legal scam

[lazygood4nothinbum]

i've been with the same health care insurance company for more than 10 years either through my previous employer, cobra and now private insurance which cranks up the first of the year. the only real condition i have is glaucoma, which my grandfather had and so i kept close monitor & caught it the very year the pressure in my eyes indicated i had it too. daily drops control it with no detectable deterioration over many years already.

when i was being sold this new private policy, i was told my glaucoma would not be a problem because i'd been with the same company with the same condition for so many years. however, when they wrote my policy, the included an exclusionary rider for a condition pre-existing the private policy even though existing to the group & cobra policies which were with the very same company.

their legal scamming difference being that the parent company issues the group plans but their subsidiary issues the private plans. they offered neither reason nor apology as to why i was initially mislead.

so now i get to pay the same premium for less insurance on top of which i can not even write off my $70/month bottle of two-drops-a-day-medicine off the yearly deductible. never mind that i'm paying $435 for this last month into cobra, but the "new" insurance says something to the effect that if anything develops within 6 months they'll consider that pre-existing too. outside of heart or kidney failure, i'd be afraid to go the doctor for a hang-nail at this point. who knows what they'd find and then dis-count as pre-existing. what a scam.

[Rich_in_Tampa]

Originally Posted by lazygood4nothinbum

their legal scamming difference being that the parent company issues the group plans but their subsidiary issues the private plans. they offered neither reason nor apology as to why i was initially mislead.

so now i get to pay the same premium for less insurance on top of which i can not even write off my $70/month bottle of two-drops-a-day-medicine off the yearly deductible. never mind that i'm paying $435 for this last month into cobra, but the "new" insurance says something to the effect that if anything develops within 6 months they'll consider that pre-existing too. outside of heart or kidney failure, i'd be afraid to go the doctor for a hang-nail at this point. who knows what they'd find and then dis-count as pre-existing. what a scam.

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

Once you drop out of a large group policy you are vulnerable to such predatory tactics. No one is looking out for your protection, there is no "greater good" at play here, and you get cherry-picked or you lose.

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. This may be company-specific , but it has come into play over the years. You get penalized for illness under these circumstances, as if dealing with the illness itself is not enough.

Some have implied that this is your fault because you failed to make the "choices" you should have regarding insurance over the years. I find that perspective to be shameful and sadly naive. Sound, fully shared, basic coverage needs to be provided for everyone somehow.

Hope you find something, even if it excludes the glaucoma. You are wise to be taking care of that.

[shiny]

Sometimes I hear stories that just make me so mad about the ins companies that I consider not getting any in order not to participate in their scams - that will show them!! But I know I'm just talking smack, cause there is no way a worry wart like me can go without health ins.

I haven't even applied for private ins yet, will start that process in Feb. I dread it - we have moved several times and have had many doctors, so I'm sure it will be a nightmare.

Originally Posted by Rich_in_Tampa

Some have implied that this is your fault because you failed to make the "choices" you should have regarding insurance over the years. I find that perspective to be shameful and sadly naive. Sound, fully shared, basic coverage needs to be provided for everyone somehow.

I agree 100%

[mykidslovedogs]

Originally Posted by Rich_in_Tampa

Some have implied that this is your fault because you failed to make the "choices" you should have regarding insurance over the years. I find that perspective to be shameful and sadly naive. Sound, fully shared, basic coverage

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. Whenever coming off an employer-sponsored plan, pre-existing conditions can create problems for anyone applying for private insurance. Lazy, you should have been forwarned of that from the very beginning, and because you were not, it now makes all insurance brokers look like scam artists, which we are not. Had you been properly informed, you might have been able to get into a policy that would have worked better for you.

Secondly, I believe the above mentioned statement probably referred to some of my earlier comments which were obviously, totally misinterpreted. I am very saddened by the large numbers of people who are trying to retire before age 65 and are now running into problems obtaining personal insurance due to pre-existing conditions. That is why I fundamentally believe that it is not a good idea to have insurance tied to employment. It worked in the old days, when people worked for the same company for many, many years and then went straight to medicare at at 65. But that culture no longer exists in our country.

