legal insurance type question

[the doctor]

scenario:

you work for a company that provides you health insurance coverage, however company insurance plan is self funded (many are) said company you work for files for protection under the bankruptcy laws and cannot make payments of any nature much less payments for health care claims

does the liability for outstanding claims fall to the insured? i.e you had a doctor visit/surgery the day before the filing

the doc

[Deagle]

I say yes it would, but only after the hospital recovers what they can from the company, through the bankruptcy court.

[randywallace]

scenario:

you work for a company that provides you health insurance coverage, however company insurance plan is self funded (many are) said company you work for files for protection under the bankruptcy laws and cannot make payments of any nature much less payments for health care claims

does the liability for outstanding claims fall to the insured? i.e you had a doctor visit/surgery the day before the filing

the doc

The responsibility for a doctor's bill is with the patient. The doc may be nice and file the bill on the patient's insurance for them or may take a reduced amount from the insurance company as payment in full. However, if the company-insurer goes belly up the patient remains responsible for the bill. Depending on how the company's insurance was set up, there my be coverage through MIGA (Mississippi Insurance Guaranty Association) to help pay the patient's bill. However, self insured plans rarely, if ever qualify.

[Jelly]

scenario:

you work for a company that provides you health insurance coverage, however company insurance plan is self funded (many are) said company you work for files for protection under the bankruptcy laws and cannot make payments of any nature much less payments for health care claims

does the liability for outstanding claims fall to the insured? i.e you had a doctor visit/surgery the day before the filing

the doc

The responsibility for a doctor's bill is with the patient. The doc may be nice and file the bill on the patient's insurance for them or may take a reduced amount from the insurance company as payment in full. However, if the company-insurer goes belly up the patient remains responsible for the bill. Depending on how the company's insurance was set up, there my be coverage through MIGA (Mississippi Insurance Guaranty Association) to help pay the patient's bill. However, self insured plans rarely, if ever qualify.

You sound like an attorney

[Seymore]

Be sure it is "insurance" in the classic sense of the word and not something like a PPO or HMO. In those situations the provider, the doc or hospital, agrees to treat a certain group of people in this plan for a certain price with certain conditions. In that case you need to read the plan document to understand exactly what happens when the plan becomes insolvent.

I've been down this road many times with medical office managers who regurgitate how the bill is the patients responsibility. That may or may not be true depending on what the provider agreed to do in order to get the business. I always love when I get to read the contract back to them. There's always this long pause where they don't know what to say.

[Deltaquack]

Be sure it is "insurance" in the classic sense of the word and not something like a PPO or HMO. In those situations the provider, the doc or hospital, agrees to treat a certain group of people in this plan for a certain price with certain conditions. In that case you need to read the plan document to understand exactly what happens when the plan becomes insolvent.

I've been down this road many times with medical office managers who regurgitate how the bill is the patients responsibility. That may or may not be true depending on what the provider agreed to do in order to get the business. I always love when I get to read the contract back to them. There's always this long pause where they don't know what to say.

There are no HMO's in the state of MS. There are PPO's but that's a different story.....it wouldn't be self-funded.

DOC, By "self-funded" do you mean funded by the company like a cafeteria plan or funded by the employee like a Health Savings account with pretax money?

[Faithful Retrievers]

self funded/ self insured I am assuming. This theory is crazy with the cost of being hospitalized much less having surgery or cancer.

[LostBoy]

It could be a PPO and Self Funded ,Employer funds its own insurance and buys access to a PPO network to get the discounted rates.

[dtwhiteh]

in most cases when a business decides to be "self funded" it purchases a reinsurance plan that covers themselves in the event of a catastrophic loss with that loss being a substantial amount of money due to sickness or death. The business can set the amount which is called a stop-loss and it usually is between 50,000-60,000 and can be higher depending on the size of the company. it also depends on what type of bankruptcy your company has filed for (chapter 7 or chapter 11). chapter 7 means the company is gonna restructure their debt and is allowed to postpone some debt for a short period of time but the company continues to function a day to day basis. if its chapter 11 then your company is liquidating all assets and not responisble for any future debt which in that case would mean you dont have a job which means you dont have insurance.

[Seymore]

Self funded PPO with a third party, like BlueCross, doing the administrative work. The office staff will say you have BlueCross insurance which is not the case. Again, read the documents. It will tell you exactly what you are dealing with and what happens in insolvency.

[i][/There are no HMO's in the state of MS. i]

Here is a list of HMOs in the state of Mississippi. This file came from the Mississippi Department of Insurance website.

http://www.mid.state.ms.us/pdf/hmolist.pdf

[lowbar]

in most cases when a business decides to be "self funded" it purchases a reinsurance plan that covers themselves in the event of a catastrophic loss with that loss being a substantial amount of money due to sickness or death. The business can set the amount which is called a stop-loss and it usually is between 50,000-60,000 and can be higher depending on the size of the company. it also depends on what type of bankruptcy your company has filed for (chapter 7 or chapter 11). chapter 7 means the company is gonna restructure their debt and is allowed to postpone some debt for a short period of time but the company continues to function a day to day basis. if its chapter 11 then your company is liquidating all assets and not responisble for any future debt which in that case would mean you dont have a job which means you dont have insurance.

You've got the Chapter 7 and 11 backwards. 11 is restructuring.

[Deltaquack]

Self funded PPO with a third party, like BlueCross, doing the administrative work. The office staff will say you have BlueCross insurance which is not the case. Again, read the documents. It will tell you exactly what you are dealing with and what happens in insolvency.

[i][/There are no HMO's in the state of MS. i]

Here is a list of HMOs in the state of Mississippi. This file came from the Mississippi Department of Insurance website.

http://www.mid.state.ms.us/pdf/hmolist.pdf

What you'll find though is that those aren't true HMO's. Those were companies formed to provide HMO insurance. United Healthcare formed that b/c they are trying to get the contract on Medicaid and CHIPS as the third party servicer. You'll likely see Doral on that list before long as well. We don't have a market for it in MS. You'd have to have a tremendous patient base in an area with it......b/c a HMO employs the doctors and they are paid a salary or capitation to see the patients in the plan. It never got going in MS due to our patient base....a doctor wouldn't make enough money to justify it. I talked with a physician last week that's on several state boards and is even called to speak with senators and representatives on these matters all the time. We were talking on the subject of United Healthcare and Doral b/c they've been calling me and sending letters. He explained to me the whole HMO debacle from the past.