Should medical insurance companies have the right...

[extrabill]

to deny coverage to people with pre-existing conditions?

[R Acree]

Hangnail or terminal cancer?

[RCjohn]

Yes in some circumstances.

[extrabill]

Yes in some circumstances.

What circumstances?

[RCjohn]

If you voluntarily gave up your last insurance coverage for one.

[DougK]

I voted no, but there are attachments to that vote of no. This is an area where I think the government should step in and provide an option given certain parameters are met. Pre-existing conditions that are proven to be a large expense over the term of the coverage should naturally have a higher premium. But, if all insurance companies are mandated to provide that coverage the market should keep the increases to the individual to a reasonable rate. For those that cannot afford the higher rate, I would be in favor of government subsidies to bridge that gap.

[extrabill]

If you voluntarily gave up your last insurance coverage for one.

So if you lost your job and could not afford to pay $500/mo for Cobra, then was diagnosed with cancer, you should forever be denied coverage?

[RCjohn]

So if you lost your job and could not afford to pay $500/mo for Cobra, then was diagnosed with cancer, you should forever be denied coverage?

Does that sound voluntarily to you?

Not to mention, that's not pre-existing.

[RCjohn]

I voted no, but there are attachments to that vote of no. This is an area where I think the government should step in and provide an option given certain parameters are met. Pre-existing conditions that are proven to be a large expense over the term of the coverage should naturally have a higher premium. But, if all insurance companies are mandated to provide that coverage the market should keep the increases to the individual to a reasonable rate. For those that cannot afford the higher rate, I would be in favor of government subsidies to bridge that gap.

That's basically the way I see it too. I don't have a problem with the government "stepping in" in some circumstances.

[extrabill]

Does that sound voluntarily to you?

Not to mention, that's not pre-existing.

Preexisting mean any medical condition you have or have had when you apply for new insurance.

[Czolgosz]

I voted yes. Screw people. All of 'em.

[Mongo]

Yes they should have the right, it's their company, why would they take ona client who will guaranteed cost more than they pay?

[RCjohn]

Preexisting mean any medical condition you have or have had when you apply for new insurance.

I assumed you meant you were diagnosed after you obtained new insurance.

But either way, see my response to Doug's idea.

It's not fair to just say an insurance company has to take on a case that they will never get any return on. Hell 10 people with over a million dollars each in bills would be a pretty big chunk of change for a company to have to take on involuntarily when they will not make anything back.

The insurance company would have to lay off an aweful lot of voters to cover that. :D

[panthercity]

Yes they should have the right, it's their company, why would they take ona client who will guaranteed cost more than they pay?

Yep.

As long as health insurance is a for-profit gig, where the administrators are answerable to their shareholders or investors, they have not only the right, but also the fiduciary obligation to do every legal thing within their power to maximize the profits of the company.

[extrabill]

I assumed you meant you were diagnosed after you obtained new insurance.

But either way, see my response to Doug's idea.

It's not fair to just say an insurance company has to take on a case that they will never get any return on. Hell 10 people with over a million dollars each in bills would be a pretty big chunk of change for a company to have to take on involuntarily when they will not make anything back.

The insurance company would have to lay off an aweful lot of voters to cover that. :D

The insurance companies have already agreed to cover people with preexisting conditions if all people, healthy or not, are required to buy insurance.

[steelcityracer]

I am not sure I have an answer, or an opinion, but I do have a question. How do health insurance companies make a profit?


I pay slightly over $100 a month for coverage, and have had a few surgeries, and the bills for them totaled around $200,000. Even if I live to be 100, my payments will still probably not cover that. I know that not everyone has to get surgery, but even a simple ER visit for stitches could wipe out two or three years worth of payments.

[RCjohn]

The insurance companies have already agreed to cover people with preexisting conditions if all people, healthy or not, are required to buy insurance.

Where did they agree to that and what are the stipulations?

[TSWebster]

Why just pre-existing conditions. Why can't any factor that increases the likelihood of medical costs be used to deny coverage? Overweight, smoking, drinking alcohol, high risk activity (motorcycle riding) etc. Once you crack the door, it's only a matter of time until it's wide open.

[RCjohn]

I am not sure I have an answer, or an opinion, but I do have a question. How do health insurance companies make a profit?


