INSURANCE BROKERAGE FIRMS Ranked by 2005 L.A. County revenues

Rank Brokerage (Ranking in 2005) Revenues (1)
* name (county/
* address national)
* Web site * 2005
* 2004
* percent gain
(loss)

1 Aon Corp. (1) $183/$2,436
707 Wilshire Blvd., Suite 6000 $175.7/$2,298
Los Angeles 90017 4.2%/6%
aon.com
2 Arthur J. Gallagher & Co. (3) 68.1/1,483.9
505 N. Brand Blvd., Sixth Floor 64.7/1,480
Glendale 91203 5.3/0.3
ajg.com
3 Lockton Benefit Group (4) 65.5/400
725 S. Figueroa St., 35th Floor 57.1/342
Los Angeles 90017 14.6/17
lockton.com
4 Total Financial & Insurance Services Inc. (5) 64.6/79.7
11835 W. Olympic Blvd., Suite 600 55.4/66.3
Los Angeles 90064 16.5/20.2
totalfinancial.com
5 Keenan & Associates (6) 51.5/110
2355 Crenshaw Blvd., Suite 200 49.4/105.1
Torrance 90501 4.3/4.7
keenan.com
6 Elkins/Jones Insurance Agency Inc. 50/50
12100 Wilshire Blvd., Suite 300 45/45
Los Angeles 90025 11.1/11.1
elkinsjones.com
7 Innovative Solutions Insurance Services (8) 29/25
200 N. Sepulveda Blvd., Suite 900 21/21
El Segundo 90245 38.1/19
isislife.com
8 Willis (7) 28/786
801 S. Figueroa St. 24/814
Los Angeles 90017 16.7/-3.4
willis.com
9 PRB Insurance & Financial Services Inc. (11) 20.8/25.6
1925 Century Park East, Fourth Floor 18.1/23.3
Los Angeles 90067 15/10
N/A
10 ABD Insurance and Financial Services (9) 20.2/156.6
21250 Hawthorne Blvd., Suite 600 20.4/132.4
Torrance 90503 -1/18.3
cybersure.com
11 Bolton & Co. (12) 17.8/21
245 S. Los Robles, Suite 105 18.1/20.8
Pasadena 91102 -1.5/1.1
boltonco.com
12 Sander A. Kessler & Associates Inc. (13) 15/15
2850 Ocean Park Blvd., Suite 200 16/16
Santa Monica 90405 -6.3/-6.3
sanderkessler.com
13 Armstrong/Robitaille Business & Insurance 13/35
Services (14) 13/35
535 N. Brand Blvd., 10th and 11th Floors 0/0
Glendale 91203
arinsurance.com
14 GNW-Evergreen Insurance Services 10.1/10.1
16030 Ventura Blvd., Suite 500 9.9/9.9
Encino 91436 2.1/2.1
gnw-eg.com
15 Arroyo Insurance Services 9.5/10.7
2900 W. Broadway 9.1/10.4
Los Angeles 90041 5/2.9
arroyoins.com

Rank L.A. County Insurers
* employees (partial list)
* year
established

1 919 all carriers
1976
2 250 all carriers
1981
3 310 all carriers
1995
4 47 Jefferson Pilot, Lincoln Benefit Life,
1974 Lincoln Life, New York Life, Mass
Mutual, John Hancock, ING, AIG,
Transamerica
5 300 N/A
1972
6 37 Fireman’s Fund, Hartford, Chubb,
1996 California Insurance Group,
St. Paul/Travelers, Allied, Safeco
7 44 Transamerica, Prudential Financial,
1998 Lincoln Benefit Life, Met Life,
John Hancock, West Coast Life,
Genworth/First Colony
8 105 all carriers
1950
9 60 Union Central Life, Mass Mutual,
1962 Manufacturers Life & Travelers,
UNUM, Transamerica, Pacific Life
10 83 all carriers
1986
11 116 all major carriers
1931
12 86 State Compensation Insurance Fund,
1954 Cigna Corp., Blue Cross, Aetna,
Applied Underwriters, St.
Paul/Travelers, Crum & Forster
13 81 AIG, Chubb, Hartford, St.
1979 Paul/Travelers, Fireman’s Fund, Blue
Cross, Blue Shield
14 70 Fireman’s Fund, Chubb, Hartford,
2004 St.Paul/Travelers, Golden Eagle, State
Camp Insurance Fund, Safeco
15 62 Chubb, Hartford, Safeco, CNA, Golden
1982 Eagle, St. Paul Travelers, State Fund

