by Guest » Fri Dec 04, 2009 01:41 pm
We have insurance through my husband's work. Our co-pay is $20 per visit, for specialists $40 and ER $150. Lately it seems like these little amounts add up to a lot. Is there a private insurance I can get that would cover those co-pays and everything else that our insurance may not cover ? Or does a secondary insurance just split the bill with the primary but doesn't cover the co-pay either ?
Posted: Fri Dec 04, 2009 01:45 pm Post Subject: Private secondary insurance
I have the same question if someone help plz reply here.
thanks
Posted: Sat Dec 12, 2009 07:24 am Post Subject:
I've never heard of such a thing. But some health insurers are now beginning to put out-of-pocket limits on copays as well as deductibles and coinsurance. It would probably be an acceptable trade off to the inability to find the "secondary" coverage you want.
A "secondary" policy such as you describe would not be economically viable for you or the insurer. It has to do with the concept known as "adverse selection" which means that people with exceptional risks are more likely to seek insurance to cover that risk than persons with little or average risk.
The persons most likely to want your secondary coverage are those who frequently see the doctor, or worse, use the ER as their primary care provider. What would you be willing to pay for such coverage?
Let's say your copays total $1020 in a year -- 30 doctor's office visits, 2 trips to the ER, and 3 specialist visits. And you've had similar claims experience in each of the last 2 or 3 years. You're paying perhaps $500 per month for the health insurance. The "secondary" insurer says, "Sure, we'll pay those copays for you. The cost will be just $80 per month." Do you take it?
If you do, you pay $960 to save $60. Sound appealing to you? And what if you have a "bad" year? You only go to the doctor 15 times, the ER once, and no specialist visits. $450 in copays, $960 in premiums, $510 net "loss" to your pocketbook.
There is not enough opportunity for insurers to limit their risk from unhealthy persons with premiums from healthy persons. Mostly because the healthy persons have no perceived need for the coverage. In my case, aside from a broken ankle in 2007 (surgery and 8 weeks in a cast and several follow ups before being released, three months of physical therapy 1-2 times per week) and a gall bladder extraction in 1992 (four days in the hospital post-op due to minor complications), I've probably seen a doctor on eight or ten other occasions in the past 20 years. I'm not paying for copay insurance. And there are lots of others out there like me (mostly men, too).
Insurers don't enter into lines of business unless they can expect to make a reasonable profit. This is one line that would probably result in consistent losses.
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