Copay Max

I love that commercial. Always gives me a laugh.

But what is copay max?

It is an idea conceived by insurance carriers to overcharge policyholders for things they don’t need. Before copay’s, patients paid the doctor as billed. Same for prescription drugs.

There were no copays, you paid the retail price and more importantly, you knew exactly how much a doctor visit or prescription cost. Today no one knows how much it costs to go to the doctor, nor do they care.

Same for medication.

Copay’s are a convenience for the patient. Copay’s also allow the doc to hide from their patient the real cost of treatment and gives them free reign to write scripts for the most expensive meds.

I recently talked to a lady who had lost her job related group health insurance. She takes 6 different medications. When she was on a copay plan she paid almost $300 per month in Rx copays for her medication. When she lost her coverage she asked her doctor to rewrite her meds for something just as effective but less expensive.

Now her monthly medication cost is under $50.

This simple change, prompted by a loss of copays, saves her almost $3,000 per year.

And no, I am not shipping you.

Fannie Med

Every once in a while an article from another health care blog will cross my desk at Georgia Insurance Shop and it will catch my eye. Richard Scott’s post Patient-based Health Reform or “Fannie Med?” at The Health Care Blog really resonated with me.

His insight, as well as his analogy to the mortgage meltdown which was created by government intervention in the free market, is spot on.

He also outlines his reasoning for the conflict between “universal care” and “patient rights” in a way that almost everyone will nod their head in agreement.

Anything that interferes with an individual’s freedom to consult their doctor of choice to make health care decisions defeats the purpose of meaningful health care reform.

He further states what he terms the “four pillars” of health care reform as it relates to patient rights. [Read more…]

Phantom Insurance and Other Ways to Waste Your Money

It seems that consumers everywhere are complaining about the cost of health care and health insurance.

At the same time they are throwing away dollars like there was no tomorrow, buying phantom insurance and other ways to waste their money.

Here are a few examples.

A lady called looking for health insurance. Her current plan was increasing to over $600 per month. Among her health issues was high cholesterol. Every year her doctor ordered a lipid panel test as part of her physical exam. He also had her on an expensive cholesterol reducing med.

I suggested a carrier that would insure her but would not cover her cholesterol med or her lipid panel.

The premium was $280 less than her renewal.

The med would run $140 per month. The lipid panel around $80, once a year.

She opted to keep what she had and pay the higher premium.

She believes she has coverage but all she really has is phantom insurance. [Read more…]

Insurance Myths & Dragons

Most folks don’t know as much about health insurance as they think they do. It’s amazing how often I talk to people here in Atlanta and other parts of Georgia and hear comments such as these.

I don’t want an HMO plan because they are all bad.

Blue Cross is accepted by all the doctors so it must be the best.

I can’t afford a high deductible plan.

I need a plan with a copay so I can afford to go to the doctor.

I don’t need doctor coverage, just something in case I go to the hospital.

I need a plan with a copay so I can afford my medicine.

I don’t need drug coverage since I don’t take any medication. [Read more…]