Self Employed & Health Insurance Questions

[Hrant]

One more thought.

Every family I know of who has health insurance and has had someone pass away after a major illness has been slammed with MASSIVE bills even after having insurance. It's wrong.

Last example I can remember, a friend of my mother's husband had brain cancer. He died. He was insured. His wife got a bill for 250k a month after he died. How is that possible. I saw the bill with my own eyes so I know it's 100% true. 11,000 dollars and hour for the operating room.

Don't confuse "billed charges" with actual payments. Most hospitals send the entire "billed charges" of a hospitalization to a patient even if the patient has insurance and the insurance covers most of it - minus, deductibles and copayment if any. It's kind of a subtle hint in case your insurance doesn't pay on their "contractual" agreement ........

The hospital industry is one of the few industries that reports on an arcane accounting system where they show totally meaningless "billed charges" only to then net out actual payments after "discounts" given to insurance companies. Billed charges are used for those who have no insurance or foreigners needing emergency services. Not insured patients then have to negotiate how much they can afford to pay from those artificial charges - especially if the hospital has filed non-profit status with IRS, whereas foreigners become instant cash cows with at least 300%+ mark up.

Yes, here in California, often a $10,000 per day hospital charge ends up actually being reimbursed by insurance companies an average of $2500 (depending of level of care and hospital) and the hospital still makes some margins on that $2500.

 

[Carguy!]

I don't have all the answers that is for sure but here are some of my thoughts on health care:

You can't have a set price for procedures from different doctors / hospitals. Some facilities are much better than others and deserve to make more money. I know I would be willing to pay MUCH more to go to a doctor that has a 10% higher survival rate on a procedure. If you are better than average in any field you should be able to get more money than someone who is below average.

The reason the big insurance companies are able to get better deals is because they give a lot of business to physicians and hospitals. I know a man who owned a plumbing company that took on a job to do 2,000 houses for a large builder. He gave them a much better price than he would of gave a single homeowner. Many doctors don't want to take certain insurance because they discount the procedures so heavely. I don't blame them for charging someone who walks through the door more, they have no idea whether or not they are going to get paid from a lot of individuals.

We have lots of problems with our health care in the U.S., but I have experienced emergency care in Canada and next time I would cross the border and come back home before going to one of their E.R.'s again!

Health care insurance is a funny thing, it is basically the only kind of insurance that I have. I self insure my cars and my homes because if something happens I know the maxiimum it can cost me to repair / replace the items. Health care on the other hand can potentially cost millions so it is difficult to self insure and take that amount of risk for relatively small payments. I was considering switching to catistrophic insurance only, but I have a client that provides full coverage for me and my family as part of my payment.

Insurance companies are in business to make money, so for example with auto insurance if you are a better than average driver and don't have any accidents you are paying for the people who have more claims. The good drivers are making up for the bad drivers, even if you are an average driver you are still having to pay additional money to generate the profit for the insurance company. I feel insurance should only be used if you can't afford to pay for the item yourself, or if you are a higher risk than an average person.

Cars are a funny thing to insure because most companies don't discount enough for someone who collects cars. I have about 10 cars that only I drive, but I can only drive one at a time and I only drive about 20k miles a year so if I add another car the insurance companies risk would be much lower than if I only had that one car.

Could you imagine if car insurance was like health insurance, you would pay a set amount no matter how many cars you own! Why is it that I have to pay the same amount for a family with two kids than someone who has eight kids?

 

[pegi]

Say to your sister, she might have to think moving to Finland. Here you got almost "free" healt care . Some good point to live here .

I hope everything goes well you sister family at the end !

OT. I have living all my life fresh, no smoking & sporty life (7times /week playing icehockey).
After all, last december doctor found something bad on me. It was cancer. Few days later, I was going to meet operation doctor.
1 week later I was in operation room. Operation it self takes 3 and half hour. After that I have been in healt care and Im not worked after that.
There is several good thing: my own doctor foud that fucking thing on me in just routine visit. Operation goes well. After all I have been in healt care.. All the time, every month I got my average salary from finish country .

All what we have to pay is about 1.3% from our monthly salary.

At least, I will be ok soon. Finally again

 

[steveny]

Why is it that I have to pay the same amount for a family with two kids than someone who has eight kids?

Don't even get me going. My insurance quadrupled when I put Renee and my daughter on it. Had I added 15 children it still would have only quadrupled. But let me ask you this, what type of person has 15 children? IMO not the type of person who can afford to pay 5 friggen cents for health insurance. So I end up paying for them.

My father does not have health insurance. I asked him if he got really sick what would he do. Would he sell everything to stay alive? He said no because he wouldn't be happy broke.

