Friends

Friends are what make bad days bearable. Friends are there when we need them. Poems, essays, and even books have been written about the value of friends. A true friend is always well meaning when advice or guidance is given, but we see what can happen when you get advice from a friend who may be misinformed. Be wary of well intentioned friends bearing bad advice.

Last week a cancer survivor called to tell me that her COBRA health insurance benefits expired 4 months ago. She said she did not pursue purchasing health insurance immediately because her friend told her she would have to pay a much higher premium because she has a history of breast cancer. That statement is totally false. Insurance companies can no longer raise the premium because of a medical history. The very sad part about this advice is that this woman has had recurrence of her disease. When she purchases health insurance now, she will have a one-year waiting period for pre-existing conditions. If she had investigated her options instead of listening to her friend, she would have learned that she could purchase a plan for the same premium a “healthy” person would pay, and would not have a waiting period for any pre existing conditions as long as she did not have a gap in coverage.

The very same day a woman from Florida called to tell me that she has been without health insurance for six months but will be eligible for coverage on the first of October. In the meantime, she was diagnosed with cancer and her doctor is urging her to have surgery before October 1. When I asked her why she did not have health insurance for the last six months, she said a friend had told her she could not purchase health insurance on an individual basis. She could only get it through an employer. Totally untrue.

A self-employed individual in Oregon called to tell me that he had just moved to Oregon from California but had recently suffered a heart attack. His friends told him that he would not be able to purchase health insurance in Oregon because of the heart attack. He had an HMO in California, but that would not help him in Oregon for regular routine care and rehabilitation services. He was still paying the premium to his California HMO. That was a good thing because now he will have continuous coverage and he can purchase a plan in Oregon with no gap in coverage. The California HMO would only be helpful in Oregon if he was dealing with an emergency medical situation. He was relieved to hear that his friends were wrong and that he could indeed purchase health insurance in Oregon with no waiting period for pre-existing conditions, and with no additional cost because of his medical history. I urged him to consider a traditional plan or a PPO plan rather than the HMO. I did this because his business requires him to do a lot of traveling throughout the country. HMO’s work best when you use your primary care physician and are in your local geographic area.

A gentleman walked in my office with a handful of medical bills related to a recent hospital stay. He had explanations of benefits from Medicare and was confused as to why he was receiving all of these bills because he thought, “Medicare takes care of everything.” He was new to Medicare and once again, he listened to a friend who told him he did not need anything in addition to Medicare. Once again, that is not at all true. In most cases, Medicare pays 80 percent of the allowable charges for your medical expenses. He is responsible for the remaining 20 percent. For his inpatient hospital stay, Medicare paid 100 % of the hospital bill, but it did not pay the first $812 deductible. This person is out of pocket a substantial amount of money because a well-meaning friend gave him bad advice. We urged him to consider purchasing a Medicare supplement.

It is always best to get advice from people that have experience in the area where you need advice.

Irene Card & Betsy Chandler share the responsibilities of running Medical Insurance Claims, Inc. a health insurance services company. If you have questions relative to this column or other related topics, we invite you to call (973) 492-2828, or visit our web site at www.miconline.com.