Lifetime Maximums - Important?

[TXINSURANCE]

Has anyone had a client exceed the policy limits?

Would you qualify for your state risk pool if you exceed the limits? I think in Texas you do...

Sti probably knows this answer.

 

[schealthagent]

In SC the lifetime max for BCBS is $2,000,000. When I questioned the individual marketing rep about it they stated that they had only had one person actually meet the maximum (ever?) They said that all of these other companies offering higher ones were just trying to impress people. That could be a flat out lie and maybe I should do some more checking.

 

[Mr. Bill]

I have a good friend in pharmaceutical sales. (The story about the annual cost of drugs for a hemopheliac at $200k got me!) All I can say is I am absolutely amazed at the money in pharmaceutical sales, and for what? Wining and dining the doctors, taking them places (how about "junkets" to Hawaii) and that's only at the sales rep level, the people in her "upline" are making even more and more!

 

[somarco]

Anything less than a $2M max is a potential disaster. I have had 1 claim exceed $2M but that was almost 15 yrs ago.

With inflation & new technology, particularly Rx, a $1M - $2M cap is ludicrous.

It is mostly public entities that cling to low lifetime max's. The private sector typically will have no less than $3M and often $5M+.

The cost of increasing the LT max from $2M to $5M is less than 5% so the argument it is too costly is BS.

So is arguing over DME or PT limits.

When most folks exceed their LT max they first go through bankruptcy and then qualify for Medicaid.

InsureBlog: The New Millionaire's

InsureBlog: The $2.5M Bite

 

[schealthagent]

Speaking of pharma reps. A prospect who is a retired pharma rep who told me how much money he made and how great it was then proceeded to got on a tirade about how evil health insurance companies are and how they are gouging consumers. He said that the profit motive should be taken out of the equation! It was all i could do to finish out the conversation cordially!

 

[Crabcake Johnny]

Me too - my next door neighbor is a pharma rep....and it's tough to be cordial sometimes.

Every day -5 days a week either FedEx, UPS, etc..pulls up and drops off around 10 to 15 cases of free samples. She loads them into her huge SUV and drives off each day to give thousands and thousands of free drug samples to her clients.

Hands down, all drug advertising needs to be banned. Period. If you have a condition, see your doctor - they'll take it from there.

 

[somarco]

the profit motive should be taken out of the equation

And when profits are banned, who will be left to run the companies?

Profit is not a 4 letter word.

It does not matter if you are talking about health care, oil or Big Mac's.

The public is completely ignorant when it comes to business economics. And the MSM is an enabling partner in the ignorance.

 

[Crabcake Johnny]

Can anyone tell me how France is doing with developing new drugs?

 

[JMO Fan]

In a few states (e.g., Vermont), guaranteed issue makes lifetime max meaningless. If claims hit the max, the insured can just apply for a new policy. Many don't know this, think it won't work, but it does.

 

[Crabcake Johnny]

But will that new policy cover an existing condition in mid-treatment?