Healthcare Insurance

Open Enrollment is Almost Over!

You have until this Friday, the 15th to select a health insurance plan, without answering any health questions.  According to Forbes and the Motley Fool, “medical debt is the No. 1 source of personal bankruptcy filings in the U.S.”  Having health insurance can help you avoid this.  Don’t delay.

Call us with any questions, 512-417-6058.


How to get a PPO!

If you’ve been trying to get insurance during the Open Enrollment, which ends December 15th, you have probably noticed you can’t get a PPO or Preferred Provider Organizations.  PPOs are only offered in the Small and Large Group markets.  The reason why is a topic for a future blog.  This topic is about how to get one if you are looking for insurance.

A small group in the State of Texas is defined as 2 to 50 employee lives.  It can’t be husband and wife, and it can’t be formed for the purposes of getting insurance.  The husband-wife thing has to do with participation.  Insurance Carriers in Texas require that 75% of eligible employees participate in the health plan, or they won’t insure you.  Having said that, a couple of insurance companies will waive the participation rates and allow a husband and wife to apply for insurance as a small group.

First, you must have a company.  A company would be an LLC, C-Corp, S-Corp or any other legal entity recognized by the State.  The company must be registered with the Secretary of State’s office.  A DBA (Doing Business As) doesn’t count.

The advantages are:  You have access to about 5 times as many plan choices including PPOs, the premiums paid are 100% deductible from the company, sometimes they premiums are cheaper and providers are more willing to take a group plan versus an individual plan.  Why providers don’t want individual insurance is a topic for a future blog.

If you think you might qualify and want to see how it might look for you, give me a call  I can answer all your insurance questions.

Ken Stephenson, MBA, FHIAS – 512-417-6058


Another Healthcare Law that Sounds Good but does No Good

In 1986, Congress enacted the Emergency Medical Treatment and Labor Act or EMTALA.  In 1994 they revised the Act to include the “prudent layperson” definition as a standard for evaluating whether a patient has an emergency condition.  Boiled down, it says if you think it is an emergency, then it is to be classified as an emergency.  It goes on to stipulate that payment is to be made for the initial evaluation and examination based upon the nature of the patient’s presenting complaint.

This federal law supersedes state law as it pertains to emergency healthcare and insurance companies.  So if you present to an Emergency Room (free standing or connected to a hospital), it doesn’t matter if it is in-network or out-of-network.  It is supposed to be paid for by your insurance company as though it were an in-network provider.

In Texas, we passed a law this year, Sponsored by State Representative Dr. Tom Oliverson (R-Cypress), HB 3276, that requires ERs to post notice of what, if any, insurance networks they are in.

Here is my question.  If ER visits are supposed to be treated as in-network, regardless of their network status.  Then why do we need a law requiring them to post a notice of what, if any, insurance networks they are in?