Texas' Short Term Health Ins. Market is Aweful, Uncompetitive

Sep 15, 2016

  1. AndrewD
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    AndrewD New Member

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    After spending way more time than any normal person would probably spend trying to find a decent short term health plan in Texas, I still only find plans and companies with major red flags of all sorts. Terrible customer service, terrible reliability, sluggish claims processing, claims paperwork obstacle course, billing/accounting incompetence, horrible website quality, etc.

    I do not qualify for a special enrollment period right now (and also NO cobra and NO hipaa) so I want some type of ST health coverage until Jan 1st (when ACA kicks in), but all the options I have found thus far are pretty terrible.

    The cost is not the issue, its the fact that they seem like swiss cheese plans with massive limitations and exclusions that are difficult to wrap ones head around. IMO these ST plans (at least in Texas) offer only the illusion of coverage.
    It seems insane to me that insurers are allowed to sell a policy BEFORE they have confirmed the customer is actually eligible based on medical records. One can only imagine how many people think that they are covered, but actually have no coverage legally speaking.

    Maybe the best strategy is to go for a cheap plan from my limited choice of semi-acceptable insurers and then layer onto it multiple supplemental policies (accidental injury, critical illness, hospitalization coverage, etc.) from better companies.
     
    AndrewD, Sep 15, 2016
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  2. CHUMPS FROM OXFORD
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    CHUMPS FROM OXFORD Guru

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    Since you only need to keep it for 3 1/2 months, it should not be a big issue. If you have major health problems now, than ST coverage won't get approved anyhow.

    Remember that ST plans are designed to cover major expenses only.
     
  3. AndrewD
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    AndrewD New Member

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    If anyone has any suggestions for short term health insurance plans in Texas from reputable/reliable companies it would be greatly appreciated.
     
    Last edited: Sep 15, 2016
    AndrewD, Sep 15, 2016
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  4. kgmom219
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    kgmom219 What's Next?

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    You win the prize for best description of a Short Term Plan:


    The cost is not the issue, its the fact that they seem like swiss cheese plans with massive limitations and exclusions that are difficult to wrap ones head around. IMO these ST plans (at least in Texas) offer only the illusion of coverage.



    Here's the deal...if you want real coverage, you can get an LLC and presuming you have 1 other adult (including a spouse), get a group plan.

    You can wait til 1/1 and get an Individual HMO. (Not sure where you are located to get more specific)

    You can get an STM (IMO, use UHC) and roll the dice. They are going to cover accidents and "lumps". Heart Attacks if you haven't had anything to do with the heart in the last 12 months. Everything else is pretty iffy. But even if they don't cover it, you get the network discounts of a major carrier.

    Also, look at paying it all upfront. They give a 23% discount and they will refund any money if you prove creditable coverage.

    Btw...you just got advice from agent with more than 20 years experience. Maybe next time you should call an agent, we don't cost you anything and would have saved your hours of research. This is a 5 minute phone call....
     
    Last edited: Sep 16, 2016
    kgmom219, Sep 16, 2016
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  5. AndrewD
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    AndrewD New Member

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    Thank you for the response. I decided to apply for a UHC short term HI plan. All was going well during the application process, until I got to the very last eligibility/medical question. I easily passed/qualified in all the previous questions, but wasn't sure about the very last question:

    "Have you or has any person named had testing performed and has not received results, or been advised by a medical professional to have treatment, testing, or surgery that has not been performed? (The person(s) named will not be covered under the policy/certificate.)"

    -Regarding surgeries: I've never had, nor been advised to have, any major surgeries. Check.
    -I am not awaiting any medical test results from any test. Check.
    -Treatment? Not sure about that part...

    Not sure what is considered "treatment" in this context?
    If it includes every single type of treatment, prescription, request, recommendation, etc. from ANY medical professional for ANY type of situation/ailment/condition/injury... then most likely I have not fulfilled at least one or more things that I may have been asked to do. "Treatments" is such a broad term that hardly anyone would be able to say with certainty that they followed every single treatment they were ever advised and/or prescribed to have in their entire life. Hardly anyone would know their entire medical appointment history to that level of detail. That question is too broad for most people to be able to honestly answer, except maybe someone that never visits the doctor.
     
    AndrewD, Sep 18, 2016
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  6. bluemarlin08
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    bluemarlin08 Guru

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    I don't understand your concerns about the medical question. If you have any pre ex you may be denied, not really that difficult. Be honest and you have no problems.
     
  7. AndrewD
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    AndrewD New Member

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    I don't know the scope of that question, so therefore I don't know how to answer it. If "treatment" applies to literally every single instruction and/or prescription, from every single medical professional, then undoubtedly there is some point that I didn't complete something they asked or didn't fill some script because it was too expensive or something along those lines.

    Very few people would be able to say that they filled every single script ever prescribed to them (some acne meds cost hundreds for 1 fill) or followed every instruction ever given. The question is clearly designed so that claims can be denied when it is convenient for the insurer.
     
    AndrewD, Sep 18, 2016
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  8. somarco
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    somarco That Medicare Expert Guy

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    My advice is, apply and see what happens. You can lie and answer "no" to every health question and the policy will be approved. The 5 yr look back when you have a claim will take care of itself.
     
    somarco, Sep 19, 2016
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  9. bluemarlin08
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    bluemarlin08 Guru

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    Get copies of your medical records and know what you have been treated for. I recommend all my clients have a copy of all records from all their doctors. Often surprised what is in the records, sometimes incorrect info.
     
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