Health coverage 'plan' was no insurance at all

Jolie, BSN · Oct 26, 2009

If the company or its sales person engaged in fruad, they should be prosecuted, and damages paid to the customers.

Otherwise, I fault the "policy-holders" for not knowing what they were buying and not learning the limits of their "coverage" until the husband was in the hospital.

I'm sorry, but I have little sypathy for people who fail to investigate what they are buying, whether it be a mortgage, insurance policy, auto loan, etc.

This happens far too often with people who have "real" insurance also, and assume it covers everything without reading the policy, its limits and exclusions.

May sound harsh, but I don't feel sorry for these poeple. They probably argue at the gorcery store over redeeming a $.25 coupon, but spend hundreds of dollars on "insurance", and don't know what they're buying. Stupid is what stupid buys.

This is not a reason for the taxpayers to become responsible for their health care expenses.

HM2VikingRN, RN · Oct 26, 2009

No but we do need a transparent "plain language" insurance marketplace. If nothing else health care reform and the exchanges will improve transparency of the products.

Taxpayers will end up eating the 50K if the couple goes into bankruptcy.

She did do her homework,,,,,(From the source...)

Mary, who took meticulous notes, initially chose a plan for $588 a month. The salesman, who identified himself as Darryl Williams of Mid South Benefits, promised it would cover all preexisting conditions, Mary Lloyd recalled. After a few questions, "he said, 'Wonderful, you qualify.' "
A month later, they were still waiting for something in writing. With their old insurance expiring in two days, Mary Lloyd called Williams in late January. That's when the salesman offered to switch them to a better and cheaper plan. She admits, in retrospect, that she didn't ask a lot of questions. Running out of time, she simply agreed.

They were "bait and switched..."

Jolie, BSN · Oct 26, 2009

No but we do need a transparent "plain language" insurance marketplace. If nothing else health care reform and the exchanges will improve transparency of the products.
Taxpayers will end up eating the 50K if the couple goes into bankruptcy.
She did do her homework,,,,,(From the source...)
They were "bait and switched..."

The "bait and switch" as you call it came about because, by her own admision, "the salesman offered to switch them to a better and cheaper plan. She admits, in retrospect, that she didn't ask a lot of questions. Running out of time, she simply agreed." Common sense would have prevented that. Doing her homework would have prevented that. Asking questions and for information in writing would have prevented that. No "better" plan is "cheaper." She wanted something for nothing. She got nothing for something because she chose to make an uninformed purchase. She was lazy and now she's in a bind of her own making. It is not the taxpayers' job to get her out of it.

I can't wait to see the "transparency" the Dems require of insurance companies. If it's anything like the transparency we've seen of the Obama administration, we're in trouble. Remember the high standards promised of Cabinet nominees, the promise to have bills available on-line 5 days for taxpayers to read prior to a vote, the proliferation of Czars who are not accountable to Congress or the electorate? Transparency is hardly the forte of this party or administration.

Jolie, BSN · Oct 26, 2009

Taxpayers will end up eating the 50K if the couple goes into bankruptcy.

A bankruptcy that will undoubtedly be blamed on "medical expenses," instead of stupidity or laziness which would be more accurate descriptors.

HM2VikingRN, RN · Oct 26, 2009

I don't think the timelines support that comment....The larger issue was that this couple was a victim of fraud....

GCTMT · Oct 26, 2009

Smart people can do some pretty stupid things.

I hope the company is prosecuted. I hope these folks are able to avoid bankruptcy.

*shrugs*

The free market at its finest.

Medic2RN, BSN, RN, EMT-P · Oct 26, 2009

It is not the free market. It is the criminal element. You'll find that element in whatever type of system we have or will have.

Long Term Care Columnist / Guide · Oct 26, 2009

It is not the free market. It is the criminal element. You'll find that element in whatever type of system we have or will have.

Yeah, and what I call criminal is paying $440 a month for health insurance through my employer that pays....for......NOTHING!!! :devil: :angryfire

That's right. I have had this insurance for a year, paid thousands of dollars into it.........and they are refusing to cover any of the expenses for my hyperparathyroidism, which have already topped a thousand bucks and continue to mount. We haven't even gotten to the DEXA scan and the renal U/S I just had a couple of weeks ago, let alone the surgery I'm going to need. :devil: Why? Well, according to them it's a "pre-existing condition", even though I have never been officially diagnosed with the condition until now.

Somebody please, tell me how in the name of all that is reasonable can an insurance company get away with ripping off consumers, month after month after month, and NOT having to provide the services we are paying for??!! And how is that moral, or right, or even good business?? My husband and I are already in so deep from having so many medical expenses over the past year for our REAL pre-existing conditions that I don't see us ever getting out from under the crushing debt load..........of course the hospitals and doctor's offices never bill us for everything all at once so we never really know just how much we owe them, but I know it's in the tens of thousands and probably will reach six figures before this particular episode of my life is over.

