Self Employed & Health Insurance Questions

[White92]

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.

 

[steveny]

I pay about the same, 1k a month. I wouldn't go without it.

Here is a story,

Guy I know, self employed. He let his insurance lapse and the very next day he fell off his own roof. The bill, over 250k. So not only did he have the medical bills he also was unable to work for over a year. Health insurance IMO is more for a disaster then for doctor visits.

Also IMO I think it is BS that health insurance companies are more like a clearing house that simply negotiate the bill down to the patients co-pay instead of actually paying the bill the doctor sends. I think if the health insurance company has the power to do that then the individual should have the same amount of power without having to pay health insurance premiums. It kind of reminds me of the mob.

 

[Dtrigg]

One thing they may want to consider is a policy that has a very high deductable. I am retired and looked at policies with a $5K or $10K deductable. After that is paid, the coverage kicks in and then goes to a $3 to $5 million limit.

These were individual policies, so I don't know if they have them for a family.

Hope this helps.

 

[druby]

I sell health policies and they should look at putting the spouse on payroll and getting a group plan. A group plan has to cover all pre-existing conditions and has to be issued and they can't charge more than a maximum premium. The spouse has to be on payroll for at least 30 hours per week at minimum wage. Have her do his books or something. That should help. I definitely wouldn't go with no coverage, like a previous post mentioned go with a high deductible plan to reduce your premium, look at a HSA plan and fund the savings account so you can pay your expenses pretax and you get the benefit of the insurance companies discounts.

If you want more advice you are welcome to call me. I might not be able to sell you anything from here but I'd be happy to give you advice and try to help you find someone to help you.

 

[Dtrigg]

I sell health policies and they should look at putting the spouse on payroll and getting a group plan. A group plan has to cover all pre-existing conditions and has to be issued and they can't charge more than a maximum premium. The spouse has to be on payroll for at least 30 hours per week at minimum wage. Have her do his books or something. That should help. I definitely wouldn't go with no coverage, like a previous post mentioned go with a high deductible plan to reduce your premium, look at a HSA plan and fund the savings account so you can pay your expenses pretax and you get the benefit of the insurance companies discounts.

If you want more advice you are welcome to call me. I might not be able to sell you anything from here but I'd be happy to give you advice and try to help you find someone to help you.

Don't you just love NSXPrime!:biggrin:

 

[White92]

This is the coolest site ever! druby, I'll pass along the info (and any other info that someone else might contribute) If they decide to call you, I'll let you know first.

 

[DocL]

Your brother in-law is a moron if he wants to drop the insurance for his kids. Other than this I have nothing more useful to contribute as druby pretty much stated what I was going to mention.

 

[NSXAMG996TT]

I'm self employed and our family gets full healthcare coverage through my wife's job. I also carry disability and life insurance because if I get sick or die and can't bring home the bacon anymore, then everything's gone overnight.

As a healthcare professional, I've have seen insurance rates skyrocket. It's definitely not going into our pockets. I often advise my patients that are reasonably healthy to pay on their own for preventative visits and put the extra money awhile for life's emergencies. With that said, all kids should have health coverage.

 

[White92]

Your brother in-law is a moron if he wants to drop the insurance for his kids. Other than this I have nothing more useful to contribute as druby pretty much stated what I was going to mention.

Sorry, didn't mean to give the impression that they actually would do that. It was more thinking out loud out of frustration. I should have worded that better.

 

[druby]

If they want to talk with me my toll free number is 888-728-7255 I see you are Utah and I'm definitely not licensed there but for the most part the plans are the same over the country. I am also a member of a prime type web site for professionals in my business so if we can get an idea that works I can post and find someone close to where they live to help them. The folks on that web site are normally very good as only folks that want to do the right thing bother to find it and join.

If they call the office just have them ask for David, it's my business so I'm out alot but if they leave a call back number I'll be glad to help them.

 

[Tom239]

Also IMO I think it is BS that health insurance companies are more like a clearing house that simply negotiate the bill down to the patients co-pay instead of actually paying the bill the doctor sends. I think if the health insurance company has the power to do that then the individual should have the same amount of power without having to pay health insurance premiums. It kind of reminds me of the mob.

I lay a lot the blame for that on the doctors and hospitals. Some providers charge uninsured patients more, some don't.

I remember Walgreens charging more for a prescription if you didn't have insurance. I live in a small town now, the pharmacy is an independent business, and he gives uninsured customers his rock-bottom price because he's a decent human being.

 

[Dtrigg]

I lay a lot the blame for that on the doctors and hospitals. Some providers charge uninsured patients more, some don't.

