HEALTH INSURANCE... THE MUSICAL

Heidy-Ho, Blogging Pals!!  Welcome back!

Alright.  The title isn't really accurate.  It isn't really a musical.  But it is another prime example of the insanity that takes up so much of our time, not allowing us to enjoy the little time we actually have!!

So... the adventure begins.  (Can you hear the overture swelling?)

In May of 2010, it was necessary to obtain personal health insurance.  This news came quickly so there was not a lot of time available to research coverage and premiums.  The cheapest route available was a hospitalization only policy... not covering any office visits, tests (outside of the hospital), or anything that we might actually need.  Oh... and the company issuing the policy actually EXCLUDED coverage for hospitalization for the spousal-unit due to a motorcycle accident.  HUH?!?!?  Yes, he does have a motorcycle endorsement on his drivers license.  Yes, he does have a motorcycle.  Hmmmm.  Since we are both in relatively good health (thank you, Lord!), that is one of the only concerns that might cause a hospitalization event.  But the company won't pay if that happens.  Alrighty then!!  Might as well not spend that $298.88 each month for coverage that isn't really going to help!!

Well now... as the renewal period loomed near, we received a letter from said insurance company advising a couple of things.  I share the following as the most ludicrous:  Seems as though since there are changes to requirements health insurance providers will be needing to meet (thanks to Obamacare), our premium will be increasing from $298.88/month to $368.04.  That's just a 23% increase.  Yeah.  No problem.  The fun part of the letter is that the "adjustment" to the premium was NOT based on our individual claim costs... which was -0- since we have a $5,000 deductible and were not hospitalized during the year... but rather was based on the "combined costs of all company policyholders who have your same plan."  Really?!?  I mean, REALLY?!?!?  This news, of course, led me to create the time to do some additional research.

So... fast-forward to my sitting at the laptop researching.  I found a policy that was nearly identical (!)... really... for a quoted premium of $165.41/month.  WOW!!!  Less than HALF of what we were now going to be paying... and $100 less than what we HAD been paying.  I'll take it.

Completed the online application, fired all off, and waited.

Long story short.  Received an email indicating the application was accepted.  There was nothing said about premium or exclusions... or anything for that  matter.

Fast-forward again.  Policy contract arrives.  Notice a couple of things:
1)  We are both "serving (a) pre-existing condition exclusion period", and
2)  I cannot log onto the company web site as I do not have a PIN.

Customer Care (CC) Call #1:  Send copy of Certificate of Coverage from previous company showing Beginning/Ending dates of coverage and the exclusion period will be waived.  Oh... and do we have any prescription drug benefit at all?  Yes.  Discounted meds just by showing the ID card.  PIN will be along shortly.  Thank you.  Drive through, please.

CC Call #2:  It's been 2 weeks since I faxed the Certificate of Coverage.  Status?  Also, why is premium $188.28 instead of $165.41 but no one mentioned that?  (They just drafted it from the account!)  Oh... and I'm still looking for that PIN for online access.  (Very curt response from rep follows.)  The contract has been "updated" with the previous coverage information.  The premium is higher as the policy has been rated but I don't know why... underwriting does that.  The PIN will be to you within 30 days of the effective date.  Anything else?  (WOW! Pretty short.)  I ask how I can find out why the policy was "rated."  She refers me to the "Medical Director" and, after I have to ask for it, provides a PO Box number and address.  I also tackily mention I find it really amazing that I won't receive anything in writing confirming that a written exclusion on the contract has been amended.  "Toni" wasn't interested in my opinion.  When I stated "Well, thank you for a very futile call.", she perked up, demanding "What kind of call?!?!?" to which I replied, "Futile.  It's in the dictionary."  (Probably didn't make a fan there.)

Sent letter to Medical Director inquiring about "rated" premium.  Took the opportunity to provide my opinion on not receiving a written amendment while I was at it.  :)

Received a letter from the company stating:  "Thank you for contacting us.  The correct amount is $188.28.  You may file an appeal."  WOW!!  Hope that didn't take anyone too much time!!

CC Call #3:  You know I'm not going to accept that stupid letter, right?  Got a REALLY excellent rep who spent a great amount of time listening to me and working toward resolution.  She eventually conferenced in an underwriting person.  You are going to love what I was eventually told.  *chuckle*  (There was a delay as the underwriter person had to call me back since she did not have everything in front of her at the time.)  (CALLBACK RECEIVED.)  Seriously.  I actually started laughing out loud on the phone as this conversation continued.  This gal tells me the policy was NOT rated.  Okay.  Then why is the premium higher?  Well, they applied a "rate-up."  HUH?!?!?!?  (This is a new thing that makes me go "Huh?")  Excuse me... isn't that being "rated?"  Well, no.  Not really.  Could you explain that to me, please?  Sure.  There is a "Preferred" rate which is the rate quoted to everyone initially.  There are seven (count them... SEVEN!) levels of "Standard" rates, each of which is higher than the first.  The policy was actually issued at the "Standard 1" rate rather than the quoted "Preferred" rate.  HUH?!?  So... the policy was "rated."  Nope.  It was just a "rate-up."  Okay... so now I am actually laughing out loud in this lady's ear (it would have been in her face had I been facing her!).  Alright.  Explain to me the difference between "rated" and a "rate-up", please?  Really.  I'm listening.  She finally had to confess that they were effectively the same thing as far as my premium was concerned.  Yeah.  Got that.  Thanks.

Finally... while the answer was inane, it was, at least, an answer.  I decided to call it a day relative to this ridiculously long process.

Epilogue:  The PINs (one for each of us) did arrive in the mail about 28 days from the effective date.  Most interesting is the correspondence dated 8/5 but received 8/13 that amended the policy contract IN WRITING removing the pre-existing condition exclusion on each of us.  And I thought they didn't send that out.  Silly me.

Until next post...