I completely agree that "we guys" are beyond belief. And, CERTAINLY, if you're bleeding to death -- take care of it!! But, the story that Dean provides (which is similar to some of my experiences) illustrates just a small part of all that is wrong with our health-care system. I know this is intended as a discussion on self-employment health-insurance options. But, if you're considering an MSA (which I think everyone should), are self-pay/insured, or have any pre-existing conditions (those who have them know what I’m talking about), then this type of knowledge is valuable. Indeed, the amount "charged" by the medical facility is also the amount least-often paid. The facility will tell you - truthfully - that they charge everyone the same. However, what they except as full-payment is quite another thing. An insurance company will send the "charge" back to the facility with a significant amount of it (usually 30-60%) marked as "disallowed." The insurance company will then pay the remaining 40-70% (or defer it to the customer's deductable), and the medical facility will accept this as full payment. Any of you with insurance will see this detailed on your EOB (explanation of benefits) which you will receive from your insurance company for each visit. If you want to negotiate a similar discount for yourself, then you need to do that "IN ADVANCE!" Once you've received services, then you're already liable (and you've probably already signed a form saying so) for the full charge. And, they will pursue payment with a vengeance! You may have very nice doctors and nurses, but the receivables department personnel are not drawn from the same employment pool. I have successfully negotiated a 10% discount after-the-fact, but only with immediate cash payment (thousands in my case). I have never been successful in negotiating anything greater than that. As you can probably tell, I've had a few "ins and outs" with the healthcare establishment. I'm happy to share what I know if it is at all helpful. Happy new year!! -bruce -----Original Message----- From: David Love [mailto:davidlovepianos@comcast.net] Sent: Saturday, December 24, 2005 11:23 PM To: ilvey@sbcglobal.net; 'Pianotech' Subject: RE: health insurance If I'm bleeding to death I say sew me up first, we'll talk price later. David Love davidlovepianos@comcast.net -----Original Message----- From: pianotech-bounces@ptg.org [mailto:pianotech-bounces@ptg.org] On Behalf Of David Ilvedson Sent: Saturday, December 24, 2005 1:45 PM To: deanmay@pianorebuilders.com; pianotech@ptg.org Subject: RE: health insurance You guys are beyond belief.... David Ilvedson, RPT Pacifica, California ----- Original message ---------------------------------------- From: "Dean May" <deanmay@pianorebuilders.com> To: Pianotech <pianotech@ptg.org> Received: 12/24/2005 6:20:49 AM Subject: RE: health insurance >Bruce, >Your emergency room observations are right on. >If you find yourself in need of emergency room treatment, it doesn't >hurt to negotiate up front. My brother had an accident with a circular >saw. He was operating a saw that had the guard broken. After making a >cut he had released the trigger so the blade was spinning down, but >before it stopped it got caught in his blue jeans. Since it was not >under power (which would have just made a clean cut) the jeans pulled >the blade into his thigh where it stalled ripping up his flesh. It was >ugly but miraculously he was in little pain, there was very little >bleeding and it had missed any arteries or nerves. >When he got to the emergency room of our local hospital he wouldn't let >them touch him until he knew how much it was going to cost. The entire >staff was dumbfounded because NOBODY ASKS THAT QUESTION!!! They finally >called someone in to negotiate with him. He said he was willing to have >his wife drive him 80 miles to an Indianapolis hospital, but he would >just as soon have it done locally. They negotiated a price of like $4500 >total (which was less than half normal) that would cover all hospital >expenses no matter how long his stay was. It would not cover radiology >(those guys have their own racket) or surgeon's expenses. >Once I had to take my son in for a broken arm because the orthopedic >doctor was in surgery that day so I couldn't do it in his office. The >doctor had an arrangement with the hospital to use the emergency room in >such cases. I asked up front if there was a cash discount. They told me >yes, I think it was around 30%. After treatment it took awhile to pull >the charges together but I paid them. They told me I shouldn't be billed >anything else and to let them know if I was. Sure enough 6 months later >(amazing how medical bills keep coming months after the fact) I got >another bill for around $200 which came from the billing office in >another state. After a few phone calls there and to the local hospital >they eventually canceled the charges. >Bottom line: Ask how much is this going to cost. Be willing to go to >another medical facility. Ask for cash discounts. Let them know you are >self pay. >Dean >Dean May cell 812.239.3359 >PianoRebuilders.com 812.235.5272 >Terre Haute IN 47802 >-----Original Message----- >From: pianotech-bounces@ptg.org [mailto:pianotech-bounces@ptg.org] On >Behalf Of Bruce D. Rempe >Sent: Saturday, December 24, 2005 12:06 AM >To: 'Geoff Sykes'; 'Pianotech' >Subject: RE: health insurance >Geoff, >I'm not sure what organization was offering you such a plan, but that >would >certainly NOT meet the technical definition of an MSA - or HSA. The >whole >idea of the MSA or HSA plan is that the money is yours and that it >accumulates. >The whole "big idea" behind the MSA/HSA plan is that you are spending >"your >own money" (or money that would otherwise be yours if you didn't spend >it on >medical expenses). The idea is to reduce needless and excessive medical >expenditures, and cause a "moment of cost/value consideration" before >you >consume medical services. >If you've ever been to a modern-day emergency room, then you know what >I’m >talking about. There's nothing more NON-emergency than today's modern >emergency room. The place is full of people who either have