Blogging About Insurance

What is covered?

My daughter broke her arm.  We only had to pay $100 for the emergency room visit (they asked about our insurance before they asked about her condition).  The doctor that tended to her in the emergency room was not an approved doctor by my insurance company so I had to find a doctor that was on the approved list. 

After contacting an orthopedic doctor that my insurance company recommended, I had to contact my daughter's primary care physician to get 'approval' to see the orthopedic doctor to care for my daughter's broken arm.  I had to prove that it was necessary for my daughter to see an orthopedic physician.

After explaining that we were in the emergency room for a fractured arm (back in the old days, it was called a broken arm) that was reset and put in a cast, I was 'approved'.

Off to the orthopedic doctor's office to the tune of $25 for the visit, which required additional X-Rays because they couldn't access the x-rays that were taken in the emergency room (another $25 co-pay for the x-rays).

Each subsequent visit to the orthopedic doctor (weekly) required additional x-rays for which$25 co-pay was expected. 

One month into her treatment, it was decided that she should undergo physical therapy, 3 times a week for 3 to 4 weeks to the tune of $25 co-pay per visit.  By the way, the insurance company informed us that for as long as my daughter remains insured with them she only gets 90 physical therapy treatments for a broken right arm for the rest of her life.  If she wants coverage for another broken arm, she will have to break her left arm. That's good to know, isn't it?

Let me see where was I, oh yeah.  I was about to tally the savings because we have insurance.

Savings for Having Insurance
 
Emergency room:  $100
Orthopedic Dr:  $25
X-Rays $25/ visit = $100
Physical Therapy: $300
Approx Annual Insurance Premium: $6,000

We paid $6,000 out of pocket so that we can get away with a $525 broken arm.  The sad part of all of this is that as a family, we generally spend more time in the Chiropractor's office than we do in a Medical Doctor's office.  Our chiropractic visits are not covered.  We've paid about as much in chiropractic visits as we have paid in insurance premiums. 

Personally, I'd rather turn my insurance premiums over to my chiropractor, but my daughter's broken arm made me realize that we pay $6,000 a year so we can get off easy for the occasional broken arm.

I'm trying not to sound too sarcastic, but just imagine how much we would have paid if we didn't have insurance...

Gone are the days of the $5 co-pay!

Having a health insurance plan allows Texas parents to insure their children to provide coverage for things like well care visits, immunizations, sick care and those trips an falls (broken legs and arms). Some parents purchase coverage through their employer's plans or, if they can afford it, they buy individual health plans.

There are parents, however, who are not so fortunate and do not have coverage under an employer's plan nor can they afford to buy individual health coverage. These Texas parents still have options. Medicaid is available for children of low-income households.

Medicaid provides health care for children whose families meet the eligibility requirements. For families who qualify, the coverage is provided at no cost. In order to qualify the child must be:

1. A Texas resident
2. A US citizen
3. Under 19
4. Living in a family that meet Medicaid's income eligibility requirements.

The Texas Department of Human Services determines Medicaid eligibility. Families that are currently receiving Temporary Assistance for Needy Families (TANF) children automatically qualify for Medicaid. The Department of Human Services evaluate the family's financial situation every six months to determine if they still qualify.

Another option for children is the Texas Children's Health Plan. This is another Federal and State funded health coverage program for families that cannot qualify for Medicaid because their income is too high, but are unable to afford private health coverage. CHIP is available throughout the state of Texas and is offered by HMO's and private insurance companies.

Families eligible for this plan pay a low monthly fee, which covers all children covered under the family's plan. In addition to the monthly premium, most families pay co-payments for doctor visits, emergency care and prescriptions (For more information download the Texas Children's Health Plan Provider Manual).

If the above plans don't suit your needs, visit the Texas Department of Insurance for more options.

We all know that purchasing life insurance at an older age is more expensive than purchasing it while very young. In an attempt to provide affordable insurance to meet the life insurance needs of older insureds, some companies are now offering Guaranteed Acceptance Life Insurance.

Guaranteed Acceptance Life Insurance policy rates are less expensive than the traditional term insurance policies. As the name implies, you are guaranteed to be accepted for this life insurance. There are no health questionnaires to complete and no physical exams to take. As long as you pay the premiums, the policies cannot be cancelled. Additionally, you may lock your premium rate for the policy amount you want. Your rates will not change for as long as you keep your insurance.

Where's the catch you may be asking. Well, the policies are written for a limited period of time. For example, Colonial Penn's policies are for a two-year limited benefit period. They are available for people between the ages of 50 and 85 (This age range varies depending on insurance company and state regulation).

Generally, if death occurs during the first few years, a reduced benefit is paid or the company may return the premiums paid plus interest. For instance, with a Gerber Life policy, if death occurs by natural causes within the first two years (during the limited benefits time), the beneficiary will receive all of the premiums paid plus 10%. However, if death was a result of an accident, or if death due to natural causes occurs after the two years, your beneficiary will receive the full benefit amount. In the event of suicide (with certain state exclusions), the beneficiary will receive the amount of premiums paid only.

Most life insurance companies offer a Guaranteed Acceptance Life policy for seniors. There may be variations from state to state, but the basic premise is the same. They all offer an affordable insurance option for seniors. However, as with all insurance, do your research and read the fine print.

Hawaii has an organization called the Hawaii Long Term Care Association (HLTCA).   This association, comprised of 25 care facilities, is an advocate group for people requiring long term care in the state of Hawaii.  They are committed to caring for the emotional, spiritual and social needs of the infirm, seniors and rehabilitating disabled.   HLTCA is politically active in getting legislation passed to help those in need of long-term care.

 

HLTCA educates the general public by informing them that nursing care is not for the elderly only.  Long-term care is sometimes necessary for the young, or people who are recovering and being rehabilitated from injuries or sickness.  The long-term care does not mean that there is no hope of getting well.

 

Some of the long term care options are:

 

1. Assisted Living facilities - These facilities provide supportive services and housing for people requiring help with personal care and medications.
   

2. Independent Retirement Housing - Independent care provides meals, housekeeping, activities and maintenance to residents who are independent.
   

3. Nursing Facilities - This is an institutional setting where the patient receives 24 hour a day comprehensive care.
   

4. Continuing Care Retirement Communities: These communities are a combination of independent, assisted living and nursing facility in one.  Hawaii has two such facilities.
   

HLTCA can assist you in finding a provider on line, by using their simple search form. You have the option to search by zip code, type of service or by island.   They also list open job positions for long-term care providers in search for employment. 

 

If you or a loved one live in Hawaii and are in need of long term care, a good place to go to get preliminary information is their user-friendly website:  www.hltca.org.  Determining the type of long term care that you or a loved one may need can be emotional and overwhelming.   Having an organization like HLTCA will help make the decision process easier.