I remember Walgreens charging more for a prescription if you didn't have insurance. I live in a small town now, the pharmacy is an independent business, and he gives uninsured customers his rock-bottom price because he's a decent human being.

Are you serious? If your want free healthcare you go to the ER. Today you can be John Smith or tomorrow you can be Bob Jones. The hospital is prohibited by law from provideding by law from providing you health care. Not leagal in the U.S. and you're having a baby. No problem, you get delivery and they don't collect. Hello, you don't have insurane to reimburse me, do I have an ability to collect your potential claim?

I worked in healthcare for over 20 years and you blame physicians? I have asked my physician buddies that exact question. I would estimate that 99.9% have told me that they would never go to medical school again.

I had an emergeny dential problem the other day. I don't have a dentist so I went to the University of the Pacific dental school which is three blocks from my house. That's when I learned that the tution for that school is $71,000 per year. That's tution only.

Oh yeah, those pharma companies, they on only risk BILLIONS of dollars to bring a product to market. Oh, by the way, my last job was taking biotech markets public, so I have a little understanding of the Pharma market.

Get a clue...

 

[Tom239]

Are you serious? If your want free healthcare you go to the ER.

Whoa. Read what Steve and I were talking about in particular: the fact that insured people get better negotiated rates, and the uninsured pay more. Neither he nor I said a word about wanting something for free.

When I go to a doctor, willing to pay cash on the spot, and he wants to charge me MORE than he will charge an insured patient-- yes, I fault the doctor for treating me poorly.

You can't even get a straight answer out of some offices for what a procedure will cost.

I clearly said that not all doctors are like that. That means I respect the ones who run a decent business.

Oh yeah, those pharma companies, they on only risk BILLIONS of dollars to bring a product to market. Oh, by the way, my last job was taking biotech markets public, so I have a little understanding of the Pharma market.

I didn't say a word about drug manufacturers. I was talking about policies of retail pharmacies.

Get a clue...

Likewise.

 

[NSXAMG996TT]

Are you sure???

All my of uninsured patients are given a cash discount. Often times it's up to the doctor to decide what to charge or discount in a private office. If you're part of a HMO, then the business men in charge are the ones to blame.

In fact, some physicians are leaving certain states (won't say which) because of the way manage care has evolved.

 

[NSXAMG996TT]

{QUOTE} "I had an emergeny dential problem the other day. I don't have a dentist so I went to the University of the Pacific dental school which is three blocks from my house."

Although UOP is a top notch dental school, do you really want a student dentist doing your root canal for example? Especially in August when the new semester just began, hope you got lucky and found a good student.

Next time, you can PM me for a referral in your area as I use to work for the CDA (CA Dental Board).

 

[peiserg]

Whoa. Read what Steve and I were talking about in particular: the fact that insured people get better negotiated rates, and the uninsured pay more. Neither he nor I said a word about wanting something for free.

When I go to a doctor, willing to pay cash on the spot, and he wants to charge me MORE than he will charge an insured patient-- yes, I fault the doctor for treating me poorly.

You can't even get a straight answer out of some offices for what a procedure will cost.

I clearly said that not all doctors are like that. That means I respect the ones who run a decent business.

I didn't say a word about drug manufacturers. I was talking about policies of retail pharmacies.

Likewise.

I guess you're not well educated in how the system works. Mammoth insurers (lets say blue cross) who have a big portion of the population under their umbrella, use their muscle to force doctors and hospitals and surgical centers to accepts ridiculously low rates, or lose a huge portion of business.

In arizona, where i practice, blue cross pays LITERALLY less than medicaid for anesthesia for a lot of procedures.

I.e., the indigent person who comes in with government paid shitty insurance for the homeless pays me more to care for than blue cross.

Let's say my usual rate is $100/hr. The medicaid system pays 32% of my usual rate. Blue cross pays a little less. Cash patients usually get a 50% discount on my full rate ($50/hr).

So in this example, yes, the insured patient pays less. but only because of the ridiculous tactics that blue cross employs. Most other insurers pay $50-100/hr, so you are getting a break vs. the normal insured patient.

Let me put it to you this way... Not knowing what line of work you are in...lets say you are a cop making $50k/yr avg.

When you respond to 911 calls for bue cross patients, your paycheck is slashed by 70% untill you are done helping that person. Oh.. wait... he's got good insurance? Now you get your full paycheck. Wait...he's uninsured but willing to try to pay? You're a nice guy and agree to only make $25k/yr while you are helping that guy. make any more sense?

what really gets to me is listening to the salaried/hourly guys employed by the hospital.. if I bitch while having to treat someone for free, I get the earful of "oh... but they need the surgery, you really should take care of him." I usually respond with "well, true, he does need the surgery... I will stop bitching if you will walk over to the front desk, and punch out for this surgery, then come back in. Then we are both working for free."

