“Saturday marks the launch of TexHealth Central Texas, a new health benefits plan that aims to cover 2,500 workers in Travis, Hays and Williamson counties in the next three years.”
The funny thing is this is not insurance. It is not regulated by the dept of insurance that monitors the financial stability of company’s that are making a claim to pay your medical bills.
“The employee and the employer each pay an average of $122 in monthly premiums — dependents aren’t covered — and the annual deductible is $250. Co-pays for primary care are $20 and specialty care visits are $40, while the limit on drug benefits per year is $1,000, and for hospitalizations, it’s $100,000. Over the next few weeks and months, Rodriguez and others will be spreading the word about it.”
DING,DING ,DING….we have a problem….you show up at MD Anderson for cancer treatment this will happen to you…so if Mr. Rodriguez spreads the word your way call your insurance agent and do a full work up on ALL your options …and if you don’t have one call or email me at 512-260-0856 … stibroker@austin.rr.com
Cash Before Chemo: Hospitals Get Tough
LAKE JACKSON, Texas
When Lisa Kelly learned she had leukemia in late 2006, her doctor advised her to seek urgent care at M.D. Anderson Cancer Center in Houston. But the nonprofit hospital refused to accept Mrs. Kelly’s limited insurance. It asked for $105,000 in cash before it would admit her.Sitting in the hospital’s business office, Mrs. Kelly says she told M.D. Anderson’s representatives that she had some money to pay for treatment, but couldn’t get all the cash they asked for that day. “Are they going to send me home?” she recalls thinking. “Am I going to die?”Mrs. Kelly’s ordeal began in 2006, when she started bruising easily and was often tired. Her husband, Sam, nagged her to see a doctor.A specialist in Lake Jackson, a town 50 miles from Houston, diagnosed Mrs. Kelly with acute leukemia, a cancer of the blood that can quickly turn fatal. The small cancer center in Lake Jackson refers acute leukemia patients to M.D. Anderson.When Mrs. Kelly called M.D. Anderson to make an appointment, the hospital told her it wouldn’t accept her insurance, a type called limited-benefit.“When an insurer is going to pay the small amounts, we don’t feel financially able to assume the risk,” says M.D. Anderson’s Mr. Tietjen.
The way Dana Christensen sees it, she and her husband got scammed. In early 2001, seven years after Doug had successfully battled bone cancer, the couple needed new health insurance. So they were all ears when a representative from a group called the National Association for the Self-Employed knocked on the door of Doug’s boat repair business in Marina del Rey, Calif. The rep offered what sounded like a great deal: For just $434 a month, MEGA Life & Health Insurance Co. would cover them both. The policy even carried a chemotherapy rider in case Doug’s cancer came back.
But when the cancer did return later that year, they received a shock: A few months after Doug started chemotherapy, Cedars-Sinai Medical Center refused to treat him anymore, saying he had already used up the MEGA coverage. The problem: It capped chemo coverage at $1,000 a day, even though Doug’s cost up to $18,000 — fine print Dana says they were never told about. The doctor got Doug transferred to another hospital. But after he died in October, 2002, at the age of 48, Dana was stuck with almost $500,000 in medical bills that MEGA refused to cover, and now lives on her boat to save money on rent. “He said to me one day, ‘I know it’s too late for me, but this should not happen to people,”‘ recalls Dana, who says the NASE rep never told them that it functions as MEGA’s marketing arm and only sells MEGA insurance. Last year, she sued MEGA and NASE for failing to disclose the caps and for endorsing a “sham” policy by pretending NASE was an independent group.