Interesting NYT Article on Obtaining Health Insurance

The article could have been entirely summed up by saying "health insurance has underwriting." If you are uninsurable, money won't buy you life insurance, disability insurance, or long term care insurance either. The person in the article admits to having or needing future testing or surgery. That is an automatic decline with all insurance companies until the issue is resolved, under control, or a diagnosis has been made. I'm surprised their agent even had them apply for a policy if that was known up front. The agent also apparently doesn't know what they're doing if they think applying separately would get them approved any differently than applying together.

There is some info missing from this story....something tells me not all of the facts have been disclosed. Would be interesting to see the application and hear the insurance company's side of the story. I often see these type of articles blaming the insurance industry. When all of the facts are made clear, it's usually easy to see why the person was declined. If I had a nickel for every time I heard something to the effect of "well I just have a little bit of diabetes, nothing major" or "I had a heart attack four years ago, but my doctor says I'm in great shape now!" well....I'd have a lot of money.

The article basically says "we have issues, we just want the insurance company to pay for it." Most people have had group plans their entire lives and don't think twice about being uninsurable on the individual market. Of course, that's why group health insurance is so expensive...the article also fails to mention their COBRA or HIPAA options, so yes, money could buy them health insurance, they just didn't like those options.
 
dgoldenz said:
The article could have been entirely summed up by saying "health insurance has underwriting." If you are uninsurable, money won't buy you life insurance, disability insurance, or long term care insurance either. The person in the article admits to having or needing future testing or surgery. That is an automatic decline with all insurance companies until the issue is resolved, under control, or a diagnosis has been made. I'm surprised their agent even had them apply for a policy if that was known up front. The agent also apparently doesn't know what they're doing if they think applying separately would get them approved any differently than applying together.

There is some info missing from this story....something tells me not all of the facts have been disclosed. Would be interesting to see the application and hear the insurance company's side of the story. I often see these type of articles blaming the insurance industry. When all of the facts are made clear, it's usually easy to see why the person was declined. If I had a nickel for every time I heard something to the effect of "well I just have a little bit of diabetes, nothing major" or "I had a heart attack four years ago, but my doctor says I'm in great shape now!" well....I'd have a lot of money.

The article basically says "we have issues, we just want the insurance company to pay for it." Most people have had group plans their entire lives and don't think twice about being uninsurable on the individual market. Of course, that's why group health insurance is so expensive...the article also fails to mention their COBRA or HIPAA options, so yes, money could buy them health insurance, they just didn't like those options.
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Thank you for discussing the other side. I got a nice "chuckle" out of a "little bit of diabetes". Since there wasn't any further treatment suggested maybe we won't have an issue.
 
Corporate ORphan, thanks for the new link. The article describes a situation that is quite similar to my own and I can easily identify with the author. No intention here to put one over on the unsuspecting insurance companies, just an effort to get coverage in a country where employer based coverage is regulated but individual is not.

Insurance is a collective initiative to share financial risk. Life, home, umbrella – these are good examples. What we call health care insurance is really health care intermediation – the intermediary is taking from providers and customers and exploiting both. Not insurance because it can’t underwrite effectively for large groups, denies individuals, and keeps the intermediation benefit (profit) entirely for itself.

The conclusion has nothing to do with “we have issues, we just want the insurance company to pay for it”. (are we even reading the same article?) It instead reinforces the need for reform in the individual market with an unlikely but smart proposal.

If members of Congress feel so strongly about undoing this important legislation, perhaps we should stop providing them with health insurance. Let’s credit their pay for the amount that has been paid by the taxpayers, and let them try to buy health insurance in the individual market. My bet is that they all would be denied. Health insurance reform might suddenly not seem to them like such a bad idea.
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I don't see anything wrong with insurance companies delving as deep as they can into people's health histories to identify factors with some statistical tendency to increase the companies' probable payouts. How could they do anything else? They're not state enterprises, but rather private for-profit companies. But I also agree with individuals' intuition that this practice is not fair to them. How do we reconcile the conflict? It's easy. We prohibit by law insurance companies from collecting information or taking into account preexisting conditions. Of course, some insurance rates will have to go up to pay for the higher incidence of health care payouts among those with preexisting conditions, but it won't harm the insurance companies -- just change the playing field a little.
 
