As an insurance agent I work mostly with Medicare and I’m happy about that. Medicare can be confusing because seniors have a number of choices to make about their coverage – but there are standards and, most importantly, nobody is refused coverage. The individual insurance market is completely different, and I hate it – especially when I have to inform a client that they have been “declined” by the insurance company, or when an insurance company gets away with unfair practices.
An Update on “United Healthcare: Can they get away with that?”
Back in September I wrote about “Terry”, who had a decent individual insurance policy with Pacificare. Pacificare was bought by UnitedHealthcare several years ago and all Pacificare policies are being terminated and coverted to UnitedHealthcare policies. Apparently, United can take Terry’s decent health insurance policy and convert it to a crappy policy – and it’s perfectly legal. As a result of my September 14th blog post about Terry, United did look at her case and corrected two out of three problems I had pointed out.
1) United acknowledged that Terry’s conversion policy should not have a $250,000 lifetime benefit limit. Oops, United had somehow missed the news about the Affordable Care Act that eliminates caps on what insurance companies must pay out for clients’ health care costs.
2) Terry’s packet of info on her conversion policy did not include drug coverage, but it turns out the policy will have a drug plan. Oops, somebody at United had left out this info.
3) Terry’s conversion policy has no cap on her 20% co-insurance, which is what she pays for her health care costs after she has met her deductible. It turns out this is perfectly legal.
I have never seen an individual health insurance policy offered by United that does not include such a cap. This cap is important because it limits financial risk in case a person has a serious illness like cancer. I’ll say it again. I have never seen a health insurance policy that does not have such a limit, so I don’t know why United designed such a policy for Terry. Oh, wait, I think I do know why. Terry has diabetes and is un-insurable. She can’t get another insurance policy because of her pre-existing condition, so she must take what United gives her. What a system! I can’t wait for 2014 when this will no longer be permitted!
Next: I’ll be writing about several people trying to get individual health insurance, some with success and one who was declined. Medicare is so easy – even if a bit confusing – and individual insurance is so disheartening and unfair. I hate it!