Posted on 08/20/2010 9:20:43 PM PDT by Libloather
Stacy, the EIB Insurance Expert
August 20, 2010
BEGIN TRANSCRIPT
RUSH: Here's Stacy from somewhere in Georgia. She is our semi-regular caller keeping us up to speed on health care and health insurance. She's our insurance analyst. Stacy, as always, welcome back. Great to have you here.
CALLER: Hey, Rush. Great to talk to you.
RUSH: Thank you.
CALLER: And for the NAGs out there, the problem is you.
RUSH: (laughing)
CALLER: I solved that real quick and they didn't even have to rent a conference room. But, listen, I have found some truly delicious information.
RUSH: On?
CALLER: On these preexisting condition insurance plans that just came into effect last month.
RUSH: By the way, before you get into this, have you heard that the Democrats have been given new marching orders? They are to stop talking about how Obamacare is going to save money.
CALLER: And I can tell you why that is.
RUSH: Well, yeah, because it's not going to save anybody any money.
CALLER: Well, these poor suckers with these preexisting conditions who thought they were gonna get all this care, the very minimum -- I calculated it -- the very minimum these people are gonna pay if you're under 35 is $12,340 a year.
RUSH: Wait. No, no, no, no, no, no. Wait, wait just a moment. You're talking about preexisting conditions are not going to be covered because people were told by the Democrats and Obama that at some point after the bill was signed that preexisting conditions and your kids and so forth would be covered, no longer could you be denied.
CALLER: Well, that's true, but, remember, they set up a two-year transition plan, quote, unquote.
RUSH: Yes, but you're telling me that the minimum cost for the free service is $12,000?
CALLER: Yes.
RUSH: Wait, per person?
CALLER: Per person.
RUSH: So the free coverage of preexisting conditions is $12,000 per year per person?
CALLER: Yes. And I can explain it to you. And another delicious factoid about this, all of these plans -- well, okay, back up. Twenty-two of the states told the Department of Health and Human Services that they didn't want to run this crap. They kicked it back to Washington and said, "You handle it."
RUSH: Wait, wait. Did not want to run the preexisting condition form of the insurance?
CALLER: Right.
RUSH: Okay.
CALLER: So they kicked it back to HHS. HHS contracted out to a private insurance company called the Government Employees Health Association.
RUSH: The Government Employees -- the GEHA, GEHA.
CALLER: Exactly.
RUSH: Writing this down.
CALLER: So they're administrating this plan on their website. And I'm going to quote it to you. This plan is an HSA qualified high deductible health plan. The plan gives you greater control over how you use your health care benefits, and they want you to open an HSA account.
RUSH: Wait. A health savings account?
CALLER: Exactly.
RUSH: They want you to open one of those?
CALLER: Yes. Now, here's the really, really fun part about it. There are no benefits payable for anything other than preventive diagnoses until you pay out of pocket $2500.
RUSH: Wait. No benefits payable, meaning the insurance company is not going to pay for your free health care other than preventive diagnoses until you pay $2500 out of pocket?
CALLER: Exactly.
RUSH: How does this relate to the 12,000?
CALLER: Well, the very minimum in Georgia, the minimum premium is $323 a month. Okay? That works out to $3,840 a year.
RUSH: For free preexisting coverage?
CALLER: Right.
RUSH: Yeah.
CALLER: Okay. So you're just gonna pay that, then you've also gotta add $2500 as your deductible before any benefits are payable, minus your preventive diagnoses. Then, it's an 80-20 for in network, 40-60 out of network until you have paid out of your pocket, not including the $2500, $6,000.
RUSH: Okay, so that's how we got to the 12. What is in network, out of network, what does that mean?
CALLER: Well, this insurance company has gone out and gotten providers to sign contracts for services. That's an "in network."
RUSH: Provider is a hospital, a doctor, or a nurse?
CALLER: Exact. All of the above.
RUSH: Okay.
CALLER: Now, mind you, that $2500 that you have meet before they're going to pay a dime --
RUSH: The deductible.
CALLER: -- that includes prescription drugs; that includes hospital stays; that includes durable medical equipment; that includes everything.
RUSH: "Gerbil" medical equipment?
CALLER: Yeah. Okay, let me give you an example to kind of clear it up for you. Say you're a diabetic.
RUSH: Wait a minute, "gerbil" medical equipment?
CALLER: Durable.
RUSH: Oh.
CALLER: Sorry.
RUSH: Whew!
