legal scam

[lazygood4nothinbum]

Originally Posted by Rich_in_Tampa

Sorry for your hassles, LG4NB. As if your year hasn't already been tough enough.

BTW, my observation over the decades suggests that the "pre-existing timer" does not start ticking when you first see your doctor for a problem, but rather from when you tell the doctor the symptoms started

Some have implied that this is your fault because you failed to make the "choices" you should have regarding insurance over the years.

thanx doc. also for info on the timing issue. but you know, rich, even on my making choices, i have always chosen the most expensive, best plan offered by my company. and there has been no gap in my medical insurance in my entire life. so it’s a little disappointing to know i’m getting penalized for being such a good player in their system.

Originally Posted by mykidslovedogs

First, let me just say that it doesn't say much for insurance brokers who allow their clients to be tricked into thinking that a private policy will cover any pre-existing condition.

lovedogs, it wasn’t an agent, it was the actual insurance company themselves. i tend to be brand loyal. i didn't even start eating jiff until decades after my mother stopped making my sandwiches with skippy. i tried to talk to the original sales guy again but apparently the bait department is no longer involved. now i have only to deal with the switch department.

Another possible fix is to teach our young about obtaining good coverage before pre-existing conditions arise…Lazy, I do not believe it is your fault for the unfortunate situation you are in. You are a victim of the times.

ah, but there, you see, is the rub. because i did have good coverage and with the very same company who will be covering me now. the only difference is before it was out of the group pocket and now it in the private one of the same pair of pants. what is this, creationism? how can something be pre-existing if it was always existing. this is no chicken or egg scenario; this is nothing but a shell game.

now why do i suddenly have a yen for a egg salad sandwich?

Originally Posted by tomz

Don't HIPAA regulations require them to sell you a conversion policy without exclusions (albeit at a higher price) after your COBRA runs out? Did you get the private insurance policy as part of a HIPAA?

sorry but i do not know what hipaa is so do not know how to answer this. i decided to keep the policy they gave me even though i feel at their mercy.

what is also outrageous is how they handled this. as i mentioned in another post they also increased my premium because of bmi which is all out of wack because i actually have more muscle than fat. point here that when they increased my premium they simply wrote me a note saying that they will contact my bank to withdraw a greater sum each month, as if my bank account is their bank account. such arrogance; it is disgusting.

Originally Posted by Martha

Lazy, in Florida you have rights under federal law (HIPAA) after your COBRA expires to either get a conversion plan from your current insurance company with no preexisting condition exclusions or if a conversion policy is not available, to buy a HIPAA compliant policy from another insurance company which also will have no preexisting condition exclusions. See the Georgetown university guide for your rights in Florida: http://healthinsuranceinfo.net/fl00.html

thank you martha. i could have cobra run one more month though this one is already paid for to start dec 31. see, this is why i should never have taken a break from the early-retirement group. but i will contact them next week and see what they say. also maybe i can contact the insurance commissioner here and have something done after the fact if i don't get too paranoid that i'll only be rocking the boat. will study the issue over the weekend. also still need to read the rest of the commentary here. always such great imput from you all.

[mykidslovedogs]

Originally Posted by lazygood4nothinbum

lovedogs, it wasn’t an agent, it was the actual insurance company themselves. i tend to be brand loyal. i didn't even start eating jiff until decades after my mother stopped making my sandwiches with skippy. i tried to talk to the original sales guy again but apparently the bait department is no longer involved. now i have only to deal with the switch department.

ah, but there, you see, is the rub. because i did have good coverage and with the very same company who will be covering me now. the only difference is before it was out of the group pocket and now it in the private one of the same pair of pants. what is this, creationism? how can something be pre-existing if it was always existing. this is no chicken or egg scenario; this is nothing but a shell game.

Sadly, some insurance service reps (the ones that work at the insurance companies) aren't always as well trained in the State and Federal laws as they should be. I would really suggest finding a good, independent broker, that you can work with who is licensed in your state. It sounds like, other than the glaucoma, you are in extremely good health. You should be able to find a good solution to help you get through early retirement, until Medicare becomes available to you. A good source for finding an independent broker in your state is here:

http://www.nahu.org/consumer/findagent.cfm

An independent broker can comparison shop and prescreen with different carriers to find the best coverage for the price. You might be able to reduce your costs significantly just by letting an independent broker do some shopping for you.

