Premiums up, profits up, employers paying the tab

[dogtowner]

Should there be a law that an insurance company one already has done business with cannot drop you merely because you developed a chronic illness after paying premiums for years? The reason you paid those premiums is to cover you if you develop an illness you can't pay for. Yes that seems totally logical to wrote such law and so much easier to implement than all the other ideas congress has come up with. Why hasn't that law been written?

Sorry your daughter was diagnosed, mine too. But she is well controlled which is good.

You enter a new policy (read contract) every year so one year is unrelated to the next (except by explicit law).

 

[PLC1]

Sorry your daughter was diagnosed, mine too. But she is well controlled which is good.

You enter a new policy (read contract) every year so one year is unrelated to the next (except by explicit law).

That is my understanding of the system. Long term insurance contracts might be a good idea, but they don't currently exist.

 

[GenSeneca]

I think the left far too often really thinks that we mean a market with zero government when we say free market and I think that we need to be real clear about what we mean. Can you blame them for opposing a totally free market?

Give me an example of where you have set a Leftist straight on something, anything, which caused them to abandon the talking points put out by leftist propaganda and be truthful about whatever it was....

Point being, no matter what you say, or how you say it, if it's not part of the Leftist agenda, the Left will always mischaraterize in an attempt to demonize and denigrate opposing views and those who hold them.

However, I do agree with you to some extent. If I were to say we needed a "totally free market", I would follow it up by saying it should be "totally free" of government regulation, government intervention, subsidies, tax incentives etc. I wouldn't add this clarification for the sake of the Left, because they will ignore it anyway, I add clarification for everyone else.

 

[dogtowner]

That is my understanding of the system. Long term insurance contracts might be a good idea, but they don't currently exist.

If they don't exist perhaps its because they are not permitted to exist ?

I know I know 'no company would issue' but I'm not so sure I agree. This parallels very well with life insurance which is really no more than a bet that you will not die before your benefit is paid for. And they always win because its taken in aggregate. And the scale slides as you get older since the risk changes.

I think we desperately need a new business model in healthcare but that cannot happen so long as state regulation exists. Oddly enoiugh it will be the AMA (and related heaalth provider groups) and insurance industry who keep that from happening.

 

[PLC1]

If they don't exist perhaps its because they are not permitted to exist ?

Maybe, or maybe because they aren't marketable.

I know I know 'no company would issue' but I'm not so sure I agree. This parallels very well with life insurance which is really no more than a bet that you will not die before your benefit is paid for. And they always win because its taken in aggregate. And the scale slides as you get older since the risk changes.

They would issue it if it were profitable. My guess is that it is not, or that it is too risky. Who knows what is going to happen to costs down the road? I don't know of any regulation that prohibits such a policy, do you?

I think we desperately need a new business model in healthcare but that cannot happen so long as state regulation exists.

Yes, we need a new business model. But, he government has to regulate it. An unregulated market sounds good on paper, but the results aren't always so good.

Oddly enoiugh it will be the AMA (and related heaalth provider groups) and insurance industry who keep that from happening.

Those groups will stop any and all reforms that might be contrary to their selfish interests.

Which is why the government needs to regulate them, instead of being controlled by them.

 

[Dr.Who]

There probably should be such a law. Is there?

There are zillions of insurance regulations and to the best of my knowledge this law does not exist.

Since no one is going to want to insure an individual with diabetes,

Well, not after they get diabetes. But they will want to insure them before they get diabetes and then they will be stuck with the cost for the few who do get it. Those costs will of course be spread out over the whole pool as is the natural state of insurance.

that person has to be a part of a group.

I don't see why.

Currently, the way to be a part of a group is to work for an employer who provides group insurance. The downsides to that are, 1. It costs a mint for the employer, which doesn't help the unemployment situation, 2. it discourages people from starting businesses of their own, 3. it means that when people lose their jobs, they also lose their health insurance and 4. it does nothing to control costs.

Congress should not have encouraged it to be connected to employment. This is one of the largest forces driving up costs. This needs to stop.

It seems to me there must be a better way.

I agree. Connect costs to consumer choices by letting the person who uses the insurance be the same one who chooses it and pays for it.

Make no laws that are designed to give insurance companies or individuals or special interest groups preferential treatment. Make laws that are designed to create equal opportunity and equal protection under the law while enforcing basic contract law..

