For the last month Blue Cross/Blue Shield has been running a TV campaign about their new, more affordable, individual health plans, so I decided to check them out.

What a joke!  Between their premier, HSA and basic polices there are over 20 plans. I spoke with a very informed customer service rep. who told me about the 128 question questionnaire all new applicants must complete. 

 He informed that that (a) all pre existing condition regardless of how minor  are forever excluded, (b) any condition that "develops" within the first year will be looked at as pre-existing unless proved otherwise.  For example, if a person is diagnosed with pneumonia soon after getting insurance, it will be assumed the person knew he/she was ill while applying and lied on the application.

There is no doubt that BC/BS cherry picks its clients and does all it can to exclude anyone that might actually need medical care.  Haven't we had enough of this?

On the healthcare-now site is a repost of an article from this month's New England Journal of Medicine denouncing our current system and advocating for universal healthcare.  When the NEJM gets into the act, you know things can change.  Among the things the article points out is doctor indifference and their willingness to acquiesce to the insurance companies that demand they see more patients in less time.  This, too, must end.

www.healthcare-now.org

www.dividedwefail.org

www.voicefortheunisured.org

www.Congress.org

MPL,

Many thanks for this post.

He informed that that (a) all pre existing condition regardless of how minor  are forever excluded, (b) any condition that "develops" within the first year will be looked at as pre-existing unless proved otherwise.  For example, if a person is diagnosed with pneumonia soon after getting insurance, it will be assumed the person knew he/she was ill while applying and lied on the application.

When I first became eligible for healthcare coverage, I signed on with BC/BS because of past experiences with them. I did not see anywhere on their paperwork that I would be excluded for the first 6 months because of pre-existing conditions.

Well, of course, I will have a pre-existing condition or I wouldn't even sign up to health care coverage. Because hypertension and diabetes runs in my family, I took a full blown physical at cost $1,500. My doctor said my insurance company rejected his payment request so I am stuck with this bill.

I did not have health care coverage before (last three years 2002-2005) because I could not afford it.

I appealed the decision. I paid the $1,500 but if I win, BC.BS will pay me that amount plus interest.

Please let us know if you prevail.

It would be a great victory if you do.

The whole issue with health care is that none of us knows what's in our genes.  Few are exempt from heart disease, cancer, diabetes, high blood pressure, etc., etc.  Yes, some dopes do dumb things and have reckless disregard with their health, but the are the minority.

For more than 30 years I've been a universal healthcare advocate.  Not free.  Nothing is free.  But reasonably priced, accessible , quality care.  It's what a lot of countries have and their populations are quite satisfied.

One of the issues few know is the HMO law signed under Nixon is the 70s bears a great deal of responsibility for the mess we're in now.  Like NAFTA it didn't deliver as promised.  Instead, it's provisions were turned on their head to see  profit superceded the provisions for providing adequate care.  

 And, when someone like the former head of United Health Group is forced to return $468 million in ill gotten stock options, you know the system is terribly out of control.

Good luck.

Hi, you certainly are a champion for this and do a great job keeping us informed! Here is a link to an article today on MSN, not sure there is anything new in it though.

http://articles.moneycentral.msn.com/Investing/HomeMortgageSavings/America'sHealthInsuranceCrisis.aspx?GT1=10927

I have a friend who is on disability (SSI) but not medicaid. Her husband was downsized and has not found another job so they are without coverage. She and her husband have an LLC and the only place they could find insurance was through the Chamber of Commerce. She has many pre-existing conditions as being on SSI would indicate. Their insurance is $30,000 per year!  I was speechless when she told me. They researched everywhere and were denied everywhere, this was the only place they could get it. The chamber acts like an association and they are members (pay their $300 a year) so it could not be denied. They have a high deductible on top of it all. Her father has investments and helps them pay the premiums.

Thanks for the post Assoc. 11. 

How many people would believe that even with insurance a family could be left with a $30,000 bill. 

It's very important that you and I and others keep bring this subject up and letting people know how serious the healthcare crisis is. 

 For years whenever anyone mentioned problems with healthcare coverage, they did it in whispers the way people used to talk about cancer.  As if they were ashamed and somehow it was their fault. 

This article brings up the underinsured issue which until now has been very under-reported.  Yes, the uninsured are an issue that deserves attention, but so are the millions of people paying for insurance who find out too late that it won't cover their needs.

Everyone should contact the candidates, sign the medicare for all petition at www.healthcare-now.com e-mail their state and DC representatives and senators at www.Congress.org and force the medical/pharmaceutical industry to put people first.

Hi again, what do you think about the high healthcare costs in general? Not whether an individual has or not insurance or high deductible or any of that. But that actual cost of care. I am blessed with good health and most of my costs are maintenance type things, mammogram, etc, but I am talking over and above that. Like when one enters a hospital. What are your thoughts on this?