One other point, and this is just a matter of fact. You might have trouble getting any better rates or getting them to remove the exclusion rider by going to the commissioner. The problem is that private insurance, regardless of the fact that it is with the same carrier you had in a group, operates under a completely different set of laws and regulations than group insurance. Believe it or not, the insurance carrier, on a private coverage level, did have the right to rate-up for BMI and they did have the right to exclude glaucoma from coverage. That's just the nature of private insurance.

On another note, the insurance company should be reported for having given you false and incorrect information with regards to moving from group coverage to private coverage. The fact that you cancelled your old coverage based on bad information is terrible and should never have happened, and you might have some recourse there.

BTW, do you mind stating which carrier it was? I'm always curious about poor service and where it is coming from....

[brewer12345]

Originally Posted by jeff2006

Sniff, sniff, sniff . . . do I smell more bait?

Yeah, he's a master baiter.

Hur, hur, hur. Couldn't resist.

[Martha]

Originally Posted by mykidslovedogs

One other point, and this is just a matter of fact. You might have trouble getting any better rates or getting them to remove the exclusion rider by going to the commissioner. The problem is that private insurance, regardless of the fact that it is with the same carrier you had in a group, operates under a completely different set of laws and regulations than group insurance. Believe it or not, the insurance carrier, on a private coverage level, did have the right to rate-up for BMI and they did have the right to exclude glaucoma from coverage. That's just the nature of private insurance.

Mykids, I am going to dog you on making sure you have your facts right when you talk about insurance because you are presenting yourself as an insurance agent and knowledgeable in the area. What insurance companies can do on the private market is dependant on federal and state law. Federal law provides some rights to people who are HIPAA eligible. States comply with HIPAA in different ways. In Florida, the state complies with HIPAA by requiring most insurers to offer a conversion policy with NO exclusions for preexisting conditions or if no conversion policy is available, to offer a HIPAA compliant policy with NO exclusions for pre-existing conditions. So be careful when saying what a private insurance company can and can't do. It really depends on where you are.

[Martha]

Originally Posted by lazygood4nothinbum

thank you martha. i could have cobra run one more month though this one is already paid for to start dec 31. see, this is why i should never have taken a break from the early-retirement group. but i will contact them next week and see what they say. also maybe i can contact the insurance commissioner here and have something done after the fact if i don't get too paranoid that i'll only be rocking the boat. will study the issue over the weekend. also still need to read the rest of the commentary here. always such great imput from you all.

Most of the commentary here has been political. :P But I would look into your situation a bit more and talk to an agent about comparing the cost and benefit are getting a HIPAA eligible policy or conversion policy instead. My guess is that the likely high cost for these options may not justify the benefit of gettting the glaucoma covered, but you should check into it. And I would follow up at some point with the insurance commissioner on the bait and switch issue.

[lets-retire]

OT...Martha, do you ride that pink scooter around?

[Martha]

Originally Posted by lets-retire

OT...Martha, do you ride that pink scooter around?

In my bra and girdle.

[donheff]

Originally Posted by Martha

In my bra and girdle.

What an awful image - that Sears Catalog girdle model puttering along on a pink scooter.

[REWahoo]

Originally Posted by donheff

What an awful image - that Sears Catalog girdle model puttering along on a pink scooter.

What, you aren't the biker type?

[mykidslovedogs]

Originally Posted by Martha

Mykids, I am going to dog you on making sure you have your facts right when you talk about insurance because you are presenting yourself as an insurance agent and knowledgeable in the area. What insurance companies can do on the private market is dependant on federal and state law. Federal law provides some rights to people who are HIPAA eligible. States comply with HIPAA in different ways. In Florida, the state complies with HIPAA by requiring most insurers to offer a conversion policy with NO exclusions for preexisting conditions or if no conversion policy is available, to offer a HIPAA compliant policy with NO exclusions for pre-existing conditions. So be careful when saying what a private insurance company can and can't do. It really depends on where you are.

