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Message

re: Rush on pre-existing ...it's not insurance, it's welfare

Posted on 5/3/17 at 1:34 pm to
Posted by Eurocat
Member since Apr 2004
15045 posts
Posted on 5/3/17 at 1:34 pm to
Zach,

84% of people between 55 and 64 have a pre-existing condition.
Posted by roadGator
Member since Feb 2009
140136 posts
Posted on 5/3/17 at 1:35 pm to
Now break out your underwriting manual and tell me what percentage of those are actually uninsurable?
Posted by tedmarkuson
texas
Member since Feb 2015
2592 posts
Posted on 5/3/17 at 1:36 pm to
in employer insurance (that's large group and small group) large group like mine is self insured, small group is underwritten meaning it's insurance, self insurance means your employer is merely paying your claims. when you are hired you have a thirty day waiting period that's typically done to facilitate the payroll deduction aspect of your premiums (in small group) or your employee contribution in large group at that time all pre existing conditions are covered, they can not be excluded. if for some reason you were to cancel your coverage and let it lapse for more than 90 days, then pre-existing conditions can be uncovered for up to 18 months for adults (16 or over) and six months for minors. you can skip coverage but you are allowed a chance to enroll during the next open enrollment period but if you haven't maintained some form of valid coverage since the past open enrollment period the 90 day lapse rule applies.

in other words you have coverage through your wife's plan you decide you want it through your employer instead, you got no problems, you just didn't want the coverage cause it's expensive and you didn't plan on getting sick then that condition will be excluded doesn't mean they won't take you it's simply means claims related to that specific pre-existing condition will not be paid.
Posted by roadGator
Member since Feb 2009
140136 posts
Posted on 5/3/17 at 1:37 pm to
Um, I've been in the health insurance industry since 1996.

Also, I served a brief time in underwriting. Not everyone with a PEC was denied coverage. It depends on what it was and actually what the market was doing at the time.
This post was edited on 5/3/17 at 1:38 pm
Posted by Zach
Gizmonic Institute
Member since May 2005
112438 posts
Posted on 5/3/17 at 1:38 pm to
quote:

84% of people between 55 and 64 have a pre-existing condition.


No. Pre-existing means existing before they think "Oh, I need health insurance now."
5% of those 84% have no health insurance.
Posted by Eurocat
Member since Apr 2004
15045 posts
Posted on 5/3/17 at 1:41 pm to
Which was why it was a GOOD thing for the ACA TO MAKE PEOPLE GET INSURANCE AND NOT WAIT UNTIL THEY GOT SICK!

Some more info.

LINK

Posted by SSpaniel
Germantown
Member since Feb 2013
29658 posts
Posted on 5/3/17 at 1:41 pm to
quote:

large group like mine is self insured



Ahh.. you are bringing up 25 year old memories of calling up blue cross every single morning, finding out what claims were paid and making a bank transfer to cover those claims at the physicians group I worked for then. Fun times.
Posted by roadGator
Member since Feb 2009
140136 posts
Posted on 5/3/17 at 1:41 pm to
quote:

ACA TO MAKE PEOPLE GET INSURANCE


It didn't exactly do that.
Posted by Mephistopheles
Member since Aug 2007
8328 posts
Posted on 5/3/17 at 1:42 pm to
40 hours a week at minimum wage is about 15k before tax.

Under the current plans, having a condition like Asthma could cost $4k a year. Asthma.

What do you do if you're on minimum wage and have Asthma? Or a more expensive condition?
Posted by roadGator
Member since Feb 2009
140136 posts
Posted on 5/3/17 at 1:42 pm to
You had to transfer daily? Holy hell.
Posted by Zach
Gizmonic Institute
Member since May 2005
112438 posts
Posted on 5/3/17 at 1:45 pm to
quote:

it was a GOOD thing for the ACA TO MAKE PEOPLE GET INSURANCE AND NOT WAIT UNTIL THEY GOT SICK!


That's unconstitutional. You cannot MAKE people buy a service. If you read the friggin' news you would know that the Sup Court 'out' on the issue was 'It's a Tax' and the federal govt has the power to tax. They do not have the power to make you buy a product.

