Pin on Pinterest

At Alkali, we love our clients, friends and neighbors. We enjoy helping you navigate the world of personal insurance so you can make the best decision regarding your needs.

For example, during the open enrollment period for the Affordable Care Act (ACA), we held several webinars entitled, What the Health is Going On?, where we covered the information you need to figure out the right steps to take to select health insurance. In addition, we put together an ACA DIY Checklist to give you as much information as possible. We also provided extra personnel and extended evening/weekend hours to assist those seeking help with ACA deadlines. It’s truly been our pleasure to serve so many!

As we look forward to the end of open enrollment on February 15th, we thought it would be helpful to provide you with some additional guidance to help you finalize health insurance in 2015.

You Need a Plan and Are Unsure About the Next Steps

It’s important to take action toward getting your health insurance coverage, so you have as much time as possible to make the best decision. We can guide you through all the different plans, both in the Federal Marketplace and the Private Exchange, to help you make the best decision.

You Went to the Government Website and It Was a Little Confusing 

Can you get a subsidy? What is the best plan? Do you choose gold or silver? You don’t have to figure this out alone. Let us support you through this process, discovering the information about the network, the cost and the out-of-pocket expenses, so you feel comfortable that you know what you are purchasing.

You Are Unsure What Factors to Consider To Make the Best Decision

There are so many factors to selecting the best plan for your situation. We can help you devise a list of important criteria to use in making your selection. For example, perhaps you have a physician you really want to continue to see. Or perhaps you wish to keep your doctors within certain geography. We are here to guide you through the process to give you all the facts.

You Need Good Advice, but Are Unsure Where to Turn

Keep calm, and give us a call. Our Plano-based team is well-trained and happy to help. Advice is free, but good advice is priceless. Find someone who really understands all the plans and will ensure you are on the right path. The most important thing is to simply take the first step in getting the best insurance for you. So let’s take it one step at a time:

  1. Download the ACA DIY Checklist.
  2. Listen to What the Health is Going On?.
  3. Find an expert who can answer your questions.
  4. Keep Calm and Call Alkali. We are here to help!
Pin on Pinterest

Have you considered adding financial health to your 2015 goals? The following tips were featured as part of an article on this very topic. To assist you, we’ve distilled the list down to 10 to help you start down the path to positive financial growth. In addition, we are holding a webinar for our neighbors in Plano to help you find both meaning in your life and improve your financial status. So the first tip I have is to mark your calendar for January 27th at 4:00 PM and join us for Meaningful Money.

Take Positive Steps Toward Financial Health

The tips below will help you make 2015 a financially healthy year:

  1. Build an emergency fund. It’s like a buffer or a security blanket that will protect you if you come across any unexpected or unforeseen incidents.
  2. Test yourself. Decide if you really need the item you are about the purchase. Doing so will help you reduce or eliminate extra expenses in order to make a positive impact on your overall finances.
  3. Learn to negotiate. There are many retailers that have price matching programs, plus they might consider an offer from you for a reduced price to move product from the shelf. You will not know until you ask, so consider negotiating (in a positive way, of course) to get the best deal.
  4. Create a separate savings account. Saving money is important, so placing it in an account that is not as easily accessible might help you think more seriously before you access the funds.
  5. Cut back. The beauty of this tip is you have the power to choose what you want to give up. For example, eating at home more frequently and making a restaurant meal a special occasion saves money and gives you something to look forward to.
  6. Sell things you don’t use. If you have items you have not used in some time, then you may have money at your fingertips. Selling unused items will clear up space and provide a little extra cash, perhaps for your emergency fund.
  7. Buy items second hand. Shopping around for good deals from second-hand stores or online retailers lets you gain access to nice items at discounted prices. Just make sure to do your research and purchase from reputable people.
  8. Look for online coupons. There are numerous coupon websites that can save you money, so it is worth the time to check for online coupons before you purchase.
  9. Research items you plan to purchase. By understanding where you might find the item on sale, where the purchase outlets are, and how many others carry the item you desire, you can save money, and give yourself information to negotiate.
  10. Create sensible goals. Taking small, continuous steps will often land you in a much better place than making radical changes and then feeling a bit overwhelmed. Financial health is a journey, so keep moving forward one step at a time.