Rank Major Lines Written
(in order of volume)

1 all lines
2 all lines
3 all lines
4 keyman life insurance, foreign nationals,
survivorship life, annuities
5 workers’ compensation, medical, dental,
property/liability, malpractice
6 real estate (lessors risk) manufacturing,
workers’ compensation, home owners,
non-profits
7 life, annuities and long-term care
8 all lines
9 life, annuities, disability, long-term care,
group employee benefits, 401(k)
10 group employee benefits,
property/casualty, workers’
compensation, 401 (k)
11 all lines
12 workers’ compensation, group health,
personal lines, 401(k), commercial
general liability, property/casualty,
commercial package, business auto
13 workers’ compensation, package
policies, auto, life and health
14 workers’ compensation, commercial
package, home owners, personal auto,
commercial general liability, E&0,
commercial umbrella
15 business property & liability coverages,
automobile fleets, workers’
compensation, professional liability

Rank Profile Top Local Executive
* parent company * name
* headquarters * title
* offices * phone
(county/total)

1 N/A Sam Cargill
Chicago president, resident main
3/500 director
(213) 630-3200
2 N/A James G. McFarlane
Itasca, III. chairman, Western regic
3/200 (818) 539-2300
3 Lockton Cos. Timothy J. Noonan
Kansas City, Mo. ceo
1/17 (213) 689-0500
4 National Financial Partners Martin Greenberg
Los Angeles president
1/1 (310) 477-7500
5 N/A Sean Smith
Torrance ceo
2/10 (310) 212-3344
6 N/A Janet C. Jones
Los Angeles president
1/2 (310) 207-9796
7 N/A Lynne Rosenberg Kidd
EI Segundo ceo
1/1 (310) 851-8222
8 Willis Group Holdings Ltd. David Fuhrman
New York ceo, Los Angeles
1/300 (213) 607-6300

9 N/A Tom Michel
Los Angeles managing partner
1/4 (310) 551-3125

10 N/A Robert Volkel
Redwood City executive v.p.
1/14 (310) 543-9995
11 N/A Steve Brockmeyer
Pasadena co-ceo, president
1/2 (626) 799-7000
12 N/A Steven K. Kessler
Santa Monica ceo
1/1 (310) 309-2200
13 Union Bank of California Paul Furlong
Fullerton area president
1/4 (818) 662-4200
14 N/A Andrew Forchelli
Encino coo
1/1 (818) 257-7400
15 N/A William E. Knauf
Arcadia president
6/7 (323) 550-7900

N/A–Not Applicable

Note: The information on this list was supplied by
representatives of the brokerages themselves. Brokerages
are ranked by 2005 L.A. County revenues from insurance
brokerage services. Numbers that appear to be tied have
been rounded.

Most managed care organizations have grown “healthier” during 1999-2002, according to the GMS Market Update on managed care organizations released March 24. Profit margins increased from 1.8 to 4.4 percent for the publicly traded companies. The Blue Cross Blue Shield plans, the publicly traded Medicaid HMOs, and Kaiser Permanente–the largest not-for-profit HMO in the country–showed similar improvement. The positive change has been attributed primarily to premiums rising at double-digit rates (8.3 percent in 2000 11.0 percent in 2001, and 12.7 percent in 2002) and staying ahead of medical costs. For 2003, that trend is expected to continue with premiums projected to rise 12 to 13 percent while medical costs go up 11 to 12 percent, on average.

Although HMOs have maintained about Z7 percent of the health plan enrollment over the past five years, the combined preferred provider organization and point-of-service enrollment has gone from 59 to 70 percent. Medicaid, the only area in which managed care is expected to grow, includes 58 percent of the beneficiaries enrolled in HMOs. The report looks at the trends of increasing employer cost sharing and self-funding, and medical cost components, along with discussion of the managed care organizations’ approaches to holding down pharmacy and other costs.

