Posted on 06/04/2005 9:43:27 AM PDT by kpp_kpp
Joan Majer is an agent for a small real estate company, and like millions of Americans working for small firms, she doesn't get health insurance from her employer. She pays for it herself.
[..]
Some lawmakers think the solution is to form what they call "Association health plans (search)" — programs that serve groups of small businesses that otherwise wouldn't be able to cover their employees as well.
But state insurance commissioners say these health plans are risky business, because of rampant opportunities for fraud. Other critics fear companies would give their best deals only to those firms with the healthiest employees.
[..]
(Excerpt) Read more at foxnews.com ...
Do something before I go bankrupt. (That might be a slight exaggeration, I'd go w/o insurance before bankruptcy... right before.)
I'm with you about not understanding the Insurance Commissioners' concerns. There are already these type programs in place. many Chambers of Commerce offer them, as does the National Federation of Independant Businesses, and numerous other trade and professional associations.
for those unaware... the issue is the difference between "group" health plans and "individual" health plans.
By law insurors must take on pre-existing conditions for members of a group plan (I know it is slightly more complicated than that), but individual health plans can exclude people or conditions for any number of things.
For example, I have a type-1 diabetic son... every (literally) insurance plan we investigated would happily cover everyone but my son (and my wife for other reasons). We did eventually find a "2 person" group BC/BS plan here in Ohio that let us split my wife and I up into two participants in a group (we have an LLC for tax and insurance purposes to funnel all our independent earnings through) -- but it cost's a fortune compared to when I was working at a larger corporation and then buying COBRA.
I've checked all of those... they are discounts on individual plans -- they are not true "group" plans covered by group insurance laws. See my previous post.
(sorry i misunderstood your post... yes I agree)
I understand your concern about the costs, they are astronomical, even with the discounts. I had a plan through the National Assoicaiton for the Self Employed for a number of years. but it was basically a 'catastrophic' policy.
Something has to be done - personally I would think the IC's would be interested in assisting in these types of programs, instead of trying to through a wrench into the works of something that is actually needed.
The left has so dumbed down the population and painted all big businesses as evil. The theft of a few thousand from an Insurance company is regarded as a victimless crime ("they have plenty of money...that's just a drop in the bucket," etc.) and in many cases the guy who gets away with it is looked at as a modern day Robin Hood, with most people too d@mn stupid to realize he has just jacked up everybody's premiums.
In most cases the Insurance company that successfully investigates and documents a fraudulent claim is happy to just terminate benefits. On a good day, they'll recoup the loss through a civil court proceeding. Rarely, and usually only in cases involving extreme dollar amounts, major rings, or other publicity drawing instances will a criminal prosecution be initiated.
if i recall, they fought pretty hard against the "pre-existing" condition clause on group insurance when in came into effect back around '94/95. i think that is why it isn't in effect for individual plans.
they're not going to roll over to the idea of expanding the definition of a "group".
I tried to report a (former) doctor of mine to the insurance company for fraud, but my insurance co said that they were obligated to pay him.
I had been complaining of pain in my foot for a few weeks, and one night, it swelled up to the point that I couldn't wear a shoe. I should probably add here that I've got nerve damage in that leg, and have nearly no feeling in that foot at all, so when it started to hurt, I thought that maybe there was something really wrong. I went to the emergency room (my aunt made me... I was going to make an appt for the following day) and they X-Rayed my foot: Something that my doctor had not done in two visits. The ER doctor asked me when I had "re-broken" the bones in my foot. It seems that there were 5 broken bones in my foot, two of which had broken, partially healed, and broken again.
I was more than a bit peaved that my own Dr didn't seem to believe me when I told him that my foot was hurting, and I took the X-Rays to show him the following day. Well, I told him that I wouldn't be back and BTW, the reason my foot hurt was these broken bones... Here's the proof! Well, he looked at the X-Ray, and said, "yup, you've got some broken bones."
A few weeks later, I got a bill from the Dr & a statement from the insurance, stating that he was being paid $150 for that "consultation!"
And when I called the insurance co, they said that since he looked at the X-Ray, and said the bones were broken, they were obligated to pay, even after I explained the situation!
Mark
that's informative - i agree fraud should be taken more seriously as it affects us all.
but i'm still not clear on "state insurance commissioners say these health plans are risky business, because of rampant opportunities for fraud" -- what new opportunities for fraud would there be under an association group health insurance plan?
i understand why the insurance industry does not want to expand the definition of group but i don't understand why a state insurance comissioner would... unless it's the old "follow the money" idea.
