Monday, August 31, 2009

Is Your Health Insurance Making You Sick?

Over the last few months I have come to the conclusion that having health insurance in Atlanta, Georgia will make you sick. This came to me as an observation from talking to quite a few people over the last few months who are losing their employer health insurance plan or COBRA is expiring.

OK, this is not a scientific sampling by any stretch. But having spent the last few years talking to people who are looking to buy health insurance in Atlanta it is fairly obvious that people shopping for medical insurance today are generally sicker than those a year ago.

Most of those who contact me now have had employer group health insurance. There are a lot of nice things about employer health insurance. For one, your employer typically pays a portion of the premium. The first time you have a clue how much health insurance really costs is when you get your COBRA notice.

That is usually when I get the first call.

They really can't believe the health insurance costs $1300 per month for their family when they were only paying $50 per week before. They think their employer is stiffing them.

That is not the case at all.

But the premium subsidy isn't making you sick. What is making you sick is the level of benefits provided under an employer health insurance plan. The usual plan design has something like $15 - $25 unlimited doctor visit copay's, $5 - $40 Rx copay's (and no deductible) and a major medical deductible of $1000.

A lot of these plans also include dental insurance and maybe even a vision benefit.

When I start to gather information to pre-screen their application, I always ask for a list of any medications they are taking. Most people don't know all of the names and they almost never know the strength. The reply usually is along the line of, "I take a white pill in the morning for blood pressure and another white pill for cholesterol. I take a blue pill so I don't get depressed over my job and bank account and then another pill at night so I can sleep. You know, just the usual stuff. It's not like I have anything wrong."

In almost every case, if they can name the medication, it is almost always a high priced brand name drug.

I will ask them if they know how much their drugs would cost if they did not have health insurance.

They never have a clue.

A few weeks ago I talked to a man who owned a company. He had canceled his group medical plan a few months ago because the premium was increasing from $1100 to $1700 just for him and his wife. An agent had convinced him that finding coverage was "no problem".


Seems the husband took 4 pills a day and was overweight while the wife took 3 pills a day. When I asked if he knew how much the medications ran he had no idea but speculated that it "couldn't be more than $250 - $300" since he only paid about $130 in copay's.

I checked, and the discounted price to those who have health insurance was $930 per month.

He all but called me a liar.

He also said there were a couple of medications he didn't really need to take but his doctor suggested them so he does.

I hear this quite often.

Last year I talked to a lady who was "healthy and did not take any medication." Seems that was not exactly the case.

When her application was processed the health insurance company discovered she had filled 17 different prescriptions in the last two years.

So I asked about the discrepancy.

Whenever she had a symptom or pain, real or imagined, she went to her doc. Like a lot of patients she has already done her research and decided not only what her ailment is but which medication she needs to correct the problem.

One of her complaints was hay fever. Rather than trying an OTC medication she went to her doc. He wrote a script for a brand name drug which she filled, took for a few days, then quit because it made her mouth dry and eye's hurt. (Her eyes were having a side effect to the medication which causes decreased tear production . . . resulting in dry eyes).

Back to the doctor who promptly writes a prescription for Restasis for dry eyes.

I am very familiar with this as a family member has a chronic case of dry eye (that has nothing to do with side effects) and she uses this daily. At $160 per month this is not something you use casually.

My client had filled the Restasis prescription but never used it. Once she stopped taking the hay fever medication she no longer had dry eyes or dry mouth.

If she had never had a plan with $20 copay's I doubt she would have gone to the doctor as often and I can almost guarantee most, if not all of those medications would never be filled.

She was promptly turned down by every carrier. This was partly due to the number of medications but also due to the fact she failed to own up to any of them on the application.

If the man who canceled his group medical plan had known how much his medications really cost, and he had to pay for them without the benefit of a copay, I can bet he would have asked the doc for a lower cost alternative.

I can't tell you how many times someone who is on medication for GERD (what we used to call indigestion) or taking an anti-depressant and sleeping pill will tell me they don't really need the medication but they take it because their doc prescribed it.

Situational depression, caused by the death of a loved one, marriage or money issues can sometimes be better managed with medication. But if you are still taking anti-depressants 10 years after your dog died it is time to get off the pill and move on.

So if it weren't for rich benefit plans, especially those provided through your job, I suspect quite a few people would not spend as much needless time in the doctor's office and would learn to "suck it up" rather than buying a medication that is going to sit in the medicine cabinet and never see the light of day.

All too often, people coming off employer group health plans are taking so many expensive medications it becomes almost impossible to find a health insurance company willing to issue coverage. If they do issue coverage the rate is jacked up to cover the cost of the medication.

Most people only need a bare bones health insurance plan, but they think they need one with all the bells and whistles.

A question I always ask is this. Does your car insurance have a copay for tires, brakes and oil changes?

The answer is always, "of course not".

If you don't need a copay for tires brakes and oil changes why do you need a copay to see the doctor or fill a prescription?

They don't, but they think they need a copay because . . . they have absolutely no idea how much it costs to see a doctor or purchase medication. There is no need for them to know because they have a copay.

Eliminate the copay and they suddenly become better shoppers for health care and, a big plus, they save a lot of money in reduced premiums and out of pocket expenses.

If you think your Atlanta health insurance policy is making you sick, we need to talk.
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