Comments on: Health Insurance After Infertility Treatment

By: Jay

Jay — Sun, 21 Dec 2008 18:47:58 +0000

@sunnie:
Most underwriters and other employees of an insurance companies are paid a salary. However, agents are only paid a commission with no benefits. So they only get paid when they are productive. And if you purchase your policy through an agent, your premium is the same as if you went directly through the health insurance company (that’s the law).

Commission based pay with no benefits (vs salary) is the most efficient way to pay a workforce when it is logistical. Not having an agent leaves you exposed to either not having representation when you have problems with the insurance company after you have the policy (billing, claims, etc), or having to actually go out and pay extra money for representation.

You mention ForHealth’s comment above, she states:
“I would prefer the free market to bring down the cost of routine health care.”

In the free market where companies are competing with each other, money has to be spent on marketing and sales in the interest of employees and stockholders. Compare that with a single payer system that doesn’t have expenses associated with marketing, sales, legal, or dividends.

In the free market system with many different companies for the providers to negotiate contracts with, many providers have the need for a dedicated salaried person just to sort out the billing with each different carrier. Compare that with a single payer system with one payer to bill.

By: sunnie

sunnie — Sun, 21 Dec 2008 15:57:53 +0000

My questions to Jay or the colorado agent.

We are talking about health insurance here. I can understand that there other logistics in place while processing an insurance claim for the clinics, which has do with dealing with underwriters. How are all these people paid? For example, I was approved for a coverage by a health insurance company, are you guys being the agents or underwriters paid on my expense. Does your salary impacts on my coverage, increases my premium? This questions brings us back to what ForHealth explained about paying the Dr’s directly. Enormous cost in the health insurance are primarily due to other logistics that has a share amount in the plan.

By: Jay

Jay — Tue, 19 Feb 2008 05:11:44 +0000

If you have ideas about how to improve the health insurance industry, you might like to share them in our new wiki. You could share your ideas about improving maternity coverage or improving individual health insurance underwriting.

By: Jay

Jay — Fri, 15 Feb 2008 16:51:17 +0000

Sam,
None of the individual health insurance companies in Colorado will cover normal maternity expenses on their standard policies. There are only a few that even have the option to purchase a rider that will. Even those options aren’t a really great deal. The least expensive is $106.40/month and covers very little and the others are between ~$220/month – ~$450/month depending on your age and zip code.
Covering maternity isn’t really an actual insurance product because (for the most part) you can plan it – unlike cancer or a broken leg. So for profit insurance companies don’t see much profit in it. The free market also doesn’t make a big demand that it be covered standard because most people don’t need it and it would just inflate prices dramatically.

By: Sam

Sam — Thu, 14 Feb 2008 13:13:48 +0000

I understand that many policies donot cover infertility treatment. However under the circumstances an individual becomes pregnet after the relevent infertility treatment. Are the expences occured then for maternity covered.

By: Jay Norris

Jay Norris — Thu, 14 Feb 2008 07:20:39 +0000

Based on forHealth’s description of the risk pool offered to her, I don’t think she is in Colorado. And I don’t think she wants to make her contact info public.

By: Colorado Agent

Colorado Agent — Thu, 14 Feb 2008 04:35:44 +0000

forHealth

I understand your frustrations…sadly I deal with these types of situations every week. I am an agent for a major medical insurance company as well as an insured person myself. It is truly a daunting and hellish task to have to navigate the health insurance world unless you have a trust worthy, knowledgeable agent. Im not saying that your agent is not trust worthy or market savy but simply that he/she may not have the ability to help you where you are. If you would like, you can reply to this post and we can discuss what your options are. From my experience, every company has different underwriting guidlines….there may be a catastrophic plan out there that will fit your needs and budget.

Colorado Agent

By: forHealth

forHealth — Wed, 13 Feb 2008 22:40:33 +0000

Correct. I would like to take the middle-man, or insurers out of the mix. I would prefer the free market to bring down the cost of routine health care. I would be in favor of paying doctors directly for a “retainer” in exchange for services. I also would be in favor of Medical “IRA’s” so that my money works for me and is not lost in the vacuum of premiums to never be seen again.

I am not completely against all insurance. I would be interested in buying a truly catastrophic plan, say “cancer” insurance or coverage for injuries from an auto accident. If such plans are available in my state, my insurance agent has not made an effort to sell them to me. (To be fair, I think he only reps the Blues. Still, it would be nice to know as a consumer).

By: Grant

Grant — Wed, 13 Feb 2008 17:40:30 +0000

It is interesting how well intended laws sometimes aren’t thought through all the way.

ForHealth,
I read through your blog. My understanding is that your idea does not have any type of payer for health care expenses other than the patient?

By: forHealth

forHealth — Tue, 12 Feb 2008 15:44:48 +0000

Thank you for bringing this to light. It is insulting to be denied for a catastrophic plan that covers nearly nothing. It is frustrating that the insurers wouldn’t even look at my medical records or talk with my doctors – to see how little infertility treatment I actually received. The sad thing is that I was covered by health insurance the entire time I was under treatment and paid out of pocket for most of it. I was never officially diagnosed with infertility, but it was the reason I sought treatment. I could have lied on my insurance application. But I knew the insurance company could come back with retroactive premiums at a later date if they actually took time to research my medical records. Unfortunately, my case is not unique. There are thousands of women playing the insurance game trying to get at least part of their infertility diagnosis and treatment covered. Almost none of them know they will become uninsurable if they no longer have their group policy. Infertility is as real a disorder as heart disease or cancer that can interfere with the quality of life.