What Would You Offer This Client?

[affirmwealth]

I am new to health insurance, especially in the light of healthcare reform, and would love to help this family.

Okay, it is a married couple with three children. He is a 47 yo diabetic. Their two oldest children are college age. He has a doctor that he travels an hour to go see. He has only been to the doctor a few times a year.

Recently, he went to the emergency room for a pinched nerve in his neck. They have coverage through Cynergy but still got a huge bill.

Now he says he is willing to pay higher premiums as long as there are no more surprise bills. Plus he wants his college students to be covered.

What would you offer this family?

 

[bluemarlin08]

Put him in a high risk pool if available, put the oldest kids on their own plan and the wife and other child on their own plan.

 

[Bob_The_Insurance_Guy]

I partially agree with BlueMarlin.

Kids and mom get their individual policies.

Send dad to Health Care

 

[affirmwealth]

This is in Texas.

 

[affirmwealth]

I just wanted to say thank you to everyone that responded, and in particular the healthcare.gov site is very helpful.

 

[AllenChicago]

I just wanted to say thank you to everyone that responded, and in particular the healthcare.gov site is very helpful.

The sad thing about the new high-risk pools created by
ObamaCare is that you have to be non-insured for six
months before being eligible.

Does anyone know how the government (U.S. or State)
will know that you are currently insured?

-Allen

 

[IndividualHealthGuy]

I am new to health insurance, especially in the light of healthcare reform, and would love to help this family.

Okay, it is a married couple with three children. He is a 47 yo diabetic. Their two oldest children are college age. He has a doctor that he travels an hour to go see. He has only been to the doctor a few times a year.

Recently, he went to the emergency room for a pinched nerve in his neck. They have coverage through Cynergy but still got a huge bill.

Now he says he is willing to pay higher premiums as long as there are no more surprise bills. Plus he wants his college students to be covered.

What would you offer this family?

I'm not sure why everyone is so quick to push this fella to the pool, but here's what I would do. I'm assuming this is a Type II diabetic, and if he has been released from care for the pinched nerve and has no other health issues I would run an Aetna plan by him. It will provide better coverage at a lower price. As far as the rest of the family, it may or may not work out cheaper to have the kids on separate plans.

Not just pimpin' my service or anything, but this is what our quoter would tell you. In a matter of 5 minutes you would know if you wanted all individual plans, wife and kids sep plan or a family plan.

If you want to see how it works, just give me a call at 866-532-2630 and ask for Mitch.

 

[dgoldenz]

The odds of any diabetic getting coverage are slim to none. Very few of them have never been prescribed blood pressure or cholesterol medication, have normal height/weight, etc. Aetna would also either increase the rate for the whole policy by 50% or have to split him off from the kids if they don't want the kids' rates to go up. I don't know about rates in Texas, but Aetna's standard rates +50% here in VA would be just about equivalent to the risk pool, but Aetna has a $5k Rx cap and the risk pool doesn't.