Since 1999, Seattle’s University of Washington Medical School has been the focus of federal investigation for Medicare fraud. In that year UW repaid Medicare $3.6 million for improperly charging the system for experimental heart-transplant devices. The following year a UW billings-office worker told authorities about false billing practices by some UW doctors. His assertion that staff doctors were charging for services that they had not performed led to a federal grand jury probe. The office worker tape-recorded incriminating conversations with doctors, some of whom had billed the government for services while they were on vacation. The university says that “the false claims were the unintentional result of complicated filing regulations.” It also noted a large discrepancy between the amount that the university billed Medicaid in 2002 ($107 million) and the amount it received ($34 million).

According to an article in The Seattle Weekly, the university has provided “hundreds” of its employees with attorneys during the federal probe. One prominent physician investigated for billing fraud was brain surgeon H. Richard Winn. Dr. Winn plea-bargained “a lesser charge of obstruction of justice.” Dr. Wina was sentenced to 5 years’ probation and 1000 hours of community service, teaching and treating patients at Tribhuvan University Teaching Hospital in Nepal. He also had to pay a $4000 criminal fee and $500,000 to Medicare and Medicaid. In exchange for resigning his position as 11W chair of neurosurgery, Dr. Winn received $970,000 and a guarantee of up to $3.7 million in UW unemployment compensation until he finds a job he wants. The university also paid his legal fees totaling $500,000. Dr. Winn is still allowed to bill Medicare for his work and is eligible for federal grants. According to The Seattle Weekly, kidney doctor and chief of nephrology, William Couser, was also considering a plea bargain. When the dust settles, the legal fees, fines, and settlement paybacks may cost the University of Washington $25 million.

According to the Seattle FBI office, health care fraud is second, after bank fraud, on the list of white-collar crime in that area of the country.

The federal bank, thrift institution, and credit union regulatory agencies issued on June 6, 2005, interim final rules under the Fair Credit Reporting Act (FCRA) that create exceptions to the statutory prohibition against obtaining or using medical information in connection with credit eligibility determinations. The interim final rules also address the sharing of medically related information among affiliates.

The effective date for these rules is nine months after the date of publication in the Federal Register, which was on June 10, 2005.

Section 411 of the Fair and Accurate Credit Transactions Act of 2003 (FACT Act) amended the FCRA to provide that a creditor may not obtain or use medical information in connection with any determination of a consumer’s eligibility, or continued eligibility, for credit except as permitted by regulations or the FACT Act. However, the FACT Act also requires the agencies to prescribe regulations that permit creditors to obtain and use medical information for credit eligibility purposes when necessary and appropriate to protect legitimate operational, transactional, risk, consumer, and other needs. A proposed rule was published for comment on April 28, 2004.

The interim final rules create exceptions to the general statutory prohibition on obtaining and using medical information. The provisions are similar to those contained in the proposed rule and include exceptions for the use of medical information that is also financial information typically considered in credit underwriting. As authorized by the FACT Act, the agencies have expanded the scope of the rules so that the exceptions will apply to all creditors, not just to creditors ordinarily regulated by one of the agencies.

Section 411 of the FACT Act also amended the FCRA to limit the ability of creditors and others to share medically related information among affiliates except as permitted by the statute, regulation, or order. The interim final rules specify the circumstances in which creditors may share medically related information among affiliates without becoming consumer reporting agencies.

The interim final rules are being issued by the Board of Governors of the Federal Reserve System, the Federal Deposit Insurance Corporation, the National Credit Union Administration, the Office of the Comptroller of the Currency, and the Office of Thrift Supervision. The rules of each agency are substantively identical.

The rules are being issued as interim final rules to allow for public comment on their expanded scope. The agencies requested comment within thirty days after publication in the Federal Register.

Practically everyone wants to reform America’s health care system. Twenty-first century demographics and medical technologies virtually guarantee that health insurers–public and private–will not be able to pay for the treatments American consumers already expect. So reform we must, but how? Goodman, Musgrave, and Herrick strongly favor market-oriented solutions. But, they fear, America could be tempted toward a single-payer system like that of Canada, Australia, New Zealand, and the U.K. In their view, the sirens luring Americans toward the rocks are myths and truisms. These are the targets of Lives at Risk.

