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Conservatives in this thread talk like their opinion is going to matter. Sorry, the train has left the station and you did NOT board. Toodles!!
BTW, I want the public option.
One thing many people forget is that Obama was elected. The members of Congress were elected. This is why I don't understand all the "let's be bipartisan" talk. If we wanted more Republicans in office, we would have voted for them, right?
I also want a Public Option. I'm concerned that the new rules Obama talked about in his speech won't be enough. In Florida we have Cover Florida and the insurance companies that participate in it cannot reject an application from someone with a pre-existing condition, although it isn't covered for 12 months. But the benefits are terrible and premiums are too high for an older person (not yet 65) Obama mentioned getting rid of annual limits if someone gets sick which would be very helpful. Having a $25,000 per year maximum won't cover even one hospital stay. A $50,000 limit doesn't cover a heart attack. I know someone who was in the hospital for 3 days and his bill was over $70,000. There have always been companies like United American that will cover someone who is turned away by other insurers, but the benefits aren't comprehensive and the premiums are higher than average.
Yes, sign me up too. Don't you just love it when an insurance company rejects a claim or increase deductibles and copays?
If a claim is rejected, there's got to be a legitimate reason for it. People talk as though insurance companies can do what ever they want.....that's just not true. Each state regulates the insurance companies it's approved to sell insurance there. They have annual audits for underwriting and claims abnormalities. They can't do something to one person that they didn't do to another....that's discrimination....they get serious fines and put on probation for things like that.
Deductibles and co-pays don't increase within a plan....the same plan may be available with higher co-pays and deductibles to lower the premium. Employers often get re-quoted at renewal (which happens annually) with other companies and sometimes end up making changes like that at renewal rather than change carriers. Chances are if that happened to you it was because your employer decided to do that rather to minimize the rate increase he got at renewel.
I also want a Public Option. I'm concerned that the new rules Obama talked about in his speech won't be enough. In Florida we have Cover Florida and the insurance companies that participate in it cannot reject an application from someone with a pre-existing condition, although it isn't covered for 12 months. But the benefits are terrible and premiums are too high for an older person (not yet 65) Obama mentioned getting rid of annual limits if someone gets sick which would be very helpful. Having a $25,000 per year maximum won't cover even one hospital stay. A $50,000 limit doesn't cover a heart attack. I know someone who was in the hospital for 3 days and his bill was over $70,000. There have always been companies like United American that will cover someone who is turned away by other insurers, but the benefits aren't comprehensive and the premiums are higher than average.
Of course the premiums are high because, they have to accept any one (I assume you're talking about individual insurance.....group they do that any, I've never heard different). If you have things like annual limits, then that's also because they have to accept everyone.....I've never heard of that before, only lifetime limits (which are usually $3,000,000 now.....if you manage to spend that much and not be dead....god bless you, you probably wish you were).
If you think the new rules won't be enough, think about what you're complaining about in Florida......benefits will be better because they're getting mandated but, prices will go through the roof from where they are now. How else will private carriers pay for the increase in claims....what do you think, they can just print more money like the government can and keeps doing (until the day comes when they pushed it too far and everything collapses).
We need to start all over from election day and elect someone else.
That is the only way we can fix this huge mistake.
I agree!!
And why the American people didn't vote Ron Paul in in 2008 is beyond me! We wouldn't have such a huge deficit bogging this country down , we wouldn't have our sons & daughters dying in foreign lands , we wouldn't have Wall Street appointees in the White House , we wouldn't have the Federal Reserve arrogantly doing whatever it wants with our hard earned $$ and NOT TELLING US what they did with it!! , we wouldn't have bankster bail outs , we wouldn't have government takeover of the auto industry , we wouldn't have threats of martial law coming at us , we wouldn't have militarized police departments , we wouldn't have foreign troops training on U.S. soil learning how to access our internal affairs so they can turn cities into prisons , we wouldn't have ....
What we would have is: more transparency of our monetary system , we'd have our sons & daughters back home with us , we'd be getting back to a currency worth something , we'd be on a path towards eliminating the federal debt , we'd be building our own bridges instead of bombing others' , we'd be on the path to real recovery instead of this downward spiral , people in this country would have REAL HOPE, instead of anger , people would have more individual freedom than despair , we'd have a happier country! We'd have a country we could be proud of again!
If a claim is rejected, there's got to be a legitimate reason for it.
Not necessarily. Talking as a consumer, not an agent, when I worked for a store and had group coverage, I submitted many claims that were eventually paid, but it was a battle. I've also helped people settle claims because they were initially rejected. Many times it was just a matter of getting addition information from the physician or hospital or resubmitting with the correct billing code. Other times proof that the treatment was medically necessary was required.
