This is technically true, but not quite as simple as it seems. At least in Ohio. In Ohio, any group between two and 50 people that applies for group coverage must be covered. However, there is no governance of premiums. If they don’t want to cover your group, they just price the premiums so high you’ll never be able to pay. It’s possible California insurance companies are kinder and less concerned about the bottom line, but it seems unlikely.
I sell group health insurance in CA and am well aware of the laws. What you are describing couldn’t happen, at least with any policy I’ve ever worked with.
And yes, it is as simple as it seems. Simple enough that most of my customers are shocked that it’s as easy as it is.
Then that’s excellent. Thanks for the info. I wish all states were as progressive.
Having re-thought it, I’ll restate my answer.
If both the insurance company missed the overage child, and the parents honestly didn’t know to say something, it’s probably not fraud.
If, on the other hand, the parents knew they were supposed to say something and didn’t in order to receive benefits, it’s fraud, at least in PA.
Having dealt with billing, which means eligibility problems, there is not a thing that will surprise me.
Insurance companies are big on data mining. Every single thing you buy in a drug store or pharmacy is collected. When you get sick, the insurance company can look up everything you bought in the hope they can find a pre-existing condition to get out of paying. If they can find a condition due to over the counter purchases you made ,they can void the policy on the claim you were not forthcoming with all your health problems. Does that bother you people at all.?They are spending billions to find ways to deny paying while they are collecting premiums.
That is a horrible health care system .
They certainly know what prescriptions I get so long as I use insurance. But is it your contention that they know when I buy Vicks VapoRub (because honestly the smell makes me giddy with joy) for a stuffed up nose?
If so, that’s a pretty incredible claim, gonzo.
ETA: Also, I’m still getting monthly reports of benefits from an insurance company that my husband switched away from BEFORE he died. So I’m having a tough time imagining these clueless clucks being that smart and coordinated.
Seems we’ve been down this road before.
All you need to do is carry your prior coverage until the new coverage takes effect. Eliminates any pre-existing condition concern. You are never “trapped” at your current employer as long as where you want to go to work offers a group plan.
Cite?
As long as where you want to go offers a group plan AND you can afford COBRA. It ain’t cheap.
This is true, but if you have pre-existing conditions, worth the investment.
It’s far from a prefect system, but workable as long as you understand and follow the rules of play.
I’ll have to look tomorrow, but I think my company’s COBRA for a family policy is right about $1100/month. We’re allowed to tack on a fee, though we don’t (or at least didn’t the last time I had anything to do with COBRA, which has been a couple of years ago).
Of course, the single or married rate is lower, as is the child rate.
THAT is freaking unfair. Pre-existing conditions are just so …freaking arbitary…I have a genetic disorder where I am INCREDIBLY healthy. I barely even see my GP. However I need good insurance since the manifestations of my disorder aren’t exactly every day.
From a European perspective, I can’t understand it either. The only sane thing to do is grab it with both hands and run like the wind.
When traveling to the US I bought a cheap additional travel insurance with the American travel agency, that would cover whatever wasn’t covered by my previous insurance (excess and so on). I managed to get an infected tick bite and went to a hospital where they examined it and prescribed antibiotics. When I approached the insurance company about it, it turned out that the insurance was only applicable to American citizens, even though the webpage didn’t mention that. However, they were still honest enough to honor the insurance.
I suppose their web forms should have caught that I did not specify myself as a US citizen, and therefore not presented the insurance option. So they bit the bullet and payed up anyway, after I sent them a letter showing that my home insurance’s excess was higher than the medical costs, and would therefore not pay up. Later I received a fancy-looking check in the mail with a sum of American dollars.
On the whole positive as they paid up even though I wasn’t technically entitled. Although the hassle and paperwork probably wasn’t worth it in the end, but I decided to cash in on principle. It did save me a small amount of money.
That’s my only experience with US health insurances :).
I’ve run the gamut. Decent insurance through work. No insurance as a fool. Best insurance I had was in college. Undergrad was all about mollycoddling its students, so there were clinics and specialists at the drop of a hat, as well as surgery and specialized sleep studies to be had for a mere thirty grand a year in tuition. No, wait, that wasn’t such a good deal.
It’s been an interesting few years. For a while, Mrs. Dvl and I had no insurance—just lots of crossed fingers. Then I got a gig with a Washington Post company (a subsidiary), which instead of a 1099 gave me a W-2 and allowed me to buy into part-timer’s insurance. MINIMAL coverage for about three grand a year. The first years had unlimited visits and a few other perks, then they cut it to just five office visits (routine or otherwise) per year and dropped a lot of other things. It wasn’t quite catastrophic coverage (wouldn’t reach that far) but it was something of a safety net.
Insurer was Aetna SRC, and they were just chock-a-block with shenanigans. Routine claims were routinely denied. Oftentimes they wouldn’t even take the time to deny a claim, they just denied our existence. Of course, I never had that problem whenever I called in, but all sorts of Doctors offices said that they (Aetna) said that Mrs. Dvl lacked coverage or some such runaround. It happened often enough and with such predictable consequences that I’m sure there’s a class action just waiting to happen.
Right as Aetna fell to the bottom, we started looking around at other plans and collecting quotes. Nicely timed, the Freelancers Union reached a critical mass and started offering a range of insurance (they did before, but vastly different policies) that blew away other quotes. Oh, and get this—in the process of switching when we found out Mrs. Dvl was with a Lil’ Dvl (woohoo! Only three weeks to go!), and found out that pregnancy is not a pre-existing condition!!! We’ve been to every appointment, had a gazillion ultrasounds, amnio, pokes and prods, all sorts of things, and haven’t had more than the co-pay. I’ve had a few hitches here and there, and same thing, virtually all covered. It’s the Blue Cross/Shield network, if that makes a difference.
I did some heavy spreadsheet work to figure out various scenarios. Turns out the lowest plan (of three PPOs) actually made the most economic sense for our risk/comfort level. In short, we’d have to have about fifty grand of bills just to begin wishing we were on a higher plan, and it didn’t start getting painful until we were at eighty or so. It maxed out at a hundred grand, then plans were identical, just we’d be about ten grand worse off.
So we’re paying about 6 grand per year for the two of us; that’ll go up to 11 grand with the three (it pays to step up a level with a family).
If anyone’s working for themselves and is insurance-less, check out Freelancers—it’s a pretty good deal.
Coupla things:
The other day I was talking about health care with a buddy who is CFO for a company with 400 employees. He said last year their provider (Blue Cross) paid off 117% of premiums paid. (I admit I assumed he was including both the company’s and employees’ contributions, but I am not certain.) Just made me wonder exactly how the insurance companies made how much money. Seems there have to be a heck of a lot of other people/companies out there who are getting far less in services than they pay in benefits.
One issue with universal health care has to be “What level of care does is universally guaranteed?” Assume someone is unemployed, indigent, underemployed, whatever. It is one thing to say everyone should be able to get pre-natal care, vaccinations, maybe an annual check-up. But should someone who has no expectation of ever earning over minimum wage be entitled to an organ transplant? Dialysis? AIDs meds?
Dinsdale, I think that’s a great topic for a new thread.
You’re missing the point by several magnitude.
Please explain what you understand me to be saying, as well as what particular point you believe I am missing exactly how.
What you’re saying seems self evident unless you’re writing in code. I’d be happy to contribute to a thread on point, and may even start one myself.
Would you take a moment or two to explain what the point you thought Dinsdale was missing and why by so much?