Blue Cross Truly Nationwide Coverage?

[Guest]

So it's slightly cheaper than a HIPAA plan, has the same exact benefits as the equivalent underwritten plan, what exactly is this greedy carrier thinking?

Huh? Did you see the rates? There is no 55 year old that I know in Sacramento who can afford (or would pay!)$11,124 a year for this plan... with a $5,000 out-of-pocket along with a $500 deduct for brand-name drugs... and it doesn't even have an HSA component. If you are going to spend $927 a month for health insurance you should get more than this plan offers.

But since we have regulators who simply rubber-stamp the rates they are given by the carriers, we get what we deserve. (And remember I worked for the CA Dept. of Managed Care... so I know what I'm talking about... I saw this system up close and personal.)

The BS Spectrum HSA 2400 plan is about the same and cost almost half as much ($423/mo) than this conversion piece of crap.

If I were the agent, I'd be "consulting" with the person to find a job at Starbucks and get group... or find a "friend" who has a business who will pay client $8.50/hr. for 20 hours a week, and work "a deal" of reimbursement and take a Kaiser HSA 30/2700 group plan for $309 per month... or start a business (walking dogs, driving people to airport, Amway, insurance sales (!)) and hire a wife or relative or friend, show a (Calif.) DE6, and get a low-cost group plan.

Legal? I don't practice law. But I know that desperate people do desperate things. Until you have had to sit down and talk with a 57 year old man who's company just went out of business (or dropped their health plan) and who has HBP and HCL and had prostate cancer 2 years ago (auto IFP deny!)... and (obviously) has no COBRA option and where HIPAA (at $1785 per month ($21,420 yr.) for him and his insulin diabetic wife) is the only option... who worked all his life, paid his taxes, has a girl in college and a boy ready to go in a year... and who can't possibly afford $2,121 per MONTH for a Blue Shield HIPAA family plan... you will come to really hate the current system and will understand why people lie, cheat, and bend the rules so that they can get the health care they need at a rate they can afford.

All you guys who sing the praises of the "private enterprise" system and who worship the ground that Blue Cross or Blue Shield or Aetna walks on (as well as worship the commissions they pay you)... walk a mile in my shoes.

Many of you make all this noise about doing what's best for the client... all the time. But what is best for just about every client is a national health system where rates are affordable and perhaps were YOU (we) are not part of it.

The current system? Best for the client? My ass. No one believes that. It's what's best for the carrier and the agent. You know it, I know it... and everyone's CMS-hating dog knows it.

For a start, let's put everyone who wants it, on Medicare. That's throwing raw meat at you guys. Come on... show me some greed. Show some unbridled capitalism. Show me why this is the greatest country in the world when it comes to providing health coverage to all of its citizens!

Trust me, if you were not making a 6-figure (or close to it) living off of this crapola health insurance system you wouldn't believe in it nor sing the praises of it. The only people who like the current system are those who are eating off of it.

Guess how many carrier parties I got invited to this holiday season. One... Kaiser. No one in the entire health care agent/carrier world wants anything to do with me. I wonder why!!

Merry Christmas (as opposed to Happy Holiday) and I hope that this time next year everyone has a National Health Service card in their wallet... and we don't have to fear losing our job, losing our health coverage, getting sick or having an accident... and losing our homes, savings... and dreams. That's my Christmas wish for all of you... and everyone.

Al

 

[TXINSURANCE]

Trust me, if you were not making a 6-figure (or close to it) living off of this crapola health insurance system you wouldn't believe in it nor sing the praises of it. The only people who like the current system are those who are eating off of it.

Guess how many carrier parties I got invited to this holiday season. One... Kaiser. No one in the entire health care agent/carrier world wants anything to do with me. I wonder why!!

Merry Christmas (as opposed to Happy Holiday) and I hope that this time next year everyone has a National Health Service card in their wallet... and we don't have to fear losing our job, losing our health coverage, getting sick or having an accident... and losing our homes, savings... and dreams. That's my Christmas wish for all of you... and everyone.

I live in the gulf coast - a lot of people were devastated by Katrina, Rita, and Ike and can not get their homes rebuilt or even buy in some cases adequate home owners insurance.

You should see the cost of insuring homes in the gulf coast, very expensive and no end in sight. Same for auto in a lot of areas of the country.

Do you advocate government run home home owners insurance as well since my home has a pre existing condition of being hit by a hurricane?

I just don't see the difference in this comparison. Let me try the national auto and home insurance first - then if it works I will risk my life and try the national health insurance. This seems fair to me.

All seriousness Al makes some valid points, and I don't see how anyone can say the current system is perfect with a straight face - that we can agree on.

 

[Dave020]

Al, I sell 60-80 of these a month and no one tells me that they can't afford it. They don't like it, but they know the risks of not being insured.

Look, the system is not perfect, nor is the federal system known as Medicare.

Bottom line on IFP is this, without a Mandate of coverage, it will never, ever get cheaper or more accessible. And now the Obama administration is backing off of the mandate they proposed, which was supported by the AHIP and health carriers.

Exactly who is helping whom here?