Remember to join us for the Meaningful Money webinar on January 27th, where you will receive even more insights into making money that builds on your purpose. Here’s to a financially healthy 2015!

Pin on Pinterest

Open enrollment for the individual health insurance market has already kicked off, but it’s not too late to get coverage before open enrollment ends 02/15/15. At Alkali, our goal is to help our neighbors get the tools needed to navigate the complexities of the Affordable Care Act and ensure that you have the coverage you need and that you don’t have to pay the penalty!


Alkali will be hosting a free, one-hour class in Plano to answer the question, "What the Health is Going on?!" 


During this informative classroom session, we are going to answer the following jarring questions:


-       Why is my medical policy being non-renewed by my carrier?

-       I have a Grandfathered plan? Can I find a better deal?

-       I am looking to buy health insurance under ACA for the 1st time. What do I need to know?

-       I already have an ACA plan but I am still confused. Did I purchase the best plan for my needs?

-       Should I leave my employer plan for the individual market?


Seats are limited, so register today! Every attendee will receive a DIY checklist on how to navigate the Affordable Care Act and determine the best fit for their health insurance needs.

Pin on Pinterest

By now, many of you have received a notification from your current insurance carrier letting you know one of two things – either your rates are going up, OR your current policy is going away and you must find a new one, which will most likely be more expensive. Why is this happening?

Several large insurance carriers have plans that were not grandfathered and are not compliant with the current version of the Affordable Care Act (ACA). These were written after March 23, 2010 and while they did incorporate some of the earliest ACA mandates, the mandates made after the plans were implemented have now made them no longer compliant. The Administration extended these reform plans for two years ending in 2015; however, it is up to the carrier as to how long they wish to facilitate these plans. Many have opted to remove them at the end of 2014 due to rate increases matching or exceeding the cost of ACA plans.

OK, so now what? Keep calm. Plano-based Alkali Insurance is here to help and can provide you with information on the best path. For example, we have a webinar coming up on November 20th at 9 AM that you can sign up for to get details on how to handle all these changes. You also have the option to consider an individual healthcare policy from the Healthcare Exchange (one of the topics we will cover during the webinar), which leads us to the next item we wish to cover so that you can be well-informed.

Open Enrollment is Coming

You have choices and while we all enjoy having the opportunity to pick what we want, when it comes to individual health insurance coverage, that task can seem daunting. There are many decisions to be made, including:

  • Do you take your employer’s coverage?
  • Do you cover your family with your employer’s coverage or consider other options?
  • How do you find the best coverage if you are in-between opportunities?
  • How do you decide the right path based on your circumstances?

These are all excellent questions to answer as you are deciding on health insurance coverage for you and your family. If you are going with investigate a plan on the Healthcare Exchange, there are some important dates and details you need.

  • Open Enrollment begins November 15th and ends February 15th.
  • You must select and enroll in a plan within that time frame to receive coverage.
  • The only way to get coverage outside this time frame is due to a qualifying event.
  • If you select coverage in November or December, your effective date will be January 1, 2015.

Now let’s talk in-network doctors for ACA plans.

In the past there were challenges with some doctors accepting plans from the Exchange. Most of these issues have since been resolved. However, just like any plan change, it is important that you find out if your doctor is accepting the plan you intend to choose. If not, is there a comparable doctor in the network you can choose. It will take a little detective work, but will be worth it and avoid unpleasant surprises later.

OK, so you have plenty of choices, even if your current health insurance policy is going away. That is good news. There is one more fact that I think is important to clarify before you make a decision.

Everyone Must Have an ACA Plan

Don’t freak out! The truth is that every health insurance policy, unless it’s Grandfathered, must be ACA compliant; therefore, in order to have health insurance, either through your employer or purchased individually, you will need an ACA compliant plan, or risk paying the penalty. The good news is again you have choices for individual health insurance coverage. You can choose to look at options on the Healthcare Exchange or you can choose off-Exchange which is the private coverage route.

