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Old 11-26-2019, 11:03 AM
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Seeing how health insurance companies force out those who play by the rules and then get sick.


I'm sure there are other ways, but a scummy method just came to light. Now this is not for me, but I see it's effect on 4 people who are long time workers, always carried medical insurance, and who have developed serious and expensive medical issues and are expected to need care for years to come.

The method takes about 3 years to implement it it's full ugliness. And the insurance representative actually used the word 'gross offenders' to describe those 4 people. It seems clear that they 'encouraged' management to do this. It basically goes like this, year one premiums jump up for that plan, and a second 'slightly lesser coverage' plan comes about at a much lower price point and incentives to jump plans, but will not do those 4 people much good - or at least it is better for them to stay with their current plan..

Year 2, due to the large number of workers who went with the cheaper plan and with the 4 gross offenders staying on the more expensive plan to get the coverage they need, the expensive plan gets a huge rate increase due to the cost of those 4 being diluted by less people on that plan. Now they also offer incentives to leave that expensive plan to a high deductible plan. More people leave.

Year 3 By the end of year 3 the price of the most expensive plan is astronomical forcing all but the most dire cases to stay on it, but at that point the price is prohibitive.
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Old 11-26-2019, 11:19 AM
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Are you bitching about the Health Insurance company or the employer?
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Old 11-26-2019, 11:50 AM
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Yeah, I've heard stories of small business premiums jumping dramatically because one person got cancer.

It's a miserable, evil system. I wish we could change it, but I have little faith that we can except via ballot initiative.
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Old 11-26-2019, 01:36 PM
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Are you bitching about the Health Insurance company or the employer?
I guess it's actually the opposite. I am impressed and somewhat in awe in a weird way at the way they went about this. So personally cruel and heartless but also so detached cold and calculated at the same time.

In some ways it's a form of shunning, excluding someone from a group and forcing them outside, which seems to live on in many different forms. I guess that's what I am bitching about.
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Old 11-29-2019, 10:41 AM
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More than just shunning. Killing.
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Old 11-29-2019, 12:00 PM
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Meh - America.
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Old 11-29-2019, 12:17 PM
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Why don't the insurance companies simply hire someone to hunt down and quietly kill those people that are making claims? Seems that this would accomplish the same goal, and be more efficient.
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Old 11-29-2019, 12:40 PM
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Yeah, I've heard stories of small business premiums jumping dramatically because one person got cancer.
I've never figured out why the risk pool for health insurance is limited to a particular group or employer. For car insurance, my risk is shared across all the policy holders for that insurance company. That's the whole point of insurance. So why does one sick person at a company impact just that company's premiums? Surely the insurer has thousands (hundreds of thousands?) of other healthy people under their coverage. That a few get sick is expected, no matter which company they're employed by.
  #9  
Old 11-29-2019, 12:46 PM
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Why don't the insurance companies simply hire someone to hunt down and quietly kill those people that are making claims? Seems that this would accomplish the same goal, and be more efficient.
Duh, that's murder. Depriving people of necessary healthcare? That's CAPITALISM!
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Old 11-29-2019, 02:50 PM
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Yeah, I've heard stories of small business premiums jumping dramatically because one person got cancer..
I used to get my insurance through a small business I did contract work for. In one year, one high level employee had kidney cancer AND TWO serious bicycle accidents. Another one had gastric bypass surgery, then later that year she was hospitalized for 8 weeks with pneumonia that would not respond to anything, then she got lung abscesses then finally they cleared it all up surgically. But can you imagine the hospital bill for an 8 week stay? The place only had 8 full time employees, and the other employees had their fair share of medical issues, although not on that scale.

Now I was reimbursing this company for the full cost of my insurance, which kept getting more and more expensive. Many insurers just flat out refused to cover them. The ACA saved me, because it allowed me to find a somewhat reasonable individual policy. Still expensive, $600 a month or so, but pre-ACA i was getting quotes of around 2K a month for an individual policy for a single person.

Last edited by Ann Hedonia; 11-29-2019 at 02:51 PM.
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Old 11-29-2019, 03:02 PM
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Duh, that's murder. Depriving people of necessary healthcare? That's CAPITALISM!
A hit job may be cheap, but staying out of prison is very expensive. From a financial perspective it's not a good move.
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Old 11-29-2019, 04:24 PM
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Not being in the US this is all alien to me, but I was always under the impression that the whole point of a group plan is that all members of the group had the same rates and coverages. Ah, but I begin to see how this works! Through the wonderful free-market feature of "choice", the victims are being offered a "choice" of different plans where, by sad coincidence, only one of the plans is any good to the four sick people, and it's exorbitantly expensive. It should also serve as a warning to anyone else who dares to get seriously ill, because they'll be in the same boat.

