Cohousing-L Mailing List: Re: Health Insurance Strategies

[Jared Frandson (jfrands]

I have seen several poor outcomes using the DGS plan of insurance.  A quick
tutorial about the current state of our health financing system for the
uninitiated:  A friend fell on the ice, dislocated his elbow.  ER visit + xray
= $5000.  The important thing to note is that an insurance company would only
pay the docs and hospitals about 30% of this price.  Rates of reimbursement are
set based on percentages of the cash price (called Usual and Customary), which
no one except the uninsured pays (It's actually illegal to give cash paying
patients a discounted price [unless they have a documented financial need],
since medicare/medicaid reimburses a certain percetage of the cash price, and
low balling that price is considered fraud).  Being a part of an insurance
plan, even if it is the most high deductible insurance plan will give you
access to the insurance's negotiated reimbursement rates.  

I'd say the average high deductible plan runs about $60 per person and up, and
you can often combine it with a Medical Savings Account.  This compared with my
health insurance through work the premium for which is over $500 a month for
the two of us if I were to pay for it myself.  This is great as long as you
don't get sick... if you are actually ill High deductible plans are a huge
headache since you will get bills and the insurance will get bills and it will
all be very confusing.  But at least it's better than nothing... remember the
$5000 1 hour ER visit.

Good luck!


 
--- Rod Lambert <rod [at] ecovillage.ithaca.ny.us> wrote:

> All,
> Have been wondering for a while what others are doing in coho world for 
> health insurance.(there are many here still on the DGS plan 
> -don't-get-sick) Has any group exploited the "buying power" of the 
> group, such as it is. We were wondering, at a small meeting on the 
> subject last night, whether pooling of money in any form has been tried. 
> Could, for instance, the group work out a system where it would agree to 
> pool its resources and pay all of an individual's medical costs up to 
> say $10,000 and approach an insurer only for catastrophic coverage 
> beyond that. It could keep increasing that large deductable as it 
> collected funds. Any other creative ideas out there? We have the Ithaca 
> Health Fund, a community based health plan but it doesn't yet cover a 
> wide enough services list.
> 
> Rod Lambert
> EcoVillage at Ithaca
> (which built its 2nd neighborhood with a competitive, sweat equity, 
> custom home approach)
> _________________________________________________________________
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> 


------
Jared M. Frandson, MD, MPH.
North Memorial Family Medicine Residency
1020 West Broadway Ave.
Minneapolis, MN 55411
612-302-8200