No health care for you! Come back one year...

[M Paquette]

Quote:

Originally Posted by CuppaJoe What Martha said, and you might look into whether coverage is denied to dead folks.

Well, apparently someone can be 12 years dead and still covered by an Accidental Death and Dismemberment Policy.

In reviewing accounts for my mother's estate, I discovered that my poor mom had been leaking $4.00 a month from her checking account as an automatic debit for accidental death and dismemberment insurance on may dad, who had passed away 12 years ago. The bank and insurance company tried to blow it off, blaming each other. The bank put a 'stop payment' on the debit, but it mysteriously didn't work. (The insurance unit is part of the bank, but they don't want to admit it. Their stops won't block internal transfers.) Soooo... Now the bank and insurer are facing a fresh complaint via the Office of the Comptroller of the Currency. (The goal isn't to recover anything. I'll be closing the account in a few weeks. The goal is just to cost the bank/insurer more in expenses dealing with OCC than they took from Mom over the last 12 years.)

If the insurance company keeps making noises about how only my deceased father can cancel the policy, I might be tempted to have him disinterred. I'm sure something must have fallen off by now.

I've also gotten a couple of offers for 'No exam needed! Anyone qualifies!' medical insurance plans for Mom. (These have really funky exceptions and limitations that make them essentially useless.) Nothing in the application requires the applicant to be living, though...

Yes, I understand that an attempt to collect would almost certainly be insurance fraud. It's pretty silly, though.

[Martha]

Quote:

Originally Posted by Want2retire I really trust your knowledge of federal law because I know that you know what you are talking about. But somehow insurance companies have managed to get around it in Louisiana, at least when it comes to homeowners' insurance. Maybe you just meant medical insurance since that is what we are talking about here! But anyway, if we make more than 3 claims in a five year period (even small claims), our homeowners' insurance can and will be cancelled ("dropped"). Insurance here is regulated by our state insurance commisioner and so there is probably some technicality that allows them to do that. I agree that anything related to heart health should be reported! It might turn out to be nothing, but if you can't get a doctor's opinion on it then we might as well be living in the jungles of a third world country. There's no sense in even having health insurance if you can't get health care.

In most states (if not all) homeowners and car insurance is different. They can (and do) cancel you for your claims history. I clarified my prior post to indicate that the law only applies to health insurance.

[lets-retire]

I've heard of the cancelling, but typically what I've heard when the story is told is a refusal to renew not a drop.

[Martha]

Quote:

Originally Posted by lets-retire I've heard of the cancelling, but typically what I've heard when the story is told is a refusal to renew not a drop.

Health insurance companies can't refuse to renew either based on your health condition. This is under HIPAA. However, they can raise the price, though in most states they can only do it for everyone who has that policy, though usually age related differences in price are fine. They can also eliminate the particular product, which they might do if the people who buy the policy are in such crummy health that it doesn't pay to keep it.

[John Galt III]

Quote:

Originally Posted by Martha JGIII, for goodness sakes tell you doc about these concerns. If they are not a problem then they are not a problem. If they are, they should be taken care of. Chest pain and palpitations are not hang nails. BTW, under federal law a health insurance company cannot cancel you for making claims. They can discontinue policies and in a few states can raise rates.

But here's the likely scenario. I'm 55. When I retire, sometime prior to age 66, if I choose to get private health ins, I'll have to get a NEW health insurance policy, not keep the old one I had through work. I won't be allowed to keep the old one. New prospective insurance co will deny me for even mentioning heart palpitations to my PCP, even if he says "you're fine. Go home". I'm assuming, perhaps wrongly, that my mentioning of heart palpitations to the dr will get recorded by him, and that the new prospective ins co will ask the dr for his medical records about me, and that the dr will provide all the info he has on me, to them.

In fact, I may already be out of the game, since I got treatment at a Phys Therapy place for frozen shoulder a year ago. If they don't care about anything that happenned over a year ago, I may have hope.