Quote:
Originally Posted by Danno3314
People talk as though insurance companies can do what ever they want.....that's just not true. Each state regulates the insurance companies it's approved to sell insurance there.
I agree. I've mentioned 100 times on this board that I'm a licensed health insurance agent. I also strongly support health care reform. The 2 do not have to be mutually exclusive. I keep hearing about companies canceling insurance when people get sick, and that's never happened to anyone in Florida AFAIK, so I understand what you're saying. However, a company can & will reject a claim it feels is for a pre-existing condition. In other words, Mr. Jones pays premiums for 2 years and then hurts his back. The insurance company can claim Mr. Jones was not completely honest on his application because he had back problems in the past. Once you reach a certain age, just about everything is a pre-existing condition.
I also realize a co-pay or deductible cannot be increased out of the blue. That's not what I meant. I was talking about the plans getting more and more expensive every year. So let's say a few years ago I paid $400 a month for insurance with a $5,000 deductible and 80/20. Now the cost has gone up over 10% every year, so the same premium will only buy a $10,000 deductible plan. That's what I meant, but looking back at my post, I guess I wasn't very clear.
Quote:
Originally Posted by Danno3314
They have annual audits for underwriting and claims abnormalities. They can't do something to one person that they didn't do to another....that's discrimination....they get serious fines and put on probation for things like that.
Yes, also true, but only to a point. They can't simply raise a policyholder's premiums just because he/she gets sick. However, there is a lot of discrimination initially which is my complaint. Try to get a good health insurance plan if you've been ill. Try to find affordable premiums when you're over 50. Of course it's obvious why the insurance companies do it, but someone 60 shouldn't have to pay more than his mortgage to get decent coverage. When Obama said the insurance executives are not bad people but they need to do what's profitable for the company, he hit the proverbial nail on the head. Getting older should not be a punishment in this country. A 59 year old working man or woman shouldn't be praying he/she doesn't get cancer or have a heart attack before age 65.
Regarding annual limits, I totally disagree with you. Many individual policies have inpatient & outpatient limits. Some only cover 10 days a year in the hospital or have maximums per hospital visit. Others limit your total benefits for diagnostic tests and emergency treatment.
[URL]http://www.coverfloridahealthcare.com/[/URL]
Click on "available plans" and you can see what I mean. Maybe I was misunderstood because health insurance is hard to discuss in a short post. There are so many variables. However, "up to $1,000 a year for in-network physicians" is not good coverage. I'm going to try to copy & paste here:
$3,000 deductible
Medical Benefits up to:
$25,000 annually
Directly from a plan on the above site. How can you tell me that there is no such thing an an annual maximumbenefit?
Last edited by justNancy; 09-11-2009 at 02:53 PM..
Reason: added link, fixed post
My post was so long that I didn't include this article. I kept editing it to shorten the comment, but it's not an easy subject to discuss in brief without missing something.
[URL="http://www.latimes.com/news/local/la-fi-deny30dec30,0,7176685.story"]Family rejects Blue Cross' claim -- latimes.com[/URL]
"Many people who are denied treatment never contest it because they are unaware that they can or are too caught up in their medical crises to bother."
A close friend was diagnosed with stage 4 breast cancer and the insurance company wouldn't pay for her chemotherapy. I can't believe all the people who keep screaming that the government will ration health care. Don't they realize this is being done now?
Just in case someone mentioned the above link is 2 years old (I just happened to remember it) here's a current article on how many times claims are rejected.
"CNA/NNOC researchers analyzed data reported by the insurers to the California Department of Managed Care. From 2002 through June 30, 2009, the six largest insurers operating in California rejected 31.2 million claims for care - 21 percent of all claims."
Last edited by justNancy; 09-11-2009 at 03:17 PM..
Reason: add link, quote
Of course the premiums are high because, they have to accept any one
I didn't address this comment in my other posts.
Yes, true. I understand all of this. It's no different with life insurance. When you see "guaranteed issue" anywhere, it means the premiums are higher. Those commercials for burial insurance (called Final Expense) always say "you can't be turned down" but they have limits for the first 2 or 3 years and they usually cost more. Anytime there is a plan, life or health, a guaranteed issue plan will cost more. It's common sense because it's a business. That's the whole problem. So you don't need to explain that to me. What I was asking is "is that fair?" Why should someone who has been sick or hasn't been able to get coverage be treated like a sub-human? We are the only industrialized country that treats its citizens like this. Everyone should matter.
