Question on Obtaining Private Health Insurance

[Rich_in_Tampa]

The problem with off-shore solutions is that a lot of expensive and serious medical conditions fail to provide a nice, tidy couple weeks of advanced notice so you can call the Hilton of your choice in Thailand or Singapore.

Stroke, heart attack and even some complications of cancer strike with little or no warning. Even mundane things like a hernia which incarcerates, a kidney stone, trauma, or any number of very common ailments fit this bill.

True, excellent quality care is available around the world, but you'd better have at least high deductible and solid coverage here or any of these events can break you. Seen it too many times.

[Sheryl]

Originally Posted by Rich_in_Tampa

The problem with off-shore solutions is that a lot of expensive and serious medical conditions fail to provide a nice, tidy couple weeks of advanced notice so you can call the Hilton of your choice in Thailand or Singapore.

Yeah... My condition has a way of flaring up without warning, unfortunately. But then again there's nothing much to be done when it does, other than take massive steroids, and I could probably get those in whatever country I happen to be in.

I'm thinking of trying to find a Spanish speaking doctor to write out a brief description of my needs and treatment that I could give to someone if I happen to need it when traveling. But I suppose they might think that is a liability risk, eh Rich?

[kramer]

Rich, Oh I agree that offshoring does not work for everything, I thought I made that clear in my post. But it does not have to be two week notice, either. For instance, there are multiple cheap daily flights to Guadalajara, Mexico, and excellent medical facilities (this is a medical destination I just happen to be familiar with, and a place where lots of gringos go). Or leave the following day from the US to Bangkok (which if memory serves, is the most flown to destination on earth). 58000 Americans received care at Bumrungrad hospital last year alone.

But if you are not already familiar with the medical system in your destination (or in the case of Guad, Mex, also speak at least some Spanish or have someone with you who does), this really is not that viable on short notice. And, of course, many illnesses just do not lend themselves to this approach. And if you have someone to go with you, the whole process is going to be much easier.

I think an "ER skill" is having prior knowledge of these sorts of alternatives. For instance, I know of specific dentists and doctors near an international airport that I could use in Mexico and I speak passable Spanish (although most of them speak English), if a problem arose.

Of course, I am fully insured in the US at this time, so I have not had to pursue this option.

Kramer

[kramer]

Also, it is not an all or nothing proposition. The goal is to reduce risk. Just because something does not remove all risk, but only reduces it, does not mean that you should not consider it as a possible alternative when it makes sense.

Kramer

[astroboy]

What's a good rule of thumb in figuring cost of private insurance based on quotes from ehealthinsurance.com. I know few if any probably qualify for those rates, but how much above your qoted rate that should you plan on? 50% above the rate, double

[REWahoo]

Originally Posted by astroboy

What's a good rule of thumb in figuring cost of private insurance based on quotes from ehealthinsurance.com.

I don't know of any rule of thumb, but I recently purchased a policy from BC/BS and what I'm paying is exactly what ehealthinsurance.com quoted.

[macnjus]

The quote below is in a letter to the Wall Street Journal regarding their recent article about a young lady with lupus and her difficulty with our health care system.

The author points out what I feel is the most vexing issue facing anybody trying to exist prior to age 65 with private health care coverage, or lack thereof because of some inability to get coverage. It seems a travesty to me that you have a group of people, meaning relatively well off individuals without health insurance, that are effectively subsidizing evrybody else in the system. This, to me, is a good argument for why we should have some sort of Federal mandate requiring access to "fair cost" coverage.

Anybody who is forced to pay the "list price" for health care services is potentially exposing themselves to financial ruin. It is not at all unheard of for a seriously ill individual to run up a $1mm plus bill, at "list prices", that would only cost an insurance company maybe $250K. This hypothetical $1mm bill represents a gross markup over the hospitals true costs, yet it probably represents a significant chunk of their profit margin, given their "charity cases" and the prices they charge the insured individuals.

