Health Care Thread

Borzak_sl said:

Except it was fine one day, then the law went into effect and suddenly I became uninsurable to any carrier in the state because the state was now setting the premium price. One day you get competitive quotes from numerous companies and the next nope, it's set by the state now. Then that poofed the day ACA went into effect but I didn't care because I got company insurance till now. Now I need Cobra.

Prior to passage of the high risk pool several years ago companies could have refused to carry me or increased the premium, but they didn't. Until the state got involved and all that went away and the price was set by the legislature instead of supply/demand and actuary tables. The ACA will eventually clusterfuck it as well.

The only thing they required in the previous 15 years was 1 year at the start of coverage before they covered my diabetes and an annual A1C. Every time I had it done the Dr. would say the same thing, my A1C was lower than a lot of fat fucks walking around without diabetes.

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States don't set the rates unless there's something bizarre unique to your state that's got nothing to do with the ACA. I can look at quotes here in Maryland and get dozens of different rates even within the same tier policies that at a quick glance seem identical.

What state are you in? One like Cali that tends to overlegislate things?

Vaclav_sl said:

States don't set the rates unless there's something bizarre unique to your state that's got nothing to do with the ACA. I can look at quotes here in Maryland and get dozens of different rates even within the same tier policies that at a quick glance seem identical.

What state are you in? One like Cali that tends to overlegislate things?

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Maybe I didn't spell out the time line correctly.

Maybe up to 7 years ago I had regular insurance like everyone else and had it since around 1989. Just shopped for a policy and paid 100% of the premium myself. Then the state started the high risk pool and I got thrown into that. When the high risk pool went into affect about 7 years ago overnight I could no longer purchase health insurance in my state from anyone other than the high risk pool. Prior to the law going into affect I could get competitive quotes from multiple companies and I would price check every few years and had no problem finding a policy that was competitive etc...When the high risk pool took affect about 7 years ago all that ended, period. You either bought insurance from the state or you had to get on a group plan somewhere. Since I am self employed that left the state.

Then that went away when the ACA went into effect Jan. 1 of this year. They literally gave me 15 days notice at the end of the year it was ending, find a new policy. I then got on a group policy that the employer paid 100% of the premium. Because of all the old people now that I lost it my Cobra premium is $2800 a month...or go find a policy thru the ACA.

Just saying I liked the days of just shopping with a company and not having to go thru the government. When the high risk pool started everyone said it was great, well the people who thought it was great who were basically uninsurable, and they were uninsurable for a reason. Like I said they sent me a deal once stating that over 10% of the people on the policy per year in TX (big state) were hitting their lifetime cap on the insurance which I don't remember but I'm sure it was in the multi millions. Prior to the law going into effect I had no problem getting insurance and it was competitive, but suddenly I got lumped into a group of people who had multiple organ transplants and a huge number of illegals as well. Every year the policy creeped up because they were going bankupt. Same thing will eventually happen to ACA, they are going to attract a huge number of people who were basically uninsurable before.

Personally contemplating just doing without and paying the fine at least for a while. I could basically self insure as long as I don't have mutiple surgeries etc....I had two MRI's that I wound up paying out of pocket with the neurologist bill and a spinal tap because the company policy ended on May 30th but I was not notified of the Cobra info and the end date of the insurance until the end of June. When notified they pushed back how long I had to enroll in Cobra. But here's the deal. Because the hospital pre qualified me or whatever they call it when I had insurance and I had the MRI and spinal tap the next day I wasn't covered. You can pay and get back on the insurance thru cobra and you will be covered including that time period I didn't have insurance, but they won't cover what you had done when you didn't know you didn't have insurance.

So $23,000 later I paid for the 2 MRI's, spinal tap and Dr. office visit...all to be told in 30-90 days you'll return to normal like nothing ever happened and it's a once in a lifetime deal. Great. Hard to believe a standard case of shingles led to partial paralyzation, dizziness, confusion, and lesions in the brain (now since resolved - IE gone) and the best part of all the immune system attacking my nerve cells so that my entire body itched BAD lol.

High risk pools have existed for a long, long time - you just didn't get "detected" for them to throw you into it - I've had this condition (congenital) from the day of my birth, but only got reported and PEC'ed/high risked around age 28 or so. My mother (who shares my condition) was high risk/PEC since around the time I was born in the early 70's.

