Alternative to Health Insurance for Families?




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For more information, do a search of the internet for the various key words on this page such as PPO, PHCS, etc.

US hospitals are charging uninsured patients about two and one-half times more than those with health insurance, a mark-up that has been steadily rising despite pressure to level prices.

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The HealthCare Role Play, Are You a Victim?

Introduction:  Understanding Health Insurance.  We will roll play using a complete stranger in order to show you how powerful the understanding of a non-insurance product can be for your business.  The story you are about to read is true; the names have been changed to help the protected.  If you have health insurance either through work or paying for it on your own, please read the following dialogue to see if you are paying too much!

Agent:  Hello Bob, how are you doing can I ask you a question?

Bob:  Sure, what would you like to ask?

Agent:  Do you have health insurance?

Bob:  Yes I do, I have been with the same company for 3 years, insures my entire family.  I am as happy as a beaver, just love my company.

Agent:  Do you pay over $200 per month?

Bob:  Have you been hiding in a woodshed?  My premiums were never less than $200 per month, even before I started.  I just received notice that my 2002 premiums are going to be over $600 per month, I was actually thinking if we could even afford them any longer. In addition, the prescription coverage has been reduced, I have to pay a $250 deductible then the co-pays are $20. Office visits have gone up, I wanted maternity care just in case we have one more baby. On top of all this, I pay 20% of the first $10,000 for hospital stays. I have a $1000 deductible with a max out of pocket of $3500 per person with a two member maximum.

Agent:  Wow!  Sounds like you know quite a bit about your coverage, most people don't even know what they are paying for.

Bob:  Well, I figured at $600.00 per month I wanted to shop around, but this was about the best deal I could find. In addition, I am 39 years old, my wife is 34 and neither one of us has ever been to the hospital. Our kids were admitted twice in three years for some minor work but they only spent the night. We are very healthy, yet we have spent nearly $20,000 in premiums the last three years alone. Our premiums started at $325.00 three years ago because we did not want HMO coverage, we wanted to choose our doctor. Our premiums have almost doubled in just three years and we have barely needed the coverage.  I wanted to add dental and chiropractic but that would have been even more.

Agent:  Why do you have insurance Bob?  Do you know the reason you even have health insurance?

Bob:  I guess if we go into the hospital, we need to make sure it does not break us.  I know the odds are not that good, but you never know when something might happen.

Agent:  So, the reason you have health insurance is to protect your family against catastrophic hospital expenses that may cost you more money than you can afford?

Bob:  Yes, isn't that why everyone has health insurance?

Agent:  Probably, but the reason why your premiums are so high is that you are trying to use insurance where insurance was never designed to be used. There are three reasons to use insurance, here are those three

  1.. A very unlikely event
  2.. The event comes without warning
  3.. The event is something you don't want to happen
 Does that describe the reason you purchased health insurance?

Bob:  Very interesting, I never knew that. I guess my office visits, prescriptions, dental and even my maternity benefits do not fall under that definition.  Are you saying I should not have insurance for any event that does not fit that criterion?

Agent:  Correct, you end up paying way more in premiums even if you get some benefit from the coverage. The key to getting proper insurance is a new development in the State of California and around the country, so don't get too mad at yourself, the solution has not been around that long. Consumers and employees can now contract directly with PPO
(Preferred Provider Organization) networks for doctors, hospitals, out-patient surgery, lab work, dental, hearing, vision, prescriptions, ambulance, emergency care, chiropractic, alternative care and much more for a fraction of the cost of insurance. These kinds of events are not designed for insurance so when an insurance policy tries to cover them you see the results in your premium and in the quality of care.

Bob:  How does that work?

Agent:  Very simple. You can now access insurance prices without having to pay insurance premiums for events that were never designed to be covered by insurance. PPO networks have given insurance companies special pricing for over 18 years when PPOs were first originated. The problem in the past has been that consumers could not access those rates known as CPT codes unless they had insurance. You can now access those rates for a very small monthly fee without insurance and then use insurance for the real reason you wanted insurance in the first place.

Bob:  Ok, so tell me how much it would be if I go with your program?

Agent:  Let me give you an estimate, I can tell you exact figures later.

1.      Direct access to PPOs for all the coverage I described above for $39.95 per month

2.      Basic Hospital coverage with $1000 dollar deductible, same max out of pocket as your other policy for $79.00 per month for the entire family with $5,000,000 per member of hospital coverage.

Total cost looks to be about $115.00 - $120.00 per month. If you would like to add custom accident or critical illness as a supplement we can do the entire family for less than $80.00 more, but you don't even need that in most cases. With the $400 or more per month in savings or $5,000 per year, you can put the money in an account and deduct a lot of that from your taxes and then pull the money out tax-free when you need it for health care. Just like a health care IRA but tax free.

Bob: This sounds too good to be true.

