insurance company scams regarding the ACA bring hefty fines (1 Viewer)

[Henry Ford]

Your policy is going up $500 per month "because of Obamacare?" May want to check out your options. Pretty good chance your company is scamming you.

http://www.addictinginfo.org/2013/11/05/insurance-companies-obamacare-scam/

 

[matttyl]

Quite a few things stand out here. First off, her old policy likely was "junk". Any 56 year old female paying only $54 a month for coverage and thinking it's "qualify coverage" is kidding themselves. That out of the way....

The only thing her carrier could do is offer her a new plan. She's under no obligation to accept that plan. I personally don't believe it is the responsibility of her carrier to inform her that she can buy coverage though a different carrier (via exchange). That's either the other carrier's responsibility, or the responsibility of whatever entity is running her state's exchange (either her state, or the federal government).

Further, you know as well as I do that the plan they found her for "$165" is a subsidized price. No plan, regardless of your age or health is that inexpensive unless (heavily) subsidized, with the possible exception of a catastrophic plan, which at her age she's not eligible for. Even then, at her age a catastrophic plan would cost more than this. In that it's subsidized, that means that her income in low enough as to qualify for a subsidy - and that neither she or her husband (if she has one) has group coverage available to them. So I ask you, how is her previous carrier suppose to know her income, and group plan eligibility?

Again, I don't believe that is the responsibility of her insurance carrier to do all of that legwork on her behalf, and then show her what her best deal may be via exchange - which likely could be another carrier. That's like AT&T telling you when your contract expires, that due to your usage pattern, physical location, and family size you should set up a new plan with Verizon or Sprint. That responsibility is on the exchange, and the newly appointed "Navigators". Just because they exchanges aren't working properly, and the navigators are as clueless as everyone else doesn't mean the insurance companies are evil for attempting to keep their customers in house during this time of great unrest and confusion in the market.

 

[Henry Ford]

My plan under the Affordable Care Act is just north of $200 per month and I don't get a subsidy.

 

[matttyl]

My plan under the Affordable Care Act is just north of $200 per month and I don't get a subsidy.

Individual or employer based? And I'm assuming your considerably younger than this 56 year old female. You also likely don't have a "platinum" or "gold" plan if on the individual market.

 

[matttyl]

This woman is from Florida, obviously we don't know her zip code. I just used the zip for Miami (33131), assumed she's a non-smoker (which we don't know), and plugged a 56 year old female into e-health.com, which will do shopping for plans for you (unsubsidized). Premiums range from $369 a month for a $6,300 deductible and zero up front benefits (you have to hit that $6,300 deductible before having any coverage for even Dr. visits or Rx) all the way up to $892 a month for a $750 deductible.

Interesting that $591 is almost exactly between those two numbers.......

 

[fatness]

Interesting. From the article:

How this scam works is that private insurance companies send out letters notifying existing customers that their current policy has been canceled, because of the ACA’s new requirements. They then offer customers a new, ACA compliant policy at far higher rates than what the customer would pay if he went through the ACA marketplace. In most cases the insurance companies do not tell their customers what other options are available or even let them know they have a choice under the new law. Some insurance companies have pressed their customers to sign up for the new policies by a certain date, saying if they don’t, their health coverage will be lost.

On the program, Barrette tells CBS that she has to hurry and make up her mind by November 1st or she will lose out on her chance to buy in. CBS offered her no explanation of her alternatives, but Consumer Reports examined Barrette’s story shortly after it aired. They easily found her a policy in the Marketplace for $165.00, not the $591 Blue Cross Blue Shield was shamelessly going to charge her.

What’s more, Consumer Reports also looked at her old policy, the one she was paying $54 a month for. They determined that it was “junk.” In essence, Barrette had been paying one of these corrupt private insurance companies nearly $650 per year, to have almost no real medical coverage, under her previous Blue Cross Blue Shield policy.

So she had a scam policy and they tried to scam her into a more expensive (than the market) policy. I'm so surprised private business would do this.

 

[matttyl]

Interesting. From the article:

How this scam works is that private insurance companies send out letters notifying existing customers that their current policy has been canceled, because of the ACA’s new requirements. They then offer customers a new, ACA compliant policy at far higher rates than what the customer would pay if he went through the ACA marketplace. In most cases the insurance companies do not tell their customers what other options are available or even let them know they have a choice under the new law. Some insurance companies have pressed their customers to sign up for the new policies by a certain date, saying if they don’t, their health coverage will be lost.

On the program, Barrette tells CBS that she has to hurry and make up her mind by November 1st or she will lose out on her chance to buy in. CBS offered her no explanation of her alternatives, but Consumer Reports examined Barrette’s story shortly after it aired. They easily found her a policy in the Marketplace for $165.00, not the $591 Blue Cross Blue Shield was shamelessly going to charge her.

What’s more, Consumer Reports also looked at her old policy, the one she was paying $54 a month for. They determined that it was “junk.” In essence, Barrette had been paying one of these corrupt private insurance companies nearly $650 per year, to have almost no real medical coverage, under her previous Blue Cross Blue Shield policy.

So she had a scam policy and they tried to scam her into a more expensive (than the market) policy. I'm so surprised private business would do this.

Again, anyone thinking that a 56 year old female paying $54 a month for quality coverage is kidding themselves. Likely the plan she had with BCBS did little more than offer her the knowledge that she was "in network" and at least was getting "in network pre-negotiated rates". For a 56 year old female, that's likely worth "nearly $650 a year" on it's own.

Further, the plan they offered her IS A MARKET PLAN, it has to be to be "compliant". It's just not subsidized. It's the exact same plan that she could purchase "on the market". She's apparently obtaining a subsidy for the coverage she obtained for $165 a month because her income qualifies her for it. So again I ask, how is her carrier suppose to know her income to determine if she's eligible for a subsidy? If her income were higher, or if she has group coverage available to her, her cost would be much higher than $165 for the very plan that she choose on the marketplace.

 

[Henry Ford]

My plan under the Affordable Care Act is just north of $200 per month and I don't get a subsidy.

Individual or employer based? And I'm assuming your considerably younger than this 56 year old female. You also likely don't have a "platinum" or "gold" plan if on the individual market.

No, I don't have a platinum or gold plan. Neither should this woman, if she's moving from a $50 a month policy.