There was an article in the AARP magazine maybe a year ago on this subject. There was a man who needed dental work, can not recall the scope of it but it was extensive and he did not want dentures. He and his wife went to Yugoslavia and had all of the work done and still had enough left over to vacation there (and this was after the airfair and lodging was deducted). I am getting an implant, I broke a tooth at the gumline. There was not enough left to put in a post and a crown so I was referred to an oral surgeon to remove the root as well as discuss the implant. I have a "fake" tooth that cost $300 (me paying 50%) and I had hoped it would suffice. There is a piece that goes across the roof of my mouth and just about drives me crazy. I can not get used to it. It looks natural and no one would ever know but it is a pain to eat or drink anything with it. Well, the cost of an implant will be around $3,000! It is a long process too as the post needs put in and that is considered surgery, and then I have to wait months for it to heal, then there is another step, have to wait again and then it can be finished, a little less than a year total. Since the rest of my teeth are fine, I will go this route as this tooth is in my smile line. But, who could afford to have multiple implants at that price? With or without insurance?

Be interested to know your thoughts just on the costs of healthcare. You may have posted this previously, but I have not read so if it is easier to point me to another post, I will be glad to look. Thanks.

Hi again,

The cost of healthcare is a topic that  I've written about many times.  Years ago survey's showed that the more doctors, hospitals, facilities in an area the HIGHER the healthcare costs.  Competition actually increased costs.  Why...because the "players" determined how much they want to earn and  how many patients they were willing to see and came up with a figure.  I'm not kidding.  In the early years of the home healthcare industry I sat at the table and heard doctors and other providers discuss the math.  It made me sick.

Another problem is that there are too many hands at the table.  Everyone gets a piece of the healthcare pie.  Unfortunately, too much of the pie goes to those who do no hands on care.

What is fair reimbursement?  That the question and the answer is not so simple.  Paperwork has driven the costs upwards as doctors must hire staff to fill in forms and monitor reimbursement.  Malpractice insurance is another area. 

Yet, I know one  physician in practice for less than two years who thinks patient without health insurance are rich and orders every test in the book.  Though his much more experienced partner and the office manager have tried to make his see the light, he's convinced himself that only rich people go without health insurance.

Several hospitals are trying a model program in which when a mistake happens the doctor/hospital admits and remedies the situation.  It reduces law suits considerably.  Most people sue because they were lied to and they're angry.  If doctors/hospitals own up and fix their mistake, people are far less likely to get a lawyer. 

But the biggest driver of upward spiraling healthcare is is now a FOR PROFIT business!!!  With regulations that favors insurers and puts few limits on the fees they can charge it's been Hi ####, Hi #### ,  it's hiking fees we go!

And, while most people were employed with employer based insurance the squeeze was gentle.  Slowly escalating premiums each year.  Now between layoff and premiums escalating at twice the cost of living index people are much more aware of the problem.  Awareness is the key.

It's been a long, hard fight to get this far.  It's unfortunate that it's taken the near distruction of the middle-class for the fight for affordable, accessible healthcare to gain national attention and support.

Exactly! I had a presentation a year or so ago for one of my boards (obviously with my screen name, I am in non profit management and vendors are always trying to get an association to endorse the product/service and to be able to reach the membership) of HSA.

While I have some problems with it and the board echoed my sentiments by not making any eye contact with this individual, there were a couple of points brought up that were valid. By the patient using his/her own monies for any tests, treatments, procedures, etc, it would drive "shopping around". I can see that being a good thing and maybe making these things more competitive but maybe not. I could also see there being a unified flat rate on them too.

Regardless, HSA's are for the young and healthy and ones who have the incomes to invest in both it and retirement. I have had to crunch numbers to prove to those under 30 that saving in a 401(k) was not going to impact his/her net pay. Once those funds are taken from the gross, well, the taxes are less. Even if not contributing 6%, it can still net to almost the same. But, to add HSA's to the mix as well, I see many younger workers deferring on this and then kicking himself in the butt down the road. We all have at some point or another.

There is no easy solution is there? Thanks again for being the champion for this cause!

Assoc,

You are RIGHT ON when  you say HSAs are for the  young and healthy.  Plus, they are usually attached to the high deductible, low coverage plans described by Consumer Reports.

After moving to another state, and researching HSA at the IRS and other sites,  and listening to a well respected radio/tv financial "guru" who advocated HSAs, I enrolled.  Let me be clear.  In my late 50s, my choices are extremely limited.

Life NAFTA  HSAs promised much and delivered little.  The devil is in the detail and insurance companies ARE NOT required to give you their full policy descriptions until you are enrolled.  That's like buying a car by only looking at the outside.  Just another example of how we the people continually get screwed by the powers that be.

As Mr. Obama stated at one rally, he meets people all the time with insurance who are afraid to use it.  I'm one of them.  He called it "house insurance," people have these policies so they won't lose thier homes in case of a medical catastrophy. However, as many are finding out, the patients portion of a healthcare bill may be well beyond their ability to pay.

We must keep advocating for affordable, accessible healthcare for all.  What was once taken for granted was taken away, corrupted and turned into gross greed for large companies literally thriving on the dead and dying. 

For the first time in twenty years people are fed up enough to do something.  We must keep those fires burning.

P.S.  Have you ever wondered why healthcare rarely shows up in polls asking Republicans about their key concerns?  It's because the question isn't asked. Unbelievable.