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Feb 25, 2010


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Joe Guarino

North Carolina has a lot of state insurance mandates, and this contributes to the rates being higher than they need to be.

People need to look at high deductible/HSA policies. I insure my family of four for $454.


I'm all in favor of high deductible plans so the ins. execs can keep their corporate jets.
Once again we are goaded by the untouchables into a race to the bottom.

Joe Guarino

I don't see executive pay and perks as the biggest part of the problem. The fundamental driver of health care inflation is third party/first dollar coverage. The very existence of third party insurance is the culprit.

Jon Lowder

A couple of years back my wife and I both turned 40 and our insurance premiums spiked by 30%. Apparently we were a much bigger risk despite having no health problems, no particularly bad health habits, being of average weight and engaging in average exercise (i.e. no extreme sports). Basically we were victims of actuarial assault.

Per Joe's comments after our rates skyrocketed we went the high deductible HSA route and our monthly expenses did indeed go down, but the real problem we had was that health care providers were not ready for people who do things like ask how much something will cost. Try getting a doctor or an office manager to tell you up front how much something will cost and you'll quickly learn that many of them can't or won't tell you. Same goes for MRI providers, labs, etc. Dentists are actually good at this, but I think that's because most people have had such crappy dental coverage for so long that they've been asking for costs up front for a long time and so dentist's offices are set up to serve them.

To be fair we also had to learn to ask about prices. We'd been conditioned for so long to simply take the treatment and cover the co-pay that we simply didn't think to ask how much something would cost. Thus we were stuck with a $1,500 MRI when we could have gone somewhere else and gotten it for less money.

If HSA-ish plans are going to work they need to be accompanied by better business practices in the health care sector. Also, we need to deal with the fact that HSA's require participants to set aside cash to cover health expenses. It's very risky the first couple of years as you build up your "investment" to the point that you have enough money to cover the high deductible.

FYI, we're back with employer based BCBSNC coverage and it's gone pretty well. Will be interesting to see how our small group (three employees) fares with increases this year.


Our BCBS went up from appx $490 to $550+ or so. But now we too are back with employer based coverage. Well, my wife is covered through work and the remaining three are add ons. We actually pay a bit more total but have MUCH better coverage (that group rate thing you know) including some dental.

Jim Caserta

Is that $454/mo? With what deductable?


Wait till ya'll get a little older. It's hard to be on the planet for 5+ decades and not have some pre-existing condition as they define them. Small biz medical increases roughly 25% each year so many small businesses are switching annually to different providers but at some point this will also become fruitless. BTW: I'm paying *more* than twice what Joe is paying to cover 2 people.

If the Chamber (or some such org) were not enjoined from acting on behalf of small business members, (a law I'm pretty sure is BCBS in origin), then this small biz town could wrangle affordable small business health insurance premiums. But it's illegal for them to do so. A deal to eliminate the pre-existing clause only for 19 years old and younger? Unbelievable and unforgivable. You're all only getting older each year. Just wait for it.

Joe Guarino

Jim, the deductible is $5,000. And Jon, yes, high deductible plans are a cultural change-- for patients, families, medical offices and insurers. There is a period of learning and adjustment-- and some require time to "get it".

Sue, you are right that coverage gets higher with advancing age. But my last annual increase, which I learned about in November, was less than 5 percent. Previous years, it was a bit higher, but nowhere near 30-40%.


I don't see high deductible/HSA coverage as being anything more than marginally useful.

The people most likely to be attracted by the lower premium costs are precisely the people who are least likely to be able to afford paying out something like a $5000 deductible.

If savings were an effective way of paying medical bills all of us would have been saving all along.


Sue's right. Stuff happens when you get older, and a lot of it isn't necessarily good news.

I've had BCBS for umpteeen years. Never had a claim other than routine care. Then 4 months after I retired, bam, I'm having cancer surgery. I was lucky, and the bill was only in the 5 figures. If I'd been slightly less lucky, as many are, the bill would have been well into in 6 figures. The notion that anyone among the un-rich can save enough to cover those kinds of medical expenses is nonsense.

Remember, the odds are that, sooner or later, everyone is going to need medical care costing that much.


Joe, is our 5K deductible per person or total per family? What's the rate of payment for hospitalizations after the deductible is paid?


typo alert: Is YOUR 5K.... not "our"

Account Deleted

Y'all need to check out Clark Benefits Group. My company insures three men over 35 for $530.96 per month.

Our premium went up 6.6 percent this year, driven primarily by one of our guys advancing into the 35 year old group.

One of is is 48 and we pay 236 a month for him.


What kind of copay and deductible

Account Deleted

Deductible is 2k. Copays for office visit and prescriptions are pretty standard ($25, scripts 10/45/60)

I am looking at the sheet now. We could have gotten a 23.9 percent decrease if we went with 5k deductible.

