AboutMichael Higgins Expertise All questions pertaining to health insurance, whether group, individual/family, student, child-only, COBRA, HIPAA, Portability, dental. No expert knowledge in areas such as life insurance, disability, workman's compensation, auto, etc.
Experience 27 years as owner of health insurance agency, primarily dealing with Blue Cross Blue Shield of Arizona.
Education/Credentials College, Business Administration.
Question QUESTION: My company has health care, I became eligible to be covered two months ago, and it was stated at no cost to me, I had co pay for say Hospital, office visit, Specialist etc, which was fine by me,
then yesterday the boss shows up at work with memo's for all employees, to state that with the rising cost of health insurance, we have to now pay $50 a week per week for our health insurance or we if we do not agree we will be removed from the policy,
there is no way I can afford $50 per week out of my wage check, i can actually find cheaper health insurance on line, which right now i cannot afford either, with me being the sole wage earner,
I happened to get ill 3 weeks ago which involved a load of tests to determine what the problem was, and get the situation resolved, but now having to pay $50 per week plus any co pay that is normal with insurance is now out of my range, which leaves me with my tests results, only to find out that i can not afford the treatment, as i cannot afford the $50 per week, which also leaves me unable to afford the medication that the specialist put me on without insurance,
Can my employer suddenly tell us we now have to pay for our insurance, my co worker signed the insurance just three days ago which also said at no cost to her now she also finds herself having to pay $50 per week or just plain simply refuse and have no coverage,
I would really appreciate a reply as i do not know how to continue treatment,
what do i do just go home and wait until i get so bad that i am in the emergency room with no means of being able to pay
or pay the $50 a week insurance and not be able to pay the co pay, or pay my bills I am in a catch 22,
ANSWER: Hello Christina:
I can hear the frustration in your words and I do empathize.
For clarification, did you ever enroll in the health insurance plan offered through your employer, and are you still insured? Who is covered, just you, or is there a spouse and children covered as well?
$200 a month isn't too bad a price actually, but it's about $199 too much if you can't afford it I understand. The employer most likely must pay at least 50% of the employee premium rate to qualify for purchasing the group plan. $200 a month for the employee rate is low, which tells me the employer is picking up some of the cost. The employer has every right to charge the employee for a portion of the premium. They also have the right to drop coverage all together. My guess is that your company is in survival mode, it's tough out there as you know. My suggestion is to do everything humanly possible to pay the $50 a week if you are still insured. There are programs that may assist you with the medications. It will be very important that all involved know exactly what you are going through financially. Let your boss know, your doctor, everyone. Things tend to work out when everyone is on the same page. I'll point you in the right direction once I know more about your current situation, whether insured or not, etc. The more information the better. Name of insurance company, type of coverage, who's insured, deductibles, etc.
Thank you.
Michael Higgins
Michael Higgins Insurance, LLC.
www.higginscompanies.com
602.405.8769
877.619.8621 toll free/and fax
---------- FOLLOW-UP ----------
QUESTION: Hi Michael
Yes i did enroll through my employer, we have Pacificare HMO
right now i am still insured, it is the first of June that they want us to start paying the $50
I have never actually never seen the policy, I just have my medical card, which i think is pretty normal with employment based insurance,
I am the only one insured, there is no dental eye etc, which was ok,
I have to pay $10 per office visit, $25 per visit to a specialist if i had to go to emergency i have to pay $125,co- pay
which is all good, as that i can afford,
My boss knows that i have had all these tests, etc, and the have found that i have blocked Carotid Arteries in my neck and the cardiologist wanted me to see a Neurologist to get these problems dealt with, and that appointment comes three days after the company wants me to pay $50 per week, they had found a few other problems too which are curable, all i need is the treatment to get me back on track,
I know the company is in survival mode and i know they are going through tough times like everyone else right now,
and i at least have a job which many do not have
it scares me to think that having a job if fine, but if i get too sick to keep that job, all because i cannot afford to pay for the treatment, then there seems little point,
I will try and pay the $50 per week, but then there comes all the co pays etc, it starts creeping up and i am so scared of getting into debt, not being able to make the house payments, the bills, etc, right now $200 per month is a lot of money for me, which would probably work out a lot more because of the co pays on top of it all
Thank you
Christna
Answer Christina:
The bad news first:
The reality is that if you do not continue with the insurance it is certainly guaranteed that you won't have a house payment to worry about, as there will be no house. You are facing some very, very large medical bills in the near future. Without a reputable insurance company, (which you have,) paying the majority of the bills you will be wiped out. Neurologists are some of the highest paid professionals in the business, and for good reason.
The good news:
You are insured with an HMO plan. Your out of pocket expenses will be nominal compared to most others. There isn't a large deductible to meet most likely, and your co-pays won't be too bad. Also, as long as you pay the doctors something each time a bill arrives you should be fine. You can also ask that the doctor to negotiate a better price with you for any outstanding amount.
As an example of how good your plan is, I have a $5500 deductible on my plan. All medical expenses up to this amount I pay before the insurance company kicks in. There are no co-pay benefits, I pay everything up to the deductible.
So, continue with the insurance and worry about the co-pays, medications, etc. when they appear. Ask for free medication samples from the doctors and any assistance programs available to you regarding these medications. The doctors will work with you on the co-pays, they understand it's tough out there. The important thing right now is to get well, everything else will work out just fine. From an outsider looking in I can tell you that you are sitting pretty. The $50 a week is a very good deal as crazy as it sounds.
