So got a call from Sam, inquiring about possible health insurance options.
Sam has a policy he bought from a company that doesn't, in fact, sell insurance, but is some kind of pre-paid, limited benefit type plan with a $2,000 deductible and $30 co-pays and costs about $300 a month (keep in mind that Sam's in his mid-50's and in good health). Problem is, no one accepts this insurance, and he's not satisfied.
That's typical of these types of plans, which sound really great, until you have to actually use them. But, lesson learned (maybe), one supposes, and I'm happy to offer an alternative.
Since we're out of Open Enrollment season, and he didn't appear to qualify for a Special Open Enrollment exemption, I turned to Short Term Medical plan options. One of my primary STM vendors recently got rid of their (obnoxious, but apparently industry-standard) application fee, and offers a $2 million lifetime maximum on their plan (unlike pretty much everyone else's $1 million max). I found several alternatives priced competitively with his (actual junk) plan, albeit with slightly higher deductibles.
I had also asked him if he was, perhaps, self-employed, and when he told me that he was, I began researching whether he might be eligible for one of those new-fangled Chamber Plans.
So, I called him back with my good news.
And, surprise, he told me that since my STM offerings weren't going to save him any premium dollars, his current deductible was so much lower, he wasn't interested. Okay, but...
And he further informed me that, after speaking with a local hospital admin, and his current carrier, he'd been assured that if he was hospitalized the facility would have to treat him and the insurance would have to cover that.
Of course, that's NOT how EMTALA works.
Since we're out of Open Enrollment season, and he didn't appear to qualify for a Special Open Enrollment exemption, I turned to Short Term Medical plan options. One of my primary STM vendors recently got rid of their (obnoxious, but apparently industry-standard) application fee, and offers a $2 million lifetime maximum on their plan (unlike pretty much everyone else's $1 million max). I found several alternatives priced competitively with his (actual junk) plan, albeit with slightly higher deductibles.
I had also asked him if he was, perhaps, self-employed, and when he told me that he was, I began researching whether he might be eligible for one of those new-fangled Chamber Plans.
So, I called him back with my good news.
And, surprise, he told me that since my STM offerings weren't going to save him any premium dollars, his current deductible was so much lower, he wasn't interested. Okay, but...
And he further informed me that, after speaking with a local hospital admin, and his current carrier, he'd been assured that if he was hospitalized the facility would have to treat him and the insurance would have to cover that.
Of course, that's NOT how EMTALA works.
So he's told me at least one lie, and who knows how many others, and all I can see is "Red Flag Ahead." I immediately cut the conversation short, and thank him for the opportunity to have at least tried to help him. He replied that he understood but was only rejecting the Short Term plan ... No thank you, and best of luck!
(Whew!)
This was definitely not the type of customer (let alone client) that I'd want to take on.
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