I have recently resigned from my company, and will start paying the 18 month COBRA, but this issue is starting to worry me a lot. At age 50, I have a ways to go before I will fall under the Medicare umbrella, should it still exist at that point. I am in good health, as is my wife, but who knows what kind of difficulty I will have obtaining comprehensive coverage when my COBRA runs out ?

"Yes, the article will bolster calls for increasing government's role in medicine, but what about the unnamed victims whose existence the article implicitly acknowledged.

The nonprofit Wellmont Bristol Regional Medical Center provided care to Ms. White at an unreimbursed cost of about $900,000, a portion of the nearly $19 million that the hospital wrote off for charitable cases in 2006. But who really "donated" this charity? Bristol Regional had to take its charitable funds out of its collected billings from non-charity patients. Only a subset of these, however, bore most of the burden. Generously insured patients, whose insurers paid sharply discounted charges to Bristol Regional, weren't on the hook for much. Neither were patients covered by Medicare's or Medicaid's stingy reimbursement schedules. By default, then, the hospital's charitable exactions fell upon uninsured or poorly insured patients with assets deemed accessible via legal action if they didn't pay hospital charges assessed at "listed" rates. How many of these patients forewent additional medical care because of its exaggerated expense? How many had their retirement plans ruined? How many were driven to penury? Their names and stories deserve to be on a par with Ms. White's."

[Baxter]

Originally Posted by REWahoo!

I don't know of any rule of thumb, but I recently purchased a policy from BC/BS and what I'm paying is exactly what ehealthinsurance.com quoted.

And I'm not sure if this is true for all states, but in Texas the policy prices are not permitted to vary from agent to agent; you get the same price no matter if you buy the policy online or from a local agent. My local agent charged exactly what ehealthinsurance.com quoted as well.

[modlair]

Question:

BCBS seems to have "divisions" or something of that sort state by state. I have recently bought a policy from them where I live now and was accepted (I have not been to a doc in 10 yrs).

I plan to move. When I do, it is my understanding that this policy won't work anymore.

If I go in and see a doc for a physical and things are discovered, and then I move, and seek a new policy from BCBS in the new state, does this constitute a pre-existing condition situation, or is it simply a situation that a problem was discovered after I already had a policy with BCBS so they can't exclude it.

[Oldbabe]

Martha, here's the update you requested on my grueling ordeal of applications to many health insurance companies. After being turned down by three, I was finally accepted by World Insurance. The details: $2700 deductible, $280/mo premium. Two exclusion riders for two years each. One permanent exclusion. What a relief to have that over with!

I've been on COBRA which will not run out until next Sept. But I would urge anyone in my position to start applying for individual coverage as early as you feel comfortable doing so. The process is lengthy. Also, you might have other, new medical problems that could pop up in the interim which would make it even more difficult to acquire insurance. So get a permanent policy while you are still healthy.

Good luck!

[Nords]

Originally Posted by rodmail

(I have not been to a doc in 10 yrs).

And you're proud of that?!?

[modlair]

(I have not been to a doc in 10 yrs).
And you're proud of that?!?

No. I don't know what tone of voice was implied in that text. It was intended to be matter of fact; not pride.

I have been a serious athlete for most of my adult life and I watch my own BP, and both those adjusted how intently I thought I needed a physical, but yes, of course as age creeps up I'm overdue for one (51) -- which is largely the prompt of the question.

One wonders if issues are found . . . does this translate into never being able to relocate again? If so, it could affect timing on relocation -- as in make it happen faster so you can get to the new locale, get insurance, and get that physical.

[Oldbabe]

Originally Posted by rodmail

Question:

BCBS seems to have "divisions" or something of that sort state by state. I have recently bought a policy from them where I live now and was accepted (I have not been to a doc in 10 yrs).

I plan to move. When I do, it is my understanding that this policy won't work anymore.

If I go in and see a doc for a physical and things are discovered, and then I move, and seek a new policy from BCBS in the new state, does this constitute a pre-existing condition situation, or is it simply a situation that a problem was discovered after I already had a policy with BCBS so they can't exclude it.