The Consumer Reports review of her old and new policies - yes, she's getting a subsidy.

http://www.consumerreports.org/cro/news/2013/10/florida-woman-s-canceled-blue-cross-plan-is-junk/index.htm

 

[matttyl]

My plan under the Affordable Care Act is just north of $200 per month and I don't get a subsidy.

Individual or employer based? And I'm assuming your considerably younger than this 56 year old female. You also likely don't have a "platinum" or "gold" plan if on the individual market.

No, I don't have a platinum or gold plan. Neither should this woman, if she's moving from a $50 a month policy.

You didn't answer the questions. Is your new "ACA plan" individual or employer based? Roughly, what is your age? What metal tier/or deductible do you have if on the individual market?

I posted all non-subsidized rates for this woman above (assuming Miami and that she's a non-tobacco user, which we don't know so her rates could be higher). $369 to $892 was the range, so the $500 and some plan offered to her is right in the middle of those numbers. I still fail to see where there is any issue here.

 

[Henry Ford]

My plan under the Affordable Care Act is just north of $200 per month and I don't get a subsidy.

Individual or employer based? And I'm assuming your considerably younger than this 56 year old female. You also likely don't have a "platinum" or "gold" plan if on the individual market.

No, I don't have a platinum or gold plan. Neither should this woman, if she's moving from a $50 a month policy.

You didn't answer the questions. Is your new "ACA plan" individual or employer based? Roughly, what is your age? What metal tier/or deductible do you have if on the individual market?

I posted all non-subsidized rates for this woman above (assuming Miami and that she's a non-tobacco user, which we don't know so her rates could be higher). $369 to $892 was the range, so the $500 and some plan offered to her is right in the middle of those numbers. I still fail to see where there is any issue here.

I'm not in Florida, so my information isn't going to inform what kind of policy she qualifies for. It's individual, not employer/group.

The issue, for me, is primarily that insurance companies are engaging in practices which have led to, for instance, $65,000.00 in fines in Kentucky. I don't think they should be doing things that states fine them for.

 

[mr roboto]

Yes, private industry is evil but government has all of our best at heart.

 

[Henry Ford]

Yes, private industry is evil but government has all of our best at heart.

You seem to be saying that like you're agreeing with someone. Did I miss that post?

 

[lod01]

Your policy is going up $500 per month "because of Obamacare?" May want to check out your options. Pretty good chance your company is scamming you.

http://www.addictinginfo.org/2013/11/05/insurance-companies-obamacare-scam/

Well of course it is. Also, if they repeal ACA, then it will also go up because it is yet another opportunity to raise rates. They will say 'ACA actually held costs down and now that it is gone, rates have to be raised.' Any chance the insurance companies get to stick it to ya, they will.

 

[mr roboto]

Yes, private industry is evil but government has all of our best at heart.

You seem to be saying that like you're agreeing with someone. Did I miss that post?

No, it was written rhetorically to the author of the article who seems to have a pretty strong biased against private industry. I don't doubt that a company may take advantage of a massive change in government regulation to increase pricing, but I also don't believe that we as a general principle should trust government anymore than private industry in this country. The relative lack of accountability in both the market and government causes me to distrust both of them equally.

 

[Ballstein]

Your policy is going up $500 per month "because of Obamacare?" May want to check out your options. Pretty good chance your company is scamming you.

http://www.addictinginfo.org/2013/11/05/insurance-companies-obamacare-scam/

Well of course it is. Also, if they repeal ACA, then it will also go up because it is yet another opportunity to raise rates. They will say 'ACA actually held costs down and now that it is gone, rates have to be raised.' Any chance the insurance companies get to stick it to ya, they will.

This guy gets it.

 

[roadkill1292]

Other countries not only trust but demand that their government run an effective health care system. WTF is wrong with Americans that we can't make it work? We are incompetents. I blame really old people.

 

[RCon]

The issue, for me, is primarily that insurance companies are engaging in practices which have led to, for instance, $65,000.00 in fines in Kentucky. I don't think they should be doing things that states fine them for.

This seems like begging the question, unless you're arguing that all laws are and all enforcement is, by definition, valid and proper.

 

[matttyl]

My plan under the Affordable Care Act is just north of $200 per month and I don't get a subsidy.

Individual or employer based? And I'm assuming your considerably younger than this 56 year old female. You also likely don't have a "platinum" or "gold" plan if on the individual market.

No, I don't have a platinum or gold plan. Neither should this woman, if she's moving from a $50 a month policy.

The Consumer Reports review of her old and new policies - yes, she's getting a subsidy.

http://www.consumerreports.org/cro/news/2013/10/florida-woman-s-canceled-blue-cross-plan-is-junk/index.htm

Of course she is. The link shows that her subsidy is $320 a month. So the full price of her new policy is 320+165 or $485 a month. That's not too far off really from the price that was offered to her from BCBS. That tells me that the plan they offered her wasn't at all unreasonable, it's just that they are showing her the unsubsidized rate. They have no way to know if she qualifies for a subsidy, nor should they in my opinion.

So again, I fail to see any issue here.

 

[matttyl]

The issue, for me, is primarily that insurance companies are engaging in practices which have led to, for instance, $65,000.00 in fines in Kentucky. I don't think they should be doing things that states fine them for.

So your issue is that Kentucky got fined for something, and your example of what they were fined for is a woman in Florida?

 

[mr roboto]

The issue, for me, is primarily that insurance companies are engaging in practices which have led to, for instance, $65,000.00 in fines in Kentucky. I don't think they should be doing things that states fine them for.

So your issue is that Kentucky got fined for something, and your example of what they were fined for is a woman in Florida?

Henry, this is the point. You were saying that because a state fined a company, there must have been something wrong. You're putting the government entities above reproach and assuming that when they determine the company has done something wrong, that they have in fact done something wrong.

 

[Sarnoff]

My plan under the Affordable Care Act is just north of $200 per month and I don't get a subsidy.

Individual or employer based? And I'm assuming your considerably younger than this 56 year old female. You also likely don't have a "platinum" or "gold" plan if on the individual market.

No, I don't have a platinum or gold plan. Neither should this woman, if she's moving from a $50 a month policy.

You didn't answer the questions. Is your new "ACA plan" individual or employer based? Roughly, what is your age? What metal tier/or deductible do you have if on the individual market?