Conversation ends very quickly I've noted. Hmm.

 

[Tom239]

Most other insurers pay $50-100/hr, so you are getting a break vs. the normal insured patient.

You seem like a fair doctor, one I would be happy to do business with.

Try to appreciate what it's like to deal with doctor's offices as an uninsured patient. Some of them charge uninsured patients the highest rate. And the pricing is only part of it; some offices treat you like a second-class citizen.

A plumber or electrician or roofer will cooperate and tell you what a job will cost; only in medicine have I been unable to get answers to simple questions about pricing. A sample conversation I had with a doctor's office:

office: what insurance do you have?
me: none.
office: we need a $300 deposit before the doctor will see you.
me: how much does a consuitation cost?
office: I don't know.

I have to emphasize: not all doctors are like this.

 

[TyraNSX]

This has come up before if you search. I had these guys for the past 13 yrs & was happy. $10 million lifetime limit, options for high deductible plan, pharmacy benefit option, etc. I recently dropped them since I now have insurance through my job. They were going to raise the monthly premium & I couldn't see pay more for something I only used twice in 13 yrs & for not much total payout. It was $175/month for just me with the $5000 deductible. Give them a call & see if they have an agent in your area or can give you some info.

http://www.nhic.com/

 

[DocL]

Since we're now on the topic of insurance reimbursement I'll add my $.01. It used to be $.02 but I have to wait until the insurance company sends their portion. I do not participate in any discount insurance plans and I am not a provider for any single HMO/PPO. My business is strictly fee for service. I have no roadblocks that would stop you from coming in my front door. Any one of you can call my office and ask how much I charge for any of my procedures. I'd rather determine how much of a loss I will take, not some insurance company exec who is taking home a seven figure salary. That being said, I do however submit the claim to the insurance company and wait the 2,4,6, or even 24 weeks to get paid if the person does have insurance. I rarely give discounts because my staff and the merchants who I do business with don't give me a discount on how much I pay them. I tell each person who has insurance that they are the one's with the contract, not me. They are told up front how much my fees are and I never "perform before I inform". If they can't afford it I will even finance the treatment. I have never gone into a restaurant and asked for a discount after I've eaten my meal. I just don't get it. I now send any person who has received three billing statements and hasn't paid me to my collection service, even if it's for $20.00. I've never known any other industry besides medicine where it is acceptable to not get paid for your services, or even be forced to take a 70% pay cut.

I too probably wouldn't have gone into the profession if I knew what I up against on the business side. :frown:

 

[steveny]

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why don't all the doctors get together and set a price schedule. you guys could get a lot of great p-r and save the system. you could set prices for people without insurance at the same rate you now accept from the insurance company. then I could keep my 10k a year I pay the insurance company so the insurance company can have me make a co-pay which is all the doctor gets anyways. like I said in my first post the insurance companies are simply being paid to negotiate for the patient. lets cut them right out of the loop since they aren't making it any better for the doctors or the patients.

I can tell you this.. if you charge 100 dollars an hour my insurance company is robbing me blind because I pay 10k a year and I spend less than 5 full hours at the doctor every year. I am talking 5 full hours with me and the dr. in the same room.

I just had a prescription filled and the co-pay on that was only a dollar less than the pills would have cost in cash. It had the cash price right on the receipt, $6.38 and my co-pay was 5 bucks. woo-hooo I paid 10k for insurance that save me a whole 1.38....wicked!!!

I hate paying for insurance (anything for that matter) which supplies me nothing for what I pay. All I am really doing here is paying into, or saving up for, the big one. I will pay this 10K a year for quite a few more years, I hope, before I really need to use it.

Quite honestly I would like a policy that would pay 100% of major illness and or accident but not pay for regular Dr. visits. So If I go to see my doctor for 15 min apt when I have the a cold and need a prescription then I pay 25 bucks, 1/4 of a hundred dollar hour plus any costs for prescriptions. BUT when I get the big one it's covered on insurance, all of it.

furthermore I am a firm believer that the reason health care cost so much is because once again I have to pay for the people who don't pay. I know it may not be the most popular opinion but there is no way I would treat someone who couldn't pay, and I wouldn't feel sorry for them either if they were able bodied before they came to the ER with a stroke from smoking crack.

