Some links - Julian http://www.mediabistro.com/insurance/ http://www.mediabistro.com/insurance/download/mediabistro-crosscarriercomp4q08.pdf http://www.ins.state.ny.us/chealth.htm Interactive Consumer Guide to HMOs - http://www.nyshmoguide.org/ Premium Rates for HMO Standard Individual Health Plans by County - http://www.ins.state.ny.us/ihmoindx.htm
archive post of chatter from fu I've got to get to work, but why would you not choose oxford over atlantis at mediabistro? i didn't look at atlantis, but oxford looks great Posted: Wednesday Nov. 19, 2008.Info12:56P Katherine:does anyone have a link to dental care providers that are covered? Posted: Wednesday Nov. 19, 2008.Info12:40P Laurie:maria, if you qualify for mediabistro.com, jump immediately! (to lock in low rates for 12 mos) Posted: Wednesday Nov. 19, 2008.Info12:25P Maria:Hi There! If I'm a new member how do I get health insurance? Does anyone know? Posted: Wednesday Nov. 19, 2008.Info12:24P margaret:Julian, he suggested atlantis, but you should call and get advice specific to you Posted: Wednesday Nov. 19, 2008.Info12:22P laurie:(ass opposed to Laurie) Julian, why not set up a forum on yahoo.com? http://groups.yahoo.com/start Posted: Wednesday Nov. 19, 2008.Info11:58A Lucy:Thanks Julian...I was also impressed with MB when I spoke with them...my check/application is going out tomorrow morning. PRIORITY! :-) Posted: Wednesday Nov. 19, 2008.Info11:54A Julian:I have one high priced monthly prescription w/o a generic alternative. what did they suggest? Posted: Wednesday Nov. 19, 2008.Info11:53A Julian:her being will know what she has visited on us. Posted: Wednesday Nov. 19, 2008.Info11:53A Julian:If only th eidea of FU was backed by action instead of being a marketing ploy. Empty marketing to progressives is appaling. i hope Sara comes back as an underinsured food service worker - maybe then Posted: Wednesday Nov. 19, 2008.Info11:52A margaret:Im still looking at Oxford--if my dotor ok's going generic on a few precrips I will do that. Posted: Wednesday Nov. 19, 2008.Info11:51A margaret:Julian I havent made the final decision yet, have to crunch a few #s Posted: Wednesday Nov. 19, 2008.Info11:51A margaret:I can't wait to be off of the FU plan but it does make me sad, I loved the idea of a freelancer's union and I wanted to support their advocacy and other things they do but oh well Posted: Wednesday Nov. 19, 2008.Info11:51A Julian:Margaret - which plan did you choose? Posted: Wednesday Nov. 19, 2008.Info11:50A Julian:underwiritng life, disability or dental insurance. Posted: Wednesday Nov. 19, 2008.Info11:50A Julian:Lucy - they are separate plans so I think as long as yo want to remain a member of fu and keep paying premiums you are covered. FIC is the health insurance change - I have heard nothing about FIC Posted: Wednesday Nov. 19, 2008.Info11:50A margaret:no one rushed into the wrong plan in their eagerness to get away from FU Posted: Wednesday Nov. 19, 2008.Info11:49A margaret:Mediabistro went through all of the options with me (I am prescription-heavy so he steered me away from Oxford, for example), and explained EVERYTHING. he was v patient and said he wanted to make sure Posted: Wednesday Nov. 19, 2008.Info11:49A margaret:I just got off the phone with mediabistro and I couldnt have been more impressed Posted: Wednesday Nov. 19, 2008.Info11:42A Lucy:does anyone know - if we cancel our health, can we still keep our life/disability? Posted: Wednesday Nov. 19, 2008.Info11:39A Laurie:btw, make sure to read the recent comment from carolyn on the petition thread--she spoke with someone inside the ny insurance industry Posted: Wednesday Nov. 19, 2008.Info11:38A Laurie:beyond me, but at least in the meantime we'll have a permanent record instead of this, which is gone Posted: Wednesday Nov. 19, 2008.Info11:34A Julian:I am blocked by waiting period from posting on craigslist forum. Posted: Wednesday Nov. 19, 2008.Info11:33A Julian:I was going to try to set up a threaded forum tonight or tomorrow - is there any way to tie that to upset fu? I think it would be easier to organize and navigate than a scroll of blog comments. Posted: Wednesday Nov. 19, 2008.Info11:31A Laurie:ie, something positive-ish could come out of all of this! Posted: Wednesday Nov. 19, 2008.Info11:30A Laurie:btw, I think we can make the new blog permanent, so offer advice in years to come, also... Posted: Wednesday Nov. 19, 2008.Info11:30A Laurie:Julian's right, better spot.. thx all! Posted: Wednesday Nov. 19, 2008.Info11:29A Julian:please post insurance info to http://upsetfu.blogspot.com/2008/11/fic-alternatives.html Posted: Wednesday Nov. 19, 2008.Info11:27A Jeanne:http://upsetfu.blogspot.com/2008/11/petition.html?showComment=1227021840000#c6724386652936446739 Posted: Wednesday Nov. 19, 2008.Info11:27A Jeanne:the blogspot doesn't have the most recent posts, the one that does says "petition" here is the url, i will post separately Posted: Wednesday Nov. 19, 2008.Info11:20A Mai:Jeanne: Awesome. Thanks! Posted: Wednesday Nov. 19, 2008.Info11:17A Jeanne:they do charge 59 to join mediabistro, so that plus 401 will work, separate checks, they will tell you, one has to be made out to oxford Posted: Wednesday Nov. 19, 2008.Info11:16A Jeanne:they will send it to you separately if you call them Posted: Wednesday Nov. 19, 2008.Info11:15A Jeanne:just check that the actual application is in the pdf file...page 11 was missing and that is the page you need for the mediabistro application Posted: Wednesday Nov. 19, 2008.Info11:15A Laurie:the first (new) thread, upsetfu.blogspot.com thanks! Posted: Wednesday Nov. 19, 2008.Info11:15A Jeanne:maybe post the url again laurie Posted: Wednesday Nov. 19, 2008.Info11:14A Laurie:can we all collectively switch over to upsetfu right now? I don't want to have to be resposting all this info? Posted: Wednesday Nov. 19, 2008.Info11:12A Laurie:hth is just one of those carriers really for internat'l but it seems like a good deal (depending on dom, network) and they take u the moment u sign up on internet! Posted: Wednesday Nov. 19, 2008.Info11:12A Mai:Jeanne: yes, rush, rush, rush to lock in 2008 rates for 1 year. Posted: Wednesday Nov. 19, 2008.Info11:11A Laurie:upsetfu just started a new thread, the first one there, for practical advise about other options Posted: Wednesday Nov. 19, 2008.Info11:11A Mai:by anyone yet... Posted: Wednesday Nov. 19, 2008.Info11:11A Mai:Laurie: I will look into hth. However, someone said that Untied Healthcare(Oxford is now a part of--is a national network that is accessible. wondered if there was any verification on that statement Posted: Wednesday Nov. 19, 2008.Info11:11A Jeanne:remember tho, you have to get the appliocation and checks in by the 25th of november for december coverage and to lock in 401 rate Posted: Wednesday Nov. 19, 2008.Info11:11A Laurie:hthtravelinsurance.com (not hth) Posted: Wednesday Nov. 19, 2008.Info11:10A Mai:Jeanne: Makes sense and Thanks. Posted: Wednesday Nov. 19, 2008.Info11:10A Jeanne:laurie good idea, this way everyone can see our posts Posted: Wednesday Nov. 19, 2008.Info11:09A Jeanne:he said he'd call oxford to make sure but really, that won't hold me back, your dr does a blood test , doesnt know 2 weeks in advance! Posted: Wednesday Nov. 19, 2008.Info11:09A Laurie:hth.com (?) gold travelgap? Posted: Wednesday Nov. 19, 2008.Info11:09A Laurie:are like, however.. but it's a stopgap Posted: Wednesday Nov. 19, 2008.Info11:08A Jeanne:yes, mal, the 2 wk certification seems impossible, he siad they prefer that but it never happens. I had oxford, i remember that Posted: Wednesday Nov. 19, 2008.Info11:08A Laurie:Hi Mai, it's a travel insurance co... if you're hurt 250 miles from home it covers up to 25,000? domestic med bills, more abroad? good deal I believe... I had for a while (don't know what network mds Posted: Wednesday Nov. 19, 2008.Info11:03A Mai:Laurie: what is hth? Posted: Wednesday Nov. 19, 2008.Info11:00A Laurie:Mai, hth has good travel insurance $150 for a year coverage? Posted: Wednesday Nov. 19, 2008.Info10:59A Laurie:guys, could we switch this to upsetfu.blogspot.com otherwise all this helpful info will shortly be lost to us? Posted: Wednesday Nov. 19, 2008.Info10:55A Mai:Jeanne: did MB have info re: 2-week pre-certification for lab/radiology etc services for Oxford metro2--also any details on the national network that we can access if injured while away (Grand Canyon) Posted: Wednesday Nov. 19, 2008.Info10:32A Jeanne:one of the people at mediabistro talked to me for over a half hour, didn't rush me despite how busy they are with our people Posted: Wednesday Nov. 19, 2008.Info10:13A Julian:Mediabistro phone support is a world of difference - helpful, very knowledgable, paitent, nice. Maybe FU could take lessons? Posted: Wednesday Nov. 19, 2008.Info10:01A Julian:polite? at least that is some progress. Snippy has been the default. Posted: Wednesday Nov. 19, 2008.Info09:56A Georgina: these posts are very interestinq and informaqtive, and according to FU te new insurance company will be Anthem, Blue Cross Posted: Wednesday Nov. 19, 2008.Info09:45A Martha:wow, so frustrated with the phones. very polite people on the end of the line, but what good is that if its not helpful?? Posted: Wednesday Nov. 19, 2008.Info09:42A Jeanne:for mediabistro, page 11...so they sent it to me separately $59 to join Posted: Wednesday Nov. 19, 2008.Info09:42A Jeanne:Julian, I called this morning, made my decision. The thing missing on my pdf was the application Posted: Wednesday Nov. 19, 2008.Info09:38A Elena: I would have rather paid an increase to Empire Posted: Wednesday Nov. 19, 2008.Info09:38A Elena: This insurance is no deal Posted: Wednesday Nov. 19, 2008.Info09:03A Julian:yes, you will - I don't thnk you would get back the membership fee to Avant guild but they might even do that - call them - they are a reputable company Jeann Posted: Wednesday Nov. 19, 2008.Info08:36A Jeanne:I mean mediabistro, who is handling Oxfird... Posted: Wednesday Nov. 19, 2008.Info08:35A Jeanne:What happens if I send my check into Oxford and something is not acceptable on my tax form? Will I get my check back? Posted: Wednesday Nov. 19, 2008.InfoWednesday Nov. 19, 2008 11:53P Matthew: has anyone here made any headway with complaints regarding the new FIC? Posted: Tuesday Nov. 18, 2008.Info11:41P anne:walter- go to yahoo. type in:nys state health insurance complaints ratio. Select the fourth listing. Posted: Tuesday Nov. 18, 2008.Info11:24P anne:Yes.They give no option to the self employed. Posted: Tuesday Nov. 18, 2008.Info11:24P walter:Anne, I went to the site. Where please is the link to Atlantis complaints? Posted: Tuesday Nov. 18, 2008.Info11:21P Jeanne:anne is that a rate for just one person? That seems excessive Posted: Tuesday Nov. 18, 2008.Info11:10P anne:walter-check out the website www.ins.state.ny There, you will find a link for the number of complaints filed against nys insurance companies. Atlantis has the highest number of complaints. Posted: Tuesday Nov. 18, 2008.Info11:05P Julian:Laurie, Re: your 8:03 post - Did you see "Sicko?" Where is the fine print? A promise to require no referrals does not mean automatic acceptance of all claims - at least I don't think it does. Posted: Tuesday Nov. 18, 2008.Info11:04P walter:Try eInsurance.com. The Atlantis offerings seem tobe the best and cheapest. Posted: Tuesday Nov. 18, 2008.Info11:04P anne:Let's attend the webinar and at least voce our dissatisfaction. Posted: Tuesday Nov. 18, 2008.Info10:56P anne:Empire BC/BS HMO POS.It is very expensive:individual-$887. per month -thats the 2008 rate. I do not know if I can afford it. Posted: Tuesday Nov. 18, 2008.Info10:52P Jeanne:anne which did you decide on, if anything? Posted: Tuesday Nov. 18, 2008.Info10:52P Jeanne:thank you Posted: Tuesday Nov. 18, 2008.Info10:51P anne:nys dept of insurance phone number: 800-342-3736 Posted: Tuesday Nov. 18, 2008.Info10:49P Jeanne:it would be so much easier to not have to go thru the process all over again though Posted: Tuesday Nov. 18, 2008.Info10:48P Jeanne:I am htinking about Oxford, downloaded all of the forms, talked to them all day Posted: Tuesday Nov. 18, 2008.Info10:48P Jeanne:this afternoon there were so many people on here, now just a few. thanks for tip Posted: Tuesday Nov. 18, 2008.Info10:46P anne:Jeanne_possibly a call to NYS Dept. of Insurance would answer your question. Posted: Tuesday Nov. 18, 2008.Info10:40P Mirit:I don't understand how people are able to get the tax return forms, but no one is able to get any news cover on how we got screwed... I feel like all the energy is geared towards the wrong places Posted: Tuesday Nov. 18, 2008.Info10:38P Jeanne:but Sara's blog says that the drs are REQUIRED to take FUI, who took our bc/bs before Posted: Tuesday Nov. 18, 2008.Info10:36P anne:Thats the point. FUI is a new,unknown,untested entity.If we need health care,are we willing to put up with the unexpected hassels when we get sick? Posted: Tuesday Nov. 18, 2008.Info10:36P walter:Thomas' post of 06:48 very interesting tax return. I bet Dear Leader got pissed on that link. Better download it now kiddies before it's censored. Posted: Tuesday Nov. 18, 2008.Info10:31P Jeanne:anne, do these drs even know what FUI is at this point? Posted: Tuesday Nov. 18, 2008.Info10:26P Laurie:I don't think they have a choice?? if they're part of the specific network? Let's not scare off all the mds (I'm stuck with FU for a while...) Posted: Tuesday Nov. 18, 2008.Info10:18P anne:The BC/BS logo on the FUI card means nothing! Posted: Tuesday Nov. 18, 2008.Info10:17P anne:I spoke to my physicians.They are not willing to accept FUI for office visits. They do not want to get burned if there will be a problem with claims.What if hospitals refuse to accept FUI? Posted: Tuesday Nov. 18, 2008.Info10:09P Alfred: freelancersunion = a sara based approach to making things worse for you and better for sara Posted: Tuesday Nov. 18, 2008.Info08:55P Laurie:also, a plus is that the fees even during deductible period will be the discounted rates set by the plan (in network) Posted: Tuesday Nov. 18, 2008.Info08:53P Laurie:doesn't have the coinsurance issue; you still have the 2/5 million annual/life max, but again, you could tranfer to NY state or another plan at that point Posted: Tuesday Nov. 18, 2008.Info08:53P Laurie:high deductible plan, the two versions FU putting out Posted: Tuesday Nov. 18, 2008.Info08:46P Jeanne:what is HD? Posted: Tuesday Nov. 18, 2008.Info08:05P Laurie:Again, the HD plans seem solid for what they offer... Posted: Tuesday Nov. 18, 2008.Info08:03P Laurie:I don't see what the problem with approving claims would be, as no specialist referral needed? Posted: Tuesday Nov. 18, 2008.Info08:03P Laurie:FU actually might be better about claims... and I don't see how we would be liable if they went under; just transition to another plan (NY state if nothing else) Posted: Tuesday Nov. 18, 2008.Info07:53P Julian:"More profits for them" I am tired.
Mediabistro's Oxford plan #2 can be had at $401 if you get the application in by November 25th. Their phone number is 212-879-0122 and they will give you that rate through December of 2009. No charge for x-rays and MRIs whereas FU's new plans ask for 20%. MRIs cost up to $2,000 so paying $400 is out of the question for me, if I ever need one, same with x-rays and lab costs. I think after looking through all the plans, this one is the best. If anyone finds something better, please post.
WOW I think freelancers union just froze both the blog page and the membership home page; everything else opens, but the two spots where you can post!!!!!!!!!!!!!!!!!!!! This is getting dramatic!
I looked over the oxford quickly and I thought it looked really good... the deductible doesn't apply to well-care, mammogram, one physical and no referral to specialists needed... seems great (the one I looked at) (and I know from experience that many columbia presby. md's participate in liberty network)
Seriously, I think she/they've blocked it, all the other pages there open for me... great story for ny times, slate etc... everyone let your journalist friends know!
okay, I was finally able to get on, but there was a definite break there--I even turned off my computer and still couldn't access those two parts.. I think they were frozen for a bit, somehow (at least to my connection...) I'm glad they're "online" otherwise it would be some story... (sad...)
I wish New York State regulators would step in (Sara, are you reading this?) and put in writing that we are not personally liable for any charges incurred that FU would owe if they go under... then we know we can always transition to the NY State plan (with no prexisting conditions) and be confident our credit history wouldn't be permanently ruined. I think we need that in writing from New York who seems to think this venture is viable. That would go quite a way towards building confidence for me (though if I could I would leap to mediabistro immediately).
Hi everyone - this is Nathan, one of the suddenly overworked people at Total Capital Planning (the people working with Mediabistro to provide info on the plans available) that several of you have either spoken or e-mailed with over the last few days, and we were just given this site earlier today.
Just thought I'd stop in and say hi - I know there's been a lot of interest in light of the whole Freelancer's Union... spectacle? Debacle? And reiterate that we are happy to help with any questions we can; obviously we've had a deluge of calls and e-mails so we're not turning around as rapidly as I would like on some people, but we'll do our best to keep up.
I know a lot of you are interested in Oxford (generally the Metro #2 plan from my conversations), and I do like them a lot as a company - most of the freelancers/sole proprietors we work with are with them. I just want to make sure everyone is aware of one feature of their plans that I don't believe I've seen talked about, since it's a pretty key one. Prescriptions.
All the Oxford plans have the same drug card - for generic prescriptions you have a $15 copayment, and for any non-generic drugs you would have a co-payment of 50% of the retail cost of that drug, after a deductible of $100 (higher for the HSA plans that most of you don't seem too interested in so I'll spare you). So while there is a prescription benefit, it's not going to be right for everyone. If you have non-generic prescriptions that you take regularly, I'd suggest pricing them with your pharmacy before signing up for this plan - there are a few expensive ones out there, and I'd hate for somebody to sign up then go to the pharmacy and wonder why they have a $500 bill!
We really do just want to help you guys out, I know you're all in the lurch over this. So if you need anything feel free to give us a call at 212-879-0122. Even if you're not eligible for these plans (FU has had some slightly different requirements in the past than these do), we'll try to point you in the right direction for something.
Although I am quite cynical about FU I do not think they could stop members from posting at this point w/o a tremendous loss of face. We are all having anxiety but let's generally keep our focus on progress. People need to read completely through the information that has been posted – I made a mistake in a post then reposted to correct it but another commenter, who I was trying to help, sent me several emails spanking me for the typos - after apologies, after everything - I am at work and I am trying to disseminate useful information on the fly - please look over my failings - Carolyn seems incapable of doing that.
If anyone wants to learn more about the health insurance options available to freelancers you can check out www.mediabistro.com/insurance or email health@mediabistro.com or call Nathan Short at 212 879 0122 - he has been very helpful.
I think we need a thread limitied to listing vialbe alternatives to FU - this has already gotten muddied wwith extraneous comments, including my own gripe. Sad-m - Thanks again for creating this Blog!
I'm considering the switch to MB's Oxford plan, but I have two concerns:
They require you to have most of your income reported on a schedule C, with proof. If I submit my 2007 tax return as proof this is not a problem. However I don't know what the next year(s) may bring. Can Oxford cut you off if your circumstances change?
Another requirement is that you work at least 20hrs/week. I sometimes work more than that and sometimes less. I'm not sure how they would verify this, but I do know insurance companies go to great lengths not to pay claims. This may be incredibly cynical of me, but what if something catastrophic happened and they decided to deny my insurance because I have not worked 20 hours every week?
I've tried calling and emailing Mediabistro for a few days now, and haven't gotten a response. I am in a small LLC partnernship but we are on our own with regards to insurance (My partners get insured through their wives). I don't file schedule C, but rather Schedule K for small business. Freelancers Union will accept this but I'm not sure if the plans at Mediabistro will find me eligible.
motionprojects, there is always someone answering their phones. Their number is posted on this blog, keep trying. They are probably very busy right now.
here's the quick info from their website for the sole proprietor... they also have info for groups of 2 or more (it's under the avant something column on the right of the media bistro page) Health Insurance for Freelancers As a Freelancer, you may be eligible for the following plans:
** The Oxford plans require that the majority of your income be untaxed income reported on a Schedule C, E, or F, but there is no minimum income requirement ** The Atlantis plans require $15,000 Gross Income on the Schedule C ** The HIP & GHI plans require approximately $10,000 Gross Income on the Schedule C – subject to Underwriters discretion. ** The MVP plans require a gross minimum income of $7,436 reported on Schedule C, which must be the majority of your earned income.
Contact Jason Silverman at 212.879.0122 for more information or to sign up.
For health insurance outside New York, please click here.
further, here is a quickie of their info re small businesses (2 or more people)
Health Insurance for Small Businesses Health Insurance is one of your largest line-item expenses. Creating an efficiency of only 10% can result in significant savings.
As a small business with between 2 and 50 full-time employees, you are eligible for plans from a wide range of insurance carriers including Aetna, Atlantis, Cigna, Empire Blue Cross Blue Shield, GHI, Guardian HealthNet, HIP, and Oxford.
How to choose a plan To help you choose the right plan for your specific situation, Total Capital Planning has a very simple process:
First, you submit a list of doctors important to you and your staff so that TCP can determine in which insurance carrier networks your doctors participate. TCP will then prepare a comparison of your current plan vs. alternative plan options that you may prefer. You will be provided with a medical benefits consultant who will work with you to decide which plan or set of plan is best for your specific needs. As part of the process, TCP will also provide guidance on setting employee contribution policies and other cost containment strategies that have proven successful.
Additional Services Once your plan is established, Total Capital Planning is available daily to handle:
Plan administration Enrollments, terminations, or COBRA applications transactions with the insurance carrier confirmation that all applications are received and processed in a timely manner resolving any billing issues and claim problems that may arise For more information about TCP go to: http://www.myhealthplans.com
How do I sign up? Call Jason Silverman at (212) 879-0122 or email health@mediabistro.com to begin the process.
What does "the majority of your income be untaxed income" mean? How do I know my application to MB won't be turned down? Can someone explain this? What numbers on my 1040 should I look at before I submit an application?
Alex, From what I understand, just look at the first page of your 1040. THere should be a line in the income box (#12 if yours is the same as mine) that gives your income from a schedule C. This number should be a majority of your income.
Yes, line 12 says my income and this is my only income. Do I need some kind of proof that I don't have another income? If the people from MB are seeing this question, can you reply please? Thanks.
Hi everyone, Nathan again. First of all - happily taken, but I'm flattered?
Alex et al, here is the fast and loose guideline for eligibility specifically for Oxford (other carriers are a bit different):
Look at Line 1 of your Schedule C (gross receipts and sales). The number listed on Line 7 of your 1040 (wages, salaries, tips, etc) can not be more than 50% of this amount. If it is, you are still eligible if you can document that you do not work for the companies that paid you on this basis. You would do this by providing a copy of the W-2 from the company, as well as a letter on letterhead or an official severance notice from the company.
Alex - it sounds like you should be eligible if you do not have any amount listed in Line 7 of the 1040 and at least some amount listed in Line 12. All we should need are the two pages of the 1040 and the two pages of your Schedule C.
If anybody thinks their situation doesn't boil down easily into this formula, we're available at 212-879-0122 until 5-ish.
Thanks for this thread. It seems pretty clear to me that I wouldn't qualify for MB, so I'll keep monitoring to see if anything else turns up. It seems likely to me that everyone who can and knows about other options will flee FU, but I may not be one of those who can.
04:13P Jeffrey:This is a disaster for us. Husband has cancer. Not qualified for medicaid or medica (yet). Cancer docs won't take Family Helth Plus or Atlantis. We can't afford this. Posted: Wednesday Nov. 19, 2008.Info 03:35P Julian:henry - but compare that to coinsurance and caps of yearly and lifetime benefits and calculate the risk/benefit for your individual needs. Posted: Wednesday Nov. 19, 2008.Info 03:32P Julian:12:22 laurie - good idea - will try tonight Posted: Wednesday Nov. 19, 2008.Info 03:28P Henry:Note that Media Bistro, while offering great rates, also specifies a 50% copay for brand name drugs. That could be damned expensive Posted: Wednesday Nov. 19, 2008.Info 03:17P Justin:at a gym that has a focus on cardio. ie. they have a treadmill. Posted: Wednesday Nov. 19, 2008.Info 03:17P Justin:In case anyone wants to know, yes, Oxford reimburses $200 every six months for gym membership Posted: Wednesday Nov. 19, 2008.Info 02:56P Kenneth: employees... Posted: Wednesday Nov. 19, 2008.Info 02:56P Kenneth: 2-50 employees who have a much better choice..particularly when the law that mandates small business owners be given affordable health care particularly says the def of small business is ONE to fifty Posted: Wednesday Nov. 19, 2008.Info 02:54P Kenneth: you all might want to ask your state assemblymen/women and senators why insurance companies can discriminate against sole proprietors by offering less beneficial plans than small business owners with Posted: Wednesday Nov. 19, 2008.Info 02:49P Justin:has anyone else confirmed the $400 reimbursement from oxford for regular gym use? Posted: Wednesday Nov. 19, 2008.Info 02:47P Rosalind: Yes, Walter I've decided to use Atlantis and my doctors take it but they say it is a hassle working with them but at least they take it. Waiting to see what President Elect Obama does about our issue Posted: Wednesday Nov. 19, 2008.Info 02:06P Julian:Thank Margaret. i think the gist is if you have high priced monthly, ongoing prescriptions the Oxford amay not be great. i still thin oxford will be better for me Posted: Wednesday Nov. 19, 2008.Info 01:07P Laurie:I've got to get to work, but why would you not choose oxford over atlantis at mediabistro? i didn't look at atlantis, but oxford looks great Posted: Wednesday Nov. 19, 2008.Info 12:56P Katherine:does anyone have a link to dental care providers that are covered? Posted: Wednesday Nov. 19, 2008.Info 12:40P Laurie:maria, if you qualify for mediabistro.com, jump immediately! (to lock in low rates for 12 mos) Posted: Wednesday Nov. 19, 2008.Info 12:25P Maria:Hi There! If I'm a new member how do I get health insurance? Does anyone know? Posted: Wednesday Nov. 19, 2008.Info 12:24P margaret:Julian, he suggested atlantis, but you should call and get advice specific to you Posted: Wednesday Nov. 19, 2008.Info 12:22P laurie:(ass opposed to Laurie) Julian, why not set up a forum on yahoo.com? http://groups.yahoo.com/start
I posted this to another thread, but it may make more sense here. I don't work at least 20 hours every single week now (which is a qualification to get Oxford SP insurance), and who knows what will happen next year. Is anybody else in the same boat?
I'm afraid I might be stuck with FU for now as well. Basically I live in fear of insurance companies, rational or not. Turns out that Oxford has a right to audit your account at any time to see if you're still eligible, and if you're not then deny your claims. I know that this is a worst-case scenario, but if I have some kind of expensive illness or accident, Oxford could, theoretically, at any time make me prove that I have worked at least 20 hours every week. What if I go two weeks without a job? And I have a feeling that many other sole proprietors (writers and editors in particular) are in this same boat. Insurance companies are not exactly known for their lenient "just pay the claim" policies, and in fact have done some amazingly shitty things to get out of paying a claim. I don't know if this is a risk I'm willing to take. November 19, 2008 4:13 PM Anonymous said...
I don't think they can suddenly audit you when you put claims through.. I think you may be being overly worried here? more likely that they can ask for evidence every year when they sign you up again? I think at teigit.com they've never had Oxford intercede... you'd be the first person they'd do that on...? November 19, 2008 4:18 PM Anonymous said...
According to Nathan, Oxford can in fact audit you at any time: "Oxford does have the right to audit your account at any time to verify that you are still eligible and if they ask you to provide documentation that shows you are ineligible, they are within their rights to refund premium and deny claims." I agree this would most likely not happen if I broke my arm, but if I have some seriously expensive medical bills, I'm not so sure. Stories are everywhere about insurance companies just denying claims. They're not exactly the world's most trusted industry. And if they did cancel my coverage, they would have every right to do so. Still scares me too much.
I've requested an answer from FU re FIC's definition of "Facility Only" care. No reply. I plan to seek an answer in writing from them. But do any of you know?
FIC's Summaries of Benefits lists really high deductibles -- even IN-network -- for what they call "facility-only" care, such as treatment at hospitals. If you go to an appointment at your doctor's office, and their office happens to be at a hospital, will that be considered "facility-only"??
Nathan, on Line 7 there is nothing filled in. I don't get a 1099, just a schedule C and C-EZ. Line 12 does give an amount. Is there another number that has to be greater or lesser than that? On C-EZ, Net Profit (line1) is a little less than Gross Receipts (line 3).