You have the right to choose whatever is best for you, your family and your beliefs. If private coverage is what you prefer, there are plenty of good individual healthcare policies available to meet your needs. We are happy to assist whether you want to pursue options on the Healthcare Exchange or private market plans. Both are widely available and we are able to provide good information so you can make the best choice.

Of course, there is the option to take the to tax penalty over purchasing insurance. There is more to consider than the cost of taking the penalty versus the cost of purchasing ACA compliant insurance. For example, what if something significant happens and you have no coverage? There are options and while these are not ACA compliant and would still require you to pay the penalty, you would have some coverage for a catastrophic need. It’s important to discuss your situation with a qualified insurance benefits specialist who can walk you through all the pros and cons.

What Are the Next Steps?

As usual, there is a lot to understand and absorb, so we have distilled it down into these simple tips:

“I’m losing coverage. What should I do next?”

  1. Check your medical expense spending.  Which benefits are an absolute “must have” in your new plan?
  2. Are employer benefits available?  If so, gather information on plan rates, benefits, and the carrier.
  3. Consider both on/off exchange plans.  Subsidies may be available for plans purchased on exchange.
  4. Keep calm and call ALKALI!

”All my options are expensive and I’m not sure I can afford my employer’s insurance for me or my family. How do I decide what is best?”

That is very simple. Keep calm and call Alkali! And remember to sign up for our webinar covering all the upcoming healthcare changes.

We are here to help our local community and help you sort out the details to make the best decision. But don’t delay. We want to help everyone, but with the large volume of calls and requests, we are scheduling calls in advance and are unable to take your call immediately. Please contact us today to reserve your spot so we can provide advice and ensure you are on the right path to select the best individual health insurance coverage for you and your family!

Pin on Pinterest

It’s that time again. The holiday decorations are already in the stores, television commercials are providing you with more options than you ever dreamed for the ideal holiday gift, and yes, your phone is ringing and mail is filling up with folks asking for donations for their charities. We know you want to help as many as possible, while also providing an awesome Christmas for your family! But it can be so tough, particularly if you are already a little short on funds.

We understand, and have definitely been there ourselves! That is why we want to help. Our belief is that we should do everything we can to make the lives of our clients and friends easier. Whether that is providing an excellent experienceregarding your personal and professional insurance, or helping out with great advice, we strive to be a partner and support you in the best way possible.

It was from this very belief that we decided to do something just a little different for the holidays – something that would make a real impact in your life and provide an opportunity for you to do something nice for your family, friends or even your favorite charity. It made sense for us to induct our own Alkali elves and create the Debt Free Christmas Cash Hunt!

Commitment to the Spirit of the Season

Why a cash hunt? Because we want to live our commitment to our clients to improve how they buy and manage insurance and to live their lives debt free. And we wanted to go beyond and provide support to our clients and friends, so we came up with the Debt Free Christmas Cash Hunt. It’s our way of supporting others and sharing our blessings. All you have to do is choose to participate!

Jump On the Sleigh and Ride!

Beginning next week, our elves will hide envelopes of cash in the North Dallas area. Yes, cash! If you want to add a little extra to your holiday fund this year, then here’s what you need to do:

  1. Start following us on Facebook – like and follow our Facebook page! We will drop clues here, but there is another, even better way to get information…
  2. Sign up for email alerts – visit our Debt Free Christmas Cash Hunt page and sign up for email alerts. These will be different than those on social media, so make sure you sign up to get the best clues!
  3. Have fun! – We want this to be a fun event for you, so check out the rules and guidelines on our page, make sure you are signed up for clues, and go grab yourself some extra cash!

We know that Christmas is a time of year where you want to give more. In keeping with the season we are doing just that – giving you an opportunity to have some fun, get some cash, and enjoy time away from your normal day-to-day routine!

Remember; follow us on Facebook, but also sign up to receive clues via email! Then just follow the clues so you can take more steps to having a Debt Free Christmas! Good luck!


Imagine…you need to shop for insurance because you just purchased a new home. Add to that you purchased another car, and your spouse has decided to start a home-based business. How do you feel? Peaceful? Calm? Certain? Unfortunately many do not. At least the clients and advisors we asked were unable to convey those emotions as part of the process of purchasing and managing their individual insurance policies.  We hated to hear this, and decided to do something about it.