I pay slightly over $100 a month for coverage, and have had a few surgeries, and the bills for them totaled around $200,000. Even if I live to be 100, my payments will still probably not cover that. I know that not everyone has to get surgery, but even a simple ER visit for stitches could wipe out two or three years worth of payments.

The 19 year old stunter that planted his Gixxer Thou into the grill of the Mack truck didn't cost the insurance company much but his parents have paid premiums for him for 19 years.

[panthercity]

Why just pre-existing conditions. Why can't any factor that increases the likelihood of medical costs be used to deny coverage? Overweight, smoking, drinking alcohol, high risk activity (motorcycle riding) etc. Once you crack the door, it's only a matter of time until it's wide open.Some ins companies already do some or all of those things. You know anything about the Insurance Portably Act and its affect on motorcyclists (as well as practitioners of other "dangerous pursuits")?

[klebs01]

I am not sure I have an answer, or an opinion, but I do have a question. How do health insurance companies make a profit?


I pay slightly over $100 a month for coverage, and have had a few surgeries, and the bills for them totaled around $200,000. Even if I live to be 100, my payments will still probably not cover that. I know that not everyone has to get surgery, but even a simple ER visit for stitches could wipe out two or three years worth of payments.

Investment income. Insurance companies are basically investment banks that have insurance subscribers instead of normal investment clients. Very little if anything is made from the insurance end of things. Its mostly made on investing the cash that is paid by the subscribers before an event happens the required the cash to be used.

[Czolgosz]

Why is it that health insurance companies don't raise rates of people who make claims (or do they)?

Seems to me if you make a claim against your auto insurance to fix a $500 broken window and you pay the $250 deductible your rate will likely go up (in theory-I don't make such claims).

So if a person is making claims against health insurance for a $100 dr. visit (has the sniffles and wants antibiotic-basically) why do the health insurance companies not raise the rate of the person in question?

I believe part of the lame cost is that people use health insurance for everything instead of having insurance for real emergencies where the bill would be unaffordable.

[H8R]

Yep.

As long as health insurance is a for-profit gig, where the administrators are answerable to their shareholders or investors, they have not only the right, but also the fiduciary obligation to do every legal thing within their power to maximize the profits of the company.

Agreed.

That is why I also support NHC.

[RCjohn]

Why is it that health insurance companies don't raise rates of people who make claims (or do they)?

Seems to me if you make a claim against your auto insurance to fix a $500 broken window and you pay the $250 deductible your rate will likely go up (in theory-I don't make such claims).

So if a person is making claims against health insurance for a $100 dr. visit (has the sniffles and wants antibiotic-basically) why do the health insurance companies not raise the rate of the person in question?

I believe part of the lame cost is that people use health insurance for everything instead of having insurance for real emergencies where the bill would be unaffordable.

I believe they do raise the rates according to the claims made but I believe it's done as a group and not an individual. Similar(but different :D) to the way Workers Comp is done.

[RCjohn]

Agreed.

That is why I also support NHC.

Do you support NHC before something is done to control costs.

This NHC crap being spouted now is putting the cart before the horse.

[Jed]

With group insurance pre-ex doesn't tend to come into play (for groups over 50 or so people.) Group insurance is a locked in predictable revenue stream for the company. Based on claims history, demographics, etc. the underwriters can predict the annual expense incurred by the group and plan the premiums accordingly to ensure a profit. Most of the time they win, sometimes they loose.

Individual policies are subject to pre-ex and generally that can be up to two years. I was pre-exed out of an individual plan for a sleep apnea diagnosis. Already seen the doc, started treatment, and have a better life expectancy now. But the insurer refused to cover me for two years regardless. Another insurer would cover me but not the apnea for two years.

Personally I think pre-ex ought to be limited as it does impact overall health of the country. People with life threatening conditions don't get picked up by insurance companies although maintenance meds may indeed keep them healthy. No insurance means they end up going to the ERs for care. That can add up to a lot more than maintenance treatment in the long run, and the taxpayers end up with the bill.

My solution? Have a gov or state funded plan to help defray the costs of pre-existing conditions but don't allow insurance companies to deny coverage based on preex. Have the scale slide so the gov pays the majority for the first 90 days and then it tapers to be 100% participant/carrier responsibility after two years. This doesn't mean the gov covers all your health care, just a portion of treatment towards cancer, diabetes, pregnancy, etc. that might keep you from otherwise being insured.