CALLER: Let's say you're an insulin-dependent diabetic, and you've been --
RUSH: Wait a minute, I'm just now getting my composure back. We are an insulin-dependent diabetic. Okay.
CALLER: Okay. So you have to buy your syringes, you have to buy your insulin, okay, the syringes are considered medical equipment.
RUSH: No, wait. You gotta buy it yourself, gotta go to the drugstore, gotta buy it yourself?
CALLER: Exactly.
RUSH: This is not part of your free health care.
CALLER: Exactly, until you have paid $2500. Now, you have to go to your physician every couple of months and have blood tests run to see what your blood levels are. That's not covered.
RUSH: Why can't you just get one of those finger prick things that you get in the drugstore to test your blood sugar, why go to the doctor?
CALLER: They do that, but you do go to the doctor because they run more expensive laboratory tests.
RUSH: Oh.
CALLER: There's different levels of sugars in your blood and they have to see your three-month average and all of that.
RUSH: Right. I'm writing all this down, so far I feel like I'm in a maze.
CALLER: It is a little crazy.
RUSH: I'm an insulin-dependent diabetic, and all I've learned here is I gotta somehow come up with $2,500 bucks to go out and buy all this equipment, and then it's going to cost me $300 a month if it's pre-existing, I'm still trying to figure out where the $6,000 per year comes into this.
CALLER: I'll help you. We'll get there. When you go to your doctor to have your blood run, that's not a preventive, so you have to pay the doctor's office.
RUSH: Wait a minute. When does your insurance kick in?
CALLER: After you have $2500 at the insurance company of claims that they've run up but they're not paying.
RUSH: All right. So you have to have the equivalent of $2500 of medical services by your provider --
CALLER: Exactly.
RUSH: -- and that's your deductible. You gotta pay that before any insurance kicks?
CALLER: Exactly.
RUSH: Even though you're paying a premium, minimum $300 some odd a month?
CALLER: Exactly.
RUSH: Under free Obamacare. Okay.
CALLER: Once you hit that $2500, then you get into some copay so your doctor would be a $25 copay. Out of pocket, and they're not really clear on what contributes to their out-of-pocket, but the --
RUSH: Whose out-of-pocket?
CALLER: The patient's. So once you get to $2500 they're gonna pay 80-20. They'll pay 80%, you'll pay 20%.
RUSH: So after you pay the $2500 plus the $300 a month, you're still paying?
CALLER: Exactly.
RUSH: Where did you find it? I know you're in the insurance business.
CALLER: It's right here on the Web. It's www dot P as in Paul, C as in cat, I as in India, P as in Paul, L as in Lima, alpha, N as in Nancy, dot.com.
RUSH: PCIPLAN.com?
CALLER: Exactly.
RUSH: And that is what?
CALLER: That is the GEHA's website for this preexisting coverage. Now, Rush, I gotta give you one more before you gotta go.
RUSH: Wait. GEHA, that's the general --
CALLER: It's the Government Employees Health Association.
RUSH: Government Employees Health Association.
CALLER: That's the insurance company.
RUSH: That's the insurance company. Okay, so it's the insurance company website.
CALLER: Exactly. Now, one of the 22 states that kicked it back to HHS and said we don't want to do this is Arizona. And guess what you have to provide GEHA in order to be approved for their plan? Proof of citizenship.
RUSH: (laughing) No!
CALLER: (laughing) Is this not delicious? I mean, I'm not normally one for schadenfreude, but when I found this last night I was falling all over the floor. Do you wanna know the states that are doing this?
RUSH: This panacea, this utopian free preexisting condition care health care plan is going to cost you $12,000 a year is only accessible if you can prove citizenship?
CALLER: Exactly. In my view, that $12,000 a year is the absolute minimum. It can go up to $27,000.
RUSH: But you said Arizona kicked it back 'cause they don't want to participate in it.
CALLER: Right.
RUSH: So illegals will now not be mandated to give their proof of citizenship.
CALLER: Well, if they're in Arizona and they want the preexisting condition insurance, then they'll have to send proof of citizenship.
RUSH: No, you said Arizona kicked it back and they're not gonna play.
CALLER: No, no, you can't do that. All states have to play, but 22 states said we are not going to deal with finding a contractor. They just said, "We're gonna let you do it, HHS. You handle it."
RUSH: Oh, as the secretary shall determine.
CALLER: Exactly.
RUSH: That would be Kathleen Sebelius.
CALLER: Yes. So for Arizona, if an illegal alien has a preexisting condition and he wants to get on this plan, he's going to have to forge him up some documents to send in because you have to provide proof of citizenship.