[Martha]

I understand JGII, but some things are too important to let go because of a possible future denial when trying to purchase insurance. If you are turned down for private insurance there will be a HIPAA option for you, though it might be pricey depending on where you live.

[Rich_by_the_Bay]

Yeah, we get it about your insurance situation.

It's your undiagnosed chest pain she's talking about. If it's a false alarm, your records will reflect that and likely not affect underwriting. If it's something that needs to be taken care of you will do so and live.

It's a bad system to be sure, but "suicide by denial" may not be the best approach...

[REWahoo]

JG3, your thinking sounds similiar to that of DD#2's father-in-law. He was self employed and kept putting off going to his doctor with some concerning symptoms because his insurance coverage wasn't very good and he was waiting until he got on Medicare. Everyone tried to tell him he shouldn't wait but he wouldn't listen.

Turns out he had prostate cancer which had already spread to his liver and his bones by the time he saw a doctor. He died within a few months of his diagnosis - but Medicare paid for 80% of his costs.

[John Galt III]

Thanks for the concern, everyone. I will mention the chest pain at my soon-to-occur annual physical. By the way, I did already mention the palpitations ( not pain) to my former PCP, about 8 years ago, and he didn't even have any tests ordered, although he said he would order tests if I wanted them. I declined. The pains are very rare, once every 2 months or so, and the palpitations occur only every month or so. May be my imagination, but I think the palpitations kick in whenever I remember to take my fish oil capsules, and after I have taken them several days in a row.
I understand the "don't gamble with your health" advice. Thanks.

[unclemick]

Quote:

Originally Posted by Want2retire I really trust your knowledge of federal law because I know that you know what you are talking about. But somehow insurance companies have managed to get around it in Louisiana, at least when it comes to homeowners' insurance. Maybe you just meant medical insurance since that is what we are talking about here! But anyway, if we make more than 3 claims in a five year period (even small claims), our homeowners' insurance can and will be cancelled ("dropped"). Insurance here is regulated by our state insurance commisioner and so there is probably some technicality that allows them to do that. I agree that anything related to heart health should be reported! It might turn out to be nothing, but if you can't get a doctor's opinion on it then we might as well be living in the jungles of a third world country. There's no sense in even having health insurance if you can't get health care.

Is the insurance commisioner in jail or out of jail nowadays? Back pre-Katrina I filed a complaint with them over my Homeowner's canceled policy and inability to get another one.

When I called up to ask(after a suitable waiting period) about my complaint - the nice lady said they couldn't do nothing - the commish was off to jail to serve his 6 month? term. I asked (being somewhat ticked) were they gonna keep getting their paychecks while the boss was in the slammer.

Yep.

heh heh heh - Got a great tax write off and Roth conversion when Katrina hit. Have a Passport but I'm not sure medical tourism can beat my Medicare/supplimental as an old phart.

[W2R]

UncleMick, I think just about all of our past insurance commissioners have done time in jail! The insurance mess down here is just one more motivation to move north, as you have done.

[Zoocat]

Quote:

Originally Posted by M Paquette They found it. Rejected: A benign polyp was found and removed on my last colonoscopy.

That is typical. The insurance companies will deny coverage for anything these days.

Lots of people are afraid to go to the doctor for fear of something (anything!) being diagnosed and treated and ending up on their medical record. The fear is future denial of insurance. I struggle with this myself. I would really like to change insurance companies but to do so I can't afford to have any more diagnoses or treatments on my records.