Just my 2 cents fwiw.

[panthercity]

...Insurance companies are basically investment banks that have insurance subscribers instead of normal investment clients. Very little if anything is made from the insurance end of things. Its mostly made on investing the cash that is paid by the subscribers before an event happens the required the cash to be used.

Which is nowhere near their original incarnation. Originally "risk pools" were set up to share the cost of risks in a community. Everyone tossed in a little then if neighbors had a catastrophe, the "risk pool" could help them out.

Of course, that was too utopian/liberal/socialist/Obamist/communist/Christian to last for long after entrepreneurs realized they could make money for themselves by "managing" those "risk pools."

[tzrider]

Yes they should have the right, it's their company, why would they take ona client who will guaranteed cost more than they pay?

So rationing in the name of capitalism is ok. Rationing by socialism is evil Nazism...

Heil Blue Cross!

:D

[RCjohn]

My solution? Have a gov or state funded plan to help defray the costs of pre-existing conditions but don't allow insurance companies to deny coverage based on preex. Have the scale slide so the gov pays the majority for the first 90 days and then it tapers to be 100% participant/carrier responsibility after two years. This doesn't mean the gov covers all your health care, just a portion of treatment towards cancer, diabetes, pregnancy, etc. that might keep you from otherwise being insured.

Just my 2 cents fwiw.

That's a workable idea once the jacked up costs are reeled in a bit with tort reform and malpractice caps. :up:

[Mongo]

I am not sure I have an answer, or an opinion, but I do have a question. How do health insurance companies make a profit?


I pay slightly over $100 a month for coverage, and have had a few surgeries, and the bills for them totaled around $200,000. Even if I live to be 100, my payments will still probably not cover that. I know that not everyone has to get surgery, but even a simple ER visit for stitches could wipe out two or three years worth of payments.

That's easy - they make money off of me who pays more than that per month and I honestly can't remember the last time I saw a doctor for anything - possibly the flu 2 years ago, before that a sprained ankle in the 90's.

[Mongo]

So rationing in the name of capitalism is ok. Rationing by socialism is evil Nazism...

Heil Blue Cross!

:D

Try actually spelling that out. Nothing is being rationed, a person with a pre existing condition can get insurance - the difference is they have to pay more. Makes sense to me. Just like bad drivers pay more for their insurance and fat people pay out more per year for food. You pay for what you actually use.

Hell for me I never go to the doc so the new system would probably benefit me personally - I still think it's a horrid idea.

[In Your Corner]

The insurance companies have already agreed to cover people with preexisting conditions if all people, healthy or not, are required to buy insurance.

And why wouldn't they, they'll be getting millions of new clients who choose not to insure themselves because they are young and healthy. Those people will increase profits because the majority won't collect on the policy. Insurance companies are already required to cover pre-existing conditions if you were covered by another policy when the condition was diagnosed.
Without the previous coverage caveat, everyone would be able to go without insurance until they actually get sick, then just join a plan and have their major medical expenses paid without ever having been a member of the risk-sharing pool, which is the basis for insurance coverage of any kind.

[Rob94]

And why wouldn't they, they'll be getting millions of new clients who choose not to insure themselves because they are young and healthy. Those people will increase profits because the majority won't collect on the policy. Insurance companies are already required to cover pre-existing conditions if you were covered by another policy when the condition was diagnosed.Without the previous coverage caveat, everyone would be able to go without insurance until they actually get sick, then just join a plan and have their major medical expenses paid without ever having been a member of the risk-sharing pool, which is the basis for insurance coverage of any kind.


I wasn't aware of that law. I am currently fighting this with my wifes policy, she changed jobs, and now we have to pick up private insurance which is turning into a costly nightmare because she has a pre existing condition. I am not sure which route to take to fix health care in this country, but I sure as hell know it's severly broken!

[RCjohn]

And why wouldn't they, they'll be getting millions of new clients who choose not to insure themselves because they are young and healthy. Those people will increase profits because the majority won't collect on the policy. Insurance companies are already required to cover pre-existing conditions if you were covered by another policy when the condition was diagnosed.
Without the previous coverage caveat, everyone would be able to go without insurance until they actually get sick, then just join a plan and have their major medical expenses paid without ever having been a member of the risk-sharing pool, which is the basis for insurance coverage of any kind.