I posted all non-subsidized rates for this woman above (assuming Miami and that she's a non-tobacco user, which we don't know so her rates could be higher). $369 to $892 was the range, so the $500 and some plan offered to her is right in the middle of those numbers. I still fail to see where there is any issue here.

I'm not in Florida, so my information isn't going to inform what kind of policy she qualifies for. It's individual, not employer/group.

The issue, for me, is primarily that insurance companies are engaging in practices which have led to, for instance, $65,000.00 in fines in Kentucky. I don't think they should be doing things that states fine them for.

"I don't know what they're doing wrong, actually, but if the gov't says it's bad, then I agree"

No one ever questions government when a Democrat is president. Once a republican is elected, though, everything government does is evil.

 

[matttyl]

The issue, for me, is primarily that insurance companies are engaging in practices which have led to, for instance, $65,000.00 in fines in Kentucky. I don't think they should be doing things that states fine them for.

So your issue is that Kentucky got fined for something, and your example of what they were fined for is a woman in Florida?

Henry, this is the point. You were saying that because a state fined a company, there must have been something wrong. You're putting the government entities above reproach and assuming that when they determine the company has done something wrong, that they have in fact done something wrong.

Exactly. If this is your example, I fail to see anything that carrier did that was wrong. They offered her a new plan that's ACA compliant. It's only so expensive because of all the mandated coverage that now has to be included. She's 56 and apparently a single on her policy - but she still has to pay for maternity coverage and pediatric dental coverage, as those are now EHBs.

The plan offered has a premium which in the end isn't that far off from the plan that she ultimately choose for herself on the exchange, it's just that they showed her the unsubsidized premium. They have no way to determine if she's eligible for a subsidy, nor should they. Also, I don't feel that is is their responsibility to show her options from other carriers. That's the responsibility of the marketplace in her state and/or those other carriers.

 

[Henry Ford]

The issue, for me, is primarily that insurance companies are engaging in practices which have led to, for instance, $65,000.00 in fines in Kentucky. I don't think they should be doing things that states fine them for.

So your issue is that Kentucky got fined for something, and your example of what they were fined for is a woman in Florida?

Henry, this is the point. You were saying that because a state fined a company, there must have been something wrong. You're putting the government entities above reproach and assuming that when they determine the company has done something wrong, that they have in fact done something wrong.

Exactly. If this is your example, I fail to see anything that carrier did that was wrong. They offered her a new plan that's ACA compliant. It's only so expensive because of all the mandated coverage that now has to be included. She's 56 and apparently a single on her policy - but she still has to pay for maternity coverage and pediatric dental coverage, as those are now EHBs.

The plan offered has a premium which in the end isn't that far off from the plan that she ultimately choose for herself on the exchange, it's just that they showed her the unsubsidized premium. They have no way to determine if she's eligible for a subsidy, nor should they. Also, I don't feel that is is their responsibility to show her options from other carriers. That's the responsibility of the marketplace in her state and/or those other carriers.

You know I didn't write this article, right?

What I think they did wrong is engage in unfair business practices and violating their duties of good faith and fair dealing with their insured.

Insurance companies have a duty to their insured to act with good faith and fair dealing - they act as agents for their policy-holders, and have extra fiduciary and other obligations, beyond what a donut shop or Jiffy Lube has. When they send letters saying "Your policy cost is going up to $591 per month as a result of the ACA" without explaining the meaning behind what they're saying, they're arguably improperly misleading a policy holder as to the terms and conditions of the contractual relationship.

Kentucky fined them for using an unapproved form of renewal notice, which is a violation of Kentucky law for insurance companies. Those forms have to be approved for precisely this reason. I don't think insurance companies should be able to violate the law in their advertising. That's not begging the question, I actually have a problem with companies breaking the law in the name of profit.

 

[Henry Ford]

The issue, for me, is primarily that insurance companies are engaging in practices which have led to, for instance, $65,000.00 in fines in Kentucky. I don't think they should be doing things that states fine them for.

This seems like begging the question, unless you're arguing that all laws are and all enforcement is, by definition, valid and proper.

They broke a law requiring them to have their advertising/letter form approved by the Insurance Commission prior to sending. I don't think they should be breaking that law.

 

[matttyl]

You know I didn't write this article, right?

What I think they did wrong is engage in unfair business practices and violating their duties of good faith and fair dealing with their insured.

Insurance companies have a duty to their insured to act with good faith and fair dealing - they act as agents for their policy-holders, and have extra fiduciary and other obligations, beyond what a donut shop or Jiffy Lube has. When they send letters saying "Your policy cost is going up to $591 per month as a result of the ACA" without explaining the meaning behind what they're saying, they're arguably improperly misleading a policy holder as to the terms and conditions of the contractual relationship.

Kentucky fined them for using an unapproved form of renewal notice, which is a violation of Kentucky law for insurance companies. Those forms have to be approved for precisely this reason. I don't think insurance companies should be able to violate the law in their advertising. That's not begging the question, I actually have a problem with companies breaking the law in the name of profit.

I get that you didn't write it, but you did post it.

And no, Kentucky didn't "fine them". Kentucky fined a totally different insurance carrier, Humana, for a letter they sent - not BCBS like in the article you posted. That's like bashing Ford for something Chevy did.

Anyway, as for that fine: "The department investigated letters sent in August to 6,543 individual plan policyholders in Kentucky. The letters said they needed to renew their plans for 2014 within 30 days or choose a more expensive option that complies with the Affordable Care Act." Now, I haven't seen a copy of the letter in question, but personally I see no issue here. These likely are people who were going to have their policies canceled on January 1st because of the ACA, and Humana was giving them an opportunity to renew that plan early (off-anniversary) in order to allow them to keep that plan into 2014 before it having to be canceled. Since the vast majority of people will only have more expensive options on the ACA exchanges if not subsidized, as directly mentioned in the letter, this to me is a favor to them.

Also, have you seen a copy of the letter sent to the woman in your posted article? I haven't. If you also haven't, then you can't say what that letter says or doesn't say - you're apparently just taking the word of the writer of that article with blind faith.

 

[Henry Ford]

You know I didn't write this article, right?

What I think they did wrong is engage in unfair business practices and violating their duties of good faith and fair dealing with their insured.

