Employer health insurance

Are you smarter than congress about health care cost?

This might seem obvious but to properly address an issue you must first understand the problem you are trying to fix. Well clearly our legislators, the media pundits, and most of the clamoring public seem to be ignoring the need for understanding the problem in discussions of Health Care cost and how to pay for it.

So let’s just dive right into the healthcare “cost” issue.

Why is it important – This goes way beyond partisan bickering and protecting political turf. Which also is why it cannot be corrected with hurried and poorly prepared legislation.
This is about you with your injured child – “Do you have insurance? How will you pay for this?”
This is about you losing everything because you – had a heart attack – lost your job – lost your insurance and now face $200,000 in medical bills you cannot pay.
This is about a national cost item that cannot be paid for in any governmental scheme that does not include care restriction and increased taxation. Yes – if you consider unlimited health care a basic right for everybody, that is true!

Language – words matter and if you don’t understand the language, you not only cannot fix the problem you may inadvertently make it worse. We all must differentiate between “Health Care cost” and “Health Insurance.” They are related but not the same:
A. Healthcare cost – this is the actual cost of medical treatment and related services. This exists if you have insurance or not. This is what nobody can afford to pay, and WHY you need insurance.
B. Healthcare insurance – this is a funding mechanism designed to “pool” risk and spread the cost. This is how we collect a relatively small amount of money from healthy people to pay the bills for somebody who needs care. This is how we as a society pay for all those healthcare costs.
C. Access to “Healthcare” – This is the ability for a person to get a healthcare professional to treat them. Everybody has basic access to general healthcare and emergency services. What you might not have is enough money or “Insurance” to pay for your treatment.

So the next time your hear somebody say “Healthcare is just too expensive we have to beat up the insurance companies”, quietly know that they are uninformed.

Economics. There is at least one un-refutable truth in economics. Money coming in must be bigger than money going out. Even governments cannot live forever if debt exceeds revenue. Eventually even government runs out of your money and your ability to create more GDP.

The problem – So the problem is the “Cost” of healthcare. How do we address that?
First it is critical we all stop blaming and finger pointing, we need to talk and agree on a few things.

Try this approach – you do not get to complain unless you have thought about it and bring forward an idea to solve the problem. You don’t have to be right the first time, but you do have to be part of the solution and not just some anonymous internet loudmouth complaining.

Start here:
Problem    National Health Care cost ___________________________________________________________________________

Solution    My idea to provide care and pay for it ___________________________________________________________________

To paraphrase a credit card company – what’s in your mind? How would you approach this problem?

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Do you really need to outrun the bear or just be self-insured?

Stop and take a breath because if the term “Self-Insurance” made you stop breathing, you need to relax and keep reading.

The purpose of this post is to introduce you to a concept, not to get real technical.  I will get technical in future messages.

There is an old joke that goes like this. Two guys are camping and one of them sees a bear coming into the camp. He begins to put on his running shoes. His buddy says “Why the shoes…you can’t outrun a bear?” The guy with the shoes says “I don’t need to outrun the bear I only need to outrun you!”

So, you might now be asking, how does that relate to being self-insured?

What if this year, your medical plan did not have a rate increase but all of your competitors saw 10% to 45%? That might be between $30 and $135 per month, per employee assuming an average cost of $300 per employee. Would that give you a competitive edge?

Read more…

For more information, contact Bill Weaver, Focus Benefits Group, 602-381-9900.

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What do you mean my doctor is not accepted in your network? I asked if they accept my insurance before I went!

I read a post in the NAHU agents blog today that said “..Always add the caveat that the client needs to confirm with the doctor/hospital that their insurance is in fact accepted, ideally in an e-mail.”  (NAHU (nahu.org) is the National Association of Health Underwriters and is the professional organization for people like me who work in health insurance and employee benefits.)

OK back to the subject. Yes it is important to ask if your physician “accepts” your  insurance but it is even more important to ask  “Are you a contracted provider?”

The majority of medical providers will say yes if you ask if they accept your insurance. (unless it it Medicare and they may say they do not accept Medicare patients.) This does not mean they will be “in network” and thus be subject to the contracts that limit what the physician may charge you.

Here are some terms you need be aware of:

Contracted Provider: A medical provider who has agreed to a contract to provide services for a medical plan that you are a currently covered by.

Balance billing: If you use a “non contracted” provider they may accept what your insurance pays and then bill you for the “balance” which is whatever they feel remains of the bill.

Out of Network: This refers to a provider that is not contracted with the network of medical providers you have an agreement with. They may tell you they “accept” your insurance but they do not have to accept any limits from your insurance nor PPO network.

Read more

 

For more information, contact Bill Weaver, Focus Benefits Group, 602-381-9900.

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