The book has three sections: “Twenty Myths” catalogs and attacks a set of commonly held beliefs about single-payer systems. “The Politics and Economics of Health Care Systems” examines obstacles that lie in the way of developing market-based, consumer-driven health insurance. These include political considerations and the incentive problems peculiar to health insurance contracts. In “Reforming the U.S. Health Care System,” the authors offer their own vision for reform.

The books structure suggests that for these authors, halting the drive toward national health insurance is priority #1. “Twenty Myths” spreads across roughly 168 pages, and it is first in the book. In contrast, “Politics and Economics …” and “Reforming …” only occupy 27 and 37 pages, respectively.

What are the arguments–myths to these authors–that turn American eyes north to Canada or east to Britain? Single-payer advocates see the following just across the border or just over the ocean: (1) a “right” to health care, (2) egalitarian access, (3) care allocation according to need, not wealth, (4) better health outcomes, (5) up-to-date technology, (6) higher quality of care, (7) better cost controls, (8) more efficient providers, (9) less unnecessary care, (10) lower administrative costs, (11) resources focused on maximizing health improvements, (12) more preventive care, (13) elimination of problems associated with U.S. managed care, (14) lower cost burden on businesses, (15) better care for the elderly, (16) better care for minorities, (17) better care for rural areas, (18) cheaper prescription drugs, (19) greater contentment with health insurance, and (20) benefits that can only come from government action.

These 20 hopes become the myths analyzed in the first 20 chapters. The authors calmly, carefully catalog and eviscerate each of these arguments. They methodically reveal how claims diverge from reality by painting a sharp contrast between the current American system (which the authors wish to change) and the single-payer systems abroad.

Single-payer proponents argue that Canada, Britain, and others deliver health care more cheaply, more efficiently, and more equitably; but in Lives at Risk these lofty claims dissolve beneath mountains of data. In the United States, five percent of patients have to wait more than four months for surgery; in Australia, New Zealand, Canada, and Britain, the percentages are 23 percent, 26 percent, 27 percent, and 36 percent, respectively. Wealthier British citizens receive better care than poorer citizens; the poor suffer higher cancer death rates than the wealthy. Americans of all socioeconomic classes have better access to MRIs, CTs, lithotripsy units, coronary catheterization, and so forth. Britain gives younger patients priority over older patients for many procedures. South Asians in Britain, Inuits in Canada, Maoris in New Zealand, and Aborigines in Australia receive poorer care and less care than their non-minority countrymen.

Goodman, Musgrave, and Herrick are not merely bomb-throwers who demolish single-payer insurance and then retire to the drawing room. Having addressed the failings they see in single-payer systems, they turn toward reforming the American system. They propose specific ways to harness the desires and intelligence of consumers to create a better system in the United States

Section 2 (”Politics and Economics …”) describes the practical difficulties of achieving reform. Here, they focus on problems familiar to readers of the public choice literature: group politics, coalition-building, income and spending distributions, bureaucratic self-interest, and organizational inertia. They also address the difficulties inherent in designing institutions for a market in which moral hazard, adverse selection, risk, uncertainty, and private information abound.

Section 3 (”Reforming …”) lays out the basics for an ideal health insurance system. For these authors, such a system will be laden with market-driven features, including Health Savings Accounts. Our current system is characterized by free riders, legions of those lacking formal insurance policies, perverse incentives, and legal obstacles to efficiency and equity. The authors list ten characteristics of an ideal system. Without getting too specific here, these cover such areas as optimal subsidies, optimal penalties, tax structures, budgetary impact, and the proper role of the federal government.

A report released in September by The Commonwealth Fund finds that, as employers cope with rising healthcare costs by dropping health benefits or increasing employee cost- sharing through higher deductibles, workers and their families are being squeezed. When people lose coverage, many who turn to the individual insurance market find that coverage is unobtainable or unaffordable. The report also finds that those with high-deductible health plans are more likely than those with lower deductibles to have burdensome medical debt and to forgo needed health care; those with low incomes are especially at risk.

Of working-age adults who sought coverage in the individual market during the past three years, 89 percent ended up never buying a plan; 58 percent found it very difficult or impossible to find affordable coverage; and 21 percent were turned down, were charged a higher price because of a pre-existing condition, or had a health problem excluded from coverage.

