Interpretation of health insurance benefits
#1
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Interpretation of health insurance benefits
Thankfully I've now been enrolled in a Kaiser Permanente HIPAA plan. I only got a very vague letter which didn't indicate any of the benefits or even the price, just that I'd been enrolled with the maximum plan. Upon phoning I found out it's $730/month with only one other plan available as an option - I'm on a $25 co-pay plan but could switch to a 30/1500 deductible plan which is about $520/month. Beyond that she couldn't/wouldn't tell me any more - but I have only 30 days in which to switch, and if past experience is anything to go by, I might not get the plan pack for a few weeks.
So I managed to find something online which compares the two plans. I ought to know this but let's go back to basics to make sure I fully understand! One thing I'm confused/concerned about is a $200 copay per day for inpatient care. Firstly, does that include everything per day (rather than 200 for board, 200 for tests, 200 for meds etc), and secondly is that capped by the annual out of pocket maximum? So, for example, a 20 day hospital stay with open heart surgery will cost a maximum of $2500?
If I went for the deductible one, it says $500 per day (after deductible). With the above example and no other claims, I'd pay up to $1500 for the first three days and then insurance would pay everything beyond? Or is that back-to-front?
This is what I'm reading: http://www.davefluker.com/60067400_1...IF_FNL_LCK.pdf - I'm aware it's not a KP-sourced document but it's the best I can find.
At least I get free mammograms.
So I managed to find something online which compares the two plans. I ought to know this but let's go back to basics to make sure I fully understand! One thing I'm confused/concerned about is a $200 copay per day for inpatient care. Firstly, does that include everything per day (rather than 200 for board, 200 for tests, 200 for meds etc), and secondly is that capped by the annual out of pocket maximum? So, for example, a 20 day hospital stay with open heart surgery will cost a maximum of $2500?
If I went for the deductible one, it says $500 per day (after deductible). With the above example and no other claims, I'd pay up to $1500 for the first three days and then insurance would pay everything beyond? Or is that back-to-front?
This is what I'm reading: http://www.davefluker.com/60067400_1...IF_FNL_LCK.pdf - I'm aware it's not a KP-sourced document but it's the best I can find.
At least I get free mammograms.
#2
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Posts: 253
Re: Interpretation of health insurance benefits
After some research and question asking, I got the overall advice that it's best to use a broker for health insurance. The subject is so involved and the small print so important, that arguably it's wise to seek expert help. Some of these policies cost as much as a mortgage
just my two cents
just my two cents
#4
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Re: Interpretation of health insurance benefits
After some research and question asking, I got the overall advice that it's best to use a broker for health insurance. The subject is so involved and the small print so important, that arguably it's wise to seek expert help. Some of these policies cost as much as a mortgage
just my two cents
just my two cents
Doesn't it explain it on the Kaiser website? Here
Was that HIPAA? Lots of plans though, all different. I was hoping somebody would say they were easy questions!
#5
Re: Interpretation of health insurance benefits
Unless I'm missing something... no! In addition, my personal log on is not available until they mail me a password as the online thingy didn't know enough about me to issue one there.
Was that HIPAA? Lots of plans though, all different. I was hoping somebody would say they were easy questions!
Was that HIPAA? Lots of plans though, all different. I was hoping somebody would say they were easy questions!
We had a booklet sent to us (this was a while back) it showed the costs for many things, for our plan and had phone numbers and stuff in it. I really used to like how I knew exactly what things were going to cost me.
We have Blue cross from Dh's work now. just as confusing
#6
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Re: Interpretation of health insurance benefits
After being given the run-around by agents previously, I'm yet to be convinced! This HIPAA thing is only available from them direct anyway, and I'm already enrolled after 2 months of stressful rejections and debates over whether the NHS qualifies as prior credible coverage because they don't issue a certificate of such in a format that Americans understand (and why should the NHS provide it).
Unless I'm missing something... no! In addition, my personal log on is not available until they mail me a password as the online thingy didn't know enough about me to issue one there.
Was that HIPAA? Lots of plans though, all different. I was hoping somebody would say they were easy questions!
Unless I'm missing something... no! In addition, my personal log on is not available until they mail me a password as the online thingy didn't know enough about me to issue one there.
