Nightmare Revisiting... Insurance

[Bobbi]

Y'know, just when I started to believe everything was all worked out with my insurance (thanks to a job transition and new policy/administrator), the entire can of proverbial worms has been re-opened.

BC/BS - in its aim toward becoming more patient-centered ... oh, not hardly - decided to raise its annual premiums a whopping 50 percent. The broker (hired by my job people) made the decision to switch me over to Kaiser PPO :eek:. Did anyone ask me how I felt about this switch-a-roo? Did anyone sit down and discuss this plan with me beforehand? Did anyone give me a bit of time to make adjustments or time for my brain to adapt to the change? Heck no.

So, I start thinking: "Don't be so obstinate that I end up getting the boot." I took all the paper work from both PPOs and did a comparision on coverage. The result: I'm getting hosed. Not only that, the "new and improved" insurance sent me my membership card for Kaiser HMO. Like that works. Not.

I decided to have a discussion with the broker; he is totally lacking in the ability to answer direct questions about the policy. I could care less what he thinks of me; since it was his idea to change my provider, he should be able to answer questions about its coverage. As an effect of speaking with him, he called H.R.

I've been told that this is the plan: K. PPO, and, whatever monies must be paid on my end, the company will reimburse. Any physicians, DME, etc., not covered, the company will pay - "x" thousands of dollars have been set into an account for this transition. But until everything is resolved, the company is also retaining my BC/BS.

I am so torn; in sum, there is a handful of people on this new plan. Because there has to be a set number of people enrolled, if I say no-go, it kills the coverage for all.

I don't know what to do; when I was hired, I spent weeks negotiating for my BC/BS PPO policy. I am paying for the premium, and I locked it in so that, with any inflation, the company would pay the increases.

The assurance I got from the broker? "You have to remember that this country is in a health care crisis." No f'ing joke... as if I'm unaware. But... I did everything I thought to assure I had a policy and coverage that best applies to my health.

By Monday morning, I have to send H.R. the names of each of my physicians, and the list of prescriptions. I am also going to med. supply to order my new w.chair - covered at 90 percent instead of 70 percent (new policy that is pending my okay).

The point to all of this: I just wonder why, when something ain't broke, some think it's best to mess with a good thing. Because I thought ahead, before placing my signature on a contract (new job), and locked in my insurance, none of this should have even surfaced. Part of me says, "Hold them to the contract. This ain't my problem." But, I wonder if they could craft a way to terminate me.

Maybe I am just stubborn or something, yet, the day I change any doctor is the day that doctor retires. I've seen and read enough about how some people have been (mis)treated to know that my doctors are excellent!

I hope that they realize, as long as this continues, it cuts into productivity. This unrest creates an uncomfortable distraction.

Before giving any yes or no on the new policy, I'm also going to look into taking my premium monies and enrolling in an individual policy - that makes me solely responsible for determining the provider.

I am not going to go through this every year.

[houghchrst]

Bobbi, I am so sorry. How unfair. How can they change you without asking, isn't there someway you can fight that? Have you talked to others that the same thing happened to that are unhappy with it? Did others voluntarily switch or was it a forced thing for everyone? I am just wondering if some volunteered for the switch and some were forced how can they force it and make it binding. Maybe they forced it because they wanted it and not enough were going for the change. I don't know, I have no clue about such things really but I am sorry that you are once again going through the wringer.

[Bobbi]

I am planning to have a sit-down with my boss and raise the points I've mentioned here: the comparison between policies (though H.R. says that is moot since monies have been set aside for gaps in coverage or differences and the company will pay); the fact that this was all negotiated and noted in a written contract prior to accepting the hiring offer; the reality that I have been paying a premium, which also affected my income level, and not even a year has elapsed; and all of the etc.

I don't want to state any specific numbers (of employees) affected by this because I don't want posting about it here to come back and bite me in the butt.

No one volunteered for the switch. Several have been forced to go to HMO - because the company pays their premiums. Those of us with the BC/BS PPO are essentially being told the new PPO is the plan. Another person voiced concerns, but those were "satisfied" after a talk with H.R. I'm not at that point, though.

Another huge discrepancy rests in the amount of lifetime coverage. The gap is vast between the old and new policies. I'm told that I should not worry about that because most people never reach that cap anyway, since companies tend to change insurance and the cap starts all over again with new policies. I don't care; I know that most people also face, at least, once catastrophic illness and the costs quickly escalate.