“Most of the increase in the number of uninsured Americans–now upwards of 46.6 million–was due to a decline in workplace coverage,” said Commonwealth Fund assistant vice president Sara Collins, lead author of the report, Squeezed: Why Rising Exposure to Health Care Costs Threatens the Health and Financial Well-Being of American Families. “Although the individual market is a last resort for those shut out of employer-sponsored coverage, it is by no means a safe or secure haven for everyone.”
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The report, based on findings from the Commonwealth Fund 2005 Biennial Health Insurance Survey, also highlights the increasing cost burdens families are facing due to the decline in the quality of coverage and more cost-shifting to employees. Adults with high-deductible health plans–those with individual market or employer-based coverage–have higher out-of-pocket costs than do those with lower-deductible plans. In addition, many adults with such plans are left with burdensome medical bills because of limits to their insurance coverage. Of those with deductibles over $1,000, 40 percent had expensive medical bills for services not covered by their insurance, compared with about 19 percent of those with deductibles under $500.

Those with high-deductible health plans were also more likely to report that they did not get needed health care or prescription drugs because of costs. In addition, many adults with such plans said they had problems with medical bills or were paying off medical debt over time and were more likely to give low ratings to their coverage. Two of five (41 percent) of those with deductibles over $1,000 had medical bill problems compared with about a3 percent of those with deductibles under $500. Of those with higher deductibles, 41 percent rated their health plan fair or poor, compared with 15 percent of those with lower deductibles.

“We need a national solution to the problem of affordable and comprehensive coverage for all,” said Commonwealth Fund President Karen Davis, “following the lead of states like Maine, Massachusetts, and Vermont that have expanded coverage through shared financial contributions from individuals, employers, and government.”

Other key findings from the report include:

* Two of five (43 percent) adults with individual coverage spent 5 percent or more of income on premiums, compared with 14 percent with employer-sponsored coverage.

* Of adults with individual coverage, 37 percent have annual deductibles of $1,000 or more.

* Adults with high deductibles are less satisfied with the quality of the health care they have received: 29 percent of those with deductibles over $1,000 are very satisfied with quality, compared with 54 percent of those with deductibles under $500.

* Of those with deductibles over $1,000, 44 percent experienced problems with access to care (didn’t fill a prescription; didn’t see a specialist when needed; skipped a recommended test, treatment, or follow-up; or had a medical problem and didn’t go to a doctor or clinic) compared with a5 percent of those with deductibles under $500.

* One-fifth (22 percent) of those with higher deductibles took on credit card debt to pay medical bills, compared with 8 percent of those with lower deductibles.

The aim of this paper is to examine possible determinants of the prevalence of private medical insurance (PMI) in England. The entire British public has access to free care in the National Health Service (NHS) financed by general taxation and national insurance paid by all employed United Kingdom (U.K.) residents. There is no option for U.K. residents to opt out of contributing to the NHS, and NHS coverage is comprehensive. Thus, PMI is supplementary, typically purchased to guarantee faster access to health care (particularly specialists) and in some cases, better amenities in health care facilities. In the United Kingdom, PMI covers treatment for curable, short-term illness or injury. PMI does not cover general practitioner (GP) services, chronic conditions, or conditions an individual had prior to taking out insurance. At the end of year 2000, 6.88 million people in the U.K. (approximately 11.5 percent of the population) were covered by PMI and the value of the PMI market was estimated at 2.45 billion [pounds sterling] (Laing and Buisson 2001), 5.1 percent of the estimated year 2000/2001 NHS expenditure of 48 billion [pounds sterling].

Since 1988, Laing and Buisson, an independent specialist consultancy in health and community care, have reviewed the U.K. PMI market. The number of subscribers covered through an employer-paid plan has increased by approximately 23 percent since 1990, while during the same period, the number of subscribers who were either paying individually or as employees (as partial payment of a company plan) declined by about 6 percent (Laing and Buisson 2001). At the end of 2000, 66.5 percent of PMI subscribers were in plans fully paid for by their employer (Laing and Buisson 2001).
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Tax policies introduced between 1979 and 1997 encouraged both employer-paid and individual PMI subscription. Employers did not pay employers’ National Insurance contributions on PMI provided to employees as a benefit-in-kind. (1) And in 1990, tax relief on the total premium cost, at the marginal tax rate, was provided to holders of individual PMI over age 60 years.