It costs $11k a year because they are going to use benefits, period. All of them. Until you can balance them against some healthy 20 year olds prices are going to continue to go up. The only reason group works is because they can balance the risk by mandating participation.

Why is it not greedy when a parent calls me to insure their 24 year old kid who had not had coverage in 4 years but suddenly needs it now?

Why is it not greedy to be uninsured by choice and to then default on payments to clinics and urgent care centers so that they can make the car and Starbucks bills?

Why is it not greedy when a small employer calls me to tell me he wants to set up a group plan for his business but can't make participation reqs because all of his hispanic employees get free services at the county clinic and don't want to have copays or coinsurance?

All three of those things have happened in the last 48 hours, more than once.

 

[HealthGuy]

Al3: Why don't you go puke your socialist opinions on some other forum? You feel important on here degrading everybody's profession don't you? Sickening.

 

[ConsumerOfHlthIns]

I'll write in CAPS below, to distinguish my responses. I've been using
the bluecard program for 20 years (and in fact, using it MORE outside of my area than inside, and using it everywhere) and most of what is written below is wrong.

Seems there are two things being discussed here so I will address them both.

BlueCard PPO is the national BCBS network for in-network services outside of the local area. Client has to call BlueCard (and be on a Blue PPO plan) and get the information on in-network services in other states

WRONG. YOU JUST GO TO A PPO PROVIDER, JUST LIKE YOU WOULD IN YOUR LOCAL AREA. EASILY FOUND ON THE BCBS WEBSITE BY ZIPCODE OR AREA. IF YOU DON'T HAVE WEB ACCESS, YOU CAN CALL BCBS NATIONAL # TO GET SOME NAMES AND PHONE NUMBERS.



TX is essentiall correct, they don't authorize preventative care on the BlueCard Program as there really is no need to get a physical in another state.
WRONG. EVERYTHING THAT IS COVERED WITHIN THE LOCAL PLAN IS COVERED NATIONWIDE (AND AS MY CONTRACT, THE ONLY EXCEPTIONS ARE SERVICES THAT ARE ADMINISTERED BY A THIRD PARTY CONRACTOR, SUCH AS VISION COVERAGE). I'VE GOTTEN COUNTLESS ANNUAL ROUTINE PHYSICALS, INCLUDING ALL LABWORK (AND INCLUDING A ROUTINE COLONOSCOPY).
It is intended to provide in-network services for non-routine urgent and emergency care.
WRONG...SEE ABOVE.
...snip...
As far a insurance reciprocation goes (obtaining a plan in new state), the general BCBS Association rule is mandatory GI coverage through conversion plans at a minimum in all 50 states.
MANY LOCAL BCBS'S SAY THAT THERE IS NO SUCH "RULE", AND THEY DO NOT HAVE TO OFFER YOU A POLICY.

FINALLY, A FEW BCBS ALLOW YOU TO MOVE AWAY PERMANENTLY TO A NEW AREA/STATE (ANYWHERE) AND KEEP YOUR CURRENT
PLAN FROM THE OLD AREA/STATE, USING THE BLUE CARD PROGRAM "FOREVER".

 

[somarco]

without a Mandate of coverage, it will never, ever get cheaper or more accessible.

Mandates do almost nothing to reduce the cost of insurance. Almost every state has mandated auto insurance but the cost has not dropped.

Mandates will bring some into the insured pool that are not there now, but it won't bring all of them in. When you look at states that have mandated health insurance the required benefits choke the system by front loading prepaid health care instead of true, risk based health insurance.

Carriers are required to offer plans with low copays, low deductibles, lot's of primary care, testing for this, testing for that. By the time you load the premium up to cover things that most can pay for out of pocket you have to strip things off the back end to keep it "affordable" and still end up subsidizing it with new taxes.

It is tantamount to mandating auto coverage that pays for tires, brakes, tune ups & oil changes.

If the gov't is going to mandate coverage it should be cat cover without prepaid medical benefits. Nothing less than a $1000 deductible, no copays, and 50-50 coinsurance to $5,000 OOP. If you want to do other things to make it affordable, limit the benefits to $100,000 a year or possibly $250,000 lifetime.

Clearly these are inadequate but better than nothing.

Of course plans like this make sense which means we will never see them from Washington.

And to Consumer of Health Insurance . . . I would guess you are a consumer and not an experienced agent who has worked with (and sold against) the Blue's for years. While your statements may be valid based on your limited experience, they do not apply universally to Blue plans, particularly those sold in the individual major medical market.

If you are an agent, you are espousing views and information that is not universally accurate.

 

[Guest]

Mandates do almost nothing to reduce the cost of insurance. Almost every state has mandated auto insurance but the cost has not dropped.

What is the profit margin on P&C? Perhaps if it were run as a non-profit, government corporation (with more regulation and oversight then Sallie and Freddie... but similar in structure) the costs might come down.

Carriers are required to offer plans with low copays, low deductibles, lot's of primary care, testing for this, testing for that.

