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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.....
Huh? For those of you who don't realize how absurd this argument is, HIPAA was enacted in 1996. This is 2009, so what's your point? I do not sell insurance in AZ but I know what it costs to insure a family in FL. I know what it costs me for health insurance. I know how many families are declined and then have to pay high premiums for basic coverage, still leaving them with mounting medical bills. FACT: Most people who filed bankruptcy due to a serious medical condition had insurance when they got sick.
I do agree managers often lie. I heard a lot of lies, especially when I sold Medicare Advantage plans for one company, which is why I quit. I am an independent broker.
The sample premiums you are giving are for healthy people. If nobody ever got sick, then we wouldn't need health reform.
Last edited by justNancy; 09-11-2009 at 10:53 PM..
Reason: fix spelling
It's after 1am, so I'm too tired to debate what it costs for good insurance. Whether someone says he/she is a consumer, an agent, or works for an insurance company, it doesn't really matter. It is what it is! So, instead of taking my word for it, even though I provided links to plans in Florida on an official State web site, here's an article in USA Today.
[URL="http://www.usatoday.com/money/industries/health/2009-08-30-health-insurance-premiums-debate_N.htm"]Health care: Lowering costs for old could raise them for young - USATODAY.com[/URL]
Note: "Yet the same policy, from the same insurer, would cost a 60-year-old man $735 a month, according to an estimate at eHealthInsurancean online marketplace that lists quotes and coverage from a variety of insurers."
That's for a healthy 60 year old! Most of the time the online quote is lower than the actual premium after underwriting.
When someone 60 gets paid 5 times as much for doing the same job, then I guess it will be fair to charge him/her 500% more than a 27 year old. A person should not be punished for getting sick or making it to her next birthday. Yes, it's underwriting, but that's my whole point. As President Obama said - it's not that the insurance executives (or underwriters) are bad people, they are doing what is profitable.
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.
I'm not sure what state you live in or what insurer you had or the plan you were on with them but, when you say, "you file a claim" do you mean that you actually submitted the claim to your insurer or the provider did it for you? Sometimes the old style indemnity plans are that way since there's no network with it....you actually have to file the claim yourself. There's no reason for any one to still have a plan like that....a PPO is the same thing but, you can use the network if you want (usually every doctor is in it any way), the premiums are lower, they pay the provider directly and the fees are all discounted (which has been pre-negotiated with the provider)....you don't have to worry about getting paid on a usual & customary basis. Other than an old plan like that, I can't imagine that situation happening very often. I can honestly say I've never had a client call me about something that wasn't a covered benefit that they already received treatment for and now wasn't getting paid.
Duplicate claims are a problem in the industry. I had insurers that offered policyholders rewards for catching duplicate claims they had paid twice or services that they paid for and you didn't actually receive. They would give you 50% of what ever it was they paid and shouldn't have. It was so bad that it was worth it for them to do that. They needed to give policyholders an incentive for checking the claims carefully that they were paying for them because, they often didn't know details that the insured knew.....like whether or not a test was actually related to an office visit but, was done on a different day at a different location, etc.
It's still confusing for them, it's just that now rather than pay something they shouldn't have, if there's a question about it, they just don't pay it at all and wait for the insured to call up and explain any details that they need to clear up any questions they had. It's what they all do insurers, doctors, hospitals, etc. if there's a problem with a bill and it's a small amount, rather than waste their calling you and trying to track you down to answer a question, they just send out a bill to you or not pay a claim and they know you'll be contacting them, to fix the problem.
I agree the current """Plan """ is a thousand pages of Bureaucratic Nonsense.
Either we go to Single Payer for everyone or forget the whole thing.
Single Payer is cheaper and would relieve small businesses of the "mandate" of providing insurance.
It would also make Workmans Comp obsolete another big savings for businesses
Auto and Homeowners Insurance would be cut in half because there would be no fault medical
What we heard was another campaign speech. None of current Democrat plans include all the features he danced around. And yes, negative public opinion did smoke him out with some comforting words to those opposed to a government takeover. No plan that includes government paying health care providers should get through both the house and the senate. There are too many better ideas out there than giving those morons in Washington any more say in peoples daily lives.
It was nonsense he said about let us do it and if it we do not realize all these savings to cover the additional costs we can re-evaluate, well I do not want to see his Plan B.