RUSH: This is too rich.
CALLER: Isn't it wonderful?
RUSH: This is just too rich.
CALLER: The schadenfreude is through the ceiling. It's insane.
RUSH: I happen to know that proof of citizenship was one of the things the Republicans were able to force into this. That's one of the few things the Republicans were able to ram through in this, was proof of citizenship into the health care reform bill.
CALLER: I would love to know if they also ran the HSA piece into it. And the reason that this private insurance company has done this as an HSA and high deductible plan is because they know they're not going to be able to cover the money that is gonna go out on this.
RUSH: Well, hell, 90% of the patients are not going to be able to afford this.
CALLER: I know. And, you know, you also have to be not covered by any insurance plan whatsoever for six months --
RUSH: Before you qualify for this?
CALLER: In order to qualify for this, and --
RUSH: You mean you gotta have no insurance for six months before you can qualify for this boondoggle?
CALLER: Yes.
RUSH: I can't believe -- well, I can believe it, actually, it sounds unbelievable but I -- well, you would know. Are you still in the insurance business?
CALLER: I am.
RUSH: Why?
CALLER: Because it's a tough job market, but I'm working on it.
RUSH: I was going to say.
CALLER: But I'm hopeful. I really am hopeful. God, please let conservatives take the House at least and starve this beast. If they don't do that, I'm going to be so frustrated I don't know what to do.
RUSH: Well, that's a two-pronged problem, taking the House and then getting the Republicans to starve the beast.
CALLER: I know.
RUSH: That's a separate issue.
CALLER: But, yeah, there is so much irony in this little piece. In my view this is only good for two years. Supposedly in 2014 all of this ends and then you go on to the exchanges.
RUSH: Right. That's essentially single payer and that's where they hope to get this.
CALLER: Exactly. Another one, Rush. You remember how they said they weren't going to put any benefit limits on people?
RUSH: Yeah.
CALLER: For this plan right here, they have all kinds of benefit limits. One of the big ones that I saw was if you need hospice care, they have a $15,000 benefit maximum that they will pay and you can wipe out 15 grand in hospice in a heartbeat, and that's including inpatient and outpatient --
RUSH: I know. And there aren't many heartbeats left in hospice --
CALLER: Yeah.
RUSH: -- to begin with. There's going to be a revolt when this happens to people.
CALLER: Well, they're starting to find out. Like I said, enrollment started last month.
RUSH: Yeah, because everybody thinks it's going to be free.
CALLER: Well, you know, that's a sucker for you.
RUSH: Stacy, thanks for the call. It's always a pleasure.
CALLER: Have a great one, dear.
RUSH: And. The "gerbil" procedures, I'm still caught on that.
BREAK TRANSCRIPT
RUSH: No, I wasn't making it up. From the Democrat talking points slideshow, "The presentation's final page of 'Don'ts' counsels against claiming 'the law will reduce costs and [the] deficit.'" They are not to talk about that now. As they go out into the campaign season (they're back home for the August recess) they are not to talk about the cost savings and deficit reduction. They're supposed to talk about the "improvements" in health care that will result, because everybody knows it's not going to reduce costs.
END TRANSCRIPT
“I know it probably came from Rush’s cochlear implant, but this was one of the funnier misunderstood words in a while.”
That was hilarious. Rush didn’t quite latch on to the gist of what Stacey was calling about with his usual quickness, but it was still an amazing call.
On another side of the coin - just wait until the school districts pass on the increased costs of their plans via more property taxes.
I pay $500 (raised twice in two years) for an 80/20 policy with Aetna — just for myself. I take a couple of generic pills per month, really cheap pills, like the generic for Zocor for cholesterol, and I pay for those with my supermarket discount card because it’s cheaper than with the insurance! For name brand pills there’s a bit of a benefit to using insurance.
I have a $40 co-pay for every visit and after several thousand dollars is reached each year, the insurance kicks in. I only carry this in case of true emergency and for now am able to write the entire premium off on income tax each year.
I’ve thought of doing without insurance but hospital bills would kill me if illness/accident did not. I’m told that only if you are very broke should you go uninsured — and in truth the indigents get the best care — and are the ones who’ve caused closure of so many ERs. I worked for another major health insurer for years and all parties are guilty of greed — insurers, doctors, hospitals, big pharma, etc. There is enough blame to go around.
Yet, our old system was still much better than Obamacare. It’s all going to hit the fan soon — and it won’t be pretty.
Anyone know how all this affects the Veterans Affairs medical system?