I hope nobody brings up auto insurance. It's been done here before. Being a safe driver is a choice. Having a chronic illness or getting old isn't.
Last edited by justNancy; 09-11-2009 at 03:44 PM..
Not necessarily. Talking as a consumer, not an agent, when I worked for a store and had group coverage, I submitted many claims that were eventually paid, but it was a battle. I've also helped people settle claims because they were initially rejected. Many times it was just a matter of getting addition information from the physician or hospital or resubmitting with the correct billing code. Other times proof that the treatment was medically necessary was required.
I'm speaking as an insurance broker and all I do is health insurance. What you're telling me is that there were legitimate reasons why your claims (or your friend claims) were rejected...there was missing information. You're a licensed agent...I don't know how much you deal with health insurance, many don't like to get involved with it if they don't need to and just do life. Since it's all I do, my clients call me from time to time to get help with a claim problem.....I'm glad they do too because, I know what's wrong and how to fix it in minutes, rather than they get frustrated finding out the long why what was wrong....which is that 99% of the time insurance info is either missing or outdated with a provider that has sent them a bill and is asking them to pay a remaining balance.
I agree. I've mentioned 100 times on this board that I'm a licensed health insurance agent. I also strongly support health care reform. The 2 do not have to be mutually exclusive. I keep hearing about companies canceling insurance when people get sick, and that's never happened to anyone in Florida AFAIK, so I understand what you're saying. However, a company can & will reject a claim it feels is for a pre-existing condition. In other words, Mr. Jones pays premiums for 2 years and then hurts his back. The insurance company can claim Mr. Jones was not completely honest on his application because he had back problems in the past. Once you reach a certain age, just about everything is a pre-existing condition.
It's a pre-ex if it was present during the time they specified on the application under the health history questions....whether it's one, two or five years....what ever they asked and then it's subject to a waiting period of whatever the policy states...usually 12 or 24 months.
If an applicant omits something like that on their application, technically it's insurance fraud....they sign the application and it becomes part of the insurance policy they get when accepted (it's copied and becomes the last several pages of the policy).
In a situation like what you used as an example, they don't just reject the claim. They have to go back and underwrite the condition they just found out about as if they had known about it on the application. If it would have been a decline, then they rescind his policy, return his premiums that he's paid minus any claims they had to cover. If they would have offered him a policy with an exclusion rider on it for his back, then that's what they'll offer him now (and he'll have to sign off on it)...which means his back isn't covered. If he says he wouldn't have accepted the policy like that and doesn't want it, then they'll rescind it just like if it had been a decline. If all that would have happened is that it would have been subject to the pre-existing condition waiting period, then they would pay the claim based on whether or not that waiting period had lapsed at that time.
I also realize a co-pay or deductible cannot be increased out of the blue. That's not what I meant. I was talking about the plans getting more and more expensive every year. So let's say a few years ago I paid $400 a month for insurance with a $5,000 deductible and 80/20. Now the cost has gone up over 10% every year, so the same premium will only buy a $10,000 deductible plan. That's what I meant, but looking back at my post, I guess I wasn't very clear.
Right, so you either change to the higher deductible so you still have the same premium or start paying the higher premium and keep the same deuctible.
Yes, also true, but only to a point. They can't simply raise a policyholder's premiums just because he/she gets sick. However, there is a lot of discrimination initially which is my complaint. Try to get a good health insurance plan if you've been ill. Try to find affordable premiums when you're over 50. Of course it's obvious why the insurance companies do it, but someone 60 shouldn't have to pay more than his mortgage to get decent coverage. When Obama said the insurance executives are not bad people but they need to do what's profitable for the company, he hit the proverbial nail on the head. Getting older should not be a punishment in this country. A 59 year old working man or woman shouldn't be praying he/she doesn't get cancer or have a heart attack before age 65.
Well that's not discrimination, that's underwriting based on health status. They're not declining because of age, they might decline because of a health condition that's common with age but, it's not because of the age itself that they're declining. What I'm talking about is within the same company, if they accept they have two people with the identical illness/condition, they have to treat the both the same......they can't accept one and not the other (assuming there are no other health problems causing the decline).
