Posted on 08/20/2010 9:20:43 PM PDT by Libloather
Stacy, the EIB Insurance Expert
August 20, 2010
BEGIN TRANSCRIPT
RUSH: Here's Stacy from somewhere in Georgia. She is our semi-regular caller keeping us up to speed on health care and health insurance. She's our insurance analyst. Stacy, as always, welcome back. Great to have you here.
CALLER: Hey, Rush. Great to talk to you.
RUSH: Thank you.
CALLER: And for the NAGs out there, the problem is you.
RUSH: (laughing)
CALLER: I solved that real quick and they didn't even have to rent a conference room. But, listen, I have found some truly delicious information.
RUSH: On?
CALLER: On these preexisting condition insurance plans that just came into effect last month.
RUSH: By the way, before you get into this, have you heard that the Democrats have been given new marching orders? They are to stop talking about how Obamacare is going to save money.
CALLER: And I can tell you why that is.
RUSH: Well, yeah, because it's not going to save anybody any money.
CALLER: Well, these poor suckers with these preexisting conditions who thought they were gonna get all this care, the very minimum -- I calculated it -- the very minimum these people are gonna pay if you're under 35 is $12,340 a year.
RUSH: Wait. No, no, no, no, no, no. Wait, wait just a moment. You're talking about preexisting conditions are not going to be covered because people were told by the Democrats and Obama that at some point after the bill was signed that preexisting conditions and your kids and so forth would be covered, no longer could you be denied.
CALLER: Well, that's true, but, remember, they set up a two-year transition plan, quote, unquote.
RUSH: Yes, but you're telling me that the minimum cost for the free service is $12,000?
CALLER: Yes.
RUSH: Wait, per person?
CALLER: Per person.
RUSH: So the free coverage of preexisting conditions is $12,000 per year per person?
CALLER: Yes. And I can explain it to you. And another delicious factoid about this, all of these plans -- well, okay, back up. Twenty-two of the states told the Department of Health and Human Services that they didn't want to run this crap. They kicked it back to Washington and said, "You handle it."
RUSH: Wait, wait. Did not want to run the preexisting condition form of the insurance?
CALLER: Right.
RUSH: Okay.
CALLER: So they kicked it back to HHS. HHS contracted out to a private insurance company called the Government Employees Health Association.
RUSH: The Government Employees -- the GEHA, GEHA.
CALLER: Exactly.
RUSH: Writing this down.
CALLER: So they're administrating this plan on their website. And I'm going to quote it to you. This plan is an HSA qualified high deductible health plan. The plan gives you greater control over how you use your health care benefits, and they want you to open an HSA account.
RUSH: Wait. A health savings account?
CALLER: Exactly.
RUSH: They want you to open one of those?
CALLER: Yes. Now, here's the really, really fun part about it. There are no benefits payable for anything other than preventive diagnoses until you pay out of pocket $2500.
RUSH: Wait. No benefits payable, meaning the insurance company is not going to pay for your free health care other than preventive diagnoses until you pay $2500 out of pocket?
CALLER: Exactly.
RUSH: How does this relate to the 12,000?
CALLER: Well, the very minimum in Georgia, the minimum premium is $323 a month. Okay? That works out to $3,840 a year.
RUSH: For free preexisting coverage?
CALLER: Right.
RUSH: Yeah.
CALLER: Okay. So you're just gonna pay that, then you've also gotta add $2500 as your deductible before any benefits are payable, minus your preventive diagnoses. Then, it's an 80-20 for in network, 40-60 out of network until you have paid out of your pocket, not including the $2500, $6,000.
RUSH: Okay, so that's how we got to the 12. What is in network, out of network, what does that mean?
CALLER: Well, this insurance company has gone out and gotten providers to sign contracts for services. That's an "in network."
RUSH: Provider is a hospital, a doctor, or a nurse?
CALLER: Exact. All of the above.
RUSH: Okay.
CALLER: Now, mind you, that $2500 that you have meet before they're going to pay a dime --
RUSH: The deductible.
CALLER: -- that includes prescription drugs; that includes hospital stays; that includes durable medical equipment; that includes everything.
RUSH: "Gerbil" medical equipment?
CALLER: Yeah. Okay, let me give you an example to kind of clear it up for you. Say you're a diabetic.
RUSH: Wait a minute, "gerbil" medical equipment?
