Insurance Questions and Suggestions

What if I have traditional insurance or an HMO can I still benefit from SimpleCare?

Will my insurance accept SimpleCare receipts?

How much could a high-deductible policy save me?

How do Medicare and SimpleCare work together?

High-deductible policies and MSA's

Link to Insurance Agent/Broker Providers

What if I have traditional insurance or an HMO can I still benefit from SimpleCare?

SimpleCare can benefit you if you are seeking medical services, alternative care or health care providers not "allowed" by your insurance carrier. With SimpleCare, the quality of care and type of treatment you receive is decided upon by you and your health care practitioner, NOT your insurance company. Your insurance carrier may or may not reimburse you for seeking care from "non-participating providers."  For more specific answers to your particular policy you should discuss this with your insurance company member services and/or your insurance broker/advisor.  Some patients are seeking health care services either not covered or disallowed within their policy  - these patients benefit with SimpleCare by paying a better price for the services that they desire from the doctors and health care providers they choose to see when they pay in full at the time of service (PIFATOS).

Will my insurance accept SimpleCare receipts?

The number of insurance companies that accept SimpleCare is continuing to increase as they have seen the advantage SimpleCare offers to their policy holders as well as themselves.  Check with your insurance company or broker/agent if you are considering submitting SimpleCare codes for reimbursement or to apply towards your deductible.  We suggest you use the SimpleTrakTM system developed by SimpleCare for easily tracking your health care expenses for possible application against your deductible. SimpleTrakTM also provides a format to track health care expenses that may  qualify for tax deductions. Your tax advisor will be able to guide you with such information.

SimpleCare does not use the insurance industry  - CPT codes.  SimpleCare doctors and health care providers can afford to lower their fees for you because they do not incur the high costs associated with insurance coding and billing.  Insurance codes usually are represented by a higher price than SimpleCare's time-based codes, so by requesting the higher-priced codes you are requesting a higher price for the visit.  If your high deductible policy or health savings account requires coding, you may or may not be able to use SimpleCare for that visit.  However, you might not need to submit each and every form to your insurance company if you do not exceed your deductible.  We recommend that patients use SimpleCare for routine health care costs and then only submit claims toward their deductible for larger items.  Also be aware of any contractual obligations that might require your provider to bill your insurance company before collecting from you.

How much could a high-deductible policy save me?

Many families can save thousands of dollars per year with affordable, high-deductible catastrophic health insurance policies.  For example, a California family can save $4,980 per year in insurance premiums by purchasing a $2,000 deductible (per family member) insurance policy for $207 per month.  The same policy with a $250 deductible is $622 per month.  Considering approximately 90% of the US population spends less than $2,000 per year on medical expenses (73% spend less than $500 per year), this is a good financial choice for many families.  Rates and policies vary by location, state and age.  Your insurance and financial advisor is professionally trained to help guide you. See below for more information about insurance companies offering high deductible plans.

How do Medicare and SimpleCare work together?

Medicare does not allow a "Medicare provider" to charge a "Medicare patient" a cash price without billing Medicare first. However, Medicare patients can see any non-Medicare provider they want and receive the SimpleCare price, as long as the service is NOT submitted to Medicare. Considering that many doctors are opting out of Medicare due to excessive administrative demands and cost, SimpleCare may be an ideal solution for patients seeking medical services, alternative treatments, or providers that are not participating with Medicare. SimpleCare may be a sensible alternative for Medicare patients who prefer to see non-Medicare providers or who do not choose Medicare Part B.

If you seek medical services or providers that are not covered by Medicare, then you can ask any licensed health care provider to join SimpleCare and you will receive their best price when you pay in full by cash, check, or credit card at the time of your visit.

High-deductible policies and HSA's

You can reduce your health care costs by using SimpleCare for routine medical expenses and purchasing a high-deductible catastrophic health policy for unexpected major medical expenses.  This approach is very simple and is used everyday by us with our car insurance.  For example, with car insurance, you pay for the routine maintenance (gas, oil-changes, wiper blades, tune-ups, etc.) and insurance pays only if there is a major accident. You do not "bill" the insurance company for each and every gas receipt, wiper blade or new tire but only when you have a major accident or event that would require your insurance companies involvement.  It would not only be very expensive and cumbersome to expect the car insurance to cover a portion of your weekly gas expenses it is not what insurance is designed to do.  True insurance covers unexpected catastrophic events, that do not usually occur.  This is simpler, less expensive, and provides more freedom to choose the doctors and type of health care you desire.

You also may wish to include a Health Savings Account (HSA).  This allows you to control the money you spend on health care, and SimpleCare helps those dollars go farther.

Resources for High Deductible Insurance and HSA - Health Savings Accounts

The following companies and insurance brokers/agents are provided for informational purposes only. You may contact these or other insurers or your state Insurance Commissioner's Office for additional information on high-deductible catastrophic insurance and HSA's.

NAIFA Community Foundation
National Insurance/Financial Educational Initiative from the National Association of Insurance and Financial Advisors - Rainier Chapter (NAIFA-Rainier). Links to brokers and agents throughout the nation who are professionals in advising clients about catastrophic health care insurance, Health Savings Accounts (HSA's) and various other insurance and financial needs. Any interested broker/agents are encouraged to visit this website.

HSA Insider
Health Savings Accounts: Politics, Regulations and Industry News

Prime Health Care
Health Savings Accounts Prime Health as an HSA administrator of Investor Driven Health Plans - compatible with SimpleCare® 4600 West 77th Street, Suite 201, Edina, MN 55435, Phone: (952) 844-0977, Fax: (952) 844-0924
Toll-Free: (866) 844-0977

Westmark Financial Services, Inc.
David D. Hagen, CIC Westmark Insurance Services toll free 877-232-9757. A consumer advocate serving Washington and Oregon residents and businesses interested in the correct placement of insurance products using risk retention, health savings accounts, and the movement toward consumer driven health care.
This site is a “catastrophic/major-medical/high deductible portal” that is very easy to use. The site lists all major insurance companies that are providing high deductible health insurance in a variety of formats. Just place your date of birth and gender in the search area and the site lists several options from many carriers for your evaluation.

Golden Rule Insurance
Golden Rule offers high-deductible “Basic Plan” insurance and Health Savings Accounts compatible with SimpleCare®. The Basic Plan, their most affordable health insurance, offers personal control of many health care expenditures while providing coverage for the more costly medical needs. For more information call 800-444-8990.

American Health Value
(800) 914-3248 AHV can set up and administer your HSA and recommend local insurance agents or companies that sell compatible high-deductible insurance.

National Association of Alternative Benefits Consultants
NAABC specializes in major medical insurance and HSA's.

State Bank of Howard's Grove
Offers HSA's nationwide, including an HSA debit card program.

The Galen Institute
An innovative research organization focused on health and tax policy - advocates for affordable health care solutions and consumer driven health plans.

American Association of Patients and Providers, Inc. – AAPP
The largest patient, physician and allied health care provider association dedicated to free-market health care solutions in America.

Association of American Physicians and Surgeons, Inc. – AAPS
A voice for private physicians since 1943 promoting freedom in medicine.

Americans for Free Choice in Medicine
AFCM promotes the philosophy of individual rights, personal responsibility and free market economics in the health care industry.


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