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!

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.

The other day I wrote about Terry,  a woman with a health insurance policy from Pacificare that is being “converted” to a UnitedHealthcare policy because United took over Pacificare about five years ago.   The new policy is a terrible policy and I have been trying to get answers from somebody/anybody who can tell me how this can be allowed – particularly because the woman involved has no choice but to accept whatever United gives her, since she is un-insurable due to diabetes and other health conditions.

The worst part of this woman’s “conversion policy” is a lifetime limit to her  health insurance benefits:  $250,000.  That amount of money could be used up during one stay in a hospital! And I thought the Affordable Care Act put an end to this kind of limit.  I did some research about the law and found that such limits will no longer be allowed in 2014, but allowable lifetime benefit limits are supposed to be $750,000 after September 23, 2010 through September 2011; $1,250,000 in 2012; $2 million in 2013.  So it looks like insurance companies can still limit the amount of money they will pay out.  And then there is the question of whether or not Terry’s new policy is considered a “grandfathered” plan to which the Affordable Care Act does not apply.

Yesterday I was looking at Blue Cross Blue Shield of Arizona’s individual health insurance plans – and I noticed something was missing from the benefits information page for each individual policy.  There was no mention of a lifetime benefits limit.

I called up Blue Cross Blue Shield of Arizona to be sure I wasn’t misreading the information. And what did I learn?  Blue Cross Blue Shield of Arizona is no longer putting lifetime benefit limits on their health insurance policies. They are implementing elements of the Affordable Care Act now and not waiting until 2014.  Blue Cross Blue Shield of Arizona policies also cover preventive care at 100%  (and the deductible does not apply to these services).  This is another part of the Affordable Care Act which Blue Cross Blue Shield of Arizona has already implemented.

On the UnitedOne website for individual insurance policies, the plans have either a $3 million or $5 million lifetime benefit limit.  So where did United come up with the conversion policy for Terry?  Did they just make up a policy for her?

I’m still trying to get answers about Terry’s insurance.  Terry is afraid to talk to United, for fear that they might take away the lousy policy.  I told Terry they can’t do that – but then again, I wouldn’t think they could convert her to such a lousy policy.