Question on Obtaining Private Health Insurance

[kz]

Just last week hubby and I were declined by Humana since he has borderline sleep apnea. Shocked the heck out of me. Our agent says BCBS will insure us with a slightly higher premium but I'm not holding my breath. Our blood pressures are 120/80, our cholesterols below 200, within the standard weight for our height, walk 2.5 miles a day and yet sleep apnea got us. Actually they'll insure me but not him. For now we'll stay with previous employer's plan although it hurts to fork out $1140/month. The saving grace, though, is we can afford it and they can never cancel us.

 

[mykidslovedogs]

KZ - Yes, sleep apnea of any sort raises a real red flag with insurance companies. I have run into that before with other clients of mine. I guess it must create a high risk for the insurance company. Just a question..why are you not going to accept the coverage for yourself and leave your husband on the old plan? Wouldn't that reduce your premiums significantly if you accepted the other policy? It is definately possible that Blue Cross may accept with a rate up, but their premiums might be higher for you than Humana One (it depends on the state you live in). I have lots of clients with spouses on two different plans. Blue Cross has recently changed underwriting guidelines to allow for rate-ups instead of exclusions and declines. You might also check into Aetna and see if they are doing business in your state. Their underwriting guidelines seem to be a bit "looser" as well.

 

[whitestick]

Anyhow, another question I wonder about is if some insurance companies are much better negotiating prices with care providers than others?

For example, I currently have COBRA under BCBS and when I look at EOB's, I'm amazed at how much less than "list" the negotiated price is. For an example, the lab cost for a thyroid test is listed at around $140, but gets paid at $24. When I'm paying all the bills, I'd much rather $24 than $140. I know this has been talked about plenty before, but it seems really important.

If one insurer is better than others at negotiating prices, even if their policy was more expensive by $50 per month, it might still be the best deal (all things equal), just because of the low prices you get as a result of having coverage through them.

Anyone know of any sources of info on this?

Jim

I don't know of source of info, but I have observed the same thing. My DW and I have different carriers, and occasionally the hospital messes up and bills the wrong one first, and there are major differences between what each carrier accepts as an negotiated price. In one instance there was several thousand dollars difference, and of course, when we have a co-pay, it affects our percentage as well.