Say Anything Blog

A basic tenet of insurance is that you cannot obtain coverage after the damage has concerned.

This is akin to being able to buy car insurance AFTER a car accident.  If that were the case then nobody would have insurance until after an accident.

The same thing goes here.  If you are relatively healthy you can skate along without being insured.  A few out of pocket doctor’s visits isn’t going to cost you as much as insurance would.  But if you get sick, bingo sign up.

Of course that won’t work in the long run because there aren’t enough healthy people paying into the system to keep costs low.

The Debate is over!  Global Whining has been confirmed.

I have been a health insurance broker for over a decade and every day I read more and more “horror” stories that are posted on the internet regarding insurance companies not paying claims, refusing to cover specific illnesses and physician’s not getting reimbursed. Unfortunately, the reality is that insurance companies are driven by profits, not people. If the insurance company can find a legal reason not to pay for something, chances are they will find it, and you, the CONSUMER will suffer. However, what many people fail to realize is that there are very few “loopholes” in insurance policies. The majority of the time, when health insurance is purchased, the prospective insured doesn’t even know what kind of coverage the policy is providing, so there is really no need for the insurance company to try to use a “loophole” to get out of paying for something.  Any insurance agent will tell you, often after your policy has been issued, that the terms of coverage are right in your policy, along with a copy of the application that you signed agreeing to those terms.  Since most people through their insurance policy in a drawer or filing cabinet as soon as they get it, the insurance company is counting on you not reading your policy.  Therefore, no “loopholes” are needed for a legally binding contract that you had 10 days to cancel (10 day free look) if you weren’t happy with the terms of coverage.

Just like you would do, if you were purchasing options for a new car, you have to weigh your “wants” and “needs.” For example, although heated seats are a nice feature, “Do you really need heated seats if you live in Arizona?” Not unless you are planning to frequently drive to Alaska.  So if you are healthy, take no medications and rarely go to the doctor, do you really need a plan with 100% coverage, and a $5 copay for prescription drugs.  Is it really worth it to give the insurance company an extra $300 a month to have this type of plan?

So what happens almost 100% of the time when I ask prospective clients “BASIC” questions about their health insurance policy?  They can’t answer them.  Below are some of the questions that I usually ask a prospective client…. see how well you do in answering them.

1. What Insurance Company are you with and what is the name of your plan?
2. What is your deductible?
3. What is your coinsurance percentage?
4. What is your stop loss number? (This determines your maximum out of pocket expense per year).
5. What is the Lifetime maximum benefit the insurance company will pay out if you become seriously ill and does your plan have any “per illness” maximums? (e.g. the plan has a 5 million dollar lifetime maximum, but only pays out 1 million per illness)
6. Is your plan a schedule plan, in that it only pays a certain amount for a specific list of procedures? (e.g., Mega Life & Health & Midwest National Life, a.k.a. National Association of the Self-Employed NASE)
7. Does your plan have doctor copays and are you limited to a certain number of doctor visits per year?
9. Does your plan offer outpatient prescription drug coverage and if it does, do you pay a copay for your prescription or do you have to meet a separate drug deductible before you receive any benefits?
10. Does your plan have any reduction in benefits for organ transplants and if so, what is maximum the plan will pay if you need an organ transplant or a second transplant?
9. Do you have to pay a separate deductible for each hospital admission or for each emergency room visit?
10. Are there any restrictions or benefit “caps” on out-patient services, such as, physical therapy, speech therapy, chemotherapy, radiation therapy, etc. or are there separate “access” fees for these services?

If YOU can’t answer all ten questions either, does that mean YOU are not a smart consumer? No! It just means that you dealt with a “bad” agent.

In closing, I hope I have given you enough information so you can become an INFORMED consumer.  However, I still feel that these words of wisdom still go along way:
1. “If it sounds too good to be true, it probably is!”
2. “If you only buy on price, you get what you pay for.”

C. Steven Tucker
Licensed Insurance Agent
Small Business Insurance Services, Inc.
“The Best Policy Is A Great Agent”
http://www.smallbusinessinsuranceservices.com