Corporate ORphan said:
http://www.nytimes.com/2011/02/20/opinion/20Dubinsky.html?_r=1

Here it is again. When I tested in the preview post, it worked.
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Yep... works... but the first post still does not for me...



I would agree that the people seem to be the average American family... they did not go without coverage and then try to get covered when they found out they had a medical emergency... I would think that as long as you had been covered by SOMEONE, they you should not be denied by another company... we have to remember that all of the companies are regulated, so nobody is going to be way out from the rest of them...
 
Texas Proud said:
Yep... works... but the first post still does not for me...



I would agree that the people seem to be the average American family... they did not go without coverage and then try to get covered when they found out they had a medical emergency... I would think that as long as you had been covered by SOMEONE, they you should not be denied by another company... we have to remember that all of the companies are regulated, so nobody is going to be way out from the rest of them...
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Again, you could apply that logic to any type of insurance. Had car insurance, got a reckless ticket and DUI, time to get new car insurance, what happens?

Life insurance - buy 20-year term, have heart attack year 19, conversion option expired year 15, should a new company still be required to cover you?

You get the idea. Sure, it can be done, and that is what will happen in 2014 if not repealed. Unfortunately for the healthy, their rates will skyrocket and then they drop the coverage because they don't "need" it and the death spiral of premiums begins.
 
I would agree that the people seem to be the average American family..
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I'm not sure I'd call this average: Donna Dubinsky, a co-founder of Palm Computer and Handspring, is the chief executive of a computer software company.

I agree that finding reasonable private coverage can be difficult. I'm especially concerned about the stories of insurance companies denying coverage retroactively on the basis of small discrepancies in applications. I think a lot of the problems arise because health insurance operates much less like insurance and more like a volume buying plan. It would be a lot less distorting to prices if actual costs of medical care were visible to consumers and not wrapped in the insurance price games that make the real cost hidden but charge people without insurance differently than those with.

Also, the article complains about insurance rates that rise every year, doubling in 6 years time. My group insurance through my employer doubled this year alone. Makes the 10-20% per year rise seem not so bad in comparison.
 
dgoldenz said:
You get the idea. Sure, it can be done, and that is what will happen in 2014 if not repealed. Unfortunately for the healthy, their rates will skyrocket and then they drop the coverage because they don't "need" it and the death spiral of premiums begins.
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That is in plan. When middle class employed people start to suffer, we will get a single payer option. Once we get a single payer option, it won't take long to get a single payer system.

My only doubt is with what appears to be uniquely dysfunctional low level government workers. If they even wanted to do anything, which they mostly do not, they may well not have the skills needed to do so.

Our best bet would be a heavily regulated but private system, but that may be too complicated for the great American electorate to comprehend.

Ha
 
Hmm... So, in the ideal unfettered medical insurance marketplace, the only people that can get insurance are those that won't need it, and the people that most need insurance can't get it.

I suspect that sales of such a product would fall off among rational consumers.
 
There is no evidence that people will only look for insurance and pay premiums when they get sick. This is a bogeyman, unproven and unsupported by any non-partisan or non-industry, objective study. It assumes people would behave in an irrational manner - different than how they currently approach other types of insurance.

This is a bogus argument that conveniently allows someone to disagree with an aspect of healthcare reform that isn't part of the reform.
 
MichaelB said:
There is no evidence that people will only look for insurance and pay premiums when they get sick. This is a bogeyman, unproven and unsupported by any non-partisan or non-industry, objective study. It assumes people would behave in an irrational manner - different than how they currently approach other types of insurance.