A side note, I don't know how long you've been selling insurance but, I have since 95. Before HIPAA took effect, I had no problems placing any one with insurance and at reasonable prices too. I could insure a 60 year old COUPLE on a PPO with a $1,000 deductible, 80/20 of the next $5,000, $2,000,000 lifetime limit, $25 office co-pays and a $10/25 drug card for $300-350/month......in an HMO with a $10 co-pay office visits, $0 co-pay for hospital for $400-500/month. I used to be able to insure a young couple with one or two children for $225-275/month. I was ablr to do that up until about 99....a year and a half after HIPAA took effect....from then on you could see the effect it was having on the industry with both premiums and companies leaving the marketplace.
Regarding annual limits, I totally disagree with you. Many individual policies have inpatient & outpatient limits. Some only cover 10 days a year in the hospital or have maximums per hospital visit. Others limit your total benefits for diagnostic tests and emergency treatment.
Click on "available plans" and you can see what I mean. Maybe I was misunderstood because health insurance is hard to discuss in a short post. There are so many variables. However, "up to $1,000 a year for in-network physicians" is not good coverage. I'm going to try to copy & paste here:
$3,000 deductible
Medical Benefits up to:
$25,000 annually
Directly from a plan on the above site. How can you tell me that there is no such thing an an annual maximumbenefit?
I didn't say there was no such thing, I said:
If you have things like annual limits, then that's also because they have to accept everyone.....I've never heard of that before, only lifetime limits (which are usually $3,000,000 now.....if you manage to spend that much and not be dead....god bless you, you probably wish you were).
Where I am in Arizona, there are no plans that have anything like that....nothing legitimate any way. Before I became a broker, I answered an ad in the paper to sell insurance....i had zero experince in the industry. The regional manager hired about a dozen people including me that month and trained us everyday in a classroom setting for about two weeks. After we passed our exam and received our license, they set us loose to sell. Within a few weeks I had lots of questions about what I was selling....it didn't seem right....after a little research, I found out it wasn't and I quit and eventually ended up brokering. Everything that manager told us was a lie...he was a crook and the company he had us selling for was a complete rip-off.....there plan had per incident limits ($50,000 if I remember correctly), that's the only time I've ever seen anything like that. They even dropped that plan as I recall shortly after I quit but, they had been selling it for years. It had all kinds of limits in it, it paid your hospital bill for with a fixed daily amount for your room (which there were several options for) and the rest of the hospital bill was paid for as misc. charges (which there were also options for). It was a terrible plan....nothing like that exists out here that I know of....the only limits are lifetime limits for hospital stays. There used to be a plan that had a limit for office visits but, it was fairly high ($300-500/visit)....something like that.
Yes, true. I understand all of this. It's no different with life insurance. When you see "guaranteed issue" anywhere, it means the premiums are higher. Those commercials for burial insurance (called Final Expense) always say "you can't be turned down" but they have limits for the first 2 or 3 years and they usually cost more. Anytime there is a plan, life or health, a guaranteed issue plan will cost more. It's common sense because it's a business. That's the whole problem. So you don't need to explain that to me. What I was asking is "is that fair?" Why should someone who has been sick or hasn't been able to get coverage be treated like a sub-human? We are the only industrialized country that treats its citizens like this. Everyone should matter.
I hope nobody brings up auto insurance. It's been done here before. Being a safe driver is a choice. Having a chronic illness or getting old isn't.
Yeah, well those burial policies barely bury you too....lol...say that fast...lol. You know why it's this way with health insurance.....it's because the "risk" an insurer will have to incur from people that already have conditions/illnesses when they apply (if they have to accept everyone by law), can't be predicted the way illness can be predicted in otherwise healthy people. Historical data can tell them how many people out of 100,000 will get cancer in a each county in Florida. They'll calculate the rate of illness for every disease in each county in Florida and the cost to treat those conditions and that will be used as the basis for determining rates. Without some kind of risk pool where the uninsurables get evenly distributed among all the insurers in a given market, each carrier can not acurrately predict the amount of risk they'll end up having to assume.....rates spiral out of control as insurers try to compensate for the amount of risk they're taking on.
If a claim is rejected, there's got to be a legitimate reason for it. People talk as though insurance companies can do what ever they want.....that's just not true. Each state regulates the insurance companies it's approved to sell insurance there. They have annual audits for underwriting and claims abnormalities. They can't do something to one person that they didn't do to another....that's discrimination....they get serious fines and put on probation for things like that.
.
I think the issue is more that you get a nasty surprise sometimes when you file a claim and learn that your expense isn't a covered benefit.
Also, we had HI once that just sucked in terms of paying claims. They would say a claim was a duplicate, even when there were two different days of service, or two different services, etc. It was a nightmare.
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We wouldn't have such a huge deficit bogging this country down 
, we'd have our sons & daughters back home with us 
