Still Waiting on UnitedHealthcare; Another Un-insurable Woman; Health Care Reform Takes Effect

When you blog about big companies, they actually read it. 

A UnitedHealthcare representative called me last week to say she had been told to look into Terry’s situation, the woman about whom I wrote last week. You can see that post here:  UnitedHealthcare: Can they get away with that?  Terry has a Pacificare health insurance policy that is being converted to a UnitedHealthcare policy, and she is going from a decent policy to a terrible one – with a $250,000 cap on her lifetime benefits.  This means that if she gets sick and runs up a bill of $250,000, UnitedHealthcare (UHC) is finished with her and her medical bills.

The UHC rep was looking into Terry’s policy and talked to Terry on Friday last week and Monday this week.  But this rep had to ask someone else to look into Terry’s policy because it is not an “individual policy” but a “conversion policy”.  Terry still hasn’t heard anything more, so we’re waiting to see what UHC’s reasoning is for converting her decent policy to a reprehensible health insurance policy, especially because Terry is a diabetic and un-insurable if she tries to get a new and better policy.

I got a call from yet another woman in her 50’s who is un-insurable. 

This woman applied for a received Social Security Disablity for health conditions I will not reveal.  Suffice it to say, she is disabled.  This woman has been on AHCCCS (Arizona Medicaid) and so has had health insurance which covers all her required treatments.  But once she got a Social Security check, which totals around $1,100 per month, she makes too much money and will be kicked off AHCCCS.

I told this woman to check with Social Security to see when she qualifies for Medicare because a person is supposed to wait 24 months to qualify for Medicare after they are deemed to be disabled .  However, the clock starts from the time a person applies for Social Security Disability and many cases take one, two, or more years to be settled.   This woman found out she will get Medicare on February 1, 2011 – but she will lose her AHCCCS/Medicaid health insurance in November.  Of course, because of her disability, she will be rejected by every insurance company. But she needs treatment each month for her illness and she will not have insurance in November, December, and January.  When her Medicare starts, she will have good insurance.  While she has no insurance, I don’t know what she will do.  Hopefully she makes it to February.

Today, September 23rd, 2010, is the day on which parts of the Affordable Care Act take effect.  As of today:

Insurance companies must offer insurance to children with pre-existing conditions.  This means that if a parent works for a small company that offers health insurance, he will be able to get his sick child coverage.  Small group plans or family plans could previously refuse coverage to a child with an illness.  That is no longer allowed.

Insurance companies can no longer cancel an individual insurance policy when a person gets sick.  Previously, when a person got sick, the insurance company would do everything it could to find something in the initial application for coverage and could say something like, “Aha, you had a yeast infection as a teenager – which you did not put on your application.  Now you have cervical cancer and we are canceling your policy because you did not divulge this pre-existing condition!”  This is no longer allowed. This really happened to someone!

Insurance policies issued after September 23rd (group, individual, and family) cannot cap lifetime benefits.  Thus one would think that Terry’s “conversion” policy, which takes effect on October 1, would not have a $250,000 lifetime benefit.  Terry is still waiting for an answer from UHC on this issue. 

Insurance policies must cover preventive care.  This means that people who have a $5,000 deductible policy, which means they pay the first $5,000 for any and all medical care, can get preventive screening tests and the insurance company must pay for them.

Republicans want to repeal these changes.  Insurance companies did not agressively fight health care reform because they are looking forward to getting 30-40 million new customers with government subsidies in 2014.

What Next?

Related Articles

6 Responses to "Still Waiting on UnitedHealthcare; Another Un-insurable Woman; Health Care Reform Takes Effect"

  1. tiponeill says:

    I was just signing up with United-healthcare, and now I am wondering if perhaps I should choose another option – I (and others) would be very interested in how Unitedhealthcare handles this case – preferably before next month.

  2. medicareblogger says:

    United is definitely looking at Terry’s policy and I think she will hear something this week.  If not, I will call the rep who called me and push some more. I hope they do the right thing.  United’s Medicare business is separate from their under-65 insurance, but I can understand your concerns about how UHC handles this situation.  I sure hope they do right by Terry.  That would be a pleasant surprise – and I will gladly write about it positively.

  3. dollarshort says:

    I anticipate UHS being required by law to provide free insurance to everyone — they should be out of business in about a day once they cannot meet the cash reserve requirements needed to pay claims.

  4. medicareblogger says:

    Honey, you obviously know nothing about the insurance industry.  UHC makes billions of dollars in profits.  In 2014 they will be getting millions of new customers who will have government subsidies to buy insurance.  Who wins?  UHC!   The insurance industry doesn’t like some of the components of the Affordable Care Act, but you might have noticed that they did not fight the law – because they win in this game.  But that’s okay by me if everyone can get health insurance.

  5. Joel says:

    Sure they will get millions of new customers, and billions of government (our) dollars, and it won’t be enough to cover the costs. But like with Medicare, hospital will get pennies on the dollar of what they billed. I for see a day when physicians and hospitals refuse insured customers & only take cash customers. Just like some are starting to do now with Medicare.

  6. medicareblogger says:

    I think you misunderstand hospital and doctor bills.  The large number on a hospital bill is made up. Then you will notice the much smaller amount they have agreed to accept from the insurance company (based on their contract with that company).  Insurance companies pay 10 to 20% more than Medicare pays for the same service, but hospitals with large numbers of Medicare patients do just fine.  They make up for lower payments by charging for more services.  This is called “fee-for-service” and it is a reason why our health care system costs too much. But don’t cry for hospitals and doctors.  Hospitals run into problems with people who don’t have insurance and can’t pay their bills.  That’s why they also support health care reform.  You should read the book, The Healing of America by TR Reid.  Maybe you will learn something about how health care systems work and how ours is broken but can be fixed.  Health care reform is the first step.
    By the way, studies have shown that very few doctors are refusing Medicare.  If they live in a location with a very young population and everybody has employer health insurance, they might be able to turn away seniors – but very few places have such demographics.

Leave a Reply

Submit Comment