 

[steveny]

Cars are a funny thing to insure because most companies don't discount enough for someone who collects cars. I have about 10 cars that only I drive, but I can only drive one at a time and I only drive about 20k miles a year so if I add another car the insurance companies risk would be much lower than if I only had that one car.

kind of like cable boxes. I pay for HBO but if I want to use it on more than one TV I get dinged for an additional box to unscramble a signal that I have already paid for to receive and unscramble on another box. Once you pay for HBO it should be unscrambled at the house not the tv set.


Same goes for cars. If I pay for insurance on the most expensive car I own then I should be able to use that plate for any car less expensive. Furthermore if only one plate is issued per person then there is no chance of someone with a DWI using additional plates insured by someone without a DWI.

 

[Hrant]

If you can self insure on your cars, that means you probably have assets - or you are really a risk taker. Especially if you are at fault in an incident, you will be sued for liabilities that you didn't dream will cost you your car but also your bank account and perhaps deed(s) and whatever else you might be hiding from IRS :wink: ........... car insurance for the rich is more about protecting their liabilities than the worries of comprehensive coverage ...... the rich also often have riders on their policies that go beyond the 300K/300K. YMMV.

As for health care premium, you need to have some perspective. If we start paying premium based on one's behavioral habits and "healthy" age/sex/ethnic demographics, then the moment you hit an illness it will jump because it becomes risk rated and not community rated. Precisely the problem that individual policies face vs. those who belong to a group or receive them from large employers.

Sure, a young single male doesn't need all the "female" or "kid" related benefits but often based on state law, such coverage whether you like it or not is statutorly mandated. Think along these lines, you least need it when you are young and perhaps peaking in your earning power, and you need it most when you are about to retire, presumably having accumulated some wealth/asset/retirement income, and before hitting Medicare benefits. And most of us with kids are right at that stage that the both health and car insurance are absolutely necessary - even if we have to pay for the former as self employed. This is the time when the college age/bound kids needs us the most. And yes I know, kids can borrow to go to college and many of us did that and yes we are spoiling our kids ......

So, keep the insane health care system going. That is how I make my "real" living and pay my kids' college expenses :tongue:

 

[curator]

I'm trying to help my sister out with this one. Her husband is self employed in the real estate industry. They have 3 little girls and one on the way. They've been paying through the nose for health insurance and are sick of it. They pay over $1,000 per month with 30% copays. My sister and one of their girls have asthma pretty bad. One of her girls was born with gastroshisis, but does not have any long term affects of it now.

They are starting to think that it might not be worth it to pay this much money to have coverage. They think it might be a better idea to have no health insurance and that if something did happen (knock on wood) that they would just make monthly payments that probably wouldn't cost more than what they are paying right now.

I know many of you are self employed. What do you do? Got any ideas, suggestions, companies that you would suggest they go through instead? It's the pre-existing conditions that really hurt them everytime they find a new company, but then get denied or charged alot higher because of them. Thanks in advance guys.

My situation,
Located in Iowa, self employed, family of four, premiums $1864.00 every six months, $3 million lifetime per person max payout, $ 10,000 deductible, does not cover high risk (bike,car racing,skydiving). Assurant Health underwritten by Time insurance co.
Rates would be cheaper if one chose their "in network plan"
Can not say they are a great insurer as we have never hit the deductible and needed them to pay. Hope it stays this way.
Paying cash and asking if they offer a discount has generally had favorable results as most but not all happily take your money that day with some even telling before you ask that they will take less for cash.
Hope this helps

 

[peiserg]

one thing i'd like to point out regarding the complaints of the uninsured paying a higher price than the insured..

If you want the lower "insured rate," why not just get insurance? then on top of your $5 pills, you might get some things paid for if you get sick.

You're already paying TEN THOUSAND bucks less than Steveny is. Why should he also get stuck paying more than you at the pharmacy?

The other thing is my in network patients who don't want to pay their 10% copay or deductible. the bitch and moan and whine to my office. They get zero discounts. their discount occured when I took a massive pay cut to be in network, AND when they signed a contract with a high deductible to lower the monthly rate.

You want your care covered 100%? then cough up on the monthly premiums. Till then, close your pie hole and follow the rules of the contract the you signed, just like I do when i go to my doctors office for health care.

 

[Carguy!]

If you can self insure on your cars, that means you probably have assets - or you are really a risk taker. Especially if you are at fault in an incident, you will be sued for liabilities that you didn't dream will cost you your car but also your bank account and perhaps deed(s) and whatever else you might be hiding from IRS :wink: ........... car insurance for the rich is more about protecting their liabilities than the worries of comprehensive coverage ...... the rich also often have riders on their policies that go beyond the 300K/300K. YMMV.

When I say that I self insure the cars I mean for collision / theft / fire etc... I still have to have the PLPD that is required by law in Michigan. It costs me about $150 / year / car. Since I dropped down this this level of insurance it has saved me about 20K / year for the last five or six years. I wish I would of done it sooner as I have never had a claim and just wasted a lot of money paying for others peoples claims.