The solution is easy..the problem is the pols who scrw it up. HMOs develped as a response to the soaring premiums of traditional third party payer plans..Byt hten all the rules were forced on HMOs..they had to cover this, fdo that, include weird treatments...chirotratic..cover pregnancy..so..the premiums went up..instead of allowing companies to market whatever plans they chose, and let the market decide..the people will buy it or not..You could solve 9% of health insurance problems , very cheaply..with yhe following...a befoe tax medical reimbursement plan.say with $2000 annual contribution..which if it wasn't all used..could be rolled forward, or trasnferred to an IRA..and then an HMO with a basic package of services..
Thanks for that info - I was unaware of that.
i agree with you. to a point.
"instead of allowing companies to market whatever plans they chose, and let the market decide..the people will buy it or not."
i'm still trying to figure out where i stand on insurance in a capitalistic society. i'm afraid the health insurance industry, left on their own w/o regulation, would only insure healthy people. which, from a business perspective, is a great way to make money.
kind of like home owners insurance - a great thing to have, just make sure you never use it because your policy will be canceled.
i'd rather depend on properly regulated capitalistic insurance company to evenly distribute the cost of helping me take care of my diabetic son than depending on the government for assistance. or maybe it was my bad luck of the draw and the costs should be all mine in a capitalistic society...?
From the sounds of it, the Doctor probably needed the money for his malpractice insurance...;-) Incompetence, in and of itself, is not a crime. Contractually, the Insurance company probably was obligated to pay him.
...and just why is it that the states themselves cannot negotiate in good conscience for all the inhabitants. Perhaps to broad a population and not enough "no or low risk clientele. Most if not all states have a plan for state workers. Is not everyone in the state a state worker.
If you want in, and have the means to pay? Has insurance overcome the ability to pay. If there was no insurance, then doctors would still be collecting chickens, potatoes, cars, and cash. The price for medical care is pretty much off the chart.
That being said, medical technology, the long climb to becoming a doctor, or for that matter any part of the medical field, isn't exactly quick or cheap.
Where your argument fails is that under insurance as presenty designed..people have no incentive NOT to use it..ands that drives up costs..They run to the doc for any ecuse or reason..when aspirin and fluids and a day in bed would work..yet most policies do NOT cover an annual physical exam and tests. HMOs tried to stress wellness..the courts wouldn't let them..Poeple are not presented with a rational alternative..Look, and again, this is simplistic..say you have one HMO plan, like many today..say the family cost is $800/month..Now, the company would be allowed to offer an identical plan..exept there would be ,among other things..NO coverage for pregnacy or childbirth, no chiropractic, NO mental health, NO free second opinions, yet the cost is $400 month..see...the issue isn't that the other plan is bad, per se, now, rather, it's very cost effective.. People are NOT being given that perspective to make an informed decision..
This isn't news. These kind of associations already exist.
I personally don't think so. Living in Louisiana, I see people who are still willing to bet on the N.O. Saints. People will always assume some degree of risk with their money if there is the opportunity to profit. Perhaps a more relevant analogy are the number of auto insurance carriers that specialize in high risk drivers. Are the premiums higher? Of course, and they should be. Even though I do work for a number of Insurance companies, I've had my own issues w/ the industry. I have a German Shepherd. You could grab a steak out of his mouth while he's eating and he'd lick you. Yet, I've always had to look hard to even find a carrier that would provide renter's or homeowner's insurance because he's one of, "those dangerous (high risk) breeds." Statistically, they have to draw lines and I'm ok with that. The neat thing about high risk groups in a capitalist society is that if there is a large enough demand for a service, someone will capitalize on it. USAA started out essentially as the effort of military officers who were finding it difficult to get auto insurance because of frequent relocation and other factors unique to their needs.
If there were enough demand for insurance from an "uninsurable" group, the service would become available.
i agree.
and i'd be happy to do away with 3rd-party-pay.
if i could get the same rates from my doctors that my insurance company gets i almost wouldn't need insurance (for the basic stuff). i whole heartedly agree.
when we were looking into insurance options we checked with the doctors to see if they had any cash-pay discounts. nope. if i go to my son's specialist and pay myself, he charges $200+ for a visit (plus all the tests etc.) and i'd owe it in full. yet he is happy with my insurance company only paying him $75 for the same visit.
it is so frustrating.
see my posts #3 & #4
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