CALLER: Durable.
RUSH: Oh.
CALLER: Sorry.
RUSH: Whew!
CALLER: Let's say you're an insulin-dependent diabetic, and you've been --
RUSH: Wait a minute, I'm just now getting my composure back. We are an insulin-dependent diabetic. Okay.
CALLER: Okay. So you have to buy your syringes, you have to buy your insulin, okay, the syringes are considered medical equipment.
RUSH: No, wait. You gotta buy it yourself, gotta go to the drugstore, gotta buy it yourself?
CALLER: Exactly.
RUSH: This is not part of your free health care.
CALLER: Exactly, until you have paid $2500. Now, you have to go to your physician every couple of months and have blood tests run to see what your blood levels are. That's not covered.
RUSH: Why can't you just get one of those finger prick things that you get in the drugstore to test your blood sugar, why go to the doctor?
CALLER: They do that, but you do go to the doctor because they run more expensive laboratory tests.
RUSH: Oh.
CALLER: There's different levels of sugars in your blood and they have to see your three-month average and all of that.
RUSH: Right. I'm writing all this down, so far I feel like I'm in a maze.
CALLER: It is a little crazy.
RUSH: I'm an insulin-dependent diabetic, and all I've learned here is I gotta somehow come up with $2,500 bucks to go out and buy all this equipment, and then it's going to cost me $300 a month if it's pre-existing, I'm still trying to figure out where the $6,000 per year comes into this.
CALLER: I'll help you. We'll get there. When you go to your doctor to have your blood run, that's not a preventive, so you have to pay the doctor's office.
RUSH: Wait a minute. When does your insurance kick in?
CALLER: After you have $2500 at the insurance company of claims that they've run up but they're not paying.
RUSH: All right. So you have to have the equivalent of $2500 of medical services by your provider --
CALLER: Exactly.
RUSH: -- and that's your deductible. You gotta pay that before any insurance kicks?
CALLER: Exactly.
RUSH: Even though you're paying a premium, minimum $300 some odd a month?
CALLER: Exactly.
RUSH: Under free Obamacare. Okay.
CALLER: Once you hit that $2500, then you get into some copay so your doctor would be a $25 copay. Out of pocket, and they're not really clear on what contributes to their out-of-pocket, but the --
RUSH: Whose out-of-pocket?
CALLER: The patient's. So once you get to $2500 they're gonna pay 80-20. They'll pay 80%, you'll pay 20%.
RUSH: So after you pay the $2500 plus the $300 a month, you're still paying?
CALLER: Exactly.
RUSH: Where did you find it? I know you're in the insurance business.
CALLER: It's right here on the Web. It's www dot P as in Paul, C as in cat, I as in India, P as in Paul, L as in Lima, alpha, N as in Nancy, dot.com.
RUSH: PCIPLAN.com?
CALLER: Exactly.
RUSH: And that is what?
CALLER: That is the GEHA's website for this preexisting coverage. Now, Rush, I gotta give you one more before you gotta go.
RUSH: Wait. GEHA, that's the general --
CALLER: It's the Government Employees Health Association.
RUSH: Government Employees Health Association.
CALLER: That's the insurance company.
RUSH: That's the insurance company. Okay, so it's the insurance company website.
CALLER: Exactly. Now, one of the 22 states that kicked it back to HHS and said we don't want to do this is Arizona. And guess what you have to provide GEHA in order to be approved for their plan? Proof of citizenship.
RUSH: (laughing) No!
CALLER: (laughing) Is this not delicious? I mean, I'm not normally one for schadenfreude, but when I found this last night I was falling all over the floor. Do you wanna know the states that are doing this?
RUSH: This panacea, this utopian free preexisting condition care health care plan is going to cost you $12,000 a year is only accessible if you can prove citizenship?
CALLER: Exactly. In my view, that $12,000 a year is the absolute minimum. It can go up to $27,000.
RUSH: But you said Arizona kicked it back 'cause they don't want to participate in it.
CALLER: Right.
RUSH: So illegals will now not be mandated to give their proof of citizenship.
CALLER: Well, if they're in Arizona and they want the preexisting condition insurance, then they'll have to send proof of citizenship.
RUSH: No, you said Arizona kicked it back and they're not gonna play.
