Miscellaneous articles

Usually prescription drugs safely treat what ails us, but the wrong combination may cause harm. Example: Jody’s treatment for her stomach ulcer (i.e., an erosion in the stomach that can bleed). After a minor ankle injury, another doctor prescribes ibuprofen for Jody’s pain–unaware of her ulcer. Ibuprofen will relieve Jody’s ankle pain but also increase the risk of Jody’s stomach ulcer bleeding, making this a potentially dangerous combination.

The situation is more common than you may think. Many of us visit several providers at one time–cardiologists for heart conditions, internists or gastroenterologists for ulcers, and family doctors for the sniffles. Trouble is, one provider may not know about the prescriptions another provider writes for the same patient.

To reduce your chances of having drug-related problems, inform your doctors and specialists about any drugs you take (including prescriptions, over-the-counter remedies, and alternative medicines such as nutritional supplements, herbal extracts, or vitamins). [Taken from “RationalMed” in The Edge, American Medical Security, May 1999 Bulletin, Page 3.] (Excerpts taken from “Generic Drugs” by Bridget Kennebeck in “Geico Direct,” Fall 1998).

When a company declines to insure us, we can feel rejected. It doesn’t hurt as badly as being rejected as a person, but it still is not a pleasant experience. First of all, we do know more about our bodies than the insurance company. We feel good and function every day at full capacity. So how can they say that we are not insurable? I understand the problem. I was declined for insurance coverage three times. In the past ten years since I was declined coverage, I have had no sick days when I was out of the office, I was never incapacitated, nor did I run up any unusual medical bills. So who are they to say that I was uninsurable? That I was an insurance risk? I felt they were not being fair.

But insurance companies do not really care how I feel or my opinion about my good health. They consider past ailments, my age, height and weight, etc. Based on their own experience with applicants similar to me (and they deal with thousands of applicants and clients), they determine if insuring me is a risk. If I am not a risk based on their experience with people who are similar to me and have had ailments similar to mine, they will provide me with an insurance quote.

So when an insurance company declines insuring you as an acceptable risk, don’t take it personally. They look at one factor only – risk! If the risk is acceptable, they will insure you.

The FDA requires that before generic drugs can be sold they must undergo three forms of equivalency testing:

1. Pharmaceutically equivalent: Generic drugs must have the same active ingredient’s), the same dosage form, and be identical in strength and purity to the brand-name version.
2. Bio-equivalent: A generic drug must be absorbed into the bloodstream at the same rate and extent as the brand name drug.
3. Therapeutically equivalent: If the drug is judged pharmaceutically and bio-equivalent, the drug is rated interchangeable with the brand name drug. Often the same company that makes the brand name drug also makes the generic version.

What should you ask the pharmacist if you buy the generic version? One question is always important: Is this generic drug “bio-equivalent” to the brand name drug?

Remember, too, that pharmacists can change the prescription from brand name to generic without asking you unless the doctor writes on the prescription: “No Substitutions.” (Excerpts taken from “Generic Drugs” by Bridget Kennebeck in “Geico Direct,” Fall 1998).

It may be hard to believe, but insurance companies that serve volunteer workers also lose money due to insurance fraud.

Often people ask me if they should reveal all of their medical problems when they fill out an application. Some feel that since they had a major medical problem some time ago and it is not bothering them now, they need not list it. Yet such misstatements can cost an insurance company thousands of dollars. And remember, whenever an insurance company pays an “undeserved claim,” someone pays for it. Who? The healthy people on the insurance plan pay. Unmerited claims always cause insurance rates to increase.

We had one experience where a senior worker failed to explain a certain pre-existing medical condition. If she had been honest, the company would have declined her insurance. Due to her pre-existing condition she ended up having major surgery. Before the insurance company discovered she had lied on her application, they had paid her claims of over $100,000.

