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And rates aren’t expected to drop anytime soon. But that doesn’t mean everybody’s losing the battle to hold rates down without cutting benefits.
While many firms face soaring insurance rates, some companies are consolidating health policies with one insurer, putting policies out to bid and reviewing and adjusting insurance.
ClearVision Optical, a wholesale distributor of eyewear based in Hauppauge, got the equivalent of a $100,000 check in the mail after switching health-insurance policies. The kicker is that ClearVision actually increased coverage.
ClearVision used to offer policies from Empire Blue Cross Blue Shield, Health Insurance Plan of Greater New York and Oxford. Now the company offers only one Blue Cross policy, the Prism Plan.
“You have more leverage with the insurance company,” Brenda Litzky, director of vendor relations, said of consolidating coverage. “They’re getting all of our business instead of it being apportioned.”
The firm took an aggressive approach, auditing its insurance portfolio and bidding out policies, saving another $15,000 on life and long-term disability, according to Litzky.
“We are now in a position to offer our employees better coverage,” Litzky said, “and still have funds to do the other things we want to do for our employees.”
Reducing risk
Health insurance is causing headaches for companies and consumers. New York is no exception. Health insurance rates rocketed more than 50 percent in New York State since 2008, according to Aon Consulting.
But Randy Shotland, an insurance agent in Melville affiliated with New York Life, said firms don’t need to simply throw up their hands.
“There are plenty of ways for people not only to slow down increases in health insurance, but in some cases even reduce the cost,” Shotland said. “You can’t just sit back and take the increases without a fight.”
The good news is firms may be able to avoid insurance inflation in health and other policies simply by being cautious and taking advantage of insurers’ desire to write policies.
“We’re going into a cycle where insurers are recording record profits, so they want to take in more premiums and make more money. They want to take in more business,” said Ronald Brunell, an agent, broker and consultant at B & B Coverage Ltd. in Valley Stream. “Health care is going up double digits, but property and casualty rates on the business side are declining.”
Despite these declining rates, you need to be vigilant, creative and spend time and money to save in the long run.
Fighting back
The first question is where to find information. Business specialists and groups devoted to the topic of insurance offer advice to executives. Litzky turned to a group called Vistage, a worldwide organization in which businesses discuss insurance issues.
ClearVision also hired a risk management consultant to identify problems, review policies and makes recommendations without taking a commission. “He’s not selling insurance,” Litzky said. “This person can ask the right questions.”
But Alex Canaan, president of Smithtown-based ACS Consulting, said good brokers should provide advice; hiring consultants means additional fees.
Canaan said small companies can get better deals through professional employer organizations that pool companies to negotiate rates. Firms with up to 50 employees pay the same amounts through what’s known as community ratings. Smaller firms, unlike their larger brethren, are not sizeable enough to negotiate their own rates.
“[Professional employer organizations] traditionally can offer a Fortune 500 suite of benefits that the individual small company could not afford,” Canaan said. “They can get benefits at lower prices. Very often the savings on the benefits side outweighs the fee.”
Companies also may get discounts through associations which pool members to get deals.
Steve Schwimmer, Long Island sales manager for Bohemia-based Renaissance Merchant Services, said his firm offers health insurance through the New York Restaurant Association and the National Association of Payment Professionals.
Another way companies are saving expenses on insurance is by altering the plan’s design. Firms are increasingly hiking deductibles and co-pays and offering health savings accounts and health reimbursement accounts.
Shotland said, “By changing the design of the plan, you can be more cost efficient.” Policies that only pay in-network providers are cheaper. Gatekeepers typically reduce price, but increase bureaucracy.

If you are currently on the Regence MedAdvantage program, are thinking about joining, or know someone who is already a member, the rates will be rising fairly substantially. How substantially? All Regence will say at this time is that it is more than we desired. New rates will be released by Regence on October 1st.

In addition, their least expensive program, called the MedAdvantage RX Core program will be going away. If you are on the Core program already, you will be given the opportunity to move with no health screening to another of the Regence MedAdvantage plans within a set widow of time.

The explanation from Regence for the rate increase is that many more people than anticipated are using the benefits of the plan. Also, the dollar amounts used by participants have also been higher than expected. How much higher? About $90 higher per member per month.