Insurance companies have a duty to their insured to act with good faith and fair dealing - they act as agents for their policy-holders, and have extra fiduciary and other obligations, beyond what a donut shop or Jiffy Lube has. When they send letters saying "Your policy cost is going up to $591 per month as a result of the ACA" without explaining the meaning behind what they're saying, they're arguably improperly misleading a policy holder as to the terms and conditions of the contractual relationship.

Kentucky fined them for using an unapproved form of renewal notice, which is a violation of Kentucky law for insurance companies. Those forms have to be approved for precisely this reason. I don't think insurance companies should be able to violate the law in their advertising. That's not begging the question, I actually have a problem with companies breaking the law in the name of profit.

I get that you didn't write it, but you did post it.

And no, Kentucky didn't "fine them". Kentucky fined a totally different insurance carrier, Humana, for a letter they sent - not BCBS like in the article you posted. That's like bashing Ford for something Chevy did.

Anyway, as for that fine: "The department investigated letters sent in August to 6,543 individual plan policyholders in Kentucky. The letters said they needed to renew their plans for 2014 within 30 days or choose a more expensive option that complies with the Affordable Care Act." Now, I haven't seen a copy of the letter in question, but personally I see no issue here. These likely are people who were going to have their policies canceled on January 1st because of the ACA, and Humana was giving them an opportunity to renew that plan early (off-anniversary) in order to allow them to keep that plan into 2014 before it having to be canceled. Since the vast majority of people will only have more expensive options on the ACA exchanges if not subsidized, as directly mentioned in the letter, this to me is a favor to them.

Also, have you seen a copy of the letter sent to the woman in your posted article? I haven't. If you also haven't, then you can't say what that letter says or doesn't say - you're apparently just taking the word of the writer of that article with blind faith.

Did you not read the rest of the article? The article doesn't end with BCBS. It has a whole section on Humana's fine.

 

[Henry Ford]

And, yes, I have read the Humana letter, which is why I'm talking about that one. The letter stated, on August 21, that the policy holder had to let the insurance company know within 30 days if he/she wanted to renew his/her policy on December 31, or would have to choose one of the more expensive options under the ACA, and attached estimated costs.

Funny part being, that meant that the policy holder had to renew more than 90 days before the end of the policy and a hilarious 10 days before the insurance exchanges opened and they could compare policies. Humana sent these out without approval, presumably because the insurance commission would have said "uh, yeah, you can't require them to renew by ten days before the other options for next year show up, more than 90 days before the new policy year would start, when they have policies that don't end until at least December." And it would be creating a new plan "fiscal year" based on December 31, rather than whatever the current year-end would have been.

Letter:

http://i2.cdn.turner.com/cnn/2013/images/11/15/kentucky.humana.letter.pdf

 

[RCon]

Just to be clear then, you're not arguing that BCBS did anything wrong in the Florida incident from the article, only that Humana did something wrong in the Kentucky incident from the article?

As a side note, I really don't see anything ethically wrong with the Humana letter. It may have technically broken the letter of the law, but I don't see anything unethical or "scamming" in there.

 

[matttyl]

And, yes, I have read the Humana letter, which is why I'm talking about that one. The letter stated, on August 21, that the policy holder had to let the insurance company know within 30 days if he/she wanted to renew his/her policy on December 31, or would have to choose one of the more expensive options under the ACA, and attached estimated costs.

Funny part being, that meant that the policy holder had to renew more than 90 days before the end of the policy and a hilarious 10 days before the insurance exchanges opened and they could compare policies. Humana sent these out without approval, presumably because the insurance commission would have said "uh, yeah, you can't require them to renew by ten days before the other options for next year show up, more than 90 days before the new policy year would start, when they have policies that don't end until at least December." And it would be creating a new plan "fiscal year" based on December 31, rather than whatever the current year-end would have been.

Letter:

http://i2.cdn.turner.com/cnn/2013/images/11/15/kentucky.humana.letter.pdf

To me, that letter is a HUGE BENEFIT to the insured. Last year I spent weeks informing my clients to do exactly what this letter is asking these folks in Kentucky to do, and if you understood insurance I think you'd fully agree. If you don't, I'd love to hear why.

What this letter is saying is that you can keep your coverage (which after all is what the president promised) for another year if you elect to accept a "December renewal" for your policy. That means that the person's first renewal after 1/1/14 (when the ACA comes online) wouldn't be until 12/30/14, which is when they then would have to have their policy canceled and replaced. This option is doing nothing but giving them the option of more time with their current coverage. Given the huge mess that the website and marketplace have been (just ask Tim in the other ACA thread who's brother's policy was canceled and he was unable to get coverage for 1/1/14), this is an enormous benefit to each and every one of their policy holders. Accepting a "December renewal" not only didn't change their rates, it didn't "lock them in" to keeping that coverage if they found a policy on the exchange that is better for them or cheaper, or both. Again, all it would do is give their current policy holders more time to make the best decision for themselves.

Further, the entire first damn paragraph of that letter is telling people about these new marketplaces, and directly mentions that they may be able for financial assistance (subsidies).

 

[Henry Ford]

Just to be clear then, you're not arguing that BCBS did anything wrong in the Florida incident from the article, only that Humana did something wrong in the Kentucky incident from the article?

As a side note, I really don't see anything ethically wrong with the Humana letter. It may have technically broken the letter of the law, but I don't see anything unethical or "scamming" in there.

I'm arguing that insurance companies are helping perpetuate the "Obamacare will cost you ten times as much" B.S. in the interest of their profits. Which is, I think, unethical, even if perfectly legal. I think it's wrong, but not illegal, to prey on peoples' fears in order to make sure they don't compare your company's options to those of other companies in the same business.

However, when consumers come out and say "Obamacare costs me ten times as much as my old insurance plan!" it's generally because they don't understand their options or because their previous plan was virtually worthless from a coverage standpoint.

 

[fourd]

And, yes, I have read the Humana letter, which is why I'm talking about that one. The letter stated, on August 21, that the policy holder had to let the insurance company know within 30 days if he/she wanted to renew his/her policy on December 31, or would have to choose one of the more expensive options under the ACA, and attached estimated costs.

Funny part being, that meant that the policy holder had to renew more than 90 days before the end of the policy and a hilarious 10 days before the insurance exchanges opened and they could compare policies. Humana sent these out without approval, presumably because the insurance commission would have said "uh, yeah, you can't require them to renew by ten days before the other options for next year show up, more than 90 days before the new policy year would start, when they have policies that don't end until at least December." And it would be creating a new plan "fiscal year" based on December 31, rather than whatever the current year-end would have been.