Some of these incentives were weakened in 1997. Tax relief for individual PMI premiums paid by those over the age of 60 years was discontinued (Laing and Buisson 2000b) and the Insurance Premium Tax on all PMI policies (in effect, a sales tax on PMI purchase) was increased to 5 percent from 4 percent (introduced in October 1994 at an initial rate of 2.5 percent [HM Customs and Excise 2001]). Also, in April 2000 the government extended employer-paid national insurance contributions (2) to cover PMI benefits in kind (Laing and Buisson 2000b). Evidence exists to suggest that incentives intended to increase PMI prevalence were expensive, and largely unsuccessful in stimulating demand (Emmerson, Frayne, and Goodman 2001). Furthermore, the elimination of tax relief for those over age 60 years increased premiums for individual subscribers in this age group by 29.9 percent (Emmerson, Frayne, and Goodman 2001).

The future trend of PMI prevalence may be influenced by two factors: substantial increases in premiums on individual PMI policies (over the calendar year 1999 they were estimated to have increased by over 15 percent or five times the rate of inflation in 1999 [Laing and Buisson 2001; U.K. National Statistics 2001] and the current government’s significant increase in funding to the NHS, pledging to increase real NHS spending by 7.3 percent in each year until 2007 [HM Treasury 2002]).

Data from the British Household Panel Survey (BHPS) 1997-2000, the U.K. Department of Health and Laing’s Healthcare Market Review 1999-2000, are used in this analysis. The panel nature of the survey allows a national, representative sample of households to be followed over the years for which data on PMI subscription are available. The BHPS has not previously been used to examine determinants of PMI prevalence. Previous analysis utilized cross-sectional data that do not well reflect the dynamic nature of the PMI market. Insurance status, PMI policy changes, individual circumstances and waiting lists are all subject to change over time. Our analysis also incorporates data from other sources. We include data on inpatient and outpatient waiting times estimated at the health authority (HA) and regional level (provided by the NHS Waiting Times Team), as well as data on the number of private acute care beds, at the regional level (Laing and Buisson 2000a), and estimates of the regional distribution of physicians working in the private health care sector (DH 2001). The results provide new evidence as to what factors determine the size of the PMI market in England.

MODELLING THE DECISION TO PURCHASE PMI

Several factors impact on the decision to purchase PMI. These include the perceived magnitude of a potential loss because of illness, relative to income and an individual’s degree of risk aversion (Cutler and Zeckhauser 2000; Santerre and Neun 2000). Choice and convenience, as offered by a private health care alternative, are also benefits sought by PMI subscribers (Bosanquet and Pollard 1997; Barr 1998). In some cases quality of care available through private insurance, relative to that available through an NHS system, may also be an incentive (Besley, Hall, and Preston 1999).

Depending on the type of major medical insurance policy you have, most insurance companies will pay for gastric bypass surgery (also called bariatric surgery) if you meet certain conditions. However, some insurance companies have exclusion clauses for treating obesity. These companies refuse to cover any treatment related to “losing weight.” They will, however, treat the diseases caused by excessive body weight. How do I qualify for coverage?

To qualify for coverage, gastric bypass surgery must be considered a medical necessity. The insurance company will make the final determination. They may rely on the information your doctor sends to them or they may require you to be seen by a doctor that they specify.

In either case, certain conditions must exist. Your weight problem must present a serious risk to your life. Don’t be surprised if they require a complete psychological evaluation in addition to your medical records. It is no secret that people eat too much of the wrong kinds of food for many reasons. While genetics and metabolic rate do affect how much a person weighs, often the primary causes of obesity are emotional and psychological. Gastric bypass surgery will not fix these emotional and psychological problems. In fact, if these issues are not dealt with prior to or along with the surgery, the patient may be more likely to experience serious complications. For this reason, all insurance companies require both a medical and psychological clearance before they will approve the surgery.

Remember, insurance companies are businesses. If they think you are a good candidate to maintain the weight loss permanently and that the $25,000 to $50,000 dollar price tag for gastric bypass surgery now will save them money in the long run by eliminating payment for other weight related medical problems, they will most likely cover the surgery.