Interesting points to ponder. :up:

[RCjohn]

I wasn't aware of that law. I am currently fighting this with my wifes policy, she changed jobs, and now we have to pick up private insurance which is turning into a costly nightmare because she has a pre existing condition. I am not sure which route to take to fix health care in this country, but I sure as hell know it's severly broken!

That would be a good law to know.

Anyone know what law that is or where it's located?

[HPPT]

Interesting points to ponder. :up:

One of the most best classes I took in college was an insurance class. It truly is a very interesting subject.

[RCjohn]

One of the most best classes I took in college was an insurance class. It truly is a very interesting subject.

I bet.

Probably some hot chicks too huh? :D

[HPPT]

I bet.

Probably some hot chicks too huh? :D

Are you kidding? It was very numbers oriented.:D

[panthercity]

Are you kidding? It was very numbers oriented.:DSo you're sayin' they were all tens?

[In Your Corner]

Are you kidding? It was very numbers oriented.:D
Papa don't make passes at chicks with coke-bottle glasses.

[Jed]

I wasn't aware of that law. I am currently fighting this with my wifes policy, she changed jobs, and now we have to pick up private insurance which is turning into a costly nightmare because she has a pre existing condition. I am not sure which route to take to fix health care in this country, but I sure as hell know it's severly broken!


How long is the break in coverage between the last day of her prior coverage and the first day of the new coverage? Under 62 days and they shouldn't pre-ex you if it's a group policy.

You may want to call your state's insurance comissioner's office for advice.

[DougK]

One of the most best classes I took in college was an insurance class. It truly is a very interesting subject.

My Insurance class for this semester was canceled. Only myself and two other people signed up for it. :mad:

[HPPT]

My Insurance class for this semester was canceled. Only myself and two other people signed up for it. :mad:

I remembered there were few of us also back then. Although I took it in the summer. Might have been different during a regular semester.

[In Your Corner]

Are you two competing for a geek title?

[DougK]

I remembered there were few of us also back then. Although I took it in the summer. Might have been different during a regular semester.

I picked up a MKGT 422 course instead. This semester starts monday. My 3 week vacation is coming to an end :(.

[DougK]

Are you two competing for a geek title?

Nah.....Papa's my mentor. Jealous?

[Rob94]

How long is the break in coverage between the last day of her prior coverage and the first day of the new coverage? Under 62 days and they shouldn't pre-ex you if it's a group policy.

You may want to call your state's insurance comissioner's office for advice.

There was never a break in coverage, I paid cobra in the interim. The problem is we have to get private insurance, the place she works at doesn't offer group care

[In Your Corner]

Nah.....Papa's my mentor. Jealous?

Nope, he's my bud too.

[knutz]

There was never a break in coverage, I paid cobra in the interim. The problem is we have to get private insurance, the place she works at doesn't offer group care
I can't remember but..... In NC i went through the same thing. We were on my wife's policy when first married and she quit work and went back to school so we went to sign up with my employer. At first they wouldn't even let us because it wasn't open enrollment. Then we found out as long as you had coverage in the last I think it was 90 days they couldn't exclude you or exclude your pre ex condition. It took a week of arguing with my HR manager and the insurance company but we got in with no restrictions on pre-ex conditions.

So def call your state's insurance commissioner's office an find out.

[Venom51]

So if I wreck my car and have no insurance. Once I buy insurance should they then have to pay for and fix the damaged caused by the previous accident?

[Jed]

There was never a break in coverage, I paid cobra in the interim. The problem is we have to get private insurance, the place she works at doesn't offer group care

And therein lies the fatal flaw of individual insurance policies. :down:

If you were switching from group to group no worries, but since your paying out of pocket then your screwed.

[Jed]

So if I wreck my car and have no insurance. Once I buy insurance should they then have to pay for and fix the damaged caused by the previous accident?

Say you wreck you car while insured, then they pay to fix it. A year later you change insurance companies (say the old one went under) and the new company says "you had a wreck, we're not covering you."