Agent:  No Bob, the other sounds too bad to be true. What made you think that $600 per month was accurate. You told me yourself you hardly ever went to the hospital, the insurance was designed to protect you from catastrophic problems, not every event under the sun. You now have much better coverage than you did before for a fraction of what you were paying.

Bob:  You are a hero, where do I sign up.

Agent:  We can do it online or by fax in a matter of minutes.

Bob:  I know hundreds of people who want you just described, can I tell them to call you as well.  Can you do for them what you just told me?

Agent:  Sure, I can do business all over California with a phone, fax or Internet access. Never have to leave my office for most of the work, I can sign up just about everyone online. Did you know that I can even use non-licensed people to help me sell the non-insurance part and they give me leads for people like yourself who want insurance to protect them for the
events that are not very likely to happen?

Bob:  Amazing, why don't more agents do what you do?

Agent:  They are too busy to read their emails and apparently already have more business than they can handle. When you help someone lower their premium, they make less money. Even though it may be better for a lot of people, it is not better for them, so they don't want to learn about it.

Bob:  Well, I will tell everyone I know to come to you and if their agent does not understand what you just said, I will tell them they need a new agent.

Agent:  Well thank you Bob, but let's see if we can help their agent first, and then if they to learn, we will be glad to take their business, sound fair enough?

Bob:  Sounds great and thanks again, make sure and leave your phone number, I want to tell everyone I run into to get the same plan that you are giving me.  When they learn how much they can save, they are going to be sooooo excited.

For questions on how to do this for your family or your business contact

Christopher S. Lawton,
Senior Advocate HealthCare Specialist


Commissioner of Insurance article mentioned below is available by request
Health Insurance Trap, Will You Be A Victim?
Why You Must Demand Direct Contracted Access to PPOs

Understanding Time, Pre-Existing Conditions and Rate Increases
What Happens When Your Current Coverage Changes Overnight?

Do you understand your health insurance policy? Most Americans have no idea what their deductible means or how it is applied. What about your Out of Pocket Maximum known as OOP, do you understand how and when that applies? We wont even talk about 80-20 plans, prescription drugs, formulary lists, maternity leave, approved office visits, medically necessary, acts of war and terrorism along with a myriad of other clauses most consumers are not aware of until it is too late.

Why put up with this when you don't have to? Not only is this entire health care nightmare hard to understand, you or your employer are being tremendously overcharged for inferior coverage, while facing an additional danger that very few realize. Take the time to read the article, it will save you or your employer thousands of dollars per year while increasing your coverage and shielding you from large premium increases coming over the next 5 years.

Consumers now realize that HMOs, health insurance premiums, and coverage that may have been adequate in the past are all but over. Industry average for family PPO coverage has now skyrocketed to over $600 per month. This will be peanuts compared to the price a few years from now which could very well be over a $1000.00 per month. Just in case you don't believe it, we are already seeing these prices quoted to many employers and/or individuals and the real price increases have not even started yet.

The dangers to consumers/employees of not switching to the new more comprehensive, less expensive coverage described later in this article are huge. These new policies based on direct access to PPOs are so much more effective that agents or employers who don't offer these plans to individuals or employees may be held liable for the future problems that will inevitably occur. When we sit around and do nothing, we risk coming down with a condition that may make us "uninsurable" should we need to purchase health care on our own in the future. This "rolling of the dice" is very risky which is why it is so important for individuals and employers to contact a representative who is aware of the new solutions in California.

Employers will no longer be able to foot the bill and employees need to realize that healthcare is not a right but a privilege. We can't keep letting our employer's pick up the tab for outdated, inadequate and overpriced health insurance.  If you are an employee reading this article, by all means, take this information to your HR or health insurance decision maker who can then replace outdated and expensive coverage with more comprehensive and far less expensive health care that will have everyone cheering.


As the Commissioner of Insurance so adequately states in the attached article, the ironic solution to the insurance nightmare starts with a product that is NOT insurance. This NON-insurance solution is what opens the door to an entire entrée of health care choices that allows insurance to cover what it is supposed to cover and NOT cover what it shouldn't.


Care Entrée, a publicly traded (NASDAQ: PCIS) company has emerged as the industry leader in providing direct access to PPOs. Consumers as well as employers can now save thousands of dollars in premiums each year while increasing their coverage with proper insurance designed to work hand in hand with direct access to networks. Featuring an entire suite of products designed to assure providers of prompt payment, Care Entrée is positioning itself as the new leader in health care and may actually attract even lower prices for members in the future due to a strong track record of prompt and accurate payments to providers who will no longer have to spend millions of dollars in collecting claims.