The less than 20 hours post seems a bit hysterical - If you are seriously ill then under you're logic you would still be expected to be working 20 hours a week even if hospitalized. That makes no sense. none. So stay with FU/FIC but don't post some illogical canard about oxford. jeez.
I really don't think I'm being "hysterical." I'm just saying that I do not work 20 hours every week and perhaps others also have irregular work hours. This is not uncommon for freelancers. And that Oxford has the right to audit you any time and deny you benefits. This is their policy and was quoted from Nathan. I assume that if you become "extremely ill" and cannot work the minimum 20 hours then perhaps you will go on disability. I don't know how that works.
I suppose FU/FIC could audit me at any time as well. But they do not have this minimum requirement. They require only that you earn $10,000 in six months OR work 20 hours a week.
If my posts aren't helpful to you, feel free to ignore them.
To the "hysterical" poster...to me, that was a perfectly reasonable question which I'm glad you asked. Guys, please let's not insult one another. These are scary times, we are all self-employed and many of us are afraid of anything happening that would disallow us from working. Even for a short time, we could be out in the streets. People's nerves are on edge now but let's not take it out on each other..please?
Helpful would be to call Meadiabistro and seek clarification rather than spouting hypotheticals - If someone threw a cow it could land in my apartment. If you want to stay with FIC then you are free to do so. We all need answers and many of us have worked hard to contact people for these answers. But we are not research librarians - if you have a question try to have it answered then post the answer - is that so unreasonable???
I think this kind of thing is a grey area "judgement" call... I believe teigit.com has never had Oxford ask for further documentation (and I think they've been doing this a lot longer than mediabistro..., also have the 20 hrs requirement?)
That said, as Nathan says I believe Oxford has the right, so, sure they could exercise it...
don't think further research is going to bring an iron clad answer; I think this is one of those gray areas, where you would be theoretically vulnerable, should prevailing practices change? sorry to ramble...
Just to clarify: Oxford does say you must work 20 hours. Every week. I spoke to MB and they told me this. Will they check to make sure you actually do? Probably not, but they have the right to do so. If you submit a lot of claims and are costing them money? Maybe more likely. I just wanted to throw that out there since I believe that many people might not work 20 hours every week.
I have health insurance to be safeguarded against catastrophic illness, not so much regular care, which is why I'm a bit more paranoid/cynical than the next person.
07:15P jerry:laurie, thanks i will check out the blog you mentioned and the one here. Posted: Wednesday Nov. 19, 2008.Info 07:10P margaret:just want to say I really appreciate the folks at upsetfu for doing the blog Posted: Wednesday Nov. 19, 2008.Info 07:07P Laurie:jerry, if you go to the blog at this site, there are lots of comments (and info) as well as the offsite blog at upsetfu.blogspot.com these are huge changes being pushed onto us Posted: Wednesday Nov. 19, 2008.Info 06:56P jerry:used to be in the writers guild and that group insurance was about 15 thou and that was oxford Posted: Wednesday Nov. 19, 2008.Info 06:56P Steven:atlantis 366 per month, no deductible, no coinsurance, and copayments are a lot less Posted: Wednesday Nov. 19, 2008.Info 06:56P Richard:I took FU Posted: Wednesday Nov. 19, 2008.Info 06:55P jerry:i'm now sure who or what to believe at this point. Posted: Wednesday Nov. 19, 2008.Info 06:55P Steven:try ehealthinsurance.com Posted: Wednesday Nov. 19, 2008.Info 06:54P jerry:i jusy discovered this chat and now i'm in a real quandry Posted: Wednesday Nov. 19, 2008.Info 06:54P jerry:i am def not a defender of medical insurance BUT it always goes up AND according to FU the benfits are similar to BCBS and those rates would have gone up even more per month. i just discovered this ch Posted: Wednesday Nov. 19, 2008.Info 06:52P Richard:a Posted: Wednesday Nov. 19, 2008.Info 06:51P Richard:I paid my $455 bill Posted: Wednesday Nov. 19, 2008.Info 06:51P Steven:any comments out there Posted: Wednesday Nov. 19, 2008.Info 06:50P Steven:the new plan of 450 amonth plus an additional 65 makes my plan 515 a month + the new deductible. Im not happy Posted: Wednesday Nov. 19, 2008.Info 06:49P jerry:we were in the equal to the new ppo 1 and its gone up about #200 but as i get it the benefits are about the same as BCBS Posted: Wednesday Nov. 19, 2008.Info 06:49P Steven:thats an additional 780 a year plus the increase in coinsurance. again, this is very steep Posted: Wednesday Nov. 19, 2008.Info 06:48P Laurie:permanent posts at upsetfu.blogspot.com all of this dies shortly Posted: Wednesday Nov. 19, 2008.Info 06:47P Steven:my freelance pos has gone up $65 a month and with a new deductible for the new plan of a $1000, thats kind of steep Posted: Wednesday Nov. 19, 2008.Info 06:47P Laurie:MB OXFORD if you qualify (only neg. is 50 % coinsu. for non-generic meds) FU untested, life/annual maximums, and diagnostic tests have no cap for coinsur Posted: Wednesday Nov. 19, 2008.Info 06:47P jerry:if i'm wrong it would be great if someone can show the benefits gotten under the original plan and the new one to show the differences Posted: Wednesday Nov. 19, 2008.Info 06:46P jerry:as far as i can tell the benefits under the new plan are not that much different from the old plan. the monthly payment is a bit more. we are members as husband and wife Posted: Wednesday Nov. 19, 2008.Info 06:43P Alan:yes, but coinsurance in network is n/a Posted: Wednesday Nov. 19, 2008.Info 06:36P Elena: the least amount is 15% Posted: Wednesday Nov. 19, 2008.Info 06:35P Elena: In addition to the $1000 deductible, you have "co-insurance" costs Posted: Wednesday Nov. 19, 2008.Info 06:35P Elena: Look at the "co-insurance"--that is out of pocket Posted: Wednesday Nov. 19, 2008.Info 06:27P Judith:so, is FIC better than MB OXford - what do you all think? Posted: Wednesday Nov. 19, 2008.Info 06:27P Alan:is there out of pocket for hospital even for the POS plan? where does it say that? Posted: Wednesday Nov. 19, 2008.Info 06:23P Elena: then to finance a new insurance co Posted: Wednesday Nov. 19, 2008.Info 06:23P Elena: i would have rather paid them an increase Posted: Wednesday Nov. 19, 2008.Info 06:23P Elena: the fact is Empire BCBS was much better Posted: Wednesday Nov. 19, 2008.Info 06:22P Elena: what are expenses can you be made to pay? Posted: Wednesday Nov. 19, 2008.Info 06:22P Elena: the max says $4000 for facility alone Posted: Wednesday Nov. 19, 2008.Info 06:22P Barbara:i can't believe those who say it's not a big change---could easily mean $15K or $20K out of pocket for a hosp. stay Posted: Wednesday Nov. 19, 2008.Info 06:21P Alfred: and FIC is a new ins company, don't you want "quality ins" Posted: Wednesday Nov. 19, 2008.Info 06:20P Alfred: the benefits are reduced Posted: Wednesday Nov. 19, 2008.Info 06:13P jerry:again i ask, why all the complaints? its gone up a bit but nothing comared to some other plans. am i missing something here???? Posted: Wednesday Nov. 19, 2008.Info 06:12P Elena: someone needs to create competition for Freelancer's Union Posted: Wednesday Nov. 19, 2008.Info 06:11P Laurie:the hospital; however u may want to discuss with Nathan at media bistro... (read the posts at upset with fu first) Posted: Wednesday Nov. 19, 2008.Info 06:10P Laurie:all MB'ers, at the other blog, one guy is posting that Nathan says Oxford could demand recert. if you're sick and refund premium... another person points out idiocy; you can't work 20 hrs/wk if in Posted: Wednesday Nov. 19, 2008.Info 06:06P Mai:plus 20% co-ins for "x-ray, MRI, CAT scan, EKG, ultrasound, and other services." with no maximum out-of-pocket Posted: Wednesday Nov. 19, 2008.Info 06:05P Elena: for hospitalization Posted: Wednesday Nov. 19, 2008.Info 06:05P Elena: instead of a $750 deductible, it is $1000 plus 15% at best Posted: Wednesday Nov. 19, 2008.Info 06:05P Elena: There is a huge change Posted: Wednesday Nov. 19, 2008.Info 05:56P jerry:i dont understand all the complaints. there;s not that much of a change with the new FU plan???????? am i missing something? Posted: Wednesday Nov. 19, 2008.Info 05:18P Karen:All so frustrating. I made a careful decision to stick w/ FrlncrsUnion coverage just a few months ago, when I had an option to switch. It's too late to pursue the other. I'm stuck! Posted: Wednesday Nov. 19, 2008.Info 04:54P John: you get charged at your current rate if you haven't chosen a new plan yet. sucks for those of us who are forced to downgrade by the rate hike- not even a one month break Posted: Wednesday Nov. 19, 2008.Info 04:46P Laurie:any newbies here please post to upsetfu.blogspot.com; anything of import, as this evaporates Posted: Wednesday Nov. 19, 2008.Info 04:45P Laurie:I reallly think we may be overreacting about the 2/5 million cap; it's terrifying, BUT the hard truth is in NY could bounce straight to the state plan, or another w/o prexisting cond. if no break Posted: Wednesday Nov. 19, 2008.Info 04:44P Matt:Fuck FIC Posted: Wednesday Nov. 19, 2008.Info 04:44P Lliam: off to add this to my list of "what should I do!" Posted: Wednesday Nov. 19, 2008.Info 04:43P Lliam: ahm well, good health to you Posted: Wednesday Nov. 19, 2008.Info 04:42P Lliam: xactly! Posted: Wednesday Nov. 19, 2008.Info 04:42P Rosalind: If its not broke don't fix it Posted: Wednesday Nov. 19, 2008.Info 04:41P Rosalind: Just crazy Posted: Wednesday Nov. 19, 2008.Info 04:41P Rosalind: If they were not going to do better than what they already had why did they change Posted: Wednesday Nov. 19, 2008.Info 04:41P Rosalind: The BCBS had worked fine for me Posted: Wednesday Nov. 19, 2008.Info 04:41P Rosalind: You got that right Posted: Wednesday Nov. 19, 2008.Info 04:41P Rosalind: he he he Posted: Wednesday Nov. 19, 2008.Info 04:41P Lliam: They coulda waited to take over till after Obama cleaned up the mess Posted: Wednesday Nov. 19, 2008.Info 04:40P Rosalind: Just crazy Posted: Wednesday Nov. 19, 2008.Info 04:40P Rosalind: And the $450 pre. Posted: Wednesday Nov. 19, 2008.Info 04:40P Rosalind: FIC want me to pay 15% of that on top of the deductible Posted: Wednesday Nov. 19, 2008.Info 04:40P Lliam: That's decent Posted: Wednesday Nov. 19, 2008.Info 04:40P Rosalind: but I only had to pay that $750 BCBS required Posted: Wednesday Nov. 19, 2008.Info 04:40P Rosalind: But when I actually saw how much they actually charge the carrier Posted: Wednesday Nov. 19, 2008.Info 04:40P Rosalind: it was crazy Posted: Wednesday Nov. 19, 2008.Info 04:40P Lliam: wow. bet you ened up spening a pretty penny anyway Posted: Wednesday Nov. 19, 2008.Info 04:40P Rosalind: It was smoothing sailing Posted: Wednesday Nov. 19, 2008.Info 04:39P Rosalind: The first time I ever used any health insurance in 20 years participating Posted: Wednesday Nov. 19, 2008.Info 04:39P Rosalind: I had surgery this year under BCBS Posted: Wednesday Nov. 19, 2008.Info 04:39P Rosalind: You got that right Posted: Wednesday Nov. 19, 2008.Info 04:39P Rosalind: You are welcome Justin Posted: Wednesday Nov. 19, 2008.Info 04:39P Lliam: I may be better of deduction the payments and setting up a bank account Posted: Wednesday Nov. 19, 2008.Info 04:38P Justin:Thank you Rosalind! Posted: Wednesday Nov. 19, 2008.Info 04:38P Rosalind: I can't afford to take care anyone but me right now Posted: Wednesday Nov. 19, 2008.Info 04:38P Rosalind: Like they want the rich to take care of the poor Posted: Wednesday Nov. 19, 2008.Info 04:38P Rosalind: The healthy are paying for the sick ones Posted: Wednesday Nov. 19, 2008.Info 04:38P Rosalind: yes Posted: Wednesday Nov. 19, 2008.Info 04:37P Lliam: It's like you have to be REAL sick to make this inusrance pay Posted: Wednesday Nov. 19, 2008.Info 04:37P Rosalind: 7370 3 SERVICES-COMPUTER PROGRAMMING, DATA PROCESSING, ETC. Posted: Wednesday Nov. 19, 2008.Info 04:37P Lliam: And then the deductible gets huge Posted: Wednesday Nov. 19, 2008.Info 04:36P Lliam: yea, I'm thinking the same thing Posted: Wednesday Nov. 19, 2008.Info 04:36P Rosalind: I hoping I can keep my dental plan though Posted: Wednesday Nov. 19, 2008.Info 04:36P Justin:anyone know the SIC code for graphic design? Posted: Wednesday Nov. 19, 2008.Info 04:35P Rosalind: My last month will be December Posted: Wednesday Nov. 19, 2008.Info 04:35P Rosalind: You got that right Lliam Posted: Wednesday Nov. 19, 2008.Info 04:35P Lliam: This FIC ins takeover is going to be expenxive for me Posted: Wednesday Nov. 19, 2008.Info 04:35P Rosalind: but maybe you are seeing something I'm not seeing Posted: Wednesday Nov. 19, 2008.Info 04:34P Rosalind: I do not see where they are resticted it to NYS residents Posted: Wednesday Nov. 19, 2008.Info 04:34P Rosalind: Oh Posted: Wednesday Nov. 19, 2008.Info 04:33P David:Like I said, I'm out-of-state, so I don't think I qualify for the open enrollment Posted: Wednesday Nov. 19, 2008.Info 04:33P Rosalind: and fill in all the necessary informatino Posted: Wednesday Nov. 19, 2008.Info 04:33P Rosalind: you can click Go to the open enrollment form Posted: Wednesday Nov. 19, 2008.Info 04:33P Rosalind: Membership Home Posted: Wednesday Nov. 19, 2008.Info 04:33P Rosalind: On the home page Posted: Wednesday Nov. 19, 2008.Info 04:32P Rosalind: then click for open enrollment david Posted: Wednesday Nov. 19, 2008.Info 04:32P Rosalind: At that rate I've paid almost $6,500 dollars Posted: Wednesday Nov. 19, 2008.Info 04:32P David:Ok. I've already looked at individual Anthem plans and they have pretty respectable rates Posted: Wednesday Nov. 19, 2008.Info 04:32P Rosalind: It doesn't make sense for me to pay $450 premium - $1,000 deductible and co-pays Posted: Wednesday Nov. 19, 2008.Info 04:31P Rosalind: Presently, I have BCBS through Freelance but sadly in the beginning of the year I will be transfer to another policies due to the increase in premium and deductibles Posted: Wednesday Nov. 19, 2008.Info 04:30P Rosalind: David shop around Posted: Wednesday Nov. 19, 2008.Info 04:30P David:I have an insurance question. I'm an out-of-state new member (in VA) trying to get insurance coverage started. The GoldenRule freelancers union page is blank Posted: Wednesday Nov. 19, 2008.Info 04:29P Rosalind: Does anyone know
If you are a sole proprietor it is very easy to bill 20 hours to yourself - sole proprrietors can operate at a loss!
Have you received this from FU/FIC: Important: For members enrolled in health insurance, if you have not yet selected your plan for 2009, you will not see a charge for it on this invoice. You will be billed for your new plan on the next invoice after you make your plan selection. If you selected your plan prior to the 11/19 invoice, you will be billed for January coverage (plus any past-due charges). If you select your plan between 11/19 and 12/15, you will be billed for both January and February coverage on the 12/15 invoice. If you select your plan between 12/15 and 12/31, you will be billed for January, February, and March coverage on the 1/15 invoice"
So we are being penalized for thinking about our choices.
and FU/FIC can check your20hours or 10K threshold - when does the threshold kick in? Could they audit you in January? Under your could do anything scenario they could audit you January 2d. That's silly. And You have such trust in FIC abiding by words when they have changed the rules some many times in the last week. best of luck with FIC and your leap of faith.
Deductibles, Coinsurance, and Out-of-Pocket Maximums: A Guide for FIC’s PPO Plans The below information applies to PPO 1, PPO 2, and PPO 3, not to the HD plans. Remember, when you use an in-network provider, your coinsurance and deductibles are applied to the provider’s negotiated, in-network rate, not the “retail” price.
Deductible (in-network): A deductible is the amount you pay out-of-pocket before your insurance starts covering you. There is no deductible for in-network doctor visits. The deductible applies only to facility (hospital) visits, both in- and out-patient. While you accrue toward your facility deductible, you will pay the negotiated rate, not the retail amount, for services. There is also a separate deductible for out-of-network services. Out-of-pocket maximum (in-network): There’s a cap to how much you would ever have to spend on in-network facility (hospital) visits per year. Once your deductible and coinsurance payments reach this amount in a given year, FIC covers 100% of the in-network hospital charges for the rest of that year. Coinsurance (in-network): Coinsurance is the percent you pay (of the negotiated rate) after meeting your deductible; FIC pays the remainder of the allowable expense. For x-rays and imaging, there’s coinsurance and no deductible. For facility (hospital) visits, both in- and out-patient, you first pay the deductible, and after that you pay only coinsurance. There is also a separate coinsurance and deductible for out-of-network expenses. Imaging (in-network): Imaging includes x-ray, MRI, CAT scan, EKG, ultrasound, and other services. It is covered with coinsurance, and there is no deductible. For imaging that takes place during a facility (hospital) visit, the cost is covered as part of the facility visit. The amount you spend toward the imaging coinsurance is not counted toward your out-of-pocket maximum.
I think that it's good news, at least re diagnostic services if you're in a hospital being covered... my god it's complicated how did they possibly think they could transition w/o more explanation... I'm not sure they get it either...
Does anyone understand the HD 5000 plan? If I am reading it right, you pay $5,000 (at negotiated rates?) plus a $225/mo. premium and then everything is free. I'm trying to figure out how that squares with PPO 1 where if you are hospitalized in patient or out-patient, you pay $4,000 plus $445/mo. plus lots of co-pays and co-insurance especially for expensive diagnostic and imaging tests, not to mention lots of co-pays. It says that it's not HSA Compatible--not sure what that means--that they haven't set up a FSA/HSA yet? Because I belong to a great credit union in Chicago (anyone can join) that has an HSA getting 5 1/2% interest and it's tax-free money. They even give you checks, etc. Alliant Credit Union.
I've never even looked at a HD before this moment so I don't know the downside. At least what's the downside compared to Sara's other brilliant PPO offerings? Isn't it actually cheaper? And it doesn't seem like any benefits are lost.
Caroline, if you are posting, can you enlighten me?
An HD (High Deductible) plan doesn't cover anything until the deductible is met, then everything is covered 100%. Personally, I think the HD 5,000 plan is a great deal.
The FIC plans seem okay. It's just the transition from the old POS to the PPO1 where there are major changes in cost and coverage.
I also have been struck by the HD seeming like a very good plan (if FU doesn't go out of business...) I'd love to see a guarantee from the NY Attorney General's office that if we're going to undertake this experiment for everyone we're not liable for the bills FU may default on.
08:36A Nancy:Must add: Freelancers Union not experienced as a company. Dread having togotothem towork out a claim. Amateurs all around. There outta be a law. There will be. Posted: Thursday Nov. 20, 2008.Info08:25A Nancy:Freelancers Union becoming an insurance company is what's wrong withthe present system. Overall--a catastrophe--what are we to do? We're stuck with paying . Totally agree; this is not genillus; it's Posted: Thursday Nov. 20, 2008.Info08:01A walter:Thank you HORROR-WITZ. For the past 10 days I think opf nothing but health insurance. You have made my life miserable. You are miserable. Enjoy your $170 G's per year. Posted: Thursday Nov. 20, 2008.Info06:43A Karen W: This is so distressing - horrible setbacks. If anyone else knows group rates out there please let us know! Posted: Thursday Nov. 20, 2008.Info05:43A Jane:I think this is a really bad deal, shame on you Freelancers Union. I did sign up for it, so it looks like I'm stuck for a little bit. Posted: Thursday Nov. 20, 2008.Info03:50A Michelle: Can anyone here discuss their experience with HSA? Posted: Thursday Nov. 20, 2008.Info03:15A Russell:Obama isn't going to be able to fix health insurance; the problem is simply that it is expensive. Only free markets and time can make it affordable by all. Posted: Thursday Nov. 20, 2008.Info01:24A Robert:A dumb question: If I sign up for a High Deductible plan, are my monthly payments included as part of the deductible? Posted: Thursday Nov. 20, 2008.Info12:19A Daniel:I agree. The new insurance plans have astronomical coinsurance and deductibles. THis is a giant step backward. Posted: Thursday Nov. 20, 2008.Info12:09A anne:Will our Guardian Dental coverage also be changed or elliminated? Posted: Thursday Nov. 20, 2008.InfoThursday Nov. 20, 2008 11:36P Peter:Can anyone recommend a good ENT doc? Posted: Wednesday Nov. 19, 2008.Info10:59P Douglas:Benefits Reduced, payments UP, Coinsurance AND Deductibles. these plans are no way near what the BC/BS plans were. very unhappy! Posted: Wednesday Nov. 19, 2008.Info10:00P David:Am I reading that right? Posted: Wednesday Nov. 19, 2008.Info10:00P David:It seems like the real killer of the new plan is co-insurance. You're stuck paying non-negligible percentages of what could be insanely high medical bills. Posted: Wednesday Nov. 19, 2008.Info09:43P Glen:any one know of editing work? Posted: Wednesday Nov. 19, 2008.Info08:01P william:anyone know where on website to sign up with your primary care physcician? Posted: Wednesday Nov. 19, 2008.Info07:59P Deborah:overhaul
I looked at the HD plan and I think it depends on your status and health - for us, if 2009 goes like 2008, the HD plan would require us to spend over $16K before anything was covered (and we will spend it, what all our Drs actually charge is terrifying), while the PPO2 will only run us about $10K. If something incredibly catastrophic happens and we are both hospitalized, yes, the PPO will be more, but if that happens, coming up with another $8K will be the least of our problems!
FU just posted this on their site on their blog, after the most recent of SH's comments... it is very reassuring in that Edith's interpretation (which would have been ruinous to anyone who was hospitalized), was a bit off. Not to blame her, who the h can figure this out!
Freelancers Union Says: November 19th, 2008 at 10:00 pm A few corrections to comment #18: The facility deductible, coinsurance, and out-of-pocket maximum apply to all services billed by the facility. Diagnostic testing, drugs administered at the facility, and surgeon fees included in that claim will have the out-of-pocket max applied. In-network doctor’s fees billed separately for inpatient care are covered at 100% of the allowable charge, including anesthesiologists. For all in-network services, the claim will reflect a discounted rate negotiated by the network. Additionally, bone density testing is covered at 100% of the allowable charge. For more information, sign in to see newly posted material on My Membership Home or contact Member Services at membership@freelancersunion.org or 800.856.9981.
Alex - it sounds like you are eligible for the plans. A Schedule C reports 1099 income.
The comments about the 20 hours a week are probably poorly phrased on my part - I apologize for any confusion that has ensued.
The rule is that Oxford requires that you be a full-time freelancer, working an average of 20 hours per week. So even if you're over some weeks, under others, if you are working on average 20 hours a week you are considered a full-time freelancer, and then we go into the questions on how you report your income (W-2, 1099, etc).
In reality, this rule has no practical standard to be enforced under - Oxford has no minimum dollar amount of income that you have to earn to be eligible, so they can't use earnings in a year to see if you're making enough money, since $1 a year is enough money as long as you don't make more than .50 on a W-2. And since you're employed by yourselves, "working" has a wide range of defintion - someone I spoke with last night made the point that she might spend 60 hours one week marketing herself for assignments with no income to show for it, and then 10 hours on an assignment the next with a sizable paycheck. In application, this requirement goes along an honor system - Oxford's underwriters can't say you are or aren't working that much on average, only you can.
On the question about auditing, to the original poster, perhaps I misunderstood your original question, but my response is not how I intended it be received.
Oxford, as with any carrier (including FU) has the right contractually to audit your plan at any time, to determine that you are still eligible for these plans. Typically, an audit does not take place unless there is a large claim issue. If, in the course of your audit, that carrier determines that you are no longer eligible for their plans they are within their rights to deny payment of your claim, issue you a refund of overpaid premium, and step aside.
Oxford determines eligibility by your most recently filed taxes - again, for most of you the two pages of your 1040 and the two pages of your Schedule C. So, if you had a tax return for 2007 that showed you as eligible, you could enroll on a plan, and if Oxford had to audit you for a claim, this is how they would base eligibility. Because even if we were 6 months into the year and you had only worked W-2 positions, there is no way to say that you couldn't or wouldn't start again on 1099 and fall back into eligibility.
What I understood your question as being was what would happen at your plans renewal, if your tax filing status had changed and you were not reporting 1099 income on your 2008 return according to the guidelines as you had on your 07, which you used to apply. Oxford typically has not asked freelancers for their latest returns at the time of their renewal - so you would be able to continue paying for the plan, but you would technically be engaging in fraud, since you are no longer eligible for the policy. And Oxford would have the right to deny payment on claims if they did conduct an audit on you and uncovered this as the case.
I hope that cleared some things up for anyone concerned. Apologies again for anyone who has had any trouble getting their questions answered - we'll continue to try to keep up as much as possible.
For mediabistro: Does Oxford have a minimum that you have to make a year? I declared only about $15,000 last year and before applying, I'd like to know if it will be turned down.
It's not about salaries, it's about perks. Every year they give me a $100 gas card, you can't put a price on that.
The Oxford plans have no minimum income requirements - as long as your W-2 income does not go over the income threshold when compared against your gross 1099 income (to calculate - take Line 1 of the Schedule C; W-2 income can't be more than 50% of that amount) you are fine.
Comment from Sara Horowitz posted to the petition signing thread November 20, 2008 9:59 AM Sara Horowitz said... I'm sorry you feel like certain issues haven’t been addressed, despite my efforts to respond to your concerns. In addition to our e-mail communications and information on the Freelancers Union website, you are probably aware that I invited members from this blog to meet with me personally. I asked that you designate a group of people who can come to our office and talk about anything that’s on your mind. I have yet to hear from anyone. As you also undoubtedly know, we have scheduled a series of webinars where all members can have their questions answered. I hope you will join one of them.
November 20, 2008 10:37 AM Anonymous said... We would love to all come to meet with you, as many as could make it at a mutually convenient time--say a Sunday afternoon to maximize people's opportunities to make it? We've posted this all along, and to you, how can a small group speak on the fly for all of us; we don't even know each other... no time to organize or even understand this horribly complicated new model of health insurance... help Sara!
November 20, 2008 11:01 AM Anonymous said... Please Sara, we need official New York State assurances in writing that if you go under we are not responsible for medical bills FU would otherwise have paid
SH on last year's "glitches" which are NOTHING compared to what she's done now...
evil nonprofits Freelancers Union Founder Apologizes For 'Glitches' By Maggie, 4:45 PM on Wed Jan 2 2008, 1,263 views Freelancers Union founder Sara Horowitz wants everyone to calm the hell down please! "Health insurance is so central to a sense of security and I realize that this is making people feel really vulnerable, but if they could just know one thing, it's that they really do have health insurance coverage," she told us when we spoke to her this afternoon about the hue and cry raised by the union's membership over a recent change in their benefits. Passing Damage Control 101 with fairly flying colors, Horowitz copped to mishandling how the details of the union's recent health plan switch were circulated to members. "People are clearly frustrated. We really truly apologize for some of these glitches," she said. "It's really our obligation and for a lot of people, we've failed."
Previously: Freelancers Union Is 'Inconvenient Mess Of An Organization' Says One Member
Billed or not, in possession of an insurance card or not, Horowitz said union members who signed up are covered under the organization's new plan with Empire. Maybe so, but they won't receive insurance cards till the middle of the month and that's got some freelancers concerned. Those who might need proof of coverage before then should head over to the FU's website, where Horowitz has posted a mea culpa and more information.
"We really are desperately learning from this, especially trying to get information to people more quickly," she told us. "A lot of what people are saying is true. I wish our phone wait times were two minutes, that our call system was perfect." Huh! Maybe they picked up some skills from the Viacom boondoggle after all! The FU took about five hours to publicly address member concerns—Viacom took nearly as many days.
9 Discussions Classic view | Expand all Collapse all Start a new discussion Show: Oldest first | Newest first | Most popular 4:48 PM on Wed Jan 2 2008 In Other News... 4:48 PM on Wed Jan 2 2008 Lines like "We really truly apologize" makes us truly, madly, deeply love freelancers. In Other News... Lines like "We really truly apologize" makes us truly,... 5:08 PM on Wed Jan 2 2008 SlimShadenfruede 5:08 PM on Wed Jan 2 2008 Glitches N' Ho's! SlimShadenfruede Glitches N' Ho's! 5:11 PM on Wed Jan 2 2008 Moff 5:11 PM on Wed Jan 2 2008 I have to say that I finally signed up for Freelancers Union coverage this past month, which should have started yesterday (and has, I hope!). There was one hassle, which was that I submitted my original payment electronically, received an error screen, panicked and mailed a check, and then received a phone call telling me that the e-payment had actually gone through. Even that was handled well, though -- the rep I spoke to assured me that my account would be notated so that me check would be torn up and ignored, and while I can't be sure that will happen, it sounded like they were on top of it.