“RATS told us all about this - right?”
No...how could they. They didn’t read it. Don’t forget, Nanzi Pewlosi said you had to first pass it to know what was in it.
I too worked for a health/life insurance company, and agree with you entirely. One thing that just infuriates me is the change in rules (around the time that health care costs started to escalate) that encouraged direct to consumer advertising.
That was a singular piece of stupidity that is heretofore unmatched. It creates a dual problem: every idiot on the planet is running to the Doc to get the latest drug for some ailment that they have self-diagnosed. And even more horrifying, the pharma companies have a financial interest in developing largely useless or redundant drugs that will appeal to the masses, while leaving the truly sick to suffer.
My personal award for "unbelievable arrogance in a healthcare setting" goes to the Iowa Hospital Association. For quite some time they were running these ridiculous ads on the radio congratulating themselves and bragging about XXX millions of dollars of "charity care" that they are providing. Yes, that's right, they were running ads BRAGGING about apparently overcharging their paying client base which consists of privately insured customers, and (largely) Medicare recipients.
I was forced to go the the emergency room last year for a couple of stitches, and I asked the billing department to itemize how much of my bill was earmarked for "charity care" so that I could be sure to deduct it on my taxes...that went over well...LOL!
Thats what my HC/I costs mostly because our pool is older.
Gawd, and these same people wanted to be able to buy medicare coverage. That’s gotta be 20-30 grand
Everyone at every level has to make a profit for it all to work. The problem is that it’s not a transparent market (as you alluded to).
“Commiecare” is a good name for that attempted power grab.
Her example was a diabetic, not a healthy individual. There are a lot of diabetics in the USA. They go to the doctor a lot.
All the dirty secrets of Obamacare will come out.
The thing that has been maddening about this preexisting condition issue is that it was almost always possible to get these conditions covered by insurance, it was just that there was often a waiting period (no different than under Obamacare) and it cost more for coverage than if there wasn’t a preexisting condition (no different than under Obamacare).
Of course, you can’t provide “insurance” for a pre-existing condition without a waiting period and higher premiums to address the KNOWN risk.
This is why my parents always said to have your baby covered by your insurance policy from the time of birth. Then if the baby was born or shortly thereafter developed a medical condition, it would not be preexisting to the coverage.
Sounds like you need to shop around some. Health insurance varies greatly state to state, but my wife and I have had an HSA through United with a $5700 combined deductible for nearly 10 years now. The insurance kicks in at 100% after the deductible has been met. I have a pre-existing heart condition that requires daily medication and regular monitoring by a Cardiologist, as well as infrequent trips to the ER when my arrhythmia acts up. Our cost is about $420/month for both of us. United has never not payed a claim. In fact, they seem to be very good at eliminating frivolous charges and holding hospitals, doctors and other medical services to their contractual obligations with the United Health Care network.
I heard this from a liberal a few days ago. The part about having to not have insurance for 6 months before one could qualify.
Her husband has some rare pre-existing and both are on COBRA now. According to their insurance broker...their monthly goes UP, yes...goes UP on this plan.
And he/she don’t qualify unless they have NO coverage for 6 months. It all seemed overly complicated as we talked about it. I didn’t understand some of what she was trying to explain, but I did get the jist of it.
1. It ain’t no free ride.
2. Her husband can/will die during the 6 month wait. (It is a serious pre-existing condition in which he has no immune system.)
3. She is taking to holding benefit dinners etc. to raise money for his medications.
She has also contacted Oprah.
If George Bush had tried to shove something this big down our throats, the MSM would have looked into it - and we'd know the downsides. As is, a dem did it, the MSM didn't look, and all the surprises will be horrors.
Cheers!
“Anyone know how all this affects the Veterans Affairs medical system?”
I don’t believe anything was done to change VA medical. I probably should look into that.
“People will feel they’re being choked financially, and neglected in terms of their health needs.”
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Wrong, dead wrong! They won’t “feel” it, they will DAMNED WELL KNOW IT!
RE: “I was forced to go the the emergency room last year for a couple of stitches, and I asked the billing department to itemize how much of my bill was earmarked for “charity care” so that I could be sure to deduct it on my taxes...that went over well...LOL!”
*******************
I wish I’d known about that ‘charity care’ business when I was forced to pay a large out of pocket bill for ER services recently — also for a couple of X-rays and stitches from a fall while walking my crazy dog on a Friday evening. No choice but to go to ER as I knew I needed stitches. My lousy insurance covered barely half the bill.
Stacy on the Rush show ping.
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