Was that HIPAA? Lots of plans though, all different. I was hoping somebody would say they were easy questions!
There is at the moment no real standard in health insurance, every policy is different and even insurance companies at times can't tell you everything that is covered, at times things can be a case by case basis.
There is no easy way when it comes to health insurance, I have a jaded view on health insurance after I got stiffed with a 30,000 bill because the insurance company decided not to pay a hospital for treatment when I was ill several years ago and in hospital for a few weeks.
This website will help hopefully understand what HIPPA is.
http://www.hhs.gov/ocr/privacy/
#7
Re: Interpretation of health insurance benefits
What kind of agents? guitarmaan meant an independent insurance brokerage that specializes in HI and can sift through the myriad companies/options and present you with choices in line with your needs -- and explain how they all work. I've used a broker for years and would never think of doing anything connected with HI without him.
#8
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Re: Interpretation of health insurance benefits
What kind of agents? guitarmaan meant an independent insurance brokerage that specializes in HI and can sift through the myriad companies/options and present you with choices in line with your needs -- and explain how they all work. I've used a broker for years and would never think of doing anything connected with HI without him.
As I already said, no agent would have been able to help with the KP HIPAA plan anyway, as it's only sold direct by KP.
I am hoping KP are going to be more prompt than my previous experiences - in the kids' cases they sent the ID cards two weeks before coverage started and I think we had the policy documentation shortly afterwards. They wanted more information from me which I sent about 2 weeks ago, so it's fair enough that I haven't had a reply until now - maybe the rest will follow soon. Blue Shield, the kids' previous cover, didn't send their documentation until nearly a month after coverage started.
In any case it seems I only have two options anyway - the $25 copay or the 30/1500. My worry is that $200/$500 hospital stay issue. If both are capped at the max out of pocket then fine, but if they're not then my risk tolerance doesn't stretch to the $500 per day plan.
#9
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Joined: Mar 2004
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Re: Interpretation of health insurance benefits
Generally:
Agents act for one Company
Brokers act for several.
I have also noticed that Agents are very unwilling to get into details and just send you loads of bumf. I am familiar with the terminology but it would take several hours to get a grip of any given situation. And then I would not want to guarantee it.
Welcome to America.
Agents act for one Company
Brokers act for several.
I have also noticed that Agents are very unwilling to get into details and just send you loads of bumf. I am familiar with the terminology but it would take several hours to get a grip of any given situation. And then I would not want to guarantee it.
Welcome to America.
#10
Re: Interpretation of health insurance benefits
And, of course, they'll throw you as soon as they can after you've had such an illness so it's not like you're paying for the future.
Seriously, save your money!
#12
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Re: Interpretation of health insurance benefits
OK, I have taken a look at the summary benefits page for these plans.
My interpretation is as follows:
Copayment 25: No deductible; co-pays you need to pay of between 25 and 100 bucks for visits/Xrays etc; in-hospital stays including board and bed/tests/meds/surgery are 200 bucks a day; other various copays for emergency treatment etc etc.
Co-pays go towards annual out of pocket expenses.
Annual out of pocket expenses maximum: 2,500 for individual/5,000 for family. This would be your total out of pocket expense.
l30/1500 Plan: Deductible (monies you need to pay) of 1,500 bucks before Plan kicks in to pay anything.
After you have paid your deductible there are various co-pays ranging from 25 for doctor visits to 250 for outpatient surgery. In-hospital stays of 500 bucks a day.
Annual out of pocket expenses 3,500 for individual/7,000 for family. this would be your total expense for this plan per year.
Have you actually been offered either of these plans by Keiser? (they are not available via agents).
Is this going to be for an individual or a number of family members?
The reason I ask is that these are HIPPA plans - Guaranteed issue plans which are USUALLY only offered under special circumstances and are therefore more expensive. They are usually offered once COBRA has been used up following being dropped from Group plans or where you have had continuous coverage under some other insurance plan, and have then taken COBRA.