Otherwise, they got back to me within one business day every time I contacted them, and everything else went smoothly. I still wish the insurance were cheaper, but the Colonel pretty much says it all.
Also: Yeah, I do wish they'd bring the fucking comment-previewing back, I'm really happy to see M. Lawson on the masthead, and I don't really understand why Denton needs his name up top and at left (or why the number of posts in the past 24 hours should impress me). Mostly, though: Happy New Year, people! Moff I have to say that I finally signed up for Freelancers... 5:14 PM on Wed Jan 2 2008 Moff 5:14 PM on Wed Jan 2 2008 @moff: See, 'cause one thing I would really have focused on fixing before I changed the other stuff would have been that part where you submit the comment and then you don't know if it will show up in three seconds or 15 minutes or never, or if you need to submit another complainy run-on sentence to make it appear. I would have fixed that. And I still would! Moff @ moff : See, 'cause one thing I would really have... 5:24 PM on Wed Jan 2 2008 Moff 5:24 PM on Wed Jan 2 2008 @moff: Also I would have changed the part where the site crashes my browsers every third or fourth time I click a link or refresh. Glad to see that's back. However, as an indication of my increasing insanity, I also expected UPS to deliver a 2nd-day air package in under three business days and for Northwest Airlines not to screw up five out of six legs of my holiday travel, each in an entirely different way. As each day passes since I quit smoking weed, I begin to remember more and more why I started smoking weed. Moff @ moff : Also I would have changed the part where the... 5:24 PM on Wed Jan 2 2008 Moff 5:24 PM on Wed Jan 2 2008 @moff: I did buy a really cool new coat, though. Moff @ moff : I did buy a really cool new coat, though. 5:30 PM on Wed Jan 2 2008 mathnet 5:30 PM on Wed Jan 2 2008 @moff: HAPPY NEW YEAR!
mathnet @ moff : HAPPY NEW YEAR! 6:02 PM on Wed Jan 2 2008 FOUND ART 6:02 PM on Wed Jan 2 2008 This is very sad for freelancers since they don't really have anywhere else to turn. If my company did this to me, I'd leave. What can a freelancer do? FOUND ART This is very sad for freelancers since they don't really... 6:38 PM on Wed Jan 2 2008 atipofthehat 6:38 PM on Wed Jan 2 2008 Maggie, when you finish fixing healthcare, please shame the world leaders into making peace for everyone.
PS Also, could you reduce our dependence on oil? Thanks! atipofthehat Maggie, when you finish fixing healthcare, please shame... 11:56 AM Got something to say? There are 3 ways to comment:
I just found out that some universitys' alumni associations offer insurance. Apparently Columbia's offers catastrophic health coverage; maybe others offer more. (If you're an alum, visit the Columbia web site's alumni sections.)
I don't want to rain on the I love Nathan parade, but I just looked at the Oxford application and it says, specifically, that you must work a minimum of 20 hours per week, not an average.
Blue Cross of California 'routinely' violated state law when it canceled individual health insurance coverage after policyholders got pregnant or sick, making no attempt to determine whether they did anything to merit such "harsh" treatment, according to a state investigation of practices that appear to be industrywide.
As a result of its unprecedented investigation, the Department of Managed Health Care on Thursday said that it had fined Blue Cross $1 million — an amount immediately criticized by canceled policyholders and consumer advocates as too small to matter to an insurer whose parent company, WellPoint Inc., earned $3.1 billion in profit last year on revenue of $57 billion.
Indianapolis-based WellPoint disputed the findings, saying it acted legally and that some rescissions are necessary to combat fraud.
The state investigation found that Blue Cross used computer programs and a dedicated department to systematically investigate and cancel the policies of pregnant women and the chronically ill regardless of whether they intentionally lied on their applications to cover up preexisting medical conditions — a standard required by state law for canceling individual policies.
Regulators examined 90 randomly selected cases of policy cancellations — out of about 1,000 a year in California — and found violations in each one.
'This looks like 'Rescission Inc.,' ' said Bryan Liang, director of the Institute of Health Law Studies at California Western School of Law in San Diego. 'It's clear if 100% of these individuals had their policies illegally pulled, that means that there's a problem. These are just the tip of the iceberg.'
Stocks down record low since 1993 today. Any wonder we're all upset? Who can afford $445 a month unless you want to live in powdered potatoes. Now they are cutting our credit card limit or revoking our cards and raising interest rate to 32%. Anyone who pays only minimum a month, they are after those people. Very upsetting.
In the "for what it's worth" file, subfile audits for eligibility: When I joined the FU plan a few years ago, I had some fairly complicated eligibility issues and wasn't sure I'd be accepted, but I was. Before I signed up and wrote my first check, I asked what would happen in a future year if I was a still a freelancer but no longer met one or more of the other requirements (industry, income). A real nice guy told me over the phone, "Once you're in, you're in. We don't ask you to keep proving your eligibility each year, and as long as you're still a freelancer, and you pay your bill every month, that's it."
In those days the FU people were so helpful (maybe they still are when you're a new customer?) that I trusted him and didn't try to get this in writing. Has anyone ever seen or heard anything about this issue? If anyone ever has a problem with this, I'd be willing to sign an affidavit as to what Mr. Nice Guy said. I don't know if that would help you, especially if you joined when the rules were different (I know the rules have changed a bit from year to year), but it seems unlikely that FU would live up to its initials and audit you and throw you out -- at least not in the near future. It sounds to me as though they want as many people as possible to make FIC work.
But Oxford? I have no idea. I'd try to get Nathan to give some stats on how often his customers have been audited, how many have been thrown out, etc.
You should also take with a grain of salt what nathan at media bistro says. Is he an insurance broker? Does he earn a commission for each person who signs up? I'd hate to be doing battle with oxford and have to use the excuse that nathan said it was ok.
Did anyone check if yo can ask Oxford directly for the Sole Proprietor plan? If Media-Bostro is a broker, I guess Oxford can offer this same plan directly. Forgive my ignorance on the subject, but, what is the advantage of going with a broker and why did Gawker article wrote: '...but you know people are getting desperate when they start writing things like, "I'm going to check out Mediabistro's insurance plans."'
Just wondering if there is anything I should know about Media-Bistro, they were indeed very friendly and helpful.
Anonymous poster from 2:32 am - we don't track the information about if anybody has ever been audited; it's handled on Oxford's end and goes on without our knowledge unless we're brought in by the member for help.
Speaking generally though, I know that Oxford has not asked our members for tax documentation at their renewals. And since we've never been contacted by anyone saying that Oxford is requesting that information, I'd venture to guess it probably hasn't happened - since as we've said, no insurance carrier is likely to underwrite you unless you have a large claim issue, if I were a freelancer who just had a costly hospital stay and now Oxford was asking me for documentation, I would probably call myself right away to try to figure out what's going on.
That is strictly conjecture of course. We do know that over 95% of the people who have registered with Oxford over the last year and a half are still enrolled with Oxford, for what that's worth.
But I mainly came on to post two more points that people are concerned about that I'd noticed.
First - these plans for sole proprietors are considered group policies. On a New York group policy, pregnancy can not be considered a pre-existing condition. I know there are a few people who are pregnant right now who might be interested in that info.
Second - we've had a few questions from people who are concerned about how they'll know that they're approved for these plans. That one is a bit longer to explain.
Most applications take about 2 - 3 weeks to process, in terms of entering member information into the system of the carrier and generating and mailing out ID cards. With the holidays, it could be even more.
But insurance in New York is guarantee issue - when you submit a completed application with the necessary documentation, you can not be denied your policy for any reason. Generally speaking, unless your situation is more complicated than the comparison of the Schedule C against the 1040, we can usually determine if you are eligible within a few minutes of having your applications in our hands.
Then we will be able to submit for the effective date of the 1st of whichever month you are interested in joining. Even if your applications go beyond that date to process, you will not be uninsured at any point. Oxford will enroll you retroactively to the first of the month and assume responsibility for any expenses you may incur during the small gap where your applications were in processing.
I'm happy to talk with anybody who's concerned about this information - our favorite policy is to remain open; our biggest fear is somebody angrily call us feeling misled or misinformed.
Gawker just likes to make fun of media bistro, I wouldn't worry about that.
As for the eligibility issue, the oxford application does say that you are not guaranteed coverage and that you should not cancel your other policy, just in case. Maybe this is a moot point in new york? Probably worthwhile to contact the insurance company directly. This contradicts what Nathan says above:
The Applicant hereby acknowledges that this Application does not constitute any obligation by Oxford to offer coverage to the Applicant until such Application is accepted, in writing, by the Home Office of Oxford. The Applicant hereby confirms that it will not cancel any current health coverage it may currently have in anticipation that this Application will be accepted by Oxford, and that Oxford shall have no obligation to provide coverage to the Applicant unless this Application is formally accepted, in writing,by the Oxford Home Office.
Ooops - Nathan back again so soon. And slightly hurt, but I accept your concerns.
We are licensed New York Life, Accident and Health insurance agents. We're independent insurance agents, it's a family business going back to the 70's (I'm not part of the family). We are not aligned to any one insurance carrier, our loyalty is to the people who contact our office looking for accurate information.
There is a commission built in to the rate you as a member would pay every month. It's there regardless of if you work through our office or directly with Oxford.
Now with that said - I generally take personal hurt at the insinuation that I, or anyone in our office, would somehow try to beguile or mislead anyone into signing up for a plan that is not right for their needs.
We want you to be as informed as possible before you pursue any option. Earlier this week we sent out notices to countless freelancers, including many on this board, urging them to consider the possibility for locking in to 4th quarter rates which will actually lower our potential commissions, rather than waiting until January 1st to pay $40 a month more for the same plan. Earlier in this posting even, I made a point to mention a benefit I felt had been neglected from conversation, for fear that it might unfairly impact someone if they weren't aware. We've sent out benefit summaries, fielded calls, researched questions, etc. I am not here to smile widely and promise you the world - I'm here to answer your questions honestly from direct experience and knowledge, and I try to make sure you know everything you need to know before you commit to something.
Ultimately the advantage of working with a broker is something I feel is significant. You have legitimate professionals who have spent years of their lives examining this information, you have a neutral third party outside of Oxford to help you with examining your case if you ever had an issue, and in reality there is no added cost to you since you'll pay the same rate for the same benefits if you go directly to Oxford, with no assistance if you do ever run in to an issue with your benefits.
So what happens if we are awaiting Oxford's approval (after signing with MB for December starting date) and we have an accident in December and have not paid FU for December? And then Oxford turns our application down? Nathan, if you can answer this, much appreciated.
I don't think anybody is out to insult you nanthan. i'm sure you're a nice fellow. Can you address the discrepancy between what you say about not getting turned down for oxford coverage and what it says in the application?
To add to Robert question - I would like to know if it is possible to have double insurance in December. It would be cheaper to lock December rates with Oxford, while still having BC/BS, so we have no risk of staying with no insurance. I do have some important tests in December and I want to make sure that if I'm covered with 2 health plans at the same time, they will not try to throw the claim at each-other and I will be "uncovered".
Another question - I got the summary of benefits from Oxford, and I do not see any mention of X-Ray and imaging tests i'm particualy interested in ultrasounds nuchal translucency and Amniocentesis are these fully covered if done in-network?
I don't know Nathan, or mediabistro, but I appreciate his honesty and commitment to sharing information with FU members as well as transparency as regards his work as an insurance agent. While he does receive a commission, keep in mind that ALL insurance providers, including FU/FIC take some fee/percentage off of the premiums that we pay. Not surprisingly, this is how insurance agents make a living.
The thing to keep in mind is that there is no guarantee that the insurance agent one uses is diligent and knowledgeable about the particular concerns of self-insurers, particuarly independent workers. Some, like me, don't qualify for mediabistro plans because I don't have the right ratio of W2/1099 income. A good insurance broker will help to explain that, and through a combination of asking questions about my needs and financail resources, and their knowledge of several lan options can help me make a good decision. As independent workers we don't have a Human Resource person to help us with this, or an annual visit from an insurer like BCBS or Oxford to answer our questions and counsel us. As many have noted in our complaints, we don't get these services from FU, and we need to question WHY and WHY NOT incorporate this issue in to their education and advocacy efforts.
In FU's favor, they support independent workers such as temps, part-time unbenefited workers, and folks that work consistently in filed that traditionally do not offer benefits, even as they cover taxes for those employees. We do not pay a higher rate for SS, or the unincorporated business tax, but remain without benefits. We're part of the 30% of Americans that are working without employers covering us or our dependents.
All that to say that we all do not have the same options, and while FU has FUpped, we need to work together to make sure that we all do the best we can as we move forward in search of affordable health care. I stress health care because the real issue here isn't how much we pay for our premiums, but what the costs are for actually getting the care we need and ensuring that we have the best insurance to cover those costs.
In ending, I'd like to say that I think Nathan is doing an admirable job of steeping into the fray and helping out, and I won't begrudge him the commisions that he may make. There is a price to pay for good and knowledgable help.
(We might want to prod Sara on that "good and knowledgeable help" thing, by the way."
I don't think anybody is saying that Nathan doesn't deserve to earn a commission. He clearly does work hard. But like everybody else who works on commission, be they car salesmen or stock brokers, you need to go in with open eyes.
Was FU honest and open when they signed up poor pregnant Mirit and Yoav only three weeks ago?
I an glad Nathan is an insurance broker. At least then he knows what he is talking about. The people manning the phones at FU member services have no idea what they are talking about and have told me incorrect information regarding coverage.
I choose the person who makes a living from Insurance versus the one who is in the customer service business.
An awkward Nathan - didn't mean to sound upset at anyone, perhaps just went a tad on the defensive!
But Robert,
With guarantee issue a completed application can not be denied for any reason. There's no sort of medical examination; your age, gender, etc play no part in your eligibility. It's all based off your tax filing status - if your tax return shows you as eligible (I've made a few posts in the past to explain how to determine eligibility in most cases) you can not be denied the policy.
So generally, unless we have a members most profound assurances that they are going to get us the missing piece of the puzzle that will show that they are actually eligible when what they've provided to date does not show that, and we must submit an application in order to act as a placeholder to preserve your desired effective date, it never comes to the point where an ineligible person is submitted to Oxford to be reviewed and then denied. Because within minutes of having your completed application in hand we can look at the lines of your tax return to confirm if you are eligible. If you are eligible, you can not be denied, even if you're 90 years old and smoke five packs a day.
In regards to what would happen if you registered for a plan for December 1st, and your application was not finished with processing until December 3rd, but you were rushed to the hospital on December 2nd - when Oxford completes processing your application you will be enrolled retroactively to December 1st. So, you were insured on December 2nd, even if the processing was after your initial date of service. Claims would be submitted retroactively, and presuming all processes as it should Oxford will handle your claim as though you rushed into the hospital with your ID card in hand on your initial date of service.
Now - the boilerplate on Oxford's applications. The formal acceptance lines refer to the processing time that the applications go through - when an application is received it goes through underwriting in accordance to NY law to determine an individuals eligibility; when this is confirmed and the enrollment is processed a formal welcome letter goes out. But again - eligibility is guarantee issue based on your tax filing status. Nobody at Oxford can receive an application from someone reporting their income in a manner that makes them eligible and for any other reason refuse them the policy.
I hope that helped to clear things up.
Adding on to the replies thta have been posted since I started typing!
Double-insuring is possible - it will almost certainly cause at least some back and forth between the insurers to determine who is going to be the primary payor on a claim, but it's an option.
There are lines for laboratory services and radiology services on the benefit summaries, and those would probably correlate to what you're asking about. If you have the specific CPT codes that your provider plans to bill under it's possible to confirm more specifically what the procedure is considered, but the name of the test probably won't go very far.
anonymous, I am in absolute agreement, which is why I applaud Nathan for being transparent about his status as a broker--and that it is his benefit to have more customers, and to keep them, which means he might be more invested in making sure they leave with a policy that they are happy with.
Some folks HAVE indeed made it seem that they shouldn't trust insurance brokers--my argument is CHOOSE WISELY. At the end of the day, though, the only person who knows my best interests is ME. We need to do our own due diligence, or have someone trustworthy do so on our behalf.
The fact that we haven't had our eyes open is why FU has been able to blindside us twice within the last year. The freelance life is hard, and I know personally why we can't always be on top of things, but that's why we should push FU to change, whether we stay on the FIC plans or not. While our eyes are open, let's make a difference. What if we had continued to push for member oversight last year? To push for a member advisory board? Could they have sprung this on us at the last minute? Would they have at least done some of the commonsense things we have asked for, like extended hours (both early and late) to answer questions; clear comparison charts; transparency about the leadership of both FU and FIC and their viability?
There has been a certain amount of smack talked about Sara and FU because they, too, make a commission on their sales, or because of their decision to open FIC. But that's not the real issue--the real issue is that FU/FIC does not have the capacity to work with members and doesn;t undersatnd the real, on the ground issues that we are currently facing. That can and should be addressed.
I am not eligible for MB. So, I am pretty stuck with FU (angry as hell but stuck nonetheless). Given that FU is unwilling/unable to negotiate with BC/BS, and all the plans they offered suck, I was wondering whether we can press FIC and their actuarial pukes to price out a truly comparable plan to BC/BS POS. Call it FIC POS or something. It would likely be even more expensive than the PPO1 but I would be willing to pay a little extra for the peace of mind and put an end to the agony of past few days.
okay, response I just got from FU.... now trying to also make sure outpatient surgery has that maximum out of pocket annual cap... my brain is so hazy about all of this...
We apologize for the confusion. Yes, when diagnostic imaging is done as part of a hospital stay, it IS subject to the annual out of pocket maximum.
Please contact us if you have any further questions.
Member Services Freelancers Union Tel: 800-856-9981 Fax: 877-707-3576 Email: membership@freelancersunion.org www.FreelancersUnion.org
Nathan and his staff have treated me like a family member through this ordeal. I imagine that they are very overworked right now and are still taking as much time as we need to answer questions. So what if they make commission? It's a business, they should! Thank you for being so thorough.
I do think one of the biggest holes in the new ppo might be if there is no annual maximum out of pocket cap for outpatient surgery. It's on the second page, and doesn't look promising! That would be a huge exposure.
That's an answer I think we all need, clearly... (try parsing that recent definition addition at FU, it still isn't clear... at all..)
jeez, people. don't get your britches in a bunch. nobody is saying nathan should work for free. he makes money for every person he signs up. do with that information what you will. and my family doesn't make any money off of hugs.
Hello Freelancers, Wow, I have gotten a nuber of calls with people who had questions, but I was not aware of the level of panic. In the interest of full disclosure, I am an licesned independent insurance agent and the Reccommend Benefit Provider for the Manhattan Chamber of Commerce. I was invited to this blog to help provide answers & alternative to people who must renew their health insurance on 1/1/09. The Manhattan Chamber offers 8 Oxford Plans & 6 Atantis plans to Sole Proprietors . We too have experienced a 17% increase, but decided to continue to offer all of our options without any reduction in benefits. 2009 pricing for both Oxford & Atlantis in now availalbe on my website. I found everyone's comments informative & useful & stand ready to assist people during this tough renewal period.
Sara Horowitz, FU's Founder & Executive Director (and now, conveniently, President & CEO of the new Freelancers Insurance Company) was on the Brian Lehrer show this morning (unfortunately Brian himself was off today) discussing the topic of Freelancer security and I was not the only one to notice and point out the hypocrisy of it, considering how Sara and FU have just made many of us freelancers much less secure for 2009...
My comments on the WNYC website can be found here: LDNY from 11201 ( http://tinyurl.com/6zs92s ) and there are comments on Sara's own Blog (her posts feebly attempt to explain and excuse this horrible thing that they have done to their members) on the FU website: https://be.freelancersunion.org/blog/ -- if you feel as strongly as I do, please leave your comments on those sites, as well as here.
So Oxford just released the Manhattan Chamber of Commerce rates for our sole prop health plan renewal. The new rates for the 8 plans are valid from 1/1/09 to 12/31/09. The increase is painful at 17% which is on to of the NYS DOI approved 115% premium we pay being an association plan. You can find the rates on my website www.pscinsurance.com. We offer a full range of Oxford offerings including Freedom POS, EPO and Cost Share options as well as similar choices in the more cost effective Liberty Network. We also have both refferal & non-referral choices.
We did not cut our benefits & preferred to allow our members to change their own coverage based on their individual needs. This year, we added 6 Atlantis plans as cost effective alternatives for certain clients. Younger clients looking to establish new relationships with Atlantis Drs do well with Atlantis. People looking to use the plan strickly on an out of network basis are destine for disappointment. They also have 5 Atlantis Medical Group Facilities that offer all services at no co-pay.
Mediabistro - a for profit - got bought by jupitermedia for $23milion- jupitermedia has some major losses this year - http://finance.google.com/finance?q=jupm
They are going to cut back on operations etc. What will happen if they stop offering their plans? where would we go?
"Our Online Media division continues to be impacted by the economy, which has put pressure on our advertising and job board sales. We have, however, made progress in reducing operating expenses, specifically with our costs of sales and general and administrative expenses."
Whoever heard bad things about Oxford--I had great experiences with them, largely once I discovered that many Col. Presbyterian md's participated (I think they actually paid them better than some of the other mds; a "deal" was negotiated, I believe someone told me) anyway they were/are great mds, check for who they have at 10032 zip and if it has the col. presb. switchboard phone # (305) or such (then, you can further often schedule these guys at the e. 60th office; but at least you immediately know they're part of col. presb.)
I am looking into getting the BC/BS HMO through healthyNY and I am trying to understand the differences between the HMO and The Oxford Exclusive Metro. Is this plan (HMO) not recommended? I know HMOs are considered to be inferior plans, but since I do want continuation with BC/BS I would rather take this plan than the Oxford one. Can someone point me to some cons and pros to help me understand better the HMO vs. the Oxford Exclusive Metro? They are both only In-Network plans... Anything I should know before I make a decision either way. Thanks!
If you had our insurance through Freelancers Union (or any insurance in the past 12 months), you cannot get Healthy New York. That's what I have been told by them...or else everyone would do it, it's so cheap! If anyone knows differently, please post.
We had a long talk with them and they say we might be able to get it since FU is not offering the same plan anymore. The woman we spoke with was very optimistic about FU switch considered as a termination of an insurance. It is cheaper, and worth trying to apply. But is it a good plan?
I had asked this on another thread but didn't get any response -- on the FU HD option - the one with a 5,000 deductible, it seems the out of network benefit is 50% co-pay but no cap -- if I understand this correctly, if you are really ill and need specialized care out of network, you will have to pay half of all your costs -- this could totally bankrupt someone. Am I reading this correctly?
I think you are, alas... it's a good point, but I guess, hopefully, you can find a good bcbs specialist? the other problem seems to be 30% coinsurance on pres. drugs?
Healthy NY is a great plan, and while not cheap at about $300 a month for Oxford in Jan 29, it's better than Cobra prices, and the plan covers a lot more than what FU will. If you qualify, it's a great option and yes, they will accept you, even if you were on the FU plans, if you meet the qualifications. See the web site for more info on plans and coverage. Google Healthy NY for address. I would encourage applying if you meet the income requirements. I heard back within a week.
FOR EVERYONE CONSIDERING MEDIABISTRO or OXFORD PLANS:
I just got off the phone with Total Capital Planning, which is the outfit that handles sole proprietor insurance for MediaBistro.
I will not be going with the Oxford plan, even though I want to because I will not be able to pass an Oxford audit if they conduct one. Here's why: they will only cover freelancers who work 20 hours per week or more. Even though I work more than 20 hours per week, I do not *bill* 20 hours per week, and so I have no auditable proof that I'm eligible for Oxford. I could start documenting my time this year, but that wouldn't cover me for last year, when I had no idea I'd need such records.
So even though I made over 60 grand last year, Oxford won't consider me part time employed because I can't show my billing as such. Thought I'd share this in case it helps anyone else.
To the last poster: I have my own business which is cash (some checks) and also would not be able to prove anything except by getting letters from my clients. Can't you do the same?
I think the MB Oxford 20 hour minimum is a total bummer. I would have chosen that plan, but it seems to me that you're giving them a blanket out if they decide they want to cancel your insurance. If I need insurance because I'm sick the last thing I want to do is have to prove to Oxford that they shouldn't have canceled my policy. The whole thing seems fishy to me, especially since Nathan says one thing on this board (you only have to work an average) and then other people talk to him directly and get another story.
Edit: Poster from 9:24 am. This is Nathan - the guy who's been posting all through here. I tracked down who gave you that information from our office - and I'm sorry about the confusion. We've had to pull in people who generally specialize with small business insurance to help with fielding all the calls, and while what they told you would be correct if you were an employee of a small business, for a sole proprietor there is no way to determine your eligibility in an audit other than your most recently filed taxes. I've gone over the guidelines some in previous posts, but if you'd like to call back at 212-879-0122 and ask for me specifically. I'll try to run through eligibility with you very quickly. And to 9:47 - I'm sorry if I've seemed inconsistent in my replies to you, but it's very hard to make a blanket catchall response to hundreds of different people with different situations, since no two are going to be the same.
And back to the original post. Hate to sound salesy in any form of the word, but as a reminder, anybody who wants to be able to lock in with the 4Q08 rates would need to have applications in our office by tomorrow. Obviously if you're not ready to make a decision yet there are always effective dates for the 1st of every month, but the premium will be going up a bit. Since we have started receiving applications since Friday I'm just wondering - does anyone on this board know definitively if you are able to terminate from the Freelancer's Union and get a refund for your premium?
And just to address a few points since there seems to be some more discourse:
-These plans are not contingent on the success of Mediabistro. They are contracts between Oxford and the specific member; so even if Mediabistro were to close tomorrow nobody's policy would be impacted in any way.
-Healthy NY is a state aid program mandated by New York to be offered by all insurance carriers in NY that market HMO products, which is almost all of them. If you meet the income and eligibility guidelines, the plans offer fairly decent coverage - co-payments for doctor/hospital/lab services, access to largely the same network as conventional group policies, etc. But Healthy NY brings the premium down from other insurance plans by virtue of not being required to provide some of the mandated benefits that group plans must offer. Things like chiropractic care, mental health coverage, and physical therapy are just a few of the benefits that are mandated to some level in NY, but are not covered, or only covered on a more limited basis on Healthy NY. The biggest limitation though, is prescriptions. The richest prescription benefit you can have with Healthy NY has a $3,000 maximum benefit per year. The plans also require referrals from your primary care physician to see a specialist, which is not a feature of any of these Oxford plans for sole proprietors.
I'm officially overwhelmed by this decision. And the whole act now or you're going to pay more later is not helping! I'[m starting to get a bad vibe from MB. I do work at least 20 hours a week, but what happens if I suddenly don't? Can any of us guarantee our work with continue unabated for a full year? We are under obligation to tell oxford if our cirucmstances change, and then what? We have to find a new policy?
Healthy NY HMO has an annual recertification process and you have to requalify each year. You will loose your coverage if you don't meet their eligibility requirements again.
It sounds like some of us are concerned/confused with the 20 hour minimum. Can you get something in writing from Oxford that says we will not have to provide any information other than a tax return if they audit us? I know that would put my mind somewhat at ease. You could email it to the administrator of this site and then he/she could post it and we could print it out.
10:09 - I apologize; no pressure is intended, there will be no benefit difference between starting on December 1st versus January 1st, only a difference in price. As I've said before, I really don't want to do anything but make sure that everyone has all the information possible available to be comfortable with their decision. To return to the 20 hours question - this is a copy paste from an 11/20 comment I left at 10:10 am:
"The rule is that Oxford requires that you be a full-time freelancer, working an average of 20 hours per week. So even if you're over some weeks, under others, if you are working on average 20 hours a week you are considered a full-time freelancer, and then we go into the questions on how you report your income (W-2, 1099, etc).
In reality, this rule has no practical standard to be enforced under - Oxford has no minimum dollar amount of income that you have to earn to be eligible, so they can't use earnings in a year to see if you're making enough money, since $1 a year is enough money as long as you don't make more than .50 on a W-2. And since you're employed by yourselves, "working" has a wide range of defintion - someone I spoke with last night made the point that she might spend 60 hours one week marketing herself for assignments with no income to show for it, and then 10 hours on an assignment the next with a sizable paycheck. In application, this requirement goes along an honor system - Oxford's underwriters can't say you are or aren't working that much on average, only you can."
I'm not sure if this answeres your question, and I believe I may need to step aside from this blog for a while - I may be spreading more confusion than intended by posting here answers to specific hypothetical situations where there can really be minute differences that impact the answers.
While I'm happy to help with any questions, it's probably best that you contact our office at 212-879-0122 or e-mail me directly at nathan@myhealthplans.com and I'll do my best to help answer your questions, specifically.
