A Little Interesting

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How Obamacare Rates with Consumers One Year Later | The Fiscal Times


The Breier Family, Downers Grove, IL

Age: Dennis, 32, Kim, 31, and their four children (all under age 6)
Occupation: Dennis runs his own wealth management business; Kim is a stay-at-home mom.
Date signed up for Obamacare: 01/01/2014
Name of plan: BCBS PPO - Gold
Qualify for the subsidy? No
Monthly Premium: $1,171
Deductible: $3,500

The Breiers had great health coverage through Dennis's prior job at a bank, but he opened his own business in March last year while Kim was pregnant and needed an insurance plan to cover the pregnancy given her "pre-existing condition." With the pregnancy, a newborn on the way, and three young kids, the family visits the doctor frequently and therefore wanted a plan with a low deductible.

How He Chose His Plan: In addition to wealth management, Dennis is certified to sell health insurance, so he felt knowledgeable about the system and researched the plans online himself. He wanted a high-quality plan that would cover the many doctors his family visits, so he chose a PPO plan that kept their doctors in-network. Dennis makes just over the amount to qualify for the subsidy, so the plan was expensive. There was an HMO plan with a lower deductible, but he heard from friends that the HMO didn't cover as many doctors. “Because we have to be at the doctor a lot, we wanted one of the best plans, and this was essentially the best coverage we could get for the cost,” he says. He went directly to the BCBS website to sign up.

His Experience Using Medical Care So Far: His family has made about 15 to 20 visits to the doctor since signing up, and Dennis says they've had to dispute the bill almost every time over charges for things that should be covered. Then after two months of having the insurance and paying premiums, they received a notice that their insurance has been discontinued because the insurance company hadn't received any premium payments – their premium payments had been going to a different person's account.

Dennis and Kim had to make multiple phone calls and spent over 10 hours resolving the issue. In addition, when their son was born in March, they tried to add him to their policy and it took nearly four months for the paperwork to be processed. In July, they hired a health care agent to help them deal with their insurance company and things have been smoother since.

His Takeaway on Obamacare: “The insurance we had before Obamacare was far better than our new policy. The frustrating thing is it’s really expensive. You'd expect pretty good service for $1,100 a month, but the administrative work has been a nightmare. So much is slipping through the cracks. I’ve been with BCBS forever, but I will switch to a health savings account this year because of the tax deductions and the fact that our current premium is too high to continue.”

- See more at: How Obamacare Rates with Consumers One Year Later | The Fiscal Times
 
Re: A Little Intresting

it also states that he was a licensed health insurance agent however had to hire an agent to figure it all out (aor change). Moral to the story: don't deal with rookies and your only way tru this mess is with qualified experienced agents.... greatest story of all time right there bruther.....
 
Re: A Little Intresting

How Obamacare Rates with Consumers One Year Later | The Fiscal Times


The Breier Family, Downers Grove, IL

Age: Dennis, 32, Kim, 31, and their four children (all under age 6)
Occupation: Dennis runs his own wealth management business; Kim is a stay-at-home mom.
Date signed up for Obamacare: 01/01/2014
Name of plan: BCBS PPO - Gold
Qualify for the subsidy? No
Monthly Premium: $1,171
Deductible: $3,500

The Breiers had great health coverage through Dennis's prior job at a bank, but he opened his own business in March last year while Kim was pregnant and needed an insurance plan to cover the pregnancy given her "pre-existing condition." With the pregnancy, a newborn on the way, and three young kids, the family visits the doctor frequently and therefore wanted a plan with a low deductible.

How He Chose His Plan: In addition to wealth management, Dennis is certified to sell health insurance, so he felt knowledgeable about the system and researched the plans online himself. He wanted a high-quality plan that would cover the many doctors his family visits, so he chose a PPO plan that kept their doctors in-network. Dennis makes just over the amount to qualify for the subsidy, so the plan was expensive. There was an HMO plan with a lower deductible, but he heard from friends that the HMO didn't cover as many doctors. “Because we have to be at the doctor a lot, we wanted one of the best plans, and this was essentially the best coverage we could get for the cost,” he says. He went directly to the BCBS website to sign up.

His Experience Using Medical Care So Far: His family has made about 15 to 20 visits to the doctor since signing up, and Dennis says they've had to dispute the bill almost every time over charges for things that should be covered. Then after two months of having the insurance and paying premiums, they received a notice that their insurance has been discontinued because the insurance company hadn't received any premium payments – their premium payments had been going to a different person's account.

Dennis and Kim had to make multiple phone calls and spent over 10 hours resolving the issue. In addition, when their son was born in March, they tried to add him to their policy and it took nearly four months for the paperwork to be processed. In July, they hired a health care agent to help them deal with their insurance company and things have been smoother since.

His Takeaway on Obamacare: “The insurance we had before Obamacare was far better than our new policy. The frustrating thing is it’s really expensive. You'd expect pretty good service for $1,100 a month, but the administrative work has been a nightmare. So much is slipping through the cracks. I’ve been with BCBS forever, but I will switch to a health savings account this year because of the tax deductions and the fact that our current premium is too high to continue.”