This is a bogus argument that conveniently allows someone to disagree with an aspect of healthcare reform that isn't part of the reform.
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Best thing I've read all day....you should try selling health insurance. That will be all the evidence you need. :whistle:
 
dgoldenz said:
Best thing I've read all day....you should try selling health insurance. That will be all the evidence you need. :whistle:
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Sarcasm? Please. My lack of further response indicates a total lack of interest in this type of discussion. You have a nice day.
 
haha said:
That is in plan. When middle class employed people start to suffer, we will get a single payer option. Once we get a single payer option, it won't take long to get a single payer system.

My only doubt is with what appears to be uniquely dysfunctional low level government workers. If they even wanted to do anything, which they mostly do not, they may well not have the skills needed to do so.

Our best bet would be a heavily regulated but private system, but that may be too complicated for the great American electorate to comprehend.

Ha
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Ha, I agree with all three points, except "this is the plan" - and that because I'm not sure there is "a plan". Maybe that's part of the problem.
 
dgoldenz said:
Again, you could apply that logic to any type of insurance. Had car insurance, got a reckless ticket and DUI, time to get new car insurance, what happens?

Life insurance - buy 20-year term, have heart attack year 19, conversion option expired year 15, should a new company still be required to cover you?

You get the idea. Sure, it can be done, and that is what will happen in 2014 if not repealed. Unfortunately for the healthy, their rates will skyrocket and then they drop the coverage because they don't "need" it and the death spiral of premiums begins.
Click to expand...

Interesting argument...

I disagree with the ticket and DUI... they would raise your insurance for those... so the new company should be able to charge you higher rates...

Life insurance... yep.. got to agree that is an issue... but can it not be addressed with the premium?

Also, we are talking about someone without current health problems that had been insured... not someone with cancer that wants to move to a better paying policy... as an example... our company just changed dental and vision plans... the new plan has a 12 month waiting period for major items, unless you have been covered the past 12 months with another dental plan... I believe the thinking is you would not have put off having something done if you were insured last year to this year and cost them money... sure, someone can... but it is part of the underwriting....
 
growing_older said:
I'm not sure I'd call this average: Donna Dubinsky, a co-founder of Palm Computer and Handspring, is the chief executive of a computer software company.

I agree that finding reasonable private coverage can be difficult. I'm especially concerned about the stories of insurance companies denying coverage retroactively on the basis of small discrepancies in applications. I think a lot of the problems arise because health insurance operates much less like insurance and more like a volume buying plan. It would be a lot less distorting to prices if actual costs of medical care were visible to consumers and not wrapped in the insurance price games that make the real cost hidden but charge people without insurance differently than those with.

Also, the article complains about insurance rates that rise every year, doubling in 6 years time. My group insurance through my employer doubled this year alone. Makes the 10-20% per year rise seem not so bad in comparison.
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I was meaning average in the context of health problems...


Agree with wanting to have price transparancy... and a fair price to the retail customer...

It is amazing to me that in almost every other purchase we know about how much something will cost... not that we all get the same price (as in a car purchase)... but there is a sticker price and we do have sites that tell how much others are paying for something... but when one group is able to get an 80% or so discount from retail... then retail is way out of whack... and the few who have to deal with it can not even do comparison shopping since nobody can tell you the price...
 
Texas Proud said:
Interesting argument...

I disagree with the ticket and DUI... they would raise your insurance for those... so the new company should be able to charge you higher rates...

Life insurance... yep.. got to agree that is an issue... but can it not be addressed with the premium?

Also, we are talking about someone without current health problems that had been insured... not someone with cancer that wants to move to a better paying policy... as an example... our company just changed dental and vision plans... the new plan has a 12 month waiting period for major items, unless you have been covered the past 12 months with another dental plan... I believe the thinking is you would not have put off having something done if you were insured last year to this year and cost them money... sure, someone can... but it is part of the underwriting....
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A car insurance can drop you in a second if you get a DUI and then when you apply elsewhere you will be auto-declined. I'm not a P&C agent, but I believe you then have to buy SR22 coverage at 3-4 times the price for half the coverage.