And the reason why that policy was ending was because the ACA killed high risk pools - it should be BETTER for you once you go to the exchanges if Texas hasn't fucked them up (intentionally). The ACA requires "high risk" people to be lumped with NORMAL people too - so you'll be bringing the normals rates up, not worse sickos dragging yours up.

RE: Borzak

I don't understand what you're saying. You can purchase a plan right now from a private insurance company since you're losing group coverage. The plan doesn't need to go through the government, it will have better coverage than your high risk plan, and it'll probably be less expensive. Your issue is with your employer dropping your coverage and from what I understand, you either didn't know, or didn't act. That's got nothing to do with the ACA.

I haven't looked, the private plans I could buy before disappeared when the high risk pool came out. I'm assuming now that people can go thru the ACA and get pre existing coverage that they aren't offering it either now.

My high risk pool wasn't all that expensive, at least I thought. It just irked me that suddenly it became you either buy this policy or all the other choices quit selling those policies in TX. So that was the only game in town then so to speak.

In fact if I could have kept the high risk pool insurance I would have. The only downside to it was having no competitor to shop against. I would have stayed a private contractor as I had for the previous 25 years and paid for my own insurance. Instead when it went away I went with the employer paid group insurance. But I would have preferred to stay where I was and I probably would still have that insurance instead of losing my insurance after 5 months.

Vaclav_sl said:

High risk pools have existed for a long, long time - you just didn't get "detected" for them to throw you into it - I've had this condition (congenital) from the day of my birth, but only got reported and PEC'ed/high risked around age 28 or so. My mother (who shares my condition) was high risk/PEC since around the time I was born in the early 70's.

And the reason why that policy was ending was because the ACA killed high risk pools - it should be BETTER for you once you go to the exchanges if Texas hasn't fucked them up (intentionally). The ACA requires "high risk" people to be lumped with NORMAL people too - so you'll be bringing the normals rates up, not worse sickos dragging yours up.

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Each insurer may have had high risk pool and increased premiums, but when TX passed the state sponsored high risk pool insurance all that disappeared overnight. It was run thru blue cross/blue shield but the state set the price of it by legilslative act and adjusted it each year by law. Companies that were happy to insure me for the previous 20 or so years just sent me a letter saying, get on the high risk pool insurance that's pretty much your only option outisde of a group policy.

Really not related to the ACA/Cobra or high risk but I've been harping for 20 years that I wish they could disconnect your insurance from your employer. I knew too many people who hung around working longer than they should just for insurance or insurance for a significant other etc...You see it a lot when you work with old farts like I do. The average age in our office is almost 63.

Pre-existing stuff is all gone, so everyone gets the same rate. You can go onto Anthem or Blue Shield's sites right now and probably purchase a policy because losing employer coverage is one of the qualifiers to get coverage out of open enrollment. The plans are all different than they were last year though. Now it's bronze, silver, gold, plat, and the limits, deductibles, etc. are the same company to company. The only real differences between carriers now are provider network, and whether it's an HMO/PPO/EPO.

But here's my complaint, if the ACA had not passed my previous insurance that I had for years wouldn't have poofed. Then when I actually got sick they would have covered it and I could continue on that insurance even today. Instead I had to change to a group policy, then lost the group policy when I got sick and now have to change to something I can get thru the ACA. See my point? Not to mention each time I change I have to start a new deductible etc...When I could have just continued on with the coverage I had. So now I'm looking at least 3 differnet policies now in 8 months and 3 different deductibles.

Why didn't you start a new policy when you knew your group plan was ending and you knew the catastrophic coverage was gone?

Borzak_sl said:

But here's my complaint, if the ACA had not passed my previous insurance that I had for years wouldn't have poofed. Then when I actually got sick they would have covered it and I could continue on that insurance even today. Instead I had to change to a group policy, then lost the group policy when I got sick and now have to change to something I can get thru the ACA. See my point? Not to mention each time I change I have to start a new deductible etc...When I could have just continued on with the coverage I had. So now I'm looking at least 3 differnet policies now in 8 months and 3 different deductibles.

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I guarantee once you find the new policy and stick with it you'll be paying a fraction of what you were before - average high risk pool before and after was between a half and a third as much - and last time I checked on meeting a deductible that's supposed to carry over between providers to some extent I thought? Be it a refund or whatever else. (I know when I got forced onto COBRA I got a refund from my old policy personally)

While I'm complainging about healthcare....

