CRNA Insurance

Investments without large fees

Investing is not one of our best endeavors and many just don’t take the time to learn. With only a few minutes left in the year, here is some information you might not want to miss.  

I was just listening to the ChooseFI podcast and found out a few things to pass along.  First, I recommend listening to them as you journey through life whether you are planning to retire early or not.  

HSAs or Health Savings accounts for any high deductible insurance plan that is define as 1350 for an individual or 2700 for a family.   You can put away 3450 individual or 6900 for a family in an HSA TAX FREE.   Any medical expenses can be taken out TAX FREE at any time / any year!  This of course means you have to keep your receipts for your accountant for years.  After age 65, it acts like a traditional IRA or can be used for medical expenses later in life.  If your plan started dec 1 you could find the entire amount.  Fidelity now has a zero fee HSA management account (funds or investments places in the account may have some fees).  

This is way different than an FSA as those funds don’t fully roll-over year to year.   these funds are for your yearly medical expenses and are typically use or lose.

We are typically interested in low fees and trying to keep our income in our pockets.  Mutual fund investments are just about the most common across the nation and ChooseFI often touts the Vanguard total stock index fund or VTSAX which had a hefty $10k minimum which has now changed to a $3k minimum for getting started.  This opens the fund up to those who are wanting to get started investing at one of the lowest fee mutual funds on the market at an annual fee of just 0.04%! 

Some of you may know these things but the mutual fund information is pretty new.  If you are thinking of setting up the Solo401k it has to be done and funded by the end of the year and if you are looking at a sep IRA it must be done and funded by April 15.   

It’s time to get your investment on! 

Happy mother’s day

Today is mother’s day and I must say mine has always pushed me to do better.  It doesn’t matter just how much I put in as far as effort, education, level of understanding or time... Mom has always been there pushing my boundaries to improve.  

I think that is missing in today’s generations and I’m hoping I can instill these values into Elizabeth’s core as she grows.  Not to instill negative worth of perception of never quite being good enough.  That isn’t the intent at all.  I see the amount of knowledge, work, time devoted to projects, continuous education, and effort that is put into every aspect of life.  I think the realization is that there is always someone that can do something differently or better in the results column.  I find an appreciation for the neighbor that has the most gorgeous lawn where mine is lucky to be mowed and have a few less weeds than a few other neighbors.  I think each of us have areas where our practice is not as strong as other.  In this area I hope that each of us would take time to learn and grow.  

Likewise, in this community of locums, business minded professionals and those that aren’t are all coming together and we can all learn.  I think our practice, our business skills, negotiation, and our personal lives have to be continually improved upon.   This is all-encompassing and is why you read so much on my personal life.  You read about my finances and how I’m making strides to have this burden significantly reduced by optimizing business, education, and leveraging my hours of work.  You see Francisco and I consider adoption as we want to build a family and seek opportunities to enrich Elizabeth’s life.  You see my real estate and investing strategies that will one day allow for a more diversified risk and likelihood of retirement or at least significantly reduced need for specific hours= specific dollars.  You read about family, conversations, my continued education, insurance and multiple facets as we continue down the road of life.  My hope is that people gain knowledge of life as a locum but also take from the stories the opportunity to enrich other aspects of their lives from family time to vacations. 

I’m continuing my journey by the FI principles of being just 1% better each time and way I can.  I hope it comes through to all out there.   

Due diligence!

I just want to make sure you know what doing your Due Diligence means.  Before you say “hmmm, the recruiter said it was a great deal” look at it & run all the numbers.  Are you having to pay to work?

What do I mean by having to pay to work.  Are you getting a stipend but you have to get your own housing?  Did you check out the deposits, fees, pet deposits, taxes, total costs for the time you are going for and if you get your 30 day notice right away?  Is your parking taken care of? Have you found out your mileage reimbursement and is it at least the IRS reimbursed rate?  

Food?  Does it cost more at your assignment?  Is there a kitchenette where you are going?  Are you getting a daily food per diem when you work especially if you are going to an area where the cafeteria seems to charge more than any should?   