And.. a TON of people refused to get covered even though the ACA 'MADE THEM.' How did that happen? Why aren't those people in prison for breaking the law?
Posted by SSpaniel
Germantown
Member since Feb 2013
29658 posts
Posted on 5/3/17 at 1:45 pm to
quote:

You had to transfer daily? Holy hell


Yep. Every day. Low man on the totem pole gets that job.
This post was edited on 5/3/17 at 1:46 pm
Posted by roadGator
Member since Feb 2009
140136 posts
Posted on 5/3/17 at 1:46 pm to
I feel for you for having to get on the phone with a BCBS employee every day. Damn.
Posted by tedmarkuson
texas
Member since Feb 2015
2592 posts
Posted on 5/3/17 at 1:46 pm to
quote:

Not everyone with a PEC was denied coverage. It depends on what it was and actually what the market was doing at the time.




if for some reason you were to cancel your coverage and let it lapse for more than 90 days, then pre-existing conditions can be uncovered for up to 18 months for adults (16 or over) and six months for minors.

it's can be not will be.
Posted by roadGator
Member since Feb 2009
140136 posts
Posted on 5/3/17 at 1:50 pm to
Sure, but not all PECs always led to a denial of coverage or subjected to a waiting period.
This post was edited on 5/3/17 at 2:00 pm
Posted by Bestbank Tiger
Premium Member
Member since Jan 2005
71000 posts
Posted on 5/3/17 at 1:59 pm to
quote:

If you want those coverages, you should certainly be able to buy a plan that includes them.

But you should also be able to buy a lower cost plan that doesn't include them. For instance, if you are a 65 year old woman... just maybe you don't need maternity coverage. But you get it. Or if you are man. You probably don't need maternity coverage then, either.


Exactly.

One advantage to the old system was you had the choice between insurance and comprehensive health care. If you chose insurance it was cheaper and rightfully so.

Patients who chose insurance were typically healthy people who never used the system. They paid in every month and covered other people, unless a catastrophic event happened. The other possibility was they had a chronic condition and bought a catastrophic plan so the premium savings could be used for their meds.

With the ACA, they have to play four certain "essential" benefits they can't use, but it's perfectly OK for the mandatory plan to leave them on the hook for thousands of dollars if their needs aren't on the politically preferred list of services. That's why you still see charitable fundraisers for medical bills.
Posted by cornhat
Member since Feb 2011
3393 posts
Posted on 5/3/17 at 2:07 pm to
quote:

I'd rather pay for a kid with cancer than mg rates going up due to his co-morbidities from obesity and drug addiction.

He is definitely not the person to deliver this message. His doctor shopping for opioids and his obesity makes him the worst type of patient.
Posted by Zach
Gizmonic Institute
Member since May 2005
112438 posts
Posted on 5/3/17 at 2:16 pm to
quote:

He is definitely not the person to deliver this message. His doctor shopping for opioids and his obesity makes him the worst type of patient.


Rush does not have any health insurance. He does have homeowner's insurance since he moved to a beach where hurricanes are an issue.
Posted by TBoy
Kalamazoo
Member since Dec 2007
23686 posts
Posted on 5/3/17 at 2:25 pm to
So it is now a conservative issue to make sure we protect the profits of health insurance companies? I've always considered health insurance companies to be second to Satan in evil. The insurance companies have the true death panels. And now yall have decided that if you have a health problem, you shouldn't be able to access treatment. Sorry guys, I'm off this train.
Posted by DawgsLife
Member since Jun 2013
58905 posts
Posted on 5/3/17 at 2:29 pm to
quote:

And now yall have decided that if you have a health problem, you shouldn't be able to access treatment.


Where did anybody say this? If you have a health problem or not doesn't determine whether or not you can access treatment. That's a silly argument.
Neither does if you have insurance or not. There are people who have never had health insurance, and they had access to treatment.

ETA
I'll go one step further. If people wanted health insurance before ObamaCare, they could have bought it. They didn't need the government to make it mandatory.
This post was edited on 5/3/17 at 2:32 pm
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