That's the problem with pre-ex. Rob94s wife was covered. He kept paying premiums as part of COBRA. She gets a new job and COBRA runs out (Rob, you could stay on COBRA for 18 months if you choose as her new employer doesn't offer a group plan.) No insurance company will cover her due to a pre-ex on an individual policy.

That's not someone being irresponsible. That's somebody playing by the rules, paying their share, maintaining coverage, and then getting shafted because the insurance companies can use their big assed shafts against individuals.

I'm in the insurance biz. The diff between group coverage and individual coverage is where the problems are in the industry.

[Jed]

I can't remember but..... In NC i went through the same thing. We were on my wife's policy when first married and she quit work and went back to school so we went to sign up with my employer. At first they wouldn't even let us because it wasn't open enrollment. Then we found out as long as you had coverage in the last I think it was 90 days they couldn't exclude you or exclude your pre ex condition. It took a week of arguing with my HR manager and the insurance company but we got in with no restrictions on pre-ex conditions.

So def call your state's insurance commissioner's office an find out.

The break in coverage is 63 days. Your previous insurance company is required to send a Certificate of Creditable Coverage when you terminate your coverage with them. This is what the new insurer uses to calculate pre-ex.

Your employer tried to dick you over hard. Spouses Loss of Coverage is a valid Life Event that opens up enrollment for you and your spouse at your employer for 30 days from the date of the event. Your HR department didn't have a right to deny you enrollment or try to force you to wait until the next Open Enrollment cycle as far as I know. Although it may differ in your state, but I doubt it.

OE is for changes not involving life events. You can drop or add coverage during OE, change plans, add dependents, do whatever you want.

A life event automatically makes you eligible to change coverage with your employer. Life events include but are not limited to Birth, Death of Spouse / Dependent, Change in Spouses Insurance, Dependent aging out (19 or 24 depending on student status.) and a few other that aren't encountered that often.


---

Great link to the FAQs here regarding HIPAA rules.

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

[Venom51]

Say you wreck you car while insured, then they pay to fix it. A year later you change insurance companies (say the old one went under) and the new company says "you had a wreck, we're not covering you."

That's the problem with pre-ex. Rob94s wife was covered. He kept paying premiums as part of COBRA. She gets a new job and COBRA runs out (Rob, you could stay on COBRA for 18 months if you choose as her new employer doesn't offer a group plan.) No insurance company will cover her due to a pre-ex on an individual policy.

That's not someone being irresponsible. That's somebody playing by the rules, paying their share, maintaining coverage, and then getting shafted because the insurance companies can use their big assed shafts against individuals.

I'm in the insurance biz. The diff between group coverage and individual coverage is where the problems are in the industry.

That's a problem easily solved with a little regulation. It doesn't require a Gov't run health care plan to fix it.

[Jed]

That's a problem easily solved with a little regulation. It doesn't require a Gov't run health care plan to fix it.

You bleeding liberals and your regulations!!! :Poke:

I haven't really formed an opinion on gov run health care yet. I'd like to see some major improvements for current indigent care, non emergent care (got the sniffles, and an ER can kick your ass out instead of wasting their time and resources on you.) pre-ex exclusions for individuals etc. But I don't think a single grand unified health plan is what we need at this point.

[Venom51]

You bleeding liberals and your regulations!!! :Poke:

I haven't really formed an opinion on gov run health care yet. I'd like to see some major improvements for current indigent care, non emergent care (got the sniffles, and an ER can kick your ass out instead of wasting their time and resources on you.) pre-ex exclusions for individuals etc. But I don't think a single grand unified health plan is what we need at this point.

Ouch...damn it that smarted. I can take being called a big gay man in the running red light thread but that liberal thing hurt.

[2Fer]

As someone who has trouble getting insurance due to an existing condition. I believe absolutely, they should have the right. Their company their rules.

I actually have a dog in this fight unlike most of you. So I think my opinion might carry a little more weight, but probably not.

[DougK]

That's a problem easily solved with a little regulation. It doesn't require a Gov't run health care plan to fix it.

Exactly. It's like were trying to fix a cold by building the trillion dollar man with government run health care. I understand 50 million do not have healthcare. But, why throw the other 250 million under the bus because of that? Fix the actual 20 million (?) who cannot get insurance rather then re-inventing the wheel.

