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Posts Tagged ‘health net’

Arizona Lawsuit Against Healthcare Reform

Friday, August 13th, 2010

The East Valley Tribune reported:

The Goldwater Institute filed a federal lawsuit Thursday to block national healthcare reform, arguing it violates the rights of a Tempe business owner, Arizona lawmakers and even members of Congress.

The lead plaintiff is Nick Coons, 31, owner of RedSeven, a Tempe-based computer repair company. The suits says he carries only catastrophic insurance coverage to save money and because he is healthy. The plan covers costs of $5,000 or more and Coons pays for other medical care himself.

“I think I would have standing in this case because I don’t have health care coverage that the bill would consider adequate,” Coons said Thursday.

The suit argues Coon’s medical privacy would be violated by forcing him to disclose medical records to an insurance company, and that those documents could be accessed by the federal government without his approval.

Mr. Coons seems to be misinformed about the health care reform insurance requirements. I am an insurance agent and my understanding is that an insurance exchange will be set up to offer a variety of coverage options for small business owners and individuals like Mr Coons. I haven’t read anything that says high deductible plans will be eliminated. I’m pretty sure he will be free to choose a $5,000 deductible plan, but that plan will be better than what he has now because it will be required to cover preventive care that is not subject to a deductible.

With regards to Mr. Coons’ concern about insurance companies seeing his medical information, I have some news for him.  When he applied for health insurance he gave the insurance company permission to access his information – and it was available from a central database. Any insurance company (with his permission) can access his medical history. And if Mr. Coons were not so healthy, an insurance company to which he applies for coverage would request medical records from his doctors (with his permission) and the insurance company might find a reason to reject him. This rejection information will go into the central database, so if he applies to another insurance company he will be red flagged – and possibly rejected automatically. My point is that health care reform is not changing anybody’s access to his information. Big brother is already out there – and it’s the health insurance industry.

One more thing:   If Mr. Coons, or his wife, or his child should be diagnosed with diabetes or some other illness, he might change his tune. He’s healthy, so he was able to get health insurance.  But what about an entrepreneur with a great business idea who has diabetes?  That person is uninsurable. Or what about a small business owner who has a child born with an illness that makes that child uninsurable?  Until the reform law was passed this year a child born with an illness could be refused coverage by his parents’ insurance company. This is something that has already changed due to the reform law.

As an insurance agent I think the reforms will free entrepreneurs to think about growing their business rather than how they are going to get health insurance for themselves and their employees. People will be able to pursue their entrepreneurial dreams if they know they can get health insurance. I think the reforms will open up many possibilities for entrepreneurs who might not be as young and healthy as Mr Coons.

How many people would quit their stinking jobs that they keep just for the health insurance?    And how many people in their 50′s and 60′s would retire early if they could get an individual health insurance policy? These people have IRA’s and 401Ks that would allow them to quit work and pursue other things – but they need health insurance.  They might not qualify under current rules that allow insurance companies to reject them because of their weight, or high cholesterol, or osteoporosis, or cancer they had five years ago.  If these people can retire early and get health insurance jobs will open up for younger workers – and this will be a big boost for the economy.

I don’t know the details of Mr. Coons’ health insurance policy, but it sounds to me like he has a weak case that is based on misinformation and paranoia. These are health conditions that seem to be rampant in Phoenix.

Why Is Health Insurance So Expensive?

Tuesday, May 11th, 2010

The seven largest American health insurance companies totaled over $265 billion in revenues in 2009.  If 20% of these revenues are spent on things other than paying medical bills for people insured by these companies, that amounts to approximately $53 billion.

Administrative costs for these companies should be around 5% of revenues, leaving 15% for marketing, sales commissions, and really big executive salaries.  That results is a $40 billion expense that Americans must add to their health insurance costs – a cost that no other country imposes on its citizens.  This is one reason our health care system is so expensive.

Correction: In my recent post on health insurance companies becoming more like utility companies, I wrote (incorrectly) that two insurance companies together would have two trillion dollars in revenue in 2010.  The correct amount is two hundred billion dollars (projected for 2010).  Sorry about that mistake.

