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.....I have Blue Cross.
No problem, I just won't ever get sick. What's the big deal?
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by KingOneEye on Wed Mar 29, 2006 at 05:38:04 PM PDT
seems that they are going after people with individual policies.
If you have a group policy, you have certain HIPPA protections.
Tell your healthcare and insurance horror stories at Guaranteed Healthcare
by nyceve on Wed Mar 29, 2006 at 05:40:28 PM PDT
[ Parent ]
for the diary. Important topic. Recommended
by dc 20005 on Wed Mar 29, 2006 at 05:42:14 PM PDT
I applied for an Individual Blue Cross policy -- just as a three month stop-gap until my group policy kicked in.
The insurance agent warned me not to list any ongoing prescriptions -- but stubborn and stupid me, I thought they'd be suspicious if I didn't list my (fairly inexpensive) prescriptions.
Sure nuff, although I was otherwise healthy, Blue Cross denied my application, and I've since heard they routinely turn down anyone with an ongoing prescription of any kind.
And don't get me started about the health insurance problems I've had over this last decade, including a fraudulent policy...
And the $630 a month group policy i've got now, that doesn't cover the weekly acupuncture, which is the only procedure that's brought me back to functioning, and the Chinese herbs that have also brought back my health.
So, I'm paying nearly $8,000 a year, in case I get hit by a bus. At which point, they'd probably cancel my policy.
My neighbors on disability get better health care from Medicaid.
by judybrowni on Wed Mar 29, 2006 at 11:18:33 PM PDT
through the NWU?
Try Mariva's Guide. You'll like it!
by mariva on Thu Mar 30, 2006 at 12:23:13 AM PDT
The just jacked it up and sent me a letter saying "due to rising costs, we will need to raise your premuims. Also, here are the services we will no longer cover."
In other words, less service, more expensive.
This doesn't surprise me.
Actually, when I tore my Achilles in 2004 they weren't too bad (although they wouldn't cover the diagnostic MRI at ALL). But when I got some routine blood work last year they wouldn't pay for the doctor visit because I didn't go to their approved "wellness center." Which they never told me about, of course, and there isn't one all that close to where I live, either.
D-Day, the newest blog on the internet (at the moment of its launch)
by dday on Wed Mar 29, 2006 at 05:54:30 PM PDT
I have blue cross and it's a group rate through FedEx. I recieved the same letter stating that they would raise my rates. They even had the courtesy to send out a survey with it to see what I thought, as if they gave a shit.
by jammin90mph on Wed Mar 29, 2006 at 06:22:34 PM PDT
and I am a provider. I get those due to rising costs your rate is going up letters, yet as a provider I have never gotten an increase in my rate or what they agree to pay me for service.
I also attempted to pay for one year, but they will not allow me. "You can only pay for 3 months at a time."
Yes, it makes me nervous that I could be left out in the cold at any time.
Insurance mafia
by hiddengnostic on Wed Mar 29, 2006 at 06:31:19 PM PDT
should band together and form a lobbying group for things like national single payer health care. Honestly, if small businesses are supposed to be the backbone of the American economy, I don't understand why we don't have more power than we do -- or why we don't exercise it.
by mariva on Thu Mar 30, 2006 at 12:27:53 AM PDT
this is the term we should use --national health CARE, not national health INSURANCE
by annetteboardman on Thu Mar 30, 2006 at 06:21:08 AM PDT
Unfortunately, most organizations of small business owners in America are fund raising arms of the Republican National Committee. Chamber of Commerce, National Federation of Independent Businesses, these groups all raise money to elect representatives who are morally opposed to "SOCIALIZED MEDICINE!!!"
Let's go back to E Pluribus Unum
by hazzcon on Thu Mar 30, 2006 at 06:39:03 AM PDT
like Small Business for America (founded by an acquaintance I met through the 2003-04 Dean campaign).
But overall, you're correct. I don't know that this has to be true, though. I'd love to see more liberal/progressive small business owners, and I'd love to see them (us) get organized in a big way.
by mariva on Thu Mar 30, 2006 at 12:25:50 PM PDT
You are correct, there ARE groups out there for folks like us. Interestingly, we just received a phone call and fax inviting us to attend dinner with dear leader in DC as part of his "Business Advisory Council" (My guess is $1000 a plate minimum) -I'd like to go and give the Buffoon in Chief a little bit of MY "Business Advice". It would consist of 3 words, the last of which being "yourself". Thanks for the link, btw. ;]
by hazzcon on Thu Apr 13, 2006 at 09:59:47 AM PDT
then terminate you if you file a claim.
This is serious stuff, dear Kossacks.
by nyceve on Wed Mar 29, 2006 at 07:50:38 PM PDT
they would put people who previously filed claims and high risk people in a "certain" group. Then as their contract says "they can cancel all people within certain groups" - and they did.