Huh? For those of you who don't realize how absurd this argument is, HIPAA was enacted in 1996. This is 2009, so what's your point? I do not sell insurance in AZ but I know what it costs to insure a family in FL. I know what it costs me for health insurance. I know how many families are declined and then have to pay high premiums for basic coverage, still leaving them with mounting medical bills. FACT: Most people who filed bankruptcy due to a serious medical condition had insurance when they got sick.
I do agree managers often lie. I heard a lot of lies, especially when I sold Medicare Advantage plans for one company, which is why I quit. I am an independent broker.
The sample premiums you are giving are for healthy people. If nobody ever got sick, then we wouldn't need health reform.
No, HIPAA was signed into law in 1996 by President Clinton, the very first part of it went into effect on 7/1/97....since then law has been added to it a little at a time and it has had different sections of it going into effect ever since 7/1/97. If you do a search for HIPAA, you'll have to dig a little to find the first part of it that went into effect on 7/1/97....most of the results you'll get near the begining will be about parts of HIPAA going into effect in 2004 or 2006, more recent sections that have been enacted.
The first section that dealt with not being able to decline a group of any size (but could be rated up as much as 400%), limiting the look back period for pre-ex's to no more than the past 6 months (from the date of enrollment) and going forward with the waiting period only 12 or in some cases 18 months....and then on individual plans that they now had to accept any one coming off a group plan that had a portability certificate regardless of pre-ex's. There are more mandates but, those are a few of the big ones......over time that's obviously going to drive rates up and it did.....there was a lag period but, once it started it not only drove rates up it made underwriting across the board more strict. Things that at one time were no problem, now often get exclusion riders or rated -up.
Here's a link to a post I made about HIPAA, it's Clinton Care in small increments (Clinton said it him self):
We don't have guaranteed acceptance here in AZ but, we did have an excellent plan that was an offshoot of Medicaid that allowed employers with as few as one employee or up to 50 (so it was good for the self employed) to get great coverage with no underwriting. The example I gave you was for that program and a couple that I was actually thinking about....they were realtors and she was 60 he was 61 it was an HMO with a $5 co-pay for office visits and zero for hospital....it was through MercyCare (the Catholic church) and their rate was $400 for both. That couple was fairly healthy but, it wouldn't have mattered if they weren't....I put them on that plan because it was the best plan for them in their situation with one of the best prices.
It was basically the same system as Medicaid but, the employer paid the full amount of the premium which would normally be getting paid by the state for people that were in Medicaid. The only catch was that the they had to be doing some kind of business in AZ....even part-time was OK (like if they had a booth they ran on the weekends at the flea market). The bulk of the people that are looking for individual insurance are self employed any way so, it worked out well.
Before HIPAA took effect though, different carriers accepted different small pre-ex's but, once HIPAA took effect that all changed....many went out of business or left the state....others started using exclusion riders liberaly. I can honestly say out of about 500 clients I had on the books, only twice did strike out trying to find someone coverage because of their health. My arguement is that HIPAA has driven rates up because of the mandates it placed on insurers....many of the smallers ones that created competition are gone. I'm 48 now, as you know, rates for men start to really go up arounf 45 or so. In 95 I was payong $85/month for excellent PPO coverage. In 2001, I was paying $135 but, after being in business almost 100 years the company chose to close while it was still in the black. Coverage for me now on here on something similar to what I had is over $400/month....my age is a factor but, not that much (it will be from now on though). Look at the rate increase in 6 years and then in the next 8 years.
If someone files bankruptcy here because of medical bills, it's not because they were insured. There are no annual limits here....that's something Florida must do I guess as a compromise to even higher premiums without that....like in NY (look at rates there):
Obama's Speech On Healthcare Tells Me We Should Start Over.
There are many ways to make insurance costs competitive.
One thing I liked about Barack's speech ( if he's not lying ) is that illegal immigrants would not get free ( taxpayer funded ) healthcare.
This must stick sharply in the craw of liberals.
Anyway, how can you trust this guy?
George Bush LIED to got to war. He lied. He committed this country to an ideological war, then lied about its progress, lied about how badly it was being run. He lied about what he could do for THIS country because over 8 years, he did NOTHING on the domestic front but allow it to regress towards the Age of the Neanderthal.