Hi Martha,

I didn't go into HIPAA too much because it sounded like he is healthy enough to qualify for a private policy without having to convert and pay the exhorbitant conversion pricing. State risk pools also tend to be much more expensive than a private policy because they are guaranteed issue, (although that fact can vary depending on the State in which you live). I think Lazy can qualify for much lower pricing in the private market without having to convert, even if he has to deal with some OOP costs for his glaucoma. Sorry I didn't make that more clear earlier.

[lazygood4nothinbum]

Originally Posted by mykidslovedogs

An independent broker can comparison shop and prescreen with different carriers to find the best coverage for the price. You might be able to reduce your costs significantly just by letting an independent broker do some shopping for you... do you mind stating which carrier it was?

overall i'm not totally displeased with the coverage. i'll be paying about $300 month with a $2850 deductible to participate in hsa if i desire. no copays or coinsurance after the deduct and they pay 75% out of network. so in-network, minus glaucoma which i do not expect to be much of a problem, my costs would max out at only $100 more per month than i was paying into cobra (which had zero deduct or coinsurance), well within my expected budget. i could get a lower monthly with a higher deductible but then the overal maximum exposure also increases were i to use up the deductible. i often side with safety even if at some cost. i thought, on shopping insurance, that i'd do better by cutting the middle man out, but at your suggestion perhaps i'll check with an agent at least to see what else is available.

if your email is available to posters i'll email the company name to you.

Originally Posted by Martha

Most of the commentary here has been political. :P

yes, i was being kind. though often i manage to find wisdom even in folly. also thanx for the hipaa info and i see a whole post on it here which i'll be reading through.


ps i might mention to all: i was discussing with my accountant uncle hsa's and the possiblity of rolling over some of my inherited ira $s there. he put my action on hold and suggested i wait until he and his group of accountants and tax attorneys figure out just how the new hsa rules apply to individuals. i didn't understand a lot of the particulars but apparently at this point they are still arguing benefit there.

[mykidslovedogs]

Originally Posted by lazygood4nothinbum

i thought, on shopping insurance, that i'd do better by cutting the middle man out, but at your suggestion perhaps i'll check with an agent at least to see what else is available.

One more thing for all to note. The rates for insurance are the same whether you work with a broker or not. Insurance companies cannot charge higher rates to those who work with a broker, and they cannot give you better rates if you don't work with a broker. The advantages of working with a broker (and especially, an independent broker that is unbiased about any particular carrier) are that you can get advice, comparative quotes from many carriers, and service on claims problems and/or billing issues after purchasing your policy.

There can be disadvantages if you don't find a reputable broker, and that's why I recommend using www.nahu.org 's agent finder tool in your state. All of the agents associated with nahu.org are licensed in the state(s) they are listed under.

[mykidslovedogs]

Originally Posted by OldMcDonald

I suspect this has more to do with expensive drugs than too much regulation:

http://www.contracostatimes.com/mld/...a/16297905.htm

$180 million in compensation for a CEO of pfizer who oversaw a 50% drop in stock price during his tenure....

Yea...its probably too much regulation driving up the cost of drugs....

PFIZER'S MCKINNELL TO GET $180 MILLION PACKAGE: Pfizer Inc.'s former chief executive, Henry McKinnell, who was forced into an early retirement in part because of investor anger about his rich retirement benefits, will get every penny of it and more, a new regulatory filing shows.

McKinnell's package, which the company disclosed in a filing with the Securities and Exchange Commission Thursday, totals more than $180 million. It includes an estimated $82.3 million in pension benefits, $77.9 million in deferred compensation, and cash and stock totaling more than $20.7 million.

The total value could grow to almost $200 million if McKinnell gets an $18.3 million stock award, but that is contingent on the future performance of the stock of the world's largest drugmaker.

If we look at the percent of total sales for Pfizer, the CEO's salary looks pretty small comparatively. Although it seems excessive, It's hard to believe that $180 mil makes much difference in drug costs when total sales for the company exceed $50 billion:

http://publicintegrity.org/rx/images...pPharmaCos.png

Here's an interesting article which might help explain for some of you why Canadians pay so much less for their prescriptions, and what might happen if we allow re-importation of "cheap" drugs from Canada back into the U.S.

http://www.invisibleheart.com/Iheart...heapDrugs.html

Here's a pretty unbiased article explaining Rx costs in more detail:

http://www.dcbar.org/for_lawyers/was...2004/drugs.cfm