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View Diary: Another Health Insurer Caught Falsely Cancelling Thousands of Health Plans (161 comments)

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  •  Ok but then you seem to remain as (1+ / 0-)
    Recommended by:
    Notreadytobenice

    confused as I about what is specifically being litigated. I don't say that harshly! I just think it is important to keep asking that question until it is answered.

    The man who moves a mountain begins by moving away small stones. -Confucius

    by Malachite on Sun Nov 10, 2013 at 03:45:12 PM PST

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    •  It's not so hard to understand. (4+ / 0-)
      Recommended by:
      Malachite, worldlotus, Vyan, Joe Bob

      Policies issued before 3/23/2010 were classified as exempt from the provisions of the ACA.   If the ACA did require invalidation of business done before it was passed, that part of the law would have been challenged in the states or declared unconstitutional by SCOTUS.  Business that was legal when it was done couldn't be made illegal by the
      ACA.

      Since it's customary to renew policies each year, the ACA requires insurers to refer to the original in-force date on policies eligible for exemption. If policies were changed in specific ways, they'd lose their exempt status:

      • coverage for a particular condition or illness was eliminated,
      • an annual dollar limit on benefits was imposed or an existing limit was reduced,
      • a coinsurance percentage was increased,
      • a dollar co-payment was increased by more than 15 percent,
      • deductibles or out-of-pocket maximums were increased by more than 15 percent.

      The type of coverage doesn't matter. Opinions on its quality don't matter. All that counts is whether the carrier followed the law. Did it identify the exempt policies correctly or did it state in a notification to consumers that policy exemption status was left up to insurers to decide?

      The policies are diverse. The law left it to consumers to decide to keep their old policies for whatever reason as the default because any of them could exercise free choice to cancel, shop, or discontinue coverage as they wished.  If a carrier acted in any way to deny them their choice or to choose for them it could be a legal matter.

      There is no existence without doubt.

      by Mark Lippman on Sun Nov 10, 2013 at 06:18:43 PM PST

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      •  But if a carrier decides to eliminate a policy (0+ / 0-)

        offering when the new year arrives, does that in and of itself constitute a denial of choice to the consumer? In the back of my mind I wonder what the specific meaning of the "in-force" date is and its significance to this.

        Actually, let me just ask this: Are the insurance companies obligated in any way to continue offering the same policy indefinitely, so long as the consumer continues to do nothing (and therefore by default choose to keep his old plan in place)? That seems weird to me but perhaps that is the crux of my confusion.

        Forgive me for being so dense.

        The man who moves a mountain begins by moving away small stones. -Confucius

        by Malachite on Sun Nov 10, 2013 at 07:21:39 PM PST

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        •  No plan continues indefinitely (5+ / 0-)

          I'm not an expert but I do work in insurance.  Most plans last -- by contractual obligation -- for a year or longer.  Then the contract ends, and has to be renewed.  At that point, an insurer can decide not to offer a plan -- but not before the contract ends.  Some plans that started a year or two ago could be "grandfathered" -- given another year or two to continue despite the 2014 deadline of ACA.  

          I think what the insurers in question did wrong was not inform their customers of this wrinkle, and then they switched their customers into another plan prematurely.  Maybe they have the legal right to do it-- that's not clear and will be sorted out by the lawsuit, or by the regulating agencies (Department of Insurance, Department of Managed Health Care).  

          Bottom line is:  Insurers CANNOT do whatever they want. The industry is highly regulated. If they break the rules, or use deceptive practices, they have to pay a fine or suffer some consequence -- including possibly losing their license to sell insurance.

          The civil rights, gay rights and women's movements, designed to allow others to reach for power previously grasped only by white men, have made a real difference, and the outlines of 21st century America have emerged. -- Paul West of LA Times

          by LiberalLady on Sun Nov 10, 2013 at 08:07:30 PM PST

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        •  A carrier can completely withdraw from Health as (2+ / 0-)
          Recommended by:
          worldlotus, maybeeso in michigan

          a line of business in a state and pursue only other types of insurance.  It can discontinue entire elements of care as well. But when you get down to the individual policy level, it's important to remember recent history.

          How a carrier conducts business is regulated by the state insurance commissioners. Insurers have to file premium rate changes and very detailed reports about their business. It's all available to the public online. Changes in business that affect consumers are normally on file with the commissioner.  

          Here's an example:

          Blue Shield of California is rescinding 115,000 cancellation letters it sent in October  

          This is just a hint of the cluster that wasn't created by anything but the insurance companies.

          There is no existence without doubt.

          by Mark Lippman on Sun Nov 10, 2013 at 09:05:13 PM PST

          [ Parent ]

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