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Fact: Go to emergency as a private pay and the bill will be (hypothetical) $3000. Go as an insured and the ins. company will settle the bill w/ the hospital for $800. I know. I saw both figures for the same visit.
Now take a person who has a lot of savings but can't get reasonablly-priced health ins. because of, say a prior hangnail. He doesn't want to shell out $1500/mo. w/ high deductibles just to have a medical event and then have the ins. co. refuse to pay for treatment because he neglected to report on his ins. coverage application a headache he visited the Dr. for about 5 years ago.
So, instead, he forms his own health ins. LLC for himself and family members, if he has any. Then he has the legal right to have an ins. card printed up. Now, if and when he has to go to emegency he just whips out his "Super-Duper Consolidated Health Ins." card, gets the treatment, and then puts on his other hat when the bill for $3000 arrives and negotiates it down to $800 like Blue Cross and Blue Shield do. Could this scenario work?
Look into a high deductible plan. They're cheap and they do all the haggling to get the discounted rates. Then you've also got catastrophic coverage in case something major happens to you.
If you combine the high deductible plan with an HSA, you get some tax benefits too.
The occasional ER visit for a hang nail is no big deal, you can pay for that in cash. The problem is when you get sick with something really serious....say, liver failure....and you'd need a liver transplant. The cost of that could easily approach half a million (or more) dollars. That's what you will need insurance for.
HSAs are a good option. I like the savings component of it. However, HSAs are only good up to the age of 65.
The occasional ER visit for a hang nail is no big deal, you can pay for that in cash. The problem is when you get sick with something really serious....say, liver failure....and you'd need a liver transplant. The cost of that could easily approach half a million (or more) dollars. That's what you will need insurance for.
Yes, but that's the issue. Read the thousands of horror stories from the link below of people who paid their high premiums faithfully for 20 years--until they needed a liver transplant, or cancer treatment and then watched their ins. co duck out of sight w/ some feeble excuse about them not reading the fine print, or they withheld pertinent info like a headache or some other lame-ass excuse so the co. could say it is not responsible for their bills.
In the Heart of the Health Care Hustle (http://www.workingamerica.org/healthcarehustle/ - broken link)
I listened to testimony from workers about how health ins. co's don't utter a peep when you submit the app and as long as you pay your premium they are happy. The moment you submit a substantial claim they immediately put a dozen workers on the case to go over your whole health history looking for the slightest discrepency in your app that they can use as a reason to deny your claim. The truth is ugly and it hurts but that's the reality we live in. But I digress; we're off the topic.
Question: are there laws that prevent a person from forming his own private health care LLC? If there are no laws, and if a person could save thousands of dollars off medical bills by doing this, would it be feasible to do?
Question: are there laws that prevent a person from forming his own private health care LLC? If there are no laws, and if a person could save thousands of dollars off medical bills by doing this, would it be feasible to do?
If your motive for forming such an LLC is to insure yourself so you can get discounted rates from a hospital (instead of paying full price), I'm not sure any hospital will buy this. The reason hospitals offer discounted rates to insurers is economies of scale. The insurers provide business (thousands of patients) to the hospital in return for discounted rates. But if you are the only patient in your health care LLC, then it makes no sense for the hospital to give you a discount.
However, you might be able to negotiate with some hospitals on their fees if you are a good cash-paying patient. I know some doctors would rather get paid up front in cash by patients at a lower rate than have to go through hoops and layers of insurance paperwork and precertification nonsense just to get paid the same low rate. In which case, you won't need to form your own LLC.....you just have to negotiate with the doctor.
Yes, but that's the issue. Read the thousands of horror stories from the link below of people who paid their high premiums faithfully for 20 years--until they needed a liver transplant, or cancer treatment and then watched their ins. co duck out of sight w/ some feeble excuse about them not reading the fine print, or they withheld pertinent info like a headache or some other lame-ass excuse so the co. could say it is not responsible for their bills.
I hate to burst your bubble, but the hospitals and doctors are as much to blame as the insurance companies. Each and every one of them is out to make a profit, and their standard operating practice is to put their needs ahead of the patient.
Everybody wants a bonus, and you have to make good numbers to get one. In the case of the collections department, its more important to look like they're getting paid fast instead of getting the full amount.
Now....if you know that they're giving 40% off to insurance companies and you offer to make an immediate payment for 60% of the billed amount instead of making payments for three years, they'll take it. They want those numbers off their books so that their department looks like its working hard.
If your motive for forming such an LLC is to insure yourself so you can get discounted rates from a hospital (instead of paying full price), I'm not sure any hospital will buy this. The reason hospitals offer discounted rates to insurers is economies of scale. The insurers provide business (thousands of patients) to the hospital in return for discounted rates. But if you are the only patient in your health care LLC, then it makes no sense for the hospital to give you a discount.
However, you might be able to negotiate with some hospitals on their fees if you are a good cash-paying patient. I know some doctors would rather get paid up front in cash by patients at a lower rate than have to go through hoops and layers of insurance paperwork and precertification nonsense just to get paid the same low rate. In which case, you won't need to form your own LLC.....you just have to negotiate with the doctor.
You're making a lot of good points, nd. Let's look at a few:
Quote:
But if you are the only patient in your health care LLC, then it makes no sense for the hospital to give you a discount.
The point is not to let them know you're the only patient. All you need is a professional-looking ins. card so when, in the emergency room, dr.'s office, hospital etc. they ask if you have ins. you say yes and pull the card out. They photocopy it and send a bill for the services, say $3000. In your role as claim adjuster you merely reply on the phone or ina letter, "We'll settle this for $1000. The check is in the mail in an hour if you agree." They agree. You mail the check. You just saved yourself $2000.
Quote:
I know some doctors would rather get paid up front in cash by patients at a lower rate than have to go through hoops and layers of insurance paperwork and precertification nonsense just to get paid the same low rate.
Remember, a hospital is a multi-dimensioned entity. The Dr. is one component. There's also the fee for the room, the lab, the radiologist, the xrays, and anyone else who even breathes on your file (and believe me they are standing in line to just pick up your file and glance at it so they can generate a fee) So the Dr. might be willing to negotiate, but you're still left with a dozen other entities to contend. The idea is to use a legal entity to get all these consolidated into one figure that you can then negotiate down 50-60%.
I've been charged less as a private pay. Billing has said that to me specifically.
Not me. I've been to emergency twice in the last year. Each time I saw the figure my ins. settled the bill for and in both cases it was 60% off the bill I would have paid if I were not insured.
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