It reminds me of another lovely industry inspired by free market capitalism, protection racketeering, as practiced by Capone-era mobsters. Insurance works somewhat well for things like car insurance, where a number of at-fault accidents quite reasonably define you as a bad driver and your rates go up. You might even decide to stop driving for a while. Do these insurance companies expect these sick people to stop living? Why, yes, in fact, although they would never explicitly say it, but "fuck off and die" is precisely their wish for them on this holiday season.

Let me say that I'm a great fan of capitalism as a fantastic engine of commerce that has brought us much of the wealth and standard of living that we have today. The mistake that conservatives make on this issue is that like the metaphorical craftsman who possesses only a hammer, everything to him looks like a nail. As illustrated in the OP, there are certain things that capitalism is very, very bad at, and human health insurance is one of the most egregious examples. When someone is seriously ill, the absolute last question that should be on anyone's mind is "how can we exploit this to maximize shareholder profit?" (or in the case of insurance, to minimize "medical loss ratios"). Because any answer to that question runs squarely against all medical ethics and human decency.
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Old 11-30-2019, 01:27 AM
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Yeah, I've heard stories of small business premiums jumping dramatically because one person got cancer.

It's a miserable, evil system. I wish we could change it, but I have little faith that we can except via ballot initiative.
Don't count on it. In Colorado we tried and thanks to the millions the insurance companies put into the campaign, 70% of my state felt the current system was just fine.
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Old 11-30-2019, 05:09 AM
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Originally Posted by Robot Arm View Post
I've never figured out why the risk pool for health insurance is limited to a particular group or employer. For car insurance, my risk is shared across all the policy holders for that insurance company. That's the whole point of insurance. So why does one sick person at a company impact just that company's premiums? Surely the insurer has thousands (hundreds of thousands?) of other healthy people under their coverage. That a few get sick is expected, no matter which company they're employed by.
Everyone who has a car has to have car insurance (liability insurance at least, comprehensive if you have a loan out) so there's no negative selection. That's no longer the case with health insurance, so there's negative selection -- the people who need health coverage are much more likely to pay for it, and healthy young people are more likely to skip it. That's true even at the group level.

Many companies are self-insured, where the insurance company is just the administrator. I don't know how small of a company can do this though. And, I don't know enough about the ins and outs of group insurance to comment on group sizes.
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Old 11-30-2019, 05:32 AM
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America's health insurance system is dysfunctional. In other news, Generalissimo Franco is still dead.

I've mentioned the story of my friend John's car insurance before. He was a week late paying the premium, but the insurance company cashed the check. Life went on. Many months later, after an accident, John filed a claim. It was refused because the payment months earlier was late. "But you cashed my check!" Oh! We'll mail you a refund.

I think many insurance executives should be in prison, but the trillion-dollar justice system is too busy killing blacks who sell loosies, or who break into their own homes. Make America Great Again!
  #16  
Old 11-30-2019, 07:56 AM
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I've never figured out why the risk pool for health insurance is limited to a particular group or employer.
Because by treating each "group policy" as an individual pool, they get more money. Since they can do it that way, they do.

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Originally Posted by Ann Hedonia View Post
Still expensive, $600 a month or so, but pre-ACA i was getting quotes of around 2K a month for an individual policy for a single person.
I pay the highest amont Seguridad Social charges and it comes up to less than 300€. I know American salaries are higher than Spanish ones, but damn.
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Last edited by Nava; 11-30-2019 at 07:59 AM.
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Old 11-30-2019, 10:08 AM
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Everyone who has a car has to have car insurance (liability insurance at least, comprehensive if you have a loan out) so there's no negative selection. That's no longer the case with health insurance, so there's negative selection -- the people who need health coverage are much more likely to pay for it, and healthy young people are more likely to skip it. That's true even at the group level.
I understand that, but once I have made the decision to buy insurance, who cares what company I work for.

Suppose I could find out what company provides health insurance to the employees of Amazon. I should be able to go them, as an individual, and say "I'll take the same coverage you're selling to Amazon." I'll have to pay the whole cost of it myself, of course. I am no more, or less, likely to get sick than an Amazon employee is. If the insurance company can sell coverage to x Amazon employees and turn a profit, they should be able to sell to x + 1 and profit even more.
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Old 11-30-2019, 01:00 PM
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Actually, the assumption on the part of the insurance empire is that if you are seeking insurance on your own it's because you ARE more likely to become sick/injured than average. You're anticipating needing it, rather than being a clueless Joe who assumes he will never get sick or injured.
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Old 11-30-2019, 01:05 PM
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I understand that, but once I have made the decision to buy insurance, who cares what company I work for.

Suppose I could find out what company provides health insurance to the employees of Amazon. I should be able to go them, as an individual, and say "I'll take the same coverage you're selling to Amazon." I'll have to pay the whole cost of it myself, of course. I am no more, or less, likely to get sick than an Amazon employee is. If the insurance company can sell coverage to x Amazon employees and turn a profit, they should be able to sell to x + 1 and profit even more.
I get insurance through a group called TRS, which provides insurance for most public educators in Texas. Our rates are TERRIBLE. I've been rold this is because we have a higher % of women, so total costs are higher, so we all pay more. If we cpuld all get into a lower risk pool, we would . . But it wouldn't be lower risk.
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Old 11-30-2019, 01:33 PM
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Duh, that's murder. Depriving people of necessary healthcare? That's CAPITALISM!
^This.