I do carry an umbrella policy for 2 million extra which was pretty cheap and covers any claims above the normal limits.

 

[peiserg]

Say to your sister, she might have to think moving to Finland. Here you got almost "free" healt care . Some good point to live here .

I hope everything goes well you sister family at the end !

OT. I have living all my life fresh, no smoking & sporty life (7times /week playing icehockey).
After all, last december doctor found something bad on me. It was cancer. Few days later, I was going to meet operation doctor.
1 week later I was in operation room. Operation it self takes 3 and half hour. After that I have been in healt care and Im not worked after that.
There is several good thing: my own doctor foud that fucking thing on me in just routine visit. Operation goes well. After all I have been in healt care.. All the time, every month I got my average salary from finish country .

All what we have to pay is about 1.3% from our monthly salary.

At least, I will be ok soon. Finally again

I'm curious, what's the taxes like over there?

I mean, lets say you make 50,000 euros. what's your "take home" pay.. after all taxes etc are removed?

My friend from the netherlands made about $60,000/yr. He told me he paid upwards of 70% taxes! I couldn't beleive it, till my accountant told me the USA has the 2nd lowest tax rates amongst all western developed countries.


i'll take my lower taxes and high health care over universal + 60-70% taxes.

 

[eddiensx]

Instead of complaining, be creative.

If you need to lower your premiums, take a plan that has a higher co-pay. You can also choose to have a plan that will only cover generic meds. If you change from a $30.00 co-pay to a higher deductible plan, you can save as much as 20%.

I am a certified financial planner. I am also type 2 diabetic. I have a blue cross $40.00 ca-pay and I pay $900.00, for my family.

Another alternative is to put the sick ones on the company plan, have the healthy ones get individual plans. This could lower your premiums by as much as 50%.

 

[steveny]

Instead of complaining, be creative.

If you need to lower your premiums, take a plan that has a higher co-pay. You can also choose to have a plan that will only cover generic meds. If you change from a $30.00 co-pay to a higher deductible plan, you can save as much as 20%.

I am a certified financial planner. I am also type 2 diabetic. I have a blue cross $40.00 ca-pay and I pay $900.00, for my family.

Another alternative is to put the sick ones on the company plan, have the healthy ones get individual plans. This could lower your premiums by as much as 50%.

all good ideas and I would be all over it IF I didn't have to pay 100% more copay for a 20% reduction in premiums.

 

[druby]

Taking the healthy off the group plan for individual policies may sound good but it can cost the group coverage for everyone. There are participation requirements that all carriers have to stop companies from is called cherry picking (leaving all the sick folks on the group plan and allowing healthy people to take individual policies) and the carrier can cancel your group plan if that is the case. The first thing to always do is shop around for a better carrier. I have found that my shopping my clients coverage we can usually keep their rates down to single digit increases or at worst low teens. In addition look at higher deductibles like others have mentioned. If you own a company and don't want your employees subjected to the higher deductible you can look at buying the higher deductible plan and then self insuring the difference between what you want your employee to be liable for and the actual deductible (this is called a HRA). This can work well in many sitiuations. If you are large enough going self insured with a stop loss (cap to your exposure) can potentially save you money, if nothing else it will show you the true utilization of your group. You might be surprised at what you find.

Best of luck your rates are definitely on the high side of what we see but it varies tremendously from state to state depending on the laws where you live.

 

[Hrant]

There is some value in taking some risk, but you have play the probability tables and figure out the various options.

For example, here in California, a single policy with $25 copay and no decutible costs about $5712/yr for a particular age/sex group with Kaiser.

A $50 copay/no-deductible costs $4452/yr
A $30 copay with $2700 deductible costs $2736/yr

And other variations/scenarios with more copays and less deductibles. The question that each one has to assess is the probability of getting sick with certain number of visits, and/or being hospitalized and depleting the $2700 out of pocket deductible. Funding an HSA as was noted above to cover the $2700 deductible would be wise since it is tax free.

If the probability of being hospitalized is 100%, $30/$2700 option will cost $5436 and not $2736. If the probability is 50%, then the cost to you is $4086 - before adding the costs of visits and prescriptions. YMMV.

 

[NSXLuvr]

Ahhh Healthcare - what a crazy situation we have. Lets see:

1. I do a procedure today but I won't get paid for 45 - 90 days. I might however not get paid at all based on some technicality that is artificially created by the Ins. Co. to delay payments. Try that next time you get a TB/WP. Ask them if you can pay them 45 days later if you feel like it...

2. "Hired Gun" physicians who don't really practice anymore. They are paid just to say your treatment wasn't necessary or to deny treatment.

3. Practice guidelines used by insurance companies to deny treatment. One time I had an "adjuster" deny a procedure because well She hadn't heard of the procedure before. Her level of education - ohhh She was applying to nursing school.

Plain crazy....