Re the W-2 vs. 1099 issue, Oxford's policy is sadly behind the Times and it's unfortunate MediaBistro doesn't seem to realize this either. There are a growing number of places that require you to be paid on a w-2, even as a part-time freelancer. My percentage of w-2 vs. 1099 has been growing and is now over 50 percent, even though i don't recieve health benefits from the places i get paid with w-2's. Nor, because of this 50 percent policy, am I eligible for Oxford. So much for Media Bistro's freelancer advocacy.
To Nathan: For those of us who didn't pay FU for December and joined Oxford through you starting December 1st, what happens if we have a medical emergency from Dec 1st until we get our official cards or numbers? What would we tell the dr or ER? Who do they call?
I am the person who posted the 9:24 comment about Oxford's 20 hour per week requirement.
I am waiting for additional info from Nathan @ Total Capital Planning to work this out, so I encourage EVERYONE who is considering making the change to MediaBistro/Oxford to make their decision only after speaking with a rep at Total Capital Planning. Don't rely on the blog as everyone's situation is unique.
Also: I just got off the phone with Freelancers Union regarding refunds. If you are planning to switch to another insurance plan in December, you can get a refund of your December FU insurance premium AS LONG AS YOU NOTIFY FREELANCERS UNION BY NOVEMBER 30 that you are terminating coverage. The FU rep advised me that the procedure to terminate coverage and get the refund is:
Send an email to benefits@freelancersunion.org stating:
-your name -your member number -advise them that your are terminating coverage as of December 1 -provide the reason for termination -advise that you are requesting a refund of the December 2008 premium
Of course you should stay on top of FU to make sure the $ comes through. Best of luck, all.
FYI: I work with a number of members from the freelancers association, helping them secure health insurance. I have a number of products available for sole props. We work with many associations and self employed individuals. Please give me a call at 1-800-427-5358 ext 172, or send me an e-mail at steveg@nysbg.com. Or you can contact my assistant Cheryl at 1-800-427-5358 ext 105 or e-mail Cherylk@nysbg.com. Thanks.
For all of those concerned about qualifying for health care coverage with inconsistent hours, minimum income or future workload, you may want to consider changing your tax filing status? If you become an S-corp. you qualify for insurance based upon your K-1 income which could be negative? It’s a “pass-through” income tax status so your Federal or city rate will not change. Still, it a major restructuring & requires sound business planning, advice & long term thought. A few pros: We NOW have an employer based health care system. It give you access to Oxford & other carriers based on your corporate status rather than you annual income or billable hours? If you have a spouse or partner that you work with, an S-corp. moves you into the small group market & out of the Sole Proprietor heath care dilemma? Retirement Age: If you have 10 year or more to be eligible for Medicare, consider taking more control? Our health care system is due for an over haul. but where is it on the new administrations crisis list? If you were both an individual/ sole proprietor as well as a small business could that create more options for you while we wait for the politicians to get to our challenges. Corporate status provides a level of insulation between you and your business. As a sole Prop, “you are the business” and as an S-corp. you can separate your personal ownership & liability from what you do for a living A few cons: Cost of establishing your business: The web, your CPA or Attorney can all help you establish an S-Corp or LLC. It’s generally in the $200 to $1000 range depending on your level of support. Tax Returns: Your business must file its own tax return! It costs an extra $100 for corporate tax filing fee, plus the prep cost of the return which is done in conjunction with your personal return. Final Comments: It extra work & costs a bit more money to shift from a sole prop to a one person business. There are other issues too, but too keep it to the point, the merits truly work for an increasing number of growing NY businesses who need the flexibility that an S-Corp or LLC can offer. If you are a viable business in it for the long haul then make the investment in yourself & develop the trademark you created. My view is certainly biased. I want people to have access to any& all health insurance options available to their peers. Telling people they don’t qualify for coverage because they don’t have the right forms is maddening. Other alternatives for Sole Props to the FU Empire, Chamber Oxford, Chamber Atlantis and MB plans are the LIA plans. For Sole props they have Perfect Health HSA, HIP & a think GHI offering which has been rebranded. Here is there link & I would be happy to assist you in investigating this option based on your request. http://www.liahealthalliance.com/ent_rates.asp
It would be great if someone could skim through posts scattered here and on FU site and add to this list so options are in one place under FIC Alternatives. Julian’s first post on top has some links.
In addition to posting other links you've seen on the blogs, maybe some of you have come up with other individual plans or know of brokers who you like and have had a good experience with. Please add them there.
PLANS:
SEEMS LIKE EMPIRE DIRECT POS IS ALIVE: http://www.empireblue.com/wps/portal/ehpemployer?content_path=employer/noapplication/f4/s8/t0/pw_ad067540.htm&rootLevel=3&label=Benefit%20Summaries
BC/BS AND LOTS OF OTHERS: http://www.individual-health-plans.com/empire.htm
OXFORD PLANS SIMILAR TO MEDIA BISTRO: http://www.nysbg.com/images/oxford/oxfordforms.html
MANHATTAN CHAMBER OF COMMERCE PRICEY, BUT LOTS OF OXFORD PLANS—INCLUDING OXFORD FREEDOM PLANS WHICH I’VE HEARD ARE BETTER THAN LIBERTY FOR WIDEST CHOICE OF DOCTORS AND HOSPITALS: (see Eric's post above) http://www.pscinsurance.com
OTHERS WE KNOW: http://www.mediabistro.com/insurance/download/mediabistro-crosscarriercomp3q08.pdf http://www.nyhealthinsurer.com/healthy_new_york/ http://www.nyc.gov/html/hra/downloads/pdf/OCHIA_insurance_plans.pdf http://www.ins.state.ny.us/chealth.htm http://www.liahealthalliance.com/enterprise.htm
To Nathan: I posted a question yesterday and didn't receive a reply. Could you tell me what happens if we need medical care between Dec. 1st and when we receive our Oxford card or numbers? I dropped FU and want to know that I would be seen with no card in my hand. Thank you.
Note from Carolyn: I started this comment on Friday as a comment on the "Petition" post -- I should have posted it here instead. Then I stopped in the middle because Sara Horowitz was on WNYC, and I didn't have a chance to pick up again until now. I like to finish what I start, so I've returned here today.
I'd also like to add that I may not be able to post very often in the future. I've spent so much time on all of this in the past two weeks -- although for the past several days I've been doing more "off blog" rather than "on blog" -- and I have to catch up on other aspects of my life. With all the hundreds of comments now posted both here and on Sara's blog, I need to be able to focus on the info that pertains to my own situation, as well as the comments from people I think I might be able to help. But neither this blog nor Sara's is organized in a way that makes that easy, and, as important as my health insurance is to me, I just can't keep devoting so much time to blogging.
Also, while I think we needed a place to express our anger and outrage in the early days of this blog, I'm a little disappointed that so many people are still venting so much of the time. I really wonder if there's anything new to say on the outrage front, but I'm sure there's a lot left to say on the practical info front. (Having just said that, I realize that a lot of the anger and outrage may be coming from people who are new to the blog, and I really do sympathize with them.)
Finally, I'm discouraged by my personal situation, and it looks as though none of the alternative plans will work very well for me, except possibly a sole proprietor Healthnet HMO plan that I learned about through an insurance agent. I haven't posted info about that plan or that agent because it looks likely that the inpatient hospital coverage is in some respects even worse than the coverage in PPO 1, so it probably doesn't have the safety net that we're looking for. But if I find that the hospital coverage is OK after all, I'll be sure to let you all know about the plan because I think it's a better plan than PPO 1 in many respects, even though the cost is $517 a month.
It's likely that I'll end up enrolling in PPO 1 in early December to ensure that I receive an invoice for Jan-Feb coverage by Dec 15 -- for tax purposes, I want to pay for that coverage before the end of the year. But I'll remain on the lookout for other plans that might meet my needs better and still be relatively affordable.
Good luck to everyone!
And here at last is the comment from last Friday, for what it's worth:
BE SURE TO DO ALL YOUR HOMEWORK BEFORE SIGNING UP FOR MEDIA BISTRO'S OXFORD PLAN (OR ANY OTHER PLAN)
I know that Nathan's a great guy, and that he's even received at least one marriage proposal somewhere on this blog, but I urge everyone who's planning to enroll in MB's Oxford Exclusive Plan Metro #2 ("the Oxford plan") to look before you leap. Maybe you're not concerned about keeping your current doctors, or maybe you've called all of their offices and are confident that they'll accept the Oxford Liberty network, but if that's not quite true, please read on.
While waiting to find out if I was eligible for the plan, I decided to do a little research on the Liberty Network. And as a result of my research, the Oxford plan looked far less attractive to me.
Before I get too far into my own situation, I want to add that I think the Oxford plan can work very well for some people. A good friend who is a real estate agent and independent healthcare consultant -- and who is neither an FU member nor an MB member -- switched to the Oxford plan, which she obtained through an independent insurance agent, earlier this year. She made the change because the plan was more affordable than her previous plan and was accepted by all her doctors in Manhattan (or at least all the doctors she really cared about). And she's been happy with the plan. And I know that some people here have said there are great doctors at Columbia Presbyterian who participate in the Network (but that part of town isn't easily accessible to me).
In my case, my research started with the Internet. My doctors are all NYU-affiliated. While their practices don't like to post anything about insurance plans, their faculty bios on the NYU Medical Center site list the plans they accept -- and for all but one doctor, "Oxford" was listed. I'd used these bios when I was looking for doctors under HIP and Empire, and they were generally pretty accurate, so at that point, I was as gung-ho about signing up for Oxford as anyone who has been posting comments here.
But when I followed up a few days later with phone calls to my doctors' offices, my bubble burst. My internist, gynecologist and gastroenterologist are all in the same large group practice in Murray Hill -- and while not all the doctors in the practice accept exactly the same insurance plans accepted by the others, no one in the practice now accepts the Liberty network. According to the secretary of one of the doctors, there had apparently been problems with paying some of the doctors in the practice, so now no one can accept Liberty. They all accept the Oxford Freedom network, though, and also Healthnet, the other plan I was researching at the same time.
After speaking with my doctors' offices, I happened to speak informally with a couple of people who knew people who had had problems with the Liberty network. So, if you already have doctors you like who are in the network, that's great. But you might have doctors who don't accept the plan. And if you need to find new doctors, you might have a much harder time than you had under Empire and even under HIP.
Nathan one last time on Steve's question - sorry for the delay, but this is probably going to be the last time I check this board in the near future and you'd be better served by contacting our office directly at 212-879-0122:
If you submit an application this late in the month for a 12/1 effective date, in all likelihood the application is still going to be in processing on December 1st. But when everything is processed, Oxford will enroll you retroactively to your initial effective date, and will assume any responsibility for medical care you had in the span while your applications were in processing. You may need to ask your provider to defer billing for a few days until you appear in the system and can provide them with an ID number, but at that point they will be able to submit their claims as though you walked in to their office with an ID card on the initial date of service.
Carolyn - we've spoken in the past and based on what you've told me, you're eligible for the plans for freelancers on Mediabistro. If your doctors do not correlate to the Liberty network which most of the plans use it may not be the best option for you, but you did sound eligible from our conversation.
And just to nitpick - the Oxford Liberty network, even as a subset of the Oxford Freedom network, is still larger in terms of sheer volume than the HIP network.
to person above about Columbia Presby. md's in Oxford's Liberty plans... remember, that while id'ing them by typing in 10032, you will see that several also participate at the satellite office on E. 60th (at Madison) (re your issue of going up to col. presby.)
If you missed out on mediabistro.com deadline of yesterday for 2008 rates, you still have till 2pm on 12/1 for the Oxfords insurance at 2008 rates over at Healthpass. Good luck all. Lets hurt them by finding alternatives. http://www.healthpass.com/hp.soleproprietor.htm
I am unhappy with the new freelancer options too. I got a much better deal thru an insurance broker: Anthony Cancela 908-756-5126 http://www.cibllc.com/ anthony@cibins.com He works with NJ,NY and CT. He really knows his stuff!
I just called BCBS to get quote on POS for a single coverage. It is close to $1400 per month. There are enough unhappy FU people here so why don't we form out own group the upset FU group and go to Empire and negotiate a plan? There is enough manpower and talent to do this? Instead of sitting her and blogging let's take some action. If anyone is interested I will write back and provide my email address. I am serious about this
David and Stan, Excellent idea. This is urgent, is there a lawyer reading this, an ins. organizer? Can you both post phones or emails? Maybe a group meeting this weekend somewhere midtown? In this economy, maybe Empire would expedite.
The Freelancers new phone system is totally dysfunctional, as is the online and phone billing system and current website. The Blue Card doctors could drop out en masse as soon as FIC starts. Not to mention, if they're not paid.
A number of people have been posting info about how to contact the NYS Department of Insurance (which approved FIC) as well as the various foundations that funded FIC. I think it's great that some of you are doing that, and I applaud you.
However, since I have a limited amount of time to make phone calls, send e-mails and write and fax letters, I decided to work on the theory that people don't like to admit that they've made mistakes and that their due diligence wasn't so diligent after all. So I've been trying to get through to those with clout who were NOT involved in the formation and approval of FIC and its plans.
I've been contacting some city and state legislators, including my own, and I wrote a long letter to the Healthcare Industry Taskforce of Andrew Cuomo's office. (http://www.oag.state.ny.us/bureaus/health_care/HIT/about.html) As far as I could tell, there's no way to reach them via Internet, so I faxed the letter. I wanted to bring the whole FU/FIC mess to the attention of the taskforce, but if you want to make a very specific complaint, Cuomo's office also has a healthcare consumer complaint form that you can fill out online.
I forgot to mention in the previous post that I've already heard from one legislator's office that his/her healthcare issues person is looking at the material I sent.
I encourage everyone who has time to contact their legislators and selected state officials.
This is not so much a alternative as it is advice to help some people decide what to do; stay with FUI or leave.
I compared my last years costs and put them on a apreadsheet. I then took the PPO #1, PPO#2 and High Deduct $5K plans for 2009 and applied them to my speadsheet as if I had each of these plans last year to see what my bottom line cost would have been.
I was shocked to see that, if I only went for check ups and the basics I would be okay with PPO #2 BUT if something bad happened and I had to go to the hospital or have tests run...I'd be paying out of my nose with all the 20% copays, plus the $2K deduct, not to mention the UP TO $24K maxiumum payout cap!
PPO #1 was no better...especially with the $988 per month premium. $1K deduc and 15% copay. The maxium cap is only $8K but your paying alot every month!! $11,856 (for two people) a year.
The best plan for me is the High Deduct $5K plan. I pay as I go actually. As I am sure the invoices I will pay will be FAIR amount after what the insurance co says is a reasonable amount for me to cover.
My husband doesn't go to doctors much. So his portion of the $526 ($263 is for his peace of mind).
If we took this plan and only I used up the $5K deduct...our yearly payout would be $11,336 (before pharmacy..but that's another post!).
So for a person that has a few minor issues and wants yearly check up's with different specialists as well...this makes the most sense. Because after the deduct is met...they pay EVERYTHING at 100%.
I hope I have helped someone out there. I know how stressed we all are, especially at this time of year and in this economy.
Re the poster right above, the HD plans do seem quite good (for what they are) but prescription drugs have an uncapped 30% coinsurance (I believe, info not in front of me right now...)
I notice that several people on this blog and the FU blog say that they've done spreadsheets to show how all their 2008 medical expenses would be paid under the various 2009 plans. I couldn't do that for all of my expenses because I've used medical services for which I never received an explanation of benefits statement (EOB) from Empire -- mainly lab tests, for which we have no copays under the Direct POS Plan. Therefore, I have no idea what the lab tests cost.
I recently spoke with a friend in NH who has a high-deductible plan, so she's paying the full cost of all her routine checkups and so forth. She mentioned what some of her routine lab tests cost, and I was surprised by how high the costs were.
Has anyone ever received an EOB from Empire that showed what charges the lab submitted and what Empire paid?
You have to go to Empire's web site..put in your account number and can pull up all your EOB's to date. This is what I did. You can see the billed rate and then the contracted rate that that was paid along with any co-pays you were resonsible for.
I have a question into FUI about the prices I would have to pay for services until I'd reach the $5K deductable...to see if the prices that would be passed onto me would also be contracted prices...so I don't have to pay full price. If they are full price...I have to rethink this plan. I mean I don't intend on going to the $5K deductable this coming year, I plan on being as frugal as I can interms of my medical health and do only really sick or needed check-ups...so I can keep my costs down.
Yes, the prescriptions aren't covered until the $5K is reached so I have to figure out how to get them at low costs elseware. Another task!
Does anyone know of a reputable insurance company that offers stand-alone prescription drug coverage for people who are NOT on or eligible for medicare.
I've never heard of such insurance, and if it exists, it doubtless would be very expensive because the people who enrolled would almost certainly be a very high-risk group. I think your best bet would be to look into the many prescription discount plans that are around. Come to think of it, I think FU has one (check the Discounts page on the Web site), but I've never looked at it carefully because I've always been in the POS plans. I don't know how good that one is, but my father (when he was alive) and a good friend who was "self-insured" for a while both saved a lot with such plans.
Yeah...but I have Brand prescriptions that I need to cover. If I choose the HD $5K plan...there is no prescription coverage until I reach the deduct, and in the meantime I would have to pay out of pocket - and alot! There are a few free and some fee based prescription plans, all are the same with the discounts they offer (which really is not much), so I signed up with a free discount card. I'll look at the FU site for the particular prescription plan you were talking about.
Hi Folks, Happy post thanksgiving Monday. A bit of feed back – aka – another talking insurance head. Regarding “stand alone RX coverage”. It does not currently exist in NYS, but if it did it would be prohibitively expensive. The RX portion of a single health insurance premium is over $100/mnth. The 2 most viable options are a discount program or a Canadian Pharmacy. There are lots of discount Rx cards that range from terrible to OK. None of them are great so I direct my clients to http://www.yourrxcard.com/. Its free & provides a competitive discount on many of the popular scripts. Regarding Canadian Pharmacy, I would need to check if my links were still active & my “donut hole” Medicare D clients are still pleased with the service.
I guess the customer service is INCORRECT again!! because I'm looking at the PDF file for the HD $5K plan on page #2 and it says under pharmacy..."Deductible, then 30% coinsurance (certain preventive drugs - 30% coinsurance, no deductable".
HD plans have networks just like a PPO or HMO plan. When you use your high deductable plan in-network you are billed the wholesale or negotiated rate. If you go out of the carrier network, you are paying retail. Some HD plans have separate in & out of network deductibles which makes the book keeping for a family nearly impossible. This same whole sale concept applies to the in-network cost sharing that has suddenly appeared as the only FUI alternatives.
Eric...yes, please do check on these Canadian pharmacies and if you could offer any positive feedback on any. It's hard to tell which are the good ones from the web.
Some people reading this blog may find the Kaiser Family Foundation’s Primer on “How Private Health Coverage Works” to be useful: http://www.kff.org/medicaid/kcmu100208pkg.cfm (There are also primers on Medicare, Medicaid, Health Care Costs and The Uninsured.)
Hi folks- I will check out web Pharmacies from Canada. FYI, the enrollment deadline for the Chamber's 8 Oxford Plan is 12/19. Good Hunting Eric Eric@pscinsurance.com
Look at TEIGIT.com. They have an arrangement with Oxford, and have special Sole Prop plans with them that are not just limited to NYC and LI, but even Westchester and further upstate.
TEIGIT also has small group (2-50) plans for people in business partnerships in NY, even if only one person wants the insurance, and the other partners are covered elsewhere. Rates are better than for Sole Props.
Freelancers who are artists, check out non-profit organization, FRACTURED ATLAS 248 W. 35th Street Suite 1202 New York, NY 10001-2505 support@fracturedatlas.org (212) 277-8020 http://www.fracturedatlas.org/site/healthcare/
They offer affordable HIP insurance plans which Freelancers Union used to offer up until 12/2006, before the switch to Empire. I just spoke with them today and they were very informative and professional.
update to my post above: ALL freelancers should check out FRACTURED ATLAS for HIP plans. Call them or you can walk in their office at the above address to speak in person. Please forward/post this message to anyone who could benefit.
I am an independent broker that has already helped members get more affordable and perhaps better benefits than the one FU is offering for 2009. Please contact us at
Not to bash anyone, but Teigit has a terrible reputation. Free Lancers has better systems, is much better staffed & professional.
Regarding a 2 person group with one person enrolling, for Oxford its great! No Sole prop-up charge or administrative fees. We can write you direct with Oxford. Direct rates are 20% less!
Send me a note & we can discuss your own insurance situation.
I am a direct agent with Atlantis Health Plan. Self-employed or free-lancers can get a full coverage plan with no deductibles that start at $325 a month. You only have to prove $10,000 in annual income as a self-employed individual. We also have comparable plans for non self-employed indiviuals and families. This is a great alternative to the plans offered by the FU.
If anyone would like additional information please contact me at 801-580-0404, I would love to help.
Child Health Plus is a wonderful alternative for children. Make sure to ask your current pediatrician which insurance they choose (you have an option of providers depending on your state). After they are accepted you pay nothing in terms of co-pays - ever!! The only thing you have to remember to do is to always get a referral if you are going to a specialist and lab tests must be done at the lab NOT the doctors office. Whatever plan you choose for yourself and spouse...the "family" coverage will surly have ded, co-pays etc....but with the kids the CHP program your premium is all you pay!
I noticed the post above from an Atlantis Health Plan rep. Does anyone know someone who has actually had Atlantis Health Plan? I was considering it but can't find one person who has it or knows anyone who has it... Would love to speak with someone who has actually used it! One negative point I discovered is that Atlantis does NOT cover any in-network physical therapy unless you've been hospitalized first. For those of us who have had painful injuries like ankle sprains, severely pulled muscles, torn ligaments, knee injuries, back problems, strained elbows, hand injuries, this plan would NOT cover ANY physical therapy treatments. Most of the time we are NOT hospitalized for these common injuries. Hard to believe it's not covered, but true!
I have a friend in Westchester who had Atlantis for about a year between the expiration of her COBRA benefits and her becoming eligible for Medicare earlier this year.
As with all plans, it's important to research whether your doctors -- and the facilities they may use -- participate in the plan. My friend's doctors participated, so she thought that Atlantis would be a good low-cost, short-term solution. However, she needed to have a colonoscopy and endoscopy, and Atlantis would not cover the procedures if they were done in the facility her gastroenterologist uses. In her case, she did not want to go to another doctor, so she put off the procedures for almost a year until she was covered under Medicare, and fortunately, she did not have any serious problems.
This is not an unusual problem. I actually had a similar problem with Empire earlier this year. I needed a colonoscopy, and my internist recommended a gastroenterologist who accepted Empire -- but it turned out that the only facility he used for colonoscopies was not an Empire provider. In my case, I'd never been to him before, so I had no problem with going to another gastroenterologist who used an Empire facility (NYU Hospital).
We have changed to Fractured Atlas, where I was able to get a person on the phone immediately and who was unbelievably helpful. Not to mention the fact that the insurance is cheaper but with better coverage.
Yes, we do have plans that only over physical therapy after hospitalization. We also do have policies that cover physical therapy at anytime for those minor but painful injuries. It just depends on the options.
Also, Atlantis comes with access to the Atlantis Medical Groups, that are state of the art medical facilities. AMG's offer basic medical proceedures such as blood work, physical therapy, x-rays, physicals, etc... at no cost to Atlantis customers - regardless of anyother proceedure the condition is affiliated with.
If anyone has any questions about Atlantis I am more them willing to help. Just call me at 801-580-0404 or email me at mhalverson@atlantishp.com
Is it true that now this only pertains to facility(hospital)? I read about a woman whose husband needs an MRI every 4-6 weeks, so theoretically under FIC, they would pay 20% (coinsurance) of that all year long with no cap? is that correct?
Regarding your Out-of-pocket maximum question, yes, you are understanding correctly. I just clarified that point with FIC and one would be responsible for those fees.
FU says that the network will be similar to BCBS but when I asked my doc if she takes FIC she didn't even know what that was. Are they still working through the BCBS system in any way or is it completely broken off?
So do I ask my docs if they take "Freelancers Union Insurance" or is there some other network they are affiliated with?
Okay....not sure if this spinoff group is actually in the works anymore. I haven't been able to be a part of the "group chats" but no e-mails or updates have been circulating to date so I'm wondering.....?
So I'm asking...has anyone found an alternative to FUI insurance out there??
I'm looking all over, using leads from this blog and various searches by myself on the internet. I'm in New York.
I have found a few decent plans and am cross referencing them on a spreadsheet..this is such a pain in the ass since I don't have time for this but it needs to get done. And the plans out there are all over the place in terms of coverage and price. Plus if I am going to give away almost $1,000 a month for me and my spouse to be covered I want to make the right decision.
Anyway...if anyone has successfully found a plan they like...please let me know. I would love to discuss what I found to date with anyone that needs help also. Please post your e-mail below and I'll contact you.
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Posts
Some links - Julian
ReplyDeletehttp://www.mediabistro.com/insurance/
http://www.mediabistro.com/insurance/download/mediabistro-crosscarriercomp4q08.pdf
http://www.ins.state.ny.us/chealth.htm
Interactive Consumer Guide to HMOs - http://www.nyshmoguide.org/
Premium Rates for HMO Standard Individual Health Plans by County - http://www.ins.state.ny.us/ihmoindx.htm
If the moderator doesn't mind, I think we should use this thread to also chatter freely, as we were at fu website?
ReplyDeleteYou can use this space however you like... I was only trying to make things a bit more organized.
ReplyDeletethank you so much for setting this up!!!
ReplyDeleteMedia bistro's Oxford offerings look pretty fabulous....
ReplyDelete(certainly in comparison to FU's new plans...)