How much will my insurance carrier cover?

If you are approved for gastric bypass surgery, your insurance company will pay anywhere from 50 to 100 percent of the hospital and doctor fees. Some policies will even cover in-home nursing care after release from the hospital if it is deemed necessary by the doctors and approved by the insurance company.

Several different expenses typically are associated with gastric bypass surgery, such as testing to determine eligibility for gastric bypass surgery, pre-admission testing, in-hospital costs, surgeon and other doctor fees, and post-surgery medication and care. Even if your insurance company will not cover the actual procedure, they may cover one or more of the other costs related to your gastric bypass surgery.

How can I make up the difference?

Your surgical center should be able to help you determine what will and will not be covered by your specific policy. In addition, many surgical centers offer low-interest, long-term loans if you are not approved by the insurance company, do not have medical insurance, or have high co-payments.

Since 2000, the total cost of all medically necessary weight loss treatment has been considered a deductible medical expense for income tax purposes. Those tax deductions can help you pay for at least part of the cost of your gastric bypass surgery or help you get back your co-payment for the surgery. Under the Internal Revenue code, treatment for weight loss includes behavioral counseling, nutritional counseling, prescriptions, and gastric bypass surgery if they are undertaken to treat or prevent specific diseases caused by excessive body weight.

This article provides an overview of health issues related to gastric bypass surgery and is not intended to replace the advice of a medical practitioner. Please consult your doctor prior to making any major medical decisions.

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So you wonder, why on earth a complete article on the medical insurance claim form? Well to be honest, I wasn’t sure myself until I began doing research for this article. Another applicable term might be health insurance claim form and from that point of view it equates with a return to health following an accident or illness and taking care of incurred expenses.

Don’t be fooled by the medical insurance claim form. There’s a lot of significance tied to filling one of these little babies out. And frankly while I have been fortunate, up ‘til now, I have had more dealings with these forms than I care to think about due to the accident and geriatric issues so prevalent among my friends and family these last few years.

Getting Down To The Nitty Gritty

Getting down to the real reason why we humans fill out yet another of the many forms required of us in order to get the things that we need involves looking at a medical insurance claim form in all its glory. Now if you don’t have a head for remembering numbers make sure and have all the necessary ones at hand because the form is rife with questions needing numerical answers.

If the person filling out the medical insurance claim form has Medicare, Medicaid, Group Health insurance or some other form of group health insurance they will need to supply that number sometimes even before being asked their name. There are questions relating to relationships. Married or not, relationship to the insured, provided the person filling out the form is not the insured himself or herself.

There are the usual questions about sex, birth, employment, employer, history of illness, federal tax numbers, account number, dates unable to work, date of admission to the hospital and date of release, how much was charged for services rendered and so on and so on.

These are all necessary components to filling a health insurance claim form. And it must be filed in order to make a claim so that insurance will pay for medical expenses as opposed to you doing so out of pocket.

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The origin of private medical insurance goes back a long way – before the NHS was formed. In pre-NHS days, people contributed to “friendly societies”, which provided financial assistance to people in times of need. Some private medical insurance providers, such as BUPA, remain non-profit-distributing bodies, though there are also many commercial insurance companies providing private medical insurance these days. One of the best-known names in private medical insurance cover is AXA PPP healthcare – which was actually conceived in 1938 to provide a health insurance scheme for middle income earners in London.

The principal aim of private medical insurance is designed to cover treatment of “acute illness” – defined by Which? As “conditions which can be cured or substantially alleviated by treatment.” Treatment of chronic illnesses, such as multiple sclerosis or arthritis, may not be covered by private medical; so critical illness insurance might be more suitable. Critical insurance cover will be based on your individual requirements – so shop around for the right policy and always be completely open with your insurance provider, or you may invalidate a claim at a later date.

Other treatments generally excluded from private medical insurance include cosmetic surgery, treatment for alcohol or drug abuse and infertility treatment. The majority of standard policies exclude private consultations of a GP, routine check-ups and dental work – unless it is undertaken in a hospital. However, always check your private medical insurance policy – as some will be more comprehensive than others.

Private medical insurance can be an effective way of ensuring swift access to medical care for your family. Just remember that insurance policies reflect your exact circumstances – so don’t assume that one size fits all.

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