[$tinkle]

Short-term customers boosting health costs

Thousands of consumers are gaming Massachusetts’ 2006 health insurance law by buying insurance when they need to cover pricey medical care, such as fertility treatments and knee surgery, and then swiftly dropping coverage, a practice that insurance executives say is driving up costs for other people and small businesses.

In 2009 alone, 936 people signed up for coverage with Blue Cross and Blue Shield of Massachusetts for three months or less and ran up claims of more than $1,000 per month while in the plan. Their medical spending while insured was more than four times the average for consumers who buy coverage on their own and retain it in a normal fashion, according to data the state’s largest private insurer provided the Globe.

The typical monthly premium for these short-term members was $400, but their average claims exceeded $2,200 per month. The previous year, the company’s data show it had even more high-spending, short-term members. Over those two years, the figures suggest the price tag ran into the millions.

Other insurers could not produce such detailed information for short-term customers but said they have witnessed a similar pattern. And, they said, the phenomenon is likely to be repeated on a grander scale when the new national health care law begins requiring most people to have insurance in 2014, unless federal regulators craft regulations to avoid the pitfall.

“These consumers come in and get their service, and then they leave because current regulations allow them to do it,’’ said Todd Bailey, vice president of underwriting at Fallon Community Health Plan, the state’s fourth-largest insurer.

thanks to former governor romney - a RETHUGLICAN!!11!

clearly, he's only one-fiftieth the man obama is

 

[Silver]

They collected premiums of 2.2B in 2008. This looks like it's a 5M loss in 2009.

Might as well shut down the industry...

 

[kidwoo]

 

[$tinkle]

 

[kidwoo]

I feel really bad for a company that lets people die over made up, fantasy terminology now making 'less' money.

 

[DaveW]

Someone rep Kidwoo for me.
I need to do some more spreading.......

 

[valve bouncer]

In 2009 alone, 936 people signed up for coverage with Blue Cross and Blue Shield of Massachusetts for three months or less and ran up claims of more than $1,000 per month while in the plan.

Outrageous....that's a 1 with 3 zeroes right?

 

[$tinkle]

and that was for just 2009.

alone.

 

[kidwoo]

Considering the treatment I've gotten from blue cross blue shield, they really should suffer a bit. Kind of like me when I've got a gaping vagina in my arm full of gravel and satan, telling the one doctor in the emergency room that I'd really rather drive to somehwhere with an 'in network' doctor.


But what's actually going to happen is that they're going to raise their rates and my agency's contract will pay it, or pass it on to employees.

Should have gone government run, single payer, no excuses and no compromises.

 

[Westy]

So what stopped people from doing this before Mandatory HC?

 

[dante]

So what stopped people from doing this before Mandatory HC?

Pre-existing conditions... If you get injured/sick and don't have health care, when you do get health care they don't have to cover it.

The US Bill has a maximum 30 or 60 day waiting period, though, so if you want to play that game you'd better hope that you don't get catastrophically ill or injured... imagine trying to wait 2 months for your insurance to kick in while you've got a broken back.

 

[Westy]

Pre-existing conditions... If you get injured/sick and don't have health care, when you do get health care they don't have to cover it.

The US Bill has a maximum 30 or 60 day waiting period, though, so if you want to play that game you'd better hope that you don't get catastrophically ill or injured... imagine trying to wait 2 months for your insurance to kick in while you've got a broken back.

Pre-existing condition clause doesn't kick in until 2014 and it only says that they can't deny you coverage, they can still charge you a ****load. Also, with required coverage don't you get fined for not getting covered? I don't think it is mandatory coverage 'some of the time'

 

[drkenan]

Don't forget that although they can't deny you for pre-existing conditions, they can still deny you.

 

[Westy]

Don't forget that although they can't deny you for pre-existing conditions, they can still deny you.

I think that will have the biggest impact on those under corporate policies. I have psoriasis, treatments are cheap now but could become very expensive down the road. If I go a day without coverage I would never get covered even under a corporate policy. I could get a personal policy but from what I have looked into would cost me a few grand a month even though my current treatments are only a few hundred dollars a year.

 

[$tinkle]

Should have gone government run, single payer, no excuses and no compromises.

so improve the bloated, unaccountable, fiscally irresponsible bureaucracy by adding more of the same?

how do you see single payer in either current or proposed form as being better in any form?

and yeah, i've heard nothing but horror stories about bc/bs in cali. i still strongly believe the key to real reform is tort reform & fraud elimination (unrealistic when you have such a quick turn-around on claims, i realize)

Don't forget that although they can't deny you for pre-existing conditions, they can still deny you.

how so? doesn't this completely undermine the intent of the new law?

i assume we're now discussing the fed'l law, and not MA, which may be parallel for the purposes of this discussion

 

[kidwoo]

so improve the bloated, unaccountable, fiscally irresponsible bureaucracy by adding more of the same?

how do you see single payer in either current or proposed form as being better in any form?

and yeah, i've heard nothing but horror stories about bc/bs in cali. i still strongly believe the key to real reform is tort reform & fraud elimination (unrealistic when you have such a quick turn-around on claims, i realize)
how so? doesn't this completely undermine the intent of the new law?