Account Deleted

@JC:"The notion that anyone among the un-rich can save enough to cover those kinds of medical expenses is nonsense."

I am beginning to agree with this perspective. In my mind I wonder how we can separate critical surgery/chronic illness care from routine care.

That to me seems logical and morally right.


Our small group must have a problem with age and health. Four people over 50, and two over 40. 4 smokers, 1 diabetic, 1 with blood pressure, and me on lipitor. My rate went up due to higher risk for the lipitor, not the cost of the drug per say. I thoght I would be a bigger risk without the treatment. But it don't work that way.

Ed Cone

I was a free-lancer with two kids for much of the '90s.

We had a decent income, and we were in good health.

So we ran with a high deductible, but made sure to do the stuff that we had to pay for, like regular checkups.

Worked for us, because we were healthy and disciplined and lucky.

Joe Guarino

To answer Sue's questions, and to be more precise:

Individual deductible: 2,700

Family deductible: 5,450

Individual out-of-pocket maximum: 5,000

Family out-of-pocket maximum: 10,000

The above are in-network benefits.

Coinsurance is required after the deductible is met: 20% up to the out-of-pocket maximum.

My policy includes certain preventive services that are paid for by BCBS with no deductible.


Those who balk at a high deductible individual/family plan should explore the benefits of adding accident indemnity and critical illness policies combined with a high decreasing deductible comprehensive health plan.

In addition, HSA programs are a way to fund medical purchases in the deductible gap, and to help with other medically related expenses with tax free money. They may not be for everyone, but for those who understand and can use the benefits, they're invaluable.


>>"In my mind I wonder how we can separate critical surgery/chronic illness care from routine care."

I doubt we can, in any practical sense, Jeffrey. My cancer was discovered when flags were raised during routine exams by a new general practitioner. Those routine exams are precisely what most of the uninsured will skip. So they won't know they have cancer until something hurts or something bleeds. They'll take themselves off to the emergency room where they will get the diagnosis. And the rest of us will cover the cost of that visit via higher taxes and higher premiums.

Here's what won't happen in the emeregency room, contrary to something I heard asserted at the HCR summit today: Surgery won't be performed to remove the malignancy. The patient won't be able to go to the ER for chemo or radiation or drugs. The ER won't help them when they are so sick at home from the chemo/radiation/drugs that they can't feed themselves.

In other words, the ER won't treat their illness. They may, one hopes, find charity treatment elsewhere. But, charity treatment isn't free. Health care providers and insurers pass the costs on to other patients.

Most of us are challenged to save for our retirements. If we manage to stash away the equivalent of a million dollars, it's cause for celebration. But, treating any of the chronic illnesses that will, in all likelihood, kill most of us can easily rack up a six-figure bill. Let's be realistic. Most new jobs are being created in the service industry. How realistic is it to imagine that someone who's flipping burgers or walking Walmart's aisles will be able to save for retirement, much less to cover any long-term medical treatment.

If saving is the way to go, then why do we all buy homeowner's insurance? Why not just save enough so we can buy a new house when the one we're living in burns down?

Much the same applies to high-deductible coverage. If you are healthy and in your twenties, catastrophic coverage with a $5000 deductible might be a reasonable approach to keeping premium costs down. If you are in your 50's or 60's, the odds that you will not require $5000 of health care in a year are markedly lower.


I'm a health care horror story.

1 year of cancer treatments then 4 years of trying to over come the side effects of Chemo.

Let's talk deductibles, they are not a one time event. They apply to each new Dr. you see, new treatments, new medications. My $2,500.00 dollar deductible was met with one Pet-scan, however but my anti-nausea pills cost $250.00 each so I had to pay out of pocket until I reached the deductible for that specific medication.

My $2,500.00 deductible became %40,000.00 a year out of pocket expenses, after paying the $14,000.00 annual premium.

Until you been in the belly of the health care beast you cannot imagine all the ways the insurance companies screw you. And like most patients I spent a considerable amount of time fighting with the insurance companies over the billings.

Forcing people, who are fighting for their lives, to fight for coverage they paid for is the norm, not the exception.

When I moved to NC last year BCBS would not cover me due to my preexisting condition of having been free of cancer for 5 years. My BC insurance premiums, from California actually went down on the 5 year anniversary, which is considered as a full recovery from cancer. In my case I actually had a curable form of cancer so I'm in a very low risk category.

Today I'm a very healthy 56 year old male, but BCBS of NC wants to push me into the High Risk insurance policies, where people are dying of their diseases.

The High Risk group premiums are beyond anything most people could ever afford.

The actions of BCBS of NC are capricious. They are not based on facts but rather profit margins. They are not in the business of helping customers rather they are a profit driven company that allows their customers to suffer and die.

These insurance executives are psychopaths, they are the biggest serial murders in the country and should be treated as the criminals they are.

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