A private insurer does something right.

July 9, 2010 at 6:58 PM (Uncategorized) (, , )

Get me a fainting couch, few but loyal readers, because I am stunned, dizzy, and very discombobulated.

(Also I did promise to publicize this, so here goes.)

An old friend advised that their COBRA health insurance had lapsed for no reason.  The company was handling the premiums via automatic debit, and stopped doing so.  Of course the policy lapsed, leaving my friend holding the bag for a possible monthly out of pocket prescription bill of $2700

It is being reinstated.

(It will take 7-10 business days to take effect so he’ll still have to pay 950 this month…but…


Whomever worked with him at the insurer and the insurer’s decision maker in this instant should get a raise and /or eventually supervise.

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Health care reform: If we lose the public option

August 16, 2009 at 8:00 PM (Uncategorized) (, , )

this is what they’ll do

Some of the 47 million will sign up for our current private insurance.

Perhaps insurance companies will no longer be able to exclude them for preexisting conditions. Well and good.

Perhaps this rescission BS will be a thing of the past, too. Well and good.

Perhaps there will be a provision limiting caps on out of pocket expenses.


One specific thing is missing. It’s my understanding that the right and/or Blue Dogs are not doing one blessed thing to regulate….

Premium expense increases over time.

It may start out affordable with both sides claiming victory.

They may not be able to drop you, or not take you due to a preexisting condition….

But they can, and will, certain as politicians lie, price you out of the market as fast as they can.

They can craft a sensible, logical reason to up your premiums once you’re in….and then, it’ll be health care or food, not just for those presently covered by a private plan — but for any of the 47 million who thought, “Well at least I can get some insurance”….and sign up.

In other non health types of insurance, if you see a sudden insanely large increase, and you’ve had no claim history, and no financial changes, sure as heck the company has decided to price a given group or area out of the market.

And, that’s what the private companies will do, if ‘reform’ passes without a public option.

I understand the art of the possible, and even embrace it.

But without the public option

It’s merely an opportunity tfor the private carriers to price people out of the system over time…some will fall, as I have, below the poverty line and thence to Medicare/Medicaid.

But many many many of the present un and under insured will (over time) simply be priced out.

Death Pricing. Brought to you by the USA

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June 18, 2009 at 10:00 AM (Uncategorized) (, , )

Remember that word.

Private insurers withdraw coverage for what they say is failure to disclose ilnesses. (Not just cancer, but acne (!)

You know, the big stuff.

They *say* it combats fraud and abuse.

It’s actually a term that was batted around years and years ago.

“Cost Avoidance.”

If a customer was feeling ill, but had not yet been *diagnosed* and *told* they had condition A

*It’s Not Fraud* you M***** ******G A*****es.

What is the natural reaction of many when we may *feel* something is wrong but we’re not sure yet?  Fear of going to the doctor for what we’ll find out?  Check.  or, denial that anything is wrong until symptoms overwhelm us? Also check.

Both of those reactions may be unwise in the long term, but they happen *every day.*

They *do not* rise to the level of fraud.

Not to mention that many times, when something *is* wrong, it isn’t easily diagnosed in its earlier stages, or missed by a less than competent physician.

It took a *very competent* internist a *year* to diagnose my Hodgkins Lymphoma back in 1991, and by the time it was diagnosed, I was just shy of stage 4, the ‘get your affairs in order’ stage.

The system isn’t just broken.  It is actively inimical to sick people.

This also, *does not* rise to the level of fraud.

Between this, high deductibles, and futile care legislation, insurance really isn’t insurance at all.

And, worse yet, as the heath care, “Not any reform if we can help it,” debate goes on, private insurers say they will continue recission as it has been, not even agreeing to limit it to clear and documented cases of fraud.

Here’s some new numbers for the ultimate cost avoidance: Death, due to no insurance.

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When Insurance Holds People Hostage…

May 10, 2009 at 11:40 AM (Uncategorized) (, , , , , )

What if dating people aren’t ready for marriage, one has good insurance and the other gets gravely ill…they have to consider marrying for that spouse to get help (eventually after the preexisting condition waiting period is over…)

How many people can’t do what they’re good at, but stay at a job that isn’t a good fit because that’s where the benefits come through?

What would happen if we had our own insurance and could work at something we were good at?

And single payor isn’t exempt from ‘hostage taking’ much as I support it.

Couples have had to divorce, so that one spouse’s income didn’t prevent the other from getting life saving hospital care under Medicaid.

(A close family member had to go through this, and chose not to divorce, thus leaving a huge debt behind…)

Potential or present illness should not hold people hostage…

But it does

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Oh, brother….

May 5, 2009 at 11:31 AM (Uncategorized) (, , , , )

From the NYT:

Well we knew HMO’s/PPO’s would continue the minute the private health insurers voices were invited as stakeholders into the health care debate.

The so-called public option still exists.  But it’s fairly toothless.  Senator Schumer’s compromise points (presumably to satisfy private insurers that they could still rake in $$$ and ‘compete.”)

The public plan must be self-sustaining. It should pay claims with money raised from premiums and co-payments. It should not receive tax revenue or appropriations from the government.

The public plan should pay doctors and hospitals more than what Medicare pays. Medicare rates, set by law and regulation, are often lower than what private insurers pay.

The government should not compel doctors and hospitals to participate in a public plan just because they participate in Medicare.

To prevent the government from serving as both “player and umpire,” the officials who manage a public plan should be different from those who regulate the insurance market.

The plan should also establish a reserve fund.

Not, Quite, Right.

If we *must* continue with private insurers as part of the plan let’s requote the text and shift it a bit shall we? And FYI I used to work in the Illlness Exploitation Industry, so I know a bit whereof I speak.

The public plan must be goverment funded for at least a percentage, the percentage to be determined in committee and be no less than 30 and no more than 50 percent with option to revise that downward should expenses be met. It should pay most of its claims with money raised from premiums and co-payments.

The public plan’s rates and Medicare’s rates should match, and Medicare’s rates should be increased to be more in line with present private insurance rates. Specifically, take the highest private reimbursement for a covered benefit and the lowest private reimbursement in a given area and *split the difference* !.

The government should compel doctors and hospitals to participate in a public plan. However, doctors can limit the *number* of appointments per week they take from recipients, should they choose to and hospitals can also decide not to take it for anything elective. (I don’t like to cut, but they will expect some, so…)

To prevent the government from serving as both “player and umpire,” the officials who manage a public plan should be former administrators of county hospitals, and other public health entities, not business people who think insurance companies are their own personal bank accounts, and yes these would be different from those who regulate the insurance market.

The plan should also establish a reserve fund. (I’m OK with that)

Private insurers, this public option, Medicare and Medicaid should also establish incentives to care for patients in the home rather than institutionally.

It’s *cheaper!* (Union leaders of groups of nursing home employees and the nursing home lobby, I’m talking to you! Get out of the *** **** way!)

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