Malpractice.  Is your insurance covered by your agency or the group you are traveling too?  Ask for a copy of the COI (copy of insurance face page).  Are you making extra to cover your own insurance and have you checked to make sure your insurance covers the location or that it won’t be significantly more expensive?   

Taking on the expenses and being reimbursed.  Are you trying to get the credit card miles, cash back or other points?  Does your contract state that you are being paid for each aspect and how long until it is paid? Do you have to submit receipts?  Are you certain you are fully covered on the reservations and no cancellation fee if they don’t get you credentialed?  

Please don’t take what the recruiter says as gospel that what they are paying will cover things.  Make the calls and find out the true costs if you are doing all inclusive or stipends.  

Lets journey on. 

Is it difficult to set-up a sep-IRA?

I have been a CRNA for quite some time, as you might be aware.  I have tended to keep my earnings and retirement away from the stock market.  As many would chastise me for not taking advantage of tax sheltering, and even I wish I were a better saver.  

I have always invested in real estate.  For a while it was my own home.  Then it was the start of rental property in Kansas.  I am still invested in Kansas and started on my current home in Virginia.  

I have avoided the stock market though.  I have used an E-Trade account as if it were a casino.  I haven’t been an investor but a speculator.  I have invested over the years in the military Thrift Savings Plan ... 1% for 9 years... you know how little that is.  I forget to take time to learn about those things.  I know I need to shelter my taxable income so I am actually doing this.  

I went for weeks totge website for Vanguard but then they said they couldn’t verify me.  Then I had to fax things for the Solo 401K but... I missed 2017.  So, I decided I would do a simple Sep-IRA if I could.   

I was checking my E*TRADE to make sure my Roth IRA transaction went through and then I had an epiphany.  Why not try to set up just an IRA.  I saw the set-up a retirement account button and so I clicked on it.  Bam, Sep-IRA option right there.  Two minutes later i had $6k coming out of my account to fund a Sep-IRA for 2017.  I have until my taxes are filed toget those dollars cought up. I would prefer a Solo-401k but I didn’t get it set-up in 2017 which means no $$$ can beplaced in it for 2017.  So, i now have a sep and I’m working on saving a tax bracket or two by saving more pre-tax dollars toward retirement as my rentals are post tax.

Is it possible to invest in retirement with real estate?  Yes, but have I done this... no.   

Every year, I will try to be more active in my tax planning and save betterfor my family and child or children (someday).   


Post Turkey Post

Let’s talk cold turkey.  Who is ready to do locums? What things do you have to consider?   


this is a big one and i hate paying people in the off chance i need insurance.  I would rather put my money to work for me so that it can pay for what i need in the future.  Alas, i still pay for the family insurance for health, vision, dental and then have a malpractice policy.  I put up that we have liberty healthshare, some form of VA, and Cigna PPO.  Vision is VSP pro and dental is Delta Dental if i recall.  Malpractice insurance is through the AANA.  Are these perfect? Nope, and they don’t cover everything.  I’m on my way for a sleeve gastrectomy in Mexico.  I have tried every weight loss plan known to man and am doing this not because insurance thinks it’s a good idea... in fact they do not cover weight loss surgery even in morbid obesity.  It’s a $9,000 surgery and not covered.  I’ll see if they will cover any portion but my guess is no.  

Time off

I absolutely love and hate time off.  I love it because i work hard and want to truly enjoy life.  I hate it because i am losing income and spending $$.  I do everything i can not to miss paychecks in the year!  Being a locum does allow me to take months off per year if i need it though.  My daughter was born in January and I didn’t go back to work until March.  I contracted for the 2.5 weeks over thanksgiving to be off for surgery and vacation.  I’ll also be off all of January this coming 2018.   

I’ll also be speaking in Costa Rica for an hour in January!  sooooo, you can see time off can be had and when it’s important.  That doesn’t however mean that i tell facilities i can work only special hours or days.  I tell them I’m here to work.  Work extra??? Most times that is a hell yes! 