 

[PLC1]

There are zillions of insurance regulations and to the best of my knowledge this law does not exist.

Well, not after they get diabetes. But they will want to insure them before they get diabetes and then they will be stuck with the cost for the few who do get it. Those costs will of course be spread out over the whole pool as is the natural state of insurance.

I don't see why.



Congress should not have encouraged it to be connected to employment. This is one of the largest forces driving up costs. This needs to stop.



I agree. Connect costs to consumer choices by letting the person who uses the insurance be the same one who chooses it and pays for it.

Make no laws that are designed to give insurance companies or individuals or special interest groups preferential treatment. Make laws that are designed to create equal opportunity and equal protection under the law while enforcing basic contract law..

Can you imagine the current Congress actually passing such laws?

 

[Dr.Who]

Sorry your daughter was diagnosed, mine too. But she is well controlled which is good.
.

Really, that is a surprise considering it is a low incident disease. Sorry for your situation too. Those 3AM checks are a real sleep killer. Mine too, thank God - A1C's all in the 7's on MDI.

 

[Dr.Who]

Give me an example of where you have set a Leftist straight on something, anything, which caused them to abandon the talking points put out by leftist propaganda and be truthful about whatever it was....

Point being, no matter what you say, or how you say it, if it's not part of the Leftist agenda, the Left will always mischaraterize in an attempt to demonize and denigrate opposing views and those who hold them.

In all and complete honesty change on forums like this is hard to come by for any group of person left or right. Those who are willing to admit when they are wrong or confess a change of mind are few no matter who they are and I think that is more a matter of individual differences rather than party affiliation.

 

[Dr.Who]

Something is not right about our discussion of long term contracts.

For example, I pay my premiums for a certain calender year and I expect that if I need care from December 28th through January 15th that all of it will be paid for not just the part that was in the previous year.

In fact I expect that if I get a disease that will last for a few years that I will continue to get coverage as long as I pay my premiums and don't exceed my lifetime limits.

I do expect that premiums will go up when people in the pool have more sickneses but I don't expect that any one person will bear the brunt of the increase.

Is it not like this?

 

[PLC1]

Something is not right about our discussion of long term contracts.

For example, I pay my premiums for a certain calender year and I expect that if I need care from December 28th through January 15th that all of it will be paid for not just the part that was in the previous year.

In fact I expect that if I get a disease that will last for a few years that I will continue to get coverage as long as I pay my premiums and don't exceed my lifetime limits.

I do expect that premiums will go up when people in the pool have more sickneses but I don't expect that any one person will bear the brunt of the increase.

Is it not like this?

I don't think it is, not with an individual policy. If you get sick, then they are supposed to continue to pay for the illness that occurred during the term of the policy even after the term has ended, yes. I don't think they have to cover something that happened later, and yes, in most states they can drop you if you're unprofitable for them. I really don't think there is a policy that you can buy when you're young and healthy, and keep after you get old and/or sick.

It depends on the regulations in the state where you live. The insurance industry is regulated by the states, not by the federal government, so there is no uniform set of rules for the country at large.

Which is why the issue of "competing across state lines" is such a controversy. On the face of it, there shouldn't be a problem with a company based in one state selling in another, and really there isn't, so long as that company has a subsidiary in the state where they want to do business. The sticker is, they have to abide by the regulations in the state where they're making the sales, not the state where they're based. If companies could sell anywhere, and not be bound by the regulations where they are doing business, then they would simply relocate to the state with the loosest regulations.

 

[Dr.Who]

and yes, in most states they can drop you if you're unprofitable for them. I really don't think there is a policy that you can buy when you're young and healthy, and keep after you get old and/or sick.
.

I tried to find the rules for when an insurance company can drop or cancel a policy. In several pages of results I did not find any links that indicated a company could drop you because you were unprofitable.

I did find this::

"
Health care insurance policies can be cancelled if there is a material omission or misrepresentation made by a policyholder in the application for coverage. Even if the policy is issued and premiums are paid, the insurer can cancel the policy later if they discover that the policyholder did not disclose significant medical history in the application. The result is that the policy is canceled, the insurer does not have to pay for the care that was rendered, and the premiums paid on the policy are returned to the policyholder (minus a reasonable cost associated with the period of time during which the policy was in force).