Regence has further explained that the higher usage of benefits is due partially to economic conditions. As people fear losing income and/or the ability to pay future premiums, they have been seeking medical care in preparation for potentially not having access to it. Thus, more people using more care and more care dollars than planned.

For now, My Health Insurance of Washington advises Regence Medicare MedAdvantage members or prospective members to watch for the October 1st release of the new rates.

My Health Insurance of Washington specializes in helping individuals, families, the self-employed, and small business find quality health insurance plans to meet their financial needs. Based in Washington State, their sole focus in on Washington State Health Insurance. www.myhealthinsurancewa.com 1-877-877-9545

For those individuals that are going to be without medical coverage for any amount of time, this plan may be the best solution, at least until something more permanent can be found. With a variety of plans available to those that need them, there is something to fit everyone’s temporary medical coverage need.

This type of policy is right for many different types of people. In many cases, short term health insurance is simply a bridge until better coverage is available. Those that have non traditional employment can benefit from this type of product as can those that are self employed, between jobs, laid off, or those that are just looking for a temporary solution.

The goal of these plans is to provide you with quick and effective protection when you need it the most. Being without any type of protection is not a good idea since it can be extremely expensive to make just one doctor’s visit (emergency or not) without any coverage. With so many options out there, short term health insurance is the solution for those that need something now, until something better is available later.

Here’s a quick example of how that may work. Let’s say a Preferred Provider Organization (PPO) covers a visit to a doctor in the network with a $60 co-pay. If the insured chooses instead to go to a doctor outside the network, the PPO may only agree to pay 50% of the physician’s bill.

In the case of prescriptions, the plan may cover 100% of the meds if they were prescribed in a network hospital. If on the other hand medications are purchased at a drugstore, they may only offer to cover 50% of the value of the drugs, after the payment of a high deductible.

The health care system is not user friendly and it’s smart to make it a point to read health care policies. As boring as it may seem, the information in it may save time and money later if there’s a dispute with the health insurance carrier.

Keep in mind that the doctor may think a certain procedure is needed, but the health care plan may not cover it. In other words, its not in the contract with the health insurance provider. This is yet another reason to know what the coverage actually “covers.”

Even knowing what’s in the policy doesn’t guarantee a claim won’t be denied. It’s like death and taxes, almost inevitable. There are things that can be done before contacting an attorney.

Do the obvious first call customer service and find out if the claim was denied because of a medical coding error. That happens fairly frequently. If it wasn’t a coding error, then attempt to get an explanation. Here’s where things get a bit sticky.

If it appears the insurer did stick to the terms of the policy, pay the bill. If on the other hand they appear to be waffling and aren’t living up to their part of the bargain this becomes a dispute and information is needed on the arbitration process.

Take time to call the state insurance department as well. They may be able to resolve things if the insurer did break any regulations. If there is no satisfaction and it comes with a huge run around, contact an attorney with experience in settling and/or litigating health care disputes.

If the insurance company is trying for a settlement for a smaller claim, or none at all; are asking for excessive documentation/verification of a claim or asking for resubmission of documents already provided, speak to a competent lawyer who will cut through the red tape and get the matter resolved.

To learn more visit http://www.sharpfirm.com.

As a result of these low-income levels, children are more likely to be at risk for many different things like abusing drugs and alcohol, twice as likely to join a gang, four times as likely to have emotional and behavioral problems, more likely to participate in violent crime, and they are apt to involve themselves in high-risk sexual behavior. These are just a few things that should be major causes of concern for families who do not have health insurance. Many of the things listed above can cause health problems or require serious medical attention, for many of these families who are already at higher risk for their children to be involved most likely do not have insurance.
There are many types of affordable health insurance that a single parent could purchase in order to try to keep their child safe when they are more at risk than other children. For example, say a teenager of a single parent goes to a party and gets alcohol poisoning, just the ambulance ride alone can cost between $350-$800 dollars, and that is just the ride. The costs could be much higher if other things were used during the trip such as a backboard, oxygen, or if an IV was used, also once the teenage gets to the hospital the costs could skyrocket depending on how life threatening the situation is. Just the cost of the ambulance ride can be more than health insurance to cover the child for an entire year, and that is before even getting to the hospital. For a single parent who does not chose to purchase one of the many types of affordable health insurance this could be economically devastating to them and their family.