It was probably a way to sidestep cancellations of individuals and avoid lawsuits. If my memory serves me they had to discontinue that practice, though I could be wrong on that.
In either case it is 'business as usual' for Blue Cross.
"You Have The Power!" - Howard Dean
by talex on Wed Mar 29, 2006 at 08:19:56 PM PDT
I'd love to give them the old heave-ho, but since I've had a kind of major surgery within two years (torn Achilles), I doubt any other provider would be willing to admit me.
And there, my friends, is the great catch-22 of insurance, which this story only seeks to cement. They only want you if you're healthy.
by dday on Wed Mar 29, 2006 at 08:21:48 PM PDT
you feel you must be grateful, drop to bended knees and thank the insurance carrier, for paying 20 cents on the dollar on a fucking claim.
by nyceve on Wed Mar 29, 2006 at 08:36:01 PM PDT
by mariva on Thu Mar 30, 2006 at 12:30:42 AM PDT
if you don't need one (i.e., if you have collateral).
by mariva on Thu Mar 30, 2006 at 12:29:54 AM PDT
and luckily was able to switch to a group policy through the NWU (which the organization later lost), and then through the Media Alliance (which the organization later lost).
Luckily, after that, I was able to get an individual policy with a high deductible and HSA plan. I'm very thankful, but I always worry that just one medical problem, even a relatively minor one, could change everything.
by mariva on Thu Mar 30, 2006 at 12:25:48 AM PDT
Everyone has HIPAA protections whether it is part of a group policy or an individual policy, protections which mostly go toward portability and security and common procedure codes, not protection from being ripped off by an insurance company, per se.
Also, don't worry too much. Blue Cross and Blue Shield plans are not a single company. They are many companies all working under an association. Blue Cross of California is not the same company as Blue Shield of California, and Empire Blue Cross and Blue Shield of New York is an entirely different company, etc. You can see a list of all the different Blue companies, most totally separate entities, at http://www.bcbsa.com/.... If you have Blue Cross of California, you may want to be concerned, maybe, I guess, if the reports are right. Otherwise, don't fret it. Most Blue plans are independent and function independently.
by Brian Bell on Wed Mar 29, 2006 at 06:49:04 PM PDT
Wellpoint owns many BCBS companies (including Blue Cross of California and Empire and Anthem). Their actuaries, which are some of the best in the country, could determine the rates for these companies, and which people they accept and reject based on their models. Just a thought or possible theory.
No complacency. Donate. Contribute. Volunteer.
by jim bow on Wed Mar 29, 2006 at 07:45:30 PM PDT
Alright, a bad example, although Blue Shield of California and Empire are two completely separate companies, even though Blue Cross of California and Empire are Wellpoint companies. And, despite being owned by the same parent company, Blue Cross of California and Empire are run as two entirely separate companies with their own actuarial departments and divisions and executives and staff and policies. Really, they act as separate entities. As I said, most Blue plans are independent and function independently. So, if you have Blue Cross Blue Shield of Illinois, or Mass., or Mich., or N.J. Horizons, etc., etc., you really don't have to worry about what Blue Cross of California is doing.
by Brian Bell on Wed Mar 29, 2006 at 10:37:37 PM PDT
I agree with 100 percent of what you just wrote. Most of the Blues run independently. If you have BCBSIL, you shouldn't have to worry about what Blue Cross of California is doing.
by jim bow on Thu Mar 30, 2006 at 05:47:41 AM PDT
I was terminated on an individual policy in NYS. I then formed a partnership and I was told that as a group of two, we have certain HIPAA protections that individual policies don't have.
As far as I was able to ascertain,I was not terminated for filing a claim, this carrier terminated all individual policies.
But I suspect what is happening with BC in California is what we can all expect to see going forward.
by nyceve on Wed Mar 29, 2006 at 07:53:53 PM PDT
Once your coverage is through, or so long as they properly returned your premiums, and so long as there was no guarantee of a time period of coverage that they violated, an insurer can ditch a plan whenever they want. Microsoft doesn't sell Windows 3.1 anymore. Some insurers decide not to sell individual policies. Although local insurance regulations may have something to do with this, HIPAA has nothing to do with it, except that if you find another individual plan within 60-odd days, you should be covered if you're willing to pay.
But, no, your individual plan has the same HIPAA guarantees as an individual plan.
by Brian Bell on Wed Mar 29, 2006 at 10:27:42 PM PDT
Insurers in WA state were barred from dropping individual policies. I don't know if this only covers those in the state, like Regence BlueShield, or any who offer policies here.