[samclem]

Congress has decided to use the employer mandate to achieve health care reform.
(From the WSJ)

Quote:

WASHINGTON -- House Democrats on Tuesday unveiled sweeping health-care legislation that would hit all but the smallest businesses with a penalty equal to 8% of payroll if they fail to provide health insurance to workers. The House bill, which also would impose new taxes on the wealthy estimated to bring in more than $500 billion over a decade, came as lawmakers in the Senate raced against a self-imposed Thursday deadline to find ways to finance their health-care bill. Senators are weighing a combination of several more-modest tax increases, including some that would hit health-care industries. Under the House measure, employers with payrolls exceeding $400,000 a year would have to provide health insurance or pay the 8% penalty. Employers with payrolls between $250,000 and $400,000 a year would pay a smaller penalty, and those less than $250,000 would be exempt. The relatively low thresholds for penalties triggered criticism from business groups and Republicans, who said the burden on small business is too high. Rep. Dave Camp of Michigan, the top Republican on the Ways and Means Committee, said the House bill would "impose massive new taxes and mandates on employers, especially small businesses."

AAAARRRGGGGHHH!! Health care/health insurance is a contentious issue, but the only thing almost everyone agrees on is that having employers pay for the health care of their employees is crazy. It makes people afraid to quit their jobs and try something new, it leaves people without insurance when they lose their employment, and the two things ("I need a job" and "I need a gall bladder removed") have nothing whatsoever to do with each other. So, Congress has decided this one universally despised facet of our present system will be the centerpiece of the new approach we were promised.

It is a mess in Massachusetts, so I guess we should bring it to the other 49 states.

The folks who study and know health care issues and who have devoted their lives to working in this area must wonder how all the collective wisdom and experience gained in the US and abroad ends up producing this result.

Here are the experts.
A

[ziggy29]

Yep. Whatever changes we make to the health care/health insurance situation, one thing that needs to happen is the decoupling of employer and health insurance. This goes in the opposite direction and, for that reason, I think it's a mistake.

[FUEGO]

FYI, for those interested in reading up a little, the House Democrat's proposal that they entered today as referenced above in the WSJ and elsewhere on the AP. Some concise summaries of what the bill includes.

I'm still reviewing their summary pages to see what real effect it would have.

[FUEGO]

The house proposal could be really good news for ER types. The low to moderate income folks are supposed to have their premiums capped at between 1.5% of income for those around poverty level and 11% of income for those making 400% the poverty level. So without knowing the tiers in between, lets say they require 5% of $40,000 income for a family of 2. $2000 a year in premiums.

They also specify that the age based premiums can't vary more than a 2 to 1 ratio. So presumably a 21 year old may pay $2000 a year and the 64 year old may pay $4000 a year. Presumably these are also capped by the income maximums too.

This is all based on the assumption that there will be no asset test for premium discounts based on low to moderate income status.

If this works out the way it is looking like it might, then my $10,000 line item for retirement health insurance may have just shrunk a lot.

[DallasGuy]

One thing I really like about the House Health Care plan is that it would change the laws so that health insurance companies can not deny coverage based on a pre-existing condition. Also, the insurance companies would not be able to charge more if you do have a pre-existing condition. This would stop the cherry picking that the insurance companies currently do. The House plan also includes a government sponsered health insurance plan which I think is a very good idea because it would force the health insurance companies to bring their premium costs down and actually be competitive with their premiums. I find it quite laughable when the health insurance companies complain that a government health insurance plan would drive them out of business. The only thing it would do would bring their profits down to a more reasonable level. The executives at these companies are trembling because they're afraid they'll have to say good bye to their huge year end bonuses. Too bad...maybe a customer who is buying one of their insurance plans won't get denied coverage instead! I have absolutely no sympathy for health insurance companies at this point....my COBRA premium was raised 37% last year....in one year. I really wonder if that was the result of the insurance companies trying to have customers pay for the bad return they had on their investments due to a down stock market. Just a guess, but I wouldn't put it past them.

It's time for a change in the way that our country handles health care coverage. It's a big mess right now. It's not a good situation where people that actually have the money to buy health insurance get denied that chance because of a pre-existing condition. It's even worse when we have people in a country like the U.S. who can't get care because they can't afford it unless they go to an emergency room. Also, as others have said in this thread, it's pretty sad when people won't tell their doctor of possible minor health problems for fear it will be a new pre-existing condition.

