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>Does Cinergy Health insurance really cover pregnancy? Does Encore Dental insurance pay for root canals? Is this Assurant Health stuff real health insurance? Will these health insurance companies really accept me if I already have previous bad health conditions? Do I have to use their doctors? Is there such thing as “full coverage” comprehensive medical insurance? Are those TV commercials telling me everything, or do I find out what is “NOT COVERED” after I try to use it later?

Let me qualify myself, I’ve been an health and life insurance agent since 2001. Unlike most other insurance agents and companies, I have made it my quest to be a full-disclosure product agent to my clients and policyholders. And it costs me business, because once most people find out the benefits that are eligible to be paid vs. the costs of the comprehensive medical health insurance premiums, they decide to bank the money and take their chances. Your found this blog post looking for: Encore dental insurance, Cinergy, HealthOne, Allied Dental TV ads or commercials, affordable dental and prescription insurance, discount plans… looking for some answers. I hope this post will address your questions and concerns, although I’m sure it won’t make you “feel better”. What I’m about to share will most likely make you angry, please read the entire post before making any conclusions.

Why am I putting this information out on my blog? Because it is those damn TV commercials that fool the average person into believing that there’s ‘affordable health insurance’ out there that can meet their needs. It makes MY job harder, and my prospective clients less trusting. Not only do I have to explain how MY real insurance products work, and why they cost hundreds more per month than they hoped to pay, but I ALSO HAVE TO EXPLAIN what those TV ads AREN’T telling, just so those companies can “generate” leads for their agents. I challenge you to pause the TV ad at the end of the commercial, where they show their “disclaimers”. Read them. Interesting, huh? From their website, the disclaimer:

The Cinergy Health Preferred plans are underwritten by American Medical and Life Insurance Company (Form No. GRP LM 2007) and Guarantee Trust Life Insurance Company (Form No. GTL GRP LM 2007) offered through a paid membership in the National Congress of Employers association and may vary by availability, vendor or member’s state of residence. It is NOT Major Medical Insurance and is not meant to replace catastrophic health insurance or major medical coverage. For costs and further details of the coverage, including exclusions, any reductions or limitations and the terms under which the coverage may be continued in-force, please call. The discount dental and prescription programs are provided by Patriot Health Florida, Inc.(except in CA), a discount medical plan organization. These programs provide discounts at certain health care providers for medical services and do not make payments directly to the providers of medical services. The member is obligated to pay for all health care services but will receive a discount from those health care providers who have contracted with Patriot Health Florida, Inc., located at 160 Eileen Way, Syosset, New York 11791. Members may cancel within 30 days and discounts may vary.

Don’t click away yet — PLEASE — I’m just scratched the surface so far…

You know how insurance companies make their profits, right? They make more than they pay out. If they pay out more than they make, then they go out of business. Maybe you saw the Disney animated hit, “The Incredibles“… you remember the insurance company boss? Well, that’s very exaggerated, but there are a few insurance carriers out there that are like that… funny in the movie, sad in real life. That’s why our country is in a health insurance / medical treatment costs crisis. How can the average person afford to pay hundreds of thousands of dollars for a catastrophic injury or illness? Hell, most of us have a serious challenge coming up with a few hundred dollars for a doctor’s office visit.

Do not buy medical insurance from a TV ad. I don’t even know how these companies get away with their advertising methods. In my state, it’s illegal to use scare tactics to sell insurance. These companies somehow skirt around it, but they’re preying on our fears. We know we can’t afford insurance, we know we have pre–exisiting health problems, we know we can’t afford to go get treatment or a hospital stay. And those stupid commercials try to make it sound affordable by breaking it down by daily costs. “For just 6 dollars a day you can get…. ” That’s almost $200 per month. And what do you get for spending $2,400 per year? 10 to 50% savings on “what” exactly? It is not COMPREHENSIVE COVERAGE, these are DISCOUNT plans set up with a network of doctors and clinics that need new patients.

If a heart attack costs, let’s say for this example, $70, 000. The good news is, no hospital can turn you away if you arrive in an ambulance after suffering a heart attack. They can turn you away if walk in not feeling well and don’t know why, but once the heart attack happens, they have to treat you. Great. You get treatment. And a bill in the mail for $70,000 (it’s much higher, but I’m doing easy math here). Your so called “TV medical insurance” will pay the doctors a total of $7,000, if you’re lucky. You came out ahead. Good for you. You paid a few years of premiums, about $4,800, they paid out $7,000… assuming you haven’t met your maximum annual payout. Oh wait. They only paid $7,000, that means you owe the other $63,000! Still good coverage?

