Jul. 31–After years on the fringe of the healthcare industry, sought after only by the desperate, discount medical plans may be gaining a toehold on respectability.
Twenty-four have made it through the arduous licensing process the state of Florida started requiring this year. Even Aetna and UnitedHealth Group have entered the field, which has been beset in the past by accusations of fraud and misrepresentation.
Though far from ideal, these plans may seem attractive to the estimated 60 million Americans who either have no health coverage or are underinsured. In Miami-Dade and Broward, about 750,000 have no insurance. More than 20 million persons nationwide may now be carrying these cards.
“With health insurance costs so very high and getting higher, the need for these plans is huge and growing,” says James Quiggle of the Coalition Against Health Fraud.
The theory behind the plans is simple: For a monthly fee that’s usually $30 to $70, a person gets discounts for doctor visits and drugs that might range from 15 to 50 percent. In most cases, consumers must pay in cash when services are rendered to get the deal.
A Herald survey of plans offered in the state found some significant discounts, though there are still glitches with some cards. Deals with hospitals remain at best problematic, at worst nonexistent.
Under the new law, discount plans sold in Florida must now say clearly in all their literature that they are not insurance. They are also required to post on a website a full list of providers that accept their discount cards so that shoppers can select a doctor who will accept a plan before they sign up for it.
The law is intended to correct past problems because many plans hinted they were insurance when they weren’t, and consumers often had to sign up for a discount plan before they were given a network list — which many found was filled with doctors who said they had never heard of the card company.
“We’re very pleased the state has stepped in,” says Richard Keelor, president of MedMore, a Miami-based discount plan. The state application ends up being a three-inch document that can cost $50,000 or more in legal and advisory fees to complete. “The ones that remain are serious players,” Keelor says. “It got rid of all the rift-raft.”
Still, experts are concerned. “Consumers need to be extremely cautious,” says Quiggle of the Coalition Against Health Fraud. “The states are having a hard time staying on top of scams.”
Concerned about such an image, some of the larger discount plans have formed a trade group with a code of conduct that includes many provisions of the Florida law.
“Florida has been a leader in the cause,” says Barry Friedman of AmeriPlan USA, a Texas-based discount plan, which supports regulation to weed out bad plans.
Two big insurers are entering the market on its fringes. Aetna has registered in Florida because it offers a discount dental plan for employers who have Aetna health coverage but don’t include dental, says spokesman Walt Cherniak.
UnitedHealth Group, meanwhile, became involved by purchasing Health Allies, a California company that has 8.7 million members nationwide. The company lists some physicians and hospitals in its network, but its primary focus is on areas not generally covered by insurance, including LASIK eye surgery, vision exams, dental work, weight loss programs, gym memberships and infertility treatments.
One Health Allies card is available through Sam’s Club outlets for $8.75 a month. “The intent here is make your healthcare dollar go farther,” says spokesman Daryl Richard.
Many of the large, Texas-based companies started out as dental discount plans, and for some it remains their primary strength. Careington International, for example, offers a dental plan for $7.95 a month for an individual, $13.95 for a family. Through AmeriPlan, basic cleaning can cost $20 and braces are available at 25 percent off.
South Florida companies are attempting to compete with the big players. MedMore, which reports it has 3,000 members, offers multiple options. One plan costs $30 a month for the basic medical service for families; $29.95 for pharmacy discounts and $63.31 for hospital indemnity insurance. The company provides subscribers with a book listing specific discounts and prices. Some doctors, for example, are shown to charge MedMore members $45 for a basic office visit.
Still, consumers need to call up to verify. The Herald tried four doctors’ offices in the book. Two said they accepted MedMore for discounts, one said they had never heard of it and another said it didn’t know but if its name was in the book, “come on in.”
One happy MedMore customer is Nora Marrero, a hostess at Larios restaurant on South Beach. She pays $7.52 a month for the card, with her employer picking up the rest. When she needed a colon scan, the MedMore card knocked the price down from $500 to $225. “This is a good plan,” she says.
Another South Florida plan, Cinergy Health, charges families $59.95, including pharmacy discounts. “We separate ourselves from most plans,” says founder Daniel Touizer, “because we will do a lot of the legwork.” Cinergy volunteers to make the first appointment with a doctor, to make sure that they will accept the discounts.
Pro Medical Plan, based in Plantation, charges $48 a month for an individual to access a network of 100 South Florida providers. Doctors have agreed to fixed fees, and owner Jose Volosin says he has contracts with 15 urgent care centers to treat a patient for a lump sum of $80 to $120.
Florida Health Solution, based in western Miami-Dade, has already been serving a mostly Hispanic clientele of 10,000 for three years. It charges $29.95 a month per person and contracts directly with physicians for office visits as low as $20 and blood tests for $5.
FHS President Marcos Socorro says he has also worked out arrangements to get discounts from local hospitals, including Kendall Regional. Peter Jude, spokesman for the hospital, says it has no contract with FHS, but works out discounts for its members.
Hospitals, the most expensive part of healthcare, are generally a problem for discount plans. Though major insurers have contracts with hospitals in which they pay a third or less of gross charges, hospitals have been generally reluctant to offer discounts to the uninsured.
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