Letter:

http://i2.cdn.turner.com/cnn/2013/images/11/15/kentucky.humana.letter.pdf

Has anyone seen the letter that the woman in Florida got from BC?

And as for the Humana letter, it's really quite different than what the article you posted made it out to be, though looking at the site you pulled it from that doesn't surprise me. Shoddy reporting on both sides seems to be the norm. What they did wrong, and it was wrong, is offer an amendment that hadn't been approved yet. But they said that in the letter. They also offered a comparison chart comparing the options. Was it a great idea to do it the way they did? Definitely not. And they were fined. But even if they had taken the offer as made nothing precluded them from shopping for a new plan come October 1.

Of course the irony is that President Obama allowed Humana to do what they were offering anyway.

 

[matttyl]

Just to be clear then, you're not arguing that BCBS did anything wrong in the Florida incident from the article, only that Humana did something wrong in the Kentucky incident from the article?

As a side note, I really don't see anything ethically wrong with the Humana letter. It may have technically broken the letter of the law, but I don't see anything unethical or "scamming" in there.

I'm arguing that insurance companies are helping perpetuate the "Obamacare will cost you ten times as much" B.S. in the interest of their profits. Which is, I think, unethical, even if perfectly legal. I think it's wrong, but not illegal, to prey on peoples' fears in order to make sure they don't compare your company's options to those of other companies in the same business.

However, when consumers come out and say "Obamacare costs me ten times as much as my old insurance plan!" it's generally because they don't understand their options or because their previous plan was virtually worthless from a coverage standpoint.

The letter specifically talks about the new marketplaces and the options people have on them, possibly with financial assistance. Did you even read that letter? If so, how can you possibly make the bolded comment?!?!

 

[Henry Ford]

And, yes, I have read the Humana letter, which is why I'm talking about that one. The letter stated, on August 21, that the policy holder had to let the insurance company know within 30 days if he/she wanted to renew his/her policy on December 31, or would have to choose one of the more expensive options under the ACA, and attached estimated costs.

Funny part being, that meant that the policy holder had to renew more than 90 days before the end of the policy and a hilarious 10 days before the insurance exchanges opened and they could compare policies. Humana sent these out without approval, presumably because the insurance commission would have said "uh, yeah, you can't require them to renew by ten days before the other options for next year show up, more than 90 days before the new policy year would start, when they have policies that don't end until at least December." And it would be creating a new plan "fiscal year" based on December 31, rather than whatever the current year-end would have been.

Letter:

http://i2.cdn.turner.com/cnn/2013/images/11/15/kentucky.humana.letter.pdf

To me, that letter is a HUGE BENEFIT to the insured. Last year I spent weeks informing my clients to do exactly what this letter is asking these folks in Kentucky to do, and if you understood insurance I think you'd fully agree. If you don't, I'd love to hear why.

What this letter is saying is that you can keep your coverage (which after all is what the president promised) for another year if you elect to accept a "December renewal" for your policy. That means that the person's first renewal after 1/1/14 (when the ACA comes online) wouldn't be until 12/30/14, which is when they then would have to have their policy canceled and replaced. This option is doing nothing but giving them the option of more time with their current coverage. Given the huge mess that the website and marketplace have been (just ask Tim in the other ACA thread who's brother's policy was canceled and he was unable to get coverage for 1/1/14), this is an enormous benefit to each and every one of their policy holders. Accepting a "December renewal" not only didn't change their rates, it didn't "lock them in" to keeping that coverage if they found a policy on the exchange that is better for them or cheaper, or both. Again, all it would do is give their current policy holders more time to make the best decision for themselves.

Further, the entire first damn paragraph of that letter is telling people about these new marketplaces, and directly mentions that they may be able for financial assistance (subsidies).

But that they won't be able to determine that before Humana requires them to renew in their unapproved letter.

 

[matttyl]

Of course the irony is that President Obama allowed Humana to do what they were offering anyway.

That's the biggest joke of them all.

 

[Henry Ford]

Just to be clear then, you're not arguing that BCBS did anything wrong in the Florida incident from the article, only that Humana did something wrong in the Kentucky incident from the article?

As a side note, I really don't see anything ethically wrong with the Humana letter. It may have technically broken the letter of the law, but I don't see anything unethical or "scamming" in there.

I'm arguing that insurance companies are helping perpetuate the "Obamacare will cost you ten times as much" B.S. in the interest of their profits. Which is, I think, unethical, even if perfectly legal. I think it's wrong, but not illegal, to prey on peoples' fears in order to make sure they don't compare your company's options to those of other companies in the same business.

However, when consumers come out and say "Obamacare costs me ten times as much as my old insurance plan!" it's generally because they don't understand their options or because their previous plan was virtually worthless from a coverage standpoint.

The letter specifically talks about the new marketplaces and the options people have on them, possibly with financial assistance. Did you even read that letter? If so, how can you possibly make the bolded comment?!?!

Because the letter required an answer before the marketplaces opened.

 

[matttyl]

And, yes, I have read the Humana letter, which is why I'm talking about that one. The letter stated, on August 21, that the policy holder had to let the insurance company know within 30 days if he/she wanted to renew his/her policy on December 31, or would have to choose one of the more expensive options under the ACA, and attached estimated costs.

Funny part being, that meant that the policy holder had to renew more than 90 days before the end of the policy and a hilarious 10 days before the insurance exchanges opened and they could compare policies. Humana sent these out without approval, presumably because the insurance commission would have said "uh, yeah, you can't require them to renew by ten days before the other options for next year show up, more than 90 days before the new policy year would start, when they have policies that don't end until at least December." And it would be creating a new plan "fiscal year" based on December 31, rather than whatever the current year-end would have been.

Letter:

http://i2.cdn.turner.com/cnn/2013/images/11/15/kentucky.humana.letter.pdf

To me, that letter is a HUGE BENEFIT to the insured. Last year I spent weeks informing my clients to do exactly what this letter is asking these folks in Kentucky to do, and if you understood insurance I think you'd fully agree. If you don't, I'd love to hear why.

