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Health Insurance

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Harsh Realities of Healthcare
Adam Thompson
Bryant & Stratton
Research and Writing II - ENGL 250 – 551
Dr. Sharma
July 26, 2014

Insurance is a two-way legal agreement between the insurer and the customer. The customer, which may be an individual, business, or other entity, agrees to pay the premiums as required, in exchange for monetary protection from the insurer for any possible substantial loss. Customers usually obtain insurance, not to cover the trivial incidents of life or business, but to cover the potential significant losses which could be a financial hardship for them. The premiums of all customers of the insurance company are pooled together. The insurance applies statistical analysis to determine the chance that a particular event might occur to one of their customers. From this analysis they can determine the premiums which must be collected and the claims. Insurance is a very important part of modern life and business. Three health insurance companies: Healthspan, Anthem Blue Cross Blue Shield and Apex. Breaking down plans and talking about what they cover, how much they cost and where they are accepted and attempt to answer the age old question “Is people’s healthcare better depending on how much one pays?” All these packages are based on someone who makes $25,000 per year and only looking to cover just them. The prices also change depending on when they want their insurance to start and if they have to prorate for the previous month and also if the clients are a tobacco user or not. After reviewing all the information, people are not here to discredit the healthcare system, but open a few eyes to the harsh realities of hospitals Healthspan formally known as Kaiser is one of the most popular insurance companies that come to mind when people talk about insurance. People many pay more out of pocket but more of the services the client may need are covered. Healthspan is also accepted at major hospitals as well as some small clinics. This insurance may be more expensive but for people who go to the hospital on a regular this may be the best choice for them. If one walks into University Hospitals with this insurance they will help them but if they go to Cleveland Clinic they don’t accept Healthspan. According to Healthspan’s website (Healthspan, 2014) “the lowest plan someone could get would cost $89.28 per month and that’s for the KP Bronze 5000/30% HSA package”. In this package they have a $5,000 deductible for singles and a $10,000 deductible for families which means that their plan doesn’t kick in until they hit that deductible. After the client have reached that deductible then they are only responsible for paying a coinsurance of 20-30% of covered services. The most expensive package according to Healthspan (Healthspan, 2014) that is offered is the KP Gold 0/20 package and that can cost them $213.09. In this package they have no deductible that they must meet before their insurance kicks in. Services like primary care visits and other practitioner visits would only cost a copay of $20, while a specialist would be a $40 copay. Depending on what other services people need they will either have copay or a coinsurance. Healthspan offers other insurances besides healthcare, they have dental, vision, life and they offer a health savings account (HAS). Blue Cross Blue Shield is another pretty good insurance that’s more on the pricey side but it’s also accepted at most hospitals and small clinics though out the United States. Blue Cross Blue Shield is more expensive then Healthspan so mostly this insurance is provided by someone’s employer because employers get the plans at a discounted price but if they want to get their own coverage it will cost them. According to Anthem’s website (Anthem, 2014) “$197.65 per month for the basic package called the Anthem Catastrophic Direct Access and for the Anthem Preferred Direct with package it would cost $377.77 per month.” The price difference in the basic package compared to the top of the line package are pretty steep. Everything depends on how sick someone is or if they are in need of constant medical care. A client who is sick a lot or maybe has some type of illness may want to opt for the higher pack whereas someone who only goes to the hospital for their yearly checkup may be better suited for the basic package. In the Catastrophic Direct Access they have a deductible of $6,350 and an out of pocket max of the same $6,350 which means that is the most that one person would pay out of pocket before their insurance kicks in. After that deductible is reached them everything is covered 100%, the only thing is that they will have a $40 copay for all primary care visits to treat an injury or illness. Anthem Preferred Direct (Anthem, 2014) is more expensive then the last package but this one have a deductible of $1,250 and have an out of pocket max of $5,000. In this package they have to pay $30 for primary care visits. On this plan they have a copay of $500 that goes towards their deductible for impatient hospitals services and $200 that goes towards their deductible for emergency room services. Both plans are not HSA compatible but could be FSA compatible. Apex is an insurance company based in Akron, Ohio and for an insurance company not to be accepted everywhere their prices are not very reasonable. Clients pay a lot more out of pocket when they have to go to the hospital or a small clinic, some small clinics don’t accept Apex nor have they even heard of them. According to Apex, the first plan is called the Individual Bronze 6350 and it would cost someone 29 years of age, who doesn’t smoke and makes around $25,000 per year $206.15 a month (Summa Care, 2014). In this plan they have a deductible of $6350 for singles and $12,700 for families and that’s in network, but if clients go out of network they would have to pay $12,700 for singles and $25,400 for families per calendar year. The only good thing about Apex is that once the client reaches their deductible for the year then everything is covered 100%. The only thing not covered at 100% after deductible is out of network prescription coverage, and then the client would have to pay 5% of the price. Individual 750 is the most expensive plan that Apex offers and it cost $337.56. With this plan one has a 750 deductible for single and a $1,500 for families for in network and $1,500 and $3,000 for out of network. When clients go for doctor visits they have no copay for the first 3 visits then it’s a $20 copay. For specialist and practitioner visits clients must pay $40 copay. Some services not included in this plan are acupuncture, bariatric and cosmetic surgery, hearing aids and infertility. Some services that are covered are chiropractic care, private duty nursing and routine eye care.
When employers switch to Apex from whatever insurance they offer then they are trying to save the company money because they automatically put people in the least expensive plan, but also making them money because when employees have Apex they are limited in the places they can go. University Hospitals offer their employees Apex and the employees can only go to a University Hospital because they are the only company that will take that insurance. Then there are things that aren’t covered and they still have to pay out of pocket for the service. Other services that Apex offer with their insurance is pediatric vision care for child up to age 19, dental for child up to age 19 also family dental and prescription. The extensive and intensive margins of health insurance coverage are further explored, focusing on Healthspan, Apex, and Blue Cross/Blue Shield. Insurance is a very important part of modern life and business. Discussed here are the basic concepts of health insurance including price and different things that the policies cover. Working in a hospital I see different types of patients and they all pay in different ways. Also working in a hospital I see the V.I.P list, and on that list are patients that either pay in cash or they are related to some big name person who works for the hospital, it’s not fair to the average person. If a patient’s name just so happen to fall on that list then they would receive special treatment based on their name or who they know. In a hospital setting there shouldn’t be a list for a certain people just great health care. Furthermore, the treatments that certain people receive based on payment types are obvious. This is important because everybody deserves to have healthcare and good healthcare at that. After looking at the different prices of the 3 insurances that have been discussed, people would need to pay a lot of money for decent healthcare courage. The best part of health insurance is that it saves lives. Oftentimes, people are rushed to the hospital only to find out that the hospital they are at doesn’t accept the insurance that they have. By the time they are taken to another hospital sometimes they end up passing or they are worse off than before. Hospitals need to start accepting all types of insurance and stop turning people away because they have no insurance or they don’t have the right insurance.

References
Anthem BlueCross BlueShield. (n.d.). Retrieved from http://shop.anthem.com/sales/eox/abcds/oh/en/shop/plan/medical/snq?execution=e1s10

Healthspan. (2014). Retrieved from http://healthspan.insxcloud.com/my-quote/individuals medical/index?qid=K0Foc3ZoSUNTVWplN3FKcitrc3RiZz09&SortBy=0&Qualified%5B0%5D=1&Qualified% My Summa Care. (n.d). Retrieved from http://mysummacare.com/docs/SummaCare%20Individual%20750.pdf

My Summa Care. (n.d). Retrieved from
http://mysummacare.com/docs/SummaCare%20Individual%206350.pdf

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