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Insurance Carriers offering claims service only ?
Old 02-20-2010, 08:57 AM   #1
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Insurance Carriers offering claims service only ?

Where I am going with this is: If I go "Bare" ( self insured ), can I get a major carrier to bill the providers at p.p.o. rates and I pay actual cost + a fee for administrative service. Many doctors will give self insured patients a large discount for cash at time of service, but this will not work with a Hospital.

I am in California , 99.9% chance of rejection for a high deductible plan due to minor pre existing conditions. My employee policy is cobra + guarantee conversion if laid off , however , i'ts about $980 / mo. now (age 50-54) , and if I am laid off with anything short of 10 years service, NO medical subidy in the retirement plan. I work for a Large City in Los Angeles County with plans to fire 1/3 of all employees not in police and fire positions to deal with a huge budget problem. I am almost certain to get the axe if this goes through. I estimate the cost for cobra and then HIPAA plan would add up to at least $ 150,000 until I can get medicare. (15 years). A High Deductible HSA plan would be just fine, however , with Medical Underwriting , I would be rejected .
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Old 02-20-2010, 11:11 AM   #2
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Quote:
Originally Posted by Lakewood90712 View Post
Where I am going with this is: If I go "Bare" ( self insured ), can I get a major carrier to bill the providers at p.p.o. rates and I pay actual cost + a fee for administrative service. Many doctors will give self insured patients a large discount for cash at time of service, but this will not work with a Hospital.

I am in California , 99.9% chance of rejection for a high deductible plan due to minor pre existing conditions. My employee policy is cobra + guarantee conversion if laid off , however , i'ts about $980 / mo. now (age 50-54) , and if I am laid off with anything short of 10 years service, NO medical subidy in the retirement plan. I work for a Large City in Los Angeles County with plans to fire 1/3 of all employees not in police and fire positions to deal with a huge budget problem. I am almost certain to get the axe if this goes through. I estimate the cost for cobra and then HIPAA plan would add up to at least $ 150,000 until I can get medicare. (15 years). A High Deductible HSA plan would be just fine, however , with Medical Underwriting , I would be rejected .
What you are asking for the ability to tag on the carrier's negotiated rates for hospital coverage, and pay the carrier for their administrative costs. If you are a group of 1000 employees, you can negotiate this. As an individual, it's not possible, unfortunately.

The only other alternative you have is to join an association that offers group health insurance to its members, where you might not be subject to medical underwriting. AARP is one that I can think of, but if you search, you may be able to find other industry groups (one that represent your career field), or benevolent organizations that offer group health plans. They would be less than Cobra, but probably more than what you employer offers now.

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Old 02-20-2010, 11:18 AM   #3
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Doubt it. Large self-insured groups often hire large carriers as "third party administrators" to process claims, negotiate contracts and so one while the funds are held by the group itself.

I've never seen such an arrangement with an individual.
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As if you didn't know..If the above message contains medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any purpose. Consult your own doctor for all medical advice.
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Old 02-20-2010, 01:08 PM   #4
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Thank's for the replys.

If I can survive the next 2 years of cutbacks and make 10 years of service, I will only need 3 years of cobra/Hipaa coverage, then at 55 , the pension plan subsidy is about 50% of the group rate. Less than 10 years, no group coverage at all.

At 40, I took a gov't job for the benefits and Job security. It has been an un-pleasnt position , and at the time , the agency had a hard time finding qualified applicants (one hire for each 800 applications). Now we are excess baggage. Many of the bad things in private industry are even worse in civil service. The type crap I have to deal with especially "Customer Contact" (my "Customers" are white collar criminals for the most part) It was never this bad in the private sector. I'm drifting too far off topic. Sorry.
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