I think insurance should cover bail money as well.

I had a Dr. examine me for 2 minutes, look at my MRI for 30 seconds and declare "You'll never be better than today, you have massive brain damage, I don't expect you to walk again or regain use of your arm. I predict your life will now be shortened to a few months on the outside".

After I got back to 99% I ran into him at the hospital and we got on the elevator together. He didn't recognize me especially since I was walking, talking, and using my arm. I hit the stop button and asked him if he ever had his ass kicked by someone with massive brain damage or that was paralyzed. He called the cops on his cell phone and they were there shortly after it opened on the ground floor.

I was "detained" for about 10 minutes and he refused to press charges. The cops pretty much blew it off and apparently they were already at the hospital. As he walked off I told him the offer was still good if he wanted his ass kicked by a brain dead cipple. The two cops laughed and walked off.

The really bad part was when I went for my steroid infusion the nurse told me her husband had gone to the same Dr. He was told he had "brain shrinkage" and that the end was imminent and he left his job (he actually works for one of my suppliers) and he had a GOOD job. His wife took leave of her job to care for him. Fast forward and nothing happened.

Some Dr.s really shouldn't be practicing. I wouldn't have kicked his ass at the hospital, but it's a relatively small town and I assume we probably live in the same area. One day. I'm glad I live in a state where ass kicking can get a "well looks like he probably deserved" from the cops. I really wouldn't hurt him, but I bet I could make him piss himself before it was all over.

My best friend was a lvl 1 trauma nurse for years and now teaches nursing. He pretty much said the same thing, when someone says "massive brain damage" he said he expect the next talk about if they are going to pull the plug or not.

Disp_sl said:

Why didn't you start a new policy when you knew your group plan was ending and you knew the catastrophic coverage was gone?

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I didn't find out till almost 2 months or whatever it was that my policy had ended. I had already had the work done at the hospital and they assumed I stll had insurance as did I. It wasn't till a few weeks later (I probably would have gotten a bill sooner or later from the hospial, and I did) that when I went into the Dr. for a final check up they said "hey your insurance is no longer valid. I called the company and they said "oh looks like we sent your cobra info to the wrong address. That's the day I found out I didn't have coverage. At that point my coverage had already ended almost 45 days before or whatever it was and I didn't know it. They contract with a company to do their cobra stuff and by the time I got the info was just a few days ago even tho it ended on May 30th. So almost two months. Until I got the info Friday I didn't know how much the Cobra was going to cost. I can still pay it if I want as a stop gap deal, but if I pay the cobra then I can't enroll in ACA till open enrollment starts. But if I don't pay the cobra I can enroll in ACA now which I'll have to look into, but I just got the notice.

When I left the comany I got a verbal notice, my mother who was caring for me at the time got a vergal notice, and I got an email that said "Don't worry about losing your insurance, we have it covered" come talk to use when it's all over. This is a company my dad retired from that has like 18 people in the office. I had done contract work for them for 20+ years. The only reason I hired on with them is someone retired and I took his job and it coincided with needing group insurance. So until one day last week I hadn't received my cobra info and just recently found out that I even needed it. Now I get a cobra notice every 2 days for whatever reason and each time they move the date eligible to enroll back a few days or a week or whatever.

Talking about healthcare now I've got some kinda of malware or virus on my computer now, it keeps restarting. Blah.

Disp_sl said:

Why didn't you start a new policy when you knew your group plan was ending and you knew the catastrophic coverage was gone?

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My question as well. I feel for you dude - $23k is a shit ton of money. But it sounds like you did this to yourself, unless I'm misunderstanding something.

Dude when the hospital calls the insurance company and they say you have insurance and schedule it for the next day and it expired that day the insurance doesn't tell the hospital that. So you go in the ext day and then you find out it expired the previous day and you have no insurance to cover it. So you finally get the cobra deal, great I can get coverage going forward and for the 2 months I thought I had coverage. But they don't cover anything you had done during that period that you didn't have coverage.

I'm not sure what else I was supposed to do other than call the insurance company to confirm it 5 minutes before my procedure at 6am the day after my policy ended that I didn't know it ended uttil over a month later.

