Farm & Ranch Healthcare

[Crabcake Johnny]

As long as it passes pre-authorization. If it doesn't then you might as well have nothing.

If anyone new doesn't know how this works then allow me to explain. You need a surgery and the estimated bill is $50,000. The hospital will then contact the insurance company to find out:

A: If the procedure covered
B: Is there enough of a benefit to cover it

So assume the client is on some indemnity plan with a $10,000 surgical benefit. In that case no surgery would be performed unless the client could show the hospital where the other $40,000 was coming from.

 

[Crabcake Johnny]

And by the way, some indemnity plans - especially the ones that takes high-risk people or are guaranteed issue, don't pay the hospital directly. They cut the client a check. In those cases the hospital may want the client to front the entire procedure.

 

[STIBROKER]

You have to look at the individual's situation. Not everyone can just go out a get a job with benefits or form a two-man group. If the person is in Tennessee, those are the only options. Is it better to have some coverage than none? Or is it major medical or nothing?

hummmmmmmmmm.....

http://www.cobrahealth.com/statehighriskpools.html

Tennessee Comprehensive Insurance Pool
http://www.state.tn.us/tenncare

(800) 669-1851
Open to New Enrollees -No Waiting Period

http://state.tn.us/tenncare/news/TCoverview/aboutTC.htm

The current TennCare program is really two programs. There is TennCare Medicaid, which is for persons who are Medicaid eligible, and TennCare Standard, which is for persons who are not Medicaid eligible but who have been determined to meet the stateÂ’s criteria as being either uninsured or uninsurable. Historically, individuals in both programs have received the same services. TennCare Standard enrollees with family incomes at or above poverty are required to pay premiums and copays, however.

 

[James]

You have to look at the individual's situation. Not everyone can just go out a get a job with benefits or form a two-man group. If the person is in Tennessee, those are the only options. Is it better to have some coverage than none? Or is it major medical or nothing?

hummmmmmmmmm.....

http://www.cobrahealth.com/statehighriskpools.html

Tennessee Comprehensive Insurance Pool
http://www.state.tn.us/tenncare

(800) 669-1851
Open to New Enrollees -No Waiting Period

http://state.tn.us/tenncare/news/TCoverview/aboutTC.htm

The current TennCare program is really two programs. There is TennCare Medicaid, which is for persons who are Medicaid eligible, and TennCare Standard, which is for persons who are not Medicaid eligible but who have been determined to meet the stateÂ’s criteria as being either uninsured or uninsurable. Historically, individuals in both programs have received the same services. TennCare Standard enrollees with family incomes at or above poverty are required to pay premiums and copays, however.

The only way to get on TNCare now is basically be completely inpoverished and in the Hospital racking up some serious charges if one is now not on it. The State is preparing its way into our next new and better program called Cover TN, yet another feable attempt or so it seems.

 

[Michael Haislip]

Last Thursday, I was in a car wreck. No surgery required, but I was still kept overnight. I'll have a bill of $20,000 in a few days.

With a policy like UA's FlexGuard ($100K lifetime limit), for example, I would be responsible for a $500 deductible and 80/20 coinsurance. My bill would have been $4500 instead of $20000.

Even with the limits on surgery and lifetime benefits, I'd rather have this policy than nothing at all.

 

[STIBROKER]

Last Thursday, I was in a car wreck. No surgery required, but I was still kept overnight. I'll have a bill of $20,000 in a few days.

With a policy like UA's FlexGuard ($100K lifetime limit), for example, I would be responsible for a $500 deductible and 80/20 coinsurance. My bill would have been $4500 instead of $20000.

Even with the limits on surgery and lifetime benefits, I'd rather have this policy than nothing at all.

how healthy were you BEFORE the car wreck.........

 

[Michael Haislip]

how healthy were you BEFORE the car wreck.........

I was uninsurable before.

 

[Crabcake Johnny]

Last Thursday, I was in a car wreck. No surgery required, but I was still kept overnight. I'll have a bill of $20,000 in a few days.

With a policy like UA's FlexGuard ($100K lifetime limit), for example, I would be responsible for a $500 deductible and 80/20 coinsurance. My bill would have been $4500 instead of $20000.

Even with the limits on surgery and lifetime benefits, I'd rather have this policy than nothing at all.

You are correct - anything is better than nothing - just make sure all of your options were explored.

 

[Crabcake Johnny]

And this points out what I think is the worst flaw in our healthcare system - a guaranteed issue product that's available to everyone. Everyone who's willing to pay a reasonable premium should be guaranteed to have access to a major med plan. Insurance companies could issue the plans and and combination of state and federal funds could off-set the costs. I hate hearing about stories of people who want coverage and can't get it.

 

[somarco]

I finally threw all my UA stuff away, but I thought the UA plan paid 80% UP TO the daily cap; and 80% UP TO the surgical limit. They also had some kind of funky accident benefit.

Right or wrong?

(Addendum)
Found this online. http://www.bmcagency.com/claimsexample.html

Looks like there is a daily cap, so your (Michael's) estimate may not be accurate.