dollar-one >coverage from their insurance company, or they have no insurance or are >covered by some gov program. >Since they have no concern for the cost, they show-up every time they >have a >sniffle -- and sometimes when they don't. For many, the attention of >emergency room docs is the most attention they ever get. So, they are >there >with some frequency. >Combine this with the fact that the ER is the MOST EXPENSIVE way to >dispense >medical care, and you have a system who's costs are out-of-control. The >same "no cost/value concern" mentality (often called the >third-party-payer >syndrome) permeates every aspect of the medical system/industry, and >needlessly drives up the cost. >The MSA/HSA approach is to make unspent money yours. That way you spend >it >more cautiously, and with an eye toward value received per dollar spent. >If >everyone had an HSA plan, you can bet that medical expenses in this >country >would be a fraction of what they are today. >Sorry to "go off" on this topic. But, it's an issue that I've been >working >the ins and outs of for some years. I’m a HUGE FAN of the HSA approach. >I >have been an MSA/HSA customer of both Assurant and Golden Rule for quite >some time now, and both companies are respectable (from my experience). >There really aren't too many options for the self-employed. >All the best to you and yours during this holiday season!! >-bruce >Bruce D. Rempe >-----Original Message----- >From: Geoff Sykes [mailto:thetuner@ivories52.com] >Sent: Friday, December 23, 2005 1:25 PM >To: 'Pianotech' >Subject: RE: health insurance >I was presented with a similar health insurance option at my last, (and >hopefully final), day job. It all sounded like a (too) good (to be true) >idea until I got to the fine print and learned that any money I had put >into >this "savings account", and subsequently did not use by years end, was >forfeit back to the insurance company. At the beginning of each year the >account started off empty and the insurance company got to keep >everything >that I had put in the account and not used the year before. And no I did >not >have the option to make withdrawals. It was a deposit only account with >accounts payable only directly to medical service providers via the >insurance company. Needless to say I did not sign up. Please tell us >that >this is not the case with your insurance company. On the other hand, if >you >DO get to rollover this account from year to year with no penalty, let >us >know how to contact these people. >-- Geoff Sykes >-- Assoc. Los Angeles >-----Original Message----- >From: pianotech-bounces@ptg.org [mailto:pianotech-bounces@ptg.org] On >Behalf >Of John Formsma >Sent: Friday, December 23, 2005 5:47 AM >To: 'Pianotech' >Subject: RE: health insurance >Greg, >Having to submit your own bills is certainly something to consider - >hadn't >thought about that. Thanks, I'll ask about that. >We currently have Golden Rule HSA and have been satisfied with their >services. This other company (Assurant) is nearly half the cost >($120/mo. >for me and two kids), but I'm naturally wary because I don't know >anything >about this company. >David, The HSA is the way to go if there aren't many hospitalization >needs. >You get to save money in your own account that builds tax-free for >medical >uses. The idea is to use that money to pay for minor things like office >visits and smaller procedures. For instance, the plan I'm looking at has >a >$5,100 annual deductible with 100% coverage after that. Rather than pay >$300+ every month with a traditional plan, you save the difference in >the >savings account (like a medical checking account). Then you pay for >small >things from that account. (Ideally, you want to build up the account to >at >least the annual deductible amount so you have that readily available.) >Our >normal medical needs are less than $500 every year, so this plan is >great >since it offers catastrophic coverage at a cheap rate. >Susan, we're doing what you suggest. Eating around 90% organic/natural >foods, trying to get exercise, etc., saying "no" to prescription meds. >It >makes some sense to me to try to cover major medical needs, especially >since >I have two little ones for whom to provide. If it were just me, I >probably >wouldn't have insurance and would be saving up money every month to be >self-insured (I'm 35 and in good health as far as I know). >Thanks, all, for the suggestions. >John Formsma >-----Original Message----- >From: pianotech-bounces@ptg.org [mailto:pianotech-bounces@ptg.org] On >Behalf >Of Greg Newell >Sent: Thursday, December 22, 2005 11:16 PM >To: Pianotech >Subject: Re: health insurance >John, > The HSA I use is thru Golden Rule. We get a check book with >which >to pay health cost that come out of the savings part of the plan. We >even >get something like 6% interest on the account. Not too bad in my book. >Others I looked at way back when made me submit bills for >re-imbursement. >Not as convenient as writing a check that's for sure. Take a good look >at >the lifetime ceiling benefit too. >best, >Greg >At 10:17 PM 12/22/2005, you wrote: >>This is business related, but it’s not piano related J >> >>What are you self-employed guys doing for health insurance? >> >>I’m currently looking at a different Health Savings Account (HSA) plan >>with Assurant Health – any negative experience with this company? It >used >>to be Fortis, from what I’ve been told. >> >>Thanks and Merry Christmas! >> >>John Formsma >Greg Newell >Greg's piano Forté >mailto:gnewell@ameritech.net >_______________________________________________ >pianotech list info: https://www.moypiano.com/resources/#archives >_______________________________________________ >pianotech list info: https://www.moypiano.com/resources/#archives >_______________________________________________ >pianotech list info: https://www.moypiano.com/resources/#archives >_______________________________________________ >pianotech list info: https://www.moypiano.com/resources/#archives _______________________________________________ pianotech list info: https://www.moypiano.com/resources/#archives
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