When you blog about big companies, they actually read it. 

A UnitedHealthcare representative called me last week to say she had been told to look into Terry’s situation, the woman about whom I wrote last week. You can see that post here:  UnitedHealthcare: Can they get away with that?  Terry has a Pacificare health insurance policy that is being converted to a UnitedHealthcare policy, and she is going from a decent policy to a terrible one – with a $250,000 cap on her lifetime benefits.  This means that if she gets sick and runs up a bill of $250,000, UnitedHealthcare (UHC) is finished with her and her medical bills.

The UHC rep was looking into Terry’s policy and talked to Terry on Friday last week and Monday this week.  But this rep had to ask someone else to look into Terry’s policy because it is not an “individual policy” but a “conversion policy”.  Terry still hasn’t heard anything more, so we’re waiting to see what UHC’s reasoning is for converting her decent policy to a reprehensible health insurance policy, especially because Terry is a diabetic and un-insurable if she tries to get a new and better policy.

I got a call from yet another woman in her 50′s who is un-insurable. 

This woman applied for a received Social Security Disablity for health conditions I will not reveal.  Suffice it to say, she is disabled.  This woman has been on AHCCCS (Arizona Medicaid) and so has had health insurance which covers all her required treatments.  But once she got a Social Security check, which totals around $1,100 per month, she makes too much money and will be kicked off AHCCCS.

I told this woman to check with Social Security to see when she qualifies for Medicare because a person is supposed to wait 24 months to qualify for Medicare after they are deemed to be disabled .  However, the clock starts from the time a person applies for Social Security Disability and many cases take one, two, or more years to be settled.   This woman found out she will get Medicare on February 1, 2011 - but she will lose her AHCCCS/Medicaid health insurance in November.  Of course, because of her disability, she will be rejected by every insurance company. But she needs treatment each month for her illness and she will not have insurance in November, December, and January.  When her Medicare starts, she will have good insurance.  While she has no insurance, I don’t know what she will do.  Hopefully she makes it to February.

Today, September 23rd, 2010, is the day on which parts of the Affordable Care Act take effect.  As of today:

Insurance companies must offer insurance to children with pre-existing conditions.  This means that if a parent works for a small company that offers health insurance, he will be able to get his sick child coverage.  Small group plans or family plans could previously refuse coverage to a child with an illness.  That is no longer allowed.

Insurance companies can no longer cancel an individual insurance policy when a person gets sick.  Previously, when a person got sick, the insurance company would do everything it could to find something in the initial application for coverage and could say something like, “Aha, you had a yeast infection as a teenager - which you did not put on your application.  Now you have cervical cancer and we are canceling your policy because you did not divulge this pre-existing condition!”  This is no longer allowed. This really happened to someone!

Insurance policies issued after September 23rd (group, individual, and family) cannot cap lifetime benefits.  Thus one would think that Terry’s “conversion” policy, which takes effect on October 1, would not have a $250,000 lifetime benefit.  Terry is still waiting for an answer from UHC on this issue. 

Insurance policies must cover preventive care.  This means that people who have a $5,000 deductible policy, which means they pay the first $5,000 for any and all medical care, can get preventive screening tests and the insurance company must pay for them.

Republicans want to repeal these changes.  Insurance companies did not agressively fight health care reform because they are looking forward to getting 30-40 million new customers with government subsidies in 2014.