Anyhow, there was much hand-wringing when the measure went through, since everybody thought that insurance companies would run for the exits. There may be a few less options, but there are certainly multiple companies to choose from.
Insurance companies are subject to the (quite variable) strictures of each state. If you don't like what they're doing to you, get your Insurance Commissioner and Attorney General on the case, and give your local law-makers an earful.
What would Gandhi do? "The cause of liberty becomes a mockery if the price to be paid is the wholesale destruction of those who are to enjoy liberty."
by Robespierrette on Thu Mar 30, 2006 at 12:11:35 AM PDT
HIPAA for individual insurance only applies to the privacy part of the act. For portability, you have to be part of a worker-based group health insurance. You cannot change from one individual insurance company to another and expect to have portability (coverage for pre-existing conditions). Note also that portability is group insurance for employee-based group insurance - so student health insurance is not considered group insurance for portability reasons. In other words, if you are a student with student insurance and get a illness (such as diabetes) while a student, your new employer's insurance doesn't have to ever cover your diabetes because you are not coming from an employer-based group insurance.
I went around and around with the main people at HIPAA about this. --------------------------------------
by HairOnFire on Wed Mar 29, 2006 at 08:18:07 PM PDT
Also, i read another comment downthread that NYS is one of the strictest in the nation regarding health insurance scams.
NYS is a community rated state as well, which means I believe, that if you have had continual coverage, the carrier cannot underwrite you or deny you insurance.
Underwriting in insurancese, is requiring you to answer questions on an application about your health.
That said, it's unbelievably expensive, and unless you have group coverage, I gather they can cancel entire populations of people.
I had individual coverage and my carrier decided to cancel all the individual policies.
by nyceve on Wed Mar 29, 2006 at 09:24:05 PM PDT
many states have laws that bolster HIPAA protections. I believe states like NY, NJ, VT, ME, MA...
But many states don't believe in regulating insurance and have little to none other laws regarding health insurance, where you are really screwed, and I hate to say but - red states for the most part.
Being in NY, you are somewhat lucky compared to living in many other states. ------------------------------------
by HairOnFire on Thu Mar 30, 2006 at 03:56:15 AM PDT
You're thinking portability means something it doesn't.
You can change from one to another individual plan or from an individual to a group plan with a pre-existing medical condition so long as there's not a gap of more than about 60 days between coverage. Also, companies can make you wait something like an additional 6 months exclusion prior to enrolling you if you had medical treatment for your pre-existing medical condition within the last 6 months of your previous coverage.
If you're a member (such as a student on a parent's plan) and not a subscriber (the person who is actually given the insurance, such as a parent of a student) on someone else's plan (the parent's plan) and you just want to switch to a company's plan, yeah, you're going to have a problem, because you never actually had insurance. Your parent did. It was someone else's policy, not your policy.
The best thing you can do in that kind of circumstance is when leaving a parent's plan is to get some kind of Cobra or find an individual plan that doesn't worry about pre-existing conditions. Once you're on that plan, after something like 48 months, you can then use that record of having been insured for your portability, so long as there's not been a lapse in coverage of more 60 days.
As you can see, portability isn't all it's cracked up to be.
by Brian Bell on Wed Mar 29, 2006 at 10:21:16 PM PDT
Having no gap doesn't matter when switching from individual plans to individual plans. If you have an individual plan and go to a group plan or an individual plan, the new plan does not have to cover you. Now the new plan may cover your pre-existing condition out of the goodness of their heart or because they don't realize they don't have to when looking at your situation but they don't have to.
Read the HIPAA literature. It talks specifically about worker-based group insurance when it comes to pre-existing condition portability.
My example, had nothing to do with parents, it was a student who was no longer covered by their parents who purchases university health plan on their own.
Here is the direct quote the HIPAA person gave me:
Unfortunately, the answer to your question is no. Because the university plan plan is not a "group health plan," and because your immediately receding coverage was not through a group health plan, the federal HPAA law does not afford you any protections against preexisting condition exclusions
by HairOnFire on Thu Mar 30, 2006 at 03:50:32 AM PDT
Brian, while you are absolutely right that the individual state Blue Crosses are corporately independent, I have anecdotal evidence that this is more of a systemic issue.
In 2002, my parents were part of a small group plan of retired ministers with Blue Cross/Blue Shield of Georgia. After a year in which both my parents had cardiac catheterizations and one had subsequent heart surgery, Blue Cross informed the whole group that it would not be renewing the policy. As you can imagine, there aren't a lot of other insurance options for people with histories of heart disease in their early 60s. After repeated letters to the insurance commissioner in Georgia (John Oxendine (R) - apparently too busy running around Atlanta with state-provided police lights for non-emergent events, but that's another story), Blue Cross agreed to continue coverage -- at a premium of $1700/month for my parents! They scraped for several years to pay the premium until their Medicare eligibility kicked in.
by bobnchitown on Thu Mar 30, 2006 at 05:24:58 AM PDT
BCBS insurance because I had a tiny sun damage spot removed. It wasn't even cancer!