I don't want to have to get ugly about any of it, and unless I see some things, once again, in writing, I'm not signing off on this "plan." It's not at all what I negotiated. I also raised the question about what happens if or when K. determines it's not cost-effective to have people outside the auspices of the HMO system; will people be absorbed under the HMO umbrella. To that, no answer. I want some type of guarantee. I thought I had that, in writing.

I think I can fight it - with legal standing - but I also think that that would lead to creative termination.

[Mark N]

Bobbi, sorry that you have to make this fight. It seems like if it isn't one thing it is another which is very frustrating. Good luck in your battle with the change over insurance.

[BrokenBladder]

Bobbi,

I'm so sorry because I remember how much you went through when you got this job and how hard you worked to get the proper insurance.

It really makes me angry the way that companies just up and change everything from the company we were with to the premiums and also our deductibles.

I just got my DH new paperwork and we will be paying more for much less. It's truly a shame especially when they do these things to people who have an illness that requires regular medical care and meds.

[Pharmacist.steve]

I suspect what is going on here is that the new company that you went to work for is probably a small group and did not understand that all groups - as far as the insurance company is concerned - must financially stand on their own - from a underwriting standpoint. One or two "high cost" employees in a small group and the premiums will shoot up.

While HIPAA may entitle you to move to a individual policy without pre-existing condition exclusion.. HIPAA does not address the guarantee of a community rated premium. If you try to go the individual route - you may be forced into a state under-written "high risk" policy - and not every state offers these. Their premiums are usually capped at 150% -200% of the "average premium" in the state.

It sounds like your company has moved to a MSA ( Medical savings account) If the company is making some sort of contribution to the MSA... you might be able to get them to place more money in yours - to satisfy the initial terms of your work contract... and your out of pocket costs.

In today's insurance marketplace... the insurance company is in the driver's seat... all they are concerned about is how high they can push their stock prices and that is driven by growth and especially growth in the BOTTOM LINE.

It would seem to me that you are caught between the insurance company's need of profits and the your company's need to not let insurance premiums drive them out of business.

[Diandra]

Bobbi,
I would call the Attorney General from your state and tell them what is going on to see if they can help you. When I had a problem with my health insurance postponing a treatment I needed I called my AG and they helped. When a doctor I had gone to refused to give me a copy of my medical records, I called my AG and their office called the doc and I got my records the next day. That is one of the thing your state Attorney General does, helps with consumer issues and this is a consumer issue. It cant hurt to call and ask.

I wish you the best Bobbi...you should not have to be dealing with the stress this is causing you.

Diandra

[Mark N]

Bobbi, this is more common than people think as my wife's small company has switched every year trying to save money and our insurance gets worse every year. They don't even ask the employees if they would rather pay higher fees they just change it to save the company money. I hope you are ready for changing every year or two because that seems to be the trend.

[GJZH]

Bobbi,

This is awful for you....We just applied for Aetna...I thought we could save some money over the BS policy we have...We are self-employed...My husband is not ill...A little high BP and Cholesterol controlled by minimum medications...My daughter does have asthma, but never hospitalized for it...and is under control....My son is well....They charged us almost $500.00 over the normal rate of the policy...making it unaffordable for us...so I had to decline the policy....I called and told them not to deduct it from my checking account....I mean my husband and son never go to the doctor...and my daughter goes for allergy shots...that is it...period...I guess we are supposed to pay for the policy and never use it...Which we did for years...We paid thousands for years to BS/BC ...never and I mean never used it...then when we did...We get hit with high premiums...really sucks...and should not be allowed...Our BS company has recorded millions in earnings last year...so why up our rates? I am not on the policy...I have my own medicare policy...but I think maybe my health is the reason for the high rates...BS would not allow my family to switch to a regular policy either after I went on medicare....I think they are penalizing my family for my lousy health record...

[suede]

Bobbi,
Sorry this is happening to you yet again.
I hope you are able to find a solution to your problem, I know it seems like you can at last take a long breathe and relax from the stress for a moment and BAM !!
Good Luck,
Lind

[Bobbi]

Though I am so sick and tired of dealing with all of this, I certainly do not want to be remiss in saying thank you to each of you who responded :).

I sincerely appreciate, too, Steve your reference to MSA. It puts so much into perspective.

At the same time, good gawd, how much are people supposed to "handle" before decrying "Uncle" and just simply going with the "flow."

It sucks, will continue to suck and suck more as I age. But, that's life.

Nite-nite, all.

I'm so tired and worn out from all of this that I'll just savor the times I can sleep soundly.