ReplyDeletearchive post of chatter from fu
ReplyDeleteI've got to get to work, but why would you not choose oxford over atlantis at mediabistro? i didn't look at atlantis, but oxford looks great Posted: Wednesday Nov. 19, 2008.Info12:56P Katherine:does anyone have a link to dental care providers that are covered? Posted: Wednesday Nov. 19, 2008.Info12:40P Laurie:maria, if you qualify for mediabistro.com, jump immediately! (to lock in low rates for 12 mos) Posted: Wednesday Nov. 19, 2008.Info12:25P Maria:Hi There! If I'm a new member how do I get health insurance? Does anyone know? Posted: Wednesday Nov. 19, 2008.Info12:24P margaret:Julian, he suggested atlantis, but you should call and get advice specific to you Posted: Wednesday Nov. 19, 2008.Info12:22P laurie:(ass opposed to Laurie) Julian, why not set up a forum on yahoo.com? http://groups.yahoo.com/start Posted: Wednesday Nov. 19, 2008.Info11:58A Lucy:Thanks Julian...I was also impressed with MB when I spoke with them...my check/application is going out tomorrow morning. PRIORITY! :-) Posted: Wednesday Nov. 19, 2008.Info11:54A Julian:I have one high priced monthly prescription w/o a generic alternative. what did they suggest? Posted: Wednesday Nov. 19, 2008.Info11:53A Julian:her being will know what she has visited on us. Posted: Wednesday Nov. 19, 2008.Info11:53A Julian:If only th eidea of FU was backed by action instead of being a marketing ploy. Empty marketing to progressives is appaling. i hope Sara comes back as an underinsured food service worker - maybe then Posted: Wednesday Nov. 19, 2008.Info11:52A margaret:Im still looking at Oxford--if my dotor ok's going generic on a few precrips I will do that. Posted: Wednesday Nov. 19, 2008.Info11:51A margaret:Julian I havent made the final decision yet, have to crunch a few #s Posted: Wednesday Nov. 19, 2008.Info11:51A margaret:I can't wait to be off of the FU plan but it does make me sad, I loved the idea of a freelancer's union and I wanted to support their advocacy and other things they do but oh well Posted: Wednesday Nov. 19, 2008.Info11:51A Julian:Margaret - which plan did you choose? Posted: Wednesday Nov. 19, 2008.Info11:50A Julian:underwiritng life, disability or dental insurance. Posted: Wednesday Nov. 19, 2008.Info11:50A Julian:Lucy - they are separate plans so I think as long as yo want to remain a member of fu and keep paying premiums you are covered. FIC is the health insurance change - I have heard nothing about FIC Posted: Wednesday Nov. 19, 2008.Info11:50A margaret:no one rushed into the wrong plan in their eagerness to get away from FU Posted: Wednesday Nov. 19, 2008.Info11:49A margaret:Mediabistro went through all of the options with me (I am prescription-heavy so he steered me away from Oxford, for example), and explained EVERYTHING. he was v patient and said he wanted to make sure Posted: Wednesday Nov. 19, 2008.Info11:49A margaret:I just got off the phone with mediabistro and I couldnt have been more impressed Posted: Wednesday Nov. 19, 2008.Info11:42A Lucy:does anyone know - if we cancel our health, can we still keep our life/disability? Posted: Wednesday Nov. 19, 2008.Info11:39A Laurie:btw, make sure to read the recent comment from carolyn on the petition thread--she spoke with someone inside the ny insurance industry Posted: Wednesday Nov. 19, 2008.Info11:38A Laurie:beyond me, but at least in the meantime we'll have a permanent record instead of this, which is gone Posted: Wednesday Nov. 19, 2008.Info11:34A Julian:I am blocked by waiting period from posting on craigslist forum. Posted: Wednesday Nov. 19, 2008.Info11:33A Julian:I was going to try to set up a threaded forum tonight or tomorrow - is there any way to tie that to upset fu? I think it would be easier to organize and navigate than a scroll of blog comments. Posted: Wednesday Nov. 19, 2008.Info11:31A Laurie:ie, something positive-ish could come out of all of this! Posted: Wednesday Nov. 19, 2008.Info11:30A Laurie:btw, I think we can make the new blog permanent, so offer advice in years to come, also... Posted: Wednesday Nov. 19, 2008.Info11:30A Laurie:Julian's right, better spot.. thx all! Posted: Wednesday Nov. 19, 2008.Info11:29A Julian:please post insurance info to http://upsetfu.blogspot.com/2008/11/fic-alternatives.html Posted: Wednesday Nov. 19, 2008.Info11:27A Jeanne:http://upsetfu.blogspot.com/2008/11/petition.html?showComment=1227021840000#c6724386652936446739 Posted: Wednesday Nov. 19, 2008.Info11:27A Jeanne:the blogspot doesn't have the most recent posts, the one that does says "petition" here is the url, i will post separately Posted: Wednesday Nov. 19, 2008.Info11:20A Mai:Jeanne: Awesome. Thanks! Posted: Wednesday Nov. 19, 2008.Info11:17A Jeanne:they do charge 59 to join mediabistro, so that plus 401 will work, separate checks, they will tell you, one has to be made out to oxford Posted: Wednesday Nov. 19, 2008.Info11:16A Jeanne:they will send it to you separately if you call them Posted: Wednesday Nov. 19, 2008.Info11:15A Jeanne:just check that the actual application is in the pdf file...page 11 was missing and that is the page you need for the mediabistro application Posted: Wednesday Nov. 19, 2008.Info11:15A Laurie:the first (new) thread, upsetfu.blogspot.com thanks! Posted: Wednesday Nov. 19, 2008.Info11:15A Jeanne:maybe post the url again laurie Posted: Wednesday Nov. 19, 2008.Info11:14A Laurie:can we all collectively switch over to upsetfu right now? I don't want to have to be resposting all this info? Posted: Wednesday Nov. 19, 2008.Info11:12A Laurie:hth is just one of those carriers really for internat'l but it seems like a good deal (depending on dom, network) and they take u the moment u sign up on internet! Posted: Wednesday Nov. 19, 2008.Info11:12A Mai:Jeanne: yes, rush, rush, rush to lock in 2008 rates for 1 year. Posted: Wednesday Nov. 19, 2008.Info11:11A Laurie:upsetfu just started a new thread, the first one there, for practical advise about other options Posted: Wednesday Nov. 19, 2008.Info11:11A Mai:by anyone yet... Posted: Wednesday Nov. 19, 2008.Info11:11A Mai:Laurie: I will look into hth. However, someone said that Untied Healthcare(Oxford is now a part of--is a national network that is accessible. wondered if there was any verification on that statement Posted: Wednesday Nov. 19, 2008.Info11:11A Jeanne:remember tho, you have to get the appliocation and checks in by the 25th of november for december coverage and to lock in 401 rate Posted: Wednesday Nov. 19, 2008.Info11:11A Laurie:hthtravelinsurance.com (not hth) Posted: Wednesday Nov. 19, 2008.Info11:10A Mai:Jeanne: Makes sense and Thanks. Posted: Wednesday Nov. 19, 2008.Info11:10A Jeanne:laurie good idea, this way everyone can see our posts Posted: Wednesday Nov. 19, 2008.Info11:09A Jeanne:he said he'd call oxford to make sure but really, that won't hold me back, your dr does a blood test , doesnt know 2 weeks in advance! Posted: Wednesday Nov. 19, 2008.Info11:09A Laurie:hth.com (?) gold travelgap? Posted: Wednesday Nov. 19, 2008.Info11:09A Laurie:are like, however.. but it's a stopgap Posted: Wednesday Nov. 19, 2008.Info11:08A Jeanne:yes, mal, the 2 wk certification seems impossible, he siad they prefer that but it never happens. I had oxford, i remember that Posted: Wednesday Nov. 19, 2008.Info11:08A Laurie:Hi Mai, it's a travel insurance co... if you're hurt 250 miles from home it covers up to 25,000? domestic med bills, more abroad? good deal I believe... I had for a while (don't know what network mds Posted: Wednesday Nov. 19, 2008.Info11:03A Mai:Laurie: what is hth? Posted: Wednesday Nov. 19, 2008.Info11:00A Laurie:Mai, hth has good travel insurance $150 for a year coverage? Posted: Wednesday Nov. 19, 2008.Info10:59A Laurie:guys, could we switch this to upsetfu.blogspot.com otherwise all this helpful info will shortly be lost to us? Posted: Wednesday Nov. 19, 2008.Info10:55A Mai:Jeanne: did MB have info re: 2-week pre-certification for lab/radiology etc services for Oxford metro2--also any details on the national network that we can access if injured while away (Grand Canyon) Posted: Wednesday Nov. 19, 2008.Info10:32A Jeanne:one of the people at mediabistro talked to me for over a half hour, didn't rush me despite how busy they are with our people Posted: Wednesday Nov. 19, 2008.Info10:13A Julian:Mediabistro phone support is a world of difference - helpful, very knowledgable, paitent, nice. Maybe FU could take lessons? Posted: Wednesday Nov. 19, 2008.Info10:01A Julian:polite? at least that is some progress. Snippy has been the default. Posted: Wednesday Nov. 19, 2008.Info09:56A Georgina: these posts are very interestinq and informaqtive, and according to FU te new insurance company will be Anthem, Blue Cross Posted: Wednesday Nov. 19, 2008.Info09:45A Martha:wow, so frustrated with the phones. very polite people on the end of the line, but what good is that if its not helpful?? Posted: Wednesday Nov. 19, 2008.Info09:42A Jeanne:for mediabistro, page 11...so they sent it to me separately $59 to join Posted: Wednesday Nov. 19, 2008.Info09:42A Jeanne:Julian, I called this morning, made my decision. The thing missing on my pdf was the application Posted: Wednesday Nov. 19, 2008.Info09:38A Elena: I would have rather paid an increase to Empire Posted: Wednesday Nov. 19, 2008.Info09:38A Elena: This insurance is no deal Posted: Wednesday Nov. 19, 2008.Info09:03A Julian:yes, you will - I don't thnk you would get back the membership fee to Avant guild but they might even do that - call them - they are a reputable company Jeann Posted: Wednesday Nov. 19, 2008.Info08:36A Jeanne:I mean mediabistro, who is handling Oxfird... Posted: Wednesday Nov. 19, 2008.Info08:35A Jeanne:What happens if I send my check into Oxford and something is not acceptable on my tax form? Will I get my check back? Posted: Wednesday Nov. 19, 2008.InfoWednesday Nov. 19, 2008
11:53P Matthew: has anyone here made any headway with complaints regarding the new FIC? Posted: Tuesday Nov. 18, 2008.Info11:41P anne:walter- go to yahoo. type in:nys state health insurance complaints ratio. Select the fourth listing. Posted: Tuesday Nov. 18, 2008.Info11:24P anne:Yes.They give no option to the self employed. Posted: Tuesday Nov. 18, 2008.Info11:24P walter:Anne, I went to the site. Where please is the link to Atlantis complaints? Posted: Tuesday Nov. 18, 2008.Info11:21P Jeanne:anne is that a rate for just one person? That seems excessive Posted: Tuesday Nov. 18, 2008.Info11:10P anne:walter-check out the website www.ins.state.ny There, you will find a link for the number of complaints filed against nys insurance companies. Atlantis has the highest number of complaints. Posted: Tuesday Nov. 18, 2008.Info11:05P Julian:Laurie, Re: your 8:03 post - Did you see "Sicko?" Where is the fine print? A promise to require no referrals does not mean automatic acceptance of all claims - at least I don't think it does. Posted: Tuesday Nov. 18, 2008.Info11:04P walter:Try eInsurance.com. The Atlantis offerings seem tobe the best and cheapest. Posted: Tuesday Nov. 18, 2008.Info11:04P anne:Let's attend the webinar and at least voce our dissatisfaction. Posted: Tuesday Nov. 18, 2008.Info10:56P anne:Empire BC/BS HMO POS.It is very expensive:individual-$887. per month -thats the 2008 rate. I do not know if I can afford it. Posted: Tuesday Nov. 18, 2008.Info10:52P Jeanne:anne which did you decide on, if anything? Posted: Tuesday Nov. 18, 2008.Info10:52P Jeanne:thank you Posted: Tuesday Nov. 18, 2008.Info10:51P anne:nys dept of insurance phone number: 800-342-3736 Posted: Tuesday Nov. 18, 2008.Info10:49P Jeanne:it would be so much easier to not have to go thru the process all over again though Posted: Tuesday Nov. 18, 2008.Info10:48P Jeanne:I am htinking about Oxford, downloaded all of the forms, talked to them all day Posted: Tuesday Nov. 18, 2008.Info10:48P Jeanne:this afternoon there were so many people on here, now just a few. thanks for tip Posted: Tuesday Nov. 18, 2008.Info10:46P anne:Jeanne_possibly a call to NYS Dept. of Insurance would answer your question. Posted: Tuesday Nov. 18, 2008.Info10:40P Mirit:I don't understand how people are able to get the tax return forms, but no one is able to get any news cover on how we got screwed... I feel like all the energy is geared towards the wrong places Posted: Tuesday Nov. 18, 2008.Info10:38P Jeanne:but Sara's blog says that the drs are REQUIRED to take FUI, who took our bc/bs before Posted: Tuesday Nov. 18, 2008.Info10:36P anne:Thats the point. FUI is a new,unknown,untested entity.If we need health care,are we willing to put up with the unexpected hassels when we get sick? Posted: Tuesday Nov. 18, 2008.Info10:36P walter:Thomas' post of 06:48 very interesting tax return. I bet Dear Leader got pissed on that link. Better download it now kiddies before it's censored. Posted: Tuesday Nov. 18, 2008.Info10:31P Jeanne:anne, do these drs even know what FUI is at this point? Posted: Tuesday Nov. 18, 2008.Info10:26P Laurie:I don't think they have a choice?? if they're part of the specific network? Let's not scare off all the mds (I'm stuck with FU for a while...) Posted: Tuesday Nov. 18, 2008.Info10:18P anne:The BC/BS logo on the FUI card means nothing! Posted: Tuesday Nov. 18, 2008.Info10:17P anne:I spoke to my physicians.They are not willing to accept FUI for office visits. They do not want to get burned if there will be a problem with claims.What if hospitals refuse to accept FUI? Posted: Tuesday Nov. 18, 2008.Info10:09P Alfred: freelancersunion = a sara based approach to making things worse for you and better for sara Posted: Tuesday Nov. 18, 2008.Info08:55P Laurie:also, a plus is that the fees even during deductible period will be the discounted rates set by the plan (in network) Posted: Tuesday Nov. 18, 2008.Info08:53P Laurie:doesn't have the coinsurance issue; you still have the 2/5 million annual/life max, but again, you could tranfer to NY state or another plan at that point Posted: Tuesday Nov. 18, 2008.Info08:53P Laurie:high deductible plan, the two versions FU putting out Posted: Tuesday Nov. 18, 2008.Info08:46P Jeanne:what is HD? Posted: Tuesday Nov. 18, 2008.Info08:05P Laurie:Again, the HD plans seem solid for what they offer... Posted: Tuesday Nov. 18, 2008.Info08:03P Laurie:I don't see what the problem with approving claims would be, as no specialist referral needed? Posted: Tuesday Nov. 18, 2008.Info08:03P Laurie:FU actually might be better about claims... and I don't see how we would be liable if they went under; just transition to another plan (NY state if nothing else) Posted: Tuesday Nov. 18, 2008.Info07:53P Julian:"More profits for them" I am tired.
Mediabistro's Oxford plan #2 can be had at $401 if you get the application in by November 25th. Their phone number is 212-879-0122 and they will give you that rate through December of 2009. No charge for x-rays and MRIs whereas FU's new plans ask for 20%. MRIs cost up to $2,000 so paying $400 is out of the question for me, if I ever need one, same with x-rays and lab costs. I think after looking through all the plans, this one is the best. If anyone finds something better, please post.
ReplyDeleteWOW I think freelancers union just froze both the blog page and the membership home page; everything else opens, but the two spots where you can post!!!!!!!!!!!!!!!!!!!! This is getting dramatic!
ReplyDeleteI looked over the oxford quickly and I thought it looked really good... the deductible doesn't apply to well-care, mammogram, one physical and no referral to specialists needed... seems great (the one I looked at) (and I know from experience that many columbia presby. md's participate in liberty network)
ReplyDeleteSeriously, I think she/they've blocked it, all the other pages there open for me... great story for ny times, slate etc... everyone let your journalist friends know!
ReplyDeleteseems to be up. I was able to post.
ReplyDeleteokay, I was finally able to get on, but there was a definite break there--I even turned off my computer and still couldn't access those two parts.. I think they were frozen for a bit, somehow (at least to my connection...) I'm glad they're "online" otherwise it would be some story... (sad...)
ReplyDeleteI wish New York State regulators would step in (Sara, are you reading this?) and put in writing that we are not personally liable for any charges incurred that FU would owe if they go under... then we know we can always transition to the NY State plan (with no prexisting conditions) and be confident our credit history wouldn't be permanently ruined. I think we need that in writing from New York who seems to think this venture is viable. That would go quite a way towards building confidence for me (though if I could I would leap to mediabistro immediately).
ReplyDeleteHi everyone - this is Nathan, one of the suddenly overworked people at Total Capital Planning (the people working with Mediabistro to provide info on the plans available) that several of you have either spoken or e-mailed with over the last few days, and we were just given this site earlier today.
ReplyDeleteJust thought I'd stop in and say hi - I know there's been a lot of interest in light of the whole Freelancer's Union... spectacle? Debacle? And reiterate that we are happy to help with any questions we can; obviously we've had a deluge of calls and e-mails so we're not turning around as rapidly as I would like on some people, but we'll do our best to keep up.
I know a lot of you are interested in Oxford (generally the Metro #2 plan from my conversations), and I do like them a lot as a company - most of the freelancers/sole proprietors we work with are with them. I just want to make sure everyone is aware of one feature of their plans that I don't believe I've seen talked about, since it's a pretty key one. Prescriptions.
All the Oxford plans have the same drug card - for generic prescriptions you have a $15 copayment, and for any non-generic drugs you would have a co-payment of 50% of the retail cost of that drug, after a deductible of $100 (higher for the HSA plans that most of you don't seem too interested in so I'll spare you). So while there is a prescription benefit, it's not going to be right for everyone. If you have non-generic prescriptions that you take regularly, I'd suggest pricing them with your pharmacy before signing up for this plan - there are a few expensive ones out there, and I'd hate for somebody to sign up then go to the pharmacy and wonder why they have a $500 bill!
We really do just want to help you guys out, I know you're all in the lurch over this. So if you need anything feel free to give us a call at 212-879-0122. Even if you're not eligible for these plans (FU has had some slightly different requirements in the past than these do), we'll try to point you in the right direction for something.
Although I am quite cynical about FU I do not think they could stop members from posting at this point w/o a tremendous loss of face.
ReplyDeleteWe are all having anxiety but let's generally keep our focus on progress. People need to read completely through the information that has been posted –
I made a mistake in a post then reposted to correct it but another commenter, who I was trying to help, sent me several emails spanking me for the typos - after apologies, after everything - I am at work and I am trying to disseminate useful information on the fly - please look over my failings - Carolyn seems incapable of doing that.
If anyone wants to learn more about the health insurance options available to freelancers you can check out www.mediabistro.com/insurance or email health@mediabistro.com or call Nathan Short at 212 879 0122 - he has been very helpful.
ReplyDeleteI think we need a thread limitied to listing vialbe alternatives to FU - this has already gotten muddied wwith extraneous comments, including my own gripe.
ReplyDeleteSad-m - Thanks again for creating this Blog!
Nathan,
ReplyDeletewill you marry me?
Ta.
ReplyDeleteNathan is a rock star
ReplyDeleteI'm considering the switch to MB's Oxford plan, but I have two concerns:
ReplyDeleteThey require you to have most of your income reported on a schedule C, with proof. If I submit my 2007 tax return as proof this is not a problem. However I don't know what the next year(s) may bring. Can Oxford cut you off if your circumstances change?
Another requirement is that you work at least 20hrs/week. I sometimes work more than that and sometimes less. I'm not sure how they would verify this, but I do know insurance companies go to great lengths not to pay claims. This may be incredibly cynical of me, but what if something catastrophic happened and they decided to deny my insurance because I have not worked 20 hours every week?
Does anyone know what are the qualifications to join the Mediabistro
ReplyDeleteimmediate post above, please go to mediabistro.com; it's complicated... most accurate if you go there yourself... thanks
ReplyDeleteI've tried calling and emailing Mediabistro for a few days now, and haven't gotten a response. I am in a small LLC partnernship but we are on our own with regards to insurance (My partners get insured through their wives). I don't file schedule C, but rather Schedule K for small business. Freelancers Union will accept this but I'm not sure if the plans at Mediabistro will find me eligible.
ReplyDeletemotionprojects, there is always someone answering their phones. Their number is posted on this blog, keep trying. They are probably very busy right now.
ReplyDeletehere's the quick info from their website for the sole proprietor... they also have info for groups of 2 or more (it's under the avant something column on the right of the media bistro page)
ReplyDeleteHealth Insurance for Freelancers
As a Freelancer, you may be eligible for the following plans:
** The Oxford plans require that the majority of your income be untaxed income reported on a Schedule C, E, or F, but there is no minimum income requirement
** The Atlantis plans require $15,000 Gross Income on the Schedule C
** The HIP & GHI plans require approximately $10,000 Gross Income on the Schedule C – subject to Underwriters discretion.
** The MVP plans require a gross minimum income of $7,436 reported on Schedule C, which must be the majority of your earned income.
Contact Jason Silverman at 212.879.0122 for more information or to sign up.
For health insurance outside New York, please click here.
further, here is a quickie of their info re small businesses (2 or more people)
ReplyDeleteHealth Insurance for Small Businesses
Health Insurance is one of your largest line-item expenses. Creating an efficiency of only 10% can result in significant savings.
As a small business with between 2 and 50 full-time employees, you are eligible for plans from a wide range of insurance carriers including Aetna, Atlantis, Cigna, Empire Blue Cross Blue Shield, GHI, Guardian HealthNet, HIP, and Oxford.
How to choose a plan
To help you choose the right plan for your specific situation, Total Capital Planning has a very simple process:
First, you submit a list of doctors important to you and your staff so that TCP can determine in which insurance carrier networks your doctors participate.
TCP will then prepare a comparison of your current plan vs. alternative plan options that you may prefer.
You will be provided with a medical benefits consultant who will work with you to decide which plan or set of plan is best for your specific needs.
As part of the process, TCP will also provide guidance on setting employee contribution policies and other cost containment strategies that have proven successful.
Additional Services
Once your plan is established, Total Capital Planning is available daily to handle:
Plan administration
Enrollments, terminations, or COBRA applications
transactions with the insurance carrier
confirmation that all applications are received and processed in a timely manner
resolving any billing issues and claim problems that may arise
For more information about TCP go to: http://www.myhealthplans.com
How do I sign up?
Call Jason Silverman at (212) 879-0122 or email health@mediabistro.com to begin the process.
motionprojects,
ReplyDeleteone way to go is to write insurance for the llc and have your partners decline it... ?
What does "the majority of your income be untaxed income"
ReplyDeletemean? How do I know my application to MB won't be turned down? Can someone explain this? What numbers on my 1040 should I look at before I submit an application?
motion projects,
ReplyDeletethis is ideal because then you can tailor exactly what you want... it's a win win
Update...just got through to Nathan finally, and he was very helpful. Good luck to all.
ReplyDeleteAlex, From what I understand, just look at the first page of your 1040. THere should be a line in the income box (#12 if yours is the same as mine) that gives your income from a schedule C. This number should be a majority of your income.
ReplyDeleteYes, line 12 says my income and this is my only income. Do I need some kind of proof that I don't have another income? If the people from MB are seeing this question, can you reply please? Thanks.
ReplyDeleteAlex,
ReplyDeletecall nathan or craig - they are very helpful.
Hi everyone, Nathan again. First of all - happily taken, but I'm flattered?
ReplyDeleteAlex et al, here is the fast and loose guideline for eligibility specifically for Oxford (other carriers are a bit different):
Look at Line 1 of your Schedule C (gross receipts and sales). The number listed on Line 7 of your 1040 (wages, salaries, tips, etc) can not be more than 50% of this amount. If it is, you are still eligible if you can document that you do not work for the companies that paid you on this basis. You would do this by providing a copy of the W-2 from the company, as well as a letter on letterhead or an official severance notice from the company.
Alex - it sounds like you should be eligible if you do not have any amount listed in Line 7 of the 1040 and at least some amount listed in Line 12. All we should need are the two pages of the 1040 and the two pages of your Schedule C.
If anybody thinks their situation doesn't boil down easily into this formula, we're available at 212-879-0122 until 5-ish.
Thanks for this thread. It seems pretty clear to me that I wouldn't qualify for MB, so I'll keep monitoring to see if anything else turns up. It seems likely to me that everyone who can and knows about other options will flee FU, but I may not be one of those who can.
ReplyDeleteArchive post of Chatter from FU:
ReplyDelete04:13P Jeffrey:This is a disaster for us. Husband has cancer. Not qualified for medicaid or medica (yet). Cancer docs won't take Family Helth Plus or Atlantis. We can't afford this. Posted: Wednesday Nov. 19, 2008.Info
03:35P Julian:henry - but compare that to coinsurance and caps of yearly and lifetime benefits and calculate the risk/benefit for your individual needs. Posted: Wednesday Nov. 19, 2008.Info
03:32P Julian:12:22 laurie - good idea - will try tonight Posted: Wednesday Nov. 19, 2008.Info
03:28P Henry:Note that Media Bistro, while offering great rates, also specifies a 50% copay for brand name drugs. That could be damned expensive Posted: Wednesday Nov. 19, 2008.Info
03:17P Justin:at a gym that has a focus on cardio. ie. they have a treadmill. Posted: Wednesday Nov. 19, 2008.Info
03:17P Justin:In case anyone wants to know, yes, Oxford reimburses $200 every six months for gym membership Posted: Wednesday Nov. 19, 2008.Info
02:56P Kenneth: employees... Posted: Wednesday Nov. 19, 2008.Info
02:56P Kenneth: 2-50 employees who have a much better choice..particularly when the law that mandates small business owners be given affordable health care particularly says the def of small business is ONE to fifty Posted: Wednesday Nov. 19, 2008.Info
02:54P Kenneth: you all might want to ask your state assemblymen/women and senators why insurance companies can discriminate against sole proprietors by offering less beneficial plans than small business owners with Posted: Wednesday Nov. 19, 2008.Info
02:49P Justin:has anyone else confirmed the $400 reimbursement from oxford for regular gym use? Posted: Wednesday Nov. 19, 2008.Info
02:47P Rosalind: Yes, Walter I've decided to use Atlantis and my doctors take it but they say it is a hassle working with them but at least they take it. Waiting to see what President Elect Obama does about our issue Posted: Wednesday Nov. 19, 2008.Info
02:06P Julian:Thank Margaret. i think the gist is if you have high priced monthly, ongoing prescriptions the Oxford amay not be great. i still thin oxford will be better for me Posted: Wednesday Nov. 19, 2008.Info
01:07P Laurie:I've got to get to work, but why would you not choose oxford over atlantis at mediabistro? i didn't look at atlantis, but oxford looks great Posted: Wednesday Nov. 19, 2008.Info
12:56P Katherine:does anyone have a link to dental care providers that are covered? Posted: Wednesday Nov. 19, 2008.Info
12:40P Laurie:maria, if you qualify for mediabistro.com, jump immediately! (to lock in low rates for 12 mos) Posted: Wednesday Nov. 19, 2008.Info
12:25P Maria:Hi There! If I'm a new member how do I get health insurance? Does anyone know? Posted: Wednesday Nov. 19, 2008.Info
12:24P margaret:Julian, he suggested atlantis, but you should call and get advice specific to you Posted: Wednesday Nov. 19, 2008.Info
12:22P laurie:(ass opposed to Laurie) Julian, why not set up a forum on yahoo.com? http://groups.yahoo.com/start
I posted this to another thread, but it may make more sense here. I don't work at least 20 hours every single week now (which is a qualification to get Oxford SP insurance), and who knows what will happen next year. Is anybody else in the same boat?
ReplyDeleteI'm afraid I might be stuck with FU for now as well. Basically I live in fear of insurance companies, rational or not. Turns out that Oxford has a right to audit your account at any time to see if you're still eligible, and if you're not then deny your claims. I know that this is a worst-case scenario, but if I have some kind of expensive illness or accident, Oxford could, theoretically, at any time make me prove that I have worked at least 20 hours every week. What if I go two weeks without a job? And I have a feeling that many other sole proprietors (writers and editors in particular) are in this same boat. Insurance companies are not exactly known for their lenient "just pay the claim" policies, and in fact have done some amazingly shitty things to get out of paying a claim. I don't know if this is a risk I'm willing to take.
November 19, 2008 4:13 PM
Anonymous said...
I don't think they can suddenly audit you when you put claims through.. I think you may be being overly worried here? more likely that they can ask for evidence every year when they sign you up again? I think at teigit.com they've never had Oxford intercede... you'd be the first person they'd do that on...?
November 19, 2008 4:18 PM
Anonymous said...
According to Nathan, Oxford can in fact audit you at any time: "Oxford does have the right to audit your account at any time to verify that you are still eligible and if they ask you to provide documentation that shows you are ineligible, they are within their rights to refund premium and deny claims." I agree this would most likely not happen if I broke my arm, but if I have some seriously expensive medical bills, I'm not so sure. Stories are everywhere about insurance companies just denying claims. They're not exactly the world's most trusted industry. And if they did cancel my coverage, they would have every right to do so. Still scares me too much.
I've requested an answer from FU re FIC's definition of "Facility Only" care. No reply. I plan to seek an answer in writing from them. But do any of you know?
ReplyDeleteFIC's Summaries of Benefits lists really high deductibles -- even IN-network -- for what they call "facility-only" care, such as treatment at hospitals. If you go to an appointment at your doctor's office, and their office happens to be at a hospital, will that be considered "facility-only"??
Nathan, on Line 7 there is nothing filled in. I don't get a 1099, just a schedule C and C-EZ. Line 12 does give an amount. Is there another number that has to be greater or lesser than that? On C-EZ, Net Profit (line1) is a little less than Gross Receipts (line 3).
ReplyDeleteThe less than 20 hours post seems a bit hysterical - If you are seriously ill then under you're logic you would still be expected to be working 20 hours a week even if hospitalized.
ReplyDeleteThat makes no sense. none.
So stay with FU/FIC but don't post some illogical canard about oxford. jeez.
Additonally 20 hour a week poster - FU/FIC could audit you at any time also - What are you saying? Be helpful, not hysterical.
ReplyDeleteI really don't think I'm being "hysterical." I'm just saying that I do not work 20 hours every week and perhaps others also have irregular work hours. This is not uncommon for freelancers. And that Oxford has the right to audit you any time and deny you benefits. This is their policy and was quoted from Nathan. I assume that if you become "extremely ill" and cannot work the minimum 20 hours then perhaps you will go on disability. I don't know how that works.
ReplyDeleteI suppose FU/FIC could audit me at any time as well. But they do not have this minimum requirement. They require only that you earn $10,000 in six months OR work 20 hours a week.
If my posts aren't helpful to you, feel free to ignore them.
To the "hysterical" poster...to me, that was a perfectly reasonable question which I'm glad you asked. Guys, please let's not insult one another. These are scary times, we are all self-employed and many of us are afraid of anything happening that would disallow us from working. Even for a short time, we could be out in the streets. People's nerves are on edge now but let's not take it out on each other..please?
ReplyDeleteWell, if you're correct you've just dashed my plans, along with many others perhaps--meaning we need to make FU work for us, alas
ReplyDeleteHelpful would be to call Meadiabistro and seek clarification rather than spouting hypotheticals - If someone threw a cow it could land in my apartment.
ReplyDeleteIf you want to stay with FIC then you are free to do so.
We all need answers and many of us have worked hard to contact people for these answers. But we are not research librarians - if you have a question try to have it answered then post the answer - is that so unreasonable???
I think this kind of thing is a grey area "judgement" call... I believe teigit.com has never had Oxford ask for further documentation (and I think they've been doing this a lot longer than mediabistro..., also have the 20 hrs requirement?)
ReplyDeleteThat said, as Nathan says I believe Oxford has the right, so, sure they could exercise it...
don't think further research is going to bring an iron clad answer; I think this is one of those gray areas, where you would be theoretically vulnerable, should prevailing practices change? sorry to ramble...
Just to clarify: Oxford does say you must work 20 hours. Every week. I spoke to MB and they told me this. Will they check to make sure you actually do? Probably not, but they have the right to do so. If you submit a lot of claims and are costing them money? Maybe more likely. I just wanted to throw that out there since I believe that many people might not work 20 hours every week.
ReplyDeleteI have health insurance to be safeguarded against catastrophic illness, not so much regular care, which is why I'm a bit more paranoid/cynical than the next person.
