Hidden Dangers of Obamacare HMO
If you believe that your Obamacare policy assures you of access to the healthcare you need...and that under Obamacare you are “well taken care of”....you might be disappointed.
Based on my 28 years of experience in health insurance, vast experience helping clients get the right care when they need it, and horrifying experiences with Obamacare policies precluding insureds from getting access to the care they need, I can tell you that under Obamacare insureds find out at the worst possible time that their Obamacare policy does not “take care” of them.
Whenever I work with a client or prospect my number one concern is to be sure that they will have the insurance coverage to pay for what they need – when they need it. But sometimes people just don't follow my advice.
Under the current Obamacare environment your choices are Obamacare, Christian Sharing, or Short Term Medical. Which should you choose?
Obamacare is an HMO. An HMO (Health Maintenance Organization) is a type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. HMO’s don't cover out-of-network care – except in an emergency. HMO’s require you to live or work in their service area to be eligible for coverage. HMOs focus on prevention and wellness – and that means a very limited doctor list.
With an HMO, even if your OBGYN or family doctor is in their network you may find that once you are diagnosed with something serious you are handcuffed into the limited network with low cost solutions – not necessarily the best – that the HMO has contracted.
Here is an example this week of a client of mine in an Obamacare Blue Cross Plan (because he didn't follow my advice) - who found out he has thyroid cancer and was not been able to find a specialist in the Blue Cross HMO Network to take care of his problem.
In his own words to me: " WTF- What can I do?” (Emphasis here – those are his words not mine.
Him: “I never dreamed I’d come down with this kind of problem. This is the only Doctor in the Blue Cross Blue Shield HMO Network. Do you have an opinion of him?”
Me: “Yes I have an opinion…there are two surgeons in this city that can perform that surgery with the least risk of complication. They are Dr. XX and Dr. YY (names withheld for obvious reasons). I know other people who decided to go with Obamacare and ended up in your situation – they used the Docs on the HMO and ended up with complications.”
Him: “I’ve heard that, and that’s why I’m calling. I should have listened when you suggested the The Family Protection Grid…and wondered who you would recommend if I would have had that coverage.”
So what’s the man do? Hi digs into his pocket to pay the surgeon himself. Because the doctor is not in network the BLUE HMO will NOT PAY any of the claim!
So now he wants to be "bailed out" but to no avail – as his bed is made and now he is stuck with it –
I did my best – because I just care enough about my clients – even the abrupt ones – to actually share knowledge and help them see if they are doing the right thing for themselves and their family.
Christian Sharing is reimbursement-- so you must be able to secure the care in the first place without a guarantee of payment.
This normally means fronting the cash.
Short term Medical
Short term medial alone is NOT the answer. It has a limited duration. But Short Term Medical in combination with a Living Benefit plan or large Critical Illness policy provides you the cash to "buy" your exit strategy at the end of the term.
You see, by getting a large infusion of cash, then you can purchase a small group PPO plan with excellent benefits. This means at the 1st of any month you can "buy" your way into group coverage PPO with excellent benefits. (A preferred provider organization (or PPO) is a managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third-party administrator to provide health care at reduced rates to the insurer's or administrator's clients.)
IT is NOT cheap! But if you are serious then this is the serious solution.
Innovative thinking -- expertise- this is what I offer.
Call me at 800-257-1723 or click here now to schedule an appointment
Until then -
Cheers!
Mark Deschenes