When we began developing the Alkali brand, Steve and I wanted to create something that really focused on our clients. From those early sessions, we were able to develop a way to not only ensure our clients stay in the center of everything we do, but to also develop a positive, client-focused culture as well. Those early questions and brainstorming sessions became something we namedThe Empowered Advantage™, which is really more than steps in a system, but a way to ensure that we are focused on accountability and we deliver on our commitments.

It All Started with Getting to Know You

Our first step in determining how the industry needed to change was to ask you – our clients, advisors and friends. The responses were very telling and gave us a good idea of the challenges you face. Just a few of the answers were:

  • How do you know what is best for me if you just ask me about my year, make, and model?
  • Are you “upselling me” or is this the coverage I really need?
  • Do I really need that much coverage?
  • Why are you recommending this?
  • I wish you guys would talk plain English. If I wanted to talk insurance I wouldn’t need an insurance agent.
  • I called to file a claim and I just got bounced around and received no support from my agent…it was such a hassle and so disruptive to my life.
  • I hate switching, it’s such a pain all of the paperwork and hassle.  It’s just not worth it.

Wow! We knew there was a better way, but it had to start internally, with our passion to do things differently so that everyone we speak to walks away informed. Basically, we show our work so you don’t have to wonder if the recommendations we provide are good. You can see it on paper!

There is a lot to it, so we thought to make it simple, we would create The Empowered Advantage™ so that you would know what was going on, and we would ensure we remained accountable. This 5-step process is comprised of touch points to ensure you feel confident about our recommendations. Let’s review in more detail so you can see how it works.

Begin With You

Rather than ask questions that are focused on the insurance products, we want to know about you and your situation. Frankly, it’s more fun to start with understanding your needs so we can get to the type of coverage that is best suited for you! We oftenlaunch our weekly meeting with understanding what is going on in our clients’ lives and how we can provide support. We begin with you!

Using The Empowered Advantage™ ensures we stay on track, so when you first contact one of our service agents, this is how we will begin:

  1. The Success Lab™
    1. Find out exactly what you need. Have you undergone recent life changes? What is coming up that may impact your life, and potentially the type of coverage you require?
    2. Get clear on what is best for the client. We are not presumptuous.
    3. Go beyond the basics. What is the most important aspect of your insurance experience? Were their bad experiences with claims in the past? Do you need expedited service of some type? What is better for you when you do need to interact with your insurance provider?
  2. The Quantitative Success Formula™
    1. What is best for you? We show our work so you understand why we are recommending a certain type or style of coverage.
    2. No conflict of interest. We have styled our agent compensation differently so you know you are getting the best fit for your circumstances, not what pays the higher commission to the agent.
    3. Leveraging technology to your best interest. Our ability to leverage technology ensures you get the most comprehensive information without overwhelming you with too much.
  3. The Partnership Accelerator™
    1. Remove the hassle of switching. We will make every effort to provide forms that are filled in and do the leg-work for you.
    2. Technology is our friend! Again, we leverage technology to minimize the amount of time you have to spend while switching insurance agents.
    3. Need to switch policies? Easy! Because we can provide forms that are pre-filled with information we have, if we find a better fit for you next year, that switch is even easier!
  4. The Leveraged Force Solution™
    1. The Single Call Resolution Process™. From the beginning, we train our representatives to ask as many questions as possible the first time you call. Our goal is to get everything we need to resolve your issue on the first call.
      1. You will get an email and a call with the response.
      2. You will also receive proof of confirmation, so you know we have done what we said we would!
    2. The Zen Claims Experience™. Wouldn’t that be great! We welcome your call and will gather all the information then warm transfer you to the right person at the insurance agency to handle the claim.
      1. We follow up to ensure that you are receiving the information you need to complete the claim.
      2. Our goal is to make everything easier for you, so we continually reach out to you.
  1. The Success Optimizer™
    1. Proactive evaluation of your situation. We meet with you to understand life changes and how they may impact your existing coverage.
    2. Why wait until renewal? Rate increases are often unpleasant, but should not be a surprise. We sit down and understand what is going on so you can make adjustments, and are aware of increases before they happen.
    3. The right coverage. We avoid unpleasant surprises like being underinsured by checking in. Now you can feel confident you have the right coverage.