Sweeping generalizations about bloated this and that government don't help credibility. There are plenty of extremely well run government agencies. No really.

Tort and fraud reform sound really good but have you seen what percentage of costs this actually amounts to in the bloated, unaccountable, fiscally irresponsible bureaucracy of insurance companies? It ain't that much.

As far as government run single payer: We are the richest nation on the planet. We pay farmers money to grow corn and throw it away. We pay ranchers to flood irrigate, and fill watersheds with cow shlt. We build roads at a loss on public land so logging trucks can drive around and make private profits. We pay defense contractors to build billion dollar planes that never fly.

Health care is people's lives.....literally. And true first world countries have a plethora of models to look at, emulate, improve upon, and implement. I really don't have much patience for pretending this is a waste of resources with all the glaring contradictions already in place of what we don't consdider wasteful but has been full on policy for decades.

 

[$tinkle]

Sweeping generalizations about bloated this and that government don't help credibility. There are plenty of extremely well run government agencies. No really.

i absolutely agree they exist (haiti response is a prime example). i just don't find this in the HC industry.

Tort and fraud reform sound really good but have you seen what percentage of costs this actually amounts to in the bloated, unaccountable, fiscally irresponsible bureaucracy of insurance companies? It ain't that much.

yu-huh
q.e.d.

As far as government run single payer: We are the richest nation on the planet.

irrelevant, and untrue to boot (a little thing i like to call the "deficit" roils your oft-echoed claim). how can bush have bankrupted us, yet we're #1? both cannot be true.

Health care is people's lives.....literally. And true first world countries have a plethora of models to look at, emulate, improve upon, and implement. I really don't have much patience for pretending this is a waste of resources with all the glaring contradictions already in place of what we don't consdider wasteful but has been full on policy for decades.

like what? not saying it doesn't exist, but much like you asked about what portion does it comprise....

and then: the recently passed HC legislation will, among other things, expand the rolls of medicaid by 16M eligible recipients and force another 15M w/o health insurance to purchase health insurance, under pain of penalty

the system *will* get gamed, and i believe to a significant & cost increasing measure. eh, well, what's another trillion?

 

[Secret Squirrel]

the system *will* get gamed, and i believe to a significant & cost increasing measure. eh, well, what's another trillion?

If you're not gaming the system, the system's gaming you.



Dear god...I think I'm starting to sound as caustic as my father...shoot me now.

 

[kidwoo]

irrelevant, and untrue to boot (a little thing i like to call the "deficit" roils your oft-echoed claim). how can bush have bankrupted us, yet we're #1? both cannot be true.

I meant spiritually.


Come on man, our current federal budget says nothing to what we still waste money on, and gladly don't collect. You know as well as I do that the potential to build coffers is enormous in this country. Quit coorparate welfare tax loopholes, quit letting douchebags in their 20s trading stocks decide what course the economy takes and it's not that hard to get back to a state of oh what's it called......'clintonian bliss'



As to the rest of your post my opinion stays the same. We can be canada, swisssssserland, the netherlands, the UK......anything as far as health care is concerned. They're all better. Not perfect, but sure as shlt better than the illusion of coverage I and a bizillion other people have. If we quit felating many of the industries that we do, especially at a loss, we'd be fackin loaded.

 

[$tinkle]

more today from the bay state:

Health insurers sue to raise rates

A half-dozen health insurers yesterday filed a lawsuit against the state seeking to reverse last week’s decision by the insurance commissioner to block double-digit premium increases — a ruling they say could leave them with hundreds of millions in losses this year.

The proposed rate hikes would have taken effect April 1 for plans covering thousands of small businesses and individuals. Insurers wanted to raise base rates an average of 8 percent to 32 percent; tacked on to that are often additional costs calculated according to factors such as the size and age of the workforce.

Yesterday’s legal action sets the stage for a showdown between state regulators and the health insurance industry.

remember, the opposite of losses is not necessarily profit, esp in a non-profit company, which some insurers are.

i'm tellin' ya, there's more to come soon nationally.

edit: here it is:

Filing the suit were Blue Cross and Blue Shield of Massachusetts, the state’s largest health insurer, and the five commercial members of the Massachusetts Association of Health Plans: Harvard Pilgrim Health Care, Tufts Health Plan, Fallon Community Health Plan, Health New England, and Neighborhood Health Plan. All are nonprofit carriers.

 

[kidwoo]

Well we can't sue them for crappy treatment, so it seems fair to me to tell them to suck it.