Yesterday I had a conference call with “Alonzo”, who is from Tucson, and Golden Rule Insurance. I waited more than ten minutes to talk to a Golden Rule representative. Then I got Alonzo on the phone. We  talked for five minutes and explained Alonzo’s situation. We asked to talk to someone who understood the type of policy Alonzo had. We waited another ten minutes to be transferred to someone who could, hopefully, explain exclusions in his health insurance policy.  We talked for maybe three minutes with a representative who had Alonzo’s information on her computer screen. We gave her information, asked her several questions, and then we got cut off.  Alonzo waited for a phone call from this Golden Rule representative, but the phone call never came.

How can a billion dollar company not follow-up on a dropped call from a client who has already paid them over $4,000 in premiums?  Alonzo’s story is complicated and frustrating.

Alonzo works for a small construction company that dropped its group health insurance because the premiums got too expensive, despite rising deductibles and co-pays each year.  Alonzo figures he paid over $80,000 in health insurance premiums over 20 years and he was never really sick all that time.  He is overweight and pre-diabetic, and at 64 he was about to be uninsured.  To make things worse, Alonzo was diagnosed with prostate cancer just as he was losing his group insurance.

Alonzo applied for coverage with Blue Cross Blue Shield and was rejected because of his pre-existing conditions (and this was before he knew about the prostate cancer).  His only choice for coverage was to use the Health Insurance Portability and Accountability Act (HIPAA) which is a federal law from 1996 that requires insurance companies to offer a health insurance policy to people who have had group insurance, but lost it.  People who would not qualify for individual health insurance due to pre-existing conditions can get a guaranteed issue health insurance policy under HIPAA.

The HIPAA law has several requirements, all of which Alonzo met.  The HIPAA law also lets insurance companies take their premium rate for a healthy person, add ten percent to it, and triple that number.  So Alonzo would pay over $1,400 per month for the Golden Rule policy which has a $3,500 deductible.  He chose to pay this premium to protect his family from financial ruin that can come with serious illness and no health insurance.

Alonzo arranged for treatment of his prostate cancer, and the oncology center contacted his insurance company to check on his coverage.  Golden Rule said Alonzo is covered, but there is a six-month exclusion for treatment of “reproductive organs”, and the prostate falls under this exclusion.

Alonzo called me and I did some research about HIPAA policies, but I think we need an expert’s help on this.  Does the HIPAA law allow insurance companies to charge ridiculously high premiums for people with pre-existing conditions and then offer a policy that excludes treatment for those pre-existing conditions?

Alonzo doesn’t have time to wait for answers.  And he may have missed his one chance to get decent (though expensive) coverage under the HIPAA law by choosing the Golden Rule plan. This is an example of why I hate individual health insurance and why I concentrate on Medicare.

UPDATE Thursday, January 6, 2011:  Golden Rule did call! And it turns out the problem was all a mistake, or mis-communication……and Alonzo has no exclusions in his policy.  See my Jan. 6th post for more details.

Reuters reported that UnitedHealth Group Inc has posted a higher-than-expected second-quarter profit, helped by growth in its Medicare Advantage plans for elderly and low-income Americans.

For the second quarter (April, May, June), UnitedHealth said net income (profit) increased to $1.12 billion from $859 million a year earlier. Revenue rose 7.4 percent to $23.26 billion.

UnitedHealth is the biggest provider of Medicare Advantage plans, and its Medicare Advantage membership rose 17 percent from 2009 to 2010. UnitedHealth’s Medicare Advantage revenue grew 13 percent to $9 billion.

Revenue in its health plans for low-income Medicaid recipients jumped 21 percent to $2.5 billion. The company’s Medicaid membership increased 16 percent.

Reuters analysis:

UnitedHealth kicked off what is expected to be a strong earnings reporting season for health insurers. However, Wall Street enthusiasm for the industry is expected to be tempered as investors question whether its performance will be sustainable under the new U.S. healthcare reform law.

Wall Street is concerned about the hit to profits next year from new regulations that will mandate how much insurers must spend on medical costs. Government regulators are also fighting back against proposed premium rate increases by the insurers.

Longer term, healthcare reforms are designed to provide insurance coverage for an additional 32 million Americans, many through the Medicaid program for low-income Americans and UnitedHealth is well-positioned in this market.

NOTE:  UnitedHealth Group companies in Arizona are: Secure Horizons Medicare Advantage plans, Evercare Medicare Advantage plans, and APIPA Medicare Advantage plans and AHCCCS health plans.

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