See below:
For those who are exhausting COBRA/Cal-COBRA programs or are losing group health coverage with no employer continuation offering, HIPAA regulations allow you to purchase guaranteed-issue health coverage under the following rules:
-COBRA or Cal-COBRA benefits must be exhausted or not offered;
-You must apply for HIPAA coverage within 63 days after termination of COBRA, Cal-COBRA or employment if no COBRA offered;
-You must have been covered for 18 months continuously prior to HIPAA effective date with the most recent coverage being employer-sponsored group health insurance with no gaps greater than 63 days between any prior coverage;
-Must not be enrolled in nor eligible for Medicare Part A or B, Medicaid or MediCal or covered by another group health insurance plan.
If you qualify and are not medically able to obtain a private underwritten health insurance plan (which would normally be less costly), you can choose a guaranteed issue health plan. Below are plan options and rates for California residents. Please note that you do not need to be declined for individual coverage to elect a HIPAA plan.
I'm just asking because you have had such a bad experience with health insurance and I don't want to see you going down another route which will end in frustration and tears !!!
My interpretation is as follows:
Copayment 25: No deductible; co-pays you need to pay of between 25 and 100 bucks for visits/Xrays etc; in-hospital stays including board and bed/tests/meds/surgery are 200 bucks a day; other various copays for emergency treatment etc etc.
Co-pays go towards annual out of pocket expenses.
Annual out of pocket expenses maximum: 2,500 for individual/5,000 for family. This would be your total out of pocket expense.
l30/1500 Plan: Deductible (monies you need to pay) of 1,500 bucks before Plan kicks in to pay anything.
After you have paid your deductible there are various co-pays ranging from 25 for doctor visits to 250 for outpatient surgery. In-hospital stays of 500 bucks a day.
Annual out of pocket expenses 3,500 for individual/7,000 for family. this would be your total expense for this plan per year.
Have you actually been offered either of these plans by Keiser? (they are not available via agents).
Is this going to be for an individual or a number of family members?
The reason I ask is that these are HIPPA plans - Guaranteed issue plans which are USUALLY only offered under special circumstances and are therefore more expensive. They are usually offered once COBRA has been used up following being dropped from Group plans or where you have had continuous coverage under some other insurance plan, and have then taken COBRA.
See below:
For those who are exhausting COBRA/Cal-COBRA programs or are losing group health coverage with no employer continuation offering, HIPAA regulations allow you to purchase guaranteed-issue health coverage under the following rules:
-COBRA or Cal-COBRA benefits must be exhausted or not offered;
-You must apply for HIPAA coverage within 63 days after termination of COBRA, Cal-COBRA or employment if no COBRA offered;
-You must have been covered for 18 months continuously prior to HIPAA effective date with the most recent coverage being employer-sponsored group health insurance with no gaps greater than 63 days between any prior coverage;
-Must not be enrolled in nor eligible for Medicare Part A or B, Medicaid or MediCal or covered by another group health insurance plan.
If you qualify and are not medically able to obtain a private underwritten health insurance plan (which would normally be less costly), you can choose a guaranteed issue health plan. Below are plan options and rates for California residents. Please note that you do not need to be declined for individual coverage to elect a HIPAA plan.
I'm just asking because you have had such a bad experience with health insurance and I don't want to see you going down another route which will end in frustration and tears !!!
#13
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Re: Interpretation of health insurance benefits
The reason I ask is that these are HIPPA plans - Guaranteed issue plans which are USUALLY only offered under special circumstances and are therefore more expensive. They are usually offered once COBRA has been used up following being dropped from Group plans or where you have had continuous coverage under some other insurance plan, and have then taken COBRA.
Thanks, I appreciate it!
#14
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Re: Interpretation of health insurance benefits
It really isn't worth it at that price. Four days in hospital, two in IC, one operation and every test known to mankind.....came out at not much more than your annual premium after discounts for cash and being uninsured.
And, of course, they'll throw you as soon as they can after you've had such an illness so it's not like you're paying for the future.
Seriously, save your money!
And, of course, they'll throw you as soon as they can after you've had such an illness so it's not like you're paying for the future.
Seriously, save your money!
#15
Re: Interpretation of health insurance benefits
I never gamble! Well, actually, I suppose I gamble on everything.....but only when I fully understand the odds. Unless you have substantial, unprotected assets, you're throwing $9000/yr on something that's probably worth almost nothing.