What this letter is saying is that you can keep your coverage (which after all is what the president promised) for another year if you elect to accept a "December renewal" for your policy. That means that the person's first renewal after 1/1/14 (when the ACA comes online) wouldn't be until 12/30/14, which is when they then would have to have their policy canceled and replaced. This option is doing nothing but giving them the option of more time with their current coverage. Given the huge mess that the website and marketplace have been (just ask Tim in the other ACA thread who's brother's policy was canceled and he was unable to get coverage for 1/1/14), this is an enormous benefit to each and every one of their policy holders. Accepting a "December renewal" not only didn't change their rates, it didn't "lock them in" to keeping that coverage if they found a policy on the exchange that is better for them or cheaper, or both. Again, all it would do is give their current policy holders more time to make the best decision for themselves.

Further, the entire first damn paragraph of that letter is telling people about these new marketplaces, and directly mentions that they may be able for financial assistance (subsidies).

But that they won't be able to determine that before Humana requires them to renew in their unapproved letter.

And what harm would that cause the customer?! A-B-S-O-L-U-T-E-L-Y N-O-N-E. It wouldn't not raise their rates, or lock them into any plan. The person can still take their business elsewhere if they want. The renewal only allowed the customer more time with the coverage that they choose for themselves, should they need it (which first the president promised, and then attempted to force the insurance companies to do).

 

[matttyl]

Just to be clear then, you're not arguing that BCBS did anything wrong in the Florida incident from the article, only that Humana did something wrong in the Kentucky incident from the article?

As a side note, I really don't see anything ethically wrong with the Humana letter. It may have technically broken the letter of the law, but I don't see anything unethical or "scamming" in there.

I'm arguing that insurance companies are helping perpetuate the "Obamacare will cost you ten times as much" B.S. in the interest of their profits. Which is, I think, unethical, even if perfectly legal. I think it's wrong, but not illegal, to prey on peoples' fears in order to make sure they don't compare your company's options to those of other companies in the same business.

However, when consumers come out and say "Obamacare costs me ten times as much as my old insurance plan!" it's generally because they don't understand their options or because their previous plan was virtually worthless from a coverage standpoint.

The letter specifically talks about the new marketplaces and the options people have on them, possibly with financial assistance. Did you even read that letter? If so, how can you possibly make the bolded comment?!?!

Because the letter required an answer before the marketplaces opened.

So the F what.

 

[fourd]

Just to be clear then, you're not arguing that BCBS did anything wrong in the Florida incident from the article, only that Humana did something wrong in the Kentucky incident from the article?

As a side note, I really don't see anything ethically wrong with the Humana letter. It may have technically broken the letter of the law, but I don't see anything unethical or "scamming" in there.

I'm arguing that insurance companies are helping perpetuate the "Obamacare will cost you ten times as much" B.S. in the interest of their profits. Which is, I think, unethical, even if perfectly legal. I think it's wrong, but not illegal, to prey on peoples' fears in order to make sure they don't compare your company's options to those of other companies in the same business.

However, when consumers come out and say "Obamacare costs me ten times as much as my old insurance plan!" it's generally because they don't understand their options or because their previous plan was virtually worthless from a coverage standpoint.

The letter specifically talks about the new marketplaces and the options people have on them, possibly with financial assistance. Did you even read that letter? If so, how can you possibly make the bolded comment?!?!

Because the letter required an answer before the marketplaces opened.

So? How would that stop them from shopping on the exchange once they did open?

 

[Henry Ford]

And, yes, I have read the Humana letter, which is why I'm talking about that one. The letter stated, on August 21, that the policy holder had to let the insurance company know within 30 days if he/she wanted to renew his/her policy on December 31, or would have to choose one of the more expensive options under the ACA, and attached estimated costs.

Funny part being, that meant that the policy holder had to renew more than 90 days before the end of the policy and a hilarious 10 days before the insurance exchanges opened and they could compare policies. Humana sent these out without approval, presumably because the insurance commission would have said "uh, yeah, you can't require them to renew by ten days before the other options for next year show up, more than 90 days before the new policy year would start, when they have policies that don't end until at least December." And it would be creating a new plan "fiscal year" based on December 31, rather than whatever the current year-end would have been.

Letter:

http://i2.cdn.turner.com/cnn/2013/images/11/15/kentucky.humana.letter.pdf

To me, that letter is a HUGE BENEFIT to the insured. Last year I spent weeks informing my clients to do exactly what this letter is asking these folks in Kentucky to do, and if you understood insurance I think you'd fully agree. If you don't, I'd love to hear why.

What this letter is saying is that you can keep your coverage (which after all is what the president promised) for another year if you elect to accept a "December renewal" for your policy. That means that the person's first renewal after 1/1/14 (when the ACA comes online) wouldn't be until 12/30/14, which is when they then would have to have their policy canceled and replaced. This option is doing nothing but giving them the option of more time with their current coverage. Given the huge mess that the website and marketplace have been (just ask Tim in the other ACA thread who's brother's policy was canceled and he was unable to get coverage for 1/1/14), this is an enormous benefit to each and every one of their policy holders. Accepting a "December renewal" not only didn't change their rates, it didn't "lock them in" to keeping that coverage if they found a policy on the exchange that is better for them or cheaper, or both. Again, all it would do is give their current policy holders more time to make the best decision for themselves.

Further, the entire first damn paragraph of that letter is telling people about these new marketplaces, and directly mentions that they may be able for financial assistance (subsidies).

But that they won't be able to determine that before Humana requires them to renew in their unapproved letter.

And what harm would that cause the customer?! A-B-S-O-L-U-T-E-L-Y N-O-N-E. It wouldn't not raise their rates, or lock them into any plan. The person can still take their business elsewhere if they want. The renewal only allowed the customer more time with the coverage that they choose for themselves, should they need it (which first the president promised, and then attempted to force the insurance companies to do).

Just to be clear then, you're not arguing that BCBS did anything wrong in the Florida incident from the article, only that Humana did something wrong in the Kentucky incident from the article?

As a side note, I really don't see anything ethically wrong with the Humana letter. It may have technically broken the letter of the law, but I don't see anything unethical or "scamming" in there.

I'm arguing that insurance companies are helping perpetuate the "Obamacare will cost you ten times as much" B.S. in the interest of their profits. Which is, I think, unethical, even if perfectly legal. I think it's wrong, but not illegal, to prey on peoples' fears in order to make sure they don't compare your company's options to those of other companies in the same business.