In another group insurance plan, a worker in the USA falsely claimed membership of a volunteer organization. Her insurance claims of $80,000 were paid before the insurance company realized she was not a volunteer worker in the organization.

It is very difficult to win the confidence of secular people in these companies when volunteer people are dishonest in insurance matters. The good news is that almost all volunteer workers are scrupulous in telling the truth when completing a health application!

We have reconfigured our web site adding several services to assist overseas workers. First, we are providing “Medical Advice for Overseas Travelers” at https://www.gninsurance.com/medical-advice-for-travelers/. Dr. Jon Askew, a medical doctor, prepared this fine overview for the international traveler and worker. Second, we have added “Tips for Understanding International Insurance.” This site includes dozens of short articles explaining deductibles, co-insurance, claims paying, pre-certification, pre-existing conditions, etc. The goal is to help the overseas worker or traveler understand and make wise decisions concerning purchasing and using international insurance coverage. Please visit: https://www.gninsurance.com/resources/ask-Jeff/.

Dr. Jon and Harriet Askew, international workers, have done much research, and have put together a fine information package with medical guidelines for international workers. Jon is an M.D. with 20 years of specialty practice in OB/GYN. He finished course work to be certified in tropical and travel medicine, as well as having a certificate in public health. They both work with CMDA, and have had experience overseas in numerous locations.

If you would like an electronic copy of this packet, please let us know. We will be happy to send it to you as a Word attachment. Good health care and health care knowledge is a simple way to cut the losses of volunteer and full-time workers.

We have had several friends seek to reapply for a similar or different insurance plan with the same company only to discover that sometimes it is difficult to get coverage.

Here is a scenario: You are on plan “A” with company “XYZ.” You want to switch to plan “B” with the same company with better benefits. The company “XYZ” will send you an application and treat you as a brand new client. They will not even consider the fact that you have been on plan “A” for five years.

Or maybe you have a deductible of $5,000 on plan “A,” and you are requesting, after five years, to reduce your deductible to $2,500. In this case, you will need to apply for the insurance coverage as if you had never been on the plan. Why is this? First of all, insurance companies are always tightening their underwriting guidelines. Five years ago they may have covered allergies. Now they have changed, and no longer cover allergies. They need to screen you through the new underwriting guidelines to make sure you haven’t developed allergies. Second, when they decrease your deductible they are increasing their risk. Since you last applied, have you developed allergies or something else that increases your need for medical care? A lower deductible to cover the allergies would be advantageous to you, but a big disadvantage to the insurance company.

To raise your deductible, you generally only need to fax a letter of request to the insurance company requesting the change. Why so simple? Because, by raising your deductible you are increasing your personal risk and decreasing the risk of the insurance company.

Lloyd’s of London is a British insurance market, the largest in the world, with over 317 years in the international arena. Lloyd’s is considered the most secure place in the world to put a client’s premium. Lloyd’s serves as a meeting place where multiple financial backers or “members,” whether individuals (traditionally known as “Names”) or corporations, come together to pool and spread risk. Unlike most of its competitors in the reinsurance market, it is neither a company nor a corporation. (Taken from Wikipedia)

The market began in Edward Lloyd’s coffeehouse around 1688 in London. While Lloyd was only the proprietor of the coffeehouse, his establishment was a popular place for sailors, merchants, and shipowners. Lloyd catered to them with reliable shipping news and a variety of services. The shipping industry community frequented the place to discuss insurance deals among themselves.

This arrangement carried on long after Lloyd’s death in 1713 until 1774 when the participating members of the insurance arrangement formed a committee and moved to the Royal Exchange as The Society of Lloyd’s. The Exchange burned down in 1838 and, although rebuilt, many of Lloyd’s early records were lost. In 1871, the first Lloyd’s Act was passed in Parliament which gave the business a sound legal footing. The Lloyd’s Act of 1911 set out the Society’s objectives, which include the promotion of its members’ interests and the collection and dissemination of information.