My employer used to have 3 levels of coverage with 3 different deductible and premium levels. Then I guess they couldn't afford that anymore so last year went down to two levels. You could have no premium and something like a $4000 deductible or you could have a premium of about $80 a month and a $2000 deductible. Whoopie! And if you wanted to have your spouse or children on it, your premiums would be pretty much unaffordable for most people working there.

This year the two plans are basically the same but the deductible has gone up $1000 for each, the premium for the "better" plan has gone up to $100 a month from $80, and the family premiums are totally unaffordable. I have opted for the no premium plan this year because being on the "better" plan for the past couple of years hasn't done much for me as far as I can tell. I'm not going to be able to afford the high deductible either way so I may as well pay no premium anymore. It worries me because I am a potential "gross offender" who hasn't had anything major while on this plan yet but could, considering my medical history.

My employer has had a terrible time finding insurance for us, apparently. This is the best they can do, they claim.

They have added some programs this year that they hope will help us with costs. There's a program to talk to a doctor online for $10 a pop for small issues like a cold or a UTI (but I can't figure out how they help you over the Internet with a urinary problem). There's a program that helps you find a lower price if you have an upcoming surgery, but it only works for certain types of surgeries - no surgery for brain or cancer. There will also be a program to give you someone to go over your medications with you and see if there's anything cheaper or redundant in your medication list.

This overall situation cannot continue, but most of the populace keeps obliviously dancing into the fire and taking the rest of us with them by voting for politicians who tell them that the free market solves everything.
  #21  
Old 11-30-2019, 01:57 PM
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I've mentioned the story of my friend John's car insurance before. He was a week late paying the premium, but the insurance company cashed the check. Life went on. Many months later, after an accident, John filed a claim. It was refused because the payment months earlier was late. "But you cashed my check!" Oh! We'll mail you a refund.
Reminds me of a joke:

A man's ox died. He told his friend, "How will I plow my field now? I can't afford $500 for a new ox!"

A couple of days later, his friend comes back and gives hi, $499.50 towards a new ox. The man was thrilled, but asked his friend, "but how did you get this money?"

The friend says, "Simple! I just sold $1000 raffle tickets for 50 cents a piece, with the winner getting your old ox."

The man asks, "did no one care that my old ox is dead?"

The friend says, "Only the guy who won did, so I gave him his money back."
  #22  
Old 11-30-2019, 02:08 PM
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OK, so maybe we can't do Medicare for All. So, howzabout we get as close as we can? Maybe have a bake sale, or skip the fun of another futile and expensive war. Just a thought.

Last edited by elucidator; 11-30-2019 at 02:08 PM.
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Old 11-30-2019, 02:27 PM
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My city is drowning in health care costs. Their “pool” is considered small, just under 100 people. But half of them are in jobs that are physically demanding so they need to be healthy to do their jobs but their bodies take a beating (service and fire/EMT). And more than half are Union (Service, Fire, police) so they demand good coverage with low contributions (which is fine with me). It really puts a strain on the company’s bottom line.

I’ve often wondered why employers aren’t raising up and demanding government sponsored health care. And why when “protecting the small business owner” comes up, nobody is talking about how health insurance costs kill the ability to compete and to hire more workers. Hell, removing the cost of health insurance from any size business can help keep jobs in the US.

Recently during a worker strike of some sort my friend posted about how the workers were going to lose their health coverage if they didn’t get back to work. She had been wondering the same thing I had about businesses not promoting government health care for all. Seeing what power employers hold over their workers by controlling their health insurance made it clear to us why businesses continue to support the private system.

It’s all sick.
  #24  
Old 11-30-2019, 02:37 PM
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Don't count on it. In Colorado we tried and thanks to the millions the insurance companies put into the campaign, 70% of my state felt the current system was just fine.
In even worse news, British people who actually benefit from one of the best socialized healthcare system in the world might see it nevertheless sold off for parts to US insurers by Tory assholes who appear to be in awe of just how much blood money and sraight up evil shit their homologues in the Colonies seem to be able to get away with.
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Old 11-30-2019, 06:14 PM
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Is the company self-insured, meaning that they pay bills out of the company's resources (of which the employees are supposed to pay a set amount to subsidize it) with the bill-paying being administered by a third party?

Many self-insurers also contract with a reinsurer, which is basically insurance for insurance companies and is designed to cover bills over a certain amount, usually $250,000 from what I have heard.

In any case, our current system isn't working. The earliest reference I have personally seen to a proposal for nationalized health care was made by FDR in 1932, and honestly, I don't see the situation being resolved 90 years from now either.
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