 

[DocL]

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why don't all the doctors get together and set a price schedule. you guys could get a lot of great p-r and save the system. you could set prices for people without insurance at the same rate you now accept from the insurance company. then I could keep my 10k a year I pay the insurance company so the insurance company can have me make a co-pay which is all the doctor gets anyways. like I said in my first post the insurance companies are simply being paid to negotiate for the patient. lets cut them right out of the loop since they aren't making it any better for the doctors or the patients.

That was done already. It's called the HMO and the doctors who started them sold them to the insurance companies.

I just had a prescription filled and the co-pay on that was only a dollar less than the pills would have cost in cash. It had the cash price right on the receipt, $6.38 and my co-pay was 5 bucks. woo-hooo I paid 10k for insurance that save me a whole 1.38....wicked!!!

Guess what. Down here in Florida the Publix grocery store gives out anitiootics and other meds for free. A seven day supply of Amoxicillin costs $10.00 with my insurance and I can get it for free at Publix. I tell all my patients to go to Publix to get their meds that are on the freebie list.

So If I go to see my doctor for 15 min apt when I have the a cold and need a prescription then I pay 25 bucks, 1/4 of a hundred dollar hour plus any costs for prescriptions. BUT when I get the big one it's covered on insurance, all of it.

I'll save you even more money Steve. For a cold there is not treatment and you don't even need to go to the doctor. Drink lots of tea and take an OTC generic decongestant.

I know it may not be the most popular opinion but there is no way I would treat someone who couldn't pay, and I wouldn't feel sorry for them either if they were able bodied before they came to the ER with a stroke from smoking crack.

When people come into my office with a broken tooth that is infected I always ask them how long ago the tooth broke. You can't believe how long people wait to see a doctor for problems. I have very little sympathy when you call me on a Saturday night in pain when I told you six months ago that this had to be addressed ASAP. I never force people into doing the treatment plan as they need to make the decision for themself, but I do tell them what will happen if they don't do it. Surprisingly 50% of the time people ignore my recommendations. But it's okay, I'll make more money the longer you wait. :wink:

 

[TyraNSX]

2 words: price fixing. FTC doesn't like it & has come down on professionals before.

What is needed is a full disclosure of all costs involved in any medical item/procedure. People complaining about their $5 co-pay going to $10 on a $90 prescription need to see how much they didn't pay out of the whole bill. Ditto for any office visit or procedure. Once people see that a $80 office visit fee is only paid at $45 by the insurance company & they only paid $10 of that, they should shut up & quit bitchin'.

Insurance companies & their 7 figure salaries need to go bye-bye. Eliminate them or regulate them like utilities.

Lines 2-4 of 1040 sched. A need to go bye-bye. All the a-hole politicians claiming health care is a right & a privilege (Hillary's words verbatim) yet they only let you deduct the part over 7.5% AGI. If it's so damn important, why are you taxing people on it??!! All non-cosmetic medical bills should be 100% deductible, period.

And for every drug that makes it to market, there are 10,000 that didn't. Drug pricing is skewed in this country, but 1 winner has to pay for many losers as well as its own development.

Steve, you need cheaper insurance. For $10K a year you should be getting a new kidney every 2 yrs or something.:biggrin:

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why don't all the doctors get together and set a price schedule. you guys could get a lot of great p-r and save the system. you could set prices for people without insurance at the same rate you now accept from the insurance company. then I could keep my 10k a year I pay the insurance company so the insurance company can have me make a co-pay which is all the doctor gets anyways. like I said in my first post the insurance companies are simply being paid to negotiate for the patient. lets cut them right out of the loop since they aren't making it any better for the doctors or the patients.

I can tell you this.. if you charge 100 dollars an hour my insurance company is robbing me blind because I pay 10k a year and I spend less than 5 full hours at the doctor every year. I am talking 5 full hours with me and the dr. in the same room.

I just had a prescription filled and the co-pay on that was only a dollar less than the pills would have cost in cash. It had the cash price right on the receipt, $6.38 and my co-pay was 5 bucks. woo-hooo I paid 10k for insurance that save me a whole 1.38....wicked!!!

I hate paying for insurance (anything for that matter) which supplies me nothing for what I pay. All I am really doing here is paying into, or saving up for, the big one. I will pay this 10K a year for quite a few more years, I hope, before I really need to use it.

Quite honestly I would like a policy that would pay 100% of major illness and or accident but not pay for regular Dr. visits. So If I go to see my doctor for 15 min apt when I have the a cold and need a prescription then I pay 25 bucks, 1/4 of a hundred dollar hour plus any costs for prescriptions. BUT when I get the big one it's covered on insurance, all of it.

furthermore I am a firm believer that the reason health care cost so much is because once again I have to pay for the people who don't pay. I know it may not be the most popular opinion but there is no way I would treat someone who couldn't pay, and I wouldn't feel sorry for them either if they were able bodied before they came to the ER with a stroke from smoking crack.