Utilizing an exclusive arrangement with one of the top PPOs in the country, Private Health Care Systems (PHCS) Care Entrée allows consumers to enjoy insurance prices without having to pay insurance premiums for every event under the sun.  Since it is not classified as insurance there is no "underwriting!" In other words, this is "guaranteed issue" consumers cannot be denied no matter their condition past or present.  The only requirement is a simple 30-day wait on hospital stays. When combined with special insurance policies that are more specific and focused, the consumer will not only save a great deal of money, but increase their coverage, lower their out of pocket expenses and shield themselves from large price increases.

From $39.95 to $54.95 per month, consumers and employers will not only access the top doctors and hospitals but also increase their coverage to dental, vision, pharmacy, hearing, alternative care, LTC, assisted daily living, air ambulance, emergency smart card, 24 hour RN assistance and much more. Care Entrée works perfectly will all types of insurance including Medicare, but is designed to work with more focused basic hospital plans such as the samples below. For a complete list of options contact your agent for specific quotes and strategies.


Group or Employee Prices Available on Request

1.      Accident Coverage:  By utilizing a strong accident policy from a stable insurer, consumers can cover over 99% of all accidents with a simple $25.00 deductible that will pay hospital stays, (up to 3-4 days) doctor visits, prescriptions and everything "related" to that accident up to a certain amount. This is an excellent strategy for many families, and is also a "guaranteed issue" covering all costs for 99% of accidents. Since 99% of all hospital stays are 3 days and less, this simple policy can be a lifesaver for many families and is very inexpensive. Prices range from $10.00 to $23.00 per month per adult and $6.00 to $13.00 per month per child (depending on amounts). A good policy will feature no annual maximums and no lifetime maximums meaning that any and all accidents for the individual or family is treated as new coverage with new benefits.  Many families love this type of policy because they can now have so much covered with just a small deductible out of their pocket.

2.      Critical Illness Policy:  These types of polices are now an excellent option that can be used as a stand alone or as supplemental to a basic hospital plan described below.  Featuring very little underwriting, these types of policies pay cash benefits upon diagnosis of critical illness such as Cancer, Stroke, Heart Disease and other types of events that can keep you in the hospital or under care for a length of time. When accessing contracted rates with Care Entrée, the cash benefit can go a lot further than in the past. $100,000 of coverage can now be compared to $750,000 or $1,000,000 at traditional retail expenses. These policies usually let individuals purchase up to $1,000,000 of cash benefit if desired and are also very inexpensive. A female age 36 non-smoker can purchase a $100,000 of cash benefit to use for any reason for as little as $50.00 per month. Males, smokers and people with certain conditions such as diabetes may pay a little more, but in most cases will still be able to purchase the policy without the scrutiny of picky underwriting that exists with many other insurance products.

3.      Basic Hospital Plans:  Although these plans have existed in various forms, they now make a lot more sense because of the contracted rates with Care Entrée. These plans are not as specific as accident or critical illness and therefore require more underwriting.  They are designed to cover any event that brings you into a hospital and usually feature lifetime maximums of over $5,000,000.  Based on contractual rates, that should be good enough for virtually every family in the U.S. They usually have a $1,000 deductible with a max out of pocket or a maximum exposure of $3500 per individual with a two member limit. In other words, the worst-case scenario a family might face would be $3500 per individual or $7000 out of pocket if two family members needed extensive hospitalization during the same year. These plans vary by carrier, but this is a good idea of how it works.  Prices for these policies are also surprisingly low and make an ideal addition if the person or family can qualify. As an example, a family plan in Santa Barbara for husband and wife with any number of children with the youngest spouse age 34 is as little as $85.00 per month.

SUMMARY CONCLUSION:  If a person, employer or family were to offer or receive all of the products above, they would have the best health care money can buy for a fraction of the cost they are currently paying. Here is a sample breakdown as an illustration. For a complete and specific quote see your agent. If they are not up to speed on this new form of healthcare, contact the number below and we can find an agent for you, or have your existing agent contact the number below for training and appointment.

Family of 3 - Youngest Spouse Age 34 Female with a 35 Year Old Spouse

1.  Family Coverage with Care Entrée               $39.95 per month
2.  Accident Coverage                                      $22.98 per month
one adult

$22.98 per month second adult

$13.05 per month for child

3.  Critical Illness
$47.00 per month $100,000 cash female

$57.00 per month $100,000 cash male

4.  Basic Hospital Entire Family                         $85.00 per month

For less than $300 per month, the family has covered every possible base, is receiving cash benefits as supplement to use as they wish with a critical illness and will have all expenses paid by the Basic Hospital leaving over $90,000 to be used for any expenses that occur with a critical illness. They have shielded themselves from large increases due to the specific nature of these products not trying to use insurance where it should not be used. All of these products may not be necessary for everyone and can be changed, switched or custom designed by your agent to lower your monthly premiums even further. The above figures were used as illustrative purposes only and may vary by zip code, age, health and other factors.  Contact your agent for a complete explanation and accurate quotes for your specific situation

Please contact me with any questions.

Christopher S. Lawton,
Senior Advocate HealthCare Specialist

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