Um... I don't see much of this in Medicare right now. True, Sups have mandates but there is an entire alphabet soup to choose from depending on need and affordability. What if we put everyone on Medicare and we leave supps to the carriers? Guys like Frank and Rick and others who play in what is now the "senior market" are going to make a fortune being able to apply their thorough knowledge of sups to a much larger population. I'd support that.

If the gov't is going to mandate coverage it should be cat cover without prepaid medical benefits. Nothing less than a $1000 deductible, no copays, and 50-50 coinsurance to $5,000 OOP. If you want to do other things to make it affordable, limit the benefits to $100,000 a year or possibly $250,000 lifetime.

I'd support this, except for the $250K lifetime. I'd make that at least five, if not ten times higher... but perhaps that can be insured by supps?

Clearly these are inadequate but better than nothing.

Yes they are inadequte compared to the benefit level of the British NHS or the French, Swiss, or German systems, but for the US it would be a good start. Maybe even the right-wing, super-greedy supporters of unbridled and unregulated capitalism would even support this system. We've always been a country that does things in increments... and this might be a start.

Have any of you read about The New Deal and how social security started and what it covered? Do you see how it has grown?

Do any of you remember (as I do) the huge political fights over "socialized medicine" in the 1960s when JFK and LBJ proposed Medicare? (I have no doubt that 95% of the agents on this board would not support Medicare back then... and if they had their way they would cancel it tomorrow... if I sense the political "rightness" of this community correctly.)

Of course plans like this make sense which means we will never see them from Washington.

I don't know. Perhaps if NAHU, AHIP, Blue/Aetna/HealthNet right-wing obstructionists stopped being the "party of no" and instead proposed something like what you propose, it could happen.

If you are an agent, you are espousing views and information that is not universally accurate.

I think his views are far, far more accurate than the vast majority of the health agents on this board want anyone in the general public to know!

Follow the money... and you will understand the reason why at least 40% of the population can't get health coverage. It's not about "doing what is best for the client." Yeah, I know we all say it to each other as a mantra on this board, but come on...it's not like anyone here really would support a soup-to-nuts national health system (say, like the British or French) where agents are not involved. Indeed, most agents I know are not part of the solution... they are part and parcel of and to the problem.

Gee, and I just can't understand why no one here invited me to Christmas dinner this evening.

Al

 

[somarco]

profit margin on P&C?

Auto is very volatile. 3 - 5% if they are lucky. Many lose money and hope to make it up on investment cash flow & HO.

I don't see much of this in Medicare right now.

Not discussing Medicare.

Look at the mandates for benefits in MA, MD and FL.

except for the $250K lifetime

Suggested only as a way to keep costs down, especially if they are going to have to offer some form of GI.

Since mandates say little or nothing about the back end risk, expect carriers to offer this in order to meet the other guidelines.

inadequte compared to the benefit level of the British NHS or the French, Swiss, or German systems,

What good is having "unlimited" coverage if you can't access it.

You are like many others who have no clue about the true scope of the cost health care here and in other countries.

Follow the money.

You also don't have a clue about where the money goes. Probably wouldn't know a profit margin if it bit you on the ass.

You are so far off base it would be hilarious if it weren't so pathetic.

 

[Guest]

You are like many others who have no clue about the true scope of the cost health care here and in other countries.

I've been to most of those countries and I've seen first-hand how a good national health care system can work. Perfect? No. Better than here? Yes. Of course guys like you don't make a six-figure income in those countries. I'm sure that's ONE CLUE you DO have.

You also don't have a clue about where the money goes. Probably wouldn't know a profit margin if it bit you on the ass.

Interesting you say that... because I've WORKED for the CA Dept. of Health Services and I've WORKED for the CA Dept. of Managed Health Care, and I've WORKED for Blue Cross as well as Blue Shield (met my first, current, and very expensive wife at Blue Shield in 1976 where she was manager of a claims exam unit.) I know full well where the money goes. A fair amount goes to you, your carriers, their execs, and a whole bunch of middle people who add very little value to the system and whose jobs could easily be done away with.

You are so far off base it would be hilarious if it weren't so pathetic.

That's the standard answer by NAHU, AHIP and their loyal minions who are part and parcel to the greed, inefficiency, and inequity of the current system.

I may be the only agent in the country who stands up in public and says "This system sucks... replace it... put me out of a job... I'm happy selling life, LTC, annuities, and DI."

True, there is only one of me... and thousands of you.

But there are tens of millions of people who would follow me, as opposed to line up behind you and say "Oh please, lets' keep the current system intact so that somarco can earn his $100K plus because we all know how much value he and his buddies add to the system. We really gotta have the current system... and who cares if half the country can't be part of it. I got mine!"

Don't you guys (collectively) ever get tired of greed? Don't you have any idea or concept of social responsibility? You used the word pathetic above. Use it again. Go right ahead. It's a good word to use here.

 

[GreenSky]

Of course guys like you don't make a six-figure income in those countries.

Al, you've mentioned six-figure incomes in about the last half dozen posts. I get the feeling that it bothers you that you've never earned more the $25,000 in any year selling insurance. Maybe your rage is based on jealousy? Or since you've proved time and again that you really don't understand the purpose of insurance, maybe you're just lashing out because you're confused.

Rick