.
The state of Florida has a small group policy that is managed by Blue Cross specifically set up for small business owners. It is good insurance, but is very costly since there is no qualifying as long as you have been in business for a set amount of time, you work at your business a certain amount of hours, and other than investments it is you primary source of income.
Unfortunately the health insurance agent's primary job is to sell the product. If they were to advise you on what is best for you and your needs, they would be giving away their commissions.
You would be best served to start buy calling all the insurance agents you can and see what plans are offered. It is going to be real tough to compare apples to apples since they all design the product differently (I think specifically so you can't do a good comparison).
Also call the local office for the state insurance commissioner and see what information they might have.
Talk with other small business owners in your city to see what they are doing.
 
Affordable is a relative term. And sometimes the answer is "Can you afford to be without it?"

If you see a benefit company specializing in small business benefits at a very attractive price, either run as fast as you can the opposite direction or verify their good standing with the state insurance agency ( which most likely will not be the case). I know from experience and I thought that I had asked all the right questions. There is class action civil suit in the federal system. There's also a federal grand jury still working on the criminal side and I sure hope to see someone go to jail for spending premium moneys and have several million dollars in outstanding claims for individuals who had to pay up out of their pockets or be sent to collections.

Wally's comment regarding Blue Cross Idaho was the best option we had available and after the trouble from the previous program, all the physicians will like us much better and I can sleep at night without worrying about thousands of dollars of unpaid claims to eventually cough up myself.
 
When you're shopping for health insurance, don't worry about a plan that will pay for every office visit and annual physical. Those plans are fading into the sunset. Think in terms of a high deductible* and the highest possible lifetime maximum, if any. That will keep the premiums down somewhat.

It's not hard at all to run up a million dollars in claims.

If you are currently uninsured, pay attention to any pre-existing clauses in your new policy. With it, if you have had a gap in coverage over, say, 63 days during the twelve months prior to a particular date of service, claims may be denied due to pre-existing conditions. It's then up to your doctor to prove you haven't already been treated for the same diagnosis before you had your current insurance.

When you're thinking about those high premiums, remember that about 78% of the premiums collected by the insurance company go right back out to pay claims. That percentage hasn't changed in a very long time, but medical costs in general have skyrocketed. Just because you're healthy and never go to the doctor doesn't mean there isn't someone out there with the same company who's in end-stage renal failure.

Spreading the risk is the concept behind group health insurance. Individual health insurance is much harder to qualify for. If you really need it, you probably can't get it. (Nobody will sell fire insurance to someone who's house is already burning.)

This is one of many reasons why I'm no longer self-employed.

*My family of four must meet a $4,000 annual deductible before my plan will pay a dime and I work for the insurance company.

[ 03-10-2006, 11:45 AM: Message edited by: Ron Eggers ]
 
I keep trying to figure out if the world would be a better place if health insurance didn't exist. I think doctors and hospitals inflate their charges to insurance companies, since they know that they will not get all of the money back, and in turn, the insurance companies charge high rates to pay for what the doctors charge... Plus all of the money that goes to filing the paperwork alone. I've been looking into the Health Savings Accounts, and they seem like a good idea, as long as the money rolls over from year to year, and continues to build. I think some of them run sort of like IRA's, where you can put money into them pre-tax, as long as it is used for medical expenses. In the case of a HSA, I think they tie in somehow with an insurance company with high deductibles, so that in the case of a catastrophic medical event, the insurance company would cover it. I may have this whole thing all mixed up, but I like the idea of having an account for medical expenses that remains MY money, and eventually can be liquidated for my own personal use.
 
There are many factors in the rising cost of health insurance that have nothing to do with the care you receive. The product I mentioned above is a case in point.
The qualification has nothing to do with preexisting conditions (as mentioned by Ron). If you are a business owner and make your living at the business and have been in business for 6 months you qualify. Their have been instances of folk that qualify having quadruple bypass surgery the week after the insurance is issued. The state controls the premiums, and the insurance company that administers it (BCBS FL) is pretty much taking a beating on this project even though it has some of the highest premiums of all their products. It is available to small groups only (1-9 people I think). My wife is an auditor for this product. Her job is to ferret out the cheaters.

So the insurance business is one of many reasons that health insurance is expensive. There are the doctors that inflate their charges so that the amount allowable from the insurance industry will increase over time. There are the manufacturers & pharmaceuticals that have to cover R&D and learjets, there are lobbyist that have to be paid to get the hospitals message to the politicians, there are organized health care workers that want a pension, there are fraudulent claims against insurers and government agencies, there is a huge bureaucracy on all sides to coordinate and support, and last on this list and my personal all time favorite, the one thing that adds the most to the cost of health care while furthering their cause above all others is (ta-da) the legal profession.

So Framinzfun, there are some really good minds out their trying to figure out how to rein in the cost of health care and private accounts are a possibility for some. I don't think that those who can't afford health care now are going to be able to afford to be self insured, but maybe something will come of it in conjunction with some other program. But you can rest assured that as long as their are bazillions of dollars changing hands there are going to be many scavengers trying to get a piece of that pie.
 
the one thing that adds the most to the cost of health care while furthering their cause above all others is (ta-da) the legal profession.
Ah, yes, how can I forget the lawsuits.
 