I assume that you had a recent physical exam before your BCBS policy was issued. That's standard across the board for individual health insurance.

And, to answer your question, as I understand the situation, yes, you would under those conditions have a new pre-existing condition and BCBS would do an underwriting based on this new condition. I had the same situation with Humana, which covers me now under COBRA. I applied for individual insurance and they turned me down due to a condition that popped up during coverage this year.

[Nords]

Originally Posted by rodmail

I have been a serious athlete for most of my adult life and I watch my own BP, and both those adjusted how intently I thought I needed a physical, but yes, of course as age creeps up I'm overdue for one (51) -- which is largely the prompt of the question.

Sure, we all do that, but we don't attempt to do our own cholesterol screenings or digital rectal exams or colonoscopies either.

I don't want to be unduly gloomy and you're probably just fine. However after 10 years away from doctors my father went to one for a minor dermatology question. Luckily the doctor decided to do an "unecessary" blood sample which called attention to a double-digit PSA and led to discovery of a stage IV prostate tumor. Another six months and Dad would've avoided the hassle & expense of the office visit.

So, yes, I'd say that you're right about getting coverage before you get your next physical.

[modlair]

I assume that you had a recent physical exam before your BCBS policy was issued. That's standard across the board for individual health insurance.

Nope. Just answered no to all the questions, almost all of which asked "Have you in the past 5 years been diagnosed with . . . ." Given no doc visits in 10 yrs, answered honestly no to all of them. They issued the policy.

And, to answer your question, as I understand the situation, yes, you would under those conditions have a new pre-existing condition and BCBS would do an underwriting based on this new condition. I had the same situation with Humana, which covers me now under COBRA. I applied for individual insurance and they turned me down due to a condition that popped up during coverage this year.

The second part of your answer fits best. The issue is it's the same company. If you already had a Humana individual policy and the new condition is discovered, next year's renewal will not have a pre-existing exclusion -- because the condition was discovered while you were with that company. Apparently you switching from group plan to individual plan got interpreted as NOT within the company.

What I'm asking is BCBS . . . same company, but switching states. Because of this, given a relocation in a matter of months, it seems wise to postpone any doc visits until after the relocation, and the acceptance at the new state (division). Sigh. That means wait a few months for the doc visit or risk not being able to relocate.

In general, this means healthcare prevents relocation. If you have coverage in Calif with BCBS and want to move to a zero income tax state -- even if still BCBS, this suggests you can't move if you have something discovered in Calif.

[modlair]

Sure, we all do that, but we don't attempt to do our own cholesterol screenings or digital rectal exams or colonoscopies either.

Yeah, I'm focused on this specific thing, but the issue is a matter of months only. If one gets a physical and has problems found, one can never move again. If one waits to move and then gets the physical, at least you're in the new locale you wanted to be.

I sort of think this is all going to be addressed over the next 5 years or so. "Association plans" for small businesses or individuals will be as good as "group plans" and all it will take to join the association will be signing up.

[whitestick]

Originally Posted by rodmail

What I'm asking is BCBS . . . same company, but switching states.

Actually, BCBS from state to state are different companies. Wellpoint in the midwest, recently bought several of the BCBS in different states, so that "might" constitute same company, but you would have to check. Not sure about Calif. My MIL had BCBS from Indiana (now Wellpoint), moved to Texas, and kept the same policy with the BCBS in Indiana, even though there is a BCBS of Texas. Other then an occasional error by the doctors/hospital in submitting a bill to the wrong BCBS, there has been no problem with the BCBS of Indiana providing the health care insurance for her in Texas. She has been here for over 9 years, so if there was a problem with that, I would expect that they would have squawked by now

[modlair]

She has been here for over 9 years, so if there was a problem with that, I would expect that they would have squawked by now

Good data. Thanks. I intend to make some phone calls this week and will report back here for use by others.

BTW my specification of Calif was not personal. Just using an example.

[Martha]

Oldbabe, thanks for the information. What a hassle!


Rodmail, I think the only way to answer your question is to make the phone calls to the insurer. Lt us know what you find out.