Next time say that instead of writing a novel - it was far more clear - thanks. Yeah, dunno what you could have done.

God bless American healthcare!

OneofOne_sl said:

Next time say that instead of writing a novel - it was far more clear - thanks. Yeah, dunno what you could have done.

God bless American healthcare!

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Trust me I condensed it down a lot. I really thought it was over when I got the Cobra deal finally, only to find out that even tho they make you pay for the past 2 months, you technically are "covered" but they don't cover anything you had done during that period.

I mean I guess I'm lucky in that I have the money to pay it, I can't imagine if that was life altering money for someone.

I mean basicallay that's a small car for someone for basically a procedure that took about 1 minute and it was done by a nurse practioner, not even a Dr. Then the spinal tap came back "inconclusive" which I didn't even know it could be. Thankfully they looked at the MRI and said it's all gone. Well gee great, should have done that first considering a MRI was $3200.

Again, unless Texas has some weird laws that override it - COBRA mandates that your employer cover you for something like 45 days after you stop working with notices the entire time at no cost to you. (I might be off in the timeframe, but there is a lapse time - god knows I had to read it off to people often enough - 90% sure its 45 days)

And regardless any policy has to give you a warning timeframe before it expires - probably 45 days as well - although I'm not sure exactly how long, just assuming its similar.

It was 45 days, and apparently the entire time they were sending it to who knows where. It's not TX. I had insurance in TX on the high risk pool until the first and I moved out of state to get this job with the group insurance.

So basically the day before my procedure my insurance expired at midnight. But I never got the info, so they kept sending it to who knows where. I didn't know till I went to a Dr. visit much later, approx the 45 days. When I contacted them they sent it to the right adress but the policy expired that 45 days or whatever it was previous. I can still pick up cobra until Sept. 2nd or whatever it is, but according to the company they contract out to handle their cobra stuff and blue cross/blue shield they won't cover anything I had done during that period where I wasn't covered or had cobra in effect yet even tho you basically pay for that missed time if you want to get cobra coverage. So to get cobra starting in August I would have to pay for June and July completely and then it would be in effect, but it wouldn't cover the stuff I had done during that gap.

Apparently just becuase they had to notify you, it's not registered mail or whatever and as long as someone doesn't send it back. To them that means you have been notified.

Yup pretty much fed up with it. I don't even want to get into the $18k of test one Dr. ordered (the insurance paid) and then refused to make an appointment to review the results. His nurse told me I could pick it up at the hospital. I don't know about you but I really can't read a neck MRI, a MRA or an EKG or whatever it was. This has been how it's been fromt he start. I wrote the insurance a letter stating they weren't getting what they paid for and they paid it anyway.

I'm off to bed my computer has come down with massive malware from somewhere and I have had 4 hours of sleep in the last 36 hours up studying all night last night and this morning. Well at least I passed, while sick I had nothing to do so I studied for my amatuer radio license. Took my 3rd and final one today so I'm legal with the FCC now.

The rules for beginning COBRA

Both you and your former employer must follow proper procedure to initiate COBRA, or else you could forfeit your rights to coverage.

The employer must notify the health plan administrator within 30 to 60 days after an employee's "qualifying event." In cases of divorce, marital separation or a child's loss of "dependent" status, it is you or your family's responsibility to notify the health plan administrator within 60 days of the event. Once notified, the plan administrator then has 14 days to alert you and your family members - in person or by first-class mail - about your right to elect COBRA.

The IRS gets tough here: If the plan administrator fails to act, he or she can be held liable for a breach of duties.If you move, it is your (or your family's) responsibility to tell the health plan administrator.

You, your spouse and/or your children have 60 days to decide whether to purchase COBRA. This "election period" is counted from the date your eligibility notification is sent to you, or the date that you lost your health insurance coverage.

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You dun goofed.

I didn't move and they can't even tell me where they sent it. I still get Cobra enrollment letters and they keep pushing the enrollment date back ever new one they send. However if they aren't going to cover what I had done during the gap what's the point of paying $2800 for 2 months of basically nothing to go forward so I can pay $2800 for the next month if I can find insurance elsewhere now. I could still enroll but according to the cobra contractor and blue cross/blue shield they won't cover what happened during that gap, a period in which I thought I had insurance because I hadn't been notified and the hospital thought I did as well.