Wednesday, January 30, 2008

The New Millionaire's

Seems like a lot of folks are focused on wealth, and what money will buy. They sometimes are possessed about how the wealthy spend their money.

Bling doesn't mean a thing if you don't have your health.

A Washington Post article opened my eyes to some little known illnesses that can be very expensive to treat. Granted, we are talking about a very small minority who are afflicted, but still this is an issue that can be remedied in exchange for very few dollars.

The most expensive coverage is the routine, first dollar plan. When folks want copays for office visits, routine well care and so forth the price of coverage sky rockets.

Same for Rx copays and low (under $2,000) major med deductibles.

I try to discourage clients from wasting money on such phantom coverage but not everyone listens . . .

Some plans (group & individual) have low caps on lifetime benefits, while others will limit the amount they pay for things like Rx or transplants.

The WP article addresses such issues.

Those who need organ transplants or who have hemophilia, Gaucher disease or other costly chronic illnesses can easily rack up medical bills that blow through the lifetime benefits cap of $1 million or more that is a standard part of many insurance policies

Until now, I had never heard of Gaucher disease. The "standard" high claim issues anticipated by carriers has been premature births, head & spinal cord injuries, and burns.

While these make up the majority of the large claims, they are not all inclusive.

Low lifetime caps are somewhat common on government plans. Given that the cost of increasing the lifetime max from $1M or $2M to $5M is relatively small, one has to wonder why we still see plans with such low caps.

In many cases the cost of increasing a lifetime cap from $2M to $5M can be in the range of $4 per month.

At age 6, Hayley Resk was diagnosed with primary sclerosing cholangitis, a progressive liver disease that scars and inflames the bile ducts, and whose most famous sufferer was the late football great Walter Payton. The family's insurance had a lifetime benefits cap of $1 million per person, but it also limited coverage for transplants to $250,000 -- not enough to pay for the liver transplant that Hayley, now 14, received from her mother on Feb. 12, 2007.

Limits on organ transplants are less common, and seem to show up more frequently in individual major med plans as opposed to group plans. But group health plans are not immune.

Hemophilia is an illness that is common enough that the public is aware, but still somewhat rare as far as illnesses go. The Fatula's have 3 boys with hemophilia.

The clotting factor they take to prevent and control bleeding costs about $150,000 a month, and at various times each has been hospitalized for internal bleeding or to treat infections of the ports that allow them to take medication intravenously, Kerry Fatula said. For now, Medicaid pays medical bills for all three. But the eldest, Paul, a senior in high school who physically can do "90 percent" of what his healthy peers can, recently turned 18 and must qualify as a disabled adult to retain federal assistance, she said.

The family could try for new insurance if Chuck, 42, a field service technician for a specialized engineering company, found a new job, but he has invested more than a decade in the company, and finding a comparable position elsewhere would be difficult, she said. Kerry Fatula, 40, does not get coverage through her work with the hemophilia foundation's western Pennsylvania chapter.

Now that's a bit of irony.

Kerry works for the Hemophilia Foundation, but does not have an employer sponsored health plan.

One would think . . .

Never mind.
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