What else? 

there is plenty to talk about!  Let me know what you think.

Liberty as an insurance provider? Is it for me?

People ask me quite often what I think of Liberty HealthShare. Most days I’m happy with them.  I have had great experiences and less than amazing experiences.  I am not a skinny person … I am about to go for a sleeve gastrectomy which is expressly not covered by Liberty.  Page one states they do not cover weight loss surgery.  I pay an additional premium and have conversations with a health coach showing that I am trying on my weight-loss and I have a plan and goal.  This is a requirement.  This would also be the same for a smoker and the plan to cease smoking along with a health coach.  Some hypertensive medications require the same. 


I started Liberty approximately last December.  My husband was not able to be insured by them as we stated his positive TB skin test revealed calcified lesions on the lung which mean he has had exposure.  This is not Medically treatable but the primary care physician was either not educated or not aware of the medical treatment and stages ofl TB classification and treatment.  They would not write in the record that TB treatment was not indicated nor needed.  Francisco uses US Health Group for his insurance.  Just one month later my biological daughter was born via Surrogacy in Mexico.  She was hospitalized from birth requiring additional medical test & procedures.  She was in the hospital for 12 days and the costs were over $1000 US per day.  It was my anticipation that no insurance would cover me.  Traditional insurance said that after 30 days they would cover my child.  I called Liberty and asked if I could add her from her date of birth.  They said yes and added her for $50.  I asked if they would cover any part of her medical bills in Mexico.  I was told that they would if they had the bill in English and in US Currency.  I couldn’t deal with this until I was at home over 2 months later after being very stuck in Mexico. 

I had the bills translated at a cost of about $150 US and sent everything certified and called them several times to explain.  The hardest part is the system for uploading bills is only set for one bill at a time.  I sent all to them and explained that it was a lot of money out of pocket up front.  They seemed to put a rush on it and with-in 2 months I had been fully reimbursed for the medical care of Elizabeth in Mexico.  She and I have since had all of our doctor’s visits this year.  We have paid our premiums and otherwise been reimbursed for countless exams and rule-out tests.  She had to be ruled out for cystic fibrosis both in Mexico and in the US.  I have had 1-2 urgent care visits for a cold. 

What’s the negative?  I have found no provider that will take Liberty as insurance and bill directly.  All have made me cash pay and be reimbursed.  This works while we are healthy or bills aren’t super high.  However, I worry about ER visits or possible surgery or Emergency that lands me in the hospital.  I know I don’t have 100K to pay a hospital bill… Thankfully, I have the insurance card and my assumption is that a hospital bill would come to me and I could send it directly to them or have them call the hospital billing directly if needed.  In the US they will let you out of the hospital with an unpaid bill.  In Mexico they would not let Elizabeth out of the hospital with an unpaid bill. 

Every appointment since has had about a 90 day delay in reimbursement.  It’s something I have come to expect.  Most providers give a significant cash pay discount and so the amounts for doctor’s appointments have ranged from $90-$1400. 

I will continue to use them as I know how they work and I believe the coverage is sufficient for now. 

This has been our experience so far.  Hope this helps.  To see a comparison of health sharing organizations...  The insurance page of the site and scroll down to health insurance

Insurance Admitted vs non admitted

Confusion sometimes arises about the difference between “admitted” and “non-admitted” insurance carriers and about the consequences of the difference. The designation of an insurance company by a state’s Insurance Commissioner as “admit­ted” may seem to give the company a stamp of authority, but this designation is primarily an administrative one rather than a mark of quality or stability. Other factors should be more important in the choice of a carrier.

Let’s take a close look at what admitted v. non-admitted really means.

What is an “Admitted” Insurance Company? – An admitted carrier is often referred to as a “standard market carri­er.” To qualify as an admitted carrier, an insurance company must file an application with each state’s insur­ance commissioner and be approved. Approval requires compliance with a state’s insurance requirements, including the filing and approval of that company’s forms and rates. This process often takes a long time.