I feel like I'm shoveling (insert vulgar term for 'feces' here) against the tide when I pay my co-pays at the time of service and then open up the bills two months afterwards to find that my insurance company has denied yet another claim. :angryfire This is what has convinced me---a political conservative in almost every other way---that single-payer health care is the ONLY way for middle- and lower-income people to survive financially, at least if they're past 35 and have a few medical issues.

I think you all know I work hard and play by the rules; I'm not lazy, looking for handouts, or trying to cheat the system. So how is it that some folks evidently think it's perfectly OK for an insurance company to cheat ME??!!

Just venting.........I am really, really ANGRY about this and it mystifies me that anyone can possibly justify the continuation of this evil non-system in light of the fact that it's not just "the poor and lazy" who are going bankrupt here. :devil: :devil: :devil:

Moogie · Oct 26, 2009

The "bait and switch" as you call it came about because, by her own admision, "the salesman offered to switch them to a better and cheaper plan. She admits, in retrospect, that she didn't ask a lot of questions. Running out of time, she simply agreed." Common sense would have prevented that. Doing her homework would have prevented that. Asking questions and for information in writing would have prevented that. No "better" plan is "cheaper." She wanted something for nothing. She got nothing for something because she chose to make an uninformed purchase. She was lazy and now she's in a bind of her own making. It is not the taxpayers' job to get her out of it.

I read the article in today's Star-Tribune as well. Apparently the couple could not afford the $1200/month payment for insurance through COBRA. They found this health plan at less than $500 a month; ad said everything was covered. Insurance agent called her to offer a "better but cheaper" plan and she switched. Was she being greedy? Perhaps. Should she have looked elsewhere when this seemed too good to be true? Definitely. But what is done is done.

And yes, she should have known better as she had been a clinic and hospital manager for something like 28 years. Maybe she was arrogant and thought she "knew it all". Maybe she didn't pay attention. Regardless, she and her husband were without insurance when he had his MI and those premiums she paid most surely went into some scammer's wallet.

If you get a chance, do try to read the entire article. It might give you a different impression about this story.

Home Health Columnist / Guide · Oct 26, 2009

cinergy health insurance

our cinergy health preferred insurance plans are limited medical benefit plans, which provide first dollar coverage for the predictable medical care people need most frequently. these insurance plans provide coverage starting with a member's very first doctor's visit without a deductible so that you don't put off important medical care. from doctor visits and diagnostics to maternity and surgeries you can feel confident that you have the essential coverage you need that's easily within your budget. and best of all, you can choose your own doctors and hospitals without being confined to a list.
cinergy health preferred includes benefits for:
doctor visits
hospital stays
surgical procedures
icu
critical care benefits
labs and x-rays
diagnostic testing
wellness check-ups
preventive tests
pregnancy
medical accidents
emergency room visits
accidental death and dismemberment coverage and more...
the cinergy health preferred plans are guaranteed issue, so everyone qualifies regardless of pre-existing medical conditions. all eligible applicants pay the same rate provided you are under age 65 upon enrollment.* however, there is a six month waiting period for benefits related to conditions for which the member was seen, treated or diagnosed within the six months prior to enrollment unless proof of prior creditable coverage is provided.

this plan was heavily advertising in pa in beginning of the year. i've had patients who had this insurance and hhave called to obtain benefits--- calling pts to set up home care services were shocked to find that it had per year limits of $1,000 for radiology, ~$10,000 for hospitalization and no coverage for home health care or durable medical equipment. from the above description, you'd think you have 100% coverage for these services.

azhiker96, BSN, RN · Oct 26, 2009

Vivalasviejas, once you have a year of creditable coverage then pre-existing conditions can't be used to deny payment. I'd suggest a letter to your state insurance commissioner. The P in HIPAA is for portability.

http://er.hipaaps.com/hipaa_portability.htm

The P in HIPAA stands for portability of medical coverage. This part of HIPAA went into effect on July 1, 1997. On the date the plan or insurer becomes subject to the HIPAA provisions, the plan or insurer may not exclude coverage for any pre-existing medical conditions for more than 12 months after an individual's enrollment date (18 months for a late enrollee).
In addition, the medical plan must count any creditable coverage that individuals accumulated prior to their enrollment date to reduce their remaining pre-existing condition exclusion period. So what does this mean? Suppose a new employee has had continuous creditable coverage for 9 months prior to the effective date of the new employer coverage. The new medical plan can enforce a waiver of any pre-existing conditions for a maximum of three more months. After 12 months of continuous creditable coverage, all pre-existing conditions must be covered as any other illness. It also means that if the employee has had at least 12 months of coverage prior to the new coverage, then no pre-existing conditions can be waived.
A late enrollee is an employee that does not elect coverage when offered and delays joining the medical plan. The creditable coverage period can be extended to 18 months. However, if the employee still has 18 continuous months of coverage, pre-existing conditions are still covered.