According to Fortune 500‘s 2010 list, the top seven health insurance companies in terms of overall revenues for 2009 were:

1. UnitedHealth Group – $87 billion
2. WellPoint – $65 billion
3. Aetna – $34.7 billion
4. Humana – $30.9 billion
5. Cigna – $18.4 billion
6. Health Net – $15.7 billion
7. Coventry Health Care – $13.9 billion

CEO COMPENSATION:

Stephen Hemsley – UnitedHealth Group

Total 2009 Compensation: $8,901,916

Compensation breakdown:

  • Base salary of $1,300,000
  • Stock awards of $4,122,694
  • Option awards of $1,442,306
  • Non-equity incentive plan compensation worth $1,950,000
  • “Other compensation” including company matching contributions for a 401(k) plan and company matching contributions under an executive savings plan valued at $86,916
Total 2009 Compensation: $6,509,452

Jay Gellert – Health Net

Total 2009 Compensation: $3,643,342

Compensation breakdown:

  • Base salary of $1,200,000
  • Non-equity incentive plan compensation worth $1,587,600
  • Change in pension value and nonqualified deferred compensation worth $767,347
  • “Other compensation” including use of a corporate aircraft, personal use of corporate vehicles and company matching contributions for a 401(k) plan valued at $88,395

What is Your Medicare Coverage? Can You Afford It?

Saturday, May 1st, 2010

Kathy needs triple by-pass surgery and is supposed to go into the hospital next week.  She has been told by the hospital that she must pay $695 before the hospital will admit her. Kathy’s mother, Lucille, called me yesterday to ask if I could sort out her daughter’s confusion over this required payment.   This was a case of putting together clues I got from Kathy and Lucille in order to figure out what kind of coverage Kathy has and why she was told she must pay a $695 advance payment to the hospital.

Clue # 1:  $695 is the hospital co-pay for Health Net’s Ruby 3 Medicare Advantage plan. Kathy did not have her Health Net card with her, so she couldn’t tell me for sure what plan she is enrolled in – but she said she is enrolled with Health Net.

Clue# 2:  I asked  Kathy if she pays a monthly premium for her Health Net plan.  She said she thought it is thirty-some dollars per month.  Last year Ruby 3 had a $38 premium (but it was raised to $59 this year).  Kathy has the premium taken out of her Social Security check, so she probably didn’t notice the increased premium.  (Note: This plan includes dental, vision, and hearing aid benefits, which is why it has a $59 monthly premium).

With  these clues, I was able to tell Kathy that she is probably enrolled in the Health Net Ruby 3 Medicare Advantage plan.  I told her she needs to carry her Health Net card with her at all times, because this is her Medicare coverage.  I said that if her doctor said she would be in the hospital for 5 or 6 days, the $695 co-payment is actually a good deal.  Most of the other Medicare Advantage plans in Tucson have a hospital co-pay of $200 per day or more,  which would cost a patient $1,000 or more for a 5-day hospital stay. Under her Medicare Advantage plan, every service Kathy receives in the hospital will be paid by Health Net, so this is a pretty good deal for a $695 co-pay.

The problem for Kathy is that she  doesn’t have $695.  And if she can’t give the hospital $695 up front, she doesn’t get the heart operation she needs.

So my questions are:  Why is Kathy enrolled in a plan she doesn’t understand?  And why is she paying $59 per month ($59 x 12 = $708 per year) if she doesn’t have $695 in the bank for her hospital co-payment? Who signed her up for this plan knowing that she lives on a Social Security check that is around $1,300 per month? And finally, will she be denied a life-saving operation if she can’t come up with $695?

I told Lucille that Kathy’s plan requires the $695 co-pay, and that it is a very reasonable co-pay for a hospital stay of 5 days (or more). Lucille felt better because she understood her daughter’s coverage -  and she said she’d find a way to get the money.  She said this is a life or death situation for her daughter, so she’d do what she could so Kathy could get the operation.

I always say to people that you don’t know how good (or how bad) your insurance coverage is until you need it. This is the case with Medicare Advantage plans.  And while a $695 co-pay for major surgery seems very reasonable, there are many people who just don’t have this kind of money on hand.  What are they to do?

Medicare Advantage plans save seniors (and people on Social Security Disability) a lot of money – as long as they are healthy.  But when they have health problems, the co-pays for specialists, tests, and hospital stays can add up.  Kathy is about to learn this, the hard way.  And what kind of health care system do we have if a person is refused life-saving surgery because she doesn’t have enough money to pay a $695  hospital co-payment?