"Ah, yes, how can I forget the lawsuits"

It's not JUST the lawsuits. The doctors are now ordering MANY MANY more tests than they previously would. They are in SERIOUS litigation avoidance mode. (Also, the "for-profit" hospitals require them to "keep their numbers up" so many people visit more often than they need to and get more tests.)
 
I'd like to see a reasonable discussion here on HSAs. Our local paper ran a pro and con on this last week: it was more a pro and a diatribe: the writer against HSAs basically said: If the poorest person can't do it, then no one should be able to. That makes no sense to me and does nothing to illuminate valid reasons against them.

There's another issue not mentioned yet: personal responsibiity for your own health. If your deductible is $5,000 (which is really Major Med), and you pay for visits, meds, etc., maybe you're more careful about your lifestyle and how you spend your medical dollars. Before anyone vilifies me for ignoring the truly ill, I'm speaking of only those choices under your own control, such as diet, exercise, and tobacco avoidance.

We had a very high deductible and did manage to stay relatively healthy, so an HSA would work for us. Will someone espouse a reasoned other view, hopefully leaving political speech out of it?
 
HSAs are meant to be tied to a high-deductible PPO plan. This is what my family has and I make sure the contributions to my HSA will at least pay the $4000 family deductible we must meet before our plan begins to pay.

Once that deductible is met, the plan pays 100% - no copays, even at the pharmacy, so we know the maximum out-of-pocket is going to be covered by the HSA.

It's certainly not a cure-all and it does force you to pay attention. You can easily let those deductibles pile up and, if you are making regular contributions to the HSA throughout the year, and you happen to get hit with a bunch of medical bills early in the year, there's no guarantee the money is going to be there.

HSAs are a tool and their utility depends on the diligence of the user. I can't imagine anyone suggesting they are intrinsically good or bad.
 
I cannot remember where I saw it and could easily be incorrect, so I am hoping that possibly Ron might have more knowledge. But, it seems that what I remember was the comparative costs of administering various types of insurance (Health, Life, Auto, General Liability etc)

The costs assigned to paperwork and administration of medical was exponentially larger (obviously as a dollar amount, but also as a percentage of premium) than any other. The amount spent (administratively) was so far ahead adding significantly to the overall premium structure.

It has become such a bureaucratic nightmare

Can you imagine if we had to put up with the same things to insure our cars, too

Did you know that the pecentages of people without car insurance vastly out distances those without medical insurance?

Do you think the government ought to force businesses to provide auto insurance for their employees?
 
You're almost certainly right about the administrative costs of health insurance, Bob, though I don't know anything about those costs for other types of insurance.

Doctors complain that claims are denied, or pended, because of a missing code. Insurance companies complain because incomplete claims are submitted. I see claims every day for things like Misc Drugs. Huh?

This is all aggravated by the fact that, for the most part, medical records are still kept on paper and about half the claims are submitted on paper. I saw an emergency room claim the other day that was submitted with ninety pages of medical notes. Somebody has to write those and somebody else has to read them before anything good is going to happen.

Claims go through the mail, get lost or misdirected and are frequently illegible if/when they arrive. The provider doesn't get paid, at least in a timely fashion, so the patient gets billed and wonders, "Why do I have insurance?"

It is a gigantic mess and there are no easy answers.
 
Ha, Bob, if we all rode bicycles, then we'd have less of a need for both! hehehe, sorry, couldn't resist. ;)

Tara, I get my health insurance through PPFA, I think it is Golden Rule. It is a high-deductible (maybe $2500.00 for a single; me) plan like what Ron mentioned and it has served me well. I have not used it at all *knock wood.* It is not cheap, I think it is close to $200.00 per month. I have it mostly for catastrophic coverage. All day-to-day health care is out of pocket and that's fine by me.

Cathie, there was a time at the beginning of my business owner career (19 years ago) that I had NO health coverage. You betcha it made me look VERY HARD at my role in my own health care. I made some changes back then that turned out to be permanent. I could preach on and on about them, but for now I will say that they had everything to do with diet, lifestyle and exercise. To this day I am grateful for the circumstances that nudged me into these changes. I can't see how this could be implemented without growing the mountain of bureaucracy already in place, though.

Ron, man, you are my Personal Insurance Guru!

edie the nopreexistingconditions goddess
 
Ron-That review was contrasting the skyrocketing increases of medical vs all others and one of the contributing factors (at least, that's how I intrepreted the analysis)was the significant costs associated with processing the claims.

One thing they did say was that the expertise of the medical customer service personnel was significantly higher due to the demands of the job and most of these skilled professionals were making 6 figure incomes whereas the Life service reps could be blathering idiots (I mean the applicant is dead or not dead-how hard can that be)LOL

I just remember that the costs of processing a medical claim was way more expensive than a car accident or home casualty claim. Of course, unless there were any bodily injuries. And then, we started all over again
 
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