One way to fix the problem is to have universal care, but with all my heart, I believe that universal healthcare will hurt the quality of care and service in our country and therefore, it is hard for me to support that ideal because I think it will help the minority of people, while hurting the majority.

Another possible fix is to teach our young about obtaining good coverage before pre-existing conditions arise, and to teach them to weigh the benefits of coverage through an employer with the costs associated with the risks of not being able to retire before age 65. Part of this fix would include offering people many choices of different levels of coverage, and allowing them to be in control of the best choices for themselves.

I support the second option, because I think there is a better chance that we will retain excellent quality of care in our country at the same time as lowering the number of uninsureds by leaps and bounds by teaching them how to make the choices that will best work for them, and by offering them incentives to do so.

Lazy, I do not believe it is your fault for the unfortunate situation you are in. You are a victim of the times. The broker who gave you advice should not be in the insurance business.

[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?

[Rich_in_Tampa]

Originally Posted by mykidslovedogs

you.
Secondly, I believe the above mentioned statement probably referred to some of my earlier comments which were obviously, totally misinterpreted.

Well, I wasn't referring to you alone, but I do feel it applies to what you have written here. Other posters can decide for themselves if I "obviousy, totally misinterpreted" them. Here are some comments from the oldest 1.5 pages of your posts alone. I tried to be careful to only repeat comments that are true to the original context:

• "I understand that there are so very many people that don't choose to get sick, but why oh why can't they have planned better while they were young and healthy?"
  
• "The only time pre-existing condition waiting periods will apply on any type of new health insurance policy (including riskpools) will be if the person obtaining coverage has ALLOWED THEMSELVES to have a gap in coverage of a certain, defined, length of time. This is only fair as it protects the insurance carriers from "adverse selection" or only buying the plan AFTER getting sick."
  
• "Most of us will get sick or disabled someday...Especially now that people are living longer and longer...so why is it so bad to ask people to plan for that?"
  
• "Maybe the people you work with didn't know better, so they depended on employer-sponsored benefits all of their lives and then lost their benefits when they became unemployed. It's too bad that someone didn't teach them about the long-term consequences of depending on employer-sponsored health insurance."
  
• "Let's encourage people to purchase coverage for themselves when they are young and healthy instead of teaching them to depend on employer sponsored benefits. What is so wrong with teaching our young to take care of themselves...to plan for the worst case scenario so that they don't end up like the millions of hardworking folks who never purchased good health insurance while they could qualify for it, and who ended up in financial ruin because of it?"
  
• "That's why you want to buy the policy while you are still healthy because the rate you are given at policy inception will define all future increases."
  
• "Why doesn't the middle class person buy their own health insurance while they are healthy? At $300 or less a month for an individual policy, it is certainly affordable for the middle class. That's less than a trip to Disney Land."
  
• "I understand your point about those born with congenital illnesses, but if their parents had had their own individual policy at the time of birth or adoption, that child would have been granted guaranteed issue onto their parent's plan and the parents would not then have to worry about qualifying for coverage for a sick baby later on."
  
• "Basic healthcare for everyone is a wonderful ideal, but how fair is it for those who take good care of themselves to have to pay for lipitor, pain killers, high cholesterol medication, and high blood pressure medication for the guy who smokes, drinks, and is way overweight?"

IMHO, you are seriously out of touch with the plight of 10s of millions of Americans who are neither foolish, self-abusive, nor lazy. Perhaps your practice or living situation insulate you from those sectors for whom this shamble of a system is not working. I don't know.

But your stated views and implications sadden me. And your "solution" is to expect working class folks to buy comprehensive health insurance on their own at age 18 before they have children, pay obscene premiums their whole life, while they receive and indirectly pay for redundant coverage when they are working?! Good heavens. I'll stick with my original characterization of this point of view.

I don't have all the answers, but at least I see that there is a problem that today's options won't come close to solving.