CALLER: No, no, you can't do that. All states have to play, but 22 states said we are not going to deal with finding a contractor. They just said, "We're gonna let you do it, HHS. You handle it."
RUSH: Oh, as the secretary shall determine.
CALLER: Exactly.
RUSH: That would be Kathleen Sebelius.
CALLER: Yes. So for Arizona, if an illegal alien has a preexisting condition and he wants to get on this plan, he's going to have to forge him up some documents to send in because you have to provide proof of citizenship.
RUSH: This is too rich.
CALLER: Isn't it wonderful?
RUSH: This is just too rich.
CALLER: The schadenfreude is through the ceiling. It's insane.
RUSH: I happen to know that proof of citizenship was one of the things the Republicans were able to force into this. That's one of the few things the Republicans were able to ram through in this, was proof of citizenship into the health care reform bill.
CALLER: I would love to know if they also ran the HSA piece into it. And the reason that this private insurance company has done this as an HSA and high deductible plan is because they know they're not going to be able to cover the money that is gonna go out on this.
RUSH: Well, hell, 90% of the patients are not going to be able to afford this.
CALLER: I know. And, you know, you also have to be not covered by any insurance plan whatsoever for six months --
RUSH: Before you qualify for this?
CALLER: In order to qualify for this, and --
RUSH: You mean you gotta have no insurance for six months before you can qualify for this boondoggle?
CALLER: Yes.
RUSH: I can't believe -- well, I can believe it, actually, it sounds unbelievable but I -- well, you would know. Are you still in the insurance business?
CALLER: I am.
RUSH: Why?
CALLER: Because it's a tough job market, but I'm working on it.
RUSH: I was going to say.
CALLER: But I'm hopeful. I really am hopeful. God, please let conservatives take the House at least and starve this beast. If they don't do that, I'm going to be so frustrated I don't know what to do.
RUSH: Well, that's a two-pronged problem, taking the House and then getting the Republicans to starve the beast.
CALLER: I know.
RUSH: That's a separate issue.
CALLER: But, yeah, there is so much irony in this little piece. In my view this is only good for two years. Supposedly in 2014 all of this ends and then you go on to the exchanges.
RUSH: Right. That's essentially single payer and that's where they hope to get this.
CALLER: Exactly. Another one, Rush. You remember how they said they weren't going to put any benefit limits on people?
RUSH: Yeah.
CALLER: For this plan right here, they have all kinds of benefit limits. One of the big ones that I saw was if you need hospice care, they have a $15,000 benefit maximum that they will pay and you can wipe out 15 grand in hospice in a heartbeat, and that's including inpatient and outpatient --
RUSH: I know. And there aren't many heartbeats left in hospice --
CALLER: Yeah.
RUSH: -- to begin with. There's going to be a revolt when this happens to people.
CALLER: Well, they're starting to find out. Like I said, enrollment started last month.
RUSH: Yeah, because everybody thinks it's going to be free.
CALLER: Well, you know, that's a sucker for you.
RUSH: Stacy, thanks for the call. It's always a pleasure.
CALLER: Have a great one, dear.
RUSH: And. The "gerbil" procedures, I'm still caught on that.
BREAK TRANSCRIPT
RUSH: No, I wasn't making it up. From the Democrat talking points slideshow, "The presentation's final page of 'Don'ts' counsels against claiming 'the law will reduce costs and [the] deficit.'" They are not to talk about that now. As they go out into the campaign season (they're back home for the August recess) they are not to talk about the cost savings and deficit reduction. They're supposed to talk about the "improvements" in health care that will result, because everybody knows it's not going to reduce costs.
END TRANSCRIPT
Not just a diabetic, a diabetic who’s getting 35 thousand dollars a year worth of medical care for twelve grand, a net savings of 23 grand over what it cost before. Actually, it could be millions in care because once the out of pocket limit is reached, 100 percent of the expenses are covered.
Citing worst cases doesn’t help because they’re easily shot down. The point is made by stating that, contrary to the claim that it’s all free, a subscriber will have to shell out four grand in premiums, plus the deductable, before the policy pays a penny.
Until Obamacare wipes it out some day, HIPAA still applies to people who are on COBRA. Once they’ve maxed out their COBRA benefits, any insurance company in the state that writes individual coverage has to accept them without a pre-existing condition exclusion. It’s not cheap, and the timing is crucial, but there’s no reason for someone on COBRA to end up uninsured. She needs to talk to a local SHIP volunteer or try a couple of new insurance brokers until she finds one who’ll level with her. The key phrase is “HIPPA Shall Issue”.