However, when consumers come out and say "Obamacare costs me ten times as much as my old insurance plan!" it's generally because they don't understand their options or because their previous plan was virtually worthless from a coverage standpoint.

The letter specifically talks about the new marketplaces and the options people have on them, possibly with financial assistance. Did you even read that letter? If so, how can you possibly make the bolded comment?!?!

Because the letter required an answer before the marketplaces opened.

So the F what.

Read these two sentences:

"You have two options: continue your current policy on December 31, 2013 and retain it through December 31, 2014 (Option A) or choose to include the new 2014 ACA benefits in your policy beginning January 1, 2014 (Option B). If you don't select Option A or B, then we will discontinue your current policy and you will receive a new policy with ACA benefits and rates (Option B)."

Keep in mind you must choose one of those two options before looking at the marketplace. Focus particularly on the first part of the first sentence "continue.... and retain it through December 31, 2014."

 

[fourd]

And, yes, I have read the Humana letter, which is why I'm talking about that one. The letter stated, on August 21, that the policy holder had to let the insurance company know within 30 days if he/she wanted to renew his/her policy on December 31, or would have to choose one of the more expensive options under the ACA, and attached estimated costs.

Funny part being, that meant that the policy holder had to renew more than 90 days before the end of the policy and a hilarious 10 days before the insurance exchanges opened and they could compare policies. Humana sent these out without approval, presumably because the insurance commission would have said "uh, yeah, you can't require them to renew by ten days before the other options for next year show up, more than 90 days before the new policy year would start, when they have policies that don't end until at least December." And it would be creating a new plan "fiscal year" based on December 31, rather than whatever the current year-end would have been.

Letter:

http://i2.cdn.turner.com/cnn/2013/images/11/15/kentucky.humana.letter.pdf

To me, that letter is a HUGE BENEFIT to the insured. Last year I spent weeks informing my clients to do exactly what this letter is asking these folks in Kentucky to do, and if you understood insurance I think you'd fully agree. If you don't, I'd love to hear why.

What this letter is saying is that you can keep your coverage (which after all is what the president promised) for another year if you elect to accept a "December renewal" for your policy. That means that the person's first renewal after 1/1/14 (when the ACA comes online) wouldn't be until 12/30/14, which is when they then would have to have their policy canceled and replaced. This option is doing nothing but giving them the option of more time with their current coverage. Given the huge mess that the website and marketplace have been (just ask Tim in the other ACA thread who's brother's policy was canceled and he was unable to get coverage for 1/1/14), this is an enormous benefit to each and every one of their policy holders. Accepting a "December renewal" not only didn't change their rates, it didn't "lock them in" to keeping that coverage if they found a policy on the exchange that is better for them or cheaper, or both. Again, all it would do is give their current policy holders more time to make the best decision for themselves.

Further, the entire first damn paragraph of that letter is telling people about these new marketplaces, and directly mentions that they may be able for financial assistance (subsidies).

But that they won't be able to determine that before Humana requires them to renew in their unapproved letter.

And what harm would that cause the customer?! A-B-S-O-L-U-T-E-L-Y N-O-N-E. It wouldn't not raise their rates, or lock them into any plan. The person can still take their business elsewhere if they want. The renewal only allowed the customer more time with the coverage that they choose for themselves, should they need it (which first the president promised, and then attempted to force the insurance companies to do).

Just to be clear then, you're not arguing that BCBS did anything wrong in the Florida incident from the article, only that Humana did something wrong in the Kentucky incident from the article?

As a side note, I really don't see anything ethically wrong with the Humana letter. It may have technically broken the letter of the law, but I don't see anything unethical or "scamming" in there.

I'm arguing that insurance companies are helping perpetuate the "Obamacare will cost you ten times as much" B.S. in the interest of their profits. Which is, I think, unethical, even if perfectly legal. I think it's wrong, but not illegal, to prey on peoples' fears in order to make sure they don't compare your company's options to those of other companies in the same business.

However, when consumers come out and say "Obamacare costs me ten times as much as my old insurance plan!" it's generally because they don't understand their options or because their previous plan was virtually worthless from a coverage standpoint.

The letter specifically talks about the new marketplaces and the options people have on them, possibly with financial assistance. Did you even read that letter? If so, how can you possibly make the bolded comment?!?!

Because the letter required an answer before the marketplaces opened.

So the F what.

Read these two sentences:

"You have two options: continue your current policy on December 31, 2013 and retain it through December 31, 2014 (Option A) or choose to include the new 2014 ACA benefits in your policy beginning January 1, 2014 (Option B). If you don't select Option A or B, then we will discontinue your current policy and you will receive a new policy with ACA benefits and rates (Option B)."

Keep in mind you must choose one of those two options before looking at the marketplace. Focus particularly on the first part of the first sentence "continue.... and retain it through December 31, 2014."

And how would they make you do that? They are telling you what your new plan year would be. They can't force you to pay them. You would still be free to shop for a new plan.

 

[Dinsy Ejotuz]

Kentucky fined them for using an unapproved form of renewal notice, which is a violation of Kentucky law for insurance companies. Those forms have to be approved for precisely this reason. I don't think insurance companies should be able to violate the law in their advertising. That's not begging the question, I actually have a problem with companies breaking the law in the name of profit.

But why would a company send an unapproved and misleading letter if they have the life-and-death interests of their customer at heart?

It's enough to make you wonder if maybe not all of the problems with health care in this country are due to Obamacare.

 

[matttyl]

Read these two sentences:
"You have two options: continue your current policy on December 31, 2013 and retain it through December 31, 2014 (Option A) or choose to include the new 2014 ACA benefits in your policy beginning January 1, 2014 (Option B). If you don't select Option A or B, then we will discontinue your current policy and you will receive a new policy with ACA benefits and rates (Option B)."

Keep in mind you must choose one of those two options before looking at the marketplace. Focus particularly on the first part of the first sentence "continue.... and retain it through December 31, 2014."

Yes, I've read all these sentences, and the ones like it that were sent to my clients with the same December renewal option.

Henry, understand that this plan was going to be canceled no matter what in 2014. If the carrier and/or customer did nothing, it would have been on January 1st. If the carrier and/or customer accepted this offer of a December renewal, it wouldn't have been until December 31.