Conservatives couldn't recognize that this village idiot lied then, what in God's name makes anyone think that you can pass judgment on what Obama says?
Edit: This post was in response to Danno 3314 who stated
Quote:
Originally Posted by Danno3314
If someone files bankruptcy here because of medical bills, it's not because they were insured.
If insurance is so affordable, why are people buying HSA qualified plans with $11,600 deductibles? This means they're paying almost $20,000 a year (depending on the monthy premiums) before getting coverage. Again, where I live it's much later, so I'll just quote the facts. Every study shows that most people who filed bankruptcy after a serious illness had medical insurance when they became ill.
[URL="http://www.cnn.com/2009/HEALTH/06/05/bankruptcy.medical.bills/"]Medical bills prompt more than 60 percent of U.S. bankruptcies - CNN.com[/URL]
"Unless you're a Warren Buffett or Bill Gates, you're one illness away from financial ruin in this country," says lead author Steffie Woolhandler, M.D., of the Harvard Medical School, in Cambridge, Mass. "If an illness is long enough and expensive enough, private insurance offers very little protection against medical bankruptcy, and that's the major finding in our study."
[URL]http://voices.washingtonpost.com/health-care-reform/2009/06/new_study_shows_medical_bills.html[/URL]
"Of those who filed for bankruptcy in 2007, nearly 80 percent had health insurance."
The following study is a few years old, but it says the same thing. It's a Harvard study from 2005 that found that most people who claimed bankruptcy due to high medical costs had health insurance.
"Surprisingly, most of those bankrupted by illness had health insurance. More than three-quarters were insured at the start of the bankrupting illness. However, 38 percent had lost coverage at least temporarily by the time they filed for bankruptcy."
Last edited by justNancy; 09-12-2009 at 01:18 AM..
Edit: This post was in response to Danno 3314 who stated
If someone files bankruptcy here because of medical bills, it's not because they were insured.
So why are people buying HSA qualified plans with $11,600 deductibles? This means they're paying almost $20,000 a year (depending on the monthy premiums) before getting coverage. Again, where I live it's much later, so I'll just quote the facts.
"Unless you're a Warren Buffett or Bill Gates, you're one illness away from financial ruin in this country," says lead author Steffie Woolhandler, M.D., of the Harvard Medical School, in Cambridge, Mass. "If an illness is long enough and expensive enough, private insurance offers very little protection against medical bankruptcy, and that's the major finding in our study."
"Of those who filed for bankruptcy in 2007, nearly 80 percent had health insurance."
This is a few years old, but it says the same thing. It's a Harvard study that found that most people who claimed bankruptcy due to high medical costs had health insurance.
"Surprisingly, most of those bankrupted by illness had health insurance. More than three-quarters were insured at the start of the bankrupting illness. However, 38 percent had lost coverage at least temporarily by the time they filed for bankruptcy."
Ok, you're talking about not being able to eventually afford the premiums because they can't work while their ill...so they were insured but, lost it during the illness and have to file for bankruptcy after that.
I thought you were telling me they had bills and had to file bankruptcy because they went over the annual limits like you have in Florida. What I was saying is that doesn't happen here, there are no limits like that (look at the context in which I wrote that....you could have saved yourself a lot of time looking all these links up). If they were ill, after their deductible and co-insurance (if they had one), there bills got paid. Now if they couldn't continue paying their premium while they were ill, that's a different story....technically they didn't have insurance when they incurred those bills....it's not that it was in force and it didn't cover their bills any way so they have to still file for bankruptcy. It's not that they have insurance and had to file, it's that they had it and couldn't keep paying for it while they were sick.
Those policies you have with annual limits though make no sense....they basically don't cover you for a catastrophic illness if it gets too expensive...that's the whole point of having it....so, people are giving that up in lieu of a more affordable premium but, that's a lot to lose and still pay so much for it....that's a rip off but, they don't have any other option.
George Bush LIED to got to war. He lied. He committed this country to an ideological war, then lied about its progress, lied about how badly it was being run. He lied about what he could do for THIS country because over 8 years, he did NOTHING on the domestic front but allow it to regress towards the Age of the Neanderthal.
Conservatives couldn't recognize that this village idiot lied then, what in God's name makes anyone think that you can pass judgment on what Obama says?
So because you claim all these lies of Bush, Obama is incapable of lying?
Got Koolaid?
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What plan?
