Molly Janczyk re: Individual HC insurance

From Molly Janczyk

Subject: Indiv. HC

Date: Sat, 23 Sep 2006

(Written in response to an e-mail)

That is exactly what I mean. Sometimes things sound a way in a general article or a sales approach, but it is to draw folks in much as what happened to some re: selling medicare RX coverage. It was found not to be as good as what we have. Also, my husband has run into this often with disclosed info the underwriters decline when no health problem exists and data shows it overwhelmingly will not. He fights hard for those and sometimes wins on their behalf but it is difficult when underwriters look at numbers only and never individuals.

People are smart but if never experienced in an area, may be misled and act without knowing based on info read. It is always best to call STRS or your provider regarding billing remembering the bill never is what you pay and it is always hugely less as costs must be approved by medicare and then by provider and in network providers must accept what they dictate. A $50,000 bill is nothing more than hoping someone will pay without checking. After medicare and provider allowed rates, that will probably be approx. a couple of hundred more or less until you meet deduc. and out of pockets and then STRS pays at 100%.

Also, STRS RX coverage IS as good as or better than other programs if you thoroughly check. If approached with something that sounds too good to be true, it usually is and call STRS for the numbers.

HC can be complicated if not encountered before. Having an ill husband and doing the bills for my mom who had OPERS and Medicare, I learned quick never to pay a dime until both had run the bills first thru medicare and then thru OPERS. There are 2 yrs. for medicare to process so don't worry about continual bills. Have your provider call the billing source and it will stop or tell the billing source you know better than to pay anything before medicare and your provider approve costs and THEY will tell you your responsibility which means you owe no more than what they tell you.

Many will try to send dramatic and threatening bills which seems like they have gone to collectors. I rec'd a huge bill like this and called Mother's provider and it was stopped immediately. OOPS! OUR ERROR , they said, and wiped it out while I was on phone. How did they know so quickly it was an error except that it was repeated attempts to get more money hoping I'd be scared, worry my credit would be hurt and pay. Happened 2-3 times over and over. Finally , it stopped when they saw I went to hospital billing, and her provider who contacted them.

Most of us learn thru experience with HC issues and lots of phone calls to decipher bills. Take articles with a grain of salt and thoroughly ck out info with STRS and YOUR HEALTH PROVIDER: MED MUT OR AETNA OR WHICHEVER PROVIDER YOU HAVE. They will tell you immediately as they keep running total which you can request.