 

[steveny]

That was done already. It's called the HMO and the doctors who started them sold them to the insurance companies.:

then why isn't it working?

Guess what. Down here in Florida the Publix grocery store gives out anitiootics and other meds for free. A seven day supply of Amoxicillin costs $10.00 with my insurance and I can get it for free at Publix. I tell all my patients to go to Publix to get their meds that are on the freebie list..:

I know I love florida. Up here you go into the doctor and pay 5 times what it's worth so you can pay for the other 4 people who are "stupid and smelly" and don't want to pay for themselves.

I'll save you even more money Steve. For a cold there is not treatment and you don't even need to go to the doctor. Drink lots of tea and take an OTC generic decongestant. .:

Thanks. I was just using the cold as an example. Generally I am a VERY healthy person and don't see the doc that often.

When people come into my office with a broken tooth that is infected I always ask them how long ago the tooth broke. You can't believe how long people wait to see a doctor for problems. I have very little sympathy when you call me on a Saturday night in pain when I told you six months ago that this had to be addressed ASAP. I never force people into doing the treatment plan as they need to make the decision for themself, but I do tell them what will happen if they don't do it. Surprisingly 50% of the time people ignore my recommendations. But it's okay, I'll make more money the longer you wait. :wink:

Your preaching to the choir. I see the same thing with our construction company all the time. Give an estimate for a roof and the client can't afford it. Come back 6 months later and fix the roof AND the ceiling. It's crazy how people waste money.

 

[steveny]

2 words: price fixing. FTC doesn't like it & has come down on professionals before.:

Maybe the prices in this case need to be fixed.

What is needed is a full disclosure of all costs involved in any medical item/procedure. People complaining about their $5 co-pay going to $10 on a $90 prescription need to see how much they didn't pay out of the whole bill. Ditto for any office visit or procedure. Once people see that a $80 office visit fee is only paid at $45 by the insurance company & they only paid $10 of that, they should shut up & quit bitchin'.:

Then it should be offered to people without insurance the same rate as it would be offered to people with insurance. Like I said before it's like the mob if only the insurance companies have the ability to negotiate the bill. That is truly BS.

Insurance companies & their 7 figure salaries need to go bye-bye. Eliminate them or regulate them like utilities.:

agreed or at least give the same power to the individual to negotiate the bill. Then the market will decide if insurance companies are even needed. Which in my case if I had the choice of paying 45 bucks to see the doctor and not pay 10k a year for coverage so someone else can negotiate the bill down too 45 I would choose to pay the 45 to the doctor directly and bank my 10k.

Lines 2-4 of 1040 sched. A need to go bye-bye. All the a-hole politicians claiming health care is a right & a privilege (Hillary's words verbatim) yet they only let you deduct the part over 7.5% AGI. If it's so damn important, why are you taxing people on it??!! All non-cosmetic medical bills should be 100% deductible, period.:

Don't know anything about this. Accountant does all that and I pay her the bill directly not through some accountant insurance who would only pay the account 1/2 or less of what she actually billed so they can rape me for 2x what she would bill thus causing her to bill 3x to have the same rate of pay as if she could just bill the client directly.

And for every drug that makes it to market, there are 10,000 that didn't. Drug pricing is skewed in this country, but 1 winner has to pay for many losers as well as its own development.:

Risk=reward. I am not saying the drug companies shouldn't make money for taking risk. I am saying if I didn't have health insurance I would have to pay for the full amount of the drug which in some cases is less than then co-pay.

Here is a story for you.

My mothers boyfriend had heart surgery. The doctor prescribed a drug for him to take which was the wrong drug. The drug cost 1500 dollars and was not covered on his insurance. He then had to get a second drug that was 1800 dollars that also was not covered on his insurance. The first drug was not returnable and he was stuck paying for both out of pocket. This is a guy who HAS health insurance.

Explain that to me. How is that fair?

Steve, you need cheaper insurance. For $10K a year you should be getting a new kidney every 2 yrs or something.:biggrin:

NY baby, the home of paying for those who don't work. There is a plan called Healthy NY for people who don't make a lot of money. There you go again NY... real smart to reward those who make an effort not to work or to work as little as possible so they can get whatever they want for free. Just go ahead and put the rest of the bill over on those of us who do want to put in the effort. Better yet load us down with charges so eventually we won't want to work at all so we can also get all the free programs.

Just cleaned out an apartment with thousands of dollars worth of prescriptions left in the bathroom from a tenant on Medicaid. Who paid for those? I DID!!

 

[steveny]

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.