- See more at: How Obamacare Rates with Consumers One Year Later | The Fiscal Times

How could a 'wealth management professional' with 4 kids even think about anything OTHER than an HSA eligible plan?

How could a 'wealth management professional with a health insurance license' take advice from friends who are unlicensed?

How could a licensed agent who is also a 'wealth management professional' not know enough to check on the status of his policy monthly when his family is using the coverage every month? As soon as the policy goes into the grace period they most likely would have been denying benefits for an Off Exchange policy as well as sending out past due notices.

If he can't get this right, how could he be trusted to manage anyone else's money?
 
Re: A Little Intresting

flm, I think your from flordia... this cat is in IL an that's the same bcbs as texas... they cant walk and chew gum at the same time.... I have had so so many billing problems, on or off exchange... dosent matter.... make up the billing problem and it probably happened....
 
Re: A Little Intresting

flm, I think your from flordia... this cat is in IL an that's the same bcbs as texas... they cant walk and chew gum at the same time.... I have had so so many billing problems, on or off exchange... dosent matter.... make up the billing problem and it probably happened....

I understand but Florida Blue is just as bad (or worse), I just think a guy who pays the premium and is licensed should know enough to register his account online and check the status of his policy, particularly after the first premium payment?

The article claims the premiums weren't credited for the 1st two months, wouldn't BCBSIL refuse to pre-authorize office copays if they didn't think they had received the premium?

I'm not taking blame away from BCBSIL, I basically dislike and distrust all insurance companies but the guy has most of the responsibility for this, IMO.
 
"The Breiers had great health coverage through Dennis's prior job at a bank, but he opened his own business in March last year while Kim was pregnant and needed an insurance plan to cover the pregnancy given her "pre-existing condition." With the pregnancy, a newborn on the way, and three young kids, the family visits the doctor frequently and therefore wanted a plan with a low deductible"

Something's not right with this "story"..

Kim knew she was pregnant in March 2013, which means conception was before March.

Policy effective 1/1/2014.

Went to the doctor 15 to 20 times the first 2 months before receiving a cancellation notice.

When was baby born? Before or after 1/1/2014.

:no:
 
Even though the guy isn't the smartest apple in the bunch, FLM, you have NO idea how bad it has been. They couldn't add newborns until the last week in May. I had January newborns not in the system for almost 6 months.

As far as billing goes, even if he called and cust service said it was right, if you looked in a different billing system, it could be wrong. There are 4 different systems and at any one time, all 4 would have a different amount. NOT KIDDING.

And if I was on auto-draft and saw that they policy was being drafted monthly, I wouldn't check beyond that, either.

Cut the guy some slack
 
Allen, someone posted all 4 story's that went along with this one on another forum and none of them sounded very feasible.

I agree if the guy was licensed and a wealth manager I certainly would not trust him with any of my money. He should have found an agent that knew what they were doing, I don't know about BCBSTX but I knew when everyone of my clients were dropped accidentally or were behind in premium's and this in 18 years was the first time I ever knew if someone was dropped or in arrears.
 
Something's not right with this "story"..

Kim knew she was pregnant in March 2013, which means conception was before March.

Just a wag, but COBRA for the balance of 2013 then Obamacare in January of this year.

She could have been pregnant when the 2014 application was submitted and due any day (like October).

Or, she could have been preggers in March with one kid and again later that year.

March last year while Kim was pregnant and needed an insurance plan to cover the pregnancy given her "pre-existing condition." With the pregnancy, a newborn on the way, and three young kids, the family visits the doctor frequently and therefore wanted a plan with a low deductible.

There are enough possibilities here without clouding the real issue.

This guy thought he knew enough to handle things himself and soon discovered he was in over his head.

At least he wasn't a navigator.
 
Allen, someone posted all 4 story's that went along with this one on another forum and none of them sounded very feasible.

I agree if the guy was licensed and a wealth manager I certainly would not trust him with any of my money. He should have found an agent that knew what they were doing, I don't know about BCBSTX but I knew when everyone of my clients were dropped accidentally or were behind in premium's and this in 18 years was the first time I ever knew if someone was dropped or in arrears.

Four differing accounts eh? I get sick of everyone blaming all insurance problems on ObamaCare. Although I'm not a fan of ObamaCare the way it's set up now, we're all mature enough to understand that if a company can't get it's billing and claims software working properly after years of preparation, it's not the fault of ObamaCare. That's like blaming HealthCare.gov operational problems on ObamaCare, instead of incompetent employees and management.

With this story, there are too many holes in it to know where to place the blame. If this guy wasn't a licensed Agent and Wealth Advisor (whatever the hell that is), his problem would have simply blended in to the background noise that's always ongoing. Maybe he would have been happier if Pre-Existing Condition Exclusions still existed.
-ac
 
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