Keeping You in the Center

While this may seem overwhelming, we believe in doing everything in our power to ensure our clients are the focus of what we do and how we do it. In fact, these clients had this to say after switching to Alkali:

  • Doesn’t get any better than this!  Just an example of why I enjoy and feel rewarded giving Alkali’s name to others, both professionally and personally.
  • This is great! You’re really making a real impact in people’s lives and their businesses. Thanks for caring and going the extra mile!
  • I appreciate your knowledge of the products/industry, your ability to communicate the information and your willingness to go above and beyond to help!  Thank you so much, you are a pleasure to work with! 
  • … over the past 10 years I can  only imagine the number of times that you have gone above and beyond what I would consider typical customer service.  I can’t tell you all how much we appreciate the great team that you have and how they are always so helpful and accommodating to our requests, every time. 

Serving our clients is our heart, and where we certainly have the most fun! If you would like more information on The Empowered Advantage™, we would certainly welcome a phone call to one of our insurance benefits specialists, who are always happy to answer your questions!


Pin on Pinterest

Other than Spongebob Squarepants, apparently many people want to take an underwater vacation. And we’re not just talking about a little scuba diving. The latest trend in unusual vacations means you actually have a hotel room under the ocean. From Fiji to Tanzania, underwater resorts are popping up all over the place. And while one of the original underwater hotels has been in Florida for years, it looks like we are really trying to get away from it all – even if that means vacationing under the sea!

Other than Florida, it takes quite a bit of traveling and logistics to take advantage of these underwater getaways. Of course, unusual vacations don’t have to be underwater. There are plenty of interesting spots to take advantage of, including eco-vacations, hiking, spas – it’s easy to find a vacation that peaks your interest and that of your whole family.

Once you’ve decided on a great place, have made the trek to get there, have you considered what you will do if you feel a sniffle coming on? Or perhaps one of the children suddenly starts feeling poorly? Fortunately, modern technology is not just for creating the most amazing vacation spot ever. It can also give you access to services so you and your family can stay well, even when a long way from home.

Stay Well on Your Vacation

If you have ever had a vacation ruined by a cold or flu, you know how frustrating it can be. After all, you did not travel to be sick in an amazing place! Fortunately, technology allows us to place a doctor at your disposal anytime, anywhere – without having to visit a local doctor. If you are out of the country, having access to a U.S. doctor provides peace of mind, not to mention no out of pocket expenses. How? Through a health discount program, like Freshbenies.

Health discount programs provide access to doctors via telephone, as well as provide savings on dental, vision care and prescription medication, and access to medical billing specialists. These programs are designed to supplement existing health benefits so that you can get medical information when you need it – which is often not when the doctor is in the office!

Another benefit of health discount programs is the ability to provide affordable access, particularly for those with a High Deductible Health Plan (HDHP) paired with a Health Savings Account (HSA)). A HDHP plan has a higher deductible and is a form of catastrophic coverage. This usually means you pay all up-front costs out of pocket for illnesses until your deductible is met. In other words, in most plans there are no-copays (except for Preventative Care). These out-of-pocket expenses can add up fast, making a plan like Freshbenies really attractive.

To read more about why Alkali Insurance likes this program, click here.


congrats-candlesThere are many exciting events that occur during your life. New baby, marriage, becoming an American citizen – these are times to celebrate! We get so caught up in life’s happy moments that we can forget about making important adjustments to our individual health insurance policy. After all, that is not the first thing we think of on our wedding day.

Of course, there are other major events in a person’s life that also call for a health insurance policy update. These events can also be all-encompassing so updating your policy again may not be top of mind. Things like termination or reduced work hours, death, divorce, even exhausting COBRA coverage all warrant an adjustment to individual health insurance policies.

