Insurance Agent Forum

[somarco]

Flex Guard brochure attached.

Looks like a $20,000 bill for an overnight stay works out like this.

$20,000
- $500
---------
$19,500
X80%
---------
$15,600

BUT . . . the maximum daily benefit is capped at $4000. So on the $20,000 bill, UA is responsible for $4000 and you pay the rest.

What have I missed?

[healthagent]

Wow - guess you have to actually read. So in the example of a $20,000 bill but you only stayed one night almost nothing gets paid and you're in a financial nightmare.

And what about follow-up treatment stemming from an accident out-patient?

[STIBROKER@AUSTIN.RR.COM]

Originally Posted by Michael Haislip

I was uninsurable before.

Then UA would not take you....and with the daily max your hosed......whats your point......

[Michael Haislip]

Originally Posted by somarco

Flex Guard brochure attached.

Looks like a $20,000 bill for an overnight stay works out like this.

My math comes out differently. I'm figuring a 2-day stay. But, yeah, I forgot about the daily cap. So, yep, I'm hosed.

[healthagent]

What - no free lunch? And by the way, I didn't even know about the $2,000/day cap - oh, that goes down to $1,000 a day the longer you stay.

Sti and others can back me up that for a major event you can easily see $5,000 to $10,000 of charges per day. I know my wife's 4 day hospital bill went far over $50,000. UA would have paid $8,000 and we'd be looking at BK.

In MD just a semi-private room runs an average of $1,400. And that just starts the bidding.

[Steve]

so whats right about a non~major medical........

So we come full circle and it starts to make sense...

[salpro22]

Originally Posted by john_petrowski

What - no free lunch? And by the way, I didn't even know about the $2,000/day cap - oh, that goes down to $1,000 a day the longer you stay.

Sti and others can back me up that for a major event you can easily see $5,000 to $10,000 of charges per day. I know my wife's 4 day hospital bill went far over $50,000. UA would have paid $8,000 and we'd be looking at BK.

In MD just a semi-private room runs an average of $1,400. And that just starts the bidding.

But wait, there is more, with the DesignMED Super Supp the client is covered

[STIBROKER@AUSTIN.RR.COM]

Originally Posted by Steve

So we come full circle and it starts to make sense...

I get flack about those types of posts as being a smart ass .....but....sometimes you have to take the long road.......thats how I roll...

[healthagent]

When you're new all these polices look like magic: "Look! I can get high risk clients covered!!!" Then you get something......experience. And you start to see the flaws in these plans and you start to see the true cost of medical expenses as your clients start filing major claims.

A little bit of money can put people in really bad shape. I told everyone on the board about my client where the doctor put an incorrect date of the accident and the claim was declined.

I'm still dealing with that appeal today. I hope everyone here understand that a "little" bill like $10,000 can ruin people - especially mentally. Here's the fax I got today followed up by a call. We're trying to get this doctor error reversed - in the mean time my client's go over $10,000+ in bill and he's hyper-freaking. Hospital is giving him 10 more days to pay or collections starts. This is no joke guys.

[somarco]

I'm figuring a 2-day stay

2 calendar days does not equal a 2 day stay. 23.5 hours, even spread over 2 days, equals one day in the hospital. You have to go over 24 hours to get a second day of coverage.

[jdechol]

Originally Posted by Michael Haislip

You have to look at the individual's situation. Not everyone can just go out a get a job with benefits or form a two-man group. If the person is in Tennessee, those are the only options. Is it better to have some coverage than none? Or is it major medical or nothing?

I think nothing is better than having the FLEXguard. There is no reason to pay for health insurance if it doesn't do the job. You're better off self insuring IMO. But when you have the state health pool for uninsurable people, there is no room for UA plans except as supplemental to major medical. If you don't have a major medical plan, then you shouldn't have a UA plan. If you are uninsurable and low budget, then get the highest deductible state health pool plan and if you really don't have the money to pay for that then you are low income and if something happens medicaid will be there. (Of course a job with benefits may also be an option.)

My point is simply this... Why spend your hard earned money on crap insurance that doesn't offer real protection??? Do you realize that the FLEX guard pays nothing for cancer? I wonder how many UA agents actually read the policies that they hand deliver...

[somarco]

I think nothing is better than having the FLEXguard

That makes no sense.

when you have the state health pool

15 states do not have a risk pool.

[healthagent]

I think everyone needs to realize that in some cases people don't have any options.

In MD say you've been laid off and you were making $30,000 a year - company picked up the tab for health insurance. Now Cobra is offered....at $800 a month. Ok, so Cobra is out. The client just had back surgery so it's off to MHIP, right? (state risk pool.) Nope. If Cobra is offered it must be elected and expired before you can go into the risk pool unless you have one of these specific conditions: http://www.marylandhealthinsurancepl...Conditions.pdf

A: Client doesn't have an eligible condition for MHIP
B: Cobra was offered so they don't qualify for MHIP
C: Client can't get underwritten with anyone
D: Client is not self-employed so they can't write themselves a group plan
E: Client is trying his best to get another job but hasn't found one yet

And this is what needs to be fixed with our healthcare system.

[somarco]

laid off and you were making $30,000 a year

In that situation Medicaid is the safety net. You can even apply for Medicaid 3 months retroactively.

[healthagent]

If he needs on-going treatment - medication, doctor visits, etc...he'd be ass-out. You have any idea of the paperwork and approval process for Medicaid?

Let's play devil's advocate and say he's on $300 a month of medication and loses his job on the 1st. His bene's run out in 31 days and if he can't afford Cobra there's not a chance in hell he'll be accepted into Medicaid in that time-frame.

By the way, most applicants who qualify for Medicaid are initially declined. It's the little game the gov't plays. Ever read about people applying for social security disability? Good Lord.

And by the way - income is just one factor for Medicaid eligibility.

[arnguy]

With regard to hospitalization costs, a client had an overnight stay for suspected cardiac irregularity, Was admitted through the ER. The hospital stay was basically for observation and was considered a 2 day stay in the CCU because the patient was there for 28 hours. The EOB indicated the total hospital bill was $19,588.67. Wow!! Fortunately the patient had good insurance coverage and ended up paying about $300.00 out-of-pocket