$2.5M Mosquito Bite

Discussion in 'General Insurance Agent Discussions' started by somarco, Sep 13, 2006.

  1. somarco
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    somarco That Medicare Guy

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  2. James
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    James Guru

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    How sad.

    Oh well this is one point I notice:

    For those who support Socialize Medicine.
     
  3. Crabcake Johnny
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    What an incredibally horrible story! Unfortunately, I don't know of a single carrier where the 2.5 million dollar bill would have been taken care of.

    One part of the article talked about the child learning to walk again. Most likely that wasn't inpatient but done in a skilled nursing facility or oupatient therapy. Most plans have a 30 day skilled nursing limit. Aetna limits outpatient therapy at $25 per day for 24 visitis and Assurant is $3,000. In theory GR has an "unlimited" outpatient therapy however it's case managed. And we all know how that goes. Also looks like a lot of home care was needed and all carriers limit that.

    People can get confused when they think they have a "5 million dollar policy." Lots of things can have caps, like organ transplants and outpatient treatment. I have a Reader's Digest article I keep called "Can't Afford to get Sick." It highlights a patient getting a heart pump. Turns out the insurance company covered the surgery, but not the pump itself.
     
  4. somarco
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    somarco That Medicare Guy

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    True, there is not much of a break down of the charges. But there was this.

    then

    Assuming continuity, that is rougly 8 weeks of hospitalization, no doubt much of it in ICU. Then another 4 months in & out


    I find this curious, and possibly a hint of the dangers

    Makes me wonder if he got one of those plans for the self employed . . .

    Especially since his insurance tapped out before it reached $1M.

    Or, it could be a plan with an annual cap on expenses.

    Of course much of the bill was for Rx, and we know plans that limit Rx.

    You can certainly make a case for avoiding any plan that pays per schedule, has little or no Rx coverage and sets annual caps on expenses.

    Of course, if your prospects are like mine, they will say it will never happen to them . . .
     
  5. James
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    The real story outside of a *Real* health coverage is the need for LTCi Policy to pick up where Health leaves off.

    Ps plus lets not forget the DI coverage!
     
  6. Tim Eubanks
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    I would guess BC/BS

    just for the fact in N.C to most, health insurance is BC/BS

    Sad story for sure
     
  7. schoolofhardknocks
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    schoolofhardknocks New Member

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    I would be VERY surprised if the company was BCBS of NC. There is a reason why BCBS is synonymous with health insurance in NC. And the reason is that the coverage simply can't be beat in the individual marketplace. That doesn't mean there wouldn't of been thousands of unpaid bills, just not hundreds of thousands or millions.

    I guess my question is how could we as agents protect our clients from this scenario? LTC, disability, critical illness? Would these of done much good? Disability would keep the lights on and food on the table. LTC may of helped with the skilled nursing limitations, but how much would that of helped based on the limits we normally sell. Critical Illness...not sure that there are any policies that would of paid in this particular situation.

    If you could go back in time and been this guys insurance agent, how would of protected him from this financial hardship? Looking forward to hearing everyones ideas.
     
  8. Crabcake Johnny
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    There are unfortunately things that can happen to you that are so cataclysmic - like a Christopher Reeve event - that nothing you have will help. Christopher Reeve's treament was helped out by celebrity friends of his like Robin William and fund raisers. Anything that will require insanely expensive ongoing treatment will never be fully covered. Some supplemental coverage might have helped, but it would have been the difference between hit by a train or a bus.
     
  9. Tim Eubanks
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    Don't take my comment as a slant against the blue boys, it was not.

    I like them as well. from a clients point, not as a agent,

    I also wonder if a DI would have helped.
     
  10. somarco
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    somarco That Medicare Guy

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    It would help to know who the carrier was, and if it was a limited benefit plan.

    The little bit you can glean from the article seems to HINT that it is not a major med plan. Since most of the charges APPEAR to be inpatient, I can't imagine a true major med would leave them hanging out to dry and pay less than $200,000.

    The reporter has not yet responded to my questions.
     

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