Archive post of Chatter from FU:
ReplyDelete07:15P jerry:laurie, thanks i will check out the blog you mentioned and the one here. Posted: Wednesday Nov. 19, 2008.Info
07:10P margaret:just want to say I really appreciate the folks at upsetfu for doing the blog Posted: Wednesday Nov. 19, 2008.Info
07:07P Laurie:jerry, if you go to the blog at this site, there are lots of comments (and info) as well as the offsite blog at upsetfu.blogspot.com these are huge changes being pushed onto us Posted: Wednesday Nov. 19, 2008.Info
06:56P jerry:used to be in the writers guild and that group insurance was about 15 thou and that was oxford Posted: Wednesday Nov. 19, 2008.Info
06:56P Steven:atlantis 366 per month, no deductible, no coinsurance, and copayments are a lot less Posted: Wednesday Nov. 19, 2008.Info
06:56P Richard:I took FU Posted: Wednesday Nov. 19, 2008.Info
06:55P jerry:i'm now sure who or what to believe at this point. Posted: Wednesday Nov. 19, 2008.Info
06:55P Steven:try ehealthinsurance.com Posted: Wednesday Nov. 19, 2008.Info
06:54P jerry:i jusy discovered this chat and now i'm in a real quandry Posted: Wednesday Nov. 19, 2008.Info
06:54P jerry:i am def not a defender of medical insurance BUT it always goes up AND according to FU the benfits are similar to BCBS and those rates would have gone up even more per month. i just discovered this ch Posted: Wednesday Nov. 19, 2008.Info
06:52P Richard:a Posted: Wednesday Nov. 19, 2008.Info
06:51P Richard:I paid my $455 bill Posted: Wednesday Nov. 19, 2008.Info
06:51P Steven:any comments out there Posted: Wednesday Nov. 19, 2008.Info
06:50P Steven:the new plan of 450 amonth plus an additional 65 makes my plan 515 a month + the new deductible. Im not happy Posted: Wednesday Nov. 19, 2008.Info
06:49P jerry:we were in the equal to the new ppo 1 and its gone up about #200 but as i get it the benefits are about the same as BCBS Posted: Wednesday Nov. 19, 2008.Info
06:49P Steven:thats an additional 780 a year plus the increase in coinsurance. again, this is very steep Posted: Wednesday Nov. 19, 2008.Info
06:48P Laurie:permanent posts at upsetfu.blogspot.com all of this dies shortly Posted: Wednesday Nov. 19, 2008.Info
06:47P Steven:my freelance pos has gone up $65 a month and with a new deductible for the new plan of a $1000, thats kind of steep Posted: Wednesday Nov. 19, 2008.Info
06:47P Laurie:MB OXFORD if you qualify (only neg. is 50 % coinsu. for non-generic meds) FU untested, life/annual maximums, and diagnostic tests have no cap for coinsur Posted: Wednesday Nov. 19, 2008.Info
06:47P jerry:if i'm wrong it would be great if someone can show the benefits gotten under the original plan and the new one to show the differences Posted: Wednesday Nov. 19, 2008.Info
06:46P jerry:as far as i can tell the benefits under the new plan are not that much different from the old plan. the monthly payment is a bit more. we are members as husband and wife Posted: Wednesday Nov. 19, 2008.Info
06:43P Alan:yes, but coinsurance in network is n/a Posted: Wednesday Nov. 19, 2008.Info
06:36P Elena: the least amount is 15% Posted: Wednesday Nov. 19, 2008.Info
06:35P Elena: In addition to the $1000 deductible, you have "co-insurance" costs Posted: Wednesday Nov. 19, 2008.Info
06:35P Elena: Look at the "co-insurance"--that is out of pocket Posted: Wednesday Nov. 19, 2008.Info
06:27P Judith:so, is FIC better than MB OXford - what do you all think? Posted: Wednesday Nov. 19, 2008.Info
06:27P Alan:is there out of pocket for hospital even for the POS plan? where does it say that? Posted: Wednesday Nov. 19, 2008.Info
06:23P Elena: then to finance a new insurance co Posted: Wednesday Nov. 19, 2008.Info
06:23P Elena: i would have rather paid them an increase Posted: Wednesday Nov. 19, 2008.Info
06:23P Elena: the fact is Empire BCBS was much better Posted: Wednesday Nov. 19, 2008.Info
06:22P Elena: what are expenses can you be made to pay? Posted: Wednesday Nov. 19, 2008.Info
06:22P Elena: the max says $4000 for facility alone Posted: Wednesday Nov. 19, 2008.Info
06:22P Barbara:i can't believe those who say it's not a big change---could easily mean $15K or $20K out of pocket for a hosp. stay Posted: Wednesday Nov. 19, 2008.Info
06:21P Alfred: and FIC is a new ins company, don't you want "quality ins" Posted: Wednesday Nov. 19, 2008.Info
06:20P Alfred: the benefits are reduced Posted: Wednesday Nov. 19, 2008.Info
06:13P jerry:again i ask, why all the complaints? its gone up a bit but nothing comared to some other plans. am i missing something here???? Posted: Wednesday Nov. 19, 2008.Info
06:12P Elena: someone needs to create competition for Freelancer's Union Posted: Wednesday Nov. 19, 2008.Info
06:11P Laurie:the hospital; however u may want to discuss with Nathan at media bistro... (read the posts at upset with fu first) Posted: Wednesday Nov. 19, 2008.Info
06:10P Laurie:all MB'ers, at the other blog, one guy is posting that Nathan says Oxford could demand recert. if you're sick and refund premium... another person points out idiocy; you can't work 20 hrs/wk if in Posted: Wednesday Nov. 19, 2008.Info
06:06P Mai:plus 20% co-ins for "x-ray, MRI, CAT scan, EKG, ultrasound, and other services." with no maximum out-of-pocket Posted: Wednesday Nov. 19, 2008.Info
06:05P Elena: for hospitalization Posted: Wednesday Nov. 19, 2008.Info
06:05P Elena: instead of a $750 deductible, it is $1000 plus 15% at best Posted: Wednesday Nov. 19, 2008.Info
06:05P Elena: There is a huge change Posted: Wednesday Nov. 19, 2008.Info
05:56P jerry:i dont understand all the complaints. there;s not that much of a change with the new FU plan???????? am i missing something? Posted: Wednesday Nov. 19, 2008.Info
05:18P Karen:All so frustrating. I made a careful decision to stick w/ FrlncrsUnion coverage just a few months ago, when I had an option to switch. It's too late to pursue the other. I'm stuck! Posted: Wednesday Nov. 19, 2008.Info
04:54P John: you get charged at your current rate if you haven't chosen a new plan yet. sucks for those of us who are forced to downgrade by the rate hike- not even a one month break Posted: Wednesday Nov. 19, 2008.Info
04:46P Laurie:any newbies here please post to upsetfu.blogspot.com; anything of import, as this evaporates Posted: Wednesday Nov. 19, 2008.Info
04:45P Laurie:I reallly think we may be overreacting about the 2/5 million cap; it's terrifying, BUT the hard truth is in NY could bounce straight to the state plan, or another w/o prexisting cond. if no break Posted: Wednesday Nov. 19, 2008.Info
04:44P Matt:Fuck FIC Posted: Wednesday Nov. 19, 2008.Info
04:44P Lliam: off to add this to my list of "what should I do!" Posted: Wednesday Nov. 19, 2008.Info
04:43P Lliam: ahm well, good health to you Posted: Wednesday Nov. 19, 2008.Info
04:42P Lliam: xactly! Posted: Wednesday Nov. 19, 2008.Info
04:42P Rosalind: If its not broke don't fix it Posted: Wednesday Nov. 19, 2008.Info
04:41P Rosalind: Just crazy Posted: Wednesday Nov. 19, 2008.Info
04:41P Rosalind: If they were not going to do better than what they already had why did they change Posted: Wednesday Nov. 19, 2008.Info
04:41P Rosalind: The BCBS had worked fine for me Posted: Wednesday Nov. 19, 2008.Info
04:41P Rosalind: You got that right Posted: Wednesday Nov. 19, 2008.Info
04:41P Rosalind: he he he Posted: Wednesday Nov. 19, 2008.Info
04:41P Lliam: They coulda waited to take over till after Obama cleaned up the mess Posted: Wednesday Nov. 19, 2008.Info
04:40P Rosalind: Just crazy Posted: Wednesday Nov. 19, 2008.Info
04:40P Rosalind: And the $450 pre. Posted: Wednesday Nov. 19, 2008.Info
04:40P Rosalind: FIC want me to pay 15% of that on top of the deductible Posted: Wednesday Nov. 19, 2008.Info
04:40P Lliam: That's decent Posted: Wednesday Nov. 19, 2008.Info
04:40P Rosalind: but I only had to pay that $750 BCBS required Posted: Wednesday Nov. 19, 2008.Info
04:40P Rosalind: But when I actually saw how much they actually charge the carrier Posted: Wednesday Nov. 19, 2008.Info
04:40P Rosalind: it was crazy Posted: Wednesday Nov. 19, 2008.Info
04:40P Lliam: wow. bet you ened up spening a pretty penny anyway Posted: Wednesday Nov. 19, 2008.Info
04:40P Rosalind: It was smoothing sailing Posted: Wednesday Nov. 19, 2008.Info
04:39P Rosalind: The first time I ever used any health insurance in 20 years participating Posted: Wednesday Nov. 19, 2008.Info
04:39P Rosalind: I had surgery this year under BCBS Posted: Wednesday Nov. 19, 2008.Info
04:39P Rosalind: You got that right Posted: Wednesday Nov. 19, 2008.Info
04:39P Rosalind: You are welcome Justin Posted: Wednesday Nov. 19, 2008.Info
04:39P Lliam: I may be better of deduction the payments and setting up a bank account Posted: Wednesday Nov. 19, 2008.Info
04:38P Justin:Thank you Rosalind! Posted: Wednesday Nov. 19, 2008.Info
04:38P Rosalind: I can't afford to take care anyone but me right now Posted: Wednesday Nov. 19, 2008.Info
04:38P Rosalind: Like they want the rich to take care of the poor Posted: Wednesday Nov. 19, 2008.Info
04:38P Rosalind: The healthy are paying for the sick ones Posted: Wednesday Nov. 19, 2008.Info
04:38P Rosalind: yes Posted: Wednesday Nov. 19, 2008.Info
04:37P Lliam: It's like you have to be REAL sick to make this inusrance pay Posted: Wednesday Nov. 19, 2008.Info
04:37P Rosalind: 7370 3 SERVICES-COMPUTER PROGRAMMING, DATA PROCESSING, ETC. Posted: Wednesday Nov. 19, 2008.Info
04:37P Lliam: And then the deductible gets huge Posted: Wednesday Nov. 19, 2008.Info
04:36P Lliam: yea, I'm thinking the same thing Posted: Wednesday Nov. 19, 2008.Info
04:36P Rosalind: I hoping I can keep my dental plan though Posted: Wednesday Nov. 19, 2008.Info
04:36P Justin:anyone know the SIC code for graphic design? Posted: Wednesday Nov. 19, 2008.Info
04:35P Rosalind: My last month will be December Posted: Wednesday Nov. 19, 2008.Info
04:35P Rosalind: You got that right Lliam Posted: Wednesday Nov. 19, 2008.Info
04:35P Lliam: This FIC ins takeover is going to be expenxive for me Posted: Wednesday Nov. 19, 2008.Info
04:35P Rosalind: but maybe you are seeing something I'm not seeing Posted: Wednesday Nov. 19, 2008.Info
04:34P Rosalind: I do not see where they are resticted it to NYS residents Posted: Wednesday Nov. 19, 2008.Info
04:34P Rosalind: Oh Posted: Wednesday Nov. 19, 2008.Info
04:33P David:Like I said, I'm out-of-state, so I don't think I qualify for the open enrollment Posted: Wednesday Nov. 19, 2008.Info
04:33P Rosalind: and fill in all the necessary informatino Posted: Wednesday Nov. 19, 2008.Info
04:33P Rosalind: you can click Go to the open enrollment form Posted: Wednesday Nov. 19, 2008.Info
04:33P Rosalind: Membership Home Posted: Wednesday Nov. 19, 2008.Info
04:33P Rosalind: On the home page Posted: Wednesday Nov. 19, 2008.Info
04:32P Rosalind: then click for open enrollment david Posted: Wednesday Nov. 19, 2008.Info
04:32P Rosalind: At that rate I've paid almost $6,500 dollars Posted: Wednesday Nov. 19, 2008.Info
04:32P David:Ok. I've already looked at individual Anthem plans and they have pretty respectable rates Posted: Wednesday Nov. 19, 2008.Info
04:32P Rosalind: It doesn't make sense for me to pay $450 premium - $1,000 deductible and co-pays Posted: Wednesday Nov. 19, 2008.Info
04:31P Rosalind: Presently, I have BCBS through Freelance but sadly in the beginning of the year I will be transfer to another policies due to the increase in premium and deductibles Posted: Wednesday Nov. 19, 2008.Info
04:30P Rosalind: David shop around Posted: Wednesday Nov. 19, 2008.Info
04:30P David:I have an insurance question. I'm an out-of-state new member (in VA) trying to get insurance coverage started. The GoldenRule freelancers union page is blank Posted: Wednesday Nov. 19, 2008.Info
04:29P Rosalind: Does anyone know
If you are a sole proprietor it is very easy to bill 20 hours to yourself - sole proprrietors can operate at a loss!
ReplyDeleteHave you received this from FU/FIC:
Important: For members enrolled in health insurance, if you have not yet selected your plan for 2009, you will not see a charge for it on this invoice. You will be billed for your new plan on the next invoice after you make your plan selection.
If you selected your plan prior to the 11/19 invoice, you will be billed for January coverage (plus any past-due charges). If you select your plan between 11/19 and 12/15, you will be billed for both January and February coverage on the 12/15 invoice. If you select your plan between 12/15 and 12/31, you will be billed for January, February, and March coverage on the 1/15 invoice"
So we are being penalized for thinking about our choices.
Then don't choose oxford. This is getting stoopid.
ReplyDeleteand FU/FIC can check your20hours or 10K threshold - when does the threshold kick in? Could they audit you in January? Under your could do anything scenario they could audit you January 2d. That's silly.
ReplyDeleteAnd You have such trust in FIC abiding by words when they have changed the rules some many times in the last week. best of luck with FIC and your leap of faith.
This surfaced on the FU membership home page--
ReplyDeleteDeductibles, Coinsurance, and Out-of-Pocket Maximums: A Guide for FIC’s PPO Plans
The below information applies to PPO 1, PPO 2, and PPO 3, not to the HD plans. Remember, when you use an in-network provider, your coinsurance and deductibles are applied to the provider’s negotiated, in-network rate, not the “retail” price.
Deductible (in-network): A deductible is the amount you pay out-of-pocket before your insurance starts covering you. There is no deductible for in-network doctor visits. The deductible applies only to facility (hospital) visits, both in- and out-patient. While you accrue toward your facility deductible, you will pay the negotiated rate, not the retail amount, for services. There is also a separate deductible for out-of-network services.
Out-of-pocket maximum (in-network): There’s a cap to how much you would ever have to spend on in-network facility (hospital) visits per year. Once your deductible and coinsurance payments reach this amount in a given year, FIC covers 100% of the in-network hospital charges for the rest of that year.
Coinsurance (in-network): Coinsurance is the percent you pay (of the negotiated rate) after meeting your deductible; FIC pays the remainder of the allowable expense. For x-rays and imaging, there’s coinsurance and no deductible. For facility (hospital) visits, both in- and out-patient, you first pay the deductible, and after that you pay only coinsurance. There is also a separate coinsurance and deductible for out-of-network expenses.
Imaging (in-network): Imaging includes x-ray, MRI, CAT scan, EKG, ultrasound, and other services. It is covered with coinsurance, and there is no deductible. For imaging that takes place during a facility (hospital) visit, the cost is covered as part of the facility visit. The amount you spend toward the imaging coinsurance is not counted toward your out-of-pocket maximum.
I think that it's good news, at least re diagnostic services if you're in a hospital being covered... my god it's complicated how did they possibly think they could transition w/o more explanation... I'm not sure they get it either...
ReplyDeleteDoes anyone understand the HD 5000 plan? If I am reading it right, you pay $5,000 (at negotiated rates?) plus a $225/mo. premium and then everything is free. I'm trying to figure out how that squares with PPO 1 where if you are hospitalized in patient or out-patient, you pay $4,000 plus $445/mo. plus lots of co-pays and co-insurance especially for expensive diagnostic and imaging tests, not to mention lots of co-pays.
ReplyDeleteIt says that it's not HSA Compatible--not sure what that means--that they haven't set up a FSA/HSA yet? Because I belong to a great credit union in Chicago (anyone can join) that
has an HSA getting 5 1/2% interest and it's tax-free money. They even give you checks, etc. Alliant Credit Union.
I've never even looked at a HD before this moment so I don't know the downside. At least what's the downside compared to Sara's other brilliant PPO offerings? Isn't it actually cheaper? And it doesn't seem like any benefits are lost.
Caroline, if you are posting, can you enlighten me?
compare -
ReplyDeletehttp://www.freelancersunion.org/insurance/new-york/health/index.html
An HD (High Deductible) plan doesn't cover anything until the deductible is met, then everything is covered 100%. Personally, I think the HD 5,000 plan is a great deal.
ReplyDeleteThe FIC plans seem okay. It's just the transition from the old POS to the PPO1 where there are major changes in cost and coverage.
I also have been struck by the HD seeming like a very good plan (if FU doesn't go out of business...) I'd love to see a guarantee from the NY Attorney General's office that if we're going to undertake this experiment for everyone we're not liable for the bills FU may default on.
ReplyDeletechatter transcript update
ReplyDelete08:36A Nancy:Must add: Freelancers Union not experienced as a company. Dread having togotothem towork out a claim. Amateurs all around. There outta be a law. There will be. Posted: Thursday Nov. 20, 2008.Info08:25A Nancy:Freelancers Union becoming an insurance company is what's wrong withthe present system. Overall--a catastrophe--what are we to do? We're stuck with paying . Totally agree; this is not genillus; it's Posted: Thursday Nov. 20, 2008.Info08:01A walter:Thank you HORROR-WITZ. For the past 10 days I think opf nothing but health insurance. You have made my life miserable. You are miserable. Enjoy your $170 G's per year. Posted: Thursday Nov. 20, 2008.Info06:43A Karen W: This is so distressing - horrible setbacks. If anyone else knows group rates out there please let us know! Posted: Thursday Nov. 20, 2008.Info05:43A Jane:I think this is a really bad deal, shame on you Freelancers Union. I did sign up for it, so it looks like I'm stuck for a little bit. Posted: Thursday Nov. 20, 2008.Info03:50A Michelle: Can anyone here discuss their experience with HSA? Posted: Thursday Nov. 20, 2008.Info03:15A Russell:Obama isn't going to be able to fix health insurance; the problem is simply that it is expensive. Only free markets and time can make it affordable by all. Posted: Thursday Nov. 20, 2008.Info01:24A Robert:A dumb question: If I sign up for a High Deductible plan, are my monthly payments included as part of the deductible? Posted: Thursday Nov. 20, 2008.Info12:19A Daniel:I agree. The new insurance plans have astronomical coinsurance and deductibles. THis is a giant step backward. Posted: Thursday Nov. 20, 2008.Info12:09A anne:Will our Guardian Dental coverage also be changed or elliminated? Posted: Thursday Nov. 20, 2008.InfoThursday Nov. 20, 2008
11:36P Peter:Can anyone recommend a good ENT doc? Posted: Wednesday Nov. 19, 2008.Info10:59P Douglas:Benefits Reduced, payments UP, Coinsurance AND Deductibles. these plans are no way near what the BC/BS plans were. very unhappy! Posted: Wednesday Nov. 19, 2008.Info10:00P David:Am I reading that right? Posted: Wednesday Nov. 19, 2008.Info10:00P David:It seems like the real killer of the new plan is co-insurance. You're stuck paying non-negligible percentages of what could be insanely high medical bills. Posted: Wednesday Nov. 19, 2008.Info09:43P Glen:any one know of editing work? Posted: Wednesday Nov. 19, 2008.Info08:01P william:anyone know where on website to sign up with your primary care physcician? Posted: Wednesday Nov. 19, 2008.Info07:59P Deborah:overhaul
I looked at the HD plan and I think it depends on your status and health - for us, if 2009 goes like 2008, the HD plan would require us to spend over $16K before anything was covered (and we will spend it, what all our Drs actually charge is terrifying), while the PPO2 will only run us about $10K. If something incredibly catastrophic happens and we are both hospitalized, yes, the PPO will be more, but if that happens, coming up with another $8K will be the least of our problems!
ReplyDeleteFU just posted this on their site on their blog, after the most recent of SH's comments... it is very reassuring in that Edith's interpretation (which would have been ruinous to anyone who was hospitalized), was a bit off. Not to blame her, who the h can figure this out!
ReplyDeleteFreelancers Union Says:
November 19th, 2008 at 10:00 pm
A few corrections to comment #18: The facility deductible, coinsurance, and out-of-pocket maximum apply to all services billed by the facility. Diagnostic testing, drugs administered at the facility, and surgeon fees included in that claim will have the out-of-pocket max applied. In-network doctor’s fees billed separately for inpatient care are covered at 100% of the allowable charge, including anesthesiologists. For all in-network services, the claim will reflect a discounted rate negotiated by the network. Additionally, bone density testing is covered at 100% of the allowable charge. For more information, sign in to see newly posted material on My Membership Home or contact Member Services at membership@freelancersunion.org or 800.856.9981.
Nathan again:
ReplyDeleteAlex - it sounds like you are eligible for the plans. A Schedule C reports 1099 income.
The comments about the 20 hours a week are probably poorly phrased on my part - I apologize for any confusion that has ensued.
The rule is that Oxford requires that you be a full-time freelancer, working an average of 20 hours per week. So even if you're over some weeks, under others, if you are working on average 20 hours a week you are considered a full-time freelancer, and then we go into the questions on how you report your income (W-2, 1099, etc).
In reality, this rule has no practical standard to be enforced under - Oxford has no minimum dollar amount of income that you have to earn to be eligible, so they can't use earnings in a year to see if you're making enough money, since $1 a year is enough money as long as you don't make more than .50 on a W-2. And since you're employed by yourselves, "working" has a wide range of defintion - someone I spoke with last night made the point that she might spend 60 hours one week marketing herself for assignments with no income to show for it, and then 10 hours on an assignment the next with a sizable paycheck. In application, this requirement goes along an honor system - Oxford's underwriters can't say you are or aren't working that much on average, only you can.
On the question about auditing, to the original poster, perhaps I misunderstood your original question, but my response is not how I intended it be received.
Oxford, as with any carrier (including FU) has the right contractually to audit your plan at any time, to determine that you are still eligible for these plans. Typically, an audit does not take place unless there is a large claim issue. If, in the course of your audit, that carrier determines that you are no longer eligible for their plans they are within their rights to deny payment of your claim, issue you a refund of overpaid premium, and step aside.
Oxford determines eligibility by your most recently filed taxes - again, for most of you the two pages of your 1040 and the two pages of your Schedule C. So, if you had a tax return for 2007 that showed you as eligible, you could enroll on a plan, and if Oxford had to audit you for a claim, this is how they would base eligibility. Because even if we were 6 months into the year and you had only worked W-2 positions, there is no way to say that you couldn't or wouldn't start again on 1099 and fall back into eligibility.
What I understood your question as being was what would happen at your plans renewal, if your tax filing status had changed and you were not reporting 1099 income on your 2008 return according to the guidelines as you had on your 07, which you used to apply. Oxford typically has not asked freelancers for their latest returns at the time of their renewal - so you would be able to continue paying for the plan, but you would technically be engaging in fraud, since you are no longer eligible for the policy. And Oxford would have the right to deny payment on claims if they did conduct an audit on you and uncovered this as the case.
I hope that cleared some things up for anyone concerned. Apologies again for anyone who has had any trouble getting their questions answered - we'll continue to try to keep up as much as possible.
Nathan,
ReplyDeleteI'm sure they don't pay you enough there. Do you want to head our new company?
For mediabistro: Does Oxford have a minimum that you have to make a year? I declared only about $15,000 last year and before applying, I'd like to know if it will be turned down.
ReplyDeleteYes, Nathan rocks! (although he may not be a rock star :-)
ReplyDeleteIt's not about salaries, it's about perks. Every year they give me a $100 gas card, you can't put a price on that.
ReplyDeleteThe Oxford plans have no minimum income requirements - as long as your W-2 income does not go over the income threshold when compared against your gross 1099 income (to calculate - take Line 1 of the Schedule C; W-2 income can't be more than 50% of that amount) you are fine.
Comment from Sara Horowitz posted to the petition signing thread
ReplyDeleteNovember 20, 2008 9:59 AM
Sara Horowitz said...
I'm sorry you feel like certain issues haven’t been addressed, despite my efforts to respond to your concerns. In addition to our e-mail communications and information on the Freelancers Union website, you are probably aware that I invited members from this blog to meet with me personally. I asked that you designate a group of people who can come to our office and talk about anything that’s on your mind. I have yet to hear from anyone. As you also undoubtedly know, we have scheduled a series of webinars where all members can have their questions answered. I hope you will join one of them.
November 20, 2008 10:37 AM
Anonymous said...
We would love to all come to meet with you, as many as could make it at a mutually convenient time--say a Sunday afternoon to maximize people's opportunities to make it? We've posted this all along, and to you, how can a small group speak on the fly for all of us; we don't even know each other... no time to organize or even understand this horribly complicated new model of health insurance... help Sara!
November 20, 2008 11:01 AM
Anonymous said...
Please Sara, we need official New York State assurances in writing that if you go under we are not responsible for medical bills FU would otherwise have paid
November 20, 2008 11:02 AM
Where do I find my 1099 income? I don't see it on my Schedule C, all I see is line 1. Line 7 was not filled in by my accountant.
ReplyDeleteSH on last year's "glitches" which are NOTHING compared to what she's done now...
ReplyDeleteevil nonprofits
Freelancers Union Founder Apologizes For 'Glitches'
By Maggie, 4:45 PM on Wed Jan 2 2008, 1,263 views
Freelancers Union founder Sara Horowitz wants everyone to calm the hell down please! "Health insurance is so central to a sense of security and I realize that this is making people feel really vulnerable, but if they could just know one thing, it's that they really do have health insurance coverage," she told us when we spoke to her this afternoon about the hue and cry raised by the union's membership over a recent change in their benefits. Passing Damage Control 101 with fairly flying colors, Horowitz copped to mishandling how the details of the union's recent health plan switch were circulated to members. "People are clearly frustrated. We really truly apologize for some of these glitches," she said. "It's really our obligation and for a lot of people, we've failed."
Previously: Freelancers Union Is 'Inconvenient Mess Of An Organization' Says One Member
Billed or not, in possession of an insurance card or not, Horowitz said union members who signed up are covered under the organization's new plan with Empire. Maybe so, but they won't receive insurance cards till the middle of the month and that's got some freelancers concerned. Those who might need proof of coverage before then should head over to the FU's website, where Horowitz has posted a mea culpa and more information.
"We really are desperately learning from this, especially trying to get information to people more quickly," she told us. "A lot of what people are saying is true. I wish our phone wait times were two minutes, that our call system was perfect." Huh! Maybe they picked up some skills from the Viacom boondoggle after all! The FU took about five hours to publicly address member concerns—Viacom took nearly as many days.
Read More: evil nonprofits, benefits, freelancers union, permalancers, sara horowitz, servicey
9 Discussions Classic view | Expand all Collapse all Start a new discussion Show: Oldest first | Newest first | Most popular 4:48 PM on Wed Jan 2 2008
In Other News...
4:48 PM on Wed Jan 2 2008 Lines like "We really truly apologize" makes us truly, madly, deeply love freelancers.
In Other News... Lines like "We really truly apologize" makes us truly,...
5:08 PM on Wed Jan 2 2008
SlimShadenfruede
5:08 PM on Wed Jan 2 2008 Glitches N' Ho's!
SlimShadenfruede Glitches N' Ho's!
5:11 PM on Wed Jan 2 2008
Moff
5:11 PM on Wed Jan 2 2008 I have to say that I finally signed up for Freelancers Union coverage this past month, which should have started yesterday (and has, I hope!). There was one hassle, which was that I submitted my original payment electronically, received an error screen, panicked and mailed a check, and then received a phone call telling me that the e-payment had actually gone through. Even that was handled well, though -- the rep I spoke to assured me that my account would be notated so that me check would be torn up and ignored, and while I can't be sure that will happen, it sounded like they were on top of it.
Otherwise, they got back to me within one business day every time I contacted them, and everything else went smoothly. I still wish the insurance were cheaper, but the Colonel pretty much says it all.
Also: Yeah, I do wish they'd bring the fucking comment-previewing back, I'm really happy to see M. Lawson on the masthead, and I don't really understand why Denton needs his name up top and at left (or why the number of posts in the past 24 hours should impress me). Mostly, though: Happy New Year, people!
Moff I have to say that I finally signed up for Freelancers...
5:14 PM on Wed Jan 2 2008
Moff
5:14 PM on Wed Jan 2 2008 @moff: See, 'cause one thing I would really have focused on fixing before I changed the other stuff would have been that part where you submit the comment and then you don't know if it will show up in three seconds or 15 minutes or never, or if you need to submit another complainy run-on sentence to make it appear. I would have fixed that. And I still would!