The first bolded part you have here in what was going to happen regardless of this letter. You get that, right? The carrier had to do that because the plan wasn't ACA compliant or grandfathered, and thus could not be renewed....until the President changed the law and allowed carriers to renew them, if given DOI approval in that state.

See, that's the funny thing if you understood what this offer is. Humana said you can continue your current plan into 2014 without DOI approval (which is why they were fined) and it was "wrong" and they were fined. Months later the President does the exact same thing, without DOI approval, and it's called "the fix". You don't find that at all ironic?

Again, the offer just allowed these individuals to remain on their current plan for longer before being canceled - without any increase in premiums. Nothing stopped them from shopping on the exchanges once they were open, and obtaining one of those plans and canceling their current Humana coverage.

 

[Henry Ford]

Read these two sentences:

"You have two options: continue your current policy on December 31, 2013 and retain it through December 31, 2014 (Option A) or choose to include the new 2014 ACA benefits in your policy beginning January 1, 2014 (Option B). If you don't select Option A or B, then we will discontinue your current policy and you will receive a new policy with ACA benefits and rates (Option B)."

Keep in mind you must choose one of those two options before looking at the marketplace. Focus particularly on the first part of the first sentence "continue.... and retain it through December 31, 2014."

And how would they make you do that? They are telling you what your new plan year would be. They can't force you to pay them. You would still be free to shop for a new plan.

Yeah, it's almost like saying that is misleading.

 

[matttyl]

Kentucky fined them for using an unapproved form of renewal notice, which is a violation of Kentucky law for insurance companies. Those forms have to be approved for precisely this reason. I don't think insurance companies should be able to violate the law in their advertising. That's not begging the question, I actually have a problem with companies breaking the law in the name of profit.

But why would a company send an unapproved and misleading letter if they have the life-and-death interests of their customer at heart?

It's enough to make you wonder if maybe not all of the problems with health care in this country are due to Obamacare.

Again, the "unapproved" part is something that the President himself asked the carriers to do. He did the exact same thing! Also, please tell me what is misleading about the letter.

 

[Henry Ford]

Read these two sentences:
"You have two options: continue your current policy on December 31, 2013 and retain it through December 31, 2014 (Option A) or choose to include the new 2014 ACA benefits in your policy beginning January 1, 2014 (Option B). If you don't select Option A or B, then we will discontinue your current policy and you will receive a new policy with ACA benefits and rates (Option B)."

Keep in mind you must choose one of those two options before looking at the marketplace. Focus particularly on the first part of the first sentence "continue.... and retain it through December 31, 2014."

Yes, I've read all these sentences, and the ones like it that were sent to my clients with the same December renewal option.

Henry, understand that this plan was going to be canceled no matter what in 2014. If the carrier and/or customer did nothing, it would have been on January 1st. If the carrier and/or customer accepted this offer of a December renewal, it wouldn't have been until December 31.

The first bolded part you have here in what was going to happen regardless of this letter. You get that, right? The carrier had to do that because the plan wasn't ACA compliant or grandfathered, and thus could not be renewed....until the President changed the law and allowed carriers to renew them, if given DOI approval in that state.

See, that's the funny thing if you understood what this offer is. Humana said you can continue your current plan into 2014 without DOI approval (which is why they were fined) and it was "wrong" and they were fined. Months later the President does the exact same thing, without DOI approval, and it's called "the fix". You don't find that at all ironic?

Again, the offer just allowed these individuals to remain on their current plan for longer before being canceled - without any increase in premiums. Nothing stopped them from shopping on the exchanges once they were open, and obtaining one of those plans and canceling their current Humana coverage.

Except the insurer told them they had to stay on it until December 31, 2014. So either that's not true, and the letter fraudulently misrepresents the terms and conditions of the policy, or it is true. Which one is it?

 

[Dinsy Ejotuz]

Also, note to self: don't have any business dealings with mattyl.

 

[Henry Ford]

Kentucky fined them for using an unapproved form of renewal notice, which is a violation of Kentucky law for insurance companies. Those forms have to be approved for precisely this reason. I don't think insurance companies should be able to violate the law in their advertising. That's not begging the question, I actually have a problem with companies breaking the law in the name of profit.

But why would a company send an unapproved and misleading letter if they have the life-and-death interests of their customer at heart?

It's enough to make you wonder if maybe not all of the problems with health care in this country are due to Obamacare.

Again, the "unapproved" part is something that the President himself asked the carriers to do. He did the exact same thing! Also, please tell me what is misleading about the letter.

It tells them that they have to decide before the exchanges open whether to keep the exact same policy they're on until December 31, 2014 or take an ACA plan which they can't even look at yet.

 

[fourd]

Kentucky fined them for using an unapproved form of renewal notice, which is a violation of Kentucky law for insurance companies. Those forms have to be approved for precisely this reason. I don't think insurance companies should be able to violate the law in their advertising. That's not begging the question, I actually have a problem with companies breaking the law in the name of profit.

But why would a company send an unapproved and misleading letter if they have the life-and-death interests of their customer at heart?

It's enough to make you wonder if maybe not all of the problems with health care in this country are due to Obamacare.

Can you point out the misleading parts?

 

[matttyl]

Again, the offer just allowed these individuals to remain on their current plan for longer before being canceled - without any increase in premiums. Nothing stopped them from shopping on the exchanges once they were open, and obtaining one of those plans and canceling their current Humana coverage.

Except the insurer told them they had to stay on it until December 31, 2014. So either that's not true, and the letter fraudulently misrepresents the terms and conditions of the policy, or it is true. Which one is it?

That is NOT what the letter said. Please reread.

 

[Henry Ford]

Kentucky fined them for using an unapproved form of renewal notice, which is a violation of Kentucky law for insurance companies. Those forms have to be approved for precisely this reason. I don't think insurance companies should be able to violate the law in their advertising. That's not begging the question, I actually have a problem with companies breaking the law in the name of profit.

But why would a company send an unapproved and misleading letter if they have the life-and-death interests of their customer at heart?

It's enough to make you wonder if maybe not all of the problems with health care in this country are due to Obamacare.

Can you point out the misleading parts?

"You have two options: continue your current policy on December 31, 2013 and retain it through December 30, 2014 (Option A) or choose to include the new 2014 ACA benefits in your policy beginning January 1, 2014 (Option B). If you don't select Option A or B, then we will discontinue your current policy and you will receive a new policy with ACA benefits and rates (Option B)."