[Tadpole]

Originally Posted by Rich_in_Tampa

But your stated views and implications sadden me. And your "solution" is to expect working class folks to buy comprehensive health insurance on their own at age 18 before they have children, pay obscene premiums their whole life, while they receive and indirectly pay for redundant coverage when they are working?! Good heavens. I'll stick with my original characterization of this point of view.

I don't have all the answers, but at least I see that there is a problem that today's options won't come close to solving.

It is easy to say that, at 18, someone should buy into an insurance that is portable throughout their life. It is another thing to look at what is happening to insurance that people have carried all their career. If you are still working and if you have stuck with the same workplace plan, you see the folly in any statement that you buy into the pool then pay your dues while young and healthy to prepare for the tougher days. The insurance companies will simply price you out or terminate the plan when your pool gets older. The "new designs" such as HSAs help those without workplace insurance, like many REs here. However, since these plans have been issued, there has been an inordinate increase in the price of lower deductible, older insurance plans. This is because, for those carrying insurance, the pools are being busted in to risk pools after the fact. So people who carried insurance plans throughout the young and healthy days are facing almost unpayable premiums with those plans now. By offering cheaper alternatives to younger people that older people do not have time to participate in, the PPO insurance plans are becoming unaffordable. I guess my point is that what is inexpensive today may not be inexpensive tomorrow. A person without employer contributions can easily be priced out with innovative, young only need apply, new plans. Insurance company "plan aheads" are at odds with personal "plan aheads". For example, today's offerrings assume a long enough work time to build up a hefty savings account. Older employees that are near retirement do not have time to build up the account, especially if their health is already deteriorating. In pretending to create an insurance model for the far future, the insurance companies are really trying to price older people out of the market. This could happen in any model, employee or private. Since this is possible and since the person cannot healthy living their way out of aging a person acting responsibly at 18 is a silly solution; it is simply a distraction from providing health care to all citizens.

[audreyh1]

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?

Companies can outright deny you coverage. I guess it depends on the state, but in many there is not obligation for an insurance company to offer you private coverage at all. If you have pre-existing conditions they can outright deny you and the only way you can have those pre-existing conditions covered is to go into the state's risk pool.

Audrey

[brewer12345]

Originally Posted by audreyh1

Companies can outright deny you coverage. I guess it depends on the state, but in many there is not obligation for an insurance company to offer you private coverage at all. If you have pre-existing conditions they can outright deny you and the only way you can have those pre-existing conditions covered is to go into the state's risk pool.

Audrey

Way, way state dependent. NJ, for example, does not allow insurers to reject anyone and has strict limits on exclusion of pre-existing conditions. The trade off is that coverage is very expensive. But if I am not in the greatest health when I retire, I know that if I remain a resident I can get coverage no matter what.

[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

These options may be expensive however. You should talk to your agent and ask why you were not told about these options. If your COBRA has not yet expired, it is not too late to look at these options. You might end up choosing not to go with a conversion policy because of the cost or other issues, but at least you should look at the option.

[mykidslovedogs]

Originally Posted by Rich_in_Tampa

Well, I wasn't referring to you alone, but I do feel it applies to what you have written here. Other posters can decide for themselves if I "obviousy, totally misinterpreted" them. Here are some comments from the oldest 1.5 pages of your posts alone. I tried to be careful to only repeat comments that are true to the original context:

Yes, all of those statements were written while I was pretty fired up, but they are all consistent with my ideal fix for the problem. I really do believe that giving people many choices rather than confining all to the same coverage is better than the alternative tradeoff of compromising the quality of care in our country. For all of you who like the idea of universal care, I believe a system like that would naturally eventually weed out quality organization like Mayo, so if that's OK with you, then why not just use the in-network facilities that your healthplans already contract with? After all, that's what I believe you'll be stuck with in a Universal system. (Only in a Universal system, the quality of care, in my opinion, probably won't even be as good as that.) Again, IMO, there will be rationing of care. Heck, we already have a shortage of good doctors in our country, so if we try to FORCE them to care for 49 million more people, there will be, IMO, rationing of care, and IMO, the universal system will ultimately create problems for more people than it will help. I cannot support a system that hurts more people than it helps.