Are There Any Time Restrictions On When My Insurance Company Can Cancel My Policy?

Generally, state law and the policy itself provide that the insurer has only 2 years from the date of application to cancel it. If discovery of the omission or misrepresentation occurs after the passage of the 2 year period of "contestability," the insurer is generally out of luck and cannot cancel the policy. After that, an insurer may only be able to contest a claim on the basis of intentional fraud on the part of the policyholder."

Which brings to mind the stories we hear about insurance companies that drop people based on made-up accusations of fraud. Which they would of course not have to make up if they could just drop one for not being profitable.

It just doesn't pass my smell test when it is said that they can drop you for being unprofitable. But I am very open to seeing some evidence.

 

[PLC1]

I tried to find the rules for when an insurance company can drop or cancel a policy. In several pages of results I did not find any links that indicated a company could drop you because you were unprofitable.

I did find this::

"
Health care insurance policies can be cancelled if there is a material omission or misrepresentation made by a policyholder in the application for coverage. Even if the policy is issued and premiums are paid, the insurer can cancel the policy later if they discover that the policyholder did not disclose significant medical history in the application. The result is that the policy is canceled, the insurer does not have to pay for the care that was rendered, and the premiums paid on the policy are returned to the policyholder (minus a reasonable cost associated with the period of time during which the policy was in force).

Are There Any Time Restrictions On When My Insurance Company Can Cancel My Policy?

Generally, state law and the policy itself provide that the insurer has only 2 years from the date of application to cancel it. If discovery of the omission or misrepresentation occurs after the passage of the 2 year period of "contestability," the insurer is generally out of luck and cannot cancel the policy. After that, an insurer may only be able to contest a claim on the basis of intentional fraud on the part of the policyholder."

Which brings to mind the stories we hear about insurance companies that drop people based on made-up accusations of fraud. Which they would of course not have to make up if they could just drop one for not being profitable.

It just doesn't pass my smell test when it is said that they can drop you for being unprofitable. But I am very open to seeing some evidence.

What you found has to do with misrepresentation by the insured. If you have a disease, and say you don't, then the insurer can drop you. There is nothing that says that they have to renew your policy, however.

What is the term of you policies?

After that term is up, what law says that they have to renew?

 

[dogtowner]

Really, that is a surprise considering it is a low incident disease. Sorry for your situation too. Those 3AM checks are a real sleep killer. Mine too, thank God - A1C's all in the 7's on MDI.

Grandmother had it and it tend to skip generations (or so I'm told). I guess we were lucky in that she was diagnosed at 13, way easier to acclimate and she had a 6-9 month "honeymoon" before she totally quit making insulin. six is pretty young so great job staying on top of it so well.

what I can't figure out is why insulin is so expensive this many years since they figured out how to synthesize it.

 

[Dr.Who]

Grandmother had it and it tend to skip generations (or so I'm told). I guess we were lucky in that she was diagnosed at 13, way easier to acclimate and she had a 6-9 month "honeymoon" before she totally quit making insulin. six is pretty young so great job staying on top of it so well.

what I can't figure out is why insulin is so expensive this many years since they figured out how to synthesize it.

Oddly enough I have zero idea how much insulin costs. It does not say on the vials or cartridges. I asked once at the pharmacy and was told they would have to look it up. Do you suppose if I knew that it was expensive or inexpensive I just might have a different perspective or attitude about it in each of those cases?

I do know that novofine needles cost about a hundred dollars a box because when I asked about that the pharmacist knew the answer.

Strips are of course sold in a display case so I can see the price on that - yikes a dollar a strip. And we use about ten per day. Even though I don't have to pay for them just knowing they are expensive makes me wary about wasting them - I am just naturally frugal and don't like to waste anything. I just makes me cringe every time we get an error message on the meter. Then this year the school scheduled recess and gym at the worst possible times so we have to test more than we would otherwise have to.

If you go to www.Childrenwithdiabetes.com you will see lots of people complaining that the insurance companies are trying to limit how many strips they can use. I got one of those letters too and had to have the clinic get special authorization i.e. jump through hoops to get more strips. Given how expensive they are I have no doubt the insurers want to limit how many people use. I also have no doubt that there are some people who just dont give a hoot how many they use or waste making collages out of.