Blood 4 Oil War 2
by TXsharon on Wed Mar 29, 2006 at 07:00:10 PM PDT
In texas? Was it an individual policy?
by nyceve on Wed Mar 29, 2006 at 07:54:45 PM PDT
by TXsharon on Thu Mar 30, 2006 at 03:51:48 AM PDT
I am a provider. I filed a claim for a patient, first time claim. They sent me back a request for extra documentation. This is the first time I have ever had such a request 100s of patients, and for a very minor diagnosis. It was for an individual plan.
In general, though, as insurers go (and that's not saying a lot), at least for mental health group coverage, I have found Blue Cross to be better than most. However, their organizational functioning has begun to deteriorate. They do not, in general, micromanage their clients' treatment, as some insurers do. They try and pay their providers a just fee (although the insurance industry -- and Medicare! -- pay much less than the community going rate).
I am not surprised by anything the insurance industry does. It is sad to me how many people naively believe in their insurance coverage, only to find out that their deductible is skyhigh, or the sessions very limited, or doctors unavailable in their area, etc. etc.
Insurance companies operate out of one of the lower circles of hell.
War is the statesman's game, the priest's delight, The lawyer's jest, the hired assassin's trade Invictus
by Valtin on Wed Mar 29, 2006 at 07:36:54 PM PDT
TINY niggling typo: you wrote "systematic" when you meant "systemic."
That is all, carry on, you rock my world, recommended, natch.
-9.63, -7.03 Rage, rage against the Lying of the Right
by Maryscott OConnor on Wed Mar 29, 2006 at 07:55:17 PM PDT
I'm going to attempt to fix it. Wish me luck.
by nyceve on Wed Mar 29, 2006 at 08:23:45 PM PDT
by nyceve on Wed Mar 29, 2006 at 08:32:42 PM PDT
The folks at Calitics would REALLY appreciate it, as would I over at MLW...
by Maryscott OConnor on Wed Mar 29, 2006 at 08:44:27 PM PDT
Thanks for asking.
by nyceve on Wed Mar 29, 2006 at 10:20:24 PM PDT
cigarette out. It's unhealthy :)
by talex on Wed Mar 29, 2006 at 08:27:20 PM PDT
goes into the enemies pockets: GOP.
Every dollar a for-profit insurance company spends on your care, is a dollar that goes against the coroporate balance sheet. --nyceve
by letsfight on Wed Mar 29, 2006 at 09:07:25 PM PDT
by talex on Wed Mar 29, 2006 at 09:47:51 PM PDT
It's the health information portability and accountability act... has to do w/ your privacy and your rights to your medical records.
However, I'd listen to the ring of fire show I linked to below - they talk about some bad things insurance plans have done to people who have coverage through their jobs.
I linked below but here it is again. http://www.ringoffireradio.com/...
Check out my new blog at La Vida Locavore!
by OrangeClouds115 on Wed Mar 29, 2006 at 07:59:09 PM PDT
when I got sick because it was through my union.
The Graduate Teaching Fellows Federation dropped me from their union rolls when I was too sick to continue graduate school. Then, the insurance I got through them was cancelled because I wasn't a member of the union. And I didn't have any protections such as COBRA, because it wasn't through my employer.
The union was extremely unsympathetic. It seems that this happened quite a bit. I support unions in general, but I have nothing but hatred for that one in particular. It's one thing to get screwed by your employer in a time of crisis, but to get screwed by your UNION is unforgivable.
I imagine that the insurance companies love to issue coverage in situations where they know they can cancel on people who get sick. Take the payments, but not the responsibility.
congratulations on your foreskin -- osteriser
by bartman on Wed Mar 29, 2006 at 08:37:31 PM PDT
while in graduate school. Her policy covered the first $50,000 of treatment and chemo -- and then she was dropped.
She's had to burn through her life-savings of $40,000 for chemo, and now has no insurance whatsoever. With odds on a reoccurence in three or so years.
She also is a single mother with a 7-year old daughter, who would like to start a career, if she lives, once she gets her PHD.
However, if the cancer reoccurs, she'll have to go on disability, with a $9,000 max of year of earnings, in order to keep Medicaid.
by judybrowni on Wed Mar 29, 2006 at 11:25:22 PM PDT
-8.38, -7.74 lern gud werds and feed the hungry!!!
by condoleaser on Thu Mar 30, 2006 at 04:36:55 AM PDT
wide narrow
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