And she’ll be happy politically, too, because it’s a gift from Teddy Kennedy.
Thanks! bttt
My wife and I have been self employed for the last 24yrs and we know about buying health insurance.
PING PING PING
TREASON from the enemies within.
I second that...
Pinging all, the caller to Rush Limbaugh’s Friday show talks about the cost of ‘0’bama-care!
Stacy, the EIB Insurance Expert (under 35, preexisting condition, free Commiecare costs $12,340/yr)
http://www.freerepublic.com/focus/news/2574787/posts?page=1#1
I like this woman. She is sharp.
Wow, Obama really put it to those evil insurance Companies didn't he? Now its law you have to buy insurance and its gonna cost everyone thousands of dollars in either premiums or higher taxes.
Welcome to the Obamanation!
Thanks, Dave. Everyone should commit these dollar amounts to memory, as well as the source (the website) for conversational Conservatism when the topic of health care comes up.
>> and its gonna cost everyone thousands of dollars
Time to start talking about the Misery Index.
>> They won’t “feel” it, they will DAMNED WELL KNOW IT!
You’re right. It’ll hurt.
People are missing a key issue, worse than the deductibles and premiums.
“CALLER: I know. And, you know, you also have to be not covered by any insurance plan whatsoever for six months —
RUSH: Before you qualify for this?
CALLER: In order to qualify for this, and —
RUSH: You mean you gotta have no insurance for six months before you can qualify for this boondoggle?
CALLER: Yes.”
Think about how much money is saved by the government as those with life threatening conditions DIE when they can’t afford six months of care on their own.
Thanks to Obamacare, even the option for expensive coverage has been taken away. You have to survive NO coverage for half a year before your serious condition is addressed. No need for “death panels” when costlier patients can be neglected to death.
“2. Her husband can/will die during the 6 month wait. (It is a serious pre-existing condition in which he has no immune system.)”
That must be emphasized. For those who most need it, NO coverage for SIX MONTHS.
Under capitalism, at least you could get coverage, albeit very expensive.
Under CommieCare, you get to die before they’ll look at coverage.
Glad I can afford my meds and maintenance on my own. I’d be dead of a stroke, wholly predictable and preventable, under Obama’s love.
I’m 47, she’s 37. BTW, I have a 34 year history of heart arrhythmia (Wolfe-Parkinson-White syndrome), including one open heart surgery in ‘91, four post op catheter procedures and I’ve been on a anti-arrhythmic beta blocker for years.
There has to be a point - somewhere - where the actual cost of medical procedures has to be questioned.
I know...administrative costs, lawyers etc.....
but seriously, when does the actual cost of medical care get questioned?
The discussion is all about insurance now.
The insurance model has pretty much failed - with plenty of help from the government (medicaid/care) and Obamacare - but seriously - there has to be, at some point, a discussion of costs charged by the entire medical industry. Insurance has allowed costs of medical care to escalate without normal restraints of the market.
Can one even ask this question in polite company on FR?
The one we currently have? Absolutely. And, I would further add that it has failed because of gubmint intervention in the marketplace. Things like not allowing health insurers to compete across state lines. There is absolutely no reason why I shouldn't be able to buy insurance from anyone who sells it. Most states limit the number of companies that can sell health insurance, some limit it to as few as 3-4 providers. This is ridiculous! Cronyism at it's worst. Another thing began shortly after WWII that hurts the cost of health insurance and that was health insurance being offered by employers as a benefit on top of wages or salaries. This removes the consumer from the equation on the front end. The company may or may not be buying the best policy that suits you and you might be really healthy, but be lumped into a pool of less than healthy insureds. The consumer is removed on the back end, too, with zero or low deductibles and co-pays that are more of a nuisance than a shared cost. There is no free market and thus absolutely no incentive to shop around for the best price on anything medically related with most insurance policies. That's the beauty of the HSA. It puts the consumer back into the equation. For incidence, I just had a little outpatient thing done. Since I've not met my deductible this year I guarantee I will be going over the bill with a fine toothed comb and will be disputing anything that does not belong. (and this is after the insurance has matched all the charges and reduced them to match their network contract)
bttt
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