For those of you that have guaranteed health coverage, I'm happy for you. But for those of us that have to buy our own coverage, this system is not good. Please don't let the conservatives in congress scare you into thinking that the status-quo is just fine. If you agree with that, you'll just be pushing the problem down the road to a later time just as we're doing with social security.

[samclem]

Quote:

Originally Posted by FUEGO The house proposal could be really good news for ER types. The low to moderate income folks are supposed to have their premiums capped at between 1.5% of income for those around poverty level and 11% of income for those making 400% the poverty level. So without knowing the tiers in between, lets say they require 5% of $40,000 income for a family of 2. $2000 a year in premiums. They also specify that the age based premiums can't vary more than a 2 to 1 ratio. So presumably a 21 year old may pay $2000 a year and the 64 year old may pay $4000 a year. Presumably these are also capped by the income maximums too. This is all based on the assumption that there will be no asset test for premium discounts based on low to moderate income status. If this works out the way it is looking like it might, then my $10,000 line item for retirement health insurance may have just shrunk a lot.

I wish the government would do something important, like make a law saying I could fly, or see through objects. That would be great. I guess no one wonders how the setting of premium caps that are below the cost of providing the service for 95% of people can co-exist with the statement that this thing somehow won't result in a big increase in taxes and also won't result in reduced quality of care. Right, it's al possible due to "increased efficiency"--the very thing for which the government is most famous. I can already see the efficiency and simplicity of these conflicting premium formulae.

I think folks are diggging through this pile of sh*t and imagining they've found their own personal ponies. "I'm okay, I found the part that says I'll get great care that is cheap--everyone else . . . good luck!"

[lets-retire]

Quote:

Originally Posted by samclem I think folks are diggging through this pile of sh*t and imagining they've found their own personal ponies. "I'm okay, I found the part that says I'll get great care that is cheap--everyone else . . . good luck!"

I think this happens more often than not when it comes to government provided benefits. People think that government can pass laws that directly conflict with common sense and economics and they will turn out great.

From what I've seen, granted I didn't read the legislation being revealed right now, government is saying we will lower the cost of health insurance, but aren't really dealing with the other end of the equation what are they going to do to improve efficiencies and control costs? The biggest thing I've heard is, we aren't going to pay providers as much. That doesn't seem to make much sense, to me. Doctors already receive a much lower payout from the insurance companies so with the government option that pay would be even lower.

[ERD50]

Quote:

Originally Posted by DallasGuy One thing I really like about the House Health Care plan is that it would... ...stop the cherry picking that the insurance companies currently do. .... it would force the health insurance companies to bring their premium costs down...

DallasGuy, please be very, very careful what you wish for. Especially when Congress is listening to the public, and remember - your wishes, if enacted affect *everyone*.

As others have pointed out, Congress cannot just magically dictate that costs be reduced - there will be some consequences, unless actual efficiency is somehow improved. Let's learn from history, and this somewhat parallel situation:

California electricity crisis - Wikipedia, the free encyclopedia

Bold mine -

Quote:

The California electricity crisis (also known as the Western U.S. Energy Crisis) of 2000 and 2001 was a situation where California had a shortage of electricity. Although California's population increased by 13% during the 1990s, the state did not build any new major power plants during that time. [1] .... Due to price controls, public utility companies were paying more for electricity than they were allowed to charge customers, forcing the bankruptcy of Pacific Gas and Electric and the public bailout of Southern California Edison. This led to a shortage in energy and, therefore, blackouts.

Did price controls lead to better efficiency of the system? Nope, just the opposite:

Quote:

By keeping the consumer price of electricity artificially low, the California government discouraged citizens from practicing conservation. In February 2001, California governor Gray Davis stated, "Believe me, if I wanted to raise rates I could have solved this problem in 20 minutes." [2]

Quote:

Originally Posted by DallasGuy It's time for a change in the way that our country handles health care coverage. It's a big mess right now.

I agree. But the real question is - will this proposal improve the situation, or make it worse? I fear the latter.

-ERD50