Dental insurance on TV, like Encore. Did you grasp the payable benefits? 100% of cleanings, and ONLY HALF of other procedures. WITH AN ANNUAL CAP (max. payout) of $1,000! Let me break it down:

You go in for your free cleaning. The dentist finds you have two teeth that need to come out and some other stuff. Understand this.. the free cleanings are designed to get you into the chair to find out what else may be wrong. Further treatments? Ah yes, more costs. The dentist recommends $2200 in treatments. “Since you’re here, we can do those now… are you ready to get started?” Sure, I have dental insurance… “proceed”.

A few days later you get “amount owed” of $2,200! What? How can that be? Did you know those procedures had a 12 month ‘elimination period’? To be honest, I doubt any network dentist would do the procedure without letting you know your out of pocket costs, that’s actually discussed before you even sit in the chair. If there’s any danger of them not getting paid, they most likely won’t do any procedure… they can’t stay in business doing anything free. Even if you met the elimination period, you would still be out of pocket $1,200… your annual cap is $1,000… remember?

Depressing isn’t it. Do not buy health insurance from a TV ad. I offer Humana insurance and other insurance products, but I certainly can’t explain it in a TV or radio ad. I seriously do not know how these companies can get away with it. You should ALWAYS buy any insurance through a local insurance agent, so you can hold HIM/HER accountable to what they sold you. Not some call center agent over the phone. The Federal Trade Commission will no doubt be knocking on some company doors soon.

“So, what am I going to do?” Pray, eat right, stop doing the things that are bad for you (you know what they are)… you can no longer afford to abuse your body and expect doctors and hospitals to fix what “you” broke. “But my health issues are NOT my fault, many are genetic!” Yep, I know that, too. There are some other options, but I can’t say they’re exactly “affordable” because what you and I mean by affordable is “damn near free full insurance coverage” and that doesn’t exist yet. I sell supplemental insurance to active military and their dependents… even THEY don’t have full coverage. I remember Obama saying something on TV like “Americans are entitled to the same health insurance coverage as Congress and other federal employees…” Believe me, the health coverage federal employees have IS NOT FULL COVERAGE, either. They think it is until they use it or need it. I’m not going to waste this space here explaining what’s not covered.

Other options: State risk pools. Health Spending Accounts. Association Benefits. Research those options in your area. Buying any insurance from a TV ad is lazy and will cost your dearly down the road. If you think I’m full of doo–doo and need to learn for yourself, then I hope you’ll ask them some good questions:

1. Give the agent on the phone an example of what you fear could happen to you or a family member. Ask them to explain the claims process and how much THEY WOULD PAY and how much you’ll HAVE TO PAY LATER.

2. Ask them what doctors are in your area that you can use?

3. Is pre-certification needed? Do you need their permission to use their insurance before seeking EMERGENCY TREATMENT?

4. What’s the maximum annual payout that the company will pay per covered person? What are the UPFRONT co-pays, confinement deductibles, which prescriptions are NOT COVERED?

5. For pregnancies, what’s NOT COVERED? Any ICU benefits for problem deliveries?

6. Are their any conditional exclusions (allergies, mental health, etc.)?

7. How OFTEN are the rate increases? What are rate increases based on?

8. Do you force coordination of benefits with supplemental carriers? If you have supplemental insurance like Aflac, some of these companies may force you to assign your supplemental benefits to the doctors or treatment centers before they pay ‘their portion due’?

9. What happens if you’re forced to use an “out of network” doctor or clinic while on vacation or visiting another city or state—OR COUNTRY?

10. Are treatment payments paid directly to the doctors and clinics, or are you reimbursed after submitting payment yourself?

I can come up with several dozen more questions you can ask, but by the time you get this far, you find yourself telling the agent, “Please remove my name and personal information from your database – I DO NOT AUTHORIZE my information to be sold to other third parties!” Your phone call will be taped and they’ll have to honor that.

I am attending several conferences in the months ahead about how the new administration is going to affect health insurance and treatment costs. It’s a mega-trillion dollar business, Mr. Obama and his associates have a very long and hard battle ahead. They say there is profit in war… imagine if you can how much money there is in pharmaceuticals and health care costs. Those profit centers will not lie down and play dead in the next ten years. It is truly up to us to save all we can for that VERY RAINY DAY and take better care of ourselves. Someone has to pay those high costs for now… the taxpayers.. you and me… one way or another. Just like the finance industry, the truth will catch up with the insurance companies and treatment centers soon enough. If open-minded people like you are willing to read articles like mine, and do their homework.

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