Life insurance - sure, you could keep the policy you have, but the premiums will change to annual renewable term insurance and skyrocket as soon as your 20-year guarantee is over. If you look at any term insurance illustration, it will look something like this:

Year 1: $1000
Year 2: $1000
Year 19: $1000
Year 20: $1000
Year 21: $36,957
Year 22: $40,528
Year 23: $46,290

You get the idea. The article is talking about people with health problems moving from one company to another. This person lives in CA, where there are no medical exclusion riders - it's either rate adjustment or decline, so as long as they have prior coverage and get approved, pre-existing conditions would be covered. They obviously had conditions which had pending testing or treatment recommended, which is an auto-decline.

Also, agreed on the price transparency issue. Just ridiculous the way that the healthcare system works in that regard...
 
Pulled the trigger

Well, we submitted our application to UHC yesterday. Now we have to just wait and see. Hopefully, everything works out ok and we get the insurance at the premium quoted. (All this for a 10,000 deductible! Hopefully, we won't have to actually use it before we are eligible for Medicare in 10 years.)

I will glad when this is finally over. I can't believe that people are actually protesting to keep this system. Totally, unfair for someone unlucky enough to get sick or in an accident or so busy with the business of life that they accidently let their insurance lapse (my SIL falls in this category. SHe has sleep apnea and got the expiration date of her COBRA mixed up when her sister (and room mate) got stage 4 breast cancer. She is paying $849 a month.)
 
And not only is it difficult to get insurance, it can also be difficult to keep it. We have automatic checking withdrawal for our premiums ($1100 a month for DH, $350 for me), but every month I only rest easy when I see it has actually been deducted. I was paranoid about this since we started since I knew that insurance companies could drop someone for an unpaid premium, but even more so after hearing about the Colorado veteran who had his insurance stopped in the midst of undergoing cancer treatment because his wife had accidentally underpaid the premium by two cents!

http://www.theinsurancenation.com/g...cause-he-accidentally-underpaid-by-two-cents/

I completely understand that insurance companies require premiums to be paid in full. They're not charities. But two cents short? It seems that most people who can pay $328 a month would also be able to come up with two pennies more, so they obviously weren't trying to stiff the company. But is the company trying to stiff the patient...and save money by no longer covering him and his expensive cancer treatments?
 
Thanks for sharing that article. I had forgotten how terrible the rules are on paying premiums on time. You know the COBRA co had 30 days after the deadline to tell them about the 2 cents before the insurance was canceled. I wonder if they get a commission on the ones that make mistakes like that.

THe company administering my health insurance when I was let go (not COBRA but part of my severance) let three months go by before they told us we were a few cents off. They were threatening to cancel us the day before we were going on vacation for a month.

I guess having UHC deduct the premium from our account has some advantages after all. Now, since we are setting up a different checking account for it, we will have to make sure it's funded!

I have heard the new law has some consumer protections to avoid this silliness. I hope it's correct.
 
Corporate ORphan said:
Well, we submitted our application to UHC yesterday. Now we have to just wait and see. Hopefully, everything works out ok and we get the insurance at the premium quoted. (All this for a 10,000 deductible! Hopefully, we won't have to actually use it before we are eligible for Medicare in 10 years.)
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Good luck. Thought about applying elsewhere - just in case?

Corporate ORphan said:
I will glad when this is finally over. I can't believe that people are actually protesting to keep this system. Totally, unfair for someone unlucky enough to get sick or in an accident or so busy with the business of life that they accidently let their insurance lapse (my SIL falls in this category. SHe has sleep apnea and got the expiration date of her COBRA mixed up when her sister (and room mate) got stage 4 breast cancer. She is paying $849 a month.)
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I think the folks that want the current system don't want this, they just don't really believe it is such a problem. Just look at the responses at this thread and the article you referenced, and the numerous other threads 'round here you have posted in.

I did read somewhere that the insurance industry has agreed to stop canceling policies once people get sick. Hope it's true.
 
I don't understand why insurance companies are not mandated to have a single pool of insured - ie. per company. Why should individual health be a separate pool from group insured? The delta risk per individual is much lower if the pool is larger.
 
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