Moff @ moff : See, 'cause one thing I would really have...
5:24 PM on Wed Jan 2 2008
Moff
5:24 PM on Wed Jan 2 2008 @moff: Also I would have changed the part where the site crashes my browsers every third or fourth time I click a link or refresh. Glad to see that's back. However, as an indication of my increasing insanity, I also expected UPS to deliver a 2nd-day air package in under three business days and for Northwest Airlines not to screw up five out of six legs of my holiday travel, each in an entirely different way. As each day passes since I quit smoking weed, I begin to remember more and more why I started smoking weed.
Moff @ moff : Also I would have changed the part where the...
5:24 PM on Wed Jan 2 2008
Moff
5:24 PM on Wed Jan 2 2008 @moff: I did buy a really cool new coat, though.
Moff @ moff : I did buy a really cool new coat, though.
5:30 PM on Wed Jan 2 2008
mathnet
5:30 PM on Wed Jan 2 2008
@moff: HAPPY NEW YEAR!
mathnet @ moff : HAPPY NEW YEAR!
6:02 PM on Wed Jan 2 2008
FOUND ART
6:02 PM on Wed Jan 2 2008 This is very sad for freelancers since they don't really have anywhere else to turn. If my company did this to me, I'd leave. What can a freelancer do?
FOUND ART This is very sad for freelancers since they don't really...
6:38 PM on Wed Jan 2 2008
atipofthehat
6:38 PM on Wed Jan 2 2008 Maggie, when you finish fixing healthcare, please shame the world leaders into making peace for everyone.
PS
Also, could you reduce our dependence on oil? Thanks!
atipofthehat Maggie, when you finish fixing healthcare, please shame...
11:56 AM Got something to say? There are 3 ways to comment:
Thanks again Nathan for the very detailed clarifications of Oxford's eligibility - hopefully that will curtail the horror show of hypotheticals.
ReplyDeleteI just found out that some universitys' alumni associations offer insurance. Apparently Columbia's offers catastrophic health coverage; maybe others offer more. (If you're an alum, visit the Columbia web site's alumni sections.)
ReplyDeleteI don't want to rain on the I love Nathan parade, but I just looked at the Oxford application and it says, specifically, that you must work a minimum of 20 hours per week, not an average.
ReplyDeleteI think this happens quite a bit:
ReplyDeleteBlue Cross of California 'routinely' violated state law when it canceled individual health insurance coverage after policyholders got pregnant or sick, making no attempt to determine whether they did anything to merit such "harsh" treatment, according to a state investigation of practices that appear to be industrywide.
As a result of its unprecedented investigation, the Department of Managed Health Care on Thursday said that it had fined Blue Cross $1 million — an amount immediately criticized by canceled policyholders and consumer advocates as too small to matter to an insurer whose parent company, WellPoint Inc., earned $3.1 billion in profit last year on revenue of $57 billion.
Indianapolis-based WellPoint disputed the findings, saying it acted legally and that some rescissions are necessary to combat fraud.
The state investigation found that Blue Cross used computer programs and a dedicated department to systematically investigate and cancel the policies of pregnant women and the chronically ill regardless of whether they intentionally lied on their applications to cover up preexisting medical conditions — a standard required by state law for canceling individual policies.
Regulators examined 90 randomly selected cases of policy cancellations — out of about 1,000 a year in California — and found violations in each one.
'This looks like 'Rescission Inc.,' ' said Bryan Liang, director of the Institute of Health Law Studies at California Western School of Law in San Diego. 'It's clear if 100% of these individuals had their policies illegally pulled, that means that there's a problem. These are just the tip of the iceberg.'
Looks like if you don't work 20/hrs week oxford is not a good choice. ANy alternatives?
ReplyDeleteFor artists or creative freelancers there's also Fractured Atlas: http://www.fracturedatlas.org
ReplyDeleteThey've got some very affordable options that don't require minimum hours or income.
Stocks down record low since 1993 today. Any wonder we're all upset? Who can afford $445 a month unless you want to live in powdered potatoes. Now they are cutting our credit card limit or revoking our cards and raising interest rate to 32%. Anyone who pays only minimum a month, they are after those people. Very upsetting.
ReplyDeleteIn the "for what it's worth" file, subfile audits for eligibility: When I joined the FU plan a few years ago, I had some fairly complicated eligibility issues and wasn't sure I'd be accepted, but I was. Before I signed up and wrote my first check, I asked what would happen in a future year if I was a still a freelancer but no longer met one or more of the other requirements (industry, income). A real nice guy told me over the phone, "Once you're in, you're in. We don't ask you to keep proving your eligibility each year, and as long as you're still a freelancer, and you pay your bill every month, that's it."
ReplyDeleteIn those days the FU people were so helpful (maybe they still are when you're a new customer?) that I trusted him and didn't try to get this in writing. Has anyone ever seen or heard anything about this issue? If anyone ever has a problem with this, I'd be willing to sign an affidavit as to what Mr. Nice Guy said. I don't know if that would help you, especially if you joined when the rules were different (I know the rules have changed a bit from year to year), but it seems unlikely that FU would live up to its initials and audit you and throw you out -- at least not in the near future. It sounds to me as though they want as many people as possible to make FIC work.
But Oxford? I have no idea. I'd try to get Nathan to give some stats on how often his customers have been audited, how many have been thrown out, etc.
You should also take with a grain of salt what nathan at media bistro says. Is he an insurance broker? Does he earn a commission for each person who signs up? I'd hate to be doing battle with oxford and have to use the excuse that nathan said it was ok.
ReplyDeleteDid anyone check if yo can ask Oxford directly for the Sole Proprietor plan? If Media-Bostro is a broker, I guess Oxford can offer this same plan directly.
ReplyDeleteForgive my ignorance on the subject, but, what is the advantage of going with a broker and why did Gawker article wrote:
'...but you know people are getting desperate when they start writing things like, "I'm going to check out Mediabistro's insurance plans."'
Just wondering if there is anything I should know about Media-Bistro, they were indeed very friendly and helpful.
Nathan again.
ReplyDeleteAnonymous poster from 2:32 am - we don't track the information about if anybody has ever been audited; it's handled on Oxford's end and goes on without our knowledge unless we're brought in by the member for help.
Speaking generally though, I know that Oxford has not asked our members for tax documentation at their renewals. And since we've never been contacted by anyone saying that Oxford is requesting that information, I'd venture to guess it probably hasn't happened - since as we've said, no insurance carrier is likely to underwrite you unless you have a large claim issue, if I were a freelancer who just had a costly hospital stay and now Oxford was asking me for documentation, I would probably call myself right away to try to figure out what's going on.
That is strictly conjecture of course. We do know that over 95% of the people who have registered with Oxford over the last year and a half are still enrolled with Oxford, for what that's worth.
But I mainly came on to post two more points that people are concerned about that I'd noticed.
First - these plans for sole proprietors are considered group policies. On a New York group policy, pregnancy can not be considered a pre-existing condition. I know there are a few people who are pregnant right now who might be interested in that info.
Second - we've had a few questions from people who are concerned about how they'll know that they're approved for these plans. That one is a bit longer to explain.
Most applications take about 2 - 3 weeks to process, in terms of entering member information into the system of the carrier and generating and mailing out ID cards. With the holidays, it could be even more.
But insurance in New York is guarantee issue - when you submit a completed application with the necessary documentation, you can not be denied your policy for any reason. Generally speaking, unless your situation is more complicated than the comparison of the Schedule C against the 1040, we can usually determine if you are eligible within a few minutes of having your applications in our hands.
Then we will be able to submit for the effective date of the 1st of whichever month you are interested in joining. Even if your applications go beyond that date to process, you will not be uninsured at any point. Oxford will enroll you retroactively to the first of the month and assume responsibility for any expenses you may incur during the small gap where your applications were in processing.
I'm happy to talk with anybody who's concerned about this information - our favorite policy is to remain open; our biggest fear is somebody angrily call us feeling misled or misinformed.
Gawker just likes to make fun of media bistro, I wouldn't worry about that.
ReplyDeleteAs for the eligibility issue, the oxford application does say that you are not guaranteed coverage and that you should not cancel your other policy, just in case. Maybe this is a moot point in new york? Probably worthwhile to contact the insurance company directly. This contradicts what Nathan says above:
The Applicant hereby acknowledges that this Application does not constitute any obligation by Oxford to offer coverage to the Applicant until such
Application is accepted, in writing, by the Home Office of Oxford. The Applicant hereby confirms that it will not cancel any current health coverage it may
currently have in anticipation that this Application will be accepted by Oxford, and that Oxford shall have no obligation to provide coverage to the Applicant unless
this Application is formally accepted, in writing,by the Oxford Home Office.
Ooops - Nathan back again so soon. And slightly hurt, but I accept your concerns.
ReplyDeleteWe are licensed New York Life, Accident and Health insurance agents. We're independent insurance agents, it's a family business going back to the 70's (I'm not part of the family). We are not aligned to any one insurance carrier, our loyalty is to the people who contact our office looking for accurate information.
There is a commission built in to the rate you as a member would pay every month. It's there regardless of if you work through our office or directly with Oxford.
Now with that said - I generally take personal hurt at the insinuation that I, or anyone in our office, would somehow try to beguile or mislead anyone into signing up for a plan that is not right for their needs.
We want you to be as informed as possible before you pursue any option. Earlier this week we sent out notices to countless freelancers, including many on this board, urging them to consider the possibility for locking in to 4th quarter rates which will actually lower our potential commissions, rather than waiting until January 1st to pay $40 a month more for the same plan. Earlier in this posting even, I made a point to mention a benefit I felt had been neglected from conversation, for fear that it might unfairly impact someone if they weren't aware. We've sent out benefit summaries, fielded calls, researched questions, etc. I am not here to smile widely and promise you the world - I'm here to answer your questions honestly from direct experience and knowledge, and I try to make sure you know everything you need to know before you commit to something.
Ultimately the advantage of working with a broker is something I feel is significant. You have legitimate professionals who have spent years of their lives examining this information, you have a neutral third party outside of Oxford to help you with examining your case if you ever had an issue, and in reality there is no added cost to you since you'll pay the same rate for the same benefits if you go directly to Oxford, with no assistance if you do ever run in to an issue with your benefits.
So what happens if we are awaiting Oxford's approval (after signing with MB for December starting date) and we have an accident in December and have not paid FU for December? And then Oxford turns our application down? Nathan, if you can answer this, much appreciated.
ReplyDeleteI don't think anybody is out to insult you nanthan. i'm sure you're a nice fellow. Can you address the discrepancy between what you say about not getting turned down for oxford coverage and what it says in the application?
ReplyDeleteNathan,
ReplyDeleteI think you're fabulous and I WISH SH understood how she needs people like you. She's just WAY over her head.
That said, I don't think I qualify for media bistro at this time, and I do think the high deductible FU plans look good (to me); for peace of mind...
ReplyDeleteTo add to Robert question -
ReplyDeleteI would like to know if it is possible to have double insurance in December. It would be cheaper to lock December rates with Oxford, while still having BC/BS, so we have no risk of staying with no insurance.
I do have some important tests in December and I want to make sure that if I'm covered with 2 health plans at the same time, they will not try to throw the claim at each-other and I will be "uncovered".
Another question - I got the summary of benefits from Oxford, and I do not see any mention of X-Ray and imaging tests
i'm particualy interested in
ultrasounds
nuchal translucency
and Amniocentesis
are these fully covered if done in-network?
Thanks a lot for all your answers here!
I don't know Nathan, or mediabistro, but I appreciate his honesty and commitment to sharing information with FU members as well as transparency as regards his work as an insurance agent. While he does receive a commission, keep in mind that ALL insurance providers, including FU/FIC take some fee/percentage off of the premiums that we pay. Not surprisingly, this is how insurance agents make a living.
ReplyDeleteThe thing to keep in mind is that there is no guarantee that the insurance agent one uses is diligent and knowledgeable about the particular concerns of self-insurers, particuarly independent workers. Some, like me, don't qualify for mediabistro plans because I don't have the right ratio of W2/1099 income. A good insurance broker will help to explain that, and through a combination of asking questions about my needs and financail resources, and their knowledge
of several lan options can help me make a good decision. As independent workers we don't have a Human Resource person to help us with this, or an annual visit from an insurer like BCBS or Oxford to answer our questions and counsel us. As many have noted in our complaints, we don't get these services from FU, and we need to question WHY and WHY NOT incorporate this issue in to their education and advocacy efforts.
In FU's favor, they support independent workers such as temps, part-time unbenefited workers, and folks that work consistently in filed that traditionally do not offer benefits, even as they cover taxes for those employees. We do not pay a higher rate for SS, or the unincorporated business tax, but remain without benefits. We're part of the 30% of Americans that are working without employers covering us or our dependents.
All that to say that we all do not have the same options, and while FU has FUpped, we need to work together to make sure that we all do the best we can as we move forward in search of affordable health care. I stress health care because the real issue here isn't how much we pay for our premiums, but what the costs are for actually getting the care we need and ensuring that we have the best insurance to cover those costs.
In ending, I'd like to say that I think Nathan is doing an admirable job of steeping into the fray and helping out, and I won't begrudge him the commisions that he may make. There is a price to pay for good and knowledgable help.
(We might want to prod Sara on that "good and knowledgeable help" thing, by the way."
I don't think anybody is saying that Nathan doesn't deserve to earn a commission. He clearly does work hard. But like everybody else who works on commission, be they car salesmen or stock brokers, you need to go in with open eyes.
ReplyDeleteWas FU honest and open when they signed up poor pregnant Mirit and Yoav only three weeks ago?
ReplyDeleteI an glad Nathan is an insurance broker. At least then he knows what he is talking about. The people manning the phones at FU member services have no idea what they are talking about and have told me incorrect information regarding coverage.
I choose the person who makes a living from Insurance versus the one who is in the customer service business.
The choice you make is solely yours of course.
An awkward Nathan - didn't mean to sound upset at anyone, perhaps just went a tad on the defensive!
ReplyDeleteBut Robert,
With guarantee issue a completed application can not be denied for any reason. There's no sort of medical examination; your age, gender, etc play no part in your eligibility. It's all based off your tax filing status - if your tax return shows you as eligible (I've made a few posts in the past to explain how to determine eligibility in most cases) you can not be denied the policy.
So generally, unless we have a members most profound assurances that they are going to get us the missing piece of the puzzle that will show that they are actually eligible when what they've provided to date does not show that, and we must submit an application in order to act as a placeholder to preserve your desired effective date, it never comes to the point where an ineligible person is submitted to Oxford to be reviewed and then denied. Because within minutes of having your completed application in hand we can look at the lines of your tax return to confirm if you are eligible. If you are eligible, you can not be denied, even if you're 90 years old and smoke five packs a day.
In regards to what would happen if you registered for a plan for December 1st, and your application was not finished with processing until December 3rd, but you were rushed to the hospital on December 2nd - when Oxford completes processing your application you will be enrolled retroactively to December 1st. So, you were insured on December 2nd, even if the processing was after your initial date of service. Claims would be submitted retroactively, and presuming all processes as it should Oxford will handle your claim as though you rushed into the hospital with your ID card in hand on your initial date of service.
Now - the boilerplate on Oxford's applications. The formal acceptance lines refer to the processing time that the applications go through - when an application is received it goes through underwriting in accordance to NY law to determine an individuals eligibility; when this is confirmed and the enrollment is processed a formal welcome letter goes out. But again - eligibility is guarantee issue based on your tax filing status. Nobody at Oxford can receive an application from someone reporting their income in a manner that makes them eligible and for any other reason refuse them the policy.
I hope that helped to clear things up.
Adding on to the replies thta have been posted since I started typing!
Double-insuring is possible - it will almost certainly cause at least some back and forth between the insurers to determine who is going to be the primary payor on a claim, but it's an option.
There are lines for laboratory services and radiology services on the benefit summaries, and those would probably correlate to what you're asking about. If you have the specific CPT codes that your provider plans to bill under it's possible to confirm more specifically what the procedure is considered, but the name of the test probably won't go very far.
anonymous, I am in absolute agreement, which is why I applaud Nathan for being transparent about his status as a broker--and that it is his benefit to have more customers, and to keep them, which means he might be more invested in making sure they leave with a policy that they are happy with.
ReplyDeleteSome folks HAVE indeed made it seem that they shouldn't trust insurance brokers--my argument is CHOOSE WISELY. At the end of the day, though, the only person who knows my best interests is ME. We need to do our own due diligence, or have someone trustworthy do so on our behalf.
The fact that we haven't had our eyes open is why FU has been able to blindside us twice within the last year. The freelance life is hard, and I know personally why we can't always be on top of things, but that's why we should push FU to change, whether we stay on the FIC plans or not. While our eyes are open, let's make a difference. What if we had continued to push for member oversight last year? To push for a member advisory board? Could they have sprung this on us at the last minute? Would they have at least done some of the commonsense things we have asked for, like extended hours (both early and late) to answer questions; clear comparison charts; transparency about the leadership of both FU and FIC and their viability?
There has been a certain amount of smack talked about Sara and FU because they, too, make a commission on their sales, or because of their decision to open FIC. But that's not the real issue--the real issue is that FU/FIC does not have the capacity to work with members and doesn;t undersatnd the real, on the ground issues that we are currently facing. That can and should be addressed.
I am not eligible for MB. So, I am pretty stuck with FU (angry as hell but stuck nonetheless). Given that FU is unwilling/unable to negotiate with BC/BS, and all the plans they offered suck, I was wondering whether we can press FIC and their actuarial pukes to price out a truly comparable plan to BC/BS POS. Call it FIC POS or something. It would likely be even more expensive than the PPO1 but I would be willing to pay a little extra for the peace of mind and put an end to the agony of past few days.
ReplyDeleteokay, response I just got from FU.... now trying to also make sure outpatient surgery has that maximum out of pocket annual cap... my brain is so hazy about all of this...
ReplyDeleteWe apologize for the confusion. Yes, when diagnostic imaging is done as part of a hospital stay, it IS subject to the annual out of pocket maximum.
Please contact us if you have any further questions.
Member Services
Freelancers Union
Tel: 800-856-9981
Fax: 877-707-3576
Email: membership@freelancersunion.org
www.FreelancersUnion.org
Nathan and his staff have treated me like a family member through this ordeal. I imagine that they are very overworked right now and are still taking as much time as we need to answer questions. So what if they make commission? It's a business, they should! Thank you for being so thorough.
ReplyDeleteI do think one of the biggest holes in the new ppo might be if there is no annual maximum out of pocket cap for outpatient surgery. It's on the second page, and doesn't look promising! That would be a huge exposure.
ReplyDeleteThat's an answer I think we all need, clearly... (try parsing that recent definition addition at FU, it still isn't clear... at all..)
jeez, people. don't get your britches in a bunch. nobody is saying nathan should work for free. he makes money for every person he signs up. do with that information what you will. and my family doesn't make any money off of hugs.
ReplyDeleteHello Freelancers,
ReplyDeleteWow, I have gotten a nuber of calls with people who had questions, but I was not aware of the level of panic. In the interest of full disclosure, I am an licesned independent insurance agent and the Reccommend Benefit Provider for the Manhattan Chamber of Commerce. I was invited to this blog to help provide answers & alternative to people who must renew their health insurance on 1/1/09. The Manhattan Chamber offers 8 Oxford Plans & 6 Atantis plans to Sole Proprietors . We too have experienced a 17% increase, but decided to continue to offer all of our options without any reduction in benefits. 2009 pricing for both Oxford & Atlantis in now availalbe on my website. I found everyone's comments informative & useful & stand ready to assist people during this tough renewal period.
Eric, please send your website address in this "post a comment" section. Can't open the link from the profile line. Thanks.
ReplyDeleteall please post here at the wnyc comments--this is a much wider audience
ReplyDeletehttp://www.wnyc.org/shows/bl/episodes/2008/11/21/segments/116265#comment77259
I'm sorry the link isn't "live" but someone posted it live at chatter on fu website (I would make it "live" here but I don't know how to do that...)
Sara Horowitz, FU's Founder & Executive Director (and now, conveniently, President & CEO of the new Freelancers Insurance Company) was on the Brian Lehrer show this morning (unfortunately Brian himself was off today) discussing the topic of Freelancer security and I was not the only one to notice and point out the hypocrisy of it, considering how Sara and FU have just made many of us freelancers much less secure for 2009...
ReplyDeleteMy comments on the WNYC website can be found here: LDNY from 11201 ( http://tinyurl.com/6zs92s ) and there are comments on Sara's own Blog (her posts feebly attempt to explain and excuse this horrible thing that they have done to their members) on the FU website: https://be.freelancersunion.org/blog/ -- if you feel as strongly as I do, please leave your comments on those sites, as well as here.
So Oxford just released the Manhattan Chamber of Commerce rates for our sole prop health plan renewal. The new rates for the 8 plans are valid from 1/1/09 to 12/31/09. The increase is painful at 17% which is on to of the NYS DOI approved 115% premium we pay being an association plan. You can find the rates on my website www.pscinsurance.com. We offer a full range of Oxford offerings including Freedom POS, EPO and Cost Share options as well as similar choices in the more cost effective Liberty Network. We also have both refferal & non-referral choices.
ReplyDeleteWe did not cut our benefits & preferred to allow our members to change their own coverage based on their individual needs. This year, we added 6 Atlantis plans as cost effective alternatives for certain clients. Younger clients looking to establish new relationships with Atlantis Drs do well with Atlantis. People looking to use the plan strickly on an out of network basis are destine for disappointment. They also have 5 Atlantis Medical Group Facilities that offer all services at no co-pay.
Membership in MCC is $195/year
I heard mostly bad things about oxford and these plans suck.
ReplyDeletehttp://insurance.freeadvice.com/reviews/126/
I hate to say it but FIC seems more attractive with the BCBS network and the drug coverage.
...also the $200 annual membership fee?
ReplyDeleteah?
Mediabistro - a for profit - got bought by jupitermedia for $23milion- jupitermedia has some major losses this year - http://finance.google.com/finance?q=jupm
ReplyDeleteThey are going to cut back on operations etc. What will happen if they stop offering their plans? where would we go?
"Our Online Media division continues to be impacted by the economy, which has put pressure on our advertising and job board sales. We have, however, made progress in reducing operating expenses, specifically with our costs of sales and general and administrative expenses."
Whoever heard bad things about Oxford--I had great experiences with them, largely once I discovered that many Col. Presbyterian md's participated (I think they actually paid them better than some of the other mds; a "deal" was negotiated, I believe someone told me) anyway they were/are great mds, check for who they have at 10032 zip and if it has the col. presb. switchboard phone # (305) or such (then, you can further often schedule these guys at the e. 60th office; but at least you immediately know they're part of col. presb.)
ReplyDeleteI am looking into getting the BC/BS HMO through healthyNY and I am trying to understand the differences between the HMO and The Oxford Exclusive Metro.
ReplyDeleteIs this plan (HMO) not recommended? I know HMOs are considered to be inferior plans, but since I do want continuation with BC/BS I would rather take this plan than the Oxford one. Can someone point me to some cons and pros to help me understand better the HMO vs. the Oxford Exclusive Metro? They are both only In-Network plans... Anything I should know before I make a decision either way.
Thanks!
If you had our insurance through Freelancers Union (or any insurance in the past 12 months), you cannot get Healthy New York. That's what I have been told by them...or else everyone would do it, it's so cheap! If anyone knows differently, please post.
ReplyDeleteWe had a long talk with them and they say we might be able to get it since FU is not offering the same plan anymore.
ReplyDeleteThe woman we spoke with was very optimistic about FU switch considered as a termination of an insurance.
It is cheaper, and worth trying to apply.
But is it a good plan?
I had asked this on another thread but didn't get any response -- on the FU HD option - the one with a 5,000 deductible, it seems the out of network benefit is 50% co-pay but no cap -- if I understand this correctly, if you are really ill and need specialized care out of network, you will have to pay half of all your costs -- this could totally bankrupt someone. Am I reading this correctly?
ReplyDeleteI think you are, alas... it's a good point, but I guess, hopefully, you can find a good bcbs specialist? the other problem seems to be 30% coinsurance on pres. drugs?
ReplyDeleteHealthy NY is a great plan, and while not cheap at about $300 a month for Oxford in Jan 29, it's better than Cobra prices, and the plan covers a lot more than what FU will. If you qualify, it's a great option and yes, they will accept you, even if you were on the FU plans, if you meet the qualifications. See the web site for more info on plans and coverage. Google Healthy NY for address. I would encourage applying if you meet the income requirements. I heard back within a week.
ReplyDeleteI am calling these guys tomorrow about their Oxford and GHI plans-
ReplyDeletehttp://www.nysbg.com/
Their Oxford plans seem comparable to MediaBistro's.
FOR EVERYONE CONSIDERING MEDIABISTRO or OXFORD PLANS:
ReplyDeleteI just got off the phone with Total Capital Planning, which is the outfit that handles sole proprietor insurance for MediaBistro.
I will not be going with the Oxford plan, even though I want to because I will not be able to pass an Oxford audit if they conduct one. Here's why: they will only cover freelancers who work 20 hours per week or more. Even though I work more than 20 hours per week, I do not *bill* 20 hours per week, and so I have no auditable proof that I'm eligible for Oxford. I could start documenting my time this year, but that wouldn't cover me for last year, when I had no idea I'd need such records.
So even though I made over 60 grand last year, Oxford won't consider me part time employed because I can't show my billing as such. Thought I'd share this in case it helps anyone else.
To the last poster: I have my own business which is cash (some checks) and also would not be able to prove anything except by getting letters from my clients. Can't you do the same?
ReplyDeleteI think the MB Oxford 20 hour minimum is a total bummer. I would have chosen that plan, but it seems to me that you're giving them a blanket out if they decide they want to cancel your insurance. If I need insurance because I'm sick the last thing I want to do is have to prove to Oxford that they shouldn't have canceled my policy. The whole thing seems fishy to me, especially since Nathan says one thing on this board (you only have to work an average) and then other people talk to him directly and get another story.
ReplyDeleteEdit: Poster from 9:24 am. This is Nathan - the guy who's been posting all through here. I tracked down who gave you that information from our office - and I'm sorry about the confusion. We've had to pull in people who generally specialize with small business insurance to help with fielding all the calls, and while what they told you would be correct if you were an employee of a small business, for a sole proprietor there is no way to determine your eligibility in an audit other than your most recently filed taxes. I've gone over the guidelines some in previous posts, but if you'd like to call back at 212-879-0122 and ask for me specifically. I'll try to run through eligibility with you very quickly. And to 9:47 - I'm sorry if I've seemed inconsistent in my replies to you, but it's very hard to make a blanket catchall response to hundreds of different people with different situations, since no two are going to be the same.
ReplyDeleteAnd back to the original post. Hate to sound salesy in any form of the word, but as a reminder, anybody who wants to be able to lock in with the 4Q08 rates would need to have applications in our office by tomorrow. Obviously if you're not ready to make a decision yet there are always effective dates for the 1st of every month, but the premium will be going up a bit. Since we have started receiving applications since Friday I'm just wondering - does anyone on this board know definitively if you are able to terminate from the Freelancer's Union and get a refund for your premium?
And just to address a few points since there seems to be some more discourse:
-These plans are not contingent on the success of Mediabistro. They are contracts between Oxford and the specific member; so even if Mediabistro were to close tomorrow nobody's policy would be impacted in any way.
-Healthy NY is a state aid program mandated by New York to be offered by all insurance carriers in NY that market HMO products, which is almost all of them. If you meet the income and eligibility guidelines, the plans offer fairly decent coverage - co-payments for doctor/hospital/lab services, access to largely the same network as conventional group policies, etc. But Healthy NY brings the premium down from other insurance plans by virtue of not being required to provide some of the mandated benefits that group plans must offer. Things like chiropractic care, mental health coverage, and physical therapy are just a few of the benefits that are mandated to some level in NY, but are not covered, or only covered on a more limited basis on Healthy NY. The biggest limitation though, is prescriptions. The richest prescription benefit you can have with Healthy NY has a $3,000 maximum benefit per year. The plans also require referrals from your primary care physician to see a specialist, which is not a feature of any of these Oxford plans for sole proprietors.
I'm officially overwhelmed by this decision. And the whole act now or you're going to pay more later is not helping! I'[m starting to get a bad vibe from MB. I do work at least 20 hours a week, but what happens if I suddenly don't? Can any of us guarantee our work with continue unabated for a full year? We are under obligation to tell oxford if our cirucmstances change, and then what? We have to find a new policy?
ReplyDeleteHealthy NY HMO has an annual recertification process and you have to requalify each year. You will loose your coverage if you don't meet their eligibility requirements again.
ReplyDeleteNathan:
ReplyDeleteIt sounds like some of us are concerned/confused with the 20 hour minimum. Can you get something in writing from Oxford that says we will not have to provide any information other than a tax return if they audit us? I know that would put my mind somewhat at ease. You could email it to the administrator of this site and then he/she could post it and we could print it out.
10:09 - I apologize; no pressure is intended, there will be no benefit difference between starting on December 1st versus January 1st, only a difference in price. As I've said before, I really don't want to do anything but make sure that everyone has all the information possible available to be comfortable with their decision. To return to the 20 hours question - this is a copy paste from an 11/20 comment I left at 10:10 am:
ReplyDelete"The rule is that Oxford requires that you be a full-time freelancer, working an average of 20 hours per week. So even if you're over some weeks, under others, if you are working on average 20 hours a week you are considered a full-time freelancer, and then we go into the questions on how you report your income (W-2, 1099, etc).