Life’s Events Call for Special Enrollment

Because we simply cannot predict everything and frankly are unable to plan our lives around open enrollment periods, individual policies allow for special enrollment to accommodate the unforeseen. The special enrollment extends to the Affordable Care Act Marketplace as well.

Qualifying events are those types of circumstances that are beyond your control, such as the birth of a child, or marriage or divorce. These types of events cannot be scheduled around open enrollment, so special dispensation is given to allow for you to make appropriate adjustments to your individual health insurance policy based on need.

Examples of qualifying events include:

  • Marriage or Divorce
  • Loss of HMO Coverage
  • Loss of MEC (Minimal Essential Coverage)
  • Exhausting COBRA Coverage
  • Employer Ceasing to Contribute to Employee or Dependents Coverage
  • Dependent Aging Off Policy
  • Death
  • Termination or Reduced Work Hours

If possible, plan ahead and speak to your health insurance benefits specialist  to prepare for the changes needed to your individual health insurance policy.

With regard to special enrollment for the Federal or State Marketplace, you can qualify if one of the following applies:

  • Qualifying Life Event – much like the scenarios discussed above, these life events include having a baby, getting married or losing other coverage.
  • Other Complicated Cases – these are thoroughly outlined on the site, but include:
    • Exceptional circumstance, such as a serious medical condition or natural disaster that kept you from enrolling.
    • Misinformation or misrepresentation, such as misconduct by a non-Marketplace enrollment assister (like an insurance company, navigator, agent or broker) that kept you from being enrolled or enrolled in the correct plan.
    • Enrollment error
    • System errors related to immigration status
    • Display errors on

For more information and details, see the website.

Life’s Little Events Call for Coverage

Whether the event is a happy occasion or a circumstance beyond your control, it is good to know that you can at least take control of your individual health insurance policy by making appropriate adjustments via the special enrollment process. If you have questions regarding qualifying events, or simply want to know more, please contact one of our health insurance benefits specialists who will be glad to assist you in answering your questions.


Flooding in MinotIt’s already started – the spring season brings some of the more radical and unpredictable weather, with hail storms, torrential rains, flooding. 2013 had a record number of billion dollar disasters globally, with the largest percentage of damage due to flooding. This brings a sobering light on the level of financial impact weather-related events can have on our lives.

According to the NOAA (National Oceanic and Atmospheric Administration) Spring Outlook, flooding is expected with drought conditions continuing in the Southwest. While we certainly need the moisture in the North Texas area, the fact that we have been in a drought makes the uncertainly of spring rains and inclement weather even more problematic for the property manager or business owner, as evidenced by the recent hail storms we experienced. Why?

Buildings have continually expanded and contracted with the fluctuation of extreme temperatures. Couple that with damage from hail storms, leaks from rain, and general wear and tear from inclement weather, the impact to commercial properties has the potential to be acute. So what are the next best steps to ensure you are ready for the challenges crazy weather bring?

Preparation is the Best Policy

There are a number of things you can do to minimize any damage and prepare for more extreme weather. First, perform an inspection of your commercial property. If you own or manage a building, consider having the inspection performed by a professional who knows what to look for. The most seemingly innocent crack in a building can turn into a major problem later.

Second, review your commercial policy. If you are unsure about the coverage, or perhaps are considering additional coverage, now is the time to contact your insurance specialist to get the ball rolling.

Finally, there are steps you can take to ensure the safety of your employees and tenants. NOAA has specific advice and videos covering weather preparedness for every type of natural disaster. From tornadoes to tsunamis, you can find tips on their website to help you be better prepared.

Another resource for weather preparedness and safety is OSHA. They have resources, videos and even opportunities for response training for those who require an official emergency preparedness plan. You can find emergency preparedness and response guidance for general business, including a Planning and Responding to Workplace Emergencies fact sheet. In addition, OSHA has prepared a section on tornado preparedness and response which provides checklists and tips to ensure the safety and wellbeing of your team.

Coverage is Key

A big part of ensuring you are prepared is important to take a good, hard look at the commercial policy you presently have.  It’s important to address property insurance coverage needs now, particularly since there is so much unpredictability around the weather. Addressing what you can control will give you peace of mind and the best coverage for your situation. Contact one of our insurance specialists to schedule a review or ask questions now, before the next major weather event wreaks havoc on our area.