Also, in my ideal system, healthcare would NOT BE TIED TO EMPLOYMENT, so there would be no redundancy of coverage. I think it's a great idea to have that benefit be given to employees in the form of higher wages IF THE EMPLOYER WANTS TO DO THAT AND NOT BECAUSE THEY ARE FORCED TO DO THAT. ...And that people be given many plans plans to choose from (NOT JUST ONE), and that they NOT BE FORCED TO BUY INTO THAT SYSTEM IF THEY DON'T WANT TO. Meanwhile, we teach them while they are young about the negative consequences of not buying into a plan, and we offer them tax incentives to be involved in a plan, thereby naturally reducing the number of uninsureds without FORCING coverage on them.

We also need to reduce the barriers to entry for doctors so that it's no so hard to become a doctor in our country. The medical schools do a pretty good job of controlling the number of Dr's that actually make it into the system, which has ultimately, IMO, has a begative impact on the cost of care in our country.

[Gumby]

I don't know why any of this should come as a surprise. Insurance companies are businesses. Like all businesses, they increase profits to their shareholders by maximizing revenue and minimizing expense. That is done by: a) raising the level of premiums they collect to the maximum the market will bear; and b) minimizing the amounts they pay out by limiting or denying coverage. It is the very nature of the system, and any insurance executive must do this to keep his or her job.

That is why universal government provided health care is, in my opinion, the only rational way to ensure that all people in this country get the health care they need. It provides the same risk-spreading feature as insurance, without the profit motive.

[brewer12345]

Originally Posted by Gumby

That is why universal government provided health care is, in my opinion, the only rational way to ensure that all people in this country get the health care they need. It provides the same risk-spreading feature as insurance, without the profit motive.

I am not quite in agreement with the reasons, but I definately agree on the outcome: we need universal healthcare in the US.

[Trek]

Originally Posted by mykidslovedogs

For all of you who like the idea of universal care, I believe a system like that would naturally eventually weed out quality organization like Mayo....

How do you figure that? Countries with universal health care also have private health insurance you can purchase and high cost private hospitals and private medical practices like in the States for the wealthier bunch that are willing to pay for that if they so choose. If enough people like what the Mayo clinic does for them, it won't go anywhere. Some of the most groundbreaking medical research and medical procedures come out of countries with universal healthcare. So that whole argument is moot.

What universal health care will do is help the people in this country that have to decide whether to buy their medicine or eat dinner. Or if they should only take 2 heart pills a week instead of every day as prescribed. The people that work jobs that don't supply health insurance and who can't afford the high monthly premiums for private insurance policies. I could go on and on.

Countries with universal health care also heavily encourage preventative health care which keeps overall costs lower. Instead of shoving pills down your throat to manage symptoms, the look for the root causes of your symptoms and treat that.

If run properly it's of great benefit to the entire society. A society of healthy people functions much better than a society of sick ones.

I digress............

[lets-retire]

Originally Posted by Trek

If run properly it's of great benefit to the entire society. A society of healthy people functions much better than a society of sick ones.

If run properly Communism works. So does Socialism. However in reality human greed prevents these systems, from working. By keeping any semblance of a free market involved with health care guarantees the system will fail. By letting our government run the program also guarantees the system will fail. I have used the government's free health care and can honestly say it s#$%s.

[brewer12345]

Originally Posted by lets-retire

If run properly Communism works. So does Socialism. However in reality human greed prevents these systems, from working. By keeping any semblance of a free market involved with health care guarantees the system will fail. By letting our government run the program also guarantees the system will fail. I have used the government's free health care and can honestly say it s#$%s.

Yeah Medicare has been a huge failure, what with all those seniors dying in the street from lack of care.

Spare us the Fox "News" Op Ed.