In reality, this rule has no practical standard to be enforced under - Oxford has no minimum dollar amount of income that you have to earn to be eligible, so they can't use earnings in a year to see if you're making enough money, since $1 a year is enough money as long as you don't make more than .50 on a W-2. And since you're employed by yourselves, "working" has a wide range of defintion - someone I spoke with last night made the point that she might spend 60 hours one week marketing herself for assignments with no income to show for it, and then 10 hours on an assignment the next with a sizable paycheck. In application, this requirement goes along an honor system - Oxford's underwriters can't say you are or aren't working that much on average, only you can."
I'm not sure if this answeres your question, and I believe I may need to step aside from this blog for a while - I may be spreading more confusion than intended by posting here answers to specific hypothetical situations where there can really be minute differences that impact the answers.
While I'm happy to help with any questions, it's probably best that you contact our office at 212-879-0122 or e-mail me directly at nathan@myhealthplans.com and I'll do my best to help answer your questions, specifically.
Re the W-2 vs. 1099 issue, Oxford's policy is sadly behind the Times and it's unfortunate MediaBistro doesn't seem to realize this either. There are a growing number of places that require you to be paid on a w-2, even as a part-time freelancer. My percentage of w-2 vs. 1099 has been growing and is now over 50 percent, even though i don't recieve health benefits from the places i get paid with w-2's. Nor, because of this 50 percent policy, am I eligible for Oxford. So much for Media Bistro's freelancer advocacy.
ReplyDeleteTo Nathan: For those of us who didn't pay FU for December and joined Oxford through you starting December 1st, what happens if we have a medical emergency from Dec 1st until we get our official cards or numbers? What would we tell the dr or ER? Who do they call?
ReplyDeleteI am the person who posted the 9:24 comment about Oxford's 20 hour per week requirement.
ReplyDeleteI am waiting for additional info from Nathan @ Total Capital Planning to work this out, so I encourage EVERYONE who is considering making the change to MediaBistro/Oxford to make their decision only after speaking with a rep at Total Capital Planning. Don't rely on the blog as everyone's situation is unique.
Also: I just got off the phone with Freelancers Union regarding refunds. If you are planning to switch to another insurance plan in December, you can get a refund of your December FU insurance premium AS LONG AS YOU NOTIFY FREELANCERS UNION BY NOVEMBER 30 that you are terminating coverage. The FU rep advised me that the procedure to terminate coverage and get the refund is:
Send an email to benefits@freelancersunion.org stating:
-your name
-your member number
-advise them that your are terminating coverage as of December 1
-provide the reason for termination
-advise that you are requesting a refund of the December 2008 premium
Of course you should stay on top of FU to make sure the $ comes through. Best of luck, all.
FYI: I work with a number of members from the freelancers association, helping them secure health insurance. I have a number of products available for sole props. We work with many associations and self employed individuals. Please give me a call at 1-800-427-5358 ext 172, or send me an e-mail at steveg@nysbg.com. Or you can contact my assistant Cheryl at 1-800-427-5358 ext 105 or e-mail Cherylk@nysbg.com. Thanks.
ReplyDeleteFor all of those concerned about qualifying for health care coverage with inconsistent hours, minimum income or future workload, you may want to consider changing your tax filing status? If you become an S-corp. you qualify for insurance based upon your K-1 income which could be negative?
ReplyDeleteIt’s a “pass-through” income tax status so your Federal or city rate will not change. Still, it a major restructuring & requires sound business planning, advice & long term thought.
A few pros:
We NOW have an employer based health care system. It give you access to Oxford & other carriers based on your corporate status rather than you annual income or billable hours?
If you have a spouse or partner that you work with, an S-corp. moves you into the small group market & out of the Sole Proprietor heath care dilemma?
Retirement Age: If you have 10 year or more to be eligible for Medicare, consider taking more control? Our health care system is due for an over haul. but where is it on the new administrations crisis list? If you were both an individual/ sole proprietor as well as a small business could that create more options for you while we wait for the politicians to get to our challenges.
Corporate status provides a level of insulation between you and your business. As a sole Prop, “you are the business” and as an S-corp. you can separate your personal ownership & liability from what you do for a living
A few cons:
Cost of establishing your business: The web, your CPA or Attorney can all help you establish an S-Corp or LLC. It’s generally in the $200 to $1000 range depending on your level of support.
Tax Returns: Your business must file its own tax return! It costs an extra $100 for corporate tax filing fee, plus the prep cost of the return which is done in conjunction with your personal return.
Final Comments: It extra work & costs a bit more money to shift from a sole prop to a one person business. There are other issues too, but too keep it to the point, the merits truly work for an increasing number of growing NY businesses who need the flexibility that an S-Corp or LLC can offer. If you are a viable business in it for the long haul then make the investment in yourself & develop the trademark you created.
My view is certainly biased. I want people to have access to any& all health insurance options available to their peers. Telling people they don’t qualify for coverage because they don’t have the right forms is maddening.
Other alternatives for Sole Props to the FU Empire, Chamber Oxford, Chamber Atlantis and MB plans are the LIA plans.
For Sole props they have Perfect Health HSA, HIP & a think GHI offering which has been rebranded.
Here is there link & I would be happy to assist you in investigating this option based on your request. http://www.liahealthalliance.com/ent_rates.asp
Be Well,
Eric
eric@pscinsurance.com
212-645-1222
It would be great if someone could skim through posts scattered here and on FU site and add to this list so options are in one place under FIC Alternatives. Julian’s first post on top has some links.
ReplyDeleteIn addition to posting other links you've seen on the blogs, maybe some of you have come up with other individual plans or know of brokers who you like and have had a good experience with. Please add them there.
PLANS:
SEEMS LIKE EMPIRE DIRECT POS IS ALIVE:
http://www.empireblue.com/wps/portal/ehpemployer?content_path=employer/noapplication/f4/s8/t0/pw_ad067540.htm&rootLevel=3&label=Benefit%20Summaries
BC/BS AND LOTS OF OTHERS:
http://www.individual-health-plans.com/empire.htm
OXFORD PLANS SIMILAR TO MEDIA BISTRO:
http://www.nysbg.com/images/oxford/oxfordforms.html
MANHATTAN CHAMBER OF COMMERCE PRICEY, BUT LOTS OF OXFORD PLANS—INCLUDING OXFORD FREEDOM PLANS WHICH I’VE HEARD ARE BETTER THAN LIBERTY FOR WIDEST CHOICE OF DOCTORS AND HOSPITALS:
(see Eric's post above)
http://www.pscinsurance.com
OTHERS WE KNOW:
http://www.mediabistro.com/insurance/download/mediabistro-crosscarriercomp3q08.pdf
http://www.nyhealthinsurer.com/healthy_new_york/
http://www.nyc.gov/html/hra/downloads/pdf/OCHIA_insurance_plans.pdf
http://www.ins.state.ny.us/chealth.htm
http://www.liahealthalliance.com/enterprise.htm
To Nathan: I posted a question yesterday and didn't receive a reply. Could you tell me what happens if we need medical care between Dec. 1st and when we receive our Oxford card or numbers? I dropped FU and want to know that I would be seen with no card in my hand. Thank you.
ReplyDeleteNote from Carolyn: I started this comment on Friday as a comment on the "Petition" post -- I should have posted it here instead. Then I stopped in the middle because Sara Horowitz was on WNYC, and I didn't have a chance to pick up again until now. I like to finish what I start, so I've returned here today.
ReplyDeleteI'd also like to add that I may not be able to post very often in the future. I've spent so much time on all of this in the past two weeks -- although for the past several days I've been doing more "off blog" rather than "on blog" -- and I have to catch up on other aspects of my life. With all the hundreds of comments now posted both here and on Sara's blog, I need to be able to focus on the info that pertains to my own situation, as well as the comments from people I think I might be able to help. But neither this blog nor Sara's is organized in a way that makes that easy, and, as important as my health insurance is to me, I just can't keep devoting so much time to blogging.
Also, while I think we needed a place to express our anger and outrage in the early days of this blog, I'm a little disappointed that so many people are still venting so much of the time. I really wonder if there's anything new to say on the outrage front, but I'm sure there's a lot left to say on the practical info front. (Having just said that, I realize that a lot of the anger and outrage may be coming from people who are new to the blog, and I really do sympathize with them.)
Finally, I'm discouraged by my personal situation, and it looks as though none of the alternative plans will work very well for me, except possibly a sole proprietor Healthnet HMO plan that I learned about through an insurance agent. I haven't posted info about that plan or that agent because it looks likely that the inpatient hospital coverage is in some respects even worse than the coverage in PPO 1, so it probably doesn't have the safety net that we're looking for. But if I find that the hospital coverage is OK after all, I'll be sure to let you all know about the plan because I think it's a better plan than PPO 1 in many respects, even though the cost is $517 a month.
It's likely that I'll end up enrolling in PPO 1 in early December to ensure that I receive an invoice for Jan-Feb coverage by Dec 15 -- for tax purposes, I want to pay for that coverage before the end of the year. But I'll remain on the lookout for other plans that might meet my needs better and still be relatively affordable.
Good luck to everyone!
And here at last is the comment from last Friday, for what it's worth:
BE SURE TO DO ALL YOUR HOMEWORK BEFORE SIGNING UP FOR MEDIA BISTRO'S OXFORD PLAN (OR ANY OTHER PLAN)
I know that Nathan's a great guy, and that he's even received at least one marriage proposal somewhere on this blog, but I urge everyone who's planning to enroll in MB's Oxford Exclusive Plan Metro #2 ("the Oxford plan") to look before you leap. Maybe you're not concerned about keeping your current doctors, or maybe you've called all of their offices and are confident that they'll accept the Oxford Liberty network, but if that's not quite true, please read on.
While waiting to find out if I was eligible for the plan, I decided to do a little research on the Liberty Network. And as a result of my research, the Oxford plan looked far less attractive to me.
Before I get too far into my own situation, I want to add that I think the Oxford plan can work very well for some people. A good friend who is a real estate agent and independent healthcare consultant -- and who is neither an FU member nor an MB member -- switched to the Oxford plan, which she obtained through an independent insurance agent, earlier this year. She made the change because the plan was more affordable than her previous plan and was accepted by all her doctors in Manhattan (or at least all the doctors she really cared about). And she's been happy with the plan. And I know that some people here have said there are great doctors at Columbia Presbyterian who participate in the Network (but that part of town isn't easily accessible to me).
In my case, my research started with the Internet. My doctors are all NYU-affiliated. While their practices don't like to post anything about insurance plans, their faculty bios on the NYU Medical Center site list the plans they accept -- and for all but one doctor, "Oxford" was listed. I'd used these bios when I was looking for doctors under HIP and Empire, and they were generally pretty accurate, so at that point, I was as gung-ho about signing up for Oxford as anyone who has been posting comments here.
But when I followed up a few days later with phone calls to my doctors' offices, my bubble burst. My internist, gynecologist and gastroenterologist are all in the same large group practice in Murray Hill -- and while not all the doctors in the practice accept exactly the same insurance plans accepted by the others, no one in the practice now accepts the Liberty network. According to the secretary of one of the doctors, there had apparently been problems with paying some of the doctors in the practice, so now no one can accept Liberty. They all accept the Oxford Freedom network, though, and also Healthnet, the other plan I was researching at the same time.
After speaking with my doctors' offices, I happened to speak informally with a couple of people who knew people who had had problems with the Liberty network. So, if you already have doctors you like who are in the network, that's great. But you might have doctors who don't accept the plan. And if you need to find new doctors, you might have a much harder time than you had under Empire and even under HIP.
Nathan one last time on Steve's question - sorry for the delay, but this is probably going to be the last time I check this board in the near future and you'd be better served by contacting our office directly at 212-879-0122:
ReplyDeleteIf you submit an application this late in the month for a 12/1 effective date, in all likelihood the application is still going to be in processing on December 1st. But when everything is processed, Oxford will enroll you retroactively to your initial effective date, and will assume any responsibility for medical care you had in the span while your applications were in processing. You may need to ask your provider to defer billing for a few days until you appear in the system and can provide them with an ID number, but at that point they will be able to submit their claims as though you walked in to their office with an ID card on the initial date of service.
Carolyn - we've spoken in the past and based on what you've told me, you're eligible for the plans for freelancers on Mediabistro. If your doctors do not correlate to the Liberty network which most of the plans use it may not be the best option for you, but you did sound eligible from our conversation.
And just to nitpick - the Oxford Liberty network, even as a subset of the Oxford Freedom network, is still larger in terms of sheer volume than the HIP network.
NYS Insurance Commissioner Contacts:
ReplyDeleteFor the Consumer Services Bureau, please call this toll-free number: 1-800-342-3736.
To reach the Licensing Bureau, call 518-474-6630.
You may also reach Consumer Services at: 518-474-6600 (Albany) or 212-480-6400 (New York City)
consumers@ins.state.ny.us
to person above about Columbia Presby. md's in Oxford's Liberty plans... remember, that while id'ing them by typing in 10032, you will see that several also participate at the satellite office on E. 60th (at Madison) (re your issue of going up to col. presby.)
ReplyDeleteIf you missed out on mediabistro.com deadline of yesterday for 2008 rates, you still have till 2pm on 12/1 for the Oxfords insurance at 2008 rates over at Healthpass. Good luck all. Lets hurt them by finding alternatives.
ReplyDeletehttp://www.healthpass.com/hp.soleproprietor.htm
I am unhappy with the new freelancer options too. I got a much better deal thru an insurance broker: Anthony Cancela 908-756-5126 http://www.cibllc.com/ anthony@cibins.com He works with NJ,NY and CT. He really knows his stuff!
ReplyDeleteI just called BCBS to get quote on POS for a single coverage. It is close to $1400 per month. There are enough unhappy FU people here so why don't we form out own group the upset FU group and go to Empire and negotiate a plan? There is enough manpower and talent to do this? Instead of sitting her and blogging let's take some action. If anyone is interested I will write back and provide my email address. I am serious about this
ReplyDeleteSorry about the spelling errors. I jammed my thumb and am awaiting a pre authorization for MRI.
ReplyDeleteOK David, How do we get together and do this (form our own group with BCBS)?
ReplyDeleteI'm all for forming our own group
ReplyDeleteThe problem is that many people already left FU and got Oxford. But many others didn't discover yet the new plans and how horrible they are.
ReplyDeleteDavid and Stan, Excellent idea. This is urgent, is there a lawyer reading this, an ins. organizer? Can you both post phones or emails? Maybe a group meeting this weekend somewhere midtown? In this economy, maybe Empire would expedite.
ReplyDeleteThe Freelancers new phone system is totally dysfunctional, as is the online and phone billing system and current website. The Blue Card doctors could drop out en masse as soon as FIC starts. Not to mention, if they're not paid.
A number of people have been posting info about how to contact the NYS Department of Insurance (which approved FIC) as well as the various foundations that funded FIC. I think it's great that some of you are doing that, and I applaud you.
ReplyDeleteHowever, since I have a limited amount of time to make phone calls, send e-mails and write and fax letters, I decided to work on the theory that people don't like to admit that they've made mistakes and that their due diligence wasn't so diligent after all. So I've been trying to get through to those with clout who were NOT involved in the formation and approval of FIC and its plans.
I've been contacting some city and state legislators, including my own, and I wrote a long letter to the Healthcare Industry Taskforce of Andrew Cuomo's office. (http://www.oag.state.ny.us/bureaus/health_care/HIT/about.html) As far as I could tell, there's no way to reach them via Internet, so I faxed the letter. I wanted to bring the whole FU/FIC mess to the attention of the taskforce, but if you want to make a very specific complaint, Cuomo's office also has a healthcare consumer complaint form that you can fill out online.
I forgot to mention in the previous post that I've already heard from one legislator's office that his/her healthcare issues person is looking at the material I sent.
ReplyDeleteI encourage everyone who has time to contact their legislators and selected state officials.
This is not so much a alternative as it is advice to help some people decide what to do; stay with FUI or leave.
ReplyDeleteI compared my last years costs and put them on a apreadsheet. I then took the PPO #1, PPO#2 and High Deduct $5K plans for 2009 and applied them to my speadsheet as if I had each of these plans last year to see what my bottom line cost would have been.
I was shocked to see that, if I only went for check ups and the basics I would be okay with PPO #2 BUT if something bad happened and I had to go to the hospital or have tests run...I'd be paying out of my nose with all the 20% copays, plus the $2K deduct, not to mention the UP TO $24K maxiumum payout cap!
PPO #1 was no better...especially with the $988 per month premium. $1K deduc and 15% copay. The maxium cap is only $8K but your paying alot every month!! $11,856 (for two people) a year.
The best plan for me is the High Deduct $5K plan. I pay as I go actually. As I am sure the invoices I will pay will be FAIR amount after what the insurance co says is a reasonable amount for me to cover.
My husband doesn't go to doctors much. So his portion of the $526 ($263 is for his peace of mind).
If we took this plan and only I used up the $5K deduct...our yearly payout would be $11,336 (before pharmacy..but that's another post!).
So for a person that has a few minor issues and wants yearly check up's with different specialists as well...this makes the most sense. Because after the deduct is met...they pay EVERYTHING at 100%.
I hope I have helped someone out there. I know how stressed we all are, especially at this time of year and in this economy.
Re the poster right above, the HD plans do seem quite good (for what they are) but prescription drugs have an uncapped 30% coinsurance (I believe, info not in front of me right now...)
ReplyDeleteI notice that several people on this blog and the FU blog say that they've done spreadsheets to show how all their 2008 medical expenses would be paid under the various 2009 plans. I couldn't do that for all of my expenses because I've used medical services for which I never received an explanation of benefits statement (EOB) from Empire -- mainly lab tests, for which we have no copays under the Direct POS Plan. Therefore, I have no idea what the lab tests cost.
ReplyDeleteI recently spoke with a friend in NH who has a high-deductible plan, so she's paying the full cost of all her routine checkups and so forth. She mentioned what some of her routine lab tests cost, and I was surprised by how high the costs were.
Has anyone ever received an EOB from Empire that showed what charges the lab submitted and what Empire paid?
You have to go to Empire's web site..put in your account number and can pull up all your EOB's to date. This is what I did. You can see the billed rate and then the contracted rate that that was paid along with any co-pays you were resonsible for.
ReplyDeleteI have a question into FUI about the prices I would have to pay for services until I'd reach the $5K deductable...to see if the prices that would be passed onto me would also be contracted prices...so I don't have to pay full price. If they are full price...I have to rethink this plan. I mean I don't intend on going to the $5K deductable this coming year, I plan on being as frugal as I can interms of my medical health and do only really sick or needed check-ups...so I can keep my costs down.
Yes, the prescriptions aren't covered until the $5K is reached so I have to figure out how to get them at low costs elseware. Another task!
Does anyone know of a reputable insurance company that offers stand-alone prescription drug coverage for people who are NOT on or eligible for medicare.
ReplyDeleteI've never heard of such insurance, and if it exists, it doubtless would be very expensive because the people who enrolled would almost certainly be a very high-risk group. I think your best bet would be to look into the many prescription discount plans that are around. Come to think of it, I think FU has one (check the Discounts page on the Web site), but I've never looked at it carefully because I've always been in the POS plans. I don't know how good that one is, but my father (when he was alive) and a good friend who was "self-insured" for a while both saved a lot with such plans.
ReplyDeleteFor generic drugs target (walgreen too?) fabulous--$10 for 3 mos ($4/month, discounted if you get three at a time)
ReplyDeleteYeah...but I have Brand prescriptions that I need to cover. If I choose the HD $5K plan...there is no prescription coverage until I reach the deduct, and in the meantime I would have to pay out of pocket - and alot! There are a few free and some fee based prescription plans, all are the same with the discounts they offer (which really is not much), so I signed up with a free discount card. I'll look at the FU site for the particular prescription plan you were talking about.
ReplyDeleteAccording to the FIC customer service, prescription costs do not contribute to the deductible in the HD plan
ReplyDeleteHi Folks,
ReplyDeleteHappy post thanksgiving Monday.
A bit of feed back – aka – another talking insurance head.
Regarding “stand alone RX coverage”. It does not currently exist in NYS, but if it did it would be prohibitively expensive. The RX portion of a single health insurance premium is over $100/mnth. The 2 most viable options are a discount program or a Canadian Pharmacy. There are lots of discount Rx cards that range from terrible to OK. None of them are great so I direct my clients to http://www.yourrxcard.com/.
Its free & provides a competitive discount on many of the popular scripts. Regarding Canadian Pharmacy, I would need to check if my links were still active & my “donut hole” Medicare D clients are still pleased with the service.
I guess the customer service is INCORRECT again!! because I'm looking at the PDF file for the HD $5K plan on page #2 and it says under pharmacy..."Deductible, then 30% coinsurance (certain preventive drugs - 30% coinsurance, no deductable".
ReplyDeleteHD plans have networks just like a PPO or HMO plan.
ReplyDeleteWhen you use your high deductable plan in-network you are billed the wholesale or negotiated rate. If you go out of the carrier network, you are paying retail. Some HD plans have separate in & out of network deductibles which makes the book keeping for a family nearly impossible. This same whole sale concept applies to the in-network cost sharing that has suddenly appeared as the only FUI alternatives.
Eric...yes, please do check on these Canadian pharmacies and if you could offer any positive feedback on any. It's hard to tell which are the good ones from the web.
ReplyDeleteSome people reading this blog may find the Kaiser Family Foundation’s Primer on “How Private Health Coverage Works” to be useful: http://www.kff.org/medicaid/kcmu100208pkg.cfm
ReplyDelete(There are also primers on Medicare, Medicaid, Health Care Costs and The Uninsured.)
Carolyn
Hi folks-
ReplyDeleteI will check out web Pharmacies from Canada. FYI, the enrollment deadline for the Chamber's 8 Oxford Plan is 12/19.
Good Hunting
Eric
Eric@pscinsurance.com
Anyone checked out the Oxford plans offered through NASRO? http://www.nasro-co-op.com/health/state/ny/index.shtml
ReplyDeleteLook at TEIGIT.com. They have an arrangement with Oxford, and have special Sole Prop plans with them that are not just limited to NYC and LI, but even Westchester and further upstate.
ReplyDeleteTEIGIT also has small group (2-50) plans for people in business partnerships in NY, even if only one person wants the insurance, and the other partners are covered elsewhere. Rates are better than for Sole Props.
ReplyDeleteFreelancers who are artists, check out non-profit organization, FRACTURED ATLAS
ReplyDelete248 W. 35th Street
Suite 1202
New York, NY 10001-2505
support@fracturedatlas.org
(212) 277-8020
http://www.fracturedatlas.org/site/healthcare/
They offer affordable HIP insurance plans which Freelancers Union used to offer up until 12/2006, before the switch to Empire.
I just spoke with them today and they were very informative and professional.
Good luck all, on your insurance coverage!
update to my post above:
ReplyDeleteALL freelancers should check out FRACTURED ATLAS for HIP plans. Call them or you can walk in their office at the above address to speak in person. Please forward/post this message to anyone who could benefit.
http://blogs.wsj.com/health/2008/12/10/freelancers-union-takes-health-insurance-in-house/
ReplyDeleteYou can now post a comment on the Wall St Journal's Health Blog - Article about the new FIC Plan.
I am an independent broker that has already helped members get more affordable and perhaps better benefits than the one FU is offering for 2009. Please contact us at
ReplyDeleteserraro@abouthealthinsurance.com
Not to bash anyone, but Teigit has a terrible reputation. Free Lancers has better systems, is much better staffed & professional.
ReplyDeleteRegarding a 2 person group with one person enrolling, for Oxford its great! No Sole prop-up charge or administrative fees.
We can write you direct with Oxford.
Direct rates are 20% less!
Send me a note & we can discuss your own insurance situation.
We are taking applications until 12/19/08.
Be Well
Eric Robinson
I am a direct agent with Atlantis Health Plan. Self-employed or free-lancers can get a full coverage plan with no deductibles that start at $325 a month. You only have to prove $10,000 in annual income as a self-employed individual. We also have comparable plans for non self-employed indiviuals and families. This is a great alternative to the plans offered by the FU.
ReplyDeleteIf anyone would like additional information please contact me at 801-580-0404, I would love to help.
I am in Manhattan.
Michael Halverson.
mhalverson@atlantishp.com
I am hoping to get my daughter covered by Child Health Plus while we get ourselves onto (probably) Fractured Atlas.
ReplyDeleteThere is a very wide scale of income requirements and Empire BCBS is one of the plans offered.
http://www.nyhealth.gov/nysdoh/chplus/
Child Health Plus is a wonderful alternative for children. Make sure to ask your current pediatrician which insurance they choose (you have an option of providers depending on your state). After they are accepted you pay nothing in terms of co-pays - ever!! The only thing you have to remember to do is to always get a referral if you are going to a specialist and lab tests must be done at the lab NOT the doctors office. Whatever plan you choose for yourself and spouse...the "family" coverage will surly have ded, co-pays etc....but with the kids the CHP program your premium is all you pay!
ReplyDeleteI noticed the post above from an Atlantis Health Plan rep. Does anyone know someone who has actually had Atlantis Health Plan? I was considering it but can't find one person who has it or knows anyone who has it... Would love to speak with someone who has actually used it! One negative point I discovered is that Atlantis does NOT cover any in-network physical therapy unless you've been hospitalized first. For those of us who have had painful injuries like ankle sprains, severely pulled muscles, torn ligaments, knee injuries, back problems, strained elbows, hand injuries, this plan would NOT cover ANY physical therapy treatments. Most of the time we are NOT hospitalized for these common injuries. Hard to believe it's not covered, but true!
ReplyDeleteI have a friend in Westchester who had Atlantis for about a year between the expiration of her COBRA benefits and her becoming eligible for Medicare earlier this year.
ReplyDeleteAs with all plans, it's important to research whether your doctors -- and the facilities they may use -- participate in the plan. My friend's doctors participated, so she thought that Atlantis would be a good low-cost, short-term solution. However, she needed to have a colonoscopy and endoscopy, and Atlantis would not cover the procedures if they were done in the facility her gastroenterologist uses. In her case, she did not want to go to another doctor, so she put off the procedures for almost a year until she was covered under Medicare, and fortunately, she did not have any serious problems.
This is not an unusual problem. I actually had a similar problem with Empire earlier this year. I needed a colonoscopy, and my internist recommended a gastroenterologist who accepted Empire -- but it turned out that the only facility he used for colonoscopies was not an Empire provider. In my case, I'd never been to him before, so I had no problem with going to another gastroenterologist who used an Empire facility (NYU Hospital).
We have changed to Fractured Atlas, where I was able to get a person on the phone immediately and who was unbelievably helpful. Not to mention the fact that the insurance is cheaper but with better coverage.
ReplyDeleteIt might be cheaper to go without haleth insurance altogether. It is a SCAM! Don;t smoke, exercize, and go to a City Hospital to get care. Screw this!
ReplyDeleteDoes anyone have info on the NASRO options or about their reputation?
ReplyDeletehttp://www.nasro-co-op.com/health/state/ny/index.shtml
I am the Atlantis Rep who posted earlier.
ReplyDeleteYes, we do have plans that only over physical therapy after hospitalization. We also do have policies that cover physical therapy at anytime for those minor but painful injuries. It just depends on the options.
Also, Atlantis comes with access to the Atlantis Medical Groups, that are state of the art medical facilities. AMG's offer basic medical proceedures such as blood work, physical therapy, x-rays, physicals, etc... at no cost to Atlantis customers - regardless of anyother proceedure the condition is affiliated with.
If anyone has any questions about Atlantis I am more them willing to help. Just call me at 801-580-0404 or email me at mhalverson@atlantishp.com
Michael Halverson
Regarding out of pocket maximum:
ReplyDeleteIs it true that now this only pertains to facility(hospital)? I read about a woman whose husband needs an MRI every 4-6 weeks, so theoretically under FIC, they would pay 20% (coinsurance) of that all year long with no cap? is that correct?
Regarding your Out-of-pocket maximum question, yes, you are understanding correctly. I just clarified that point with FIC and one would be responsible for those fees.
ReplyDeleteFIC Network question
ReplyDeleteFU says that the network will be similar to BCBS but when I asked my doc if she takes FIC she didn't even know what that was. Are they still working through the BCBS system in any way or is it completely broken off?
So do I ask my docs if they take "Freelancers Union Insurance" or is there some other network they are affiliated with?
Greg,
ReplyDeleteIf they took our current insurance, they will take it... the bcbs logo will be on the card
Okay....not sure if this spinoff group is actually in the works anymore. I haven't been able to be a part of the "group chats" but no e-mails or updates have been circulating to date so I'm wondering.....?
ReplyDeleteSo I'm asking...has anyone found an alternative to FUI insurance out there??
I'm looking all over, using leads from this blog and various searches by myself on the internet. I'm in New York.
I have found a few decent plans and am cross referencing them on a spreadsheet..this is such a pain in the ass since I don't have time for this but it needs to get done. And the plans out there are all over the place in terms of coverage and price. Plus if I am going to give away almost $1,000 a month for me and my spouse to be covered I want to make the right decision.
Anyway...if anyone has successfully found a plan they like...please let me know. I would love to discuss what I found to date with anyone that needs help also. Please post your e-mail below and I'll contact you.
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