Recent statistics on U.S. health insurance received at a recent Roundtable Discussion:

• The USA spends 16.2 percent of its GDP (Gross Domestic Product) on insurance, Canada 11 percent.
• Per-capita spending for medical care: USA $7498, France $4000.
• Heart bypass/angioplasty per 100,000: USA 587, Switzerland 115.
• CT Scanners per million: Japan 92, USA 32, UK 7.
• Average per day in-hospital expenses: USA $2434, Australia $848.
• Specialist annual income: USA $230,000, Germany $77,000.

In the world, the USA has the 5th highest caesarean section rate, one of the top five rates of organ transplants, and one of the top five of intensive heart procedures such as Revascularization, CABGs (Heart Bypass), and angioplasties.

What is also of interest is that overseas workers receive 85 percent of their medical care in the USA. If overseas workers received less medical care in the USA, it would have a tremendous impact on insurance rates. Most international plans do not charge co-insurance if medical care is received outside the USA. Therefore, getting care outside the USA would also save you money.

Our suggestion is to choose a plan with a high deductible to keep your rates down and get most of your medical care outside the USA, even if it means going to another country, e.g., Thailand or Singapore.

I know the feeling well. I consider myself perfectly healthy. Everyday I get up, feel good, do my laps in the local pool, watch my diet, don’t smoke or drink, go about my business, enjoy making a living, and seldom complain about how my body is operating because there is seldom anything to complain about.

But when I applied for insurance the company was not concerned about all the above. They were concerned about those records in my doctor’s office. Several years ago I had some annoying pain in my lower back, and the doctor wrote down “degenerative arthritis.” Then I had a little skin cancer (basil cell carcinoma) removed several years ago. That went on my records, too, although it is not a problem now.

So what did the insurance company say? Uninsurable! That arthritis is a problem. The word “degenerative” is scary to the company. The result is that I had to find a company that didn’t consider the arthritis a problem, and they put a “rider” on the basil cell carcinoma for two years.

What can we learn from this? Get insurance with a good company when you are young and healthy and don’t let it lapse. If you want to change companies, don’t drop coverage with one until you have it with another. This way you will avoid the curse of being declined for health insurance.

Generally such filters are not a problem but a solution. Yet it is becoming quite common for individuals to ask us for insurance information and then not receive it because a spam filter has kept it from getting into their inbox. We are not asking you to disable your spam filter, but we do want you to receive the insurance information that you have requested.

The best solution is to realize that rarely do we take more than 24 hours to respond to an e-mail and almost never more than two days. So if you have requested insurance information from us and you do not receive it within 48 hours (unless you have written on Friday which means we won?t respond until Monday), we would encourage you to check your ?Junk Mail? file. I also have a spam filter on my e-mail (I get as many as 500 junk e-mails a day), therefore I have to scan my Junk Mail folder every day. Sometimes I find a client?s letter in that folder.

We generally try to list the country you are going to in the subject line, e.g., “International Health Insurance for Costa Rica,” in order to make it easier for you to spot our response.

One major reason is sometimes insurance companies are not tight enough on underwriting. This means that they do not carefully screen applicants, and then end up insuring people who are too great a risk. If a person is overweight, has high blood pressure, and smokes, that person may be a real risk. If they insure too many people like this, they could end up losing money. Another reason could be poor administration. Administration adds cost to all products and services. If a company is not streamlined or is not seeking to increase worker productivity, they can end up losing money. Another problem could be that they have priced their insurance plans below market value. Often companies do this to get “market share,” but if their prices are too low they will not have adequate income from premiums to pay for their claims. Do all of these things happen? Sure! Just a couple of years ago two large insurance companies in Arizona went bankrupt.

What do we get from this? Well, tight underwriting and plans that are close in price to plans from other companies are probably signs of a good healthy insurance company. Although we don’t like not getting a “live person” when we call the insurance company, we need to remember that they are trying to cut their service costs.