Once a carrier is licensed to transact insurance business in a certain state, the carrier is required to pay a portion of its income into the state's insurance guaranty association. One of the main selling points of being an admitted is that the carrier’s liabilities are backed by that state’s “guaranty fund.” If an admitted company becomes insolvent, the state will help pay off policyholders’ claims. 

What is a “Non-Admitted “Insurance Company?  – A non-admitted carrier is often referred to as an “excess and surplus line carrier” and operates in a state without going through the approval process required for admitted companies. Non-admitted carriers are not bound by filed forms or rates and therefore have much greater flexibility to write and design policies to cover unique and specific risks, and to adjust premiums accordingly. When standard markets can’t or won’t write a risk, or when an admitted carrier cannot offer the appropriate terms, the non-admitted market is available to fill this gap.

Non-admitted insurance carriers are regulated by the state Surplus Lines offices, but regulation is far less invasive than for the admitted markets. The most obvious difference between admitted and non-admitted is that purchasers of non-admitted policies do NOT have the protection af­forded by the state’s guaranty fund. Each state does charge taxes for non-admitted insurance, and agents must be licensed in surplus lines to sell non-admitted insurance.

The designation as “non-admitted” should not be taken as an indication that these insurance carriers aren’t legitimate or financially stable. In fact, to sell surplus lines insurance, non-admitted insurance companies have to set aside a large monetary reserve or secure adequate re-insurance.

Insolvency – When an insurance commissioner determines that an insurance company is having significant financial difficulties, the insurance company will go through a process called “rehabilitation.” The state’s insurance commissioner will make every attempt to help the struggling company regain its financial footing. If the company cannot be rehabilitated, the company is declared insolvent, and the court will order liquidation.

Liquidation of an Admitted Carrier – If the carrier to be liquidated is an admitted company, the processing/pay­ment of existing and future claims is taken over by that state’s guaranty fund. However, the guaranty fund’s obliga­tions are limited by regulations and will only pay claims up to that state’s cap.  In some cases, if insureds exceed a certain revenue threshold they may not quality for any guaranty fund coverage. 

Depending on the state, guaranty funds usually provide only $100,000 to $500,000 of protection per policy even if the policy had a much higher limit. Most states are at $300,000. In addition, if several liquidations take place in one state, the state’s guaranty fund may be depleted. Policyholders often only receive pennies on the dollar of their true loss amount from a guaranty fund.

While state guaranty funds try to pay claims as quickly and efficiently as possible, payments are often slow.

In sum, although the guaranty funds provide some level of comfort if a carrier becomes insolvent, in reality, policyholders can be left with little or no assistance.

Liquidation of a Non-admitted Carrier – If a non-admitted insurance company goes “belly up,” the liquidator/receiver collects the assets of the company, determines all the liabilities/creditors outstanding, develops a plan to distribute the company’s assets and submits the plan to the court for approval (much like a typical bankruptcy pro­ceeding). In most cases, the insurance company’s estate will not yield sufficient money to pay the company’s cred­itors (including their policyholders' claims) in full. Policyholders often have to fund defense and settlement payments themselves before they can request reimbursement from the estate. Usually, the policyholder will have to wait patiently and will,  again, only get pennies on the dollar.

The largest surplus lines writer in the U.S. is Underwriters at Lloyd’s, London. In 1925, Lloyd’s created the Lloyd’s Central Fund, which pays claims in case any underwriting member should be unable to meet his or her liabilities. Unlike the guaranty funds, the Central Fund does not have a cap. The only cap for the Central Fund is the policy limit. (Illinois, Kentucky and the Virgin Islands are exceptions because Lloyd’s is admitted there and is subject to the state guaranty funds.)

Bottom Line – The choice between admitted and non-admitted insurance companies is something that needs to be considered, but examining the financial strength of the individual providers, the breadth of coverage and competitiveness of terms is more important. The priority should always be to seek a high-quality provider, regardless of whether the company is admitted or non-admitted.

Taken from Laura Zaroski as approved by Canyon Clifton Insurance