[DougK]

As someone who has trouble getting insurance due to an existing condition. I believe absolutely, they should have the right. Their company their rules.

I actually have a dog in this fight unlike most of you. So I think my opinion might carry a little more weight, but probably not.

And if we target persons such as yourself and bridge that gap, the number on un-insured will be reduced substantially. Those left without insurance will predominantly be those who are choosing not to get insurance and illegals. I believe that making it mandatory to cover pre-existing along with a competitive market and government subsidies to suppliment the higher costs based upon an individuals actual needs is a much better way to go to achieve this.

[RCjohn]

The break in coverage is 63 days. Your previous insurance company is required to send a Certificate of Creditable Coverage when you terminate your coverage with them. This is what the new insurer uses to calculate pre-ex.

Your employer tried to dick you over hard. Spouses Loss of Coverage is a valid Life Event that opens up enrollment for you and your spouse at your employer for 30 days from the date of the event. Your HR department didn't have a right to deny you enrollment or try to force you to wait until the next Open Enrollment cycle as far as I know. Although it may differ in your state, but I doubt it.

OE is for changes not involving life events. You can drop or add coverage during OE, change plans, add dependents, do whatever you want.

A life event automatically makes you eligible to change coverage with your employer. Life events include but are not limited to Birth, Death of Spouse / Dependent, Change in Spouses Insurance, Dependent aging out (19 or 24 depending on student status.) and a few other that aren't encountered that often.


---

Great link to the FAQs here regarding HIPAA rules.

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

Many HR people are clueless about those detailed laws. Pretty sad actually how many don't know. We of course hire HR people with degrees in HR but many companies just turn their office managers into HR managers and don't give them enough training.

My Dad has always said, "if you feel like your insurance company is screwing you then don't hesitate to call the State Insurance Commissioner". I've actually done that once before to get a qestion answered. I think it was in South Carolina. Minor question about something Allstate(IIRC) was saying. They were wrong/confused and when they realized I has spoke to the Commish they immediately admitted they would have to research and get back to me. It wasn't a big deal... I was mostly just fucking with a new adjuster. :p

Of course my Dad was President of the Arkansas Claims Manager Association for years so the Commish was one of his friends. :D

[RCjohn]

Ouch...damn it that smarted. I can take being called a big gay man in the running red light thread but that liberal thing hurt.

Damn, that is a very low down mean thing to call a guy. :down:

:p

[Venom51]

Damn, that is a very low down mean thing to call a guy. :down:

:p

You'd think the guy doesn't like me or something.

[R Acree]

You'd think the guy doesn't like me or something.

I can't understand how anyone could consider you to be anything other than a warm, tolerant, upstanding individual.

[Jed]

You'd think the guy doesn't like me or something.

Wanna see my new bicycle you liberal hippy?

:moon:









:Poke:

[Venom51]

Wanna see my new bicycle you liberal hippy?

:moon:









:Poke:

Sure...give me a minute...I need to go start the big gay truck. :Poke:

[Jed]

Sure...give me a minute...I need to go start the big gay truck. :Poke:

I heart the bbs. :beer:

[RR558]

I am not sure I have an answer, or an opinion, but I do have a question. How do health insurance companies make a profit?


I pay slightly over $100 a month for coverage, and have had a few surgeries, and the bills for them totaled around $200,000. Even if I live to be 100, my payments will still probably not cover that. I know that not everyone has to get surgery, but even a simple ER visit for stitches could wipe out two or three years worth of payments.

I doubt your ins. co. even payed a fraction of that total as they negotiate down all the time

[breaux]

I'm on the fence about this one. I can't blame a company for not wanting to take on a client that is, in all likelyhood, going to cost them more than they'll make.

But on the other hand insurance is a gamble and if you choose to sit at the table you should be forced to take what ever hand you get dealt. They won't all be winners. It comes with the game.

Its like the pharmacist that doesn't want to issue birth control, or the morning after pill, because it's against their religion. You picked that line of work.....suck it up.

So I'm on the fence......

[R Acree]

Its like the pharmacist that doesn't want to issue birth control, or the morning after pill, because it's against their religion. You picked that line of work.....suck it up.


If they own the store, I have no problem with it. If they work for someone else, I agree with you.