Freestanding MRI clinics are being purchased by large hospital groups. Currently the freestanding, independent clinics typically charge significantly less than a hospital. However, once they are acquired, the price increases dramatically. Here is a prime example:

Behemoth Hospital Group purchases Small Guy Imaging. Once the acquisition is complete, SGI now has to carry the operational costs of a much larger group. When compared to We Stayed Independent imaging, the cost differences are extreme! (NOTE: Names have been changed to respect privacy, but the scenarios are true.)

We Stayed Independent vs. Small Guy Imaging

CPT Code Description

We Stayed Independent Rates

Small Guy Imaging (All 51% Hospital Owned)

$ DIFFERENCE (Potential Patient Savings)



MRI Joint Lower Ext W/O




MRI Joint Upper Ext W/O




MRI Brain W & W/O



 $  488.33



MRI Lumbar W/O


 $   708.00

 $  283.65



MRI Cervical W/O


 $   700.00

 $  275.96



MRI Brain W/O


 $   765.00

 $  295.14



CT Abd/Pelv W

 $ 307.81





CT Abd W/O




CT Chest W


 $   460.00

 $  177.41



CT Sinus W/O




CT Brain W/O


 $   292.00

 $  113.34



This is just a representative example of the price differentials between an independent medical imaging facility and a hospital-owned facility.  Obviously the numbers speak for themselves. But there is more to consider.

Patients with HSA accounts and high deductible accounts pay the full difference of the rates.  Patients that have met their deductibles still have to pay 10 – 30 % co-insurance, meaning they are paying 10-30% of the cost differential even after meeting their deductible.

Finally, this drives up healthcare costs across the board and payers (insurance companies and self-funded health plans) have to respond with higher member monthly premiums.  Thus, these increases in medical imaging costs impact any company with group employee benefits.

But here is the rub – insurance is not setting these rates. Medical providers are and with the cost of medical services continuing to go up, it is more difficult for a smaller clinic to stay in business. Therefore, it makes good business sense for them to sell to a larger hospital. Now we have major medical communities, rather than hospitals that are separate from clinics and surgical centers.

Insurance is Only Part of the Equation

The cost of health insurance is a by-product of the increasing costs of medical service. As those costs rise, the doctors, hospitals and medical facilities do not absorb the costs – the consumers do. Furthermore, ACA requires insurance companies to pay out 80-85% of their gross premium revenue in claims, thereby giving insurance companies a % cap on gross profit margins. The law does not cover, however, other cost contributors such as rising costs of prescription drugs, or malpractice insurance.

Don’t get me wrong, insurance companies are a contributing factor to our healthcare challenge, but not the entire problem. In fact, if you take all the insurance companies profit numbers and added it up, that extremely large number only pays forless than a week of healthcare in the United States. We have a whole other side to the equation that needs to be solved. It goes beyond employers paying for insurance.

Losing the Entrepreneurial Spirit

With large hospitals buying up practices and labs to gain a larger portion of the market, there is early data indicating the unintended consequence will be the decline of entrepreneurial spirit in the healthcare industry. Providers who sell to hospitals, will not have as much control, nor feel the empowerment of having their own practice. The end result may be they simply do not work as hard which ended up becoming one of the down falls of HMOs in the past.

If you add that to the continued decline of providers taking Medicare and Medicaid, simply because it is not profitable, now the consumers are in the hot seat again. There will be less opportunity for quality healthcare for those on Medicare and Medicaid programs simply because there are fewer providers who will take that risk. Once again, ACA ends up negatively impacting those the law was intended to help.

Fortunately, there are still positive options out there. Decoupling how providers are incented to ensure the best healthcare options is the reason we created The Empowered Advantage. There are ways to minimize and even negate some of the unintended consequences of ACA. Fortunately, you don’t have to navigate those rough waters alone. Our group health benefits specialists are well-versed in the nuances of ACA and are happy to answer your questions and address your concerns. Then you can focus on your business, keeping it running smoothly without being sidelined by the complexities of ACA.