THCB

Mr. President, I Like My Health Insurance. I’d Like to Keep It. Can You Please Help Me Out?

How many times have I talked about rate shock, the millions of people who would be getting cancellation letters from their current health plan, and the problem of people having to put up with more narrow networks?

And, how many times have those predictions been met by push back and spin: Today’s policies are just junk and people will be better off finding lower cost health insurance under Obamacare.

I have been in this business for 40 years. I know junk health insurance when I see it and I know “Cadillac” health insurance when I see it.

Right now I have “Cadillac” health insurance. I can access every provider in the national Blue Cross network––about every doc and hospital in America––without a referral and without higher deductibles and co-pays. I value that given my travels and my belief that who your provider is makes a big difference. Want to go to Mayo? No problem. Want to go to the Cleveland Clinic? No problem. Need to get to Queens in Honolulu? No problem.

So, I get this letter from my health plan. It says I can’t keep my current coverage because my plan isn’t good enough under Obamacare rules. It tells me to go to the exchange or their website and pick a new plan before January 1 or I will lose coverage.

First, the best I can get in a Blue Cross network plan are HMOs or HMO/Point-of-Service plans. In the core network those plans offer, I would have to go to fewer providers than I can go to now in the MD/DC/VA market. And, the core network has no providers beyond my area. I can go to the broader Blues network but only if I pay another big deductible for out-of-network coverage.


Now, my plan covers about everything. Never had a procedure for either my wife or myself  turned down. Wellness benefits are without a deductible. It covers mental health, drugs, maternity, anything I can think of.

The new plan would have a deductible $500 higher than the one I now have and a lot more if I go “out-of-network” inside the rest of the Blue Cross national network.

And, wait all you people telling me rate shock does not exist, it far more restricted plan costs 66% more than our current monthly premium. Mr. Rate Shock got rate shocked––and benefit shocked to boot.

Now here’s the real corker: Maryland has been bragging they have the lowest premiums of all of the exchanges. More, I figured being an old fart the age rating rules, that force younger people to pay more so older people pay less, would help me. Didn’t work out.

There are other plans on the exchange but every comparable plan had much higher premiums.

Thankfully, my Blue Cross plan is offering me an “early renewal” which means I can keep this plan I really like until December 2014––at which point my beloved health plan is toast. My health insurance company is doing everything they can––this is not their fault.

Mr. President: I really like my health plan and I would like to keep it. Can you help me out here?

Robert Laszewski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog, where this post first appeared.

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Guest

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griffin
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griffin

I lost my insurance today. I am self employed and have been paying it for years, I mean years. They didn’t renew it because I wasn’t a group and according to NY law I have to be an individual. Am I going to be fined ? And worse yet what happens if I get hit by bus tomorrow? Are there any lawyers out there that think I have a case of breach of contract? Im going to pursue it, I’m all for people having health care, but it shouldn’t effect mine.

Kyle Kosup
Guest
Kyle Kosup

Anyone who says only the rich are complaining is in total denial and refusing to look at the facts. After taxes make I make $37,000, I live in the SF Bay Area, hardly rich. Under ACA, out of that $37,000 I have to spend almost $7,000 in insurance premiums per year! This is for catastrophic insurance. If god forbid I actually get sick, I have to spend over $11,000 (on top of the $7,000) before my policy starts paying for everything. This will drive many middle class people into poverty. I am a leftist, and I say to my fellow… Read more »

jw
Guest
jw

I believe those who like their non ACA compliant plans should be able to keep them if they so desire. I personally like my families coverage. We are a family of 5, and our premiums and deduct/max out of pocket are reasonable, and our coverage is great. Unfortunately, our plan is not ACA compliant and it is not grandfathered, we missed it by 2 months. At the end of 2014, we will have no option but to transition to an ACA compliant plan. Per the healthcare exchange, a similar plan would cost our family almost 400% more and the max… Read more »

robert
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robert

It’s not Obama care…it’s is simply the insurance companies and doctors who demand way to much to give you the right treatment you need . It’s Saad that the doctors who ” supossibly became doctors to help and cute the I’ll… Want so much money to do it.. While taking up with insurance companies to rob us.. It’s not Obama… It’s all about money..Obama is trying to make it affordable for us all..I myself would be a different person had I had the choice of health care when I was younger.. Wake up people..only the Rich are complaining…. Ours simpler..if… Read more »

Kyle Kosup
Guest
Kyle Kosup

I’m self employed. I’m one of those kicked off my previous plan. My premiums will go up from $285/mo to $545/mo. My deductibles will be much higher and coverage will be worse. If you believe I’m being saved from a “bad” plan, you’re wrong, I’ll be getting a far “crappier” policy. The (un)Affordable Care act still allows lots of crappy policy clauses. If I have to be taken to an emergency room out of my system its the same as if I have no insurance. Under Obamacare I do get pregnancy insurance (I’m a 50 year old male) and my… Read more »

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messijack
Guest

Insurance Verification Service is said to be a key comfort in the medical billing cycle. In this service, the patient’s active coverage is checked with the insurance company to make sure that he/she is eligible for the procedure scheduled in hospital.

Mr James
Guest
Mr James

This is turning into kind of a showcase of the amazing condescension of the left. Here is a recap: 1. People were promise they were going to see their premiums GO DOWN by an average of $2,500 a family. Lie. They are going up. 2. People were repeatedly told they could keep their existing insurance (period). Lie. These implementing the law know that most of these existing policies would be cancelled. 3. People were told they could keep their existing doctors. Lie. So, now that the law is being implemented we see that (a) it was sold with lies and… Read more »

Peter1
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Peter1

“1. People were promise they were going to see their premiums GO DOWN by an average of $2,500 a family. Lie. They are going up.” Well for those getting subsidies coverage cost did go down. For pre-exist they can now get covered at less cost due to community rating. For older people their cost went down as younger peoples cost went up. So not a lie. For those who don’t get subsidy and buy their own the cost went up because of above factors and more comprehensive coverage. “2. People were repeatedly told they could keep their existing insurance (period).… Read more »

Carol
Guest
Carol

All those accusations of whining from the comfort of their cushy employer provided plans. Well, many of them will be in for a shock next year as they get tossed by their employers into the exchanges, and learn the definition of crap plans.

Bob Hertz
Guest
Bob Hertz

Note to T: I think that a few states have firm protection against balance billing in the ER. Colorado and California come to mind. Furthermore, the ACA did have some language about limits on balance billing — but CMS has made this a very low priority, and it was not going to apply to all hospitals. Why there is no national leadership on this is depressing to me also. Note to Peter 1: For what it is worth, the cost of health care has been coming down all over the place for 20 years. The problem is that the prices… Read more »

Peter1
Guest
Peter1

“Note to Peter 1:
For what it is worth, the cost of health care has been coming down all over the place for 20 years. The problem is that the prices have stayed high!”

When I was insured that was well represented by my 6% – 10% premium increase per compounded year! along with she bump every so often.

jw
Guest
jw

It is interesting how people seem to blame the insurance companies for our high cost of health care. What about the providers? Here is my own personal experience with health care costs. I had a baby in 2003, the total amount billed to my insurance by my Dr. and the hospital, all costs, was only $2500. That same child went to the ER with abdominal pain and vomiting in 2010. We were in the ER for only 3hrs, 8oz of IV fluid and an abdominal CT scan. She was diagnosed with a kidney stone. We were sent home and told… Read more »

t
Guest
t

I love how almighty pie in the sky people talk about winners and losers. It’s easy to do that when someone else is a loser, not you.

Well, *I* am a loser in the ACA and I find such discussions disgusting, heartless, cruel and elitist.

But such a good Democrat you are.

Joel Hassman, MD
Guest
Joel Hassman, MD

I genuinely look forward to reading and hearing every stalwart democrat supporter who gets harmed by this legislation as is , be it financially or health care wise, scream about being screwed or harmed. This reflexive and dismissive dialogue by all these apologists and shrill defenders, simply because this is democrat driven legislation, deserve pain and inconvenience.

It is the only way rigid and inflexible people can possibly learn and change responsibly. And, most partisan hacks don’t and won’t.

Sorry, harsh and rude. As is this law and implementation.

Jeff Goldsmith
Guest
Jeff Goldsmith

Still no word from Robert L on precisely why his plan was not renewed. . . maybe it was the lack of OB coverage. Sure doesn’t sound like a “minimum essential coverage” problem.

Bob Hertz
Guest
Bob Hertz

Of all the troubling news in health insurance these days, the exclusion of high priced hospitals from networks is one thing that gives me pleasure. In these hospitals, the number of doctors and administrators making over $500,000 tends to be relatively very large. Any health insurance move that involves reference pricing and cost control is going to penalize these institutions. Either patients will avoid them when they find out what they will have to pay over and above the insurer’s price, or the insurance plan will avoid them by network exclusion. Way too much of American medicine has been cost-driven… Read more »

t
Guest
t

So you’ll also be happy when someone goes out of network to an ER and gets the balance bill for the out of network services. The law does not protect against balance billing, even in the ER.

If the politicians were up front about the narrow networks then maybe what you’re saying would have some merit. But they are lying about these networks too. They are lying about every aspect of this law.

If you want to control healthcare costs, do it by controlling healthcare costs. Don’t do it by surprising people with outrageous bills.

Peter1
Guest
Peter1

“If you want to control healthcare costs, do it by controlling healthcare costs. Don’t do it by surprising people with outrageous bills.”

Patients have always been surprised by outrageous bills. I agree with actually controlling costs, not back door smoke and mirrors, but how do you get past the lobbyists and corporate funders?

Barry Carol
Guest
Barry Carol

In Southern CA, all 13 insurers offering plans on the exchange are excluding Cedars Sinai from their hospital networks and 12 of the 13 are excluding UCLA Medical Center. Physician networks are also narrower than in the broader network off exchange plans. Not contracting with the most expensive hospitals and doctors results in a significantly lower premium than would otherwise have to be charged.

GH
Guest
GH

Just verified with Blue Shield on their PPO plans both through covered california and their non ACA plans the doctors are the same. No separate list of docs.

Those that really don’t want ACA have not investigated the shortcomings of their existing plans or have not logged on to see what kind of plans are available. I know the troubles with healthcare.gov but really, give it a chance.

spike
Guest
spike

GH that may be true in California that’s not true everywhere.

I’m virtually certain that providers (at least hospitals) contract for exchange products separately from other products the carrier sells. I know of a hospital executive who decided not to contract for any exchange insurance even though obviously